Search

The correct management of patients with coronavirus disease-2019 (COVID-19) and acute coronary syndrome is still uncertain. We describe the percutaneous treatment of an unprotected left main coronary artery in a patient who is positive for COVID-19 with unstable angina, dyspnea and fever. Particular attention will be dedicated to the measures adopted in the catheterization laboratory to protect the staff and to avoid further spread of the infection. (Level of Difficulty: Intermediate.)

Background: Thin strut 3rd generation drug eluting stents offer the potential advantage over the previous generation of better technical performance and reduced neointimal proliferation parameters, which are linked to mid and late term device failure. Aim: To evaluate the performance of the Xlimus sirolimus-eluting stent (SES) against the Synergy everolimus-eluting stent (EES) in terms of device reendothelialization in patients undergoing PCI for coronary artery disease (CAD). Methods: XLIMIT is a multicenter randomized controlled trial targeting 180 patients requiring percutaneous coronary interventions (PCI). Patients will be treated with Xlimus SES or Synergy EES implantation and randomization will be performed in a 2:1 ratio. The primary endpoint will be the reendothelialization grade of the Xlimus stent in terms of strut coverage and neointimal hyperplasia volume as compared to Synergy. Secondary endpoints will be represented by clinical and procedural outcomes. The first patient was enrolled on February 2019. Conclusions: A clearer understanding of the endothelialization process of new generation DES could significantly impact the treatment with dual antiplatelet therapy in the future. Moreover, although not powered for clinical end-points, the XLIMIT trial will provide randomized data in a population with minimal exclusion criteria. Trial registration: ClinicalTrials.gov Identifier: NCT03745053. Registered on November 19, 2018. Keywords: Clinical trials, Drug-eluting stent, Coronary artery disease

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner.

Apical hypertrophic cardiomyopathy is part of the broad clinical and morphologic spectrum of hypertrophic cardiomyopathy. We report a patient with electrocardiographic abnormalities in whom acute coronary syndrome was excluded and apical hypertrophic cardiomyopathy was demonstrated by careful differential diagnosis. Resumo: A miocardiopatia hipertrófica apical faz parte do amplo espectro clínico e morfológico da miocardiopatia hipertrófica. Nós reportamos um doente com alterações electrocardiográficas no qual foi excluída uma síndrome coronária aguda e foi demonstrada uma miocardiopatia hipertrófica apical usando um processo correto de diagnóstico diferencial. Keywords: Electrocardiogram, Hypertrophic cardiomyopathy, Congenital heart disease, Palavras-chave: Eletrocardiograma, Miocardiopatia hipertrófica, Cardiopatias congénitas

Objective. Aim of this study was to compare the hemodynamic profiles of 2 aortic valve bioprostheses: the Carpentier Edwards Perimount Magna (CEPM) valve and the Trifecta valve. Methods. 100 patients who underwent AVR for severe symptomatic AS between September 2011 and October 2012 were analyzed by means of standard trans-thoracic Doppler-echocardiography. Results. Mean and peak gradients were significantly lower for the 21 mm Trifecta vs CEPM (11 ± 4 vs 15 ± 4 mmHg, and 20 ± 6 vs 26 ± 7 mmHg, respectively; all p < 0.05) and the 23 mm Trifecta vs CEPM (8 ± 2 vs 14 ± 4 mmHg, and 17 ± 6 vs 25 ± 9 mmHg; all p < 0.05). Effective orifice area tended to be slightly higher for the Trifecta valve. Conclusion. The new bioprosthetic valve Trifecta has an excellent hemodynamic profile, and lower trans-prosthesic gradients when compared to CEPM valve.

Abstract This paper investigates the air quality in 107 Italian provinces in the period 2014–2019 and the association between exposure to nine outdoor air pollutants and the COVID-19 spread and related mortality in the same areas. The methods used were negative binomial (NB) regression, ordinary least squares (OLS) model, and spatial autoregressive (SAR) model. The results showed that (i) common air pollutants—nitrogen dioxide (NO2), ozone (O3), and particulate matter (PM2.5 and PM10)—were highly and positively correlated with large firms, energy and gas consumption, public transports, and livestock sector; (ii) long-term exposure to NO2, PM2.5, PM10, benzene, benzo[a]pyrene (BaP), and cadmium (Cd) was positively and significantly correlated with the spread of COVID-19; and (iii) long-term exposure to NO2, O3, PM2.5, PM10, and arsenic (As) was positively and significantly correlated with COVID-19 related mortality. Specifically, particulate matter and Cd showed the most adverse effect on COVID-19 prevalence; while particulate matter and As showed the largest dangerous impact on excess mortality rate. The results were confirmed even after controlling for eighteen covariates and spatial effects. This outcome seems of interest because benzene, BaP, and heavy metals (As and Cd) have not been considered at all in recent literature. It also suggests the need for a national strategy to drive down air pollutant concentrations to cope better with potential future pandemics.

The COVID-19 pandemic is a serious threat to all of us. It has caused an unprecedented shock to the world’s economy, and it has interrupted the lives and livelihood of millions of people. In the last two years, a large body of literature has attempted to forecast the main dimensions of the COVID-19 outbreak using a wide set of models. In this paper, I forecast the short- to mid-term cumulative deaths from COVID-19 in 12 hard-hit big countries around the world as of 20 August 2021. The data used in the analysis were extracted from the Our World in Data COVID-19 dataset. Both non-seasonal and seasonal autoregressive integrated moving averages (ARIMA and SARIMA) were estimated. The analysis showed that: (i) ARIMA/SARIMA forecasts were sufficiently accurate in both the training and test set by always outperforming the simple alternative forecasting techniques chosen as benchmarks (Mean, Naïve, and Seasonal Naïve); (ii) SARIMA models outperformed ARIMA models in 46 out 48 metrics (in forecasting future values), i.e., on 95.8% of all the considered forecast accuracy measures (mean absolute error [MAE], mean absolute percentage error [MAPE], mean absolute scaled error [MASE], and the root mean squared error [RMSE]), suggesting a clear seasonal pattern in the data; and (iii) the forecasted values from SARIMA models fitted very well the observed (real-time) data for the period 21 August 2021–19 September 2021 for almost all the countries analyzed. This article shows that SARIMA can be safely used for both the short- and medium-term predictions of COVID-19 deaths. Thus, this approach can help government authorities to monitor and manage the huge pressure that COVID-19 is exerting on national healthcare systems.