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The outcome of SARS-CoV-2 as well as COVID-19 upon man duplication and also men's well being.
Finally, the position paper highlights the importance of an adequate environment and of an appropriate organization in order to optimize all steps of the procedure.Infective endocarditis (IE) affecting the heart valves is burdened by a high risk of mortality and complications. In the aortic valve IE, when valve replacement is essential, there is evidence of good results with the use of pulmonary autographs (Ross procedure), but the application of this technique remains limited due to its poor dissemination. We present a complex case of mitro-aortic IE treated with the Ross procedure associated with removal of vegetation from the mitral valve in a 28-year-old patient undergoing hemodialytic treatment, already undergoing cardiac surgery through sternotomy in the past.Rotational atherectomy represents an option to improve the treatment of calcified/undilatable coronary stenoses, but its use in ST-elevation myocardial infarction (STEMI) is controversial. We report the case of a patient with an occlusive and calcified coronary stenosis and its management not previously described. A 67-year-old man with STEMI was referred to our cath-lab. Coronary angiography showed a complex calcified and thrombotic occlusion of the right coronary artery. Vessel patency was obtained with balloon dilation, achieving clinical stability. The patient started dual antiplatelet therapy and was scheduled for a staged procedure using rotational atherectomy ("Rota-staged PCI"), performed 6 days later reaching optimal angiographic and clinical results. Our purpose was to manage this STEMI patient with an occluded and heavily calcified coronary artery in two times a primary coronary angioplasty to quickly reopen the artery and an early staged PCI using rotational atherectomy to optimize the intervention (coronary dilation and stent deployment) minimizing the risk of stent underexpansion or acute complications.
Transvenous pacing is nowadays the cornerstone of interventional management of bradyarrhythmias. It is still associated, however, with significant complications, mostly related to indwelling transvenous leads or device pocket. In order to reduce these complications, leadless pacemakers have been recently introduced into clinical practice, but no guidelines are yet available to indicate who are those patients that might benefit the most and whether leadless pacing should be preferred in the old or young population. This survey aims to describe the use of leadless pacemaker devices in a real-world setting.

Eleven arrhythmia centers in the Lombardy region (out of a total of 17 participating centers) responded to the proposed questionnaire regarding patient characteristics and indications to leadless pacing.

Out of a total of 411 patients undergoing leadless pacing during 4.2 ± 0.98 years, the median age was 77 years, with 0.18% of patients having less than 18 years, 29.9% 18-65 years, 34.3% 65-80 years and 35.6% >80 years. The most common indication was slow atrial fibrillation (49% of patients), followed by atrioventricular block and sinoatrial dysfunction. Two centers reported in-hospital complications.

Leadless pacemakers proved to be a safe pacing strategy actually destined mostly to elderly patients.
Leadless pacemakers proved to be a safe pacing strategy actually destined mostly to elderly patients.Antithrombotic therapy, in particular oral anticoagulation, is associated with an increased risk of bleeding. During anticoagulant treatment bleedings may also be caused by occult cancer, allowing its early diagnosis. The use of direct oral anticoagulants is associated with a lower risk of bleeding compared to vitamin K antagonists, but in the presence of a cancer lesion the risk of bleeding is not inferior. Atrial fibrillation patients with gastrointestinal bleeding during warfarin therapy are 6 times more likely to be diagnosed with cancer than patients without bleeding. In patients with hematuria, the probability of cancer is almost triple if treated with warfarin. With all the four direct oral anticoagulants newly colon cancer diagnoses have been reported in association with bleedings in phase III randomized clinical trials. In the real world, a 4.5% incidence of newly diagnosed cancer has been reported, mainly in the early stage and preceded by a bleeding event. Gastrointestinal bleeding is associated with a 13 times higher risk of newly diagnosed gastrointestinal cancer, genitourinary bleeding with a 18 times higher risk of newly diagnosed genitourinary cancer, and bronchopulmonary bleeding with a 15 times higher risk of newly diagnosed lung cancer. In the presence of bleeding during oral anticoagulant therapy, a diagnostic screening is warranted in order to detect occult cancer. An adverse event such as bleeding can become a favorable opportunity.Clinical research is gaining interest among healthcare professionals. This review provides an in-depth analysis of key study designs used in epidemiology, which can help researchers use the right methodology to design and conduct a research project. Case-control studies evaluate the association between an exposure to a specific risk factor and a study endpoint. Cross-sectional studies are indicated to assess the prevalence of a given risk factor. Cohort studies consist of longitudinal studies, in which a population is followed over time. These studies allow to evaluate the association between a risk factor and one or more study endpoints which are absent at the time of the population enrollment. Experimental studies are designed to test the efficacy and safety of an intervention. Generally, they include two groups of individuals who are assigned to either an experimental treatment or a standard treatment, respectively. Meta-analyses are studies that summarize the evidence already published concerning a specific research question and constitute an important source for evidence-based medicine and for the production and updating of guidelines.Clinical management of adult patients with congenital heart disease (GUCH) is a difficult task for multiple reasons, which include their own pathology and clinical history complexity, diagnostic complexity and organization of care. GUCH specialists are present in very small numbers and are concentrated in few centers, thus generating considerable transfer problems for patients. During the COVID-19 pandemic, telemedicine has become the standard of care, ensuring health assistance continuity, and implementing communication channels between patients and health professionals. We suggest to stratify GUCH patients into three groups, which correspond to different levels of risk (low, moderate and high, respectively) to develop complications over time, using a GUCH-specific multiparametric complexity score; so, each patient pathway will be defined according to the specific group, with indication of site, timing and type of clinical and instrumental evaluations, including virtual visits and consults. In conclusion, practical tools are provided for the implementation of updated care pathways for GUCH patients, who finally are inserted in a new model of care in which even if in-person visit still represents the crucial moment of each patient care pathway, on the other hand, telemedicine incorporation could contribute to improving and making even more complete and effective GUCH patient care.Renin-angiotensin-aldosterone (RAAS) system inhibition is a mainstay of the pharmacological treatment of heart failure with reduced ejection fraction and has been implemented by the introduction of angiotensin receptor-neprilysin inhibitors (ARNI), that combine RAAS inhibition with the inhibition of neprilysin, enhancing the favorable effects of natriuretic peptides. The PARADIGM-HF trial demonstrated a favorable effect of sacubitril/valsartan over enalapril in terms of mortality and heart failure hospitalization rate reduction. Then several randomized clinical trials and observational studies confirmed the favorable role of ARNI in different clinical scenarios, supporting the guideline class I recommendation for the use of sacubitril/valsartan in patients with reduced systolic function. The first part of this position paper summarizes the history of RAAS inhibition and reports the results of ARNI trials that support the recommendations of the most recent guidelines.We describe the case of a patient presenting with acute myocardial infarction complicated by cardiogenic shock in the setting of an unknown bioprosthetic aortic valve endocarditis and in absence of obstructive coronary artery disease. Given the angiographic finding, the most likely etiology was external compression by a perivalvular abscess, which was confirmed during autopsy. Although rare, coronary artery compression should be considered in the differential diagnosis of acute coronary syndromes complicating infective endocarditis.
The multidisciplinary network of Emilia-Romagna for the study of juvenile sudden cardiac death (SCD) was started in Bologna in June 2018 in order to (1) define the spectrum of etiologies and mechanisms of SCD in young people; (ii) standardize diagnostic terminology and categories; (iii) identify potentially hereditary genetic heart diseases and define the contribution of post-mortem genetic analysis (so-called molecular autopsy) to the overall diagnostic process; (iv) identify preclinical forms of the pathologies in the first-degree relatives of the deceased subject using both phenotypic and genotypic evaluation and, where possible, undertake therapeutic/prophylactic measures (primary prevention).

In the first 2 years of activity (01/06/2018-27/08/2020) 50 cases of SCD came to the attention of the Cardiovascular Pathology Unit of the S. Orsola-Malpighi Polyclinic in Bologna, from Centres of Forensic Medicine and Pathological Anatomy in most of the region.

Sixty-two percent of cases were sent by forensicays involving molecular genetics, clinical genetics, and toxicology.
The network is necessarily centered on post-mortem pathological activities, but it does not end with these. If in 60% of cases the pathological autopsy examination was decisive in identifying the cause of death, in the other cases a detailed final diagnosis was reached only with more complex pathways involving molecular genetics, clinical genetics, and toxicology.Post-infarction mechanical complications include left ventricular free-wall rupture, ventricular septal rupture, and papillary muscle rupture. With the advent of early reperfusion strategies, including thrombolysis and percutaneous coronary intervention, these events now occur in fewer than 0.3% of patients following acute myocardial infarction. However, unfortunately, there has been no parallel decrease in associated mortality rates over the past two decades. Moreover, during the ongoing COVID-19 pandemic the incidence of mechanical complications resulting from ST-elevation myocardial infarction has possibly risen. Early diagnosis and prompt management are crucial to improving outcomes. Although some percutaneous device repair approaches are available, surgical treatment remains the gold standard for these catastrophic post-infarction complications. The timing of surgery, also related to the type of complication and patient's clinical conditions, and the possible role of mechanical circulatory supports before and after surgery, represent main topics of debate that still need to be fully addressed.
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