Next-day Discharge Following Transcatheter Aortic Valve Implantation With The Acurate neo/neo2 Self-expanding Aortic Bioprosthesis.

Prior studies have shown the safety of early discharge (ED) pathways in selected patients and using selected transcatheter heart valves. Hence, we sought to evaluate the safety of next-day discharge (NDD) in patients who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) with the Acurate neo/neo2 (Boston Scientific, Marlborough, MA) self-expanding aortic bioprosthesis. Patients who underwent TF-TAVI between January 2018 and April 2023 were prospectively included. Patients were stratified into 3 groups according to discharge times within 24h (NDD), between 24-48h and those discharged >48h following TAVI. The primary outcome was the first unplanned readmission at 30 days after TAVI. Log-rank test was used to assess differences in the outcome of interest among groups. A total of 368 allcomers were included in this study. According to discharge times, 204 patients followed NDD, 69 patients 24-48h discharge and 95 patients >48h discharge following TAVI. The mean age was 84±6.3 years and 61% were female, without differences between groups. The mean STS-score was lower among those with NDD versus 24-48h and >48h (2.9±1.0, 3.2±1.2 and 3.4±1.4, respectively, P=0.014). There were no differences between the groups in terms of preprocedural right bundle branch block or pacemaker. The need for new permanent pacemaker implantation (PPI) was the leading postprocedural complication; it occurred more frequently among the >48h group compared with the 24-48h and <24h groups (24% versus 8.6% and 2.2%, P<0.001). There were 5 (1.4%) strokes and all of them occurred in the >48h group (P=0.005). At 30 days after discharge, there were no deaths, and no differences in all-cause readmissions (9.3% in <24h, 8.6% in 24-48h, and 19% in >48h, log-rank P=0.087). Readmission rates for new PPI requirement were 3.3% (n=6) in NDD, 0% in 24-48h and 1.6% (n=5) in >48h groups (P=0.27). In conclusion, in unselected patients undergoing TF-TAVI with the Acurate neo/neo2 self-expanding bioprosthesis, the NDD pathway is feasible and appears to be safe, without an increased risk of death or all-cause rehospitalization through 30 days after hospital discharge.

Effects of Implantable Cardioverter-Defibrillator Leads on the Tricuspid Valve and Right Ventricle: A Randomized Trial.

BACKGROUND: There are no randomized data to inform the extent to which transvenous cardiac leads cause tricuspid regurgitation (TR). OBJECTIVES: This study sought to determine the effect of a transvenous implantable cardioverter-defibrillator (TV-ICD) on TR severity, and secondarily, on right ventricular (RV) size and function. METHODS: We evaluated TR severity before and 6 months after implantable cardioverter-defibrillator insertion in a post hoc analysis of adults randomized to receive a transvenous (n = 252) or subcutaneous implantable cardioverter-defibrillator (S-ICD) (n = 251) device. TR and RV size and systolic function were assessed by echocardiographic images analyzed in a core laboratory. RESULTS: At baseline, at least mild TR was present in 30% of individuals. At 6 months, the proportion of participants with any TR in the TV-ICD group was 42% vs 19% in the S-ICD group (P < 0.001). The proportion with moderate or severe TR was 7% in the TV-ICD group vs 2% in the S-ICD group (P = 0.021). At 6 months, the OR of at least 1 grade worsening of TR in the TV-ICD group as compared with the S-ICD group was 7.2 (95% CI: 3.3-15.8; P < 0.001). There were no differences between groups with respect to RV size or systolic function. CONCLUSIONS: Six months following TV-ICD insertion, there was a 7-fold increase in the risk of at least 1 grade worsening of TR, with 7% of individuals having TR that was moderate or severe. There was no detectable difference in RV size or function; however, longer follow-up is needed.

Acute graft rejection mimicking constrictive pericarditis after heart transplantation. A case report.

Constrictive pericarditis (CP) is an infrequent complication following heart transplantation (HTx) and arises from diverse postoperative occurrences, including mediastinitis, pericardial effusion, or allograft rejection. Indeed, this rare clinical entity can be misdiagnosed as a rejection episode or restrictive cardiomyopathy. In this report, we present the case of a 43-year-old male who underwent HTx 1.5 years prior and was subsequently admitted to our center due to the gradual onset of symptoms indicative of right congestive heart failure, with an initial diagnosis of constrictive pericarditis.

La pericarditis constrictiva (PC) representa una complicación rara después de un trasplante de corazón (TC), derivada de diversos eventos posoperatorios como mediastinitis, derrame pericárdico o rechazo del injerto. De hecho, esta entidad clínica poco común puede ser diagnosticada erróneamente como un episodio de rechazo o miocardiopatía restrictiva. En este informe presentamos el caso de un hombre de 43 años que se sometió a un TC 1,5 años antes y que fue ingresado posteriormente a nuestra institución debido al inicio gradual de síntomas indicativos de insuficiencia cardíaca congestiva derecha, con diagnóstico inicial de pericarditis constrictiva.

Veno-arterial ECMO ventricular assistance as a direct bridge to heart transplant: A single center experience in a low-middle income country.

INTRODUCTION: The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a direct bridge to heart transplantation (BTT) is not common in adults worldwide. BTT with ECMO is associated with increased early/mid-term mortality compared with other interventions. In low- and middle-income countries (LMIC), where no other type of short-term mechanical circulatory support is available, its use is widespread and increasingly used as rescue therapy in patients with cardiogenic shock (CS) as a direct bridge to heart transplantation (HT). OBJECTIVE: To assess the outcomes of adult patients using VA-ECMO as a direct BTT in an LMIC and compare them with international registries. METHODS: We conducted a single-center study analyzing consecutive adult patients requiring VA-ECMO as BTT due to refractory CS or cardiac arrest (CA) in a cardiovascular center in Argentina between January 2014 and December 2022. Survival and adverse clinical events after VA-ECMO implantation were evaluated. RESULTS: Of 86 VA-ECMO, 22 (25.5%) were implanted as initial BTT strategy, and 52.1% of them underwent HT. Mean age was 46 years (SD 12); 59% were male. ECMO was indicated in 81% for CS, and the most common underlying condition was coronary artery disease (31.8%). Overall, in-hospital mortality for VA-ECMO as BTT was 50%. Survival to discharge was 83% in those who underwent HT and 10% in those who did not, p < .001. In those who did not undergo HT, the main cause of death was hemorrhagic complications (44%), followed by thrombotic complications (33%). The median duration of VA-ECMO was 6 days (IQR 3-16). There were no differences in the number of days on ECMO between those who received a transplant and those who did not. In the Spanish registry, in-hospital survival after HT was 66.7%; the United Network of Organ Sharing registry estimated post-transplant survival at 73.1% ± 4.4%, and in the French national registry 1-year posttransplant survival was 70% in the VA-ECMO group. CONCLUSIONS: In adult patients with cardiogenic shock, VA-ECMO as a direct BTT allowed successful HT in half of the patients. HT provided a survival benefit in listed patients on VA-ECMO. We present a single center experience with results comparable to those of international registries.

Use of glucarpidase (carboxypeptidase-G2) in pediatric cancer patients: 11-year experience of a tertiary center.

Methotrexate is an essential drug in the treatment of childhood cancer that is not exempt from toxicities. Glucarpidase is a drug used to reduce the toxic concentration of plasma methotrexate in patients with delayed elimination or at risk of toxicity. We describe the characteristics of a cohort of pediatric patients that received glucarpidase and analyze its role in the treatment of toxicity induced by high doses of methotrexate (HDMTX). Retrospective observational study of all pediatric cancer patients who received glucarpidase between 2012 and 2022 at a single center. Fifteen patients were treated with a single dose of glucarpidase, eleven of them presented with acute lymphoblastic leukemia and received HDMTX at 5 g/m2 in 24-hour infusion. In eight patients, glucarpidase was administered during the first cycle of HDMTX. The indication in thirteen cases was acute renal failure with delayed elimination of plasma methotrexate. The median maximum creatinine was 1.22 mg/dl (0.68 2.01 mg/dl), with a median increase over its baseline level of 313%. All patients normalized renal function after glucarpidase administration, with a median methotrexate excretion time of 193 hours (42-312 hours). No grade ≥2 adverse events derived from carboxypeptidase administration. Eleven patients received new doses of HDMTX in subsequent cycles, without new episodes of serious toxicity. The use of glucarpidase is effective and safe in the treatment of acute renal failure and methotrexate elimination delay in pediatric cancer patients. Further HDMTX doses may be prescribed without additional toxicities.

Cardiac Interventions in Patients With Active, Advanced Solid and Hematologic Malignancies: JACC: CardioOncology State-of-the-Art Review.

Invasive cardiac interventions are recommended to treat ST-segment elevation myocardial infarction, non-ST-segment elevation acute coronary syndromes, multivessel coronary disease, severe symptomatic aortic stenosis, and cardiomyopathy. These recommendations are based on randomized controlled trials that historically included few individuals with active, advanced malignancies. Advanced malignancies represent a significant competing risk for mortality, and there is limited evidence to inform the risks and benefits of invasive cardiac interventions in affected patients. We review the benefit conferred by invasive cardiac interventions; the periprocedural considerations; the contemporary survival expectations of patients across several types of active, advanced malignancy; and the literature on cardiovascular interventions in these populations. Our objective is to develop a rational framework to guide clinical recommendations on the use of invasive cardiac interventions in patients with active, advanced cancer.

Diagnosis and Management of Cardiovascular Effects of Bruton's Tyrosine Kinase Inhibitors.

PURPOSE OF REVIEW: Bruton's tyrosine kinase inhibitors (BTKis) have changed the treatment and prognosis of several B-cell malignancies. However, since the approval of the first BTKi, ibrutinib, reports of cardiovascular adverse events especially atrial fibrillation have arisen. In this review, we discuss the cardiovascular side effects of BTKis and the management of these toxicities in clinical practice. RECENT FINDINGS: BTKIs increase the risks of atrial fibrillation, bleeding, hypertension, heart failure, and potentially ventricular arrhythmia. Newer second and third-generation BTKis appear to have a lower risk of cardiovascular adverse events; however, long-term follow-up data are not available for these new BTKis. BTKis are an effective treatment for some B-cell malignancies; however, they can cause cardiovascular side effects. The best preventive strategies to minimize cardiovascular complications remain undefined. Currently, a practical approach for managing patients receiving BTKis includes the management of cardiovascular risk factors and side effects of BTKis to prevent interruption of cancer treatment.

Asociación entre niveles de empatía en médicos y satisfacción del paciente / Association between empathy levels in physicians and patient satisfaction

Resumen Introducción: Una buena relación médico-paciente es crucial para la práctica médica. Un elemento fundamen tal de la misma es la empatía del médico tratante, y esta puede ser cuantificada mediante una escala validada llamada Escala de Empatía de Jefferson. Métodos: En este estudio buscamos correlacionar los valores de empatía de los médicos del servicio con los resultados de las encuestas de satisfacción del pa ciente ambulatorio, medido mediante una herramienta llamada HCAPS. Resultados: Encontramos que los pacientes percibían un mayor trato respetuoso y que se les explicaba mejor sus opciones de tratamiento por parte de los médicos con mayores niveles de empatía. No hubo diferencias en los niveles de empatía de los médicos según su edad, sexo, o tiempo desde la obtención del título de especialista. Discusión: Los resultados validan a la empatía como una habilidad clave dentro de la relación médico-paciente.

Abstract Introduction: A good doctor-patient relationship is crucial to medical practice. A fundamental element of it is the empathy of the treating physician, and it can be quantified by means of a validated scale called the Jefferson Empathy Scale. Methods: In this study we sought to correlate the empathy values of our physicians with the results of outpatient satisfaction surveys, measured using a tool called HCAPS. Results: We found that patients perceived greater respectful treatment and had their treatment options better explained to them by physicians with higher lev els of empathy. There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist. Discussion: These results validate empathy as a key skill in the doctor-patient relationship.

[Association between empathy levels in physicians and patient satisfaction]. / Asociación entre niveles de empatía en médicos y satisfacción del paciente.

INTRODUCTION: A good doctor-patient relationship is crucial to medical practice. A fundamental element of it is the empathy of the treating physician, and it can be quantified by means of a validated scale called the Jefferson Empathy Scale. METHODS: In this study we sought to correlate the empathy values of our physicians with the results of outpatient satisfaction surveys, measured using a tool called HCAPS. RESULTS: We found that patients perceived greater respectful treatment and had their treatment options better explained to them by physicians with higher levels of empathy. There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist. DISCUSSION: These results validate empathy as a key skill in the doctor-patient relationship.

Introducción: Una buena relación médico-paciente es crucial para la práctica médica. Un elemento fundamental de la misma es la empatía del médico tratante, y esta puede ser cuantificada mediante una escala validada llamada Escala de Empatía de Jefferson. Métodos: En este estudio buscamos correlacionar los valores de empatía de los médicos del servicio con los resultados de las encuestas de satisfacción del paciente ambulatorio, medido mediante una herramienta llamada HCAPS. Resultados: Encontramos que los pacientes percibían un mayor trato respetuoso y que se les explicaba mejor sus opciones de tratamiento por parte de los médicos con mayores niveles de empatía. No hubo diferencias en los niveles de empatía de los médicos según su edad, sexo, o tiempo desde la obtención del título de especialista. Discusión: Los resultados validan a la empatía como una habilidad clave dentro de la relación médico-paciente.

Telemonitoreo y sistema de alerta en tiempo real en insuficiencia cardiaca: estudio piloto de factibilidad, aceptabilidad y eficacia / Telemonitoring and a real-time alert system in heart failure: a preliminary pilot study of feasibility, acceptability and efficacy

Resumen Introducción: Existe creciente evidencia que el telemonitoreo (TM) de pacientes con insuficiencia cardíaca (IC) parece mejorar su evolución. No se han diseñado y evaluado plataformas de TM en Argentina. El objetivo fue evaluar la factibilidad, aceptabilidad, usabilidad y eficacia preliminar de una plataforma de TM de IC. Métodos: Se realizó un ensayo piloto apareado abierto, con un modelo de intervención de un solo grupo. Los pacientes con IC fueron incluidos en una consulta ambulatoria en enero de 2021. Se diseñó una pla taforma de TM las 24 h y 7 días de la semana. El punto final primario a 30 días fue la factibilidad, aceptabilidad y usabilidad. Resultados: Se incluyeron 20 pacientes, con una media de edad 62 ± 10 años. Se analizaron 542 cargas de parámetros. La autopercepción relacionada al estado de salud en comparación al inicio fue "levemente" o "marcadamente mejor" en el 60% de los pacientes, y en 75% "de acuerdo" o "totalmente de acuerdo" que el TM mejora el cuidado de la IC. En el 80% la carga diaria de parámetros no interfirió en su vida cotidiana. La media total de adherencia farmacológica previa a la intervención de TM fue de 6.8 ± 1.3 y posterior 7.7 ± 0,4 (p = 0.019), sin encontrar diferencias en las escalas de autocuidado. Conclusión: El TM de pacientes con IC parece ser factible, con un adecuado grado de aceptabilidad. Se observó un aumento significativo en la tasa de total adherencia, plantea una hipótesis de potencial beneficio a evaluar en una muestra mayor.

Abstract Introduction: There is growing evidence that telemonitoring (TM) in heart failure (HF) seems to improve their outcome. TM platforms have not been designed and evaluated in Argentina. The objective was to evaluate the feasibility, acceptability, usability and preliminary efficacy of a HF TM platform. Methods: An open-label, paired pilot trial was conducted with a single-group intervention model. HF patients were included in an outpatient clinic in January 2021. A 24-hour*7-day TM platform was designed. The primary endpoint at 30 days was feasibility, acceptability, and usability. Results: Twenty patients were included, mean age 62 ± 10 years; 542 parameter loads were analyzed. Self-perception related to health status compared to baseline was "slightly" or "markedly better" in 60% of patients, and in 75% "agree" or "totally agree" that TM improves patient care. In 80%, the load ing of parameters did not interfere with their daily activities. The total mean pharmacological adherence prior to the TM intervention was 6.8 ± 1.3 and 7.7 ± 0.4 afterward (p = 0.019), with no differences found in the self-care scales. Conclusion: The TM of patients with HF seems to be feasible, with an adequate degree of acceptability. A significant increase in the total adherence rate was reduced, raising a hypothesis of potential benefit to be evaluated in a larger sample.

[Telemonitoring and a real-time alert system in heart failure: a preliminary pilot study of feasibility, acceptability and efficacy]. / Telemonitoreo y sistema de alerta en tiempo real en insuficiencia cardiaca: estudio piloto de factibilidad, aceptabilidad y eficacia.

INTRODUCTION: There is growing evidence that telemonitoring (TM) in heart failure (HF) seems to improve their outcome. TM platforms have not been designed and evaluated in Argentina. The objective was to evaluate the feasibility, acceptability, usability and preliminary efficacy of a HF TM platform. METHODS: An open-label, paired pilot trial was conducted with a single-group intervention model. HF patients were included in an outpatient clinic in January 2021. A 24-hour 7-day TM platform was designed. The primary endpoint at 30 days was feasibility, acceptability, and usability. RESULTS: Twenty patients were included, mean age 62 ± 10 years; 542 parameter loads were analyzed. Self-perception related to health status compared to baseline was "slightly" or "markedly better" in 60% of patients, and in 75% "agree" or "totally agree" that TM improves patient care. In 80%, the loading of parameters did not interfere with their daily activities. The total mean pharmacological adherence prior to the TM intervention was 6.8 ± 1.3 and 7.7 ± 0.4 afterward (p = 0.019), with no differences found in the self-care scales. CONCLUSION: The TM of patients with HF seems to be feasible, with an adequate degree of acceptability. A significant increase in the total adherence rate was reduced, raising a hypothesis of potential benefit to be evaluated in a larger sample.

Introducción: Existe creciente evidencia que el telemonitoreo (TM) de pacientes con insuficiencia cardíaca (IC) parece mejorar su evolución. No se han diseñado y evaluado plataformas de TM en Argentina. El objetivo fue evaluar la factibilidad, aceptabilidad, usabilidad y eficacia preliminar de una plataforma de TM de IC. Métodos: Se realizó un ensayo piloto apareado abierto, con un modelo de intervención de un solo grupo. Los pacientes con IC fueron incluidos en una consulta ambulatoria en enero de 2021. Se diseñó una plataforma de TM las 24 h y 7 días de la semana. El punto final primario a 30 días fue la factibilidad, aceptabilidad y usabilidad. Resultados: Se incluyeron 20 pacientes, con una media de edad 62 ± 10 años. Se analizaron 542 cargas de parámetros. La autopercepción relacionada al estado de salud en comparación al inicio fue "levemente" o "marcadamente mejor" en el 60% de los pacientes, y en 75% "de acuerdo" o "totalmente de acuerdo" que el TM mejora el cuidado de la IC. En el 80% la carga diaria de parámetros no interfirió en su vida cotidiana. La media total de adherencia farmacológica previa a la intervención de TM fue de 6.8 ± 1.3 y posterior 7.7 ± 0,4 (p = 0.019), sin encontrar diferencias en las escalas de autocuidado. Conclusión: El TM de pacientes con IC parece ser factible, con un adecuado grado de aceptabilidad. Se observó un aumento significativo en la tasa de total adherencia, plantea una hipótesis de potencial beneficio a evaluar en una muestra mayor.

Multiparameters associated to successful weaning from VA ECMO in adult patients with cardiogenic shock or cardiac arrest: Systematic review and meta-analysis.

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39-50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33-60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3-18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8-26.4 I2 = 0) were higher. They also had lower values of creatinine [MD -0.59 (95%CI: -0.9 to -0.2) I2 = 7%], lactate [MD -3.1 (95%CI: -5.4 to -0.7) I2 = 89%], and creatine kinase [-2779.5 (95%CI: -5387 to -171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: -0.2-36.2) I2 = 91%, and MD 15.9% (95%CI 11.9-20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.

[Impact of a multidisciplinary team "ECMO Team" on the prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock and cardiac arrest]. / Impacto del equipo multidisciplinario "ECMO Team" en el pronóstico de pacientes sometidos a membrana de oxigenación extracorpórea venoarterial por choque cardiogénico o paro cardiorrespiratorio refractario.

Objectives: Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown. Objective: We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA. Materials and methods: . We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume. Results: Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for device indication was different: postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal cardiopulmonary resuscitation was 14.5%. The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37), and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2 +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups. Conclusions: After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.

Design and rationale of the inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure (CAVAL US-AHF Study): a randomised controlled trial.

BACKGROUND: Between 25% and 30% of patients hospitalised for acute heart failure (AHF) are readmitted within 90 days after discharge, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. OBJECTIVE: To evaluate if inferior vena cava (IVC) and lung ultrasound (CAVAL US)-guided therapy for AHF patients reduces subclinical congestion at discharge. METHODS: CAVAL US-AHF is a single-centre, single-blind randomised controlled trial designed to evaluate if an IVC and lung ultrasound-guided healthcare strategy is superior to standard care to reduce subclinical congestion at discharge. Fifty-eight patients with AHF will be randomised using a block randomisation programme that will assign to either lung and IVC ultrasound-guided decongestion therapy ('intervention group') or clinical-guided decongestion therapy ('control group'), using a quantitative protocol and will be classified in three groups according to the level of congestion observed: none or mild, moderate or severe. The treating physicians will know the result of the test and the subsequent adjustment of treatment in response to those findings guided by a customised therapeutic algorithm. The primary endpoint is the presence of more than five B-lines and/or an increase in the diameter of the IVC, with and without collapsibility. The secondary endpoints are the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days, variation of pro-B-type natriuretic peptide at discharge, length of hospital stay and diuretic dose at 90 days. Analyses will be conducted as between-group by intention to treat. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Review Board and registered in the PRIISA.BA platform of the Ministry of Health of the City of Buenos Aires. TRIAL REGISTRATION NUMBER: NCT04549701.

How a pediatric neuro-oncology unit was managed in Madrid during the first wave of the COVID-19 pandemic.

INTRODUCTION: During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, infection prevention measures were enforced at our Pediatric Neuro-Oncology unit. METHODS: A retrospective study analyzing patients booked in this unit during lockdown was performed to describe its performance. RESULTS: There were 438 consultations for 123 patients (320 on-site/118 telephone). Eight new diagnoses were made, with one significant delay. Only one patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Delay in imaging testing occurred in 15 patients. Chemotherapy was delayed in one case. There were no delays in radiotherapy. CONCLUSIONS: Measures implemented were effective in minimizing the risk of COVID-19 infection, achieving continuity in diagnoses and treatment, and avoiding delays that could impact survival.

Burnout Syndrome in Cardiology Residents. Impact of the COVID-19 Pandemic on Burnout Syndrome in Cardiology Residents.

Burnout syndrome (BO) may be increased during periods of high work and emotional stress, as occurred in the 2019 coronavirus disease pandemic (COVID-19). Resident physicians appear to be more exposed due to the higher workload, prolonged exposure and the first contact with patients. To compare the incidence of burnout syndrome before and during the COVID 19 pandemic in cardiology residents. A prospective study was carried out. The Maslach questionnaire was implemented in cardiology residents of an institution of the City of Buenos Aires, in the month of September 2020, during the COVID-19 pandemic and the results were compared with those prospectively collected in the same population during September of 2019. The survey was anonymous. The questionnaire was responded by 39 residents (2019: 16; 2020: 23). Burnout was observed in 30% (n = 7) in 2019, and in 39% (9%) residents during the COVID-19 pandemic (P= 0.77). The median score for emotional exhaustion was 38 (IQR 29-43) for the 2020s group, and 34 (IQR 27-42) for the 2019 (P = 0.32). The median score for depersonalization was 12 (IQR 5-19) and 15 (IQR 11-18) for 2020 and 2019 respectively (P = 0.50). The median score for personal accomplishment in the 2020s group was 30 (IQR 23-37) and 31 (IQR 26-35) in the 2019s (P = 0.28). The COVID-19 pandemic was not associated with an increase in the incidence of burnout in cardiology residents, who already report a significant prevalence of this syndrome in pre pandemic period. We emphasize the importance of creating prevention strategies aimed at improving resident's working conditions and quality of life, especially in periods of high stress and workload such as a global health emergency.

Usefulness of Ultrasound in the Diagnosis of Intestinal Anisakiasis.

OBJECTIVES: To evaluate the ultrasound (US) findings of gastrointestinal anisakiasis and the utility of US in its early diagnosis. METHODS: We retrospectively assessed the imaging findings and clinical data of 21 patients with gastrointestinal anisakiasis. Diagnosis was confirmed by a positive antigen (n = 16), endoscopy (n = 2), or a compatible clinical presentation, physical examination, and history of raw fish consumption (n = 3). Ultrasound findings reviewed included segmental circumferential bowel wall thickening, segmental edema of the valvulae conniventes, dilated small bowel loops with hyperperistalsis or hypoperistalsis, free fluid, and color Doppler hyperemia. RESULTS: Segmental circumferential bowel wall thickening was present in all 21 patients, whereas segmental edema of the valvulae conniventes was visualized in 13 patients, moderately dilated small-bowel loops proximal to the affected segment with increased peristalsis in 14 patients, small-to-moderate ascites in 18 patients, and color Doppler hyperemia in 7 patients. The US evaluation ruled out a surgical pathologic examination in all patients, and the diagnosis of anisakiasis was suggested by the radiologist on the basis of US findings in 12 patients. CONCLUSIONS: Familiarity with the suggestive US presentation of intestinal anisakiasis may allow the radiologist to propose the diagnosis of this overlooked cause of abdominal pain and may also prompt an investigation of recent raw or lightly cooked seafood ingestion. Ultrasound findings of bowel wall thickening, especially segmental edema of the valvulae conniventes, hyperperistalsis, and dilatation of small-bowel loops proximal to the affected segment, ascites, and color Doppler hyperemia, along with a history of raw fish ingestion should aid the radiologist in the diagnosis of anisakiasis.

Vascular calcification in patients with nondialysis CKD over 3 years.

BACKGROUND AND OBJECTIVES: Vascular calcification (VC) is common in CKD, but little is known about its prognostic effect on patients with nondialysis CKD. The prevalence of VC and its ability to predict death, time to hospitalization, and renal progression were assessed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Study of Mineral and Bone Disorders in CKD in Spain is a prospective, observational, 3-year follow-up study of 742 patients with nondialysis CKD stages 3-5 from 39 centers in Spain from April to May 2009. VC was assessed using Adragao (AS; x-ray pelvis and hands) and Kauppila (KS; x-ray lateral lumbar spine) scores from 572 and 568 patients, respectively. The primary end point was death. Secondary outcomes were hospital admissions and appearance of a combined renal end point (beginning of dialysis or drop >30% in eGFR). Factors related to VC were assessed by logistic regression analysis. Survival analysis was assessed by Cox proportional models. RESULTS: VC was present in 79% of patients and prominent in 47% (AS≥3 or KS>6). Age (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.02 to 1.07; P<0.001), phosphorous (OR, 1.68; 95% CI, 1.28 to 2.20; P<0.001), and diabetes (OR, 2.11; 95% CI, 1.32 to 3.35; P=0.002) were independently related to AS≥3. After a median follow-up of 35 months (interquartile range=17-36), there were 70 deaths (10%). After multivariate adjustment for age, smoking, diabetes, comorbidity, renal function, and level of phosphorous, AS≥3 but not KS>6 was independently associated with all-cause (hazard ratio [HR], 2.07; 95% CI, 1.07 to 4.01; P=0.03) and cardiovascular (HR, 3.46; 95% CI, 1.27 to 9.45; P=0.02) mortality as well as a shorter hospitalization event-free period (HR, 1.14; 95% CI, 1.06 to 1.22; P<0.001). VC did not predict renal progression. CONCLUSIONS: VC is highly prevalent in patients with CKD. VC assessment using AS independently predicts death and time to hospitalization. Therefore, it could be a useful index to identify patients with CKD at high risk of death and morbidity as previously reported in patients on dialysis.