Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

The efficacy of trans-radial approach (TRA) in chronic total occlusions (CTO) percutaneous coronary interventions (PCI) is not well established. Thus, we sought to review the feasibility and long-term results of TRA for CTO PCI performed by dedicated TRA operatorsof our center

A violência contra mulheres: demandas espontâneas e busca ativa em unidade básica de saúde

Acolher demandas e assistir mulheres que sofrem violência é parte dos direitos em saúde, embora a assistência não esteja estruturada e ocorra pouca detecção de casos. Buscou-se um diagnóstico de situação em serviços, avaliando-se a emergência de demandas referidas à violência por parte das usuárias de uma unidade básica da rede pública, contrastando-se a demanda espontânea com a busca ativa de casos. Realizou-se um primeiro estudo por técnicas de observação participante, seguida de estudo de prontuário, com 142 mulheres sendo acompanhadas; num segundo estudo, em uma amostra de 322 usuárias, aplicou-se entrevista. Em atividades grupais observou-se relatos espontâneos e nos prontuários médicos registros de demandas espontâneas; o mesmo não ocorreu em consultas individuais. A entrevista detectou uma prevalência de casos muito maior. Então, a possibilidade de detecção de casos, seu acolhimento e algumas respostas do serviço, requer especificidade de abordagem e cuidados próprios para que a violência contra mulheres possa emergir como parte da demanda usual na saúde

Acute changes in mitral valve geometry after MitraClip procedure: a look beyond the EVEREST criteria.

Background. MitraClip procedure is a treatment option in patients with symptomatic mitral regurgitation (MR) and prohibitive surgical risk. Echocardiographic evaluation of mitral valve (MV) is of paramount importance for the correct identification of patient eligibility and procedural success. Our aim is to assess the acute effect of device implantation on mitral annular geometric parameters still little explored with the use of three-dimensional (3D) trans-oesophageal echocardiography (TEE) and its relationship with residual MR at discharge. Methods. We recorded 67 consecutive patients undergoing percutaneous MV repair with MitraClip between January 2016 and November 2019 at San Donato Hospital. Patients eligibility was evaluated according to the EVEREST criteria and current guidelines. Four groups were identified on the base of MR aetiology: 22 were degenerative (DMR), 19 ischemic functional (IFMR), 19 non-ischemic functional (NIFMR) and 7 atrial functional (AFMR). 3D-TEE was performed before and immediately after clip deployment using new analysis software for MV anatomical quantification. Results. Mean age was 78.7±7.2 years. 16 and 50 patients had respectively severe MR (4+) and moderate-severe MR (3+). Thirteen cases were unsuccessful because of unchanged or residual MR>2+. Immediately after device positioning, almost all the evaluated parameters showed a significant modification within each group with a reduction of anterior-posterior and bi-commissural MV diameters (4.0±0.6 and 3.6±0.6 cm; P<0.0001) and MV annulus area and an increase in tenting volume, tenting height and posterior mitral leaflet angle (PML α). Only anterior mitral leaflet angle (AML α) and sphericity index remained unchanged. We observed no significant difference in the sub-analysis between degenerative and all functional MR groups, although a different trend of parameters variation could be evidenced. Post-procedural tenting height was a predictor of procedural success, while at univariate analysis basal AP-D in DMR group and sphericity index, PMLα and MA height at baseline in the FMR group were significantly correlated to the entity of MR reduction at discharge. Conclusions. Percutaneous edge-to-edge repair with MitraClip acutely changes the MV annular geometry in degenerative and both ventricular and atrial functional MR, with a different trend within each group. Tenting height variation correlates with significant MR reduction at discharge

Impact of operator experience and wiring technique on procedural efficacy of trans-radial percutaneous chronic total occlusion recanalization performed by dedicated radialists

Background: The efficacy of trans-radial approach (TRA) in chronic total occlusions (CTO) percutaneous coronary interventions (PCI) is not well established. Thus, we sought to review the feasibility and long-term results of TRA for CTO PCI performed by dedicated TRA operatorsof our center.Methods: CTO PCI performed by dedicated radialists were considered. Primary end-points were “PCI success” (stent implantation with residual stenosis &lt; 20% and TIMI 3) and “patient success” (PCI success in a first or second attempt). Vascular complications and major adverse cardiac events (MACE) were also assessed. Procedures were divided into: Period 1 — no systematic adoption of TRA nor systematic wire selection, and Period 2 — systematic TRA with stepwise wire selection. The starting guidewire was initially an intermediate wire (Period 2a), and, thereafter, a tapered soft polymeric guidewire (Period 2b).Results: Two operators performed 167 TRA PCI on CTO in 158 patients. PCI success rate was 74.3% and patient success rate was 78.5%. Drug-eluting stents were implanted in 95.1% of successful procedures. One (0.6%) patient had a (minor) vascular complication. After a mean follow-up of 580 days, 93.7% of patients were free from MACE. PCI success (57.1% in Period 1 vs. 76.5% in Period 2a vs. 80.5% in Period 2b, p = 0.029) and patient success (62.5% in Period 1 vs. 77.8% in Period 2a vs. 86.1% in Period 2b, p = 0.025) significantly improved during the study.Conclusions: CTO PCI by TRA is safe and feasible. Its efficacy seems to be strongly dependenton operator experience with CTO techniques and may be influenced by the strategy of guidewire selection

Impact of rotavirus vaccine in reducing hospitalization rates in pediatric patients: a single center experience in Italy

Rotavirus is a major cause of acute gastroenteritis in children under 5 years of age, with severe illness occurring in 30–40% of cases. In Italian region of Liguria, vaccination with a two-dose human attenuated vaccine was introduced in 2013. We conducted a retrospective study to assess the impact of rotavirus vaccine on hospitalizations for rotavirus-related gastroenteritis (RVGE) at the IRCCS Istituto Giannina Gaslini. Every hospitalization due to laboratory-confirmed RVGE and acute gastroenteritis of unknown origin (AGUO) in patients aged 0–14 years in the period 2008–2019 were anonymously extracted. Vaccine coverage were obtained from the regional vaccination registry. The results were divided in 2008–2012 (before RV vaccine) and 2013–2019 (after) periods. From 2008 to 2012, there was a continuous reduction of AGUO hospitalizations while RVGE increased. Since 2013, a reduction in hospitalization rate was observed for RVGE with a sharp decrease from 17.81 per 10.000 children in 2012 to 0.79 per 10,000 in 2019, parallel with the ascending values of RV vaccination coverage that increased from 36.3% in 2013 to 63.9% in 2019. A significant negative correlation was found between the proportions of vaccinated newborns and RVGE rates (p = .012). Intussusception-related hospitalization did not show substantial modifications. We confirm vaccination as a safe practice that has a significant impact in pediatric hospitalization rates

Fractional flow reserve or optical coherence tomography guidance to revascularize intermediate coronary stenosis using angioplasty (FORZA) trial: study protocol for a randomized controlled trial

The management of patients with angiographically intermediate coronary lesions is a major clinical issue. Fractional flow reserve provides validated functional insights while optical coherence tomography provides high resolution anatomic imaging. Both techniques may be applied to guide management in case of angiographically intermediate coronary lesions. Moreover, these techniques may be used to optimize the result of percutaneous coronary intervention. We aim to compare the clinical and economic impact of fractional flow reserve versus optical coherence tomography guidance in patients with angiographically intermediate coronary lesions