One-year clinical outcome of patients with left ventricular thrombus after acute myocardial infarction discharged on triple or dual antithrombotic therapy.

In patients with left ventricular thrombus (LVT) after acute myocardial infarction (MI), both anticoagulant and antiplatelet therapies are needed. It is unknown whether dual antithrombotic therapy (DAT) is able to reduce the incidence of bleeding complications without significantly increasing the number of thromboembolic events, compared to triple antithrombotic therapy (TAT). We retrospectively evaluated all post-MI patients with LVT discharged on TAT or DAT from our tertiary hospital in the last decade. The primary outcome was the occurrence of all-cause mortality, thromboembolic events, hospitalizations for re-MI or heart failure and any bleeding at 1 year. A propensity-score matching was performed in order to compare the primary outcome between TAT and DAT. Out of 2564 acute MI patients, 83 (3.2%) had an LVT at echocardiography: 51 (61.4%) discharged on TAT and 32 (38.6%) on DAT. At clinical follow-up, completed in 93% of cases, the incidence of the primary outcome was 18.2% (25.5% in TAT and 6.7% in DAT group; p = 0.04). More than 2/3 of the events included in the primary outcome were related to bleeding complications and occurred during the first month from hospital discharge. In the matched cohort of 42 patients with follow-up data available, the primary outcome occurred in 9 (42.9%) patients in the TAT and 2 (9.5%) in the DAT group (p = 0.03). In post-MI patients with LVT, DAT seems more effective than TAT in reducing clinical outcome, especially early bleeding complications. A randomized study is warranted to confirm this hypothesis.

Knowledge, attitudes and practices towards COVID-19 among nursing students of the University of Palermo: results from an online survey.

INTRODUCTION: The aim of the study was to evaluate the knowledge, attitude and practices towards SARS-CoV-2 among nursing students of University of Palermo during the rapid rise period of the COVID-19 pandemic. MATERIALS AND METHODS: This is cross-sectional study. A survey was provided to all nursing students and consisted of two parts: demographics and Knowledge, Attitude and Practices (KAP) survey. A multivariate linear regression model was used and adjusted Odds Ratios (aOR) are presented. RESULTS: 575 students were interviewed, and their mean age was 22.29 ± 4.2. The overall score indicates good knowledge (p=0.046) and good practices among the four courses of study (p=0.038). Multivariate linear regression showed that Attitude score (b = -0.29; p = 0.024) and Knowledge score (b = 0.10; p = 0.026) adjusted for age, gender, year of study, perceived economic status, perceived health status were significantly associated with Practice score. CONCLUSION: Our results suggest that proper health education is useful for encouraging optimistic attitudes and maintaining safe practices among future category of nurses.

Effectiveness of fondaparinux vs unfractionated heparin following percutaneous coronary intervention in survivors of out-of-hospital cardiac arrest due to acute myocardial infarction.

AIM: There is no specific evidence on the antithrombotic management of survivors of out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI). We sought to compare the short-term outcome of unfractioned heparin (UFH) vs fondaparinux in OHCA survivors due to AMI admitted in our Institution in the last decade. METHODS: We performed a retrospective cohort study on survivors of OHCA due to AMI managed with UFH or fondaparinux during the hospitalization. The primary outcome was the occurrence of any bleeding, all-cause mortality, cerebrovascular accidents, re-MI, and unplanned revascularization at 1 month. A propensity-score matching was performed to compare the outcome between UFH and fondaparinux. RESULTS: Out of 2083 AMI patients undergoing successful PCI, OHCA was present in 94 (4.5%): 41 (43.6%) treated with UFH and 53 (56.4%) with fondaparinux. At clinical follow-up, the incidence of the primary outcome was 65.9% in UFH and 35.8% in fondaparinux group (p = 0.007). More than half of the events included in the primary outcome were related to bleeding complications. In the matched cohort of 56 patients, the primary outcome occurred in 46.4% and 25.0% (p = 0.16), while bleeding was present in 32.1% and 7.1% (p = 0.04), in the UFH and fondaparinux group, respectively. CONCLUSIONS: The present analysis suggests that fondaparinux is safer than UFH in the management of OHCA due to AMI by reducing early bleeding complications at one month.

Fondaparinux During Intra-Aortic Balloon Pump Counterpulsation in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Although anticoagulation with unfractionated heparin (UFH) is commonly used during intra-aortic balloon pump (IABP) counterpulsation to prevent thromboembolic events, no data or guidelines exist to support this strategy, especially in the setting of acute myocardial infarction (AMI). This study sought to compare the short-term outcome of UFH vs fondaparinux in AMI patients who underwent successful percutaneous coronary intervention (PCI) and IABP insertion. METHODS: The anticoagulation therapy of revascularised AMI patients who received IABP counterpulsation and admitted to a tertiary hospital in the last decade was retrospectively evaluated. The primary outcome was the occurrence of all-cause mortality, stroke or transient ischaemic attack, reinfarction, unplanned revascularisation, major or minor limb ischaemia, and any bleeding at 1 month. Propensity score matching was performed to compare the primary outcome between UFH and fondaparinux. RESULTS: Of 1,355 AMI survivors at 2 days after hospital admission and who underwent successful PCI, an IABP was inserted in 197 (14.5%): 72 (36.5%) were treated with UFH and 125 (63.5%) with fondaparinux (2.5 mg o.d.). At clinical follow-up, completed in 98.5% of cases, the incidence of the primary outcome was 22.5% in UFH and 5.7% in fondaparinux groups (p=0.0009). More than two-thirds of the events included in the primary outcome were related to early bleeding complications. In the matched cohort of 62 patients, the primary outcome occurred in 14 (45.2%) patients in the UFH and two (6.5%) in the fondaparinux group (p=0.01). CONCLUSIONS: This study suggested that fondaparinux is safer, by reducing early bleeding complications at one month, than UFH in the management of IABP.

COVID-19 infection: comparing the knowledge, attitude and practices in a sample of nursing students.

BACKGROUND: SARS-CoV-2 infection is a global health problem that is primarily detected in Italy with progressive increase in cases and deaths. To facilitate the management of the pandemic in Italy, it is essential to understand the level of attention on COVID-19. The aim of the study was to evaluate the knowledge, attitude and practices towards SARS-CoV-2 among the nursing students of University of Palermo during the rapid rise period of the COVID-19 pandemic. METHODS: The current study was a cross-sectional study. On-line questionnaires were used for the collection of the data by providing a survey in all nursing students. The questionnaire consisted of two parts: demographics and Knowledge, Attitude and Practices (KAP) survey. A multivariate linear regression model was used and adjusted Odds Ratios (aOR) are presented. RESULTS: 525 students were interviewed and their mean age was 21.8. The overall score indicates good practices among the three courses of study (p=0.025). The Multivariable logistic regression showed that the dependent variable "Practice poor score" is statistically significant associated with these independent variables: "Other country of birth" (aOR 17.7, 95% CI 2.31-136.03), "second" (aOR 2.65, 95% CI 1.21-7.80) and "third" (aOR 2.96, 95% CI 1.31-6.72) year of study, "low perceived health status"(aOR 2.35, 95% CI 1.04-5.30) and "Knowledge poor score (aOR 3.05, 95% CI 1.06-8.77). CONCLUSION: Our results suggest that health education programs aimed at improving COVID-19 knowledge are helpful for nursing students to hold optimistic attitudes and maintain appropriate practices.

Investigate the sexual habits of young people: a cross-sectional study among nursing students of the University of Palermo.

INTRODUCTION: Sexually transmitted diseases are an emerging problem especially among young people, increasing the burden of disease in this population. The aim of the study was to evaluate sexual habits, sexual relations and knowledge of STIs among the students in the nursing science course of the University of Palermo. MATERIALS AND METHODS: In April 2019, a survey was provided to students that investigate on: personal information and habits, knowledge of sexually transmitted diseases, anti-HPV vaccination. Multivariable logistic regression was performed, considering it as a dependent variable "Have you occasionally had unprotected sex (without a condom)? Yes", in order to evaluate the role of the variables of the questionnaire. Results are expressed as adjusted Odds Ratio (aOR). RESULTS: 405 students completed the questionnaire. The mean age of the sample is 21.65 years, 69.63% of the interviewees are women. The multivariable logistic regression shows that the risk of having occasional unprotected sex (without condom) is significantly associated with "Do you permanently have unprotected sex (without a condom)? Yes" (aOR 4.46); "Have you ever received information on sex education and/or sexually transmitted diseases? No" (aOR 6.02); "Age Class <22 years old (aOR 2.03); "Number of sexual partners: As the unit increase" (aOR 1.18). CONCLUSIONS: Too many young people receive confusing and conflicting information about relationships and sex, as they make the transition from childhood to adulthood. Nurses play an important role in promoting public health. The study showed that young students are not still enough sensitized on sexually transmitted infections and preconception care.(www.actabiomedica.it).

Nursing students and depressive symptomatology: an observational study in University of Palermo.

PURPOSE: Depression is a common and serious medical illness, considered as a public health issue because it interferes with the interpersonal, social and professional functioning of the individual, and its frequency is constantly increasing. According to a recent review, approximately 34 per cent of nursing students had experienced depression worldwide. The university period may represent a moment in which the mental well-being of students is subjected to stress with a relative predisposition to the development of diseases related to mood disorders. The purpose of this study is to estimate the prevalence and examine the socio-demographic correlates of depressive symptomatology. DESIGN/METHODOLOGY/APPROACH: In April 2019, a questionnaire was administered to all the nursing students of University of Palermo of the three years of course, accompanied by informed consent. Multivariable logistic regression was performed. The statistical significance level chosen for all analyses was 0.05. The results were analyzed using the STATA statistical software version 14. Results are expressed as adjusted odds ratio (aOR) with 95 per cent confidence intervals. FINDINGS: The sample consists of 493 students who completed the questionnaire, and the average age of the sample participants is 21.88 years. The multivariable logistic regression model shows that the risk to have depressive symptomatology is significantly associated with the following independent variables: female gender (aOR 1.91), being single (aOR 1.87), second year of study (aOR 1.94), third year of study (aOR 1.92), not performing regular physical activity (aOR 1.78) and perceived low health status (aOR 3.08). ORIGINALITY/VALUE: This study shows that belonging to the female gender, being further along in the years of study, having a chronic illness and perceiving a low state of health are all factors that can increase the risk of developing the symptoms of depression; rather, regular physical activity, friendship and romantic relationships can be considered factors protecting them from the risk of falling into depression that can undermine both the study and work performance. Certainly, it is important to analyze all the involved variables to improve the global health not only of the nursing students but of all the students.

[Evaluation of adverse drug reactions associated with direct oral anticoagulants recorded in the Italian Pharmacovigilance Network database using a specifically developed risk index]. / Valutazione delle reazioni avverse agli anticoagulanti orali diretti registrate nella Rete Nazionale di Farmacovigilanza mediante uno specifico indice di rischio.

The introduction into clinical practice of direct oral anticoagulants (DOAC) has widened the scenario in the prevention and treatment of thromboembolism. However, the evaluation of the balance between the thrombotic and hemorrhagic risks is a critical issue in the choice of an oral anticoagulant agent. The availability of safety and efficacy data for each drug represents the basis to operate treatment choices. As there are no head-to-head studies comparing the different DOACs in terms of safety and efficacy, and considering the differences in registrative trial designs and characteristics of enrolled populations, several meta-analyses and real-life studies have tried to trace the safety and efficacy profiles on DOACs, but at present no definitive conclusions can be drawn due to numerous existing biases. One possible aid to help clinicians in their treatment choice is the evaluation of self-reported adverse drug reactions (ADRs) available in drug regulatory agency databases such as the Italian Medicines Agency (AIFA) pharmacovigilance database. We conducted a search in the National Pharmacovigilance Network database, available on AIFA website, in order to retrieve all the ADRs related to oral anticoagulants occurred in the period 2016-2017. We then calculated an ADR risk index (RI) for each drug, where an RI =1 indicates a balance between the percentage of ADR share and the percentage of market share for each DOAC; and an RI <1 indicates a rate of ADR lower than the rate of market share (more safe DOAC). The results showed that rivaroxaban is the DOAC with the lowest RI among the four molecules available today in Italy. Despite the limitations of this study, we believe that ADR RI can be a valuable adjunctive tool to help clinicians in their everyday clinical practice.

[Stress echocardiography in valvular heart disease]. / L'ecocardiografia da stress nelle valvulopatie: una metodica da rivalutare.

The assessment of the severity of a valvular lesion traditionally relies on the evaluation of valvular anatomy and on the demonstration of resting hemodynamic disturbances. In patients with stenotic lesions, this is usually achieved by measuring the trans-stenotic pressure difference and by calculating the surface of the stenotic orifice. In patients with regurgitant lesions, assessment of lesion severity involves the demonstration of a significant volume or pressure overload of the various chambers participating in the process. In many instances, however, discrepancies are found between the severity of valvular lesions and either the symptoms or the hemodynamic impairment. As echocardiography is also the method of choice for assessing the severity of valvular disease, stress echocardiography may offer the unique opportunity to assess the hemodynamic consequences of valvular lesions both at rest and during stress.

Functional mitral regurgitation in heart failure.

Mitral regurgitation commonly occurs in patients with heart failure. Systolic dysfunction is the hallmark of dilated cardiomyopathy. Mitral functional regurgitation is mitral incompetence in the absence of intrinsic lesions of the mitral valve apparatus. Echocardiography can make a major contribution to the diagnosis of cardiomyopathies. A more careful anatomic and hemodynamic evaluation of mitral regurgitation mechanisms is possible with spectral Doppler, color Doppler, three-dimensional echocardiography and transesophageal echocardiography. Functional mitral regurgitation is due to the incomplete closure of mitral leaflets and is based on alterations of mitral annulus, left ventricular dimensions, function and geometry, left atrial dimensions and function. Knowledge of the mechanisms of mitral regurgitation helps us to gain an insight into therapeutic interventions that modify the mechanistic factors. Medical therapy reduces the tethering forces and also augments transmitral pressure; surgical approaches can modify geometric relationships in the left ventricular chamber and resynchronization therapy can improve co-ordinated timing of mechanical activation of papillary muscles.

[Mitral valve prolapse]. / Il prolasso valvolare mitralico.

Mitral valve prolapse (MVP) is still a clinical challenging problem. In this report, we review the main characteristics of this entity. Epidemiology of MVP, which relies on the diagnostic criteria adopted, and the incidence of complications, both arrhythmic and structural, are influenced by the characteristics of the population studied, which may lead to bias in data interpretation. Even the definition of MVP may differ according to the cardiologist's or cardiac surgeon's point of view. Usually, cardiologists define MVP as the protrusion of all or part of the mitral leaflets into the left atrium, independent of maintenance of coaptation. Therefore, using this definition, mitral regurgitation is considered as a complication rather than a diagnostic criterion. Arrhythmias, either supraventricular or ventricular, are other possible complications, mostly not life-threatening and associated with myxomatous degeneration of the valve. Diagnosis of MVP is based on echocardiography, which provides detailed anatomic and functional evaluation of the affected valve. Leaflet thickness and motion as well as presence and severity of mitral regurgitation can be assessed, with important diagnostic and prognostic implications. Echocardiographic evaluation of the mitral valve requires a systematic approach in order to define the leaflet/scallop involved and the mechanisms of mitral regurgitation. To this aim, three-dimensional reconstruction may add further insights into objective rendering of mitral valve pathology. Finally, surgical timing in mitral regurgitation due to MVP is an evolving issue and the likelihood of surgical repair is a crucial factor in the optimal timing of surgical intervention, especially in asymptomatic patients with severe mitral regurgitation.

Eustachian valve endocarditis: a rare localization of right side endocarditis. A case report and review of the literature.

BACKGROUND: Right-sided endocarditis occurs predominantly in intravenous drug users, in patients with pacemaker or central venous lines and in patients with congenital heart disease. The vast majority of cases involve the tricuspid valve. Eustachian valve endocarditis is an uncommon disease with similar signs and symptoms of the tricuspid valve endocarditis. A series of only 16 cases of eustachian valve endocarditis are reported in the literature. CASE PRESENTATION: We present a case of a 25-year old woman with intravenous drug abuse who had a staphylococcus aureus tricuspid valve endocarditis associated to eustachian valve endocarditis. Transthoracic echocardiography, as first line examination, showed the vegetations on tricuspid and eustachian valve. CONCLUSION: Our case describe an unusual location of right side endocarditis in a intravenous drug abuser. In our case, in accord with other cases described in the literature, transthoracic echocardiography disclosed eustachian valve endocarditis. Antimicrobial management is not altered by the recognition of eustachian valve endocarditis. Antibiotic treatment and duration of eustachian endocarditis depends on the isolated organism and is similar to antibiotic therapy used in native valve endocarditis.

[First-aid treatment for acute myocardial infarction. Experience at the San Camillo Hospital of Rome]. / Trattamento in pronto soccorso dell'infarto acuto del miocardio. L'esperienza dell'Ospedale San Camillo di Roma.

STUDY OBJECTIVE: The aim of the study is to verify: 1) the trustworthiness level of the diagnosis of AMI defined in Emergency Department (ER); 2) the frequency and the effectiveness (length of staying in hospital, mortality rate) of the invasive or not invasive treatment which are implemented in the ER area. METHODS: We have studied the crowding of the patients suffering from chest pain (CP) who asked the ER for assistance during the year 2000 and that of the patients with AMI diagnosed in ER (diagnosis at the admittance and at the discharge from the hospital, therapeutic procedures, staying in hospital, mortality rate). RESULTS: The patients suffering from CP have been the 5.4% of all the patients who reached the ER and were admitted to the hospital more than the patients who reached the ER for all the other causes (41.5% versus 22.1%). In 61.7% of the patients affected by AMI the disease was identified by the physicians of the ER; the invasive treatment has been developed in 67.7% of those patients and the not invasive in 32.3% of the same patients. The mean length of the staying in hospital for the patients who have been treated with PTCA was 10.3 days; on the contrary, the same value for the patients treated with thrombolysis was 13.8 days and the difference was significant at the 0.001 level. The mortality rate during the staying in Hospital was 5.9% in the patients treated with PTCA and 13% in the patients treated with thrombolysis but the difference was not significant because of the little number of the dead patients. CONCLUSION: The sensitivity (62%) and the specificity (100%) of the diagnosis of AMI defined in the ER demonstrate the utility of a Cardiologic Service in ER.