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Cardiac amyloidosis (CA) is related to the aggregation of insoluble fibrous deposits of misfolded proteins within the myocardium. Transthyretin amyloidosis (ATTR) and immunoglobulin light-chain amyloidosis are the main forms of CA. Atrial fibrillation (AF) is a common arrhythmia in CA patients, especially in those with ATTR amyloidosis. Increased atrial preload and afterload, atrial enlargement, enhanced atrial wall stress, and autonomic dysfunction are the main mechanisms of AF in CA patients. CA is associated with the formation of endocardial thrombi and systemic embolism. The promoters of thrombogenesis include endomyocardial damage, blood stasis, and hypercoagulability. The prevalence of thrombi in patients with AF remains elevated despite long-term anticoagulation. Consequently, transesophageal ultrasound examinations before cardioversion should be performed to exclude endocardiac thrombi despite anticoagulation. Furthermore, the CHA 2 DS 2 -VASc score should not be used to assess the thromboembolic risk in CA patients with AF. Rate control is challenging in patients with CA, while rhythm control is the preferred treatment option, especially in the early stages of the disease process. Although catheter ablation is an effective treatment option, more data are needed to explore the role of the procedure in CA patients., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Clinical suspicion, clinical presentation, and electrocardiogram can help clinicians diagnose flecainide toxicity. Currently, there are no guidelines for the management of patients with flecainide toxicity. Sodium bicarbonate, lipid emulsion therapy, and extracorporeal life support have been used in this setting. Amiodarone and lidocaine can be used for the management of wide QRS complex tachycardias in hemodynamically stable patients with flecainide toxicity., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Experimental in vivo and in vitro studies showed that electric currents applied during the absolute refractory period can modulate cardiac contractility. In preclinical studies, cardiac contractility modulation (CCM) was found to improve calcium handling, reverse the foetal myocyte gene programming associated with heart failure (HF), and facilitate reverse remodeling. Randomized control trials and observational studies have provided evidence about the safety and efficacy of CCM in patients with HF. Clinically, CCM therapy is indicated to improve the 6-min hall walk, quality of life, and functional status of HF patients who remain symptomatic despite guideline-directed medical treatment without an indication for cardiac resynchronization therapy (CRT) and have a left ventricular ejection fraction (LVEF) ranging from 25 to 45%. Although there are promising results about the role of CCM in HF patients with preserved LVEF (HFpEF), further studies are needed to elucidate the role of CCM therapy in this population. Late gadolinium enhancement (LGE) assessment before CCM implantation has been proposed for guiding the lead placement. Furthermore, the optimal duration of CCM application needs further investigation. This review aims to present the existing evidence regarding the role of CCM therapy in HF patients and identify gaps and challenges that require further studies., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: University teachers, who primarily provide guidance and advice to their students, can play a significant role in educational process transformation. As there is no particular e-learning framework, it is important to understand the factors and variables that may impact both its effective usage and further successful implementation. The current study aims to outline the influence of university faculty, and possible barriers preventing medical students from using apps for learning purposes., Subjects and Methods: Α cross-sectional study was conducted with an online survey questionnaire. The population of the study included 1,458 students from all the seven Greek schools of medicine., Results: University faculty (51.7%), followed by fellow students and friends (55.6%), constitute the second most common source of information on adopting apps for medical education. 45.8% of students rated their educational guidance as insufficient/inadequate, 33.0% as moderate, 18.6% as quite good, and only 2.7% as sufficient/complete. University professors have proposed certain apps to 25.5% of students. PubMed (41.7%), Medscape (20.9%), and Complete Anatomy (12.2%) were the leading suggestions. The main barriers to app usage were the lack of knowledge of apps' benefits (28.8%), insufficient updates of their content (21.9%), their cost-effectiveness (19.2%), and financial reasons (16.2%). Most students preferred using free apps (51.4%) and 76.7% preferred universities to cover apps' expenses., Conclusions: University faculty represent the main source of information regarding the adaptation of medical apps in the educational process. However, students need improved and enhanced guidance. The main barriers are ignorance about apps and financial reasons. The majority prefer free apps and universities to cover their cost.

Objective: Medical applications ("apps") can offer innovative educational capabilities, facilitating the acquisition of learning objectives and enhancing decision making. The present study aims at demonstrating the usage characteristics and relevant perceptions among students in seven medical schools in Greece., Materials and Methods: A descriptive cross-sectional study was conducted through an online survey. Popularity, usage patterns and medical student perceptions regarding medical apps were studied., Results: A total of 1,458 undergraduate medical students participated, 99.2% owned a smartphone, 72.8% were aware of medical apps' existence, although only 53.9% used them. Apps awareness was higher in higher-ranked universities. Overall, 46% used 1-3 apps, 7.9% more than four apps. 40.3% stated apps' usage at least 1-3 times a month, followed by 16.0% using them 1-3 times per week. Only 2.5% reported daily usage. Students who used more apps tend to use them more frequently. 77.3% used at least half of the downloaded apps. Awareness of medical apps, number of apps in use and frequency of usage tend to increase in each succeeding year of study. The most popular apps and the main reasons of usage are presented in this study. Current and future perceptions have been investigated. No disparities have been observed between genders., Conclusions: Overall medical apps usage was relatively low, despite the high percentage of smartphone ownership. Quantitative traits are enhanced across the progression of medical studies. Utilization frequency is higher in those using more apps. Distinct utilization patterns were identified between preclinical and clinical students, possibly depicting particular needs, portraying apps as a special adjunctive educational tool.

Introduction: Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects., Methods: Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns., Results: Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7-70.0], mean forced vital capacity %predicted [FVC %pred.] ± standard deviation [SD]: 69.4 ± 18.3, mean diffusing capacity of lung for carbon monoxide %pred. ± SD: 40.8 ± 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 ± 2.04) and 1 year (-0.39 ± 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4-30.0] vs. 20.0 [95% CI: 14.4-25.6]) and %reticulation (5.0 [95% CI: 2.0-15.6] vs. 7.5 [95% CI: 2.0-17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression., Conclusion: Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools., (© 2021 S. Karger AG, Basel.)

Antimicrobial Resistance (AMR) is an ongoing threat to modern medicine throughout the world. The World Health Organisation has emphasized the importance of adequate and effective training of medical students in wise prescribing of antibiotics Furthermore, Antimicrobial Stewardship (AMS) has been recognized as a rapidly growing field in medicine that sets a goal of rational use of antibiotics in terms of dosing, duration of therapy and route of administration. We undertook the current review to systematically summarize and present the published data on the knowledge, attitudes and perceptions of medical students on AMS. We reviewed all studies published in English from 2007 to 2020. We found that although medical students recognize the problem of AMR, they lack basic knowledge regarding AMR. Incorporating novel and effective training methods on all aspects of AMS and AMR in the Medical Curricula worldwide is of paramount importance.

In this study the Multi-Test was applied in 48 patients with inflammatory bowel disease and in 25 normal controls. A significant difference between normal controls and patients with Crohn's disease but not between normal controls and patients with ulcerative colitis was found with regard to anergic status, frequency of positive skin reactions, and size of skin infiltration. The authors conclude that in patients with Crohn's disease a defect exists in the cellular immunity.