Clinical outcomes for patients with cardiovascular diseases before, during, and after the COVID19 pandemic. A pooled analysis of 600.000 patients.

BACKGROUND: The unexpected virulence of the COVID19 pandemic brought to significant changes of generally accepted therapeutic approaches. The consequences of these changes were difficult to define during the pandemic period. METHODS: We analyzed the National Registries including 97% of hospital admissions in Italy, regarding data describing number of operations for aortic valve implantation or repair, carotid and coronary revascularization, AAA repair, and lower limb arterial reconstruction performed in the period 2015 to 2019 and in the pandemic years 2020, 2021, and 2022. Primary outcomes were number and type of surgical procedures, 30-days operative mortality. RESULTS: During the three years of the pandemic there was a statistically significant increase of the number of all-causes deaths in comparison with the mean of the previous five years (2015-2019). In Italy there was a total increase of all causes-deaths of 251.911 (+105900 in 2020; +66929 in 2021; and +79082 in 2022), and 73% of the excess of deaths was related with COVID19 infection and 27% occurred in COVID 19 negative patients. During the first year of the pandemic, worse clinical outcomes for hospitalized patients with CVD were registered. The medical system responded adequately and in the following two pandemic years clinical outcomes for hospitalized patients were similar with those of the pre-pandemic period. CONCLUSIONS: The unexpected virulence of COVID19 pandemic determined worse clinical outcomes for patients with CVD during the first year. The adopted preventive measures allowed in the following two pandemic years improved clinical outcomes, similar with those of the pre-pandemic period.

Trends towards increase of Cardiovascular diseases mortality in USA: A comparison with Europe and the importance of preventive care.

BACKGROUND: the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS: We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS: Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS: Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.

The role of education and information to prevent trends towards increase of cardiovascular mortality rates in Europe from 2015 TO 2019.

BACKGROUND: In Europe Cardio Vascular Disease (CVD) mortality rates decreased significantly in the last 25 years, with less decline in the last 5 years. The aim of our study was to analyze trends of risk factors which may explain plateauing of CVD mortality rates in the period 2015-2019 in Europe. METHODS: We analyzed data from the Global Burden Disease and EUROSTAT concerning trends of CVD mortality rates for 25 European countries and simultaneous changes of exposure to risk factors of the population RESULTS: CVD related mortality decreased significantly in the analyzed countries in the period 2000-2015; in the period 2015-2019 there was a trend towards plateauing of CVD related mortality rates, which was associated with an increased exposure to several established risk factors including cigarette smoking, obesity and arterial hypertension. A decrease in expenditure for information, education and counseling programs was documented in most countries in the same period. Level of exposure to risk factors was correlated with educational attainment . Exposure to risk factors in the interval 2014-2019 increased for people with lower education, whereas decreased in people with higher education (p<0.001). CONCLUSIONS: Organized information about risk factors for CVD have the potential to reduce mortality and burden, with diminished total health expenses. Education and information in this setting should consider the cultural and social level of the public.

Mortality and burden related with aortic aneurysms and dissections. The importance of information and education.

BACKGROUND: In this study we correlated changes of risk factors for cardiovascular diseases with trends of age standardized mortality rates and burden for aortic aneurysms and dissections. METHODS: We analyzed data from the Global Burden of Diseases and EUROSTAT. FINDINGS: There was a significant increase of expenditure for health from 1980 and 2019. In the period 1980-2000, despite higher health spending, age standardized mortality rates increased in almost all European countries. During the period 2000-2019, in Western European Countries and in Poland, Estonia, Latvia, Slovenia there was a correlation between higher health expenditure and decrease of ASMR. The most important changes between the period 1980-2000 and the period 2000-2019 was the proportion of health expenditure devoted to preventive care and to the increased use of aspirin and statins. INTERPRETATION: Information about risk factors for cardiovascular diseases have leads to decreased aortic aneurysm related mortality and burden.

Spatio-temporal correlation between admissions for ruptured abdominal aortic aneurysms and levels of atmospheric pollution in Italy.

AIMS: The aim of our study was to determine a correlation between rates and number of patients admitted with ruptured abdominal aortic aneurysms (rAAA) in Italian regions with different levels of atmospheric pollution. METHODS: We analyzed a possible correlation between the number and rate (ruptured versus not ruptured) of patients with rAAA admitted in eight Italian regions with different levels of atmospheric pollution. RESULTS: Number and rates of patients with rAAA were statistically correlated with levels of air pollution and low air temperature (RR = 1.90, 95% CI: 1.42, 2.1.0) (p<0.01). Even if low temperatures amplified the correlation between admissions for rAAA and PMs exposure, also during Summer and Spring there were sudden increases of the number of admissions for rAAA patients in periods with higher air pollution. The regions with high levels of atmospheric pollution had higher rates of admissions of patients with rAAA in comparison with regions with low level of air pollution. However, there was no difference between regions with low and very low level of atmospheric pollution. Mean age, sex distribution, exposure to established risk factors were similar for the population of the eight analyzed Italian regions. CONCLUSIONS: The findings of this study highlight the potential to reduce AAA related mortality and burden by addressing the negative effects of exposure to high levels of atmospheric pollution. The possibility of a dose-dependent effect of atmospheric pollution on the cardiovascular system opens research initiatives and discussions about when and how to modulate interventions to reduce atmospheric pollutants.

Sutures in general surgery. New materials and advice.

The suture thread used in digestive surgery must have several characteristics, including resistance to tension until the anastomosis coalescence, rapid absorption to avoid complications, biocompatibility and ease of handling. The preference is for monofilament polymers as they offer greater guarantees in biliary-digestive anastomoses. Suturing with synthetic polymers and mechanical devices such as staplers are the most suitable techniques. It is believed that staplers may become the gold standard technique in robotic surgery based on their experience and experimental data. In general, the goal is to use materials that minimize the risk of post-operative complications and offer maximum reliability in the anastomosis. KEY WORD: Suture material, Stapler.

The management of locally advanced, ulcerated breast cancer in a menopausal woman: a case report.

Introduction and importance: This case report presents the clinical details of a 46-year-old postmenopausal woman who was diagnosed with a locally advanced, ulcerated, hormone receptor-positive, HER2-negative stage 2B lobular carcinoma of the breast. The complexity of the case necessitated a multidisciplinary, personalized approach. Case presentation: The patient, a postmenopausal woman, presented with locally advanced lobular carcinoma of the breast. The tumor was of significant size and exhibited ulceration. Given the hormone receptor-positive status of the tumor, a comprehensive treatment plan was formulated, taking into account the patient's overall health and potential tolerance to treatment. Surgical removal of the tumor was performed, followed by adjuvant therapy with aromatase inhibitors. Clinical discussion: The complexity of this case highlights the importance of a personalized and patient-centered strategy in managing breast cancer. The patient's menopausal status, tumor characteristics, and potential tolerance to treatment were crucial factors that influenced the treatment plan. The successful outcome of the treatment and the patient's ability to tolerate the therapy underscores the significance of individualized treatment planning. Conclusion: This case report emphasizes the necessity for a comprehensive and patient-centered approach to managing complex cases of breast cancer. The findings support the development of personalized therapeutic strategies aimed at improving patient outcomes and quality of life. The successful treatment of the locally advanced, ulcerated lobular carcinoma of the breast in this postmenopausal patient further highlights the importance of considering individual factors and tailoring treatment plans accordingly.

Nodular cutaneous metastasis of the leg in advanced urothelial bladder carcinoma: a case report and systematic literature review.

Cutaneous metastases from urothelial carcinoma (UC) are very rare and indicate advanced disease with a poor prognosis. A 63-year-old female patient with a history of urothelial bladder carcinoma, treated 2 months prior with radical cystectomy and adjuvant gemcitabine and cisplatin (GC) therapy, presented a skin lesion localized in the lower third of the right leg. Punch biopsy revealed carcinomatous metastasis whose urothelial origin was confirmed by immunohistochemical analysis. 18-FDG PET-CT showed the spread of metastases to the lung and left ischium. Our review focuses on the time between surgery and skin metastasis, localization, and prognosis after metastasis diagnosis. In many cases, skin metastases occur within one year of initial UC surgery and in most cases occur on the abdominal wall. Local wide excision of metastasis should be considered in selected cases; however, chemotherapy remains the main treatment.

Sentinel Lymph Node Detection in Breast Cancer: An Innovative Technique.

(1) Background: Sentinel lymph node biopsy is important in the search for metastases, especially in patients with malignant breast disease. Our study proposed new techniques to prevent complications such as possible postoperative seroma formation, pain or hypoesthesia of the axillary cord and medial arm surface, as well as motor deficits, to avoid disabling outcomes and presents initial data from our experience with the sentinel lymph node biopsy technique. (2) Methods: We mainly used two radioactive tracer detection techniques and a new technique using a radiotracer called Sentimag-magtrace. The positive lymph node was located and removed to perform histologic analysis. In our study, we evaluate 100 patients who underwent breast cancer surgery. (3) Results: We calculated the identification rates of the different methods of sentinel lymph node detection and found that it was 88.9% using radioactive tracers vs. 89.5% using the magnetic tracer technology (Sentimag). (4) Conclusions: Thus, this technique avoids radiation exposure for both patients and health care providers, and can reduce costs and time.