VDD pacemaker: An effective and reliable physiological pacing modality in elderly patients.

BACKGROUND: In elderly patients, single chamber pacing may be considered. For sinus rhythm patients, VDD pacemaker (PM), by preserving atrial sensing, is a more physiological mode than VVI devices. This study aims to evaluate the long-term performance of VDD PM in elderly patients with atrioventricular block (AVB). METHODS: We conducted a retrospective, observational study of 200 elderly patients (≥75 years) with AVB and normal sinus rhythm who consecutively implanted VDD PM between 2016 and 2018. Baseline clinical characteristics were analyzed, complications related to pacemaker implantation were assessed and a 3-years follow-up (FUP) was made. RESULTS: Mean age was 84 ± 5 years. After 3-years FUP, 90.5% (n = 181) of the patients preserved their original VDD mode. Only 19 patients (9.5%) switched to VVIR mode, 5.5% (n = 11) due to P-wave undersensing and 4% (n = 8) due to permanent AF. Those patients had a less amplitude of sensed P wave at baseline [median value of 1.30 (IQR 0.99-2.0) versus 0.97 (IQR 0.38-1.68), p = 0.04]. One third of the patients died during the FUP, 89% (n = 58) from non-cardiovascular causes. All-cause, CV, and non-CV mortality did not relate with atrial sensing loss during FUP (p = 0.58, p = 0.38 and p = 0.80, respectively). However, atrial sensing loss during FUP was associated with de novo atrial fibrillation (12.7% vs. 31.6%, p = 0.038). CONCLUSION: VDD pacing is a reliable pacing modality in elderly patients even in long-term. The majority of VDD-paced elderly patients maintained their original VDD mode program, with good atrial sensing.

Orchiectomy after torsion testis: Simultaneous prosthesis placement versus staged procedures.

BACKGROUND/PURPOSE: Testicular torsion(TT) with unsalvageable testis has a significant psychosocial impact. Orchiectomy can be performed with optional testicular prosthesis(TP) placement, commonly deferred(dTP). Orchiectomy and simultaneous testicular prosthesis placement(sTP) may be a feasible and safe option and has been implemented in our department since 2018. AIM: The authors aim to perform a reflective analysis of the patient's experience and assess the feasibility, safety, and satisfaction of the sTP, by comparing it with the dTP. METHODS: All patients with TT and unsalvageable testis submitted to orchiectomy were included in the study. An anonymous questionnaire assessed the patients' experience. Those submitted to orchiectomy and TP placement were divided in sTP and dTP groups and their clinical details, satisfaction and quality-of-life were analyzed and compared. RESULTS: Scrotal exploration due to TT was performed in 185 patients, 54 were submitted to orchiectomy and 37 placed a TP(17 sTP, 20 dTP). All dTP patients and 66.7% of those without TP, would prefer having a prosthesis placed at the time of the orchiectomy. No significant differences in clinical details and outcomes were found, except prosthesis position (higher in dTP, p = 0.011) and operative time (13 min longer in sTP, p = 0.015). Both groups reported being satisfied with the prosthesis. Only one patient regretted placing a prosthesis(in dTP). CONCLUSION: The sTP approach is as safe and effective as dTP. The patients preferred the sTP, as it avoids a second operation and possibly by having a lower psychological impact. LEVELS OF EVIDENCE: Level III.

Persistent Pulmonary Hypertension of the Newborn: Pathophysiological Mechanisms and Novel Therapeutic Approaches.

Persistent pulmonary hypertension of the newborn (PPHN) is one of the main causes of neonatal morbidity and mortality. It is characterized by sustained elevation of pulmonary vascular resistance (PVR), preventing an increase in pulmonary blood flow after birth. The affected neonates fail to establish blood oxygenation, precipitating severe respiratory distress, hypoxemia, and eventually death. Inhaled nitric oxide (iNO), the only approved pulmonary vasodilator for PPHN, constitutes, alongside supportive therapy, the basis of its treatment. However, nearly 40% of infants are iNO resistant. The cornerstones of increased PVR in PPHN are pulmonary vasoconstriction and vascular remodeling. A better understanding of PPHN pathophysiology may enlighten targeted and more effective therapies. Sildenafil, prostaglandins, milrinone, and bosentan, acting as vasodilators, besides glucocorticoids, playing a role on reducing inflammation, have all shown potential beneficial effects on newborns with PPHN. Furthermore, experimental evidence in PPHN animal models supports prospective use of emergent therapies, such as soluble guanylyl cyclase (sGC) activators/stimulators, l-citrulline, Rho-kinase inhibitors, peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists, recombinant superoxide dismutase (rhSOD), tetrahydrobiopterin (BH4) analogs, ω-3 long-chain polyunsaturated fatty acids (LC-PUFAs), 5-HT2A receptor antagonists, and recombinant human vascular endothelial growth factor (rhVEGF). This review focuses on current knowledge on alternative and novel pathways involved in PPHN pathogenesis, as well as recent progress regarding experimental and clinical evidence on potential therapeutic approaches for PPHN.

Community intervention: assessment of parental training of a family prevention programme of substance use and associated risk behaviours / Intervención comunitaria: evaluación de la formación de los padres de un programa de prevención familiar de consumo de sustancias y comportamientos de riesgo asociados

Abstract The manuscript presents the results of a family and community intervention project to prevent drug use. The project was theoretically based in two integrative models - Structural Model of Cowen and Eco-Developmental Model - taking a multicausal perspective and the methodological principle of empowerment. This study had two assessment moments: (T1) a week before the intervention and (T2) a week after the end of the intervention. Data was collected from 42 adults with parenting responsibilities and the results indicate significant changes in the increase of cohesion, expressivity, control, and the increase of the orientation for recreational activities. It has also observed a decrease of the educational strategies that characterise the authoritarian and permissive styles.

Resumen El manuscrito presenta los resultados de un proyecto familiar de intervención comunitaria de prevención del consumo de drogas. El proyecto se basa en dos modelos de integración: modelo estructural de Cowen y modelo ecodesarrollo, adoptando una perspectiva multicausal y guiándose por el principio metodológico de empoderamiento. Este estudio tuvo dos momentos de evaluación: (T1) una semana antes de la intervención y (T2) una semana después del final de la intervención. Se presentan los datos reunidos de 42 adultos con responsabilidades parentales y los resultados indican cambios significativos en el ámbito familiar en el aumento de la cohesión, expresividad, el control y de la orientación de las actividades recreativas. También se observa una disminución de las estrategias educativas que caracterizan los estilos autoritarios y permisivos.