The role of ethnicity and native-country income in multiple sclerosis: the Italian multicentre study (MS-MigIT).

OBJECTIVE: Multiple sclerosis (MS) is a complex disorder in which environmental and genetic factors interact modifying disease risk and course. This multicentre, case-control study involving 18 Italian MS Centres investigated MS course by ethnicity and native-country economic status in foreign-born patients living in Italy. METHODS: We identified 457 MS patients who migrated to Italy and 893 age- and sex-matched native-born Italian patients. In our population, 1225 (93.2%) subjects were White Europeans and White Northern Americans (WENA) and 89 (6.8%) patients were from other ethnical groups (OEG); 1109 (82.1%) patients were born in a high-income (HI) Country and 241 (17.9%) in a low-middle-income (LMI) Country. Medical records and patients interviews were used to collect demographic and disease data. RESULTS: We included 1350 individuals (973 women and 377 men); mean (SD) age was 45.0 (11.7) years. At onset, 25.45% OEG patients vs 12.47% WENA (p = 0.039) had > 3 STIR spine lesions. At recruitment, the same group featured mean (SD) EDSS score of 2.85 (2.23) vs 2.64 (2.28) (p = 0.044) reached in 8.9 (9.0) vs 12.0 (9.0) years (p = 0.018) and underwent 1.10 (4.44) vs. 0.99 (0.40) annual MRI examinations (p = 0.035). At disease onset, patients from LMI countries had higher EDSS score than HI patients (2.40 (1.43) vs 1.99 (1.17); p = 0.032). DISCUSSION: Our results suggested that both ethnicity and socio-economic status of native country shape MS presentation and course and should be considered for an appropriate management of patients. To the best of our knowledge, this is the first study reporting on the impact of ethnicity in MS at an individual level and beyond an ecological population-perspective.

Effect of RNS60 in amyotrophic lateral sclerosis: a phase II multicentre, randomized, double-blind, placebo-controlled trial.

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with limited treatment options. RNS60 is an immunomodulatory and neuroprotective investigational product that has shown efficacy in animal models of ALS and other neurodegenerative diseases. Its administration has been safe and well tolerated in ALS subjects in previous early phase trials. METHODS: This was a phase II, multicentre, randomized, double-blind, placebo-controlled, parallel-group trial. Participants diagnosed with definite, probable or probable laboratory-supported ALS were assigned to receive RNS60 or placebo administered for 24 weeks intravenously (375 ml) once a week and via nebulization (4 ml/day) on non-infusion days, followed by an additional 24 weeks off-treatment. The primary objective was to measure the effects of RNS60 treatment on selected biomarkers of inflammation and neurodegeneration in peripheral blood. Secondary objectives were to measure the effect of RNS60 on functional impairment (ALS Functional Rating Scale-Revised), a measure of self-sufficiency, respiratory function (forced vital capacity, FVC), quality of life (ALS Assessment Questionnaire-40, ALSAQ-40) and survival. Tolerability and safety were assessed. RESULTS: Seventy-four participants were assigned to RNS60 and 73 to placebo. Assessed biomarkers did not differ between arms. The mean rate of decline in FVC and the eating and drinking domain of ALSAQ-40 was slower in the RNS60 arm (FVC, difference 0.41 per week, standard error 0.16, p = 0.0101; ALSAQ-40, difference -0.19 per week, standard error 0.10, p = 0.0319). Adverse events were similar in the two arms. In a post hoc analysis, neurofilament light chain increased over time in bulbar onset placebo participants whilst remaining stable in those treated with RNS60. CONCLUSIONS: The positive effects of RNS60 on selected measures of respiratory and bulbar function warrant further investigation.

SARS-CoV-2 Variants in COVID-19 Disease: A Focus on Disease Severity and Vaccine Immunity in Patients Admitted to the Emergency Department.

Tracking SARS-CoV-2 variants along with vaccinations are fundamental for severe COVID-19 disease prevention. A study was performed that focused on 43 patients with the SARS-CoV-2 infection who were admitted to the Emergency Department. RT-PCR-positive nasopharyngeal samples were sequenced using the MiSeq II system for variant detection. The main reason for Emergency Department admission was COVID-19 (67%), followed by other causes (33%); 51% patients were unvaccinated or vaccinated with a single dose and 49% had completed the vaccination course with two or three doses. Among the vaccinated group, 38% were admitted for COVID-19, versus 94.5% of the unvaccinated group. After admission, 50% of the vaccinated group and 36% of the unvaccinated group were discharged and allowed to go home, and 80% of the unvaccinated had no major comorbidities; 63% needed hospital admission and 5% required a stay in the Intensive Care Unit. Of these, 37% were vaccinated with 3 doses, 11% with two doses, 4% with a single dose, and 48% were unvaccinated. The 70% of the vaccinated patients who were admitted to hospital presented major comorbidities versus 38% of the unvaccinated group. Two unvaccinated patients that needed intensive care had relevant comorbidities and died. Genome sequencing showed the circulation of three omicron and two pure sub-lineages of omicron, including 22 BA.1, 12 BA.1.1, and 7 BA.2. Data showed the SARS-CoV-2 national and international migration patterns and how vaccination was useful for severe COVID-19 disease prevention.

Early anticoagulation after aortic valve replacement with porcine bioprosthesis randomized control trial (ANTIPRO).

OBJECTIVES: Most evidence for anticoagulation (AC) in aortic bioprosthesis is centred on embolic events, bleeding and reintervention risk. The effect of AC on haemodynamics has not been previously assessed. Our hypothesis was that patients with early AC after aortic valve replacement (AVR) with porcine bioprosthesis have better haemodynamics at 1 year of follow-up. METHODS: Prospective, randomized, open-label trial conducted at 2 cardiac surgery centres. All patients undergoing AVR with porcine bioprosthesis were consecutively recruited. The anticoagulated group received warfarin + aspirin and the non-anticoagulated (control) only aspirin. The primary outcome was mean gradient after 1 year of AVR and change in New York Heart Association class. Secondary outcomes were major and minor bleeding, embolic events and prosthetic leak. RESULTS: Of 140 participants in the study, 71 were assigned to the anticoagulated group and 69 to the control group. The mean age of the overall population was 72.4 (SD: 7.1) years. Global EuroSCORE was 7.65 (SD: 5.73). At 1 year, the mean gradient was similar between both groups [18.6 (SD: 1.1 mmHg) and 18.1 (SD: 1.0 mmHg) in the control and anticoagulated groups, respectively, P = 0.701]. No differences in functional class at 3 months or 1 year were found among groups. No differences were found among groups in the secondary outcomes. CONCLUSIONS: The addition of 3 months of oral AC to anti-aggregation treatment was not detected to affect bioprosthetic haemodynamics nor functional class at 1 year after AVR. Likewise, AC does not lead to the higher incidence of complications.

Genomic Epidemiology Unveil the Omicron Transmission Dynamics in Rome, Italy.

Since 2020, the COVID-19 pandemic represented an important worldwide burden. Well-structured surveillance by reliable and timely genomic data collection is crucial. In this study, a genomic monitoring analysis of all SARS-CoV-2 positive samples retrieved at the Fondazione Policlinico Universitario Campus Bio-Medico, in Rome, Italy, between December 2021 and June 2022, was performed. Two hundred and seventy-four SARS-CoV-2-positive samples were submitted to viral genomic sequencing by Illumina MiSeqII. Consensus sequences were generated by de novo assembling using the iVar tool and deposited on the GISAID database. Lineage assignment was performed using the Pangolin lineage classification. Sequences were aligned using ViralMSA and maximum-likelihood phylogenetic analysis was performed by IQ-TREE2. TreeTime tool was used to obtain dated trees. Our genomic monitoring revealed that starting from December 2021, all Omicron sub-lineages (BA.1, BA.2, BA.3, BA.4, and BA.5) were circulating, although BA.1 was still the one with the highest prevalence thought time in this early period. Phylogeny revealed that Omicron isolates were scattered throughout the trees, suggesting multiple independent viral introductions following national and international human mobility. This data represents a sort of thermometer of what happened from July 2021 to June 2022 in Italy. Genomic monitoring of the circulating variants should be encouraged considering that SARS-CoV-2 variants or sub-variants emerged stochastically and unexpectedly.

Chronic Wasting Disease Monitoring in Italy 2017-2019: Neuropathological Findings in Cervids.

Chronic wasting disease (CWD) is a prion disease that affects cervids; it is classified under transmissible spongiform encephalopathies (TSEs). CWD is particularly contagious, making its eradication in endemic areas very difficult and creating serious problems for cervid conservation and breeding. It has recently become an emerging public health risk to be managed by health authorities. Starting in 2017, active CWD surveillance in Italy has intensified with the monitoring of wild and farmed cervids. The present study summarizes findings from a histopathological survey of the brains from wild ruminants collected via CWD monitoring between 2017 and 2019. A total of 113 brains from 62 red deer (Cervus elaphus) and 51 roe deer (Capreolus capreolus) were submitted for analysis at the National Reference Center for Animal Encephalopathies (CEA) to determine major patterns of neuropathological lesions and correlated pathogens. Brain lesions were detected in 20 animals, 10 brain samples were unsuitable for examination, and 83 presented no lesions. Neuropathological examination revealed non-suppurative encephalitis or meningoencephalitis in most cases (15/20). This brain study revealed evidence for the absence of CWD in Italy and provided a reference spectrum of neuropathological lesions for differential diagnosis in cervids.

Factors Associated with Delirium in COVID-19 Patients and Their Outcome: A Single-Center Cohort Study.

BACKGROUND: A significant proportion of patients with coronavirus disease 2019 (COVID-19) suffer from delirium during hospitalization. This single-center observational study investigates the occurrence of delirium, the associated risk factors and its impact on in-hospital mortality in an Italian cohort of COVID 19 inpatients. METHODS: Data were collected in the COVID units of a general medical hospital in the South of Italy. Socio-demographic, clinical and pharmacological features were collected. Diagnosis of delirium was based on a two-step approach according to 4AT criteria and DSM5 criteria. Outcomes were: dates of hospital discharge, Intensive Care Unit (ICU) admission, or death, whichever came first. Univariable and multivariable proportional hazards Cox regression models were estimated, and risks were reported as hazard ratios (HR) along with their 95% confidence intervals (95% CI). RESULTS: A total of 47/214 patients (22%) were diagnosed with delirium (21 hypoactive, 15 hyperactive, and 11 mixed). In the multivariable model, four independent variables were independently associated with the presence of delirium: dementia, followed by age at admission, C-reactive protein (CRP), and Glasgow Coma Scale. In turn, delirium was the strongest independent predictor of death/admission to ICU (composite outcome), followed by Charlson Index (not including dementia), CRP, and neutrophil-to-lymphocyte ratio. The probability of reaching the composite outcome was higher for patients with the hypoactive subtype than for those with the hyperactive subtype. CONCLUSIONS: Delirium was the strongest predictor of poor outcome in COVID-19 patients, especially in the hypoactive subtype. Several clinical features and inflammatory markers were associated with the increased risk of its occurrence. The early recognition of these factors may help clinicians to select patients who would benefit from both non-pharmacological and pharmacological interventions in order to prevent delirium, and in turn, reduce the risk of admission to ICU or death.

SARS-CoV-2 AY.4.2 variant circulating in Italy: Genomic preliminary insight.

The appearance of emerging variants of SARS-CoV-2 carrying mutations into the spike protein has recently raised concern with respect to tracking their transmission and mitigating the impact in the evolving pandemic across countries. AY.4.2, a recently detected Delta variant sublineage, is considered a new variant under investigation (VUI) as it carries specific genetic signatures present in the spike protein, called Y145H and A222V. Here, using genomic epidemiology, we provide the first preliminary insight regarding the circulation of this emerging VUI in Italy.

Low eGFR Is a Strong Predictor of Worse Outcome in Hospitalized COVID-19 Patients.

BACKGROUND: The clinical course of COVID-19 is more severe in elderly patients with cardio-metabolic co-morbidities. Chronic kidney disease is considered an independent cardiovascular risk factor. We aimed to evaluate the impact of reduced eGFR on the composite outcome of admission to ICU and death in a sample of consecutive COVID-19 hospitalized patients. METHODS: We retrospectively evaluated clinical records of a consecutive sample of hospitalized COVID-19 patients. A total of 231 patients were considered for statistical analysis. The whole sample was divided in two groups on the basis of eGFR value, e.g., ≥ or <60 mL/min/1.73 m2. Patients with low eGFR were further divided among those with a history of chronic kidney disease (CKD) and those without (AKI, acute kidney injury). The primary outcome was a composite of admission to ICU or death, whichever occurred first. The single components were secondary outcomes. RESULTS: Seventy-nine (34.2%) patients reached the composite outcome. A total of 64 patients (27.7%) died during hospitalization, and 41 (17.7%) were admitted to the ICU. A significantly higher number of events was present among patients with low eGFR (p < 0.0001). Age (p < 0.001), SpO2 (p < 0.001), previous anti-platelet treatment (p = 0.006), Charlson's Comorbidities Index (p < 0.001), serum creatinine (p < 0.001), eGFR (p = 0.003), low eGFR (p < 0.001), blood glucose levels (p < 0.001), and LDH (p = 0.003) were significantly associated with the main outcome in univariate analysis. Low eGFR (HR 1.64, 95% CI 1.02-2.63, p = 0.040) and age (HR per 5 years 1.22, 95% CI 1.10-1.36, p < 0.001) were significantly and independently associated with the main outcome in the multivariate model. Patients with AKI showed an increased hazard ratio to reach the combined outcome (p = 0.059), while those patients with both CKD had a significantly higher probability of developing the combined outcome (p < 0.001). CONCLUSIONS: Patients with reduced eGFR at admission should be considered at high risk for clinical deterioration and death, requiring the best supportive treatment in order to prevent the worst outcome.

The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID-19 Patients: Prospective Evaluation by Care Setting.

BACKGROUND: Endothelial dysfunction, coupled with inflammation, induces thrombo-inflammation. In COVID-19, this process is believed to be associated with clinical severity. Von Willebrand factor (VWF), and a disintegrin and metalloproteinase with thrombospondin motifs 13 (ADAMTS-13), are strong markers of endothelial dysfunction. We evaluated the impact of the VWF/ADAMTS-13 fraction on COVID-19 severity and prognosis. MATERIALS AND METHODS: A cohort study including 74 COVID-19 patients, with 22 admitted to the intensive care unit (ICU) and 52 to the medical ward (MW), was carried out. We also evaluated, in a group of 54 patients who were prospectively observed, whether variations in VWF/ADAMTS-13 correlated with the degree of severity and routine blood parameters. RESULTS: A VWF:RCo/ADAMTS-13 fraction above 6.5 predicted in-hospital mortality in the entire cohort. At admission, a VWF:RCo/ADAMTS-13 fraction above 5.7 predicted admission to the ICU. Furthermore, the VWF:RCo/ADAMTS-13 fraction directly correlated with C-reactive protein (CRP) (Spearman r: 0.51, p < 0.0001) and D-dimer (Spearman r: 0.26, p = 0.03). In the prospective cohort, dynamic changes in VWF:RCo/ADAMTS-13 and the CRP concentration were directly correlated (Spearman r, p = 0.0014). This relationship was significant in both groups (ICU: p = 0.006; MW: p = 0.02). CONCLUSIONS: The present findings show that in COVID-19, the VWF/ADAMTS-13 fraction predicts in-hospital mortality. The VWF/ADAMTS-13 fraction may be a helpful tool to monitor COVID-19 patients throughout hospitalization.

Genetic diversity of Staphylococcus aureus influences disease phenotype of systemic lupus erythematosus.

OBJECTIVE: We investigated the genetic diversity, molecular epidemiology and evolutionary dynamics of Staphylococcus aureus (SA) isolated from SLE patients by means of phylogenetic analysis. METHODS: Consecutive SLE patients (ACR 1997 criteria) were enrolled: clinical/laboratory data were collected and nasal swab for SA identification was performed. On the basis of the translation elongation factor (tuf) gene, a phylogenetic analysis was performed to investigate relationships and to assess significant clades. Selective pressure analysis was used to investigate the evolution of the SA tuf gene. The gene sequences from non-SLE individuals, downloaded from the GenBank database, were compared through phylogenetic analysis with the tuf gene from SLE patients. RESULTS: We enrolled 118 patients [M/F 10/108; median (interquartile range (IQR)) age 45.5 (13.2) years; median (IQR) disease duration 120 (144) months]. Twenty-four patients (20.3%) were SA carriers (SA+), three of them MRSA. SA+ SLE showed significantly higher SLEDAI-2k values [SA+: median (IQR) 2 (3.75); SA-: 0 (2); P = 0.04]. The phylogenetic analysis, restricted to 21 non-MRSA SA+, revealed a statistically supported larger clade (A, n = 17) and a smaller one (B, n = 4). Patients located in clade A showed a significantly higher prevalence of joint involvement (88.2%) in comparison with clade B (50.0%, P < 0.0001) and SA- (62.7%, P < 0.0001). Haematological manifestations were significantly more frequent in clade A (64.7%) compared with B (50.0%, P = 0.004). CONCLUSION: We suggest a possible role of SA nasal carriage status in SLE disease activity. Moreover, our findings support the hypothesis that bacterial genetic variants may be associated with specific disease features.

Best diagnostic accuracy of sepsis combining SIRS criteria or qSOFA score with Procalcitonin and Mid-Regional pro-Adrenomedullin outside ICU.

Early diagnosis and treatment significantly reduce sepsis mortality. Currently, no gold standard has been yet established to diagnose sepsis outside the ICU. The aim of the study was to evaluate the diagnostic accuracy of sepsis defined by SIRS Criteria of 1991, Second Consensus Conference Criteria of 2001, modified Second Consensus Conference Criteria of 2001 (obtaining SIRS Criteria and SOFA score), Third Consensus Conference of 2016, in addition to the dosage of Procalcitonin (PCT) and MR-pro-Adrenomedullin (MR-proADM). In this prospective study, 209 consecutive patients with clinical diagnosis of sepsis were enrolled (May 2014-June 2018) outside intensive care unit (ICU) setting. A diagnostic protocol could include SIRS criteria or qSOFA score evaluation, rapid testing of PCT and MR-proADM, and SOFA score calculation for organ failure definition. Using this approach outside the ICU, a rapid diagnostic and prognostic evaluation could be achieved, also in the case of negative SIRS, qSOFA or SOFA scores with high post-test probability to reduce mortality and improve outcomes.

Celiac Disease Diagnosed in an Older Adult Patient with a Complex Neuropsychiatric Involvement: A Case Report and Review of the Literature.

We present a case of celiac disease (CD) diagnosis in a 75-year-old woman with a long-term history of chronic delusional jealousy and a complex neurological involvement. The case describes a very unusual clinical picture, provides some clinical clues, and highlights the importance of being aware of CD extraintestinal manifestations in order to get a timely diagnosis.

Migrants rescued on the Mediterranean Sea route: nutritional, psychological status and infectious disease control.

INTRODUCTION: North Africa has become a key migratory hub where a large number of migrants attempt the journey by sea from the Libyan coastline to the south of Europe. In this humanitarian disaster scenario, the Mediterranean route has been one of the most used by illegal boats. METHODOLOGY: In this report, the state of physical and psychological health of a cluster of Eritrean migrants, escaped from Libya and rescued in the Mediterranean Sea after a shipwreck, was described by epidemiological, clinical and laboratory investigations. RESULTS: Data suggest that despite the majority  of the migrants being apparently in good health upon a syndromic surveillance approach, most of them suffered a decline in psychological status as well as severe malnutrition. The emergence of infectious diseases, related to poor living conditions during the journey, is not a rare event. CONCLUSION: The present report highlights the risks of failures of the syndromic medical approach in the setting of the extremely challenging migration route and underlines migrant frailties consequent to a prolonged journey and long period of detention. These stressors, which can degrade the initial health condition of traveling migrants, can lead to a premature "exhausted migrant effect" that should be carefully investigated in order to avoid the early emergence of diseases related to frailty.

Whole genome sequencing of carbapenem-resistant Klebsiella pneumoniae: evolutionary analysis for outbreak investigation.

Aim: Carbapenemase-resistant Enterobacteriaceae represents a major concern in hospital setting. Materials & methods: The evolutionary history of carbapenem-resistant Klebsiella pneumonia strains was analyzed by core genome multilocus sequence typing and Bayesian phylogenesis by whole genomes sequencing. Results: A great increase carbapenem-resistant K.pneumoniae causing blood stream infection was observed in the years 2015-2016. At multilocus sequence typing (MLST), they were prevalently ST512 and ST101. ST512 were core genome (cg)MLST 53, while ST101 mainly cgMLST453. The minimum-spanning tree, based on cgMLST, showed strains clustering based on the different STs. By Bayesian phylogenetic analysis, maximum clade credibility tree showed that strains were introduced in the year 2005 with the most probable location in the ICU ward. Two outbreaks by ST101 and ST512 strains with Tower T8 as the probable location were evidenced. Conclusion: Molecular epidemiology is a powerful tool to track the way of transmission of resistant bacteria within the hospital setting.

Perfil clínico de la fibrilación auricular en el posoperatorio de cirugía cardíaca. Experiencia de un centro universitario / Clinical profile of postoperative atrial fibrillation in cardiac surgery; Experience of a university center / Perfil clínico da fibrilação atrial no pós-operatório de cirurgia cardíaca; Experiência de um centro universitário

Resumen: Introducción: la fibrilación auricular (FA) es una complicación frecuente del posoperatorio de cirugía cardíaca (POCC). Internacionalmente se registra una incidencia de 30%, siendo su pico máximo entre el segundo y tercer día de posoperatorio; nuestro objetivo fue conocer los datos en nuestro centro. Método: se realizó un estudio de cohorte prospectivo, aprobado por el Comité de Ética institucional. Incluyó pacientes mayores de 18 años que recibieron cirugía cardíaca entre el 1o de enero y el 31 de diciembre de 2018 en un centro cardiovascular universitario. Se excluyeron aquellos pacientes con FA al momento de la cirugía. Se registraron variables preoperatorias, operatorias y posoperatorias. Las variables continuas se presentaron como mediana e intervalo intercuartílico, las categóricas en valor absoluto y frecuencias relativas. La incidencia se calculó como número de casos nuevos/población total. Las asociaciones se evaluaron con chi cuadrado y Mann-Whitney test. Se realizó regresión logística univariada y multivariada. Se consideró significativo una p < 0,05. Resultados: se incluyeron 104 pacientes. Mediana de edad 66 años; 51% sexo masculino. La incidencia de FA en el POCC (FAPO) fue de 29%, con un máximo entre el segundo y tercer día, y una duración menor a 24 horas en 83% de los casos. La recurrencia durante el ingreso fue de 38%. Se utilizó amiodarona para tratamiento agudo de la FAPO en el 100% de los casos, betabloqueantes en 63%, digoxina en 7% y cardioversión eléctrica en 27%. Todos los pacientes se encontraban en ritmo sinusal al alta, y al mes de la cirugía en los 20 casos en que se realizó electrocardiograma. Las variables con asociación significativa en análisis univariado para riesgo de FAPO fueron edad (OR 1,07, IC 95%: 1,01-1,12 p=0,007) y enfermedad renal crónica (OR 3,75, IC 95%: 1,4-9,4 p=0,005). Un score de riesgo menor a 14 en el Multicenter Risk Index (OR 0,18, IC 95%: 0,34-0,93 p=0,04) y el tabaquismo resultaron "protectores" en el análisis univariado (OR 0,38, IC 95%: 0,14-0,98 p=0,048). En el análisis multivariado ninguna variable alcanzó significancia estadística. Se identificó asociación significativa entre FAPO y edema pulmonar (p<0,001), shock (p<0,04) e insuficiencia renal aguda (p<0,01). Los pacientes con FAPO tuvieron una mediana de 5 días más de hospitalización (p<0,0003). Conclusión: en la población estudiada se encontró una alta incidencia de FAPO. Se identificaron factores asociados a mayor riesgo de FAPO, así como asociación con otras complicaciones graves en el posoperatorio. Los resultados destacan la importancia de protocolizar el reconocimiento de los pacientes de riesgo así como su tratamiento.

Summary: Introduction: atrial fibrillation is a frequent postoperative complication of cardiac surgery. Internationally, an incidence of 30% is registered, being its maximum peak between the second and third postoperative day, however, we do not have data in our center. Method: a prospective cohort study was carried out, approved by the institutional ethics committee. It included patients over the age of 18 years, who received cardiac surgery between January 1 and December 31, 2018 at a university cardiovascular center. Those patients with AF at the time of surgery were excluded. Preoperative, operative, and postoperative variables were recorded. Continuous variables were presented as median and interquartile range, categorical variables in absolute value and relative frequencies. The incidence was calculated as the number of new cases / total population. Associations were evaluated with chi square and Mann Whitney test. Univariate and multivariate logistic regression was performed. A p <0.05 was considered significant. Results: 104 patients were included. Median age of 66 years, 51% male. The incidence of postoperative atrial fibrillation was 29%, with a maximum between the second and third day, and a duration of less than 24 hours in 83% of cases. Recurrence during admission was 38%. Amiodarone was used for acute treatment of postoperative atrial fibrillation in 100% of cases, beta-blockers in 63%, digoxin 7%, and electrical cardioversion in 26%. All the patients were in sinus rhythm at discharge and one month after surgery. Variables with a significant association in univariate analysis for postoperative atrial fibrillation risk were age (OR 1.07, 95% CI: 1.01-1.12 p = 0.007) and chronic kidney disease (OR 3.75, 95% CI: 1.4-9.4 p = 0.005). A risk score of less than 14 in the Multicenter Risk Index (OR 0.18; 95% CI: 0.34-0.93 p = 0.04) and smoking were "protective" in the univariate analysis (OR 0.38; 95% CI: 0.14-0.98 p = 0.048). In the multivariate analysis, no variable reached statistical significance. A significant association was identified between postoperative atrial fibrillation and pulmonary edema (p <0.001), shock (p <0.04) and acute renal failure (p <0.01). Postoperative atrial fibrillation patients had a median of 5 aditional days of hospitalization (p <0.0003). Conclusion: A high incidence of postoperative atrial fibrillation was found in the studied population. Factors associated with a higher risk of postoperative atrial fibrillation were identified, as well as an association with other serious complications in the postoperative period. The results highlight the importance of protocolizing the recognition of risk patients as well as their treatment.

Resumo: Introdução: a fibrilação atrial é uma complicação frequente no pós-operatório de cirurgia cardíaca. Internacionalmente, registra-se uma incidência de 30%, sendo seu ponto máximo entre o segundo e o terceiro dia de pós-operatório, no entanto, não temos dados a respeito do nosso centro. Método: foi realizado um estudo de coorte prospectivo, aprovado pelo comitê de ética institucional. O mesmo incluiu pacientes com idade superior a 18 anos, que receberam cirurgia cardíaca entre os dias 1ro de janeiro e 31 de dezembro de 2018 no centro cardiovascular universitário. Os pacientes com fibrilação atrial no momento da cirurgia foram excluídos. Foram registradas variáveis pré-operatórias, operatórias e pós-operatórias. As variáveis contínuas foram apresentadas em mediana e intervalo interquartil, as variáveis categóricas em valor absoluto e frequências relativas. A incidência foi calculada como o número de novos casos / população total. As associações foram avaliadas com o teste do qui quadrado e teste de Mann Whitney. Foi realizada a regressão logística univariada e multivariada. Foi considerado significativo um p <0,05. Resultados: 104 pacientes foram incluídos. Idade média de 66 anos, 51% do sexo masculino. A incidência de fibrilação atrial no pós-operatório foi de 29%, com um máximo entre o segundo e o terceiro dia,e uma duração inferior a 24 horas em 83% dos casos. A recorrência durante a internação foi de 38%. A amiodarona foi utilizada no tratamento em agudo da fibrilação atrial no pós-operatório em 100% dos casos, betabloqueadores em 63%, digoxina 7% e cardioversão elétrica em 26%. Todos os pacientes estavam em ritmo sinusal no momento da alta e um mês após a cirurgia. As variáveis com associação significativa na análise univariada para risco de fibrilação atrial no pós-operatório foram: idade (OR 1,07, IC 95%: 1,01-1,12 p = 0,007) e doença renal crônica (OR 3,75, IC 95%: 1,4-9,4 p = 0,005). Um score de risco menor que 14 no Multicenter Risk Index (OR 0,18; IC 95%: 0,34-0,93 p = 0,04) e o tabagismo foram "protetores" no univariado (OR 0,38; IC 95%: 0,14-0,98 p = 0,048). Na análise multivariada, nenhuma variável atingiu significância estatística. Foi identificada associação significativa entre a fibrilação atrial no pós-operatório e edema pulmonar (p <0,001), choque cardiogênico (p <0,04) e insuficiência renal aguda (p <0,01). Pacientes com fibrilação atrial no pós-operatório tiveram uma mediana de 5 dias a mais de internação (p <0,0003). Conclusão: Foi encontrada alta incidência de fibrilação atrial no pós-operatório na população estudada. Foram identificados fatores associados a maior risco de fibrilação atrial no pós-operatório, bem como associação com outras complicações graves no pós-operatório. Os resultados destacam a importância de protocolar o reconhecimento de pacientes de risco e seu tratamento.

Strain de la aurícula izquierda por speckle tracking: evaluación de su reproducibilidad global y segmentaria / Left atrium strain by speckle tracking: evaluation of its global and segmental reproducibility / Strain do atrio esquerdo por speckle tracking: avaliação da sua reprodutibilidade global e segmentar

Resumen: Objetivos: evaluar la reproducibilidad intra e interobservador en la medición del strain auricular izquierdo función reservorio mediante speckle tracking, usando un protocolo para su análisis global y segmentario. Métodos y resultados: se estableció un protocolo para la adquisición y medición del strain de la aurícula izquierda (SAI), para un análisis global y segmentario, utilizando un modelo tipo "ojo de buey". Se evaluó su reproducibilidad mediante el coeficiente de correlación intraclase (CCI) en 20 participantes de la cohorte GEnotipo, Fenotipo y Ambiente de la HiperTensión arterial en el UruguaY (GEFA-HT-UY). Se obtuvo una excelente reproducibilidad global intraobservador de 0,92 (IC: 0,81-0,97) y buena reproducibilidad interobservador de 0,82 (IC: 0,59-0,92). El análisis segmentario de SAI no fue reproducible. Los valores promedio de SAI fueron 31,0% (± 7,5) para la vista de 4 cámaras; 34,6% (± 9,9) para la vista de 2 cámaras, y 36,8% (± 13,9) para la vista de 3 cámaras. El valor global de SAI tomando las tres vistas fue de 34,1% (± 7,8) y de 32,8% (± 6,5) considerando las vistas de 4 y 2 cámaras. Conclusión: el protocolo de adquisición y análisis de SAI para la función de reservorio fue reproducible para su análisis global, no así para su análisis segmentario.

Summary: Objective: to evaluate intra and inter-observer reproducibility of speckle tracking left atrial strain reservoir function using a protocol for its global and segmental analysis. Methods: a protocol for acquisition and measurement of left atrial strain was created (bull's-eye type), for its global and segmental analysis. Reproducibility was assessed using intraclass correlation coefficient in twenty participants from the GEnotipo, Fenotipo y Ambiente de la HiperTensión arterial en el UruguaY cohort. For global assessment intra-observer reproducibility graded excellent (0.92 (IC: 0.81-0.97)) while inter-observer reached good reproducibility (0.82 (IC: 0.59-0.92)). Left atrial strain segmental analysis was not reproducible. Mean (±SD) left atrial strain was 31.0±7.5% for 4 chamber view, 34.6±9.9% for 2 chamber view and 36.8±13.9% for 3 chamber view. Global left atrial strain considering three views was 34.1±7.8%, and 32.8±6.5% considering 4 and 2 chamber views. Conclusion: left atrial strain acquisition and analysis protocol for reservoir function was reproducible for its global but not for its segmental analysis.

Resumo: Objetivo: avaliar a reprodutibilidade intra e interobservador do strain speckle tracking atrial esquerdo função de reservatório usando um protocolo para sua análise global e segmentar. Métodos: foi criado um protocolo de aquisição e mensuração de strain do atrio esquerdo, por sua análise global e segmentar (tipo olho de boi). A reprodutibilidade foi avaliada por meio do coeficiente de correlação intraclasse em vinte participantes da coorte GEnotipo, Fenotipo e Ambiente da Hiper-Tensiologia arterial em UruguaY. Para a avaliação global, a reprodutibilidade intra-observador foi excelente (0,92 (IC: 0,81-0,97)), enquanto o interobservador alcançou boa reprodutibilidade (0,82 (IC: 0,59-0,92)). A análise segmentar de strain do atrio esquerdo não foi reprodutível. A média (± SD) de strain do atrio esquerdo foi 31,0 ± 7,5% para 4 câmaras, 34,6 ± 9,9% para 2 câmaras e 36,8 ± 13,9% para 3 câmaras. A strain global, considerando três visualizações, foi de 34,1 ± 7,8% e 32,8 ± 6,5% considerando a visão de 4 e 2 câmaras. Conclusão: o protocolo de aquisição e análise de strain do atrio esquerdo para função de reservatório foi reproduzível para sua análise global, mas não para sua segmentação.

Estimación de la presión arterial pulmonar mediante ecocardiografía / Echocardiographic estimation of pulmonary arterial pressure / Estimativa da pressão arterial pulmonar por ecocardiografia

Resumen: Los avances tecnológicos en ecocardiografía durante los últimos 30 años han aumentado la precisión en la evaluación anatómica y funcional de las cavidades cardíacas derechas, así como en la estimación de la presión arterial pulmonar y en la evaluación hemodinámica pulmonar. Las conclusiones derivadas de un informe ecocardiográfico deben sugerir la probabilidad de hipertensión pulmonar (HTP) en función de los elementos que permiten estimar la presión sistólica, diastólica o media en la arteria pulmonar más la presencia de elementos indirectos de HTP. Analizamos la evidencia que sustenta la utilidad de los diferentes métodos ecocardiográficos para la estimación de la presión pulmonar. Es de suma importancia que el cardiólogo tenga presente los diferentes métodos -directos e indirectos- que permiten evaluar la HTP.

Summary: Technological advances in echocardiography over last 30 years have increased the accuracy in anatomical and functional evaluation of right cardiac cavities, as well as in estimation of pulmonary artery pressure and pulmonary hemodynamic evaluation. Conclusions derived from an echocardiographic report should suggest the probability of pulmonary hypertension depending on the elements that allow to estimate the systolic, diastolic and/or mean pulmonary artery pressure in addition to the presence of indirect elements of pulmonary hypertension. We analyze the evidence that supports the usefulness of different echocardiographic methods for estimation of pulmonary pressure. It is very important that the cardiologist keep in mind the different methods -direct and indirect- that allow to evaluate it.

Resumo: Os avanços tecnológicos da ecocardiografia nos últimos 30 anos aumentaram a acurácia na avaliação anatômica e funcional das cavidades cardíacas direitas, bem como na estimativa da pressão arterial pulmonar e na avaliação hemodinâmica pulmonar. As conclusões derivadas de um relatório ecocardiográfico devem sugerir a probabilidade de hipertensão pulmonar com base nos elementos que permitem estimar a pressão sistólica, diastólica e/ou média na artéria pulmonar mais a presença de elementos indiretos da hipertensão pulmonar. Analisamos as evidências que sustentam a utilidade dos diferentes métodos ecocardiográficos na estimativa da pressão pulmonar. É da maior importância que o cardiologista tenha em mente os diferentes métodos -diretos e indiretos- que permitem a sua avaliação.