Pulmonary Embolism in Pregnancy: A Review for Clinical Practitioners.

Diagnostic and therapeutic decision-making in pregnancy with suspected pulmonary embolism (PE) is challenging. European and other international professional societies have proposed various recommendations that are ambiguous, probably due to the unavailability of randomized controlled trials. In the following sections, we discuss the supporting diagnostic steps and treatments. We suggest a standardized diagnostic work-up in pregnant patients presenting with symptoms of PE to make evidence-based diagnostic and therapeutic decisions. We strongly recommend that clinical decisions on treatment in pregnant patients with intermediate- or high-risk pulmonary embolism should include a multidisciplinary team approach involving emergency physicians, pulmonologists, angiologist, cardiologists, thoracic and/or cardiovascular surgeons, radiologists, and obstetricians to choose a tailored management option including an interventional treatment. It is important to be aware of the differences among guidelines and to assess each case individually, considering the specific views of the different specialties. This review summarizes key concepts of the diagnostics and acute management of pregnant women with suspected PE that are supportive for the clinician on duty.

One-fourth of COVID-19 patients have an impaired pulmonary function after 12 months of disease onset.

BACKGROUND: There is increasing data that show a persistently impaired pulmonary function upon recovery after severe infection. Little is known however about the extent, recovery and determinants of pulmonary impairment across the full spectrum of COVID-19 severity over time. METHODS: In a well characterized, prospective cohort of both hospitalised and non-hospitalised individuals with SARS-CoV-2 infection, the RECoVERED study, pulmonary function (diffusing capacity for carbon monoxide (DLCO)) and spirometry) was measured until one year after disease onset. Additionally, data on sociodemographics, clinical characteristics, symptoms, and health-related quality of life (HRQL) were collected. Pulmonary function and these determinants were modelled over time using mixed-effect linear regression. Determinants of pulmonary function impairment at 12 months after disease onset were identified using logistic regression. FINDINGS: Between May 2020 and December 2021, 301 of 349 participants underwent at least one pulmonary function test. After one year of follow-up, 25% of the participants had an impaired pulmonary function which translates in 11%, 22%, and 48% of the participants with mild, moderate and severe/critical COVID-19. Improvement in DLCO among the participants continued over the period across one, six and twelve months. Being older, having more than three comorbidities (p<0·001) and initial severe/critical disease (p<0·001) were associated with slower improvement of pulmonary function over time, adjusted for age and sex. HRQL improved over time and at 12 months was comparable to individuals without impaired pulmonary function. INTERPRETATION: The prevalence of impaired pulmonary function after twelve months of follow-up, was still significant among those with initially moderate or severe/critical COVID-19. Pulmonary function increased over time in most of the severity groups. These data imply that guidelines regarding revalidation after COVID-19 should target individuals with moderate and severe/critical disease severities.

[Dyspnoea]. / Dyspneu.

Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this updated educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies. We propose a strategy to assess dyspnoea in clinical practice. Key points are determining the severity of the problem, forming a differential diagnosis, thinking about the mechanism of dyspnoea and intervening in a timely manner. We conclude that the assessment and treatment of dyspnoea often requires a multidisciplinary approach.

[Dyspnoea]. / Dyspneu.

Dyspnoea is an important and common symptom in patients with pulmonary or cardiovascular disease. It is a vital signal that we all can experience, for instance during heavy exercise, but it can also be an expression of a variety of diseases. In this educational article, we provide an answer to 10 questions on the causes of dyspnoea and the effectiveness of various diagnostic and therapeutic strategies. We propose a strategy to assess dyspnoea in clinical practice. Key points are determining the severity of the problem, forming a differential diagnosis, thinking about the mechanism of dyspnoea and intervening in a timely manner. We conclude that the assessment and treatment of dyspnoea often requires a multidisciplinary approach.

Psychological gender of men with systolic heart failure: a neglected strategy to cope with the disease?

Diminished exercise capacity is a fundamental symptom of heart failure (HF), which is particularly disadvantageous for men for whom exercise capacity contributes significantly to their gender identity, self-esteem, and quality of life. In this study, we aimed to examine whether psychological gender would be different in men with systolic HF as compared with their healthy peers. The authors examined 48 men with systolic HF (age = 64 ± 10 years; body mass index = 28.3 ± 3.4 kg/m(2); NYHA I/II/III [%] = 25/65/10; left ventricular ejection fraction [LVEF] = 32.1 ± 7.8%) and 15 age-matched healthy men. Based on the results of the Polish version of the Bem Sex Role Inventory, the examined men were divided into four types of psychological gender: "masculine" (M), "feminine" (F), "unspecified" (U), and "androgynous" (A). None of the men with HF presented M type of psychological gender, whereas this type was found in 27% of the healthy men (p = .0002). The prevalence of both A (38% vs. 47%) and F (10% vs. 20%, both p > .05) types of psychological gender was similar between men with HF versus without HF. More men with HF fulfilled the criteria of the U type of psychological gender as compared with healthy peers (51% vs. 7%, p = .002). Men with HF and the F type of psychological gender were treated with spironolactone more frequently than those classified with the U and A types (both p < .05). The lack of "psychologically masculine" and the overrepresentation of "psychologically unspecified" gender types in the HF group suggests that psychological gender may be affected among men with HF.

The influence of the sounds of crying baby and the sounds of violence on haemodynamic parameters and autonomic status in young, healthy adults.

INTRODUCTION: There is evidence that various stimuli affect the balance in the autonomic nervous system (ANS) and the functioning of cardiovascular system. OBJECTIVE: The aim of the study was to assess whether the sounds of crying baby and the sounds of violence affected haemodynamic parameters and ANS in young, healthy adults and to measure differences in these reactions between the genders and these 2 stimuli. METHODS: Haemodynamic parameters (measured non-invasively by the NEXFIN device), heart rate and blood pressure variability (HRV and BPV, respectively) and baroreflex sensitivity (BRS) were analyzed in 65 adults (21 women, mean age: 23years) during a 15-minute rest followed by the emission of two 5-minute acoustic stimuli: sounds of crying baby and sounds of violence emitted randomly and separated by a 4-minute pause. RESULTS: Resting systolic blood pressure was lower, whereas indices of HRV (RMSSD, NN50, pNN50, high frequency component of HRV - HRV HF) and BPV (high frequency component - BPV HF) as well as BRS were higher in women as compared to men. During the emission of the sounds of crying baby, a decrease in diastolic blood pressure (DBP), systemic vascular resistance index, HRV HF and BPV LF (low frequency component of BPV) and an increase in stroke volume index were observed in the whole examined group, whereas during the emission of the sounds of violence subjects presented a decrease in DBP, mean blood pressure, HRV HF and BPV LF. The reaction to the sounds of crying baby (expressed as a decrease in HRV HF) was greater in women as compared to men (-0.28±0.49 versus -0.04±0.38ms(2), p=0.04). The comparison of the reaction between 2 stimuli revealed no differences. CONCLUSIONS: The stronger decrease in parasympathetic drive in women exposed to the sounds of crying baby may be related to a particular role of this stimulus, which signals the baby's distress and compels the caregivers to react.