Monocentric Observational Study Research Articles

How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience.

The standardization of preoperative imaging in primary hyperparathyroidism is one of the current challenges of endocrine surgery. A correct localization of the hypersecretory gland by neck ultrasound and 99mTc-sestamibi (MIBI) scintigraphy are not sufficiently sensitive in some cases. In recent years, CT-4D, 18F-Fluorocholine PET/CT, and radio-guided parathyroidectomy have come into common use. The aim of this study is to evaluate the performance of 18F-Fluorocholine PET/CT after prior negative or discordant first-line imaging in patients with primary hyperparathyroidism undergoing parathyroid surgery. Monocentric observational study on patients affected by pHPT undergoing surgery from July 2009 to April 2024at the Division of General Surgery, Cattinara Teaching Hospital of Trieste. Preoperative, intra-operative, and follow-up data were collected. The imaging methods used were neck ultrasound, 99mTc-sestamibi (MIBI) scintigraphy, and 18F-Fluorocholine PET/CT (since 2018). 172 patients were included. As first radiologic examination, neck ultrasound (US) was performed in 140 cases and 99mTc-sestamibi (MIBI) scintigraphy in 162. Ultrasound and/or scintigraphy imaging were sufficient for the identification of the gland in 127 patients (73.8%), while in 45 patients (26.2%), the localization was defined with other techniques. Particularly, three patients with negative or discordant first-line imaging underwent neck 4D-CT scan who was useful for parathyroid localization all cases (100%). Only one patient received a neck magnetic resonance (MRI) and resulted positive for preoperative localization. Starting in 2018, 29 out of 45 patients underwent 18F-FCH PET/CT yielding a positive result in 29 patients (100%). In other 16 cases (before the introduction of PET/CT in our preoperative imaging study), the preoperative localization was inconclusive and bilateral neck exploration (BNE) was necessary. The sample was homogeneous in terms of age, anthropometric characteristics, and preoperative biochemical parameters. Male/female ratio was 1:5.1. In the intra-operative site, in the cases of exclusive PET/CT positivity, in 28 cases (96.5%), a diagnostic agreement was confirmed, and the gland was macroscopically smaller or normal in size. The combination of ultrasound and MIBI scintigraphy remains the preferred imaging approach for preoperative studies of pHPT. If secondary imaging is required, 18F -FCH PET/CT stands out as the most advantageous option due to its ability to provide anatomical and functional specificity. FCH PET/CT resulted an effective imaging modality with the highest sensitivity of the available imaging techniques for localizing the hyperfunctioning parathyroid gland. Therefore, this method can be recommended in patients showing negative or inconclusive results in the conventional diagnostic imaging.

Correlation between skin cancer and therapy with anti-IL monoclonal antibodies in patients affected by moderate-to-severe psoriasis: an observational monocentric study.

Our study aimed to investigate the correlation between skin cancer and anti-interleukin (IL) therapy in patients with moderate-to-severe psoriasis. This was an observational monocentric study in which we enrolled a total of 235 patients in which 127 patients were affected by moderate-to-severe psoriasis and treated with anti-IL monoclonal antibodies (mAbs) for at least 6 months, whereas 108 patients affected by mild psoriasis were treated with topical therapies. Afterward, we performed a dermatologic visit to all the subjects, collecting anamnestic information including risk factors for skin cancer. We examined the skin lesions on their entire body by polarized and nonpolarized dermoscopy. A total of 21 suspicious lesions in the first group and 17 in the second one were removed and histologically analyzed. Twelve (9.4%) cancerous or precancerous lesions were found in the first group: seven (5.5%) basal cell carcinoma (BCC) and five actinic keratosis. The mean time to cancer onset was identified as 22 months after the start of four therapy, with an SD of 18 months, suggesting an earlier onset with respect to the start of therapy in our population. On univariate analysis, age (P = 0.001) and age of psoriasis onset (0.009) were statistically significant. Nine of 17 were skin cancers in the second group. Our study provided real-life evidence of the percentage of patients with skin cancers during therapy with anti-IL mAbs, demonstrating a good safety profile of the investigated drugs.

Clinical Characteristics and Outcomes in Patients with Chronic HBV Infection and Hospitalized for COVID-19 Pneumonia: A Retrospective Cohort Study

The effects of a concomitant infection of hepatitis B virus (HBV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are still debated, with a recognized major risk of HBV reactivation during immune-suppressive treatments. The aim of this study was to determine the prevalence and predictive factors of HBV reactivation in a cohort of hospitalized patients with coronavirus disease 2019 (COVID-19) and a current or past hepatitis B infection. In a monocentric retrospective observational study, we enrolled all consecutive hospital admitted patients with COVID-19 pneumonia and a positive HBV serology (N = 84) in our Infectious Diseases Unit from April 2021 to December 2023. We identified 18 (21%) HBsAg-positive/anti-HBc-positive, 41 (49%) HBsAg-negative/anti-HBc-positive/anti-HBs-positive, and 25 (30%) HBsAg-negative/anti-HBc-positive/anti-HBs-negative subjects. The overall rate of hepatitis flare was 10.7%, without any HBsAg seroreversion, severe HBV reactivation, and/or need for new HBV antiviral therapy introduction. Systemic corticosteroid treatment for COVID-19 and baseline anti-HBsAg status were associated with this risk of HBV reactivation. In conclusion, the overall risk of hepatitis flares in hospitalized COVID-19 was reasonably low, with higher doses of corticosteroids treatment being the major risk factor for HBV reactivation, and anti-HBs-positive serological status as a protective element.

Endocrinologic Dysfunctions and Neuropsychiatric Sequelae in Pediatric Patients With a History of Central Nervous System Infection (ENDLESS): A Prospective Monocentric Study.

Central nervous system (CNS) infections represent some of the most critical pediatric health challenges, characterized by high mortality rates and a notable risk of long-term complications. Despite their significance, standardized guidelines for endocrinological follow-up of CNS infection survivors are lacking, leading to reliance on the expertise of individual centers and clinicians. Prospective monocentric observational study conducted at the Fondazione Policlinico Universitario Agostino Gemelli in Rome, Italy. It included patients with a history of CNS infection, admitted to various pediatric departments of the hospital. The participants were selected based on a coded diagnosis of CNS infection and had completed their follow-up at the Pediatric Endocrinology Day Hospital after October 2019. Eighty participants were included, comprising 53 patients with a prior CNS infection and 27 healthy controls, with a median age of 7.4 years (range 3.6-12.3 years). Endocrinologic alterations were detected in 13 patients, with 8 cases in those who had meningitis, 4 in encephalitis survivors, and 1 in a patient with a cerebral abscess. Patients with a history of CNS infections were shorter compared with healthy controls (P = 0.027). Moreover, those who had meningitis exhibited an increased risk of developing epilepsy (P = 0.01), neurosensory disabilities (P = 0.034) and the need for ventriculoperitoneal shunt insertion (P = 0.006). Patients with bacterial CNS infections were more prone to neurosensory and endocrine dysfunctions compared to those with viral or other infections. Significant differences were observed in hormone levels between previously infected patients and controls, specifically in TSH (P < 0.001), ACTH (P = <0.001), and cortisol (P = 0.019). IGF-1 levels were considerably lower in the infection group, both in absolute terms and when adjusted for sex and age (P < 0.001). The regression analysis suggested that the reduction in IGF-1 was more pronounced the earlier the CNS infection occurred, irrespective of infection type. Our study found several endocrinologic imbalances in children who survived CNS infections.

Acute type A aortic syndromes and ski: management in an emergency care network.

Skiing can cause aortic syndromes. The pre-hospital management of these patients may be compromised by the mountainous terrain. A regional emergency care network helps to optimize time frames, especially in a challenging geography. We compared the characteristics of patients operated for acute type A aortic syndromes (ATAAS) that occurred while skiing with those that did not. Monocentric retrospective observational study of patients operated for ATAAS from 01/01/1990 to 31/12/2019. Five hundred and twenty-three patients were included. Data were compared between skiers and non-skiers. Thirty-seven (7.1%) patients suffered from an acute type A aortic syndrome while skiing. Skiers were more often male (89.2% vs. 69.1%, P=0.017), younger (54.4±10.9 years vs. 63.5±13.0 years, P<0.001) and taller (175.9±8.1 cm vs. 171.6±9.4 cm, P=0.003). They were more often transported by helicopter (16.2% vs. 6.8%, P=0.048) and had less often isolated supra-coronary aortic replacements (51.4% vs. 71.6%, P=0.029). Skiing-related aortic syndromes were more frequent in patients not living in mountainous regions (70.3% vs. 20.4%, P< 0.001). Hospital mortality in skiers was comparable to the one in non-skiers (8.1% vs. 19.3%, P=0.122). People not acclimatized to high mountain conditions may be at greater risk of aortic syndrome while skiing. Our regional emergency care network facilitates rapid transfer of patients with increased use of helicopter transport for skiers, thereby limiting the mortality of skiing-related aortic syndromes.

Community-onset pediatric status epilepticus: Barriers to care and outcomes in a real-world setting.

Status epilepticus (SE) is a neurological emergency in childhood, often leading to neuronal damage and long-term outcomes. The study aims to identify barriers in the pre-hospital and in-hospital management of community-onset pediatric SE and to evaluate the effectiveness of pediatric scores on outcomes prediction. This monocentric observational retrospective cohort study included patients treated for community-onset pediatric SE in a tertiary care hospital between 2010 and 2021. Data were extracted following Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Inclusion criteria were community-onset SE (according to the International League Against Epilepsy [ILAE] Task Force on SE Classification), admission to the pediatric emergency department (PED), age: 1 month to 18 years. Pre-hospital, in-hospital management and outcomes were analyzed. Pediatric scores for prediction of clinical worsening (Pediatric Early Warning Score - PEWS) and SE outcome (Status Epilepticus in Pediatric patients Severity Score - STEPSS; Pre-status Epilepticus PCPCS, background Electroencephalographic abnormalities, Drug refractoriness, Semiology and critical Sickness Score - PEDSS) were retrospectively assessed for their accuracy in predicting short-term and long-term outcomes. A total of 103 consecutive episodes of SE were included. Out-of-hospital rescue medications administration occurred in 54.4% of cases and was associated with higher SE resolution rate before PED admission (48.2% vs 27.6%, p = .033). Longer in-PED time to treatment was observed in case of delay to PED referral (r = 0.268, p = .048) or non-red triage labels (12 vs 5 min, p = 0.032), and was associated with longer in-PED duration of SE (r = 0.645, p < .001). Longer SE duration was observed in episodes leading to hospitalization compared to those discharged (50 vs 16 min, p < .001). In-PED electroencephalography (EEG) recordings were available in 39.8% of events. Predictive scores varied in accuracy, with PEWS ≥5 showing high sensitivity for intensive care unit (ICU) admission but low specificity. No patients died, 6.3% of SE was refractory. Effective pre-hospital administration of rescue medications and prompt PED management are crucial to reduce SE duration and improve outcomes. Predictive scores can aid in assessment of the severity and prognosis of SE; their utility is still not defined. Identifying and addressing actionable care barriers in SE management pathways is essential to enhance patient outcomes in pediatric SE.

Impact of the interchangeability of infliximab biosimilars on the efficacy in patients followed for chronic inflammatory bowel disease within the gastroenterology department of CHU Mustapha Pacha.

Introduction. Infliximab (IFX) is a monoclonal antibody used in the treatment of chronic inflammatory bowel disease (IBD). Interchangeability is the medical practice of replacing one drug with another that is expected to produce the same clinical effect. Products intended for the treatment of inflammatory bowel diseases, such as infliximab, are dispensed according to the availability of products at the level of the central hospital pharmacy, which imposes interchangeability at the level of the user department. The lack of clinical data on this practice prompted us to evaluate the impact of the interchangeability of different infliximab molecules (originator and biosimilars) on efficacy, tolerability and the occurrence of adverse events in patients with IBD in the Gastroenterology Department of the MUSTAPHA PACHA CHU. Methods and materials. This is a monocentric observational study with retrospective data collection, carried out in the Gastroenterology Department of UNIVERSITY HOSPITAL OF MUSTAPHA PACHA using a data collection sheet filled from the patient's medical record and/or EXCEL file in collaboration with clinicians. Significance was calculated using the Fisher exact statistical test and the MC'namer test for assessment of maintenance of clinical and biological response before and after treatment interchangeability. Significance was assessed at P &lt; 0,05. Results: The study compared the clinical and biological response of patients with chronic inflammatory bowel disease (IBD) before and after interchangeability. Results showed that there was no significant difference in the clinical status of Crohn's disease patients (p =0,527), and that the four patients with ulcerative colitis in remission maintained the same profile after interchangeability. The Fisher exact test also showed that the variation in CRP value (P = 0,133) and Hb level (P = 0,167) were not significant. Conclusion. Interchangeability has no impact on the clinical and biological status of IBD patients.

A Prospective Monocentric Study of Invasive Breast Carcinoma Diagnosed at 80 Years and Older: Survival Outcomes and Peculiar Challenges.

Background: The lengthening of the lifespan led to an increase in breast cancer (BC) diagnosed in very old age, but the treatment recommendations in this patient group usually lack evidence-based practice. We conducted a prospective observational monocentric study specifically targeting patients diagnosed with invasive BC at 80 years of age or older. Methods: We enrolled 88 patients consecutively observed for a new BC diagnosis at 80 years or older. The aim was to investigate progression-free (PFS) and overall survival (OS), with a long follow-up period, along with clinico-pathological characteristics of the population. Results: At the end of the 5-year follow-up, the estimated OS and PFS probabilities were 82.9% (95% CI: 71.3-95.3%) and 64.0% (95% CI: 51.7-79.2%), respectively. After 8.5 years from the BC diagnosis, 48.9% died. The cause of death was BC in 32.6% of patients, different from BC in 13.9%, and unknown in the remaining. Surgery was performed in 69.3% of the cases and was associated with improved 12-month PFS (p < 0.001). Adjuvant systemic therapy and radiotherapy were omitted in 32% and 93% of eligible patients, respectively. A higher rate of metastatic disease at the diagnosis was observed in comparison with data described in younger people, as well as a significantly high rate of drop-out (27.3%). Conclusions: Ultra-old patients have a not negligible life expectancy; therefore, the oncologic treatment should be optimal and should adequately fight BC, always considering the quality of life of these frail patients. Future research should focus on developing personalized treatment protocols that incorporate comprehensive geriatric assessments and quality-of-life metrics. Additionally, larger, multicentric studies are needed to validate our findings and explore the role of emerging therapies in this age group.

A Decade of Non-Invasive Prenatal Testing (NIPT) for Chromosomal Abnormalities in Croatia: First National Monocentric Study to Inform Country's Future Prenatal Care Strategy.

Chromosomal numerical and structural alterations are significant causes of various developmental disorders in foetuses. Non-invasive prenatal testing (NIPT) has emerged as an effective screening tool for detecting common aneuploidies, aiding in the identification of individuals who may require further diagnostic work-up. This retrospective, monocentric observational study evaluates the usage patterns, test choices, turnaround times (TAT), and outcomes of NIPT between 2013 and 2023 on a sample of 2431 pregnant women at a special hospital offering outpatient services and comprehensive gynaecological/obstetric inpatient care. We analysed the trends in NIPT usage, high-risk results, prior screening procedures, as well as factors such as age, gestational age and in vitro fertilisation (IVF) status. NIPT was performed using cell-free foetal DNA (cffDNA) extracted from maternal plasma, followed by library construction, sequencing and result analysis. The sequencing results were aligned with reference genomes, and z-scores were calculated to assess the likelihood of aneuploidy. Statistical significance was set at p < 0.05. The average age of women undergoing NIPT decreased from 36.1 years in 2013 to 33.01 years in 2023 (p = 0.0287), and mean TAT dropped from 12.44 days in 2013 to 7.08 days in 2023 (p = 0.0121), with the most substantial reduction occurring between 2013 and 2019. The study identified a stable rate of women who underwent IVF seeking prenatal testing, with no statistically significant difference between the first half and the second half of the analysed period (p = 0.2659). Among high-risk results, there were 39 chromosomal abnormalities detected, most of them belonging to trisomy 21 (59%). Our findings demonstrate the increasing efficiency and accessibility of NIPT in prenatal care in Croatia, while the significant reduction in TAT and the decreasing age of women undergoing NIPT reflect enhanced operational practices and broader acceptance. Introducing NIPT into the public healthcare system in the Republic of Croatia could improve equitable access to advanced prenatal care and enhance pregnancy outcomes. Future advancements in technology and genetic counselling will further enhance its role, requiring careful attention to ethical and regulatory considerations.

Intra-abdominal pressure, renal resistive index, sublingual microcirculation and total body water for guidance of volume resuscitation to avoid acute kidney injury during shock therapy

Background/objectivesShock and accompanying acute kidney injury (AKI) as a frequent complication is a well-known cause of morbidity and mortality worldwide. The current standard parameters to guide fluid resuscitation therapy (i.e., cardiac output, heart rate, blood pressure, central venous pressure) to avoid AKI and renal replacement therapy remain imprecise, and fluid overload with consequent organ oedema and high intestinal pressures result in further complications. The VoluKid study investigated additional non-invasive fluid volume parameters including assessment of total body water (TBW), renal vascular resistance [renal resistive index (RRI)], intra-abdominal pressure (IAP) and microcirculatory blood flow (MBF) to predict AKI during the first 72 h of intensive care therapy.Methods, design and analysisThis mono-centre observational cohort study included patients with shock who presented to the intensive care unit (ICU). Routine volume resuscitation parameters (i.e., cardiac output, heart rate, blood pressure, central venous pressure) were used to guide fluid therapy. In addition, four parameters, including MBF using sublingual incident dark-field microscopy, IAP, RRI assessed by duplex-sonography, and TBW using bioimpedance analysis (BIA), were measured daily and evaluated for predicting the primary outcome of acute kidney injury (AKI) and need for renal replacement therapy within the first 72 h of admission. Baseline and post-ICU admission values of these parameters were compared between patients with and without AKI.ResultsA total of 45 patients were enrolled in this study. Of those 45 patients, 37 could be followed for the entire study period of 72 h and 14 patients developed AKI (31.1%). Twelve patients (26.7%) had pre-existing renal impairment, one of whom died during the observation period. Nineteen patients (42.2%) had no renal impairment. RRI and IAP did not differ between patients with AKI and without AKI and did not predict AKI. TBW measured by BIA predicted AKI (p = 0.029). After adjustment for covariates (age, body mass index,and gender) this prediction was not significant [adjusted odds rato (OR) 0.99, p = 0.258, 95% confidence interval (CI) [0.97,1.01]]. MBF could not be estimated due a high number of missing values.ConclusionsBased on our limited data, none of the non-invasive parameters (TBA, IAP, RRI,) serve as predictors for AKI when assessed during the first 72 h after ICU admission, either when analysed separately or in combination.RegistrationClinicalTrials.gov Identifier: NCT02666404, registered 28/01/2016; URL: https://classic.clinicaltrials.gov/ct2/show/NCT02666404.

Evolution of the medium-term functional outcomes of holmium laser prostate enucleation (HoLEP).

The boom in surgery for benign prostatic hyperplasia using Holmium laser enucleation (HoLEP) has reduced length of hospitalization, catheterization duration and the risk of bleeding, with comparable results to the old gold standard. The aim of this study is to evaluate the evolution of medium-term functional results after HoLEP. Retrospective monocentric observational study in patients who underwent HoLEP surgery from 2014 to 2019. We analyzed our post-operative functional results (scores USP, IPSS, QdV and Qmax) at short and medium term. The results were compared to preoperative data. At last consultation was performed at least one year after the procedure. A total of 338 patients underwent HoLEP surgery during this period. The mean follow-up time at the last consultation was 3.5 years. At the last consultation, the USP was 0.5 for the dysuria score (a 2.7-point improvement) (p<0.001), 1.6 points for the overactive bladder score (a 3.9-point improvement) (p<0.001), 0.5 for the stress urinary incontinence score (a 0.1-point improvement) (p=0.67). Among the patients, 2% had severe urinary incontinence (Stress urinary incontinence USP ≥ 7). The average IPSS at the last consultation was 3.7, an improvement of 16 points compared with the pre-operative score (p<0.001), and the average QoL was 1, a improvement of 4.3 (p<0.001). Surgical treatment of benign prostatic hyperplasia using HoLEP appears to be an efficient technique at medium term with a 2% rate of severe stress urinary incontinence. Overactive bladder is corrected from the 6th month postoperatively.

Long-term heart function in refractory out-of-hospital cardiac arrest treated with prehospital extracorporeal cardiopulmonary resuscitation

IntroductionExtracorporeal cardiopulmonary resuscitation (ECPR) is a treatment for refractory out-of-hospital cardiac arrest (OHCA), often due to acute coronary syndrome (ACS). However, the long-term impact of prehospital ECPR on heart function in surviving patients remains unclear. MethodsWe conducted a 9 year monocentric retrospective observational study in Paris, France (January 1, 2015, to December 31, 2023). Patients were included if they had a refractory OHCA caused by ACS and were treated with prehospital ECPR. The primary outcome was the New York Heart Association Functional Classification (NYHA-FC) at one year. We also evaluated survival with good neurological outcomes (CPC 1 or 2) and left ventricular ejection fraction (LVEF) at the same time interval. Finally we assessed the ability to work in patients who were still alive. ResultsA total of 114 patients were included, 24/114 (21 %) survived at one year with good neurological outcomes (CPC 1 or 2). Among them, the median NYHA-FC at one year was 1 (1–1), and more than half had recovered an LVEF > 50 %. At the time of data collection, 21 patients were still alive, with a median follow-up time of 6.8 (3.6–8.0) years. Half of these patients were actively working, with a median time of 10 months (3–21) to regain the ability to work since the onset of OHCA. ConclusionMost patients who were treated with prehospital ECPR for refractory OHCA due to ACS and survived with good neurological outcomes recovered a good heart function at one year, and half of them were working.

Pre- and Post-COVID-19 Antibiotic Consumption and Stewardship Program in a Southern Italian Hospital.

Antibiotic resistance is a growing global threat that significantly impacts public health and healthcare costs. The Italian National Action Plan on Antimicrobial Resistance (PNCAR) was introduced in 2017 to address this issue by improving antibiotic stewardship. This study aimed to evaluate the effectiveness of the PNCAR in enhancing antibiotic management practices in a hospital in southern Italy before and after its implementation. We conducted an observational monocentric study to analyze antibiotic consumption in a hospital setting before and after the COVID-19 pandemic (2019 and 2023) and to examine prescription appropriateness and the types of used antibiotics. After PNCAR introduction, we recorded a significant increase in antibiotic prescription appropriateness and in Access antibiotic and targeted therapy usage, while Reserve antibiotics were prescribed in ~10% of the cases, with an increasing trend in 2023. Our study supports the importance of targeted stewardship initiatives, including continuous monitoring and education, to sustain antibiotic prescription appropriateness and to reduce antimicrobial resistance.

Patients with low socio-economic status: is orthodontic treatment more complex?

Patients from low socioeconomic backgrounds are empirically considered more difficult to treat. The objectives were to evaluate low socioeconomic status of patients as a factor associated with increased treatment need and the correlation between socioeconomic status and dysmorphosis on one hand, and cooperation level on the other. This was a retrospective comparative monocentric observational cohort study. Included subjects were under 16years old at the time of orthodontic braces placement and were beneficiaries of the complémentaire santé solidaire (C2S) or not (non-C2S). Evaluated criteria included treatment need (IOTN-DHC), antero-posterior and vertical dysmorphosis (FMA, ANB, IMPA, I/F), and compliance. Fisher and Wilcoxon tests were performed. A 5% threshold was retained. Overall, 173patients were included and divided into two groups: C2S/non-C2S. Neither treatment need nor skeletal and alveolar-dental dysmorphosis are correlated with socioeconomic status. Cooperation is correlated with low socioeconomic status across all evaluated criteria: three times more bracket debondings, three times more remarks about failure to wear elastics, 1.25times more missed appointments, ten times more treatment abandonments. It may not be dysmorphosis that makes orthodontic treatment of low socioeconomic status patients more difficult, but rather a lack of cooperation. This calls for clinical and policy interventions to increase patient involvement in treatment. Randomized trials are needed to corroborate the results.

Incidence of post-intensive care syndrome among patients admitted to post-ICU multidisciplinary consultations: the retrospective observational PICS-MIR study

To determine the prevalence of functional, respiratory and renal impairments and of post-intensive-care-syndrome (PICS) among patients who had attended a post-ICU multidisciplinary consultation (post-ICU-MC) around 3 months after ICU discharge, we performed a retrospective, monocentric observational study, at Clermont Ferrand University hospital, France. We included patients who had attended a post-ICU-MC. Their characteristics during ICU stay and at the post-ICU-MC were collected. Functional status was assessed by the 6-min-walking test, handgrip test and peak inspiratory pressure, respiratory function by exploratory functional outcomes, mental status by SF-36 score, and quality of life by SF-36 score and European Quality of Life 5 Dimensions questionnaire. Overall, we enrolled 67 patients, of whom 70%, 74%, and 68% had functional, respiratory, and renal impairments, respectively, at the post-ICU-MC. Additionally, 40%, 28%, 19%, and 2.5% had three, two, one, and none of these impairments, respectively. All patients experienced mental disorders and a decline in quality of life. Functional impairment correlated with frailty score and sex, and respiratory function with age. To conclude, the prevalence of PICS in our cohort was high, as was that of functional, respiratory and renal failure.

Factors associated with anxiety disorders among healthcare workers (HCWS) involved in the first wave of the COVID-19 pandemic.

In a context of reorganization of the activity, of increase of the psychological, emotional and physical constraints of the nursing staff induced by the first wave of the COVID-19 pandemic, an increase of the anxiety disorders could occur. This study aims to assess the prevalence of anxiety disorders in healthcare workers (HCWs) by wards and to investigate medical, personal, and occupational factors associated with anxiety disorder. In France, in May 2020, a monocentric observational cross-sectional study was proposed to 285 HCWs of the University Hospital of Saint Etienne, working in 3 types of randomly selected care wards. Information was collected using an anonymous self-questionnaire offered to eligible HCWs. Validated questionnaires were used to assess anxiety (Hospital anxiety and Depression Scale) and burnout (Maslach Burnout Inventory). Of the 164 HCWs who participated in the study (57% participation rate), 69 (42%) caregivers had anxious symptomatology. The prevalence of anxiety disorders did not differ significantly by type of wards. Anxiety disorders are significantly associated with occupational factors (increased COVID-19 stress level, increased emotional load, increased mental load, high work/life stress during confinement, emotional exhaustion and loss of empathy), with medical factors (medical history of anxiety disorders, psychotropic treatment and impaired sleep quality) and personal factors (concern about working conditions and/or media reports). Preventive actions focusing on organizational factors could be carried out to reduce the emotional and mental load, the level of stress and the burnout of HCWs.

Impact of high intensity and long duration exercise in genetic arrhythmogenic left ventricular cardiomyopathy

Abstract Background Arrhythmogenic left ventricular (LV) cardiomyopathy (ALVC) is a genetic disease associating extensive LV myocardial fibrosis with or without dysfunction and no or mild right ventricle (RV) involvement, at risk of life-threatening ventricular arrhythmias (VA). While high intensity (HI) and long duration (LD) exercise has been identified as a precipitating factor of RV dysfunction and VA in arrhythmogenic RV cardiomyopathy including in asymptomatic genetic variant carriers, the impact of exercise on disease phenotype and risk is not known in ALVC. Objective To study the relationship between practicing HI and LD exercise and the risk of developing an ALVC phenotype and its severity. Methods In a monocentric retrospective observational study, patients with a pathogenic variant in common ALVC genes (DSP, FLNC, DES, PLN, RBM20, TMEM43), including asymptomatic carriers without ALVC phenotype, were interviewed about their physical practice from age 7 to the time of genetic or disease diagnosis. Intensity and weekly duration of each activity were reported. HI and LD exercise were defined as having practiced at least 1 sport with an intensity ≥ 6 METs and ≥ 2.5 hours/week respectively. We studied the association of HI and LD exercise practice with the risk of ALVC phenotype occurrence and its severity, derived from clinical, ECG and imaging data. Results 114 out of 128 eligible patients answered the questionnaire and were included (85 (74.6%) with a DSP variant, 22 FLNC (19.3%), 6 DES (5.3%), 1 RBM20 (0.9%)). 35 were probands (31%) and 79 relatives (69%) among 46 families. 31 (27%) had no ALVC phenotype at the time of genetic diagnosis. Mean age at diagnosis was 41±18. 62 (54%) patients were women. 97 (85%) had practiced at least one sport, among which 81 (83.5%) at HI and 79 (81.4%) of LD. Median lifetime exercise dose was 18.5 MET.h/week. There were no differences in HI and LD exercise practice between probands and relatives (74.3% vs 69.6%, p=0.6 and 74.3% vs 67.1%, p=0.4 respectively), as well as between patients with and patients without ALVC phenotype at the time of diagnosis (74.7% vs 61.3%, p=0.2 and 72.3% vs 61.3%, p=0.3 respectively). Phenotypic features at diagnosis did not differ between patients with and without HI and LD practice (Table 1). Multivariate analysis adjusted on age and gender showed that HI and LD exercise were not significantly associated with an increased risk of developing an ALVC phenotype (Odds Ratio [95% confidence interval] for age, gender, HI and LD exercise were 1.03 [1.01-1.06] (p=0.013), 1.41 [0.58 ; 3.47] (p=0.45), 2.15 [0.63 ; 7.27] (p=0.22) and 1.17 [0.35 ; 3.87] (p=0.79) respectively). Phenotypic features at diagnosis did not differ across observed quartiles of lifetime exercise dose (Table 2). Conclusion Practicing HI and LD exercise was not associated with an increased risk of developing an ALVC phenotype and its severity at the time of diagnosis in genetic ALVC variant carriers.

Non-penetrative sexuality and sexual satisfaction among partners of prostatectomy candidates

IntroductionCurative surgery for localized prostate cancer can lead to iatrogenic erectile dysfunction (ED), affecting couples. Sexuality remains influenced by social norms, often requiring men to provide pleasure through rigid erections. However, iatrogenic ED does not prevent male orgasm, although it can disrupt body image and self-esteem. This study aims to describe couples’ sexual repertoire and partners’ sexual satisfaction post-radical prostatectomy at the Centre Hospitalier Universitaire de Martinique. Materials and methodsA monocentric retrospective observational study was conducted with data collected from January 2021 to March 2024. The Valentin and ASEX questionnaires were administered to the partners of future vesiculo-prostatectomy patients at the start of the sex-rehabilitation program. Responses were analyzed anonymously using the Sphinx iQ2 application. ResultsThe characteristics of the population were described in terms of proportions and means, with a significance threshold set at 0.05 for statistical tests. Of the 152 couples identified, 65 Valentine questionnaires were available. Respondents were heterosexual women, with an average age of 59, and their partners had an average age of 64. Non-penetrative sex was already part of the sexual repertoire for 52% of couples prior to prostate cancer diagnosis. After surgery, 32% of partners resumed penetrative sex, while 43% had not yet resumed sexual intimacy, and 14% had resumed non-penetrative sex. Mutual fondling (85%), vaginal penetration (70%), female oro-genital sex (70%) and male oro-genital sex (52%) were the most popular sexual stimuli. DiscussionSurgery was therefore no obstacle to sexual satisfaction for our respondents, with a satisfaction level of 90% before and 86% after total prostatectomy. The same applies to orgasm before and after total prostatectomy. The results show that erectile dysfunction is not an obstacle to partners’ sexual satisfaction, with couples able to reinvent their sexuality around non-penetrative practices. Sexual satisfaction indicators before and after RA show a strong correlation, confirming that surgery does not negatively affect sexual satisfaction. ConclusionThe results show that men suffering from post-RP ED can free themselves from the dogma of penile erection by exploring female sexual pleasure to a greater extent. Couples practicing non-penetrative sexuality report satisfying, more playful, complicit and varied sexuality. Finally, ED has less of an impact on partners than future operators believe. Level of evidence5.

Managing a 4000-participant cohort with a novel mobile app: data from the RisCoin study in Germany

Abstract Issue RisCoin, a prospective monocentric longitudinal observational study, aimed to identify risk factors for COVID-19 vaccine failure. Secondary aim is to monitor symptoms, SARS-CoV-2 infection, vaccination status of 3816 enrolled healthcare workers (HCW) and 180 patients with inflammatory bowel disease (IBD). Since the LMU University Hospital Munich served both as study sponsor and employer of the HCW, a secured approach was required. Description of the solution Participants accessed the study app (CentraXX, KAIROS GmbH, Germany) via pseudonymized Contact-ID with irreversible anonymization after 6 months. Key app features were the serological results report, bidirectional messaging, and weekly survey for self-reported data on vaccinations, infections, and symptoms. Active app use was defined as submitting &amp;gt;1 weekly survey during the study period 10.2021-12.2022. Results Over 15 months, our study team maintained 1964 two-way communications with 958 participants via the app. Of 3979 participants with app access, 3622 (91%) were active users, 2606 (65%) submitted 1 to 11 surveys, 1016 (26%) made ≥12 submissions (P75, “frequent users”). Frequent users were more likely to be IBD patients (p = 0.001), female (p &amp;lt; 0.001), aged 60 or older (p &amp;lt; 0.001). Staff in administration and nurses were more likely to be frequent users compared to physicians (p &amp;lt; 0.001). Main problems included the initial operational system disparities resulting in app crashes and continuous need for app reactivation. Both led to loss of active participants and required substantial staff resources to onboard and support participants during the study. Lessons The study app enabled secure, flexible, bidirectional communication with all participants. Despite technical issues, the majority actively used the app and provided valuable longitudinal data through weekly survey submissions. Key messages • A study-specific app provides a flexible and secure bidirectional anonymous communication for the study team and participants. • Adherence to app-based communication and data collection for pandemic monitoring was particularly high among patients, nurses and administrative staff.

Echocardiographic evaluation of ventricular performance in VA-ECMO weaning: results from a observational monocentric prospective study

Abstract Background Although temporary mechanical circulatory support (MCS) devices are increasingly used in the management of cardiogenic shock (CS), several open question regarding the kind of support and timing of institution/weaning remains open. Echocardiography is widely applied to drive the weaning process and decision although there are no standardized protocols for the trial nor accordance on the parameters to apply. Purpose We sought to evaluate the overall accuracy of echocardiographic indices in predicting successful weaning from VA ECMO in patients with CS. Specifically, we tested total isovolumic time (tIVT), an index of ventricular performance, and longitudinal function (MAPSE) on top of the commonly used parameters (left ventricular ejection fraction, LVEF; left ventricular velocity time integral, LV VTI; TAPSE; right ventricular S’ at tissue Doppler imaging, RV S’). Methods Monocentric prospective study on adults receiving VA-ECMO due to refractory CS and/or cardiac arrest (CA) from 2012 to 2020. Echocardiography was performed at VA-ECMO placement and during the weaning trials. Weaning trials were performed daily, starting 48 hours after VA-ECMO institution, when patients were hemodynamically stable: mean arterial pressure &amp;gt;65 mmHg, no or minimum adrenergic support (vasoactive inotropic score &amp;lt;10), heart rate &amp;lt;110 bpm, lactate &amp;lt;2 mmol/L, and no signs of respiratory distress. Weaning trials were performed with a stepwise decrease of VA-ECMO blood flow until reaching 1 or 1.5 L/min under adequate anticoagulation. Successful weaning was defined as removal of VA-ECMO with no requirement for further MCS in the following 30 days. Results 76 patients were enrolled (23.8% female, 54.2±10.6 years-old), 52.6% due to CA. Median duration of VA-ECMO was 58 hours; 47 (61.8%) had intra-aortic balloon pump (IABP) inserted upfront. In-hospital mortality was 62.4% overall, 40% for CS without CA. 6 of the 32 weaned patients died for multiorgan failure due to septic shock. The baseline echocardiographic parameters associated with successful weaning were (table): stroke volume &amp;gt;13.9 mL (p 0.002), tIVT &amp;gt;23.6 min/sec (p 0.053), LV VTI &amp;gt;6.6 cm (p&amp;lt;0.001), MAPSE &amp;gt;6.15 mm (p 0.001), TAPSE &amp;gt;11 mm (p 0.023), RV S’ &amp;gt;10 cm/s (p 0.012). LVEF did not reach the statistical significance. Figure shows Kaplan-Meier analysis on echocardiographic indices collected at time of cannulation (panel A) and during the last weaning trial (panel B). Conclusions Echocardiography is pivotal in defining cardiac recovery and monitoring the weaning trial. Indices reflecting ventricular performance and delivered flow from LV were associated with weaning success both at VA-ECMO institution and throughout the weaning trials. Considering the known limitations of LVEF (heart rate, loading and left ventricular dyssynchrony dependence), tIVT and MAPSE should be introduced in the standard evaluation of patients in the acute setting.TableFigure