Outcomes of Patients With Takotsubo Syndrome Compared With Type 1 and Type 2 Myocardial Infarction.

Background Takotsubo syndrome (TS) and myocardial infarction (MI) share similar clinical and laboratory characteristics but have important differences in causes, demographics, management, and outcomes. Methods and Results In this observational study, the National Inpatient Sample and National Readmission Database were used to identify patients admitted with TS, type 1 MI, or type 2 MI in the United States between October 1, 2017, and December 31, 2019. We compared patients hospitalized with TS, type 1 MI, and type 2 MI with respect to key features and outcomes. Over the 27-month study period, 2 035 055 patients with type 1 MI, 639 075 patients with type 2 MI, and 43 335 patients with TS were identified. Cardiac arrest, ventricular fibrillation, and ventricular tachycardia were more prevalent in type 1 MI (4.02%, 3.2%, and 7.2%, respectively) compared with both type 2 MI (2.8%, 0.8%, and 5.4% respectively) and TS (2.7%, 1.8%, and 5.3%, respectively). Risk of mortality was lower in TS compared with both type 1 MI (3.3% versus 7.9%; adjusted odds ratio [OR], 0.3; P<0.001) and type 2 MI (3.3% versus 8.2%; adjusted OR, 0.3; P<0.001). Mortality rate (OR, 1.2; P<0.001) and cardiac-cause 30-day readmission rate (adjusted OR, 1.7; P<0.001) were higher in type 1 MI than in type 2 MI. Conclusions Patients with type 1 MI had the highest rates of in-hospital mortality and cardiac-cause 30-day readmission. Risk of all-cause 30-day readmission was highest in patients with type 2 MI. The risk of ventricular arrhythmias in patients with TS is lower than in patients with type 1 MI but higher than in patients with type 2 MI.

Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017.

Background Most published reports describing outcomes of patients with cardiovascular implantable electronic device-related infective endocarditis (CIED-IE) are single-center studies with small patient sample sizes. The goal of this study was to utilize population-based data to assess trends in CIED-IE hospitalization and to compare outcomes between patients hospitalized with CIED-IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE). Methods and Results A query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED-IE, and 26 111 (4%) had PVE. There was a 509% increase in CIED-IE hospitalizations in the United States from 2003 to 2017 (P trend<0.001). In-hospital mortality and length of stay associated with CIED-IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 (P trend=0.032 and 0.018, respectively). The in-hospital mortality rate was lower in patients hospitalized with CIED-IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED-IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED-IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE). Conclusions Despite the fact that the number of comorbidities per patient with CIED-IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED-IE than for patients with NVE and PVE. Patients with CIED-IE had the longest lengths of stay and highest hospital costs.

Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients hospitalized with COVID-19.

BACKGROUND: Cardiovascular events in the context of COVID-19 infection increase the risk of negative patient outcomes, but large cohort studies describing this association are limited. The purpose of the current study was to investigate the potential associations between cardiovascular events and mortality in patients hospitalized due to COVID-19. METHODS: A retrospective chart review was performed in 2450 patients hospitalized for confirmed COVID-19 infection within a single hospital network between March 15 and June 15, 2020. Logistic regression analysis was used to identify predictors of mortality. RESULTS: In the study population, 57% of patients had elevated high sensitivity troponin (hs-TnT) levels. Acute heart failure occurred in 23% of patients and arrhythmias were observed in 8% of patients. Of the 1401 patients with elevated hs-TnT levels, a primary cardiac etiology (e.g., myocardial infarction) was identified in 653 (47%) patients. In the remaining 748 (53%) patients, there was evidence of a primary non-cardiac etiology for hs-TnT elevation such as renal failure (n = 304) and critical illness (n = 286). Elevated hs-TnT was associated with increased risk of mortality. A significantly higher mortality rate was observed for hs-TnT elevation associated with a primary cardiac etiology (OR 4.6, 95% CI: 2.7-7.6; P < 0.001) than a primary non-cardiac etiology (OR 2.7, 95% CI: 1.6-4.5; P < 0.001). CONCLUSIONS: Elevated hs-TnT in the context of COVID-19 infection is associated with a significantly increased mortality risk. Hs-TnT elevation in the context of a primary cardiac etiology confers a nearly 2-fold higher mortality risk than hs-TnT elevation due to a primary non-cardiac etiology.

Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease.

BACKGROUND: Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease. METHODS: A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality. RESULTS: Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05-1.07; P<0.001), complete heart block (OR: 21.5; 95% CI: 12.9-35.7; P<0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7-32.6; P<0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%). CONCLUSIONS: Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.

MAUDE Database Analysis of Post-Approval Outcomes following Left Atrial Appendage Closure with the Watchman Device.

Left atrial appendage closure (LAAC) is an important strategy to reduce stroke risk in patients with non-valvular atrial fibrillation (AF) who are at high risk of bleeding on long-term anticoagulation. Real-world assessments of the safety of the Watchman LAAC device remain limited. The objective of this study was to determine the frequency and timing of adverse events associated with Watchman LAAC device implants performed after FDA approval. Adverse events associated with Watchman LAAC implants performed between March 2015 and March 2019 were identified through a search of the FDA Manufacturer and User Facility Device Experience (MAUDE) database. During the study period, 3,652 unique adverse events were identified. An estimated 43,802 Watchman implants were performed in the United States during the study period. The overall adverse event rate was 7.3% and the mortality rate was 0.4%. Of the 159 unique types of adverse events identified, pericardial effusion was most common (1.4%). Most adverse events (73%) occurred intraoperatively (59%) or within 1 day of the procedure (15%). However, 19% of deaths, 24% of strokes and 27% of device embolizations occurred >1 month after implantation. The rates of most Watchman-related adverse events reported in the MAUDE database were comparable to those observed in clinical trials. A majority of adverse events occurred within 1 day of implant. In conclusion, while the absolute event rates were low, a significant proportion of device embolizations, strokes, and deaths occurred >1 month after Watchman implant.

Gelatin Methacryloyl Bioadhesive Improves Survival and Reduces Scar Burden in a Mouse Model of Myocardial Infarction.

Background Delivery of hydrogels to the heart is a promising strategy for mitigating the detrimental impact of myocardial infarction (MI). Challenges associated with the in vivo delivery of currently available hydrogels have limited clinical translation of this technology. Gelatin methacryloyl (GelMA) bioadhesive hydrogel could address many of the limitations of available hydrogels. The goal of this proof-of-concept study was to evaluate the cardioprotective potential of GelMA in a mouse model of MI. Methods and Results The physical properties of GelMA bioadhesive hydrogel were optimized in vitro. Impact of GelMA bioadhesive hydrogel on post-MI recovery was then assessed in vivo. In 20 mice, GelMA bioadhesive hydrogel was applied to the epicardial surface of the heart at the time of experimental MI. An additional 20 mice underwent MI but received no GelMA bioadhesive hydrogel. Survival rates were compared for GelMA-treated and untreated mice. Left ventricular function was assessed 3 weeks after experimental MI with transthoracic echocardiography. Left ventricular scar burden was measured with postmortem morphometric analysis. Survival rates at 3 weeks post-MI were 89% for GelMA-treated mice and 50% for untreated mice (P=0.011). Left ventricular contractile function was better in GelMA-treated than untreated mice (fractional shortening 37% versus 26%, P<0.001). Average scar burden in GelMA-treated mice was lower than in untreated mice (6% versus 22%, P=0.017). Conclusions Epicardial GelMA bioadhesive application at the time of experimental MI was performed safely and was associated with significantly improved post-MI survival compared with control animals. In addition, GelMA treatment was associated with significantly better preservation of left ventricular function and reduced scar burden.

Whole exome sequencing in a child with acute disseminated encephalomyelitis, optic neuritis, and periodic fever syndrome: a case report.

BACKGROUND: Acute disseminated encephalomyelitis is generally preceded by an infection, and it is usually self-limiting and non-recurrent. However, when there are multiple attacks of acute disseminated encephalomyelitis followed by optic neuritis, it is defined as acute disseminated encephalomyelitis-optic neuritis. To the best of our knowledge, there are no previous reports of acute disseminated encephalomyelitis and optic neuritis preceded by autoinflammation, triggered by periodic fever syndrome. We report on a case of acute disseminated encephalomyelitis with optic neuritis and periodic fever syndrome in a 12-year-old Ecuadorian Hispanic boy with several relapses over the past 10 years, always preceded by autoinflammatory manifestations and without evidence of infectious processes. Whole exome sequencing was performed, and although the results were not conclusive, we found variants in genes associated with both autoinflammatory (NLRP12) and neurological (POLR3A) phenotypes that could be related to the disease pathogenesis having a polygenic rather than monogenic trait. CONCLUSION: We propose that an autoinflammatory basis should be pursued in patients diagnosed as having acute disseminated encephalomyelitis and no record of infections. Also, we show that our patient had a good response after 1 year of treatment with low doses of intravenous immunoglobulin and colchicine.

First report on a pupping area of the tope shark Galeorhinus galeus (Carcharhiniformes, Triakidae) in the south-west Atlantic.

Neonates of the tope shark Galeorhinus galeus are captured in sport and recreational coastal fisheries from January to April each year in Engaño Bay (42° 58'-43° 41' S), Chubut, Argentina. The presence of these neonates is the first evidence of a pupping area for this shark in the south-west Atlantic Ocean. Knowledge of the pupping areas of chondrichthyans is important for establishing conservation measures and appropriate fishing regulations.

Resistencia a metales pesados, antibióticos y factores de virulencia en cepas de Enterococcus aisladas en la provincia del Chubut, Argentina / Heavy metal resistance and virulence factors in Enterococcus strains isolated from the Chubut province, Argentina

La contaminación por metales pesados (MP) constituye un problema creciente para la salud pública. La utilización de bioindicadores permite evaluar el impacto de la contaminación antrópica. En este estudio se evaluaron 730 cepas de Enterococcus provenientes de diferentes fuentes de la comarca VIRCh-Valdés (Provincia de Chubut), mediante la prueba de sensibilidad a Pb++ por el método de dilución en placa, a concentraciones comprendidas entre 50 mg/L y 1.200 mg/L. De las cepas evaluadas, 223 exhibieron resistencia a plomo a concentraciones ≥ 50 mg/L. Dentro de este grupo se seleccionaron 22 aislados altamente resistentes a plomo (≥ 800 mg/L) con el objetivo de evaluar su resistencia a otros metales pesados, resistencia a antibióticos y determinar sus factores de virulencia. Todas las cepas seleccionadas mostraron alta sensibilidad a Hg++, un patrón variable de resistencia frente a Cd++ y Cr+6 y resistencia moderada a Ni++. Las cepas resultaron susceptibles a ampicilina y penicilina, y presentaron un patrón variable de resistencia a los restantes antibióticos ensayados. Entre los factores de virulencia, se detectó actividad de gelatinasa en dos cepas y sólo una cepa exhibió actividad hemolítica. Estos resultados sugieren una relación entre la resistencia a metales pesados, resistencia a antibióticos y factores de virulencia en cepas de Enterococcus aisladas del medio ambiente.

Contamination by heavy metals is a growing problem for public health and the use of bio-indicators are means for assessing anthropogenic pollution. In this study 730 Enterococcus strains were isolated from different sources of the region VIRCh - Valdés (Province of Chubut) were tested for sensibility to Pb++ by the plate dilution method at concentrations ranging from 50 mg/L to 1200 mg/L. A total of 223 strains displayed resistance to lead at concentration ≥ 50 mg/L. Among this group, and on the basis of its high resistance to lead (≥ 800 mg/L), 22 strains were selected with the goal to determine antibiotic and heavy metal resistance pattern and also the presence of virulence traits. All isolates showed high sensibility to Hg++, a variable pattern against Cd++ and Cr+6, and moderate resistance to Ni++. The strains were all susceptible to ampicillin and penicillin and displayed a variable pattern of resistance towards the remaining antibiotics assayed. Among the virulence traits determined, gelatinase production was detected in 2 strains and only one isolate showed hemolytic activity. The results obtained in this work suggest a relationship between heavy metal resistance, antibiotic resistance and virulence factors in Enterococcus strains isolated from the environment.

Efecto de las condiciones de crecimiento y composición del medio de cultivo sobre la producción de bacteriocina de Enterococcus mundtii Tw56 / Effect of growth conditions and culture medium composition on bacteriocin production by Enterococcus mundtii Tw56

Enterococcus mundtii Tw56 es una cepa productora de bacteriocina que fue aislada del contenido intestinal de pejerrey (Odontesthes sp.). El objetivo del presente trabajo fue determinar los factores fisicoquímicos y la composición del medio de cultivo para lograr un mayor rendimiento de células viables y producción de bacteriocina. No se observaron cambios en la producción del antimicrobiano cuando la glucosa fue sustituida por fructosa o maltosa en la formulación del medio MRS. Por el contrario, la mayor actividad de las bacteriocinas se obtuvo cuando se utilizó el extracto de carne como fuente única de nitrógeno. Mientras que la máxima biomasa se alcanzó a 35 °C, las temperaturas óptimas para la producción de bacteriocina se observaron a 25 y 30 °C. El pH inicial óptimo para el crecimiento celular y bioactividad fue 6,5, ambos parámetros disminuyeron cuando la experiencia comenzó a pH 6,0 o 5,5. La formación de biomasa y la producción de bacteriocina disminuyeron en presencia de cloruro de sodio. La cepa comenzó a producir bacteriocina en la fase exponencial tardía. La actividad aumentó en función de la masa celular y alcanzó el máximo al final de la fase exponencial (12 h). Una disminución de la actividad antimicrobiana se observó en la fase estacionaria (16 h), posiblemente debido a la degradación por enzimas proteolíticas.

Enterococcus mundtii Tw56 is a bacteriocin-producing strain that was isolated from intestinal content of silverside (Odontesthes sp.). The aim of the present work was to determine physicochemical factors and culture medium composition for higher yield of viable cells and bacteriocin production. No changes were observed in the antimicrobial production when glucose was replaced by fructose or maltose in the MRS medium formulation. On the other hand, highest bacteriocin activity was obtained when meat extract was used as a sole nitrogen source. While the maximun biomass was achieved at 35 ºC, the optimal temperatures for bacteriocin production were observed at 25 and 30 ºC. The optimal initial pH for cell growth and bioactivity was 6.5, both parameters dropped when the experience started at pH 6.0 or 5.5. Biomass formation and bacteriocin production decreased in the presence of sodium chloride. The strain started producing the bacteriocin at the late exponential phase. The activity increased as a function of the cell mass and reached the maximun at the end of exponential phase (12 h). A decrease of antimicrobial activity was observed in the stationary phase (16 h), possibly due to degradation by proteolitic enzimes.

Disponibilidad de fósforo soluble en ensilado experimental fermentado con una cepa de Lactococcus lactis subsp. lactis con alta actividad de fitasa / Soluble phosphorous availability in experimental silage fermented with a Lactococcus lactis subsp. lactis strain with high phytase activity

El fitato es la forma principal de almacenamiento de fósforo en semillas y granos, pero el fósforo unido a fitato resulta inaccesible para los peces. El objetivo del presente trabajo fue estudiar la eficacia de Lactococcus lactis subsp. lactis Tw34 para liberar fósforo de fitato en un alimento experimental que contenía harina de cereal. La bacteria inoculante del ensilado biológico se seleccionó por su alta actividad de fitasa y las mezclas se prepararon con productos de descarte de merluza (Merluccius hubbsi). Las harinas de girasol, maíz, trigo y cebada se mezclaron con desechos picados de merluza hasta alcanzar el 25% y se inocularon con la bacteria citada. Después de 7 días de fermentación a 18 ºC los mejores resultados se obtuvieron cuando se utilizó harina de cebada. La cepa fue capaz de reducir el valor del pH a 4,4 y aumentar cuatro veces la concentración inicial de fósforo libre. Los resultados sugieren que la fitasa de Lactococcus lactis subsp. lactis Tw34 puede aumentar la accesibilidad del fósforo en dietas basadas en harina de cereales, evitando los efectos negativos del ácido fítico en la biodisponibilidad de minerales y proteínas, y disminuyendo la liberación de residuos de fósforo.

Phytate is the main phosphorous storage form in grains and seeds, but phytate linked phosphorous is inaccessible for fishes. The purpose of this wok was to study the efficacy of Lactococcus lactis subsp. lactis Tw34 for liberating phosphorous in an experimental feed which contained cereal flour. The inoculating bacterium of the biological silage was selected due to its high phytase activity, and the mixtures were prepared with waste hake products (Merluccius hubbsi). Sunflower, corn, wheat and barley flours were mixed with waste ground hake products up to 25% and inoculated with the bacterium mentioned. After 7 days fermentation at 18 oC, the best results were obtained when barley flour was used. The strain was able to reduce the pH value to 4.4 and increase four times the initial concentration of free phosphorous. The results suggest that Lactococcus lactis subsp. lactis Tw34 can increase phosphorous accessibility in cereal flour based diets, avoiding the negative effects of phytic acid on the bioavailability of minerals and proteins, and decreasing the liberation of phosphorous residues.

Caracterización parcial de enterocinas producidas por una cepa de Enterococcus faecium aislada de leche ovina / Partial characterization of enterocins produced by an Enterococcus faecium strain isolated from ovine milk

Los enterococos son constituyentes de la microflora de quesos artesanales y contribuyen a sus características organolépticas. También producen enterocinas que pueden prevenir el crecimiento de patógenos alimentarios. En este estudio se aislaron 27 cepas de enterococos a partir de leche y queso ovinos provenientes de la Patagonia (Argentina) y se investigó la producción de bacteriocinas. De las 27 cepas aisladas, 22 cepas de Enterococcus faecium y 1 cepa de E. faecalis inhibieron el crecimiento de Listeria innocua ATCC 33090. E. faecium Tw6 mostró la mayor actividad antimicrobiana entre las cepas estudiadas y se seleccionó con el propósito de caracterizar el principio activo y su espectro de inhibición. La tripsina abolió la actividad antilisteria, lo que sugiere que el compuesto activo es de naturaleza proteica; resultó ser estable al calor, resistente al pH y permaneció estable durante más de 12 meses. La masa molecular determinada mediante electroforesis fue aproximadamente de 5,6 KDa. La reacción en cadena de la polimerasa (PCR) mostró la presencia de múltiples secuencias de enterocinas (entA, entB, entP y entL50A/B). Las características físico-químicas y bioquímicas de las enterocinas producidas por E. faecium Tw6 las convierten en potenciales candidatas para ser utilizadas en la conservación de alimentos.

Enterococci are part of the microflora of artisan type cheese and contribute to their organoleptic characteristics. They also produce enterocins which can prevent the growth of food pathogens. In this study 27 enterococci strains were isolated from ovine milk and cheese produced at the Argentine Patagonia and they were investigated regarding their bacteriocin production. Of the 27 strains isolated. 22 Enterococcus faecium and one E. faecalis inhibited the growth of Listeria innocua ATCC 33090; E. faecium Tw6 showed the highest antimicrobial activity among the strains studied and it was selected with the purpose of characterizing the active principle and its inhibition spectrum. Trypsin abolished antilisteria activity, which suggests that the active component has a protein nature; it was heat stable, pH resistant, and it remained stable during more than 12 months. The molecular mass determined by electrophoresis was approximately 5.6 KDa. The polymerase chain reaction (PCR) showed the presence of multiple enterocin sequences (entA, entP, and ent50A/B). The physicochemical and biochemical characteristics of the enterocins produced by E. faecium Tw6 identify them as a potential candidates for use in food preservation.

Dose-dependent significance of monosaccharides on intracellular alpha-L-rhamnosidase activity from Pseudoalteromonas sp.

Intracellular alpha-L-rhamnosidase (EC 3.2.1.40) from the psychrotolerant Pseudoalteromonas sp. 005NJ showed a dose-dependent inhibition for L-rhamnose (IC(50) = 20 mM) and D-ribose (IC(50) = 95 mM), whereas D-glucose and L-fucose presented a lower inhibition, with IC(50) values as high as >0.5 and >0.2 M, respectively. On the other hand, D-fructose enhanced enzyme activity threefold, reaching a plateau of maximum specific activity between 0.2 and 0.4 M of this monosaccharide. Both effects, low inhibition and stimulation, caused by key fruit sugars (glucose and fructose), make this biocatalyst an interesting system in terms of its potential application for debittering fruit juices.