Prosthetic Valve Endocarditis: A Retrospective Cohort Study Conducted at "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest.

OBJECTIVE: To evaluate patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment can be utilized to enhance the quality of care for individuals with infective endocarditis who have undergone prosthetic valve replacement surgery. RESULTS: During the period of investigation (January 2017-December 2022), 78 patients diagnosed with infective endocarditis (IE) on a prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 patients (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who received only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of the patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%) and Streptococcus mitis (10.3%). The mortality rate of patients infected with S. aureus was 29.2%, indicating the severity of this infectious agent. CONCLUSIONS: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high.

A Pilot Study on the Association between Cardiovascular Risk Factors and Coronary Artery Calcification in a Group of Patients Investigated via Cardiac Computed Tomography in a European Country with High Cardiovascular Risk.

(1) Background: Cardiovascular disease is the leading cause of mortality worldwide; the prevention and early detection of coronary artery disease are of critical importance; and the coronary artery calcium score is a powerful method in the assessment of coronary artery disease. Among European countries, Romania ranks as a country with a very high risk of cardiovascular diseases, but the data are limited in regard to the prevalence of the calcium score. (2) Methods: A retrospective study was conducted to establish the coronary calcium score in a group of patients investigated via cardiac CT and to determine the correlation with the presence of cardiovascular risk factors. (3) Results: According to the Agatston calcium score, 50% of the patients had a positive calcium score. High calcium scores above 400 UA were present in 12.6% of patients. Regarding the association between the presence of cardiovascular risk factors and the levels of coronary artery calcification, a mild level of calcification was associated with age over 50 years (X2 = 3.88, p = 0.04, OR = 3.25; 95% CI 0.94-11.14); a moderate level of calcification with the age of patients over 50 years (X2 = 6.54, p = 0.01, OR = 5.58; 95% CI 1.29-24.16), dyslipidemia (X2 = 7.28, p = 0.007, OR = 3.37; 95% CI 1.34-8.51), and arterial hypertension (X2 = 5.37, p = 0.02, OR = 2.88; 95% CI 1.14-7.27); a severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81); and a very severe level of calcification with hypertension (X2 = 4.61, p = 0.03, OR = 7.03; 95% CI 0.90-54.81), smoking (X2 = 8.07, p = 0.004, OR = 4.44; 95% CI 1.47-13.44), and diabetes (X2 = 13.65, p = 0.001, OR = 6.59; 95% CI 2.5-20.18). (4) Conclusion: Half of the patients investigated by using cardiac CT had a calcium score of zero. Predictors for coronary calcium scores in relation to risk factors varied. For the very severe coronary calcification level, the strongest predictor was the presence of smoking and diabetes, which increased the odds for very severe calcification by 13.46 times. Patients who had multiple cardiovascular risk factors, hypertension, diabetes, and smoking were 9.18 times more likely to have very severe calcification.

A Pilot Study on the Role of Computed Tomography in the Management of Patients with Coronary Artery Anomalies in Romania.

Coronary artery anomalies may occur during embryogenesis and can lead to changes in the vascularization of the heart, possible ischemia, and an increased risk of sudden death. A retrospective study was conducted with the aim of assessing the prevalence of coronary anomalies in a Romanian sample of patients, investigated with computed tomography angiography for coronary artery disease. The objectives of the study were to identify the anomalies of the coronary arteries and to conduct an anatomical classification according to Angelini. The study also consisted of evaluations regarding coronary artery calcification in the sample of patients by the Agatston calcium score and assessments regarding the presence of cardiac symptoms and their association with coronary abnormalities. The results showed a prevalence of coronary anomalies of 8.7%, of which 3.8% were origin and course anomalies and 4.9% were coronary anomalies with intramuscular bridging of the left anterior descending artery. Recommendations for practice include the widespread use of coronary computed tomography angiography for the diagnosis of coronary artery anomalies and coronary artery disease in larger patient groups and encouraging this investigation across the country.

Classification of Pulmonary Damage Stages Caused by COVID-19 Disease from CT Scans via Transfer Learning.

The COVID-19 pandemic has produced social and economic changes that are still affecting our lives. The coronavirus is proinflammatory, it is replicating, and it is quickly spreading. The most affected organ is the lung, and the evolution of the disease can degenerate very rapidly from the early phase, also known as mild to moderate and even severe stages, where the percentage of recovered patients is very low. Therefore, a fast and automatic method to detect the disease stages for patients who underwent a computer tomography investigation can improve the clinical protocol. Transfer learning is used do tackle this issue, mainly by decreasing the computational time. The dataset is composed of images from public databases from 118 patients and new data from 55 patients collected during the COVID-19 spread in Romania in the spring of 2020. Even if the disease detection by the computerized tomography scans was studied using deep learning algorithms, to our knowledge, there are no studies related to the multiclass classification of the images into pulmonary damage stages. This could be helpful for physicians to automatically establish the disease severity and decide on the proper treatment for patients and any special surveillance, if needed. An evaluation study was completed by considering six different pre-trained CNNs. The results are encouraging, assuring an accuracy of around 87%. The clinical impact is still huge, even if the disease spread and severity are currently diminished.

Prognostic markers in the pathology of cardiac failure: echocardiography and autonomic nervous system dysfunction.

INTRODUCTION: Chronic heart failure is a major health problem worldwide and despite the therapeutic advances, the mortality and morbidity still remain high. Echocardiography is the gold standard for left ventricular function assessment and may provide prognostic information for predicting future heart failure events. PATIENTS AND METHODS: We analyzed the main echocardiographic markers used for the prognostic of chronic heart failure patients such as the ejection fraction, diastolic impairment and the collapse of inferior vena cava. Also, another parameter is studied, recently recognized as a marker for future cardiac events: autonomic nervous dysfunction. The current paper makes a comprehensive approach of the echocardiographic markers recommended for the diagnosis and follow-up of heart failure adapted to what we really find in our everyday practice with a correct patient management in a clinical and biological context. Even though left ventricle ejection fraction is the most often used parameter for cardiac failure follow-up and prognostic, new and more accurate parameters should be used: Tissue Doppler Imaging and Heart rate recovery - which may become a therapeutic target in the era of cardiac rehabilitation. CONCLUSIONS: There is no stand-alone marker for the assessment of cardiac failure; each of the parameters presented has its advantages and its pitfalls. Echocardiography allows a morphologic study, which should always be correlated with clinical and functional studies (exercise stress test and autonomic nervous system dysfunction).