Outcome of acute type A aortic dissection: single-center experience from 1998 to 2007

Introduction. Acute aortic dissection (AAD) is a serious disease of the aorta with high mortality and morbidity, which requires emergency surgical treatment in order to close the site of the dissection and direct blood flow into the true lumen. Improve- ments in surgical technique have led to better management of patients with reduced operative mortality, although it still remains high. The aim of this study is to evaluate early and late outcomes of the surgical treatment of acute type A aortic dissection at the hospital of Lecce between 1998 and 2007. We also aim to establish a correlation between these outcomes and pre-operative conditions, surgical procedures and location of the site of the tear. Methods. From 1998 to 2007, 100 patients (69 males and 31 females, average age 62.2 ± 12.3 years, range 22-85 years) underwent surgery for acute AAD at the center. Surgical tech- niques included replacement of the ascending aorta (Asc Ao) with or without valve replacement (including five patients who underwent the Bentall/De Bono procedure) and replacement of the Asc Ao with or without arch or hemiarch replacement. Results. In-hospital mortality was 22%, with different results between surgery for replacement of the aorta and for aorta with valve replacement (respectively, 16% and 23%). Different mor- tality rates were found between the distal surgical treatments, with rates of 20.8% and 18.2% respectively between replace- ments of the Asc Ao and of Asc Ao with arch/hemiarch, although they were not statistically significant. A different mortality rate that was subject to the patient?s preoperative condition has also been found (33.3% of mortality in patients in unstable or high- risk condition vs 13.8% in patients in stable condition). The peak reached 43.5% mortality in patients taken to the operating room while in shock or cardiac tamponade. The location of the site of the tear is another factor that distinguishes mortality rates, which are 17.8% if localized at the proximal ascending aorta and 22.2% in the aortic arch. Assessment of the outcome (10 years after surgery), has shown that four patients died several years later but for reasons unrelated to the surgery. Conclusions. The surgery of dissection is still an intervention with a relatively high in-hospital mortality risk, and whose outcome, which has been steady in the last 20 years, can be predicted according to the preoperative condition of the patient. This underlines the need to reduce the time of diagnosis indicat- ing immediate surgical treatment

Clinical features of COVID-19 and SARS epidemics. A literature review

SARS-CoV-2, responsible for the current pandemic, is a novel strain of the Coronaviridae family, which has infected humans as a result of the leap to a new species. It causes an atypical pneumonia similar to that caused by SARS-CoV in 2003. SARS-CoV-2 has currently infected more than 9,200,000 people and caused almost 480,000 deaths worldwide. Although SARS-CoV-2 and SARS-CoV have similar phylogenetic and pathogenetic characteristics, they show important differences in clinical manifestations. We have reviewed the recent literature comparing the characteristics of the two epidemics and highlight their peculiar aspects. An analysis of all signs and symptoms of 3,365 SARS patients and 23,280 COVID-19 patients as well as of the comorbidities has been carried out. A total of 17 and 75 studies regarding patients with SARS and COVID-19, respectively, were included in the analysis. The analysis revealed an overlap of some symptoms between the two infections. Unlike SARS patients, COVID-19 patients have developed respiratory, neurological and gastrointestinal symptoms, and, in a limited number of subjects, symptoms involving organs such as skin and subcutaneous tissue, kidneys, cardiovascular system, liver and eyes. This analysis was conducted in order to direct towards an early identification of the infection, a suitable diagnostic procedure and the adoption of appropriate containment measures

Aestivation and hypoxia-related events share common silent neuron trafficking processes

10.1186/1471-2202-13-39BMC Neuroscience131-BNME

Low serum phosphate levels are related to increased cardiovascular risk in HIV-1 infected patients

Purpose of the study Hypophosphatemia may contribute directly to the devel- opment of obesity, hypertension and dyslipidemia. Hyperglycemia, insulin resistance, hyperlipidemia and hypertension, which are components of metabolic syn- drome, are also recognized as strong risk factors for car- diovascular disease [1]. This study was performed to determine whether serum phosphate levels are asso- ciated with increased risk for cardiovascular events. Methods We enrolled 125 consecutive HIV-1-infected patients in a cross-sectional study. All patients were receiving highly active antiretroviral therapy (HAART) for more than six months. Fasting phosphate, lipids (cholesterol, HDL, triglycerides), Homeostasis Model Assessment (HOMA), blood pressure were evaluated. Framingham 10 years risk of general cardiovascular disease was used to assess three cardiovascular risk (CVR) categories (low CVR 20%). Summary of results We observed a statistically significant decrease in serum phosphate levels in the three different CVR groups (low risk: 3.5 mg/dl; medium risk: 3.3 mg/dl; high risk: 2.9 mg/dl; p=0.001). There was a strong negative correlation between Framingham score and phosphate levels (r:- 0.37, p<0.0001). Figure 1 Multiple regression analysis, including age, months of HAART, CD4 cells count, cholesterol, HDL, HOMA, systolic pressure, months of Tenofovir use, showed that only HOMA (r:-0.30, p<0.01) and age (r:-0.3, p<0.01) were the most important determinants of serum phos- phate values. Conclusions We found that lower phosphate level is correlated with cardiovascular risk and insulin resistance. Therefore, when serum phosphate levels are too low the patients is at risk for cardiovascular events and/or metabolic syndrome

Should the visceral peritoneum at the bladder flap closed at caesarean sections a post partum sonographic and clinical assessment?

Objective. To compare cesarean section (CS) using open or closed visceral peritoneum of the bladder flap (BF) in relation to fluid collection in vesico-uterine space (VUS) by ultrasound (US) and clinical outcome. Material and methods. A prospective cohort of repeat CS in 474 in advanced first and second stage of labor was studied. All women underwent a Misgav Ladach CS, in local combined anesthesia. These were divided into two groups by surgical management of the BF at the time of CS: Group I (n?262), with visceral peritoneum left open and Group II (n?212), with visceral peritoneum closed. An US check for the fluid collections in the VUS was done in the third post-operative day. The two groups were also clinically compared for: intra-operative estimated blood loss, the need for post-CS pain killers, febrile morbidity and duration of hospital stay. Results. Visceral peritoneum (VP) closure resulted in a significant increase blood collections in the VUS (p50.05). VP closure resulted in a significantly higher morbidity in all the following parameters. Rate of BFHs, post-operative fever, need for post-operative analgesia, require antibiotic administration and prolonged hospitalisation (p50.05). Conclusions. VP suturing of women requiring CS for dystocia is associated to increased rate of blood collection in the VUS, which could possibly explain the higher rate of puerperal complications in these patients. These data clearly indicate that suturing the VP of the BF in women undergoing CS for dystocia is contraindicated. This data could be probably extrapolated to all cesarean deliveries

Human metapneumovirus and human bocavirus associated with respiratory infection in Apulian population

AbstractWe have studied the occurrence of hBoV, hMPV and InfA-B in an Apulian population with respiratory tract infections. During influenza season 2008–2009, 116 oropharingeal swabs were collected from patients affected by Influenza-Like Illness (ILI). The PCR products of hMPV M and HBoV NP-1 genes were sequenced. 78 out of 116 samples were positive for at least one respiratory virus; hBoV was detected in 53, hMPV in 22 and InfA-B in 41 out of 116 swabs. A high rate of hBoV infection in adult (18.9%) and elderly (26.4%) subjects was found. The co-infection rate was higher for hMPV (18/22 cases, 81.8%) compared to hBoV (26/53 cases, 49.1%), and InfA-B (25/41 cases, 61.0%). Co-infections were common in children. hBoV positive samples shared a high level of genetic similarity with the hBoV1 genotype, and hMPV positive samples clustered with A2 subgroup. Our results suggest that hBoV and hMPV play a role in ILI

Altered phosphate metabolism in HIV-1-infected patients: another feature of metabolic syndrome?

Purpose of the study Metabolic syndrome represent a cluster of cardiovascu- lar risk factors that has become a serious problem for HIV-1-infected patients. It was proposed that distur- bances in phosphate metabolism may represent a key feature of metabolic syndrome. Because phosphate is involved directly in carbohydrate metabolism, hypopho- sphatemia can results in impaired utilization of glucose, insulin resistance and hyperinsulinemia. Thus, we undertook the present study to investigate the relation- ship between phosphate levels and the presence of the characteristics of metabolic syndrome, as well as the mechanism that may be responsible for reduced phos- phate levels in patients with this syndrome. Methods 130 HIV-1-infected patients were consecutively enrolled in a prospective, cross-sectional, single centre study. All patients were receiving HAART for more than six months. We selected two groups: HIV+ patients with metabolic syndrome (group A, n=86) and HIV+ patients without metabolic syndrome (group B, n=44). The diag- nosis of metabolic syndrome was based on Adult Treat- ment Panel III guidelines. Demographic characteristics, metabolic variables, duration of Tenofovir therapy, dura- tion of HAART, CD4 and viral load were collected. Kid- ney tubular function was examined using tubular resorption of phosphate and normalized renal threshold phosphate concentration. Summary of results Patients with metabolic syndrome showed significantly lower phosphate (3.13 mg/dl vs 3.55 mg/dl, p<0.01) and higher insulin (13.2 mg/dl vs 6.9 mg/dl, p<0.01) levels compared with controls. There was a linear significant decrease in phosphate values as the number of compo- nents of metabolic syndrome increased (p<0.001). Multi- ple regression analysis including all 5 components of metabolic syndrome and months of TDF treatment showed that insulin level was the most discriminant of serum phosphate (r= -0.22, p<0.01). Figure 1 Conclusions Our preliminary data demonstrated that HIV-1-infected patients with metabolic syndrome showed significantly lower phosphate levels compared with HIV-1-infected patients without metabolic syndrome regardless of teno- fovir based therapy. The clinical significance of these disturbances, as well as their importance as target for preventive or therapeutic interventions, remains to be established

Kidney tubular function and serum phosphate levels in HIV-1-infected patients treated with tenofovir: preliminary results

Purpose of the study There is concern that human immunodeficiency virus (HIV) infection and the use of highly active antiretro- viral therapy lead to cumulative toxicity. Tenofovir (TDF) is the first choice for most subjects. Even if it has a safe metabolic profile, much attention has been fixed on kidney tubular function and regulation of phosphate metabolism. We performed this study to evaluate the role of a TDF based regimen has on renal tubular over time. Methods Prospective, cross-sectional, single centre study was car- ried out. 121 HIV-1-infected patients were consecutively enrolled in six groups based on duration of TDF exposi- tion: G0, from 6 to 12 months; G1 from 13 to 24 months; G2 from 25 to 36 months; G3 from 37 to 48 months; G4 more than 48 months and G5 under HAART but never exposed to TDF. Glomerular func- tion was assessed using creatinine clearance (CrCL) cal- culated by MDRD. Tubular function was assessed using fractional excretion ratio of phosphate and normalized renal threshold phosphate concentration. Demographic, CD4, serum phosphate levels, viral load were collected. Summary of results A total of 121 consecutive HIV-1-infected patients were analyzed: 15 in G0, 11 in G1, 14 in G2, 32 in G3, 35 in G4 and 14 in G5. Mean of TDF exposure was 10.26, 21.4, 36.2, 47.3 and 67.4 months in G0, G1, G2, G3 and G4 respectively. There was no statistically significant dif- ference of mean values of FEP(11.2, 10.3, 8.4, 9.8, 11.1 and 10% in G0, G1, G2, G3, G4 and G5 respectively), TmPO4/GFR (3.5, 3.5, 3.6, 3.6, 3.4 and 3.4 mg/dl in G0, G1, G2, G3, G4 and G5 respectively ), CrCL (102.2, 94.3, 92.9, 106.5, 103.1 and 101.6 ml/min/1.73m2 in G0, G1, G2, G3, G4 and G5 respectively) and serum phos- phate levels (3.4, 3.3, 3.1, 3.5, 3.3 and 3.4 in G0, G1, G2, G3, G4 and G5 respectively) between groups. Moreover, we did not find correlation of FEP (r:0.04, p:0.6) and TmPO4/GFR (r:0.05, p:0.5) with duration of TDF therapy. Conclusions Treatment with TDF is not associated with altered kid- ney tubular function and serum phosphate levels over time

HIV infection and frequency of micronucleus in human peripheral blood cells

Purpose. People living with HIV have higher rates of malignancies than the general population in the era of active antiretroviral therapy (ART). Genotoxic effects of HIV infection and/or ART that can induce neoplastic development are not yet well known. A prospective cohort study to investigate DNA damage measured through the micronuclei (MN) frequency in HIV-patients has been performed. Methods. Peripheral blood mononuclear cells (PBMC) were isolated from 52 HIV-patients treated with ART and 55 healthy controls. Results. By the comparison of MN frequency, a significant difference between HIV-patients (15.5 ± 9.8) and controls (6.0 ± 3.6) (p < 0.001) has been revealed. In univariate linear regression analysis, HCV infection (r = 0.31; p < 0.001), HIV-RNA (r = 0.29; p < 0.03) and duration of infection (r = - 0.16; p < 0.25) were associated with MN frequency; while only viral load (VL) significantly correlates (r = 0.29; p < 0.05) in a multiple regression model. Conclusions. The association of VL with MN frequency supports a genotoxic effect of HIV infection