Current status and needs for changes in critical care training: the voice of the young cardiologists.

AIMS: The implementation of the 2013 European Society of Cardiology (ESC) Core Curriculum guidelines for acute cardiovascular care (acc) training among European countries is unknown. We aimed to evaluate the current status of acc training among cardiology trainees and young cardiologists (<40 years) from ESC countries. METHODS AND RESULTS: The survey (March-July 2019) asked about details of cardiology training, self-confidence in acc technical and non-technical skills, access to training opportunities, and needs for further training in the field. Overall 614 young doctors, 31 (26-43) years old, 55% males were surveyed. Place and duration of acc training differed between countries and between centres in the same country. Although the majority of the respondents (91%) had completed their acc training, the average self-confidence to perform invasive procedures and to manage acc clinical scenarios was low-44% (27.3-70.4). The opportunities for simulation-based learning were scarce-18% (5.8-51.3), as it was previous leadership training (32%) and knowledge about key teamwork principles was poor (48%). The need for further acc training was high-81% (61.9-94.3). Male gender, higher level of training centres, professional qualifications of respondents, longer duration of acc/intensive care training, debriefings, and previous leadership training as well as knowledge about teamwork were related to higher self-confidence in all investigated aspects. CONCLUSIONS: The current cardiology training program is burdened by deficits in acc technical/non-technical skills, substantial variability in programs across ESC countries, and a clear gender-related disparity in outcomes. The forthcoming ESC Core Curriculum for General Cardiology is expected to address these deficiencies.

Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study.

BACKGROUND: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). AIM: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. DESIGN: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. RESULTS: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. CONCLUSIONS: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

Prematurity and Sepsis - Features and Approach Difficulties During Neonatal Emergency Transfer.

Purpose - We aimed to identify conditions, means and methods of suspecting, certification and stratification of neonatal sepsis, to prioritize and define levels of management during evacuation, and to follow the neonatal sepsis succeeding the transfer. Material and method - An observational study was conducted between 1January 2011 - the 1 January 2015, that included 610 preterm newborns with suspected sepsis transferred by UTIM NN or HEMS Craiova. We statistically studied confirmation rate of suspected sepsis, the sepsis onset condition, severity stratification, and correlate with medical centers performance assisting newborns and planning transfers. A follow up performed two weeks after evacuation. Results - We detected low rate of detection and affirmed sepsis: n=38 (6.25%) - C.I. (95%): 4.454309335 and very high level of founded unsuspected sepsis: n=85 (13.98026316%) C.I. (95%): 4.982552268, 9of them being very low body weight newborns (1.480263158%). High rate of founded, unaffirmed respiratory distress 23.35526316% (n=142), C.I. (95%): 5.383960957, as sign of sepsis. High rate of accidental hypoglycemia/hypothermia founded by emergency evacuation team: n=131 (21.54605263%), especially to VLBW newborns, associate with sepsis, respiratory failure or confounding with. Conclusions - Newborns transfer its self generates multiple additional risks, including sepsis, but not neglected any stress generated by transport conditions, so that ,,in utero'' transfer has to be extended in current practice for high risk fetus, mother or special medical conditions to limit newborns transfers. Wider use of telemedicine would facilitate refining the transfer criteria.

Assessment of Oxidative Stress Genes SOD2 and SOD3 Polymorphisms Role in Human Colorectal Cancer.

PURPOSE: The aim of this study was to ascertain the oxidative stress genes SOD2 and SOD3 polymorphisms in patients with colorectal cancer and to assess the possible involvement of these polymorphisms that might increase the risk for patients to develop malignant intestinal tumors. MATERIAL AND METHODS: A total number of 306 subjects were divided into two groups (109 colorectal cancer patients as the study group and 197 normal healthy individuals as the control group).We genotyped two polymorphisms, SOD2 - 201A>G (rs4880) and SOD3 - 896C>G (rs1799895), by allelic discrimination, with TaqMan RT-PCR specific probes. RESULTS: No significant differences were found with either of the polymorphisms when comparing the association between them and an increased risk of developing colorectal tumors. CONCLUSION: In Romanian population, the risk of developing colorectal cancer is not increased by SOD2 and SOD3 polymorphisms.

In Vivo Experimental Study of an Endoscopic Ultrasound Multifunctional Radiofrequency Ablation Probe.

The aim of our study was to test the feasibility of a new developed RFA probe made especially for EUS use and also capable of injecting iron oxide nanoparticles within the targeted liver area. The procedures were performed on domestic pigs, divided in groups: A.liver RFA was performed; B -IONs were injected in the liver followed by EUS-RFA in the same area; C.local EUS-guided liver IONs injection were performed. After EUS measurements for the ablation areas, group A had a mean of 4.9 cm, while group B had a mean of 5.2 cm (Fig.3, 4). IONs exposure was on a median area of 3.1 cm. EUS imaging pointed out a regular oval shape in group A, and a slightly irregular outline on group B, with more echo bubbles around. MRI sections revealed different patterns for each group separately. In group A and B, RFA lesions were easily identified with specific liver parenchyma changes. Group B revealed few deposits of nanoparticles further away from the targeted point. The last group pointed out a large amount of IONs within the injection region and a larger amount of dispersed IONs within the liver than group B.

Study of the Etiological Spectrum of Spontaneous Bacterial Peritonitis in a Group of Patients Suffering from Liver Cirrhosis.

INTRODUCTION: Spontaneous bacterial peritonitis (SBP) represents the most severe and common infectious complication in patients suffering from liver cirrhosis. The objectives of the study were the evaluation of the risk factors responsible for the occurrence of the spontaneous bacterial peritonitis in a group of patients suffering from liver cirrhosis, the identification of the bacterial spectrum and assessing the response to antibiotic therapy. Material and method - The studied group included 64 patients suffering from liver cirrhosis, with an episode of SBP, who were admitted to the IInd Medical Clinic of the County Hospital of Craiova, within a period of 24 months. The control group included 61 patients with liver cirrhosis with an episode of decompensation of liver disease. The diagnosis of liver cirrhosis was established by using clinical, biological and imagistic criteria, and the SBP's diagnosis was based on cytological and bacteriological analysis of the ascites fluid. Patients suffering from hepatocellular carcinoma, portal vein thrombosis and other infectious conditions were excluded. The anamnesis, the duration of the disease, the alcohol intake, the complete clinical examination, the clinical, biological and imagistic evaluation were monitored. Results and conclusions - The most frequent etiology of SBP is represented in 67% of the cases by Gram negative germs, and thus, the antibiotic therapy will be orientated against this etiological segment. In what antibiotic sensitivity is concerned, most of the germs were sensitive to third generation cephalosporins, quinolones, carbapenems and vancomycin.

Liver Fatty Acid Binding Protein And Hemojuvelin - Potential Biomarkers For Liver Function in Rat Model.

PURPOSE: The purpose of the present study was to investigate whether the co-administration of aripiprazole and fluoxetine could produce impaired liver function in Wistar rats by means of liver fatty acid binding protein (L-FABP) and hemojuvelin (HJV) serum levels. Furthermore, the experiment intended to assess the salivary levels of L-FABP and HJV and to determine whether they correlate with the serum levels of the two markers. MATERIALS AND METHODS: Adult male Wistar rats were randomly assigned to four groups: control (saline 10ml/kg), aripiprazole (4.05 mg/kg), fluoxetine (10 mg/kg) and aripiprazole + fluoxetine (4.05 mg/kg + 10 mg/kg). The drugs were administered by gavage, daily at the same hour, along a 6 week period. L-FABP and HJV levels were determined in serum, from intraventricular blood, and in saliva. Also from intraventricular blood, serum levels for aspartate aminotransferase (ASAT) and alanine amino transferase (ALAT) were assessed. RESULTS: Positive and statistically significant correlations between serum and salivary levels of L-FABP and HJV were found. Aripiprazole + fluoxetine group experienced increased serum L-FABP levels than aripiprazole and fluoxetine groups, and salivary L-FABP as compared to aripiprazole group; but it registered decreased levels for serum and salivary HJV, for ASAT and ALAT than aripiprazole and fluoxetine groups, and for salivary L-FABP compared to fluoxetine group. CONCLUSIONS: The data indicate that: aripiprazole coprescribed with fluoxetine do not cause additional alterations in liver function; L-FABP and HJV levels can be helpful as biomarkers for impaired function of hepatocytes; and that their salivary determination can replace serum determination.

The Estrogen-Induced Effects on Myometrium Are the Result of Activation of Two Different Receptor Types: GPER and ERα.

GPER (G protein coupled estrogen receptor 1), a particular estrogen binding site, is ubiquitously present in human tissues, but its precise physiological role is still very disputed. GPER is associated with normal and abnormal estrogen-dependent proliferations in female tissues and is involved in generation of rapid estrogenic answers. A very important fact is that GPER-induced genomic effects are additive to those mediated by "classic" estrogen receptors, but regarding the rapid effects, as we prove in this study, these can be significant different or even antagonistic.