Donor-derived fulminant herpes simplex virus hepatitis after liver transplantation: Two cases and review of literature

BACKGROUND Fulminant herpetic hepatitis due to herpes simplex virus (HSV), serotype 1 or 2, is a rare but often fatal complication after solid organ transplantation (SOT). HSV hepatitis in SOT recipients can occur either due to primary infection acquired post transplantation, viral reactivation in a seropositive patient, or as donor-derived infection. Cases of fatal hepatitis have been reported in the liver as well as in other SOT recipients. The fatal outcome is mostly due to delayed diagnosis and treatment, which is explained by the lack of clinical specificity of HSV hepatitis. METHODS We report two cases of fatal donor-derived HSV hepatitis in liver-transplanted recipients. We reviewed all published cases of donor-derived HSV infections after SOT with an evaluation of the presence of prophylaxis and outcome. RESULTS In both liver recipients, the retrospective determination of HSV serostatus was negative, and both cases occurred in the absence of cytomegalovirus or HSV prophylaxis. A review of the literature showed a significant series of cases of severe hepatitis, mostly fatal, as well as the absence of specific preventive therapy guidelines in cases of HSV serology mismatch. CONCLUSIONS The occurrence of two fatal donor-derived hepatitis made the Swiss Transplant Infectious Diseases working group modify its national recommendations regarding pretransplant serostatus determination and HSV prophylaxis after liver transplantation. Further studies are needed to assess this approach

Forming intracluster gas in a galaxy protocluster at a redshift of 2.16

Galaxy clusters are the most massive gravitationally bound structures in the Universe, comprising thousands of galaxies and pervaded by a diffuse, hot intracluster medium (ICM) that dominates the baryonic content of these systems. The formation and evolution of the ICM across cosmic time1 is thought to be driven by the continuous accretion of matter from the large-scale filamentary surroundings and energetic merger events with other clusters or groups. Until now, however, direct observations of the intracluster gas have been limited only to mature clusters in the later three-quarters of the history of the Universe, and we have been lacking a direct view of the hot, thermalized cluster atmosphere at the epoch when the first massive clusters formed. Here we report the detection (about 6σ) of the thermal Sunyaev-Zeldovich (SZ) effect2 in the direction of a protocluster. In fact, the SZ signal reveals the ICM thermal energy in a way that is insensitive to cosmological dimming, making it ideal for tracing the thermal history of cosmic structures3. This result indicates the presence of a nascent ICM within the Spiderweb protocluster at redshift z = 2.156, around 10 billion years ago. The amplitude and morphology of the detected signal show that the SZ effect from the protocluster is lower than expected from dynamical considerations and comparable with that of lower-redshift group-scale systems, consistent with expectations for a dynamically active progenitor of a local galaxy cluster

Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy

AIMS With ongoing intensive vaccination programme against COVID-19, numerous cases of adverse reactions occur, some of which represent rare events. Enlargement of the injection site’s draining lymph nodes is increasingly reported, but is not yet widely recognised as being possibly associated with recent vaccination. As patients at risk of a severe course of COVID-19, indicated by their medical history such as a previous diagnosis of malignancy, receive priority vaccination, newly palpable lymph nodes raise concerns of disease progression. In this case series, we report on five patients who presented with enlarged lymph nodes after COVID-19 vaccination. METHODS Sonography guided fine needle aspiration (FNA) was performed in five patients presenting with PET-positive and/or enlarged lymph nodes after COVID-19 vaccination with either the Pfizer-BioNTech or Moderna vaccine. RESULTS COVID-19 vaccination had been carried out in all cases, with an interval of between 3 and 33 days prior to FNA. Three of five patients had a history of neoplasms. The vaccine was administered into the deltoid muscle, with subsequent enlargement of either the cervical, supra-, infra- or retroclavicular, or axillary lymph nodes, in four out of five cases ipsilaterally. In all cases, cytology and additional analyses showed a reactive lymphadenopathy without any sign of malignancy. CONCLUSIONS Evidence of newly enlarged lymph nodes after recent COVID-19 vaccination should be considered reactive in the first instance, occurring owing to stimulation of the immune system. A clinical follow-up according to the patient’s risk profile without further diagnostic measures is justified. In the case of preexisting unilateral cancer, vaccination should be given contralaterally whenever possible. Persistently enlarged lymph nodes should be re-evaluated (2 to) 6 weeks after the second dose, with additional diagnostic tests tailored to the clinical context. Fine needle aspiration is a well established, safe, rapid and cost-effective method to investigate an underlying malignancy, especially metastasis. Recording vaccination history, including date of injection, site and vaccine type, as well as communicating this information to treating physicians of different specialties is paramount for properly handling COVID-19 vaccine-associated lymphadenopathy

Grey zones in the supportive treatments of cardiac amyloidosis

Recent advances in the diagnosis and treatment of cardiac amyloidosis (CA) have translated into a longer life expectancy of patients and more challenging clinical scenarios. Compared to the past, patients with CA and heart failure (HF) currently encountered in clinical practice are a more heterogeneous population and require tailored strategies. The perception of CA as a treatable disease has opened new possibilities for the management of these patients, but many grey areas remain to be explored. The aim of this review is to provide practical suggestions for daily clinical activity in the management of challenging scenarios in CA, including the effectiveness and tolerability of evidence-based HF medication; rate vs. rhythm control in atrial fibrillation, thromboembolic risk, and anticoagulation therapies; replacement of severe aortic valve stenosis; the impact of implantable cardioverter defibrillator on survival; and the usefulness of cardiac resynchronization therapy

Guidelines on retrofitting of shopping malls

publishedVersio

Guidelines on how to approach the energy-efficient retrofitting of shopping centres

Special architectural conditions and needs are common in almost all shopping centres. The main retrofit drivers are: (i) improve the indoor environmental quality and functionality, to enhance the customers experience; (ii) reduce the energy consumption; (iii) optimize the building operation and relative maintenance costs and (iv) improve the overall sustainability level reducing the environmental, social, and economic impact. Shopping centres vary in their functions, typologies, forms and size, as well as the (shopping) trip purpose. To consider the shopping centre building stock as one segment with its own boundaries and trends, the EU FP7 CommONEnergy project set a shopping centre definition1: “A shopping centre is a formation of one or more retail buildings comprising units and ‘communal’ areas, which are planned and managed as a single entity related in its location, size and type of shops to the trade area that it serves.” The European wholesale and retail sector is the big marketplace of Europe, contributing with around 11% of the EU’s GDP2. Therefore, sustainability of the retail sector may significantly contribute to reaching the EU long-term environmental and energy goals. Within the retail sector, shopping centres are of particular interest due to: their structural complexity and multi-stakeholders’ decisional process, their high energy savings and carbon emissions reduction potential, as well as their importance and influence in shopping tendencies and lifestyle. A shopping centre is a building, or a complex of buildings, designed and built to contain many interconnected activities in different areas. Next to public spaces, there are areas related to work spaces, with different use and location and according to the shopping centre type. They have different opening hours and entrances than the shopping centre. Today, in addition to the mere commercial function, a shopping centre responds to several customer needs: it exhibits recreational attractions …publishedVersio

Data_Sheet_1_Evolving trends in epidemiology and natural history of cardiac amyloidosis: 30-year experience from a tertiary referral center for cardiomyopathies.docx

ObjectiveNatural history of cardiac amyloidosis (CA) is poorly understood. We aimed to examine the changing mortality of different types of CA over a 30-year period.Patients and methodsConsecutive patients included in the “Trieste CA Registry” from January 1, 1990 through December 31, 2021 were divided into a historical cohort (diagnosed before 2016) and a contemporary cohort (diagnosed after 2016). Light chain (AL), transthyretin (ATTR) and other forms of CA were defined according to international recommendations. The primary and secondary outcome measures were all-cause mortality and cardiac death, respectively.ResultsWe enrolled 182 patients: 47.3% AL-CA, 44.5% ATTR-CA, 8.2% other etiologies. The number of patients diagnosed with AL and ATTR-CA progressively increased over time, mostly ATTR-CA patients (from 21% before 2016 to 67% after 2016) diagnosed non-invasively. The more consistent increase in event-rate was observed in the long-term (after 50 months) in ATTR-CA compared to the early increase in mortality in AL-CA. In the contemporary cohort, during a median follow up of 16 [4–30] months, ATTR-CA was associated with improved overall and cardiac survival compared to AL-CA. At multivariable analysis, ATTR-CA (HR 0.42, p = 0.03), eGFR (HR 0.98, p = 0.033) and ACE-inhibitor therapy (HR 0.24, p ConclusionIncidence and prevalence rates of ATTR-CA and, to a less extent, of AL-CA have been increasing over time, with significant improvements in 2-year survival of ATTR-CA patients from the contemporary cohort. Reaching an early diagnosis and starting disease-modifying treatments will improve long-term survival in CA.</p