Pubblicazioni recenti - pediatric cardiac
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Predictors of in-hospital death in children with myocardial injury related to COVID-19.
J Infect Dev Ctries2024 Mar;18(3):355-361. doi: 10.3855/jidc.18582.
Souza Filho César Augusto de Oliveira, Lima Junior Emilton,
Abstract
INTRODUCTION:
Myocardial injury due to COVID-19 infection is associated with higher mortality rates, higher intensive care unit admissions, and greater levels of inflammatory and cardiac markers. However, given the smaller number of papers regarding pediatric patients, there is still scarce data about mortality predictors in this population. This study aims to identify independent predictors of in-hospital death among pediatric patients hospitalized with myocardial injury related to COVID-19.
METHODOLOGY:
This is an observational, prospective, and longitudinal study of pediatric patients who were hospitalized between March 2020 and June 2021 in a tertiary pediatric hospital. A total of 1,103 consecutive pediatric patients tested positive for COVID-19, and 232 were admitted. All patients underwent cardiac evaluation with electrocardiogram, echocardiogram, and cardiac markers. Of these patients, 88 were diagnosed with myocardial injury but 1 patient refused to participate, therefore 87 patients were included in the study.
RESULTS:
The median age at the time of diagnosis was 2 years (0-18), 38% had pre-existing comorbidities, and the mortality was 12% (n = 11). Cardiac evaluation has revealed high levels of troponin I in 63%, and electrocardiogram and echocardiogram abnormalities in 81% and 22% respectively. We found that high levels of inflammatory markers had higher mortality, but they didn't emerge as significant predictors of mortality when adjusted for other variables. Patients without pre-existing comorbidities were less likely to die in both univariate and multivariate analysis.
CONCLUSIONS:
Our findings may help healthcare providers better understand the cardiac implications of COVID-19 and define the necessity of cardiac surveillance amongst hospitalized pediatric patients.
Copyright (c) 2024 César Augusto de Oliveira Souza Filho, Emilton Lima Junior.
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Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study.
PLoS One2024 ;19(4):e0298893. doi: 10.1371/journal.pone.0298893.
Saifan Ahmad Rajeh, Hayeah Haneen Abu, Ibrahim Ateya Megahed, Dimitri Alexandra, Alsaraireh Mahmoud Mohammad, Alakash Hikmat, Yateem Nabeel Al, Zaghamir Donia Elsaid, Elshatarat Rami A, Subu Muhammad Arsyad, Saleh Zyad Taher, AbuRuz Mohannad Eid,
Abstract
BACKGROUND:
Quantitative studies have provided valuable statistical insights into Health-Related Quality of Life (HRQoL) among patients with Heart Failure (HF), yet they often lack the depth to fully capture the nuanced, subjective experiences of living with HF particularly in the specific context of Jordan. This study explores the personal narratives of HF patients to understand the full impact of HF on their daily lives, revealing HRQoL aspects that quantitative metrics often miss. This is crucial in developing regions, where the increasing prevalence of HF intersects with local healthcare practices, cultural views, and patient expectations, providing key insights for tailored interventions and better patient care.
METHODS:
Utilizing a phenomenological qualitative design, this study conducted face-to-face semi-structured interviews with 25 HF patients to deeply explore their lived experiences. Thematic analysis was employed to identify major themes related to their perceptions of HF as a disease, its impact on various HRQoL domains, and their recommended strategies to enhance HRQoL.
RESULTS:
The study involved 25 participants (13 males, 12 females), aged 26-88 years (mean 63), with diverse education and heart failure (HF) severities. It revealed three themes: HF perceptions, its impact on health-related quality of life (HRQoL) across physical, psychosocial, spiritual, cognitive, and economic domains, and HRQoL improvement strategies. Participants had varied HF knowledge; some lacked basic understanding. The physical impact was most significant, affecting daily life and causing symptoms like breathing difficulties, coughing, edema, and fatigue. This physical aspect influenced their psychosocial and spiritual lives, cognitive functions, and economic stability, leading to fear, frustration, worry, social isolation, spiritual and cognitive challenges, and employment problems.
CONCLUSIONS:
The results underscores the need for holistic healthcare approaches, integrating medical, psychological, and social support. Key recommendations include integrated care models, comprehensive patient education, support networks, and policy interventions to enhance HF patient care.
Copyright: © 2024 Saifan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Durability of Original Monovalent mRNA Vaccine Effectiveness Against COVID-19 Omicron-Associated Hospitalization in Children and Adolescents - United States, 2021-2023.
MMWR Morb Mortal Wkly Rep2024 Apr;73(15):330-338. doi: 10.15585/mmwr.mm7315a2.
Zambrano Laura D, Newhams Margaret M, Simeone Regina M, Payne Amanda B, Wu Michael, Orzel-Lockwood Amber O, Halasa Natasha B, Calixte Jemima M, Pannaraj Pia S, Mongkolrattanothai Kanokporn, Boom Julie A, Sahni Leila C, Kamidani Satoshi, Chiotos Kathleen, Cameron Melissa A, Maddux Aline B, Irby Katherine, Schuster Jennifer E, Mack Elizabeth H, Biggs Austin, Coates Bria M, Michelson Kelly N, Bline Katherine E, Nofziger Ryan A, Crandall Hillary, Hobbs Charlotte V, Gertz Shira J, Heidemann Sabrina M, Bradford Tamara T, Walker Tracie C, Schwartz Stephanie P, Staat Mary Allen, Bhumbra Samina S, Hume Janet R, Kong Michele, Stockwell Melissa S, Connors Thomas J, Cullimore Melissa L, Flori Heidi R, Levy Emily R, Cvijanovich Natalie Z, Zinter Matt S, Maamari Mia, Bowens Cindy, Zerr Danielle M, Guzman-Cottrill Judith A, Gonzalez Ivan, Campbell Angela P, Randolph Adrienne G, ,
Abstract
Pediatric COVID-19 vaccination is effective in preventing COVID-19-related hospitalization, but duration of protection of the original monovalent vaccine during SARS-CoV-2 Omicron predominance merits evaluation, particularly given low coverage with updated COVID-19 vaccines. During December 19, 2021-October 29, 2023, the Overcoming COVID-19 Network evaluated vaccine effectiveness (VE) of ?2 original monovalent COVID-19 mRNA vaccine doses against COVID-19-related hospitalization and critical illness among U.S. children and adolescents aged 5-18 years, using a case-control design. Too few children and adolescents received bivalent or updated monovalent vaccines to separately evaluate their effectiveness. Most case-patients (persons with a positive SARS-CoV-2 test result) were unvaccinated, despite the high frequency of reported underlying conditions associated with severe COVID-19. VE of the original monovalent vaccine against COVID-19-related hospitalizations was 52% (95% CI = 33%-66%) when the most recent dose was administered
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Dapagliflozin and Empagliflozin in Paediatric Indications: A Systematic Review.
Paediatr Drugs2024 Apr;():. doi: 10.1007/s40272-024-00623-z.
Lava Sebastiano A G, Laurence Craig, Di Deo Alessandro, Sekarski Nicole, Burch Michael, Della Pasqua Oscar,
Abstract
INTRODUCTION:
In adults, sodium-glucose cotransporter type 2 inhibitors have revolutionised the treatment of type 2 diabetes mellitus, heart failure, and chronic kidney disease.
OBJECTIVE:
We aimed to review information on compassionate use, clinical pharmacology, efficacy, and safety of dapagliflozin and empagliflozin in children.
METHODS:
We conducted a systematic review of published clinical trials, case reports, and observational studies in Medline, Excerpta Medica, and Web of Science databases from inception to September 2023. For the two randomised controlled trials on type 2 diabetes mellitus (T2DM), we implemented a meta-analysis on the primary outcome (mean difference in glycosylated haemoglobin [HbA1c] between intervention and placebo groups). Review Manager (RevMan), version 5.4.1, was used for this purpose.
RESULTS:
Thirty-five articles (nine case reports, ten case series, one prospective non-controlled trial, four controlled randomised trials, two surveys, six pharmacokinetic studies, and three pharmacovigilance studies) were selected, in which 415 children were exposed to either dapagliflozin or empagliflozin: 189 diabetic patients (mean age 14.7 ± 2.9 years), 32 children with glycogen storage disease type Ib (GSD Ib), glucose-6-phosphatase catalytic subunit 3 (G6PC3) deficiency, or severe congenital neutropenia type 4 (8.5 ± 5.1 years), 47 children with kidney disease or heart failure (11.2 ± 6.1 years), 84 patients in pharmacokinetic studies (15.1 ± 2.3 years), and 63 patients in toxicological series. The effect of dapagliflozin and empagliflozin in T2DM was demonstrated by HbA1c reduction in two randomised trials among a total of 177 adolescents, with a mean HbA1c difference of -0.82% (95% confidence interval -1.34 to -0.29) as compared to placebo (no heterogeneity, I = 0%). Dosage ranged between 5 and 20 mg (mean 11.4 ± 3.7) once daily for dapagliflozin and between 5 and 25 mg (mean 15.4 ± 7.4) once daily for empagliflozin. Among the paediatric cases of GSD Ib, empagliflozin 0.1-1.3 mg/kg/day improved neutropenia, infections, and gastrointestinal health. Dapagliflozin (mean dosage 6.9 ± 5.2 mg once daily) was well-tolerated in children with chronic kidney disease and heart failure. Side effects were generally mild, the most frequent being hypoglycaemia in children with GSD Ib (33% of patients) or T2DM (14% of patients) on concomitant hypoglycaemic drugs. Diabetic ketoacidosis is rare in children.
CONCLUSION:
Early evidence suggests that dapagliflozin and empagliflozin are well tolerated in children. A clinical pharmacology rationale currently exists only for adolescents with diabetes mellitus.
PROSPERO REGISTRATION NUMBER:
CRD42023438162.
© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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Current advances in human-induced pluripotent stem cell-based models and therapeutic approaches for congenital heart disease.
Mol Cell Biochem2024 Apr;():. doi: 10.1007/s11010-024-04997-z.
Cao Meiling, Liu Yanshan, Sun Ying, Han Ruiyi, Jiang Hongkun,
Abstract
Congenital heart disease (CHD) represents a significant risk factor with profound implications for neonatal survival rates and the overall well-being of adult patients. The emergence of induced pluripotent stem cells (iPSCs) and their derived cells, combined with CRISPR technology, high-throughput experimental techniques, and organoid technology, which are better suited to contemporary research demands, offer new possibilities for treating CHD. Prior investigations have indicated that the paracrine effect of exosomes may hold potential solutions for therapeutic intervention. This review provides a summary of the advancements in iPSC-based models and clinical trials associated with CHD while elucidating potential therapeutic mechanisms and delineating clinical constraints pertinent to iPSC-based therapy, thereby offering valuable insights for further deliberation.
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country.
Pediatr Cardiol2024 Apr;():. doi: 10.1007/s00246-024-03486-w.
Wadile Santosh, Kondgekar Divya, Banpurkar Ashishkumar Moreshwar, Raeen Shahena Parveen, Kulkarni Komal, Kulkarni Snehal,
Abstract
Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97?±?2.79 months and 5.07?±?1.16 kg, respectively. The mean follow-up duration was 8.99?±?2.31 months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (- 3.67?±?1.18 vs. - 1.76?±?1.14, p?=?0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8 months of age (2-4 months?=?3588 g, 5-6 months?=?3592 g, 7-8 months?=?3606 g, 9-10 months?=?2590 g, 11-12 months?=?2250 g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.
© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Significance of colonization by antibiotic-resistant organisms prior to congenital heart disease surgery in children from low- to middle-income countries sent by non-governmental organizations to Switzerland.
Infection2024 Apr;():. doi: 10.1007/s15010-024-02251-8.
Cousin Vladimir L, Mwizerwa Leonce, Joye Raphael, Wagner Noémie, Nalecz Tomasz, Bouhabib Maya, Sologashvili Tornike, Wacker Julie, Schrenzel Jacques, Beghetti Maurice, Polito Angelo,
Abstract
PURPOSE:
Children with congenital heart disease (CHD) from low- to middle-income countries (LMIC) are suspected to have a high prevalence of antibiotic-resistant microorganisms (ARMOs) carriage, but data are currently lacking. Carriage of ARMOs could impact the post-operative course in pediatric intensive care unit (PICU). The aim of the study was to assess the prevalence of ARMOs carriage in children with CHD from LMIC and its impact on post-operative outcomes.
METHODS:
This was a retrospective monocentric study from 01/2019 to 12/2022. Included patients were children (0-18 years) from a LMIC admitted after CHD surgery and with AMRO screening performed the week before. Infections and post-operative evolution were compared based on ARMOs carriage status.
FINDINGS:
Among 224 surgeries (median age 38.5 months (IQR 22-85.5)), ARMOs carriage was evidenced in 95 cases (42.4%). Main organisms isolated were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli (75/224) 33.5%)) and ESBL-K. pneumoniae (30/224) 13.4%)). Median mechanical ventilation duration was 1 day (IQR 0-1), PICU stay 3 days (IQR 2-4) and hospital stay 6.5 days (IQR 5-10). A total of 17 infectious episodes occurred in 15 patients, mostly consisting in hospital-acquired pneumonia (HAP) (12/17). Only two infections were caused by a colonizing ARMO. Occurrence of infections and patients' outcome were similar between ARMO carriers and non-carriers. Higher use of carbapenems (6 (6.3%) vs 1 (0.8%), p?=?0.04) and a trend to a higher use of vancomycin (14 (13.7%) vs 9 (6.9%), p?=?0.04) in case of ARMOs carriage. Applying current guidelines, negative swab screening could have led to sparing most of empirical vancomycin therapy (11/12) for HAP based on current guidelines.
CONCLUSION:
Prevalence of AMROs carriage is high in children from LMIC and has a limited impact on patients' outcome. However, ARMOs carriage leads to higher consumption of antibiotics. Screening may help saving use of broad-spectrum antibiotic in non-carrier patients.
© 2024. The Author(s).
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Radiomics and machine learning for renal tumor subtype assessment using multiphase computed tomography in a multicenter setting.
Eur Radiol2024 Apr;():. doi: 10.1007/s00330-024-10731-6.
Uhlig Annemarie, Uhlig Johannes, Leha Andreas, Biggemann Lorenz, Bachanek Sophie, Stöckle Michael, Reichert Mathias, Lotz Joachim, Zeuschner Philip, Maßmann Alexander,
Abstract
OBJECTIVES:
To distinguish histological subtypes of renal tumors using radiomic features and machine learning (ML) based on multiphase computed tomography (CT).
MATERIAL AND METHODS:
Patients who underwent surgical treatment for renal tumors at two tertiary centers from 2012 to 2022 were included retrospectively. Preoperative arterial (corticomedullary) and venous (nephrogenic) phase CT scans from these centers, as well as from external imaging facilities, were manually segmented, and standardized radiomic features were extracted. Following preprocessing and addressing the class imbalance, a ML algorithm based on extreme gradient boosting trees (XGB) was employed to predict renal tumor subtypes using 10-fold cross-validation. The evaluation was conducted using the multiclass area under the receiver operating characteristic curve (AUC). Algorithms were trained on data from one center and independently tested on data from the other center.
RESULTS:
The training cohort comprised n?=?297 patients (64.3% clear cell renal cell cancer [RCC], 13.5% papillary renal cell carcinoma (pRCC), 7.4% chromophobe RCC, 9.4% oncocytomas, and 5.4% angiomyolipomas (AML)), and the testing cohort n?=?121 patients (56.2%/16.5%/3.3%/21.5%/2.5%). The XGB algorithm demonstrated a diagnostic performance of AUC?=?0.81/0.64/0.8 for venous/arterial/combined contrast phase CT in the training cohort, and AUC?=?0.75/0.67/0.75 in the independent testing cohort. In pairwise comparisons, the lowest diagnostic accuracy was evident for the identification of oncocytomas (AUC?=?0.57-0.69), and the highest for the identification of AMLs (AUC?=?0.9-0.94) CONCLUSION: Radiomic feature analyses can distinguish renal tumor subtypes on routinely acquired CTs, with oncocytomas being the hardest subtype to identify.
CLINICAL RELEVANCE STATEMENT:
Radiomic feature analyses yield robust results for renal tumor assessment on routine CTs. Although radiologists routinely rely on arterial phase CT for renal tumor assessment and operative planning, radiomic features derived from arterial phase did not improve the accuracy of renal tumor subtype identification in our cohort.
© 2024. The Author(s).
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Predictors of psychosocial adaptation in children with CHD.
Cardiol Young2024 Apr;():1-5. doi: 10.1017/S1047951124000593.
Metelski Jessica L, Allen Kiona Y, Barrera L, Heffernan M, Hinkle Clayton D, Parikh Pooja, Foster Carolyn C,
Abstract
Survival of CHD has significantly improved, but children with CHD remain susceptible to neurodevelopmental and psychosocial impairments. Our goal was to investigate the association between socio-demographic factors and psychosocial adaptation for future intervention. A retrospective cross-sectional study of an independent children's hospital's records was conducted. Psychosocial adaptation was measured by the Pediatric Cardiac Quality of Life Inventory Psychosocial Impact score (range 0-50, higher score indicates greater psychosocial adaptation). Bivariate and regression analyses were performed to estimate relationships between Psychosocial Impact score and socio-demographic variables including Child Opportunity Index, family support, financial support, academic support, and extracurricular activities. A total of 159 patients were included. Compared to patients in high opportunity neighbourhoods, patients in low opportunity neighbourhoods had a 9.27 (95% confidence interval [-17.15, -1.40], p = 0.021) point lower Psychosocial Impact score, whereas patients in moderate opportunity neighbourhoods had a 15.30 (95% confidence interval [-25.38, -5.22], p = 0.003) point lower Psychosocial Impact score. Compared to patients with adequate family support, those with limited support had a 6.23 point (95% confidence interval [-11.82, -0.643], p = 0.029) lower Psychosocial Impact score. Patients in moderate opportunity neighbourhoods had a higher Psychosocial Impact score by 11.80 (95% confidence interval [1.68, 21.91], p = 0.022) when they also had adequate family support compared to those with limited family support. Our findings indicate that among children with CHD, psychosocial adaptation is significantly impacted by neighbourhood resources and family support structures. These findings identify possible modifiable and protective factors to improve psychosocial adaptation in this vulnerable population.
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Influence of cardiac diagnosis on outcomes of pediatric heart-lung transplantation.
Clin Transplant2024 Apr;38(4):e15318. doi: 10.1111/ctr.15318.
Sainathan Sandeep, Ryan John, Mullinari Leonardo, Sanchez Pablo,
Abstract
OBJECTIVE:
Pediatric Heart-lung transplant (HLTX) is performed for endstage congenital heart disease (CHD) with irreversible pulmonary hypertension or non-congenital heart disease (NCHD) with end-stage heart and lung disease. CHD could influence the outcomes of HTLX due to increased complexity of the operation as compared to NCHD. In this study we evaluated the influence of cardiac diagnosis on outcomes of pediatric HTLX.
METHODS:
The UNOS database (1987-2022) was queried for primary HTLX in patients
RESULTS:
Ninety of the 213 patients who underwent HLTX had CHD. There were no demographic differences. Heart listing status was similar but with a higher LAS score for NCHD. NCHD had higher pre-operative life support use (mechanical ventilation, inotropes or dialysis) but the use of ECMO as a bridge to transplantation was similar. Wait-list times were longer for CHD. The ischemic times were similar. Post-transplant dialysis, stroke, prolonged mechanical ventilation, and rejection were similar. Survival at 30-days, 1-year, and long-term survival at 17 years was similar. Non-survivors at 30-days post-transplant were on life support, used ECMO as a bridge, had lower wait-list times, longer ischemic times and had strokes. Non-survivors at 1-year had similar factors in addition to a higher dialysis use.
CONCLUSION:
Cardiac diagnosis had no impact on outcomes after Pediatric HLTX. Patients on life support or ECMO before transplantation were transplanted faster but with lower survival.
© 2024 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.
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Adenylyl cyclase isoforms 5 and 6 in the cardiovascular system: complex regulation and divergent roles.
Front Pharmacol2024 ;15():1370506. doi: 10.3389/fphar.2024.1370506.
Maghsoudi Saeid, Shuaib Rabia, Van Bastelaere Ben, Dakshinamurti Shyamala,
Abstract
Adenylyl cyclases (ACs) are crucial effector enzymes that transduce divergent signals from upstream receptor pathways and are responsible for catalyzing the conversion of ATP to cAMP. The ten AC isoforms are categorized into four main groups; the class III or calcium-inhibited family of ACs comprises AC5 and AC6. These enzymes are very closely related in structure and have a paucity of selective activators or inhibitors, making it difficult to distinguish them experimentally. AC5 and AC6 are highly expressed in the heart and vasculature, as well as the spinal cord and brain; AC6 is also abundant in the lungs, kidney, and liver. However, while AC5 and AC6 have similar expression patterns with some redundant functions, they have distinct physiological roles due to differing regulation and cAMP signaling compartmentation. AC5 is critical in cardiac and vascular function; AC6 is a key effector of vasodilatory pathways in vascular myocytes and is enriched in fetal/neonatal tissues. Expression of both AC5 and AC6 decreases in heart failure; however, AC5 disruption is cardio-protective, while overexpression of AC6 rescues cardiac function in cardiac injury. This is a comprehensive review of the complex regulation of AC5 and AC6 in the cardiovascular system, highlighting overexpression and knockout studies as well as transgenic models illuminating each enzyme and focusing on post-translational modifications that regulate their cellular localization and biological functions. We also describe pharmacological challenges in the design of isoform-selective activators or inhibitors for AC5 and AC6, which may be relevant to developing new therapeutic approaches for several cardiovascular diseases.
Copyright © 2024 Maghsoudi, Shuaib, Van Bastelaere and Dakshinamurti.
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FAPi PET/CT for assessment and visualisation of active myositis-related interstitial lung disease: a prospective observational pilot study.
EClinicalMedicine2024 Jun;72():102598. doi: 10.1016/j.eclinm.2024.102598.
Kastrati Kastriot, Nakuz Thomas S, Kulterer Oana C, Geßl Irina, Simader Elisabeth, Mrak Daniel, Bonelli Michael, Kiener Hans Peter, Prayer Florian, Prosch Helmut, Aletaha Daniel, Langsteger Werner, Traub-Weidinger Tatjana, Blüml Stephan, Lechner-Radner Helga, Hacker Marcus, Mandl Peter,
Abstract
BACKGROUND:
Interstitial lung disease (ILD) is a common manifestation of idiopathic inflammatory myopathies (IIM) and a substantial contributor to hospitalisation, increased morbidity, and mortality. In-vivo evidence of ongoing tissue remodelling in IIM-ILD is scarce. We aimed to evaluate fibroblast activation in lungs of IIM-patients and control individuals using ??Ga-labelled inhibitor of Fibroblast-Activation-Protein (FAPi) based positronic emission tomography and computed tomography imaging (PET/CT).
METHODS:
In this prospective observational pilot study, consecutive patients with IIM and participants without rheumatic conditions or ILD serving as a control group were recruited at the Medical University of Vienna, Austria, and underwent FAPi PET/CT imaging. Standard-of-care procedures including clinical examination, assessment of severity of dyspnoea, high-resolution computed tomography (HR-CT), and pulmonary function testing (PFT) were performed on all patients with IIM at baseline and for patients with IIM-ILD at follow-up of 12 months. Baseline pulmonary FAPi-uptake was assessed by the maximum (SUVmax) and mean (SUVmean) standardized uptake values (SUV) over the whole lung (wl). SUV was corrected for blood pool background activity and target-to-background ratios (TBR) were calculated. We compared pulmonary FAPi-uptake between patients with IIM-ILD and those without ILD, as well as controls, and correlated baseline FAP-uptake with standard diagnostic tools such as HR-CT and PFT. For predictive implications, we investigated whether patients with IIM and progressive ILD exhibited higher baseline FAPi-uptake compared to those with stable ILD. Metrics are reported as mean with standard deviation (±SD).
FINDINGS:
Between November 16, 2021 and October 10, 2022, a total of 32 patients were enrolled in the study. Three participants from the control group were excluded due to cardiopulmonary disease. In individuals with IIM-ILD (n = 14), wlTBR and wlTBR were significantly increased as compared with both non-ILD-IIM patients (n = 5) and the control group (n = 16): wlTBR: 2.06 ± 1.04 vs. 1.04 ± 0.22 (p = 0.019) and 1.08 ± 0.19 (p = 0.0012) and wlTBR: 0.45 ± 0.19 vs. 0.26 ± 0.06 (p = 0.025) and 0.27 ± 0.07 (p = 0.0024). Similar values were observed in wlTBR or wlTBR between non-ILD IIM patients and the control group. Patients with progressive ILD displayed significantly enhanced wlTBR and wlTBR values at baseline compared to patients with stable ILD: wlTBR: 1.30 ± 0.31 vs. 2.63 ± 1.04 (p = 0.0084) and wlTBR: 0.32 ± 0.08 vs. 0.55 ± 0.19 (p = 0.021). Strong correlations were found between FAPi-uptake and disease extent on HR-CT (wlTBRmax: R = 0.42, p = 0.07; wlTBRmean: R = 0.56, p = 0.013) and severity of respiratory symptoms determined by the New York Heart Association (NYHA) classification tool (wlTBRmax: R = 0.52, p = 0.022; wlTBRmean: R = 0.59, p = 0.0073). Further, pulmonary FAPi-uptake showed inverse correlation with forced vital capacity (FVC) (wlTBRmax: R = -0.56, p = 0.012; wlTBRmean: R = -0.64, p = 0.0033) and diffusing capacity of the lungs for carbon monoxide (DLCO) (wlTBRmax: R = -0.52, p = 0.028; wlTBRmean: R = -0.68, p = 0.0017).
INTERPRETATION:
Our study demonstrates higher fibroblast activation in patients with IIM-ILD compared to non-ILD patients and controls. Intensity of pulmonary FAPi accumulation was associated with progression of ILD. Considering that this study was carried out on a small population, FAPi PET/CT may serve as a useful non-invasive tool for risk stratification of lung disease in IIM.
FUNDING:
The Austrian Research Fund.
© 2024 The Authors.
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Reduced lung function during childhood in identical twins with discordant fetal growth: a cohort study.
EClinicalMedicine2024 Jun;72():102600. doi: 10.1016/j.eclinm.2024.102600.
Spekman Jip A, Israëls Joël, de Vreede Ilja, Los Mady, Geelhoed Miranda J J, van Zwet Erik W, Haak Monique C, Roest Arno A W, van Klink Jeanine M M, Lopriore Enrico, Groene Sophie G,
Abstract
BACKGROUND:
Fetal growth restriction (FGR) can negatively affect lung development, leading to increased respiratory morbidity and reduced lung function later in life. Studies regarding the impact of FGR on lung function in singletons are influenced by genetic, obstetric, and maternal factors. To overcome these confounding factors, we aim to investigate lung function in identical twins with selective FGR (sFGR).
METHODS:
Lung function assessments were performed in identical twins with sFGR born in our centre between March 1, 2002, and December 31, 2017, aged between 5 and 17 years. sFGR was defined as birthweight discordance ?20%. Outcome measures consisted of forced expiratory volume in 1 s (FEV), forced vital capacity (FVC), and transfer factor for carbon monoxide (DLCO) and were compared between the smaller and larger twin.
FINDINGS:
Thirty-nine twin pairs performed spirometry of sufficient quality. Median gestational age at birth was 34.3 (interquartile range (IQR) 32.1-36.0) weeks with median birthweights of 1500 (IQR 1160-1880) grams and 2178 (IQR 1675-2720) grams for the smaller and larger twin, respectively. Smaller twins had significantly lower z-scores for FEV (-0.94 versus -0.41, = 0.0015), FVC (-0.56 versus -0.06,
INTERPRETATION:
Although being genetically identical, sFGR in identical twins is associated with a reduction in static and dynamic lung volume and a reduction in lung diffusion, even when taking the reduced lung volume into account. This indicates that adverse growth conditions in utero negatively affect lung development and function, potentially contributing to an increase in respiratory morbidities later in life.
FUNDING:
The Dutch Heart Foundation and The Bontius Foundation.
© 2024 The Authors.
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An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices.
ATS Sch2024 Mar;5(1):71-83. doi: 10.34197/ats-scholar.2022-0132OC.
Patel Bhoumesh, Said Ahmed S, Justus Angelo, Abrams Darryl, Pham Tái, Antonini Marta Velia, Moore Elizabeth, Shekar Kiran, Zakhary Bishoy,
Abstract
BACKGROUND:
The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge.
OBJECTIVE:
The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics.
METHODS:
We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains.
RESULTS:
A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high-ECMO volume centers compared with 136 (87.5%) low-ECMO volume centers (?=?0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high-ECMO volume centers compared with 51 (37.5%) low-ECMO volume centers (?=?0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non-Extracorporeal Life Support Organization center (?0.001).
CONCLUSION:
We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.
Copyright © 2024 by the American Thoracic Society.
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Ketorolac Dosing and Outcomes in Neonates Following Congenital Heart Surgery: A Retrospective Analysis.
Crit Care Explor2024 Apr;6(4):e1078. doi: 10.1097/CCE.0000000000001078.
Kiskaddon Amy L, Goldenberg Neil A, Abel Trent, Fierstein Jamie L, Khayat Delia, Quintessenza James A, Stock Arabela C,
Abstract
BACKGROUND:
Pain management is essential for postoperative surgery. Given the association of opioids with adverse outcomes, interest in the use of nonopioid analgesics, such as ketorolac, has increased. Published data on use in neonates are limited.
OBJECTIVES:
To describe ketorolac dosing and safety and efficacy outcomes in the first 48 hours postcardiac surgery in neonates.
DESIGN:
We performed a single-center retrospective cohort study of neonates (ages
INTERVENTIONS:
Ketorolac was administered at 0.5?mg/kg every 6 hours as per an institutional clinical management algorithm.
MEASUREMENTS AND MAIN RESULTS:
Thirty-nine patients met the eligibility criteria. The median ketorolac dose was 0.5?mg/kg/dose, and median (interquartile range [IQR]) duration of therapy was 48 hours (6-48 hr). No patients experienced a significant decline in renal function, and there were no clinically significant bleeding events. The median (IQR) IV morphine milligram equivalents (MMEs)/kg/d of opioid administration was 0.2 MME/kg/d (0.1-0.25 MME/kg/d) at the time of ketorolac initiation and 0.1 MME/kg/d (0.1-0.2 MME/kg/d) at 48 hours post-ketorolac initiation.
CONCLUSIONS:
If validated prospectively, these findings suggest that a ketorolac regimen of 0.5?mg/kg/dose every 6 hours in neonates postcardiac surgery may be safe with regard to renal function and bleeding risk. Additional randomized studies would be needed to determine efficacy with regard to opioid-sparing capacity.
Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
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High-Risk Anomalous Aortic Origin of the Left Coronary Artery: Consecutive Admissions Presenting With Sudden Cardiac Arrest.
World J Pediatr Congenit Heart Surg2024 Apr;():21501351241237945. doi: 10.1177/21501351241237945.
Burns Joseph, Emeruwa Ezinne, Connell Patrick, Borges Nirica, Reaves-O'Neal Dana, Molossi Silvana,
Abstract
Anomalous aortic origin of the left coronary artery (AAOLCA) confers high risk for sudden cardiac arrest (SCA). This series aims to describe consecutive admissions with interarterial AAOLCA presenting with SCA and distinct clinical trajectories. An eight-year-old boy collapsed at school and received 10-min of cardiopulmonary resuscitation (CPR) and defibrillation prior to return of spontaneous circulation. He had no end-organ dysfunction and underwent uneventful coronary unroofing. In contrast, a 14-year-old boy presented with collapse while jogging. He received 40-min of CPR prior to extracorporeal membranous oxygenation cannulation with multisystem dysfunction and persistent severely depressed left ventricular function. He is now rehabilitating following uneventful orthotropic heart transplantation. These cases illustrate the diverse outcomes of AAOLCA with SCA following exertional syncope.
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Application of propofol-remifentanil intravenous general anesthesia combined with regional block in pediatric ophthalmic surgery.
BMC Anesthesiol2024 Apr;24(1):147. doi: 10.1186/s12871-024-02531-8.
Li Ming-Ying, Fei Yu-Da, Zhang Xiao-Xia, Chen Tian-Wen, Li Jie, Sun Xiao-Li, Wang Zhen-Yuan,
Abstract
OBJECTIVE:
The aim of this study is to observe the anesthetic effect and safety of intravenous anesthesia without muscle relaxant with propofol-remifentanil combined with regional block under laryngeal mask airway in pediatric ophthalmologic surgery.
METHODS:
A total of 90 undergoing ophthalmic surgery were anesthetized with general anesthesia using the laryngeal mask airway without muscle relaxant. They were randomly divided into two groups: 45 children who received propofol-remifentanil intravenous anesthesia combined with regional block (LG group), and 45 children who received total intravenous anesthesia (G group). The peri-operative circulatory indicators, awakening time after general anesthesia, postoperative analgesic effect and the incidence of anesthesia-related adverse events were respectively compared between the two groups.
RESULTS:
All the children successfully underwent the surgical procedure. The awakening time after general anesthesia and removal time of laryngeal mask were significantly shorter in the LG group than in the G group (P?0.05). There was no statistically significant difference in the heart rates in the perioperative period between the two groups (P?>?0.05). There was no statistically significant difference in the incidence of intraoperative physical response, respiratory depression, postoperative nausea and vomiting (PONV) and emergence agitation (EA) between the two groups (P?>?0.05). The pain score at the postoperative hour 2 was lower in the LG group than in the G group (P?0.05).
CONCLUSION:
Propofol-remifentanil intravenous anesthesia combined with long-acting local anesthetic regional block anesthesia, combined with laryngeal mask ventilation technology without muscle relaxants, can be safely used in pediatric eye surgery to achieve rapid and smooth recovery from general anesthesia and better postoperative analgesia. This anesthesia scheme can improve the comfort and safety of children in perioperative period, and has a certain clinical popularization value.
© 2024. The Author(s).
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Results of the implementation of a double-check protocol with point-of-care ultrasound for acute heart failure in the emergency department.
Ultrasound J2024 Apr;16(1):25. doi: 10.1186/s13089-024-00373-6.
Villén Tomás, Tung Yale, Llamas Rafael, Neria Fernando, Carballo César, Vázquez José Luis, Monge Diana,
Abstract
OBJECTIVE:
To determine the effectiveness of a double-check protocol using Point-of-Care Ultrasound in the management of patients diagnosed with Acute Heart Failure in an Emergency Department.
METHOD:
Prospective analytical cross-sectional observational study with patients diagnosed with Acute Heart Failure by the outgoing medical team, who undergo multi-organ ultrasound evaluation including cardiac, pulmonary, and inferior vena cava ultrasound.
RESULTS:
96 patients were included. An alternative diagnosis was found in 33% of them. Among the 77% where AHF diagnosis was confirmed, 73.4% had an underlying cause or condition not previously known (Left Ventricular Ejection Fraction less than 40% or moderate-severe valvulopathy). The introduction of the protocol had a clinically relevant impact on 47% of all included patients.
CONCLUSIONS:
The implementation of a double-check protocol using POCUS, including cardiac, pulmonary, and inferior vena cava assessment in patients diagnosed with Acute Heart Failure, demonstrates a high utility in ensuring accurate diagnosis and proper classification of these patients.
© 2024. The Author(s).
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2-Step-Scores with optional nephropathology for the prediction of adverse outcomes for brain-dead donor kidneys in Eurotransplant.
Nephrol Dial Transplant2024 Apr;():. doi: gfae093.
Ernst Angela, Regele Heinz, Chatzikyrkou Christos, Dendooven Amélie, Turkevi-Nagy Sándor, Tieken Ineke, Oberbauer Rainer, Reindl-Schwaighofer Roman, Abramowicz Daniel, Hellemans Rachel, Massart Annick, Ljubanovic Danica Galesic, Senjug Petar, Maksimovic Bojana, Aßfalg Volker, Neretljak Ivan, Schleicher Christina, Clahsen-van Groningen Marian, Kojc Nika, Ellis Carla L, Kurschat Christine E, Lukomski Leandra, Stippel Dirk, Ströhlein Michael, Scurt Florian G, Roelofs Joris J, Kers Jesper, Harth Ana, Jungck Christian, Eccher Albino, Prütz Isabel, Hellmich Martin, Vasuri Francesco, Malvi Deborah, Arns Wolfgang, Becker Jan U,
Abstract
BACKGROUND AND HYPOTHESIS:
The decision for acceptance or discard of the increasingly rare and marginal brain-dead donor kidneys in Eurotransplant (ET) countries has to be made without solid evidence. Thus, we developed and validated flexible clinicopathological scores called 2-Step Scores for the prognosis of delayed graft function (DGF) and one-year death-censored transplant loss (1y-tl) reflecting the current practice of six ET countries including Croatia and Belgium.
METHODS:
The training set was n=620 for DGF and n=711 for 1y-tl, with validation sets n=158 and n=162. In step 1, stepwise logistic regression models including only clinical predictors were used to estimate the risks. In step 2, risk estimates were updated for statistically relevant intermediate risk percentiles with nephropathology.
RESULTS:
Step 1 revealed an increased risk of DGF with increased cold ischaemia time, donor and recipient BMI, dialysis vintage, number of HLA-DR mismatches or recipient CMV IgG positivity. On the training and validation set, c-statistics were 0.672 and 0.704, respectively. At a range between 18% and 36%, accuracy of DGF-prognostication improved with nephropathology including number of glomeruli and Banff cv (updated overall c statistics of 0.696 and 0.701, respectively).Risk of 1y-tl increased in recipients with cold ischaemia time, sum of HLA-A. -B, -DR mismatches and donor age. On training and validation sets, c-statistics were 0.700 and 0.769, respectively. Accuracy of 1y-tl prediction improved (c-statistics = 0.706 and 0.765) with Banff ct. Overall, calibration was good on the training, but moderate on the validation set; discrimination was at least as good as established scores when applied to the validation set.
CONCLUSION:
Our flexible 2-Step Scores with optional inclusion of time-consuming and often unavailable nephropathology should yield good results for clinical practice in ET, and may be superior to established scores. Our scores are adaptable to donation after cardiac death and perfusion pump use.
© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.
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Association of dexmedetomidine use with haemodynamics, postoperative recovery, and cost in paediatric anaesthesia: a hospital registry study.
Br J Anaesth2024 Apr;():. doi: S0007-0912(24)00147-8.
Azimaraghi Omid, Rudolph Maíra I, Luedeke Can M, Ramishvili Tina, Jaconia Giselle D, Scheffenbichler Flora T, Chambers Terry-Ann, Karaye Ibraheem M, Eikermann Matthias, Chao Jerry, Jackson William M,
Abstract
BACKGROUND:
Dexmedetomidine utilisation in paediatric patients is increasing. We hypothesised that intraoperative use of dexmedetomidine in children is associated with longer postanaesthesia care unit length of stay, higher healthcare costs, and side-effects.
METHODS:
We analysed data from paediatric patients (aged 0-12 yr) between 2016 and 2021 in the Bronx, NY, USA. We matched our cohort with the Healthcare Cost and Utilization Project-Kids' Inpatient Database (HCUP-KID).
RESULTS:
Among 18 104 paediatric patients, intraoperative dexmedetomidine utilisation increased from 51.7% to 85.7% between 2016 and 2021 (P
CONCLUSIONS:
Intraoperative use of dexmedetomidine is associated with unwarranted haemodynamic effects, longer postanaesthesia care unit length of stay, and higher costs, without preventive effects on emergence delirium.
Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
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