Search

Introduction: The perioperative management of patients with pulmonary hypertension (PH) undergoing cardiac surgery is challenging, mainly due to the potential risk of right ventricular failure (RVF). Levosimendan is a calcium-sensitizing agent that has primarily been used in the treatment of decompensated heart failure. However, recently levosimendan has been shown to be an effective and safe therapeutic strategy for patients with pulmonary arterial hypertension and PH associated with left heart disease. The aim of this study was to investigate the potential utility of the preemptive administration of levosimendan in cardiac surgical patients with preexisting PH and to compare its effectiveness with milrinone, which represents an already established therapeutic option in the management of PH during cardiac surgery. Materials and Methods: In this study, 40 adult cardiac surgical patients with PH were randomly assigned to receive either levosimendan intravenously or milrinone via inhalation in a double-blind fashion prior to a cardiopulmonary bypass (CPB). Hemodynamic and echocardiographic parameters were recorded and evaluated before and after the administration of the drugs. Results and Conclusions: The results of this study demonstrated that both levosimendan and milrinone administered before CPB in cardiac surgical patients with PH may offer protective benefits, reducing pulmonary artery pressure and preventing the exacerbation of PH and RVF. Pulmonary vasodilation attributed to levosimendan is of longer duration and greater magnitude compared to pulmonary vasodilation afforded by milrinone.

In this paper, an innovative approach concerning the investigation of the human heart is introduced, employing state-of-the-art technologies. In particular, sophisticated algorithms were developed to automatically reconstruct a 3D model of a human heart based on DICOM data and to segment the main parts that constitute it. Regarding the reconstructed 3D model, a diagnosis of the examined patient can be derived, whereas in the present study, a clinical case involving the coarctation of the aorta was inspected. Moreover, numerical approaches that are able to simulate flows on complex shapes were considered. Thereupon, the outcomes of the computation analysis coupled with the segmented patient-specific 3D model were inserted in a virtual reality environment, where the clinicians can visualize the blood flow at the vessel walls and train on real-life medical scenarios, enhancing their procedural understanding prior to the actual operation. The physical model was 3D-printed via the MultiJet 3D printing process utilizing materials possessing an adequate mechanical response replicating the mechanical properties and the geometrical characteristics of the human heart. The presented tools aim at the creation of an innovative digital environment, where gaining surgical experience and developing pre-operative strategies could be achieved without the risk and anxiety of actual surgery.

Several lines of evidence suggest that binding SARS-CoV-2 antibodies such as anti-SARS-CoV-2 RBD IgG (anti-RBD) and neutralising antibodies (NA) are correlates of protection against SARS-CoV-2, and the correlation of anti-RBD and NA is very high. The effectiveness (VE) of BNT162b2 in preventing SARS-CoV-2 infection wanes over time, and this reduction is mainly associated with waning immunity, suggesting that the kinetics of antibodies reduction might be of interest to predict VE. In a study of 97 health care workers (HCWs) vaccinated with the BNT162b2 vaccine, we assessed the kinetics of anti-RBD 30–250 days after vaccination using 388 individually matched plasma samples. Anti-RBD levels declined by 85%, 92%, and 95% at the 4th, 6th, and 8th month from the peak, respectively. The kinetics were estimated using the trajectories of anti-RBD by various models. The restricted cubic splines model had a better fit to the observed data. The trajectories of anti-RBD declines were statistically significantly lower for risk factors of severe COVID-19 and the absence of vaccination side effects. Moreover, previous SARS-CoV-2 infection was associated with divergent trajectories consistent with a slower anti-RBD decline over time. These results suggest that anti-RBD may serve as a harbinger for vaccine effectiveness (VE), and it should be explored as a predictor of breakthrough infections and VE.

BNT162b2 has proven to be highly effective, but there is a paucity of data regarding immunogenicity factors and comparison between response to vaccination and natural infection. This study included 871 vaccinated healthcare workers (HCW) and 181 patients with natural infection. Immunogenicity was assessed by measuring anti-SARS-CoV-2 against the RBD domain of the spike protein (anti-RBD). Samples were collected 1–2 weeks after vaccination or 15–59 days post-onset of symptoms. Post-vaccine anti-RBD concentrations were associated with age, gender, vaccination side-effects (VSE) and prior infection (Pr-CoV). Anti-RBD median levels (95%CI) were lower by 2466 (651–5583), 6228 (3254–9203) and 7651 (4479–10,823) AU/mL in 35–44, 45–54, 55–70 yrs, respectively, compared with the 18–34 yrs group. In females, the median levels were higher by 2823 (859–4787), 5024 (3122–6926) in individuals with VSE, and 9971 (5158–14,783) AU/mL in HCWs with Pr-CoV. The ratio of anti-RBD in vaccinated individuals versus those with natural infection varied from 1.0 to 19.4. The high immunogenicity of BNT162b2 is verified, although its sustainability has yet to be elucidated. The use of comparative data from natural infection serological panels, expressing the clinical heterogeneity of natural infection, may facilitate early decisions for candidate vaccines to be evaluated in clinical trials.

IntroductionGreece is a country with limited spread of SARS-CoV-2 and cumulative infection attack rate of 0.12% (95% CI 0.06-0.26). Health care workers (HCWs) are a well-recognized risk group for COVID-19. The study aimed to estimate the seroprevalence of antibodies to SARS-CoV-2 in a nosocomial setting and assess potential risk factors.MethodsHCWs from two hospitals participated in the study. Hospital-1 was a tertiary university affiliated center, involved in the care of COVID-19 patients while hospital-2 was a tertiary specialized cardiac surgery center not involved in the care of these patients. A validated, CE, rapid, IgM/IgG antibody point-of-care test was used. Comparative performance with a reference globally available assay was assessed.Results1,495 individuals consented to participate (response rate 77%). The anti-SARS-CoV-2 weighted prevalence was 1.26% (95% CI 0.43, 3.26) overall and 0.53% (95% CI 0.06, 2.78) and 2.70% (95% CI 0.57, 9.19) in hospital-1 and hospital-2, respectively although the study was underpowered to detect statistically significant differences. The overall, hospital-1, and hospital-2 seroprevalence was 10, 4 and 22 times higher than the estimated infection attack rate in general population, respectively. Suboptimal use of personal protective equipment was noted in both hospitals.ConclusionsThese data have implications for the preparedness of a second wave of COVID-19 epidemic, given the low burden of SARS-CoV-2 infection rate, in concordance with national projections.

We describe a case of a 43-year old woman with Marfan’s syndrome, tricuspid valve regurgitation and severe pectus excavatum who required an aortic root replacement and valvuloplasty for an ascending aortic aneurism with aortic valve regurgitation and tricuspid valve regurgitation. There was a severe angulation of the sternum which was close to 1.5 cm to the column vertebrae. Such cases are quite rare and always a challenge for surgeons to achieve adequate exposure of the heart and prevent excessive cardiac compression. We present our access, a safe and efficient exposure of the heart in order to achieve the best outcome.

Congenital lobar emphysema (CLE) is a rare lung congenital malformation. Differential diagnosis of the disease remains challenging in an infant with acute respiratory distress. We report a case of a 3-week-old female infant with a weight of 2.1 kg who presented respiratory distress related to CLE. Left upper lobectomy was performed and she had an uneventful recovery.

Background: Radiation dermatitis in children covers a wider range of symptoms and manifestations of skin toxicity after radiation therapy (RT). The rapid development of radiology in recent years has led to a significant improvement in the effectiveness of cancer treatment. Aim: This systematic review aimed to investigate the incidence of radiodermatitis in children, adolescents, and young adults with cancer undergoing radiotherapy. Method and Material: A systematic review of the literature was conducted from 01/01/2002 to 15/02/2022, using the keywords: radiotherapy, radiology, toxicity, dermatitis, radiodermatitis, actinodermatitis, dermatologic complications, pediatric patients, children, cancer, for articles written in the English language, in the following databases: MEDLINE (via PubMed), The Cochrane Library, CINAHL, Web of Science Collection, and Scopus. The PICOTS process (Population, Intervention, Comparator, Outcome, Timing, Setting) was used as an evaluation criterion for the induction of articles in the study. After the articles' evaluation, 16 articles emerged. Results: The results of 16 studies in 2,818 children, adolescents, and young adults showed that dermal toxicity after radiotherapy varies not only in the frequency of occurrence but also in the severity and extent, independently of the radiotherapy method. Skin effects of radiodermatitis vary considerably in severity, course, and prognosis, and the most apparent relation of its occurrence was the higher dose of RT and the extent of skin therapy. Moreover, limited evidence indicates higher rates of radiodermatitis in smaller children compared to adolescents or young adults. Conclusions: The incidence of radiodermatitis in children undergoing radiotherapy appears to occur quite frequently. Further research is needed to substantiate strong evidence for assessing and managing radiodermatitis. [ABSTRACT FROM AUTHOR]

Storytelling and Narrative Techniques: Research Findings Support their Implication in any Healthcare Setting