Notes

Ventilation of common hides.
To determine the frequency and pattern of cardiac complications in patients hospitalised with coronavirus disease (COVID-19).

CAPACITY-COVID is an international patient registry established to determine the role of cardiovascular disease in the COVID-19 pandemic. In this registry, data generated during routine clinical practice are collected in a standardised manner for patients with a (highly suspected) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring hospitalisation. For the current analysis, consecutive patients with laboratory confirmed COVID-19 registered between 28 March and 3 July 2020 were included. Patients were followed for the occurrence of cardiac complications and pulmonary embolism from admission to discharge. In total, 3011 patients were included, of which 1890 (62.8%) were men. The median age was 67 years (interquartile range 56-76); 937 (31.0%) patients had a history of cardiac disease, with pre-existent coronary artery disease being most common (
=463, 15l admission is low, despite a frequent history of cardiovascular disease. Long-term cardiac outcomes and the role of pre-existing cardiovascular disease in COVID-19 outcome warrants further investigation.The natural history of aortic regurgitation is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival in these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery has attracted a great deal of attention because it has a significant survival benefit over replacement. Nonetheless, aortic valve-preserving surgery has not been widely adopted due to the complexity of the technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, aortic valve-preserving surgery has increasingly been performed with better outcomes, and therefore earlier surgical intervention in cases of aortic regurgitation has been considered. Recent advances in aortic valve-preserving surgery include repair-oriented classification of the etiology of aortic regurgitation, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of aortic valve-preserving surgery, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of aortic valve-preserving surgery in the treatment of aortic regurgitation in the near future.An example of the East-Freeman Automatic Vent from Oxford was found in the early anaesthesia equipment collection at St George Hospital, Sydney. It weighs less than 200 g and is representative of a group of miniature ventilators that were described in the 1960s, including the Minivent from South Africa and the Microvent from Canada. All relied on a pressure-operated inflating valve that was described in 1966 by Mitchell and Epstein from Oxford. The ventilators were compact, portable and were powered by the gas supply from the anaesthesia machine or other driving source that distended a reservoir bag. The main problem was that they could stick in the inspiratory phase. This led to pressure in the lungs rising towards the driving pressure. There was a risk of barotrauma to the patient if the system was not promptly disconnected. While theyhad provided an alternative to hand bagging, they were superseded, as more sophisticated and safer ventilators became widely available.Accidental extubation in the prone position is a medical emergency in which quick and low resource demanding airway management is required. Regaining oxygenation is the primary goal, but sometimes intubation may be required to regain oxygenation. Blind intubation through an i-gel® (Intersurgical Ltd, Wokingham, Berkshire, UK) may be a quick and low resource demanding method. However, the success rate of the use of an i-gel as an intubation conduit in the prone position is unknown. This was a prospective study in patients scheduled for lumbar surgery. General anaesthesia was induced in the prone position and an i-gel was inserted. After successful ventilation, up to three attempts at intubation using a VivaSight-SL single-lumen tube (Ambu A/S, Ballerup, Denmark) were performed. The first attempt was blinded for the operator and the patient's head was in a neutral position. The second attempt was blinded for the operator with the patient's head rotated laterally. The third attempt was on-screen and allowed various manoeuvres to facilitate intubation. A success rate of 70% was deemed clinically acceptable. The study was terminated early after 14 subjects because the success rate of 70% was not achievable. However, ventilation using the i-gel in the prone position was successful in 13 patients (93%). Intubation was successful in only one patient at the first attempt, one patient at the second attempt and three patients at the third attempt. Overall, the success rate was 36%. Blind intubation using an i-gel as an intubation conduit in the prone position is not recommended.Netherlands Trial Register number NL6387 (NTR7659).
Isocitrate dehydrogenase (IDH)-mutant lower-grade gliomas (LGGs) are further classified into two classes with and without 1p/19q codeletion. IDH-mutant and 1p/19q codeleted LGGs have better prognosis compared with IDH-mutant and 1p/19q non-codeleted LGGs.

To evaluate conventional magnetic resonance imaging (cMRI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) for predicting 1p/19q codeletion status of IDH-mutant LGGs.

We retrospectively reviewed cMRI, DWI, SWI, and DSC-PWI in 142 cases of IDH mutant LGGs with known 1p/19q codeletion status. Features of cMRI, relative ADC (rADC), intratumoral susceptibility signals (ITSSs), and the value of relative cerebral blood volume (rCBV) were compared between IDH-mutant LGGs with and without 1p/19q codeletion. Receiver operating characteristic curve and logistic regression were used to determine diagnostic performances.

IDH-mutant and 1p/19q non-codeleted LGGs tenmprove the diagnostic performance for predicting 1p/19q codeletion status.
The purpose of this study was to explore healthcare provider-perceived challenges to HBPC patient referral and elicited providers' feedback for overcoming these challenges.

We conducted a qualitative study using semi-structured interview
with 25 Medicaid managed care providers (primary care physicians, nurse practitioners, and care managers) working in the greater Los Angeles area. Our interview protocol elicited providers' knowledge and awareness of palliative care; perceived barriers to HBPC referral; and suggestions for overcoming these barriers. We analyzed verbatim transcripts using a grounded theory approach.

Themes related to referral barriers included providers' lack of palliative care knowledge and clarity regarding referral processes, provider reluctance to refer to HBPC, and provider culture. Providers also identified patient-level barriers, including financial barriers, reluctance to have home visits, health literacy, cultural barriers, and challenges related to living situations. Themes related to methods for overcoming challenges included increased HBPC education and outreach to providers, specifically by HBPC agency staff.

Findings from this study underscore the need for additional palliative care education for Medicaid healthcare providers. They point to the need for novel strategies and approaches to address the myriad barriers to patient identification and referral to HBPC.
Findings from this study underscore the need for additional palliative care education for Medicaid healthcare providers. They point to the need for novel strategies and approaches to address the myriad barriers to patient identification and referral to HBPC.A case of dysphagia secondary to anti-HMGCR myopathy is presented and a brief review of this pathology is made.
The aim of our study was to develop a POEM program in our Unit following a two steps sequence training on animal models and supervision by an experienced endoscopist during our first human cases.

A single endoscopist experienced in advanced endoscopy was trained in POEM. After observing POEM in referral centers, training was implemented on swine models (preclinical phase). Technical aspects and adverse events were prospectively recorded. NVS-816 We compared a first subset of cases (group A) to a second one (group B) to assess our progression. Finally, POEM was implemented in humans under the supervision of an experienced endoscopist (clinical phase). The outcomes and adverse events were prospectively recorded.

Preclinical phase. Fifteen POEM procedures were performed on live pigs. In group B severe AE were less frequent than in group A (12% vs. 57%, p = 0.07). After nine cases, a plateau regarding adverse events was observed. Clinical phase. Eleven POEM procedures were performed in patients under expert supervision. Technical and clinical (Eckardt score ≤ 3) success were 100% and 91%, respectively (follow-up 3-21 months). In 2 cases, the experienced endoscopist intervention was required (cases 2 and 3) because of difficult orientation at the esophagogastric junction. One mild pneumoperitoneum occurred, with no severe adverse events reported.

Training in animal models and supervision by experienced endoscopist during first cases could provide the necessary skills to perform POEM safely and effectively.
Training in animal models and supervision by experienced endoscopist during first cases could provide the necessary skills to perform POEM safely and effectively.We present the case of a patient diagnosed with HIV who developed cirrhosis due to chronic hepatitis E. The good response of this chronic infection is evident in our immunosuppressed patient with a 12-week treatment with Ribavirin.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and effective technique in the diagnosis of mediastinal and abdominal masses. However, the usefulness of EUS-FNA in the diagnosis and classification of lymphomas is controversial. Our aim was to determine the yield of EUS-FNA in the diagnosis and classification of lymphomas.

A retrospective case series was performed in a tertiary referral center. All consecutive patients referred for EUS-FNA who had a suspected diagnosis of lymphoma from March 2013 to June 2019 were included.

35 patients (54.3% women, median age 72 years) were included. The most frequent localization of the node was the abdomen (67.9%). Nodes were punctured using 22-gauge (85.7%) and 19-gauge needle (14.3%) with slow-pull technique. The number of passes performed were three or more in 82.9% of patients. The samples were processed by cell block method. Adequate samples for immunohistochemical and molecular biological study were obtained in 33 (94.3%) patients. EUS-FNA correctly diagnosed lymphoma in 30 out of 35 patients (85.7%), and subclassification was determined in 23 patients (65.7%). The most frequent diagnosis was Non-Hodgkin Lymphoma (85.7%). There was one moderate adverse event (bleeding), which was solved during the procedure.

EUS-FNA may be a valuable technique in the evaluation ofsuspected lymphomas with an adequate diagnostic yield and a very low adverse events rate.
EUS-FNA may be a valuable technique in the evaluation of suspected lymphomas with an adequate diagnostic yield and a very low adverse events rate.
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