Peri-operative fever and LVAD: SIRS or impaired right ventricular strain?

BACKGROUND: An inflammatory milieu after left ventricular assist device (LVAD) implantation is associated with multi-organ dysfunction and pre-operative heightened inflammatory state is associated with right ventricular failure after LVAD implantation. METHODS: We performed a retrospective analysis of 30 LVAD patients in our institution within the last 2 years for the development of fever and compared them to 30 non-LVAD open-heart surgery patients. RESULTS: Our results suggest that patients undergoing LVAD implantation are more likely to develop fever in the immediate post-operative period compared to other open-heart surgeries. This is independent of pharmacological treatment, age, or ethnical background. Females and obese patients were more likely to develop fever. CONCLUSION: Patients with right ventricular dysfunction, as demonstrated by elevated central venous pressure (CVP), had the strongest correlation with fever development. These results pose the question if there is a systemic inflammatory response-like phenomenon driven by increased right ventricular dysfunction.

Anatomical considerations and clinical interpretation of the 12-lead ECG in the prone position: a prospective multicentre study.

AIMS: The aim of this study is to provide guidance for the clinical interpretation of electrocardiograms (ECGs) in prone position and to establish the electroanatomic explanations for the possible differences to supine position ECGs that may be observed. Additionally, to determine if prone back ECG can be used as an alternative to standard ECG in patients who may benefit from prone position. METHODS AND RESULTS: The ECG in supine (standard ECG), prone back (precordial leads placed on the patient's back), and prone anterior position (precordial leads placed in the standard position with the subjects in prone position) were prospectively examined on 85 subjects. Comparisons of ECG parameters between these positions were performed. Computed tomography (CT) scans were performed in both positions to determine possible electroanatomic aetiologies for prone-associated ECG changes. There were significant differences in QRS amplitude in Leads V1-V5 between supine and prone positions. Q waves were more frequently observed in prone back position vs. supine position (V1: 74.1 vs. 10.6%, P < 0.0001; V2: 23.5 vs. 0%, P < 0.0001, respectively). Flat and inverted T waves were more common in prone back leads (V1: 98 vs. 66%, P < 0.0001; V2: 96 vs. 8%, P < 0.0001; V3: 45 vs. 7%, P < 0.0001). The 3D-CT reconstructions measurements corroborated the significant inverse correlation between QRS amplitude and the distance from the centre of the heart to the estimated lead positions. CONCLUSION: In prone back position ECG, low QRS amplitude should not be misinterpreted as low voltage conditions, neither should Q waves and abnormal T waves are considered anteroseptal myocardial infarction. These changes can be explained by an increased impedance (due to interposing lung tissue) and by the increased distance between the electrodes to the centre of the heart.

[Clinical and prognostic profile evolution of patients discharged from hospital due to heart failure in the first two decades of the 21st century. The INCA-Ex Registry]. / Evolución del perfil clínico y pronóstico de pacientes con alta hospitalaria por insuficiencia cardíaca en las dos primeras décadas del sigloxxi. El Registro INCA-Ex.

AIM: To study the evolution of the clinical profile of a population discharged with a main diagnosis of heart failure (HF) in the first two decades of the century and the predictive variables of mortality and readmission in the first year of discharge. DESIGN: Observational, retrospective, longitudinal study. SITE: Don Benito Villanueva de la Serena Badajoz health area. PARTICIPANTS: All patients discharged with a main diagnosis of HF between 2000 and 2019 in a general hospital complex were included. MAIN MEASUREMENTS: Sociodemographic and clinical variables were collected, and a one-year follow-up; the result variable was a composite of mortality and/or readmission. RESULTS: A total of 4107 discharges were included, mean age 77.1 (SD±10.5) years, 53.1% women. The number of admissions, age, history of neoplasms, stroke, kidney failure, and anemia increased, as did readmissions (P for trends <.001), while mortality remained constant. Predictive variables for readmission and/or death were HR (95%CI): age (per year) 1.04 (1.03-1.04), diabetes: 1.11 (1.01-1.24), previous HF 1.41 (1.28-1.57), composite variable myocardial infarction, stroke and/or peripheral artery disease 1.24 (1.11-1.38), chronic obstructive pulmonary disease (COPD) 1.29 (1.15-1.44), neoplasia 1.33 (1.16-1.53), anemia 1.63 (1.41-1.86), chronic kidney failure 1.42 (1.26-1.60). CONCLUSIONS: In the last 20 years, admissions for heart failure, patient age, and comorbidity have increased. Predictive variables for mortality and/or readmission were age, diabetes, previous cardiovascular disease, neoplasms, COPD, kidney failure, and anemia; however, mortality at one year remained constant.

A nonparametric method of estimation of the population size in capture-recapture experiments.

A recent method for estimating a lower bound of the population size in capture-recapture samples is studied. Specifically, some asymptotic properties, such as strong consistency and asymptotic normality, are provided. The introduced estimator is based on the empirical probability generating function (pgf) of the observed data, and it is consistent for count distributions having a log-convex pgf ( LC -class). This is a large family that includes mixed and compound Poisson distributions, and their independent sums and finite mixtures as well. The finite-sample performance of the lower bound estimator is assessed via simulation showing a better behavior than some close competitors. Several examples of application are also analyzed and discussed.

Hypoxic hepatitis in an extensive aortic disecction: case report.

Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.

Endovascular management of inferior vena cava filter thrombotic occlusion.

Objective Inferior vena cava occlusion is a potentially life-threatening complication related to caval filters. We present our experience with filter-induced inferior vena cava occlusion in order to assess the feasibility, safety, and effectiveness of endovascular management. Methods A retrospective review of all patients undergoing inferior vena cava filter placement over a 60-month study period was performed. From this cohort, a total of 10 cases of inferior vena cava occlusion after filter placement were identified. Demographics, clinical data, procedures, and outcomes were extracted. Patients were followed to the last clinic visit or until they died. Results One-hundred eighty filters were placed by our group practice during the study period. Of those, a total of 10 patients were identified. Overall, there were 7 males; the mean age was 57.1 years (25-78 years). The median time between inferior vena cava filter placement and filter occlusion was 105 days (range 5-4745 days). All patients were clinically symptomatic at the time of their presentation. Nine out of 10 patients were successfully managed endovascularly. Trellis™-8 thrombectomy was the most common endovascular strategy performed ( n = 9). Four patients had balloon angioplasty, two of those with stent placement for chronically occluded inferior vena cava/iliac veins. No thromboembolic complications developed during a median follow-up period of 233 days (range 4-1083 days). Conclusions Endovascular management of inferior vena cava occlusion is feasible, safe, and effective in decreasing thrombus burden in the presence of an inferior vena cava filter. Further studies evaluating long-term inferior vena cava patency and optimal surveillance regimen after endovascular management of filter-related inferior vena cava occlusion are warranted.

[Non-cirrhotic portal hypertension due to didanosina. A rare case]. / Hipertensión portal no cirrótica por didanosina. Un caso infrecuente.

Liver involvement is usually seen in patients infected with the human immunodeficiency virus (HIV), especially in patients coinfected with hepatitis B or C, in alcohol abuse, etc. However, there is a group of patients who develop liver involvement and portal hypertension of unspecified cause. Non-cirrhotic portal hypertension (NCPH) is a liver disorder recently described, but potentially serious. It has been reported in HIV-infected patients with highly active antiretroviral therapy (HAART), specifically didanosine (DDI). The pathophysiology involves the infectious agent (HIV) and its treatment (HAART), since both generate a pre-hepatic portal venulopathy. Similarly, HIV infection produces a prothrombotic state by protein S deficiency leading to the obliteration of small hepatic venules. It has been postulated that DDI as a cofactor in the pathogenesis of NCPH. All this leads that many of the liver biopsies show nodular regenerative hyperplasia. We present the case of a HIV-infected patient who was treated with a longstanding DDI. She developed upper gastrointestinal bleeding (UGB) and ascites due to NCPH, whose diagnosis was confirmed by biopsy. However, there is no similar study in our country.

Catheter Ablation of Left Ventricular Summit Arrhythmias from Adjacent Anatomic Vantage Points.

Idiopathic ventricular arrhythmias (VA), particularly left ventricular outflow tract (LVOT) VA accounts for up to 10% of all VAs referred for ablative therapy. In addition to being infrequent, its intricate anatomy and its pathophysiology make catheter ablation (CA) of these arrhythmias a challenge even for experts. In this scenario, detailed right ventricular outflow tract as well as LVOT electroanatomic mapping including epicardial mapping are essential. In this article, we will emphasize our approach toward the CA technique used for LVOT VA, particularly IVS and/or LVS VA originating from intramural foci, along with its acute and long-term efficacy and safety.

Fluoroless Catheter Ablation of Left Ventricular Summit Arrhythmias: A Step-by-Step Approach.

Prolonged use of fluoroscopy during catheter ablation (CA) of arrhythmias is associated with a significant exposure to ionizing radiation and risk of orthopedic injuries given the need for heavy protective equipment. CA of ventricular arrhythmias (VAs) arising from the left ventricular (LV) summit is challenging, requiring a vast knowledge of the intricate cardiac anatomy of this area and careful imaging delineation of the different anatomical structures, which is frequently performed using fluoroscopic guidance. Certain techniques, including pericardial mapping and ablation, use of intracoronary wires, and mapping and ablation inside the coronary venous system have been proposed, further prolonging fluoroscopy time. Fluoroless CA procedures are feasible with currently available technology and appear to have similar safety and efficacy outcomes compared with conventional techniques. To successfully perform fluoroless CA of LV summit arrhythmias, it is important to be fully acquainted with intracardiac echocardiography (ICE) imaging and electroanatomic mapping (EAM). We will describe our approach to perform fluoroless CA in LV summit VAs.

Human metapneumovirus strains circulating in Latin America.

The human metapneumovirus (HMPV) is responsible for acute respiratory tract infections in young children, elderly patients, and immunocompromised hosts. In this study, we genetically analyzed the circulating HMPV in Central and South America from July 2008 to June 2009 and characterized the strains present in this region. Samples were collected during an international collaborative influenza like illness surveillance study and then sequenced with specific primers for the HMPV G gene. Our results show that two distinct clusters of HMPV circulated in Central and South America, subtypes A2 and B2 being the predominant strains.

Creativity in Recreational Figure Roller-Skating: A Pilot Study on the Psychological Benefits in School-Age Girls.

Creative strategies allow students to feel ownership of their learning, fostering interest and motivation towards sports and educational contexts. This study aimed to compare different psychological variables after applying creative and traditional sessions of recreational figure roller-skating. Twelve school-age female skaters (9.00 ± 1.09 years old) participated in this pilot study. They performed two sessions: (1) a creative session (where participants created their own choreography) and (2) a traditional session (where participants followed the choreography created by the sports professional). In the creative session, participants created their choreographies without instructions. The basic psychological needs scale, the measure of intentionality to be physically active (sports adherence) and the games and emotions scale were administered after each session. The creative intervention led to a higher satisfaction of the needs of perceived competence (p-value = 0.04; effect size = 0.59), social relationships (p-value = 0.03; effect size = 0.62) and adherence to figure roller-skating (p-value = 0.02; effect size = 0.69), compared to the traditional intervention in female skaters. Participants showed significantly more humor and less surprise in the creative session than in the traditional session. This greater satisfaction with perceived competence and social relationships could translate into greater adherence to sports.

Are Subjective Intensities Indicators of Player Load and Heart Rate in Physical Education?

Physical education teachers need valid, low-cost, subjective techniques as an alternative to high-cost new technologies to monitor students' intensity monitoring. This study aimed to investigate the correlations between both objective and subjective external (eTL) and internal (iTL) intensities. A total of 95 primary education students participated in this study. In this regard, 40 played soccer, and 55 performed basketball tasks, recording a total of 3956 units of analysis. The intensities caused by the different soccer and basketball tasks were measured using objective techniques (inertial devices and heart rate monitors) and subjective techniques (a sheet of task analysis and ratings of perceived exertion). Matrix scatter plots were made to show the values of two variables for a dataset. In this regard, adjustment lines were plotted to determine the trend of the correlations. Then, Spearman's correlation was calculated to measure the association between two variables. Despite the low correlation levels obtained, the main results showed significant positive correlations between the intensities. This means that the high intensity values recorded by objective techniques also implied high intensity values recorded by subjective techniques, and vice versa. Negative correlations (r Rho = -0.19; p = 0.00) were only found between the following eTL variables: task eTL per minute (subjective technique) and player load per minute (objective technique). This negative correlation occurred when students played in the same 3 vs. 3 game situation without variability in subjective eTL (M ± SD, 28.00 ± 0.00). Therefore, subjective eTL and iTL techniques could be proposed as a suitable alternative for planning and monitoring the intensities supported by students in physical education classes. Moreover, these subjective techniques are easy to use in schools.

Game Space and Game Situation as Mediators of the External Load in the Tasks of School Handball.

The teacher's didactic intervention also requires knowledge and control of learning tasks' workloads. The objectives of the study were as follows: (i) to quantify the subjective external load-eTL of tasks framed in didactic units designed by in-service teachers; and (ii) to analyze the differences in the subjective eTL according to the game situation and the game space. A total of 306 learning tasks designed by seven in-service teachers (five men and two women), with more than 10 years of teaching practice, were analyzed. These tasks were coded through the Integral System for Training Task Analysis (SIATE, acronym in Spanish). The interobserver reliability of the coded variables obtained a considerable concordance (MKfree > 0.70). The results indicated that there were significant differences in the subjective eTL according to the game situation and game space. The situations of small-sided games in numerical equality or inequality and full games, in medium spaces or large spaces, presented a higher subjective eTL and therefore the highest physiological and motor demands on students. The inclusion of attacking or defending players and an adequate selection of the game space indicated the importance of planning and organizing learning tasks.

Determinant Factors of Achievement Motivation in School Physical Education.

Today, it is important for physical education teachers to know students' motivation profiles for learning. Therefore, this study aimed to analyze achievement motivation according to four variables: students' sex, the taught sport modality, students' experience and teaching methodology. Likewise, the effects of students' sex and experience on the methodologies applied were analyzed. A total of 108 primary education students (10.95 ± 0.48 years), 54 boys and 54 girls, from three state schools participated in the study. The students answered the Achievement Motivation in Physical Education test (Spanish version) after participating in soccer and basketball programs based on different methodologies. Each class-group received a different educational program (soccer or basketball). The differences between the categories of the variables analyzed were calculated for each dimension of the motivational test through the Mann−Whitney U and Kruskal−Wallis H tests. The effects of students' sex and experience on the teaching methodologies applied were analyzed using the univariate General Linear Model test. In soccer and basketball, boys perceived being more motor competent (U = 732.00; p < 0.05; r = 0.43) than girls. In addition, experienced students in both sports perceived being more motor competent (U = 695.50; p < 0.05; r = 0.27) than inexperienced students. In turn, they indicated feeling less failure anxiety and stress (U = 780.00; p < 0.05; r = 0.22). All of the students who played soccer reported more commitment (learning dedication) (U = 1051.50; p < 0.05; r = 0.20) and perceived motor competence (U = 972.00; p < 0.05; r = 0.24) than students who played basketball. Considering the effects of students' sex and experience on the methodologies (perceived motor competence dimension), there were significant differences (F = 7.68; p < 0.05; ηp2 = 0.07) in favor of experienced boys who played soccer and basketball using the Tactical Games Approach methodology. Soccer was practiced more in school and out of school. This made students feel greater commitment (learning dedication) and perceived motor competence towards this invasion sport in physical education. In addition, it was shown that teachers should take into account students' sex and experience because they are two factors that influence the teaching of sports and achievement motivation.

Electrocardiographic Features of Patients with COVID-19: An Updated Review.

Numerous systemic manifestations, including cardiac involvement in the form of myocardial infarction, myocarditis, and electrocardiographic changes, have been associated with COVID-19..In this review, the authors describe the electrocardiographic features that have been reported to date in patients affected by this disease and their possible underlying mechanisms.

Examining the immune signatures of SARS-CoV-2 infection in pregnancy and the impact on neurodevelopment: Protocol of the SIGNATURE longitudinal study.

The COVID-19 pandemic represents a valuable opportunity to carry out cohort studies that allow us to advance our knowledge on pathophysiological mechanisms of neuropsychiatric diseases. One of these opportunities is the study of the relationships between inflammation, brain development and an increased risk of suffering neuropsychiatric disorders. Based on the hypothesis that neuroinflammation during early stages of life is associated with neurodevelopmental disorders and confers a greater risk of developing neuropsychiatric disorders, we propose a cohort study of SARS-CoV-2-infected pregnant women and their newborns. The main objective of SIGNATURE project is to explore how the presence of prenatal SARS-CoV-2 infection and other non-infectious stressors generates an abnormal inflammatory activity in the newborn. The cohort of women during the COVID-19 pandemic will be psychological and biological monitored during their pregnancy, delivery, childbirth and postpartum. The biological information of the umbilical cord (foetus blood) and peripheral blood from the mother will be obtained after childbirth. These samples and the clinical characterisation of the cohort of mothers and newborns, are tremendously valuable at this time. This is a protocol report and no analyses have been conducted yet, being currently at, our study is in the recruitment process step. At the time of this publication, we have identified 1,060 SARS-CoV-2 infected mothers and all have already given birth. From the total of identified mothers, we have recruited 537 SARS-COV-2 infected women and all of them have completed the mental health assessment during pregnancy. We have collected biological samples from 119 mothers and babies. Additionally, we have recruited 390 non-infected pregnant women.

White Clot Formation at Acetylcholine Testing: A Change of Heart in MINOCA?

Coronary intraluminal white clot formation, apparently in response to acetylcholine testing, may explain a woman's long-term history of daily chest pain and multiple myocardial infarctions. Acetylcholine testing reproduced chest pain and revealed luminal filling defects in multiple vessels; imaging showed fresh white platelet clots. Antiplatelet prasugrel has substantially suppressed her symptoms. (Level of Difficulty: Advanced.).

Influence of the Pedagogical Model and Experience on the Internal and External Task Load in School Basketball.

The methodology used by the teacher in Physical Education sessions conditions the physical fitness of the students, since the design of the tasks determines the physical and physiological demands to which they are exposed. This study aimed to quantify and compare, according to the teaching methodology and students' previous experience, the external (eTL) and internal (iTL) load resulting from the application of three intervention programmes that follow different teaching methodologies to teach school basketball: the Tactical Games Approach (TGA), Direct Instruction (DI) and Service Teacher's Basketball Unit (STBU). The Ratings of Perceived Exertion (RPEs) recorded in the assessments (pre-test/post-test) were also studied. A total of 49 students, aged 11 to 12 and divided into three class groups, from the sixth grade of primary education at a state school in Spain, participated in the study. Teaching-learning programs were randomly assigned to student groups. All the sessions were monitored with inertial devices that made it possible to record physical activity and convert the information into kinematic parameters. The results indicated that during the sessions, the students who followed the TGA method recorded higher values of eTL (player load; DI = 4.92, TGA = 6.95, STBU = 2.99) and iTL (mean heart rate; DI = 142.94, TGA = 157.12, STBU = 143.98). In addition, during the evaluation tests, they presented heart rate levels similar to those obtained by the students in the other programmes. However, they spent more time doing high-intensity activity, working longer in the running (DI = 3.42, TGA = 11.26, STBU = 8.32) and sprinting speed ranges (DI = 0.00, TGA = 0.12, STBU = 0.11), and presenting better physical fitness. During the assessments, students with no prior basketball experience showed higher levels of top speed; experienced students had higher levels of heart rate. The TGA method favours the physical condition and health of primary education students, which is why this method is recommended when planning Physical Education sessions.