Technical and Clinical Outcomes After Transcatheter Edge-to-Edge Repair of Mitral Regurgitation in Male and Female Patients: Is Equality Achieved?

Currently, no clear impact of sex on short- and long-term survival following transcatheter edge-to-edge mitral valve repair (TEER) is evident, although no data are available on postprocedural life expectancy. Our aim was to assess sex-specific differences in outcomes of patients with mitral regurgitation (MR) treated by TEER. Short-term and 5-year outcomes in men and women undergoing TEER between 2011 and 2018 who were included in the large, multicenter, real-world MitraSwiss registry were analyzed. Outcomes were compared stratified by sex and according to MR cause (primary versus secondary). The impact of TEER on postprocedural life expectancy was estimated by relative survival analysis. Among 1142 patients aged 60 to 89 years, 39.8% were women. They were older, with fewer cardiovascular risk factors and lower functional capacity compared with men. Thirty-day mortality was higher in men than in women (3.3% versus 1.1%; odds ratio, 3.16 [95% CI, 1.16-10.7]; P=0.020). Five-year survival was comparable in both sexes (adjusted hazard ratio for 5-year mortality in men, 1.14 [95% CI, 0.90-1.44], P=0.275). Both men and women with either primary or secondary MR showed similar clinical efficacy over time. TEER provided high relative survival estimates among all groups, and fully restored predicted life expectancy in women with primary MR (5-year relative survival estimate, 97.4% [95% CI, 85.5-107.0]). TEER is not associated with increased short-term mortality in women, whereas 5-year outcomes are comparable between sexes. Moreover, TEER completely restored normal life expectancy in women with primary MR. A residual excess mortality persists in secondary MR, independently of sex

Control of scabies outbreaks in an Italian hospital: An information-centered management strategy

BACKGROUND: Scabies is a dermatologic infestation caused by Sarcoptes scabiei. In industrialized countries, hospitals and other health structures can sometimes be hit. The optimal management of scabies outbreaks still has to be established, mass prophylaxis being one possible option. METHODS: To identify the optimal approach to containing this re-emerging disease, a local health authority in Lombardy, Northern Italy, carried out an epidemiologic study into 2 scabies epidemics that took place from September to December 2012 in a 600-bed hospital with 26,000 admissions a year. RESULTS: Over a 3-month period, there were 12 cases of scabies on 4 wards; 43 contacts received prophylaxis. When the first cases were identified, an information campaign involving all hospital personnel was immediately set up. Regular staff meetings were organized, and information leaflets were distributed to patients. Family doctors of discharged patients were informed of the outbreak. CONCLUSION: A management model based on an information-centered strategy was used in place of mass prophylaxis to deal with scabies epidemics. The success of this approach was confirmed by the managers of the hospital involved (reduced expenditure for prophylactic drugs) and by hospital staff who did not have to deal with potential drug adverse effects

Elevated troponin in patients with coronavirus disease 2019: possible mechanisms

Coronavirus disease 2019 (COVID-19) is a pandemic that has affected more than 1.8 million people world-wide, overwhelmed health care systems owing to the high proportion of critical presentations, and resultedin more than 100,000 deaths. Since the first data analyses in China, elevated cardiac troponin has beennoted in a substantial proportion of patients, implicating myocardial injury as a possible pathogenic mecha-nism contributing to severe illness and mortality. Accordingly, high troponin levels are associated withincreased mortality in patients with COVID-19. This brief review explores the available evidence regardingthe association between COVID-19 and myocardial injury

Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application.

Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure. This narrative review provides an overview of the use of PET imaging in heart failure, highlighting the different PET tracers and modalities, and discussing fields of present and future clinical application

L'ESPERIENZA DELLE CURE SUB ACUTE PRESSO L'ASL DELLA PROVINCIA DI COMO

Il Piano Socio Sanitario Regionale 2010-2014 ha modificato l'organizzazione del Sistema Sanitario Regionale della Regione Lombardia prevedendo l'attivazione di strutture di cure intermedie tra ospedale per acuti e strutture territoriali idonee alla gestione dei pazienti (pz) affetti da patologie croniche gestiti nel contesto dell'assistenza primaria o dimissibili da un'Unit\ue0 Operativa per acuti, ma non sufficientemente stabili da consentirne l'assistenza al domicilio. Con la DGR 1479/2011 \ue8 stata prevista una dotazione pari a 1.145 posti letto (pl) tecnici

L'ESPERIENZA DELLE CURE SUB ACUTE PRESSO L'ASL DELLA PROVINCIA DI COMO

Il Piano Socio Sanitario Regionale 2010-2014 ha modificato l'organizzazione del Sistema Sanitario Regionale della Regione Lombardia prevedendo l'attivazione di strutture di cure intermedie tra ospedale per acuti e strutture territoriali idonee alla gestione dei pazienti (pz) affetti da patologie croniche gestiti nel contesto dell'assistenza primaria o dimissibili da un'Unit\ue0 Operativa per acuti, ma non sufficientemente stabili da consentirne l'assistenza al domicilio. Con la DGR 1479/2011 \ue8 stata prevista una dotazione pari a 1.145 posti letto (pl) tecnici

Structured telephone support programs in chronic heart failure may be affected by a learning curve

The efficacy of a telephone support program in chronic heart failure has been questioned particularly when considering short-term follow-up. This study is aimed to assess the impact of the HeartNetCare telephone support program in chronic heart failure within 18 months of observation and to verify a possible effect of a learning-tocare curve on outcome. We retrospectively compared a cohort of 269 chronic heart failure patients included in HeartNetCare program with 200 patients receiving usual care as a control group. All-cause death and hospitalization for heart failure or implantation of left ventricular assist device were the primary composite outcome. Secondary endpoints were the changes in left ventricular ejection fraction and in New York Heart Association (NYHA) functional class. Outcome data were also analyzed in relation to the time of enrollment from program initiation. At baseline, HeartNetCare group showed lower ejection fraction and higher NYHA class. At the follow-up, 59 HeartNetCare patients (21.9%) and 49 usual care patients (24.5%) reached the primary endpoint (P U 0.51). After 18 months of follow-up, HeartNetCare patients improved ejection fraction and NYHA class compared with the usual care patients (P< 0.001). We also observed that the HeartNetCare patients enrolled after 12 months from the initiation of the program had a more favorable outcome in primary endpoint compared with controls. These results indicate that the long-term impact of a structured telephone support program might be able to positively influence symptoms and reduce events in chronic heart failure. These appreciable effects where more evident after an initial period essential for completing the learning-to-care curv

Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives

Complete atrioventricular block (CAVB) is a total dissociation between the atrial and ventricular activity, in the absence of atrioventricular conduction. Several diseases may result in CAVB in the pediatric and young-adult population. Permanent right ventricular (RV) pacing is required in permanent CAVB, when the cause is neither transient nor reversible. Continuous RV apical pacing has been associated with unfavorable outcomes in several studies due to the associated ventricular dyssynchrony. This study aims to summarize the current literature regarding CAVB in the pediatric and young adult population and to explore future treatment perspectives

Air Pollution Impact on Pregnancy Outcomes in Como, Italy

Objective: This retrospective observational study investigates the association between maternal exposure to air pollutants and pregnancy adverse outcomes in low urbanization areas. Methods: We used multivariate regression analysis to estimate, in the Como province (2005\u20132012), the effects of NOx, NO2, SO2, O3, CO, and PM10 on low birth weight (LBW), babies small for gestational age (SGA), and preterm birth (PTB). Results: PTB was inversely associated with high (5.5mg/m3) exposure to SO2 (adjusted odds ratio [aOR]\ubc0.74, 95% confidence interval [95% CI]\ubc0.58\u20130.95) and to CO (1.8 mg/m3, aOR\ubc0.84, CI\ubc0.72\u20130.99). PTB risk increased with second trimester exposure to NOx (118.3mg/m3, aOR\ubc1.53, CI\ubc1.25\u20131.87), while LBW risk increased with third trimester PM10 (56.1mg/m3, aOR\ubc1.44, CI\ubc1.03\u20132.02). SGAwas inversely associated with third trimester NOx (115.8mg/m3, aOR\ubc0.89, CI\ubc0.79\u20130.99). Conclusions: Exposure to SO2 and CO seems to postpone delivery: a longer gestation could compensate for maternal hypoxemic-hypoxic damag