CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).
"Objective. This narrative review sought to identify the most frequently used types of exercises in cardiopulmonary rehabilitation programs and to verify the level of efficiency and feasibility of this treatment method in cardiovascular diseased patients. Methods. We conducted research via Pubmed over two months using specific keywords related to cardiorespiratory rehabilitation, cardiovascular rehabilitation, endurance exercises, and respiratory exercises. In addition, we included studies that involved physical training for patients diagnosed with coronary artery disease, chronic heart failure, valvular disease or valvular surgery, asthma, and chronic obstructive pulmonary disease. Results. A total of fifteen articles were included in this narrative review. Eight studies investigated the effect of aerobic training, alone or combined, in the rehabilitation process for patients with cardiovascular disease and/or pulmonary disease. It showed that this type of training is the most recommended and used for these specific pathologies. Seven studies showed the effects of the resistance training and progressive resistance training, alone or combined, and proved the importance of their integration in patients with skeletal muscle weakness and altered functional capacity. High-intensity interval training was not superior to moderate-intensity continuous training in improving aerobic capacity and changing ventricular remodeling in patients with chronic heart failure. However, the results were promising in patients with coronary artery disease. Combined training had the best results in improving the aerobic capacity, muscle strength, functional capacity, ventilatory responses, and enhancing the quality of life for cardiovascular patients. Conclusions. Combined training was found superior to aerobic training, resistance training, respiratory training, or inspiratory muscles training applied alone as a treatment in cardiopulmonary rehabilitation programs. Thus, every rehabilitation program should be individualized for every patient to increase the effort capacity using aerobic training and functional capacity of the skeletal muscles by increasing the muscle mass (hypertrophy) as an effect of resistance training or progressive resistance training "
The SARS-CoV-2 pandemic challenged the authorities into taking measures that limit the spread of the virus in the community. TAMEC project (Advanced Community Approaches to Epidemic Management) developed a system that detects the contacts of patients infected with the SARS-CoV-2 virus and alerts them using mobile applications. It allows real-time analysis of confirmed patients and identified contacts, early detection of new outbreaks, and provides decisionmaking information to prevent viral transmission. The system uses its patent for homomorphic encryption, a method that allows to process and manipulate data in an encrypted format, without having access to the original data. Thus, the solution proposed in the TAMEC project fully respects the privacy rules of citizens imposed by the EU, using the concept of privacy preservation. Our solution offers the possibility to identify and validate a risk score that could become an extremely helpful tool in the stratification of COVID-19 patients. The TAMEC system is innovative in its simplicity and ability to facilitate the prevention of the spread of the SARS-CoV-2 virus in the community.
Hypertension poses a significant burden in the general population, being responsible for increasing cardiovascular morbidity and mortality, leading to adverse outcomes. Moreover, the association of hypertension with dyslipidaemia, obesity, and insulin resistance, also known as metabolic syndrome, further increases the overall cardiovascular risk of an individual. The complex pathophysiological overlap between the components of the metabolic syndrome may in part explain how novel antidiabetic drugs express pleiotropic effects. Taking into consideration that a significant proportion of patients do not achieve target blood pressure values or glucose levels, more efforts need to be undertaken to increase awareness among patients and physicians. Novel drugs, such as incretin-based therapies and renal glucose reuptake inhibitors, show promising results in decreasing cardiovascular events in patients with metabolic syndrome. The effects of sodium-glucose co-transporter-2 inhibitors are expressed at different levels, including renoprotection through glucosuria, natriuresis and decreased intraglomerular pressure, metabolic effects such as enhanced insulin sensitivity, cardiac protection through decreased myocardial oxidative stress and, to a lesser extent, decreased blood pressure values. These pleiotropic effects are also observed after treatment with glucagon-like peptide-1 receptor agonists, positively influencing the cardiovascular outcomes of patients with metabolic syndrome. The initial combination of the two classes may be the best choice in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors because of their complementary mechanisms of action. In addition, the novel mineralocorticoid receptor antagonists show significant cardio-renal benefits, as well as anti-inflammatory and anti-fibrotic effects. Overall, the key to better control of hypertension in patients with metabolic syndrome is to consider targeting multiple pathogenic mechanisms, using a combination of the different therapeutic agents, as well as drastic lifestyle changes. This article will briefly summarize the association of hypertension with metabolic syndrome, as well as take into account the influence of antidiabetic drugs on blood pressure control.
Simultaneous or sequential combination of prosthetic valve (PV) thrombosis and infectious endocarditis is a rare clinical finding. The management of these patients involves a complex multidisciplinary strategy using clinical judgment and imaging techniques. Transesophageal echocardiography (TEE) and especially 3D transesophageal echocardiography is essential. Moreover, positron emission tomography with fluorodeoxyglucose (F18-FDG PET/CT) can be a valuable tool to diagnose and manage these complicated clinical scenarios.
We present the case of a 65-year-old patient who was admitted in our clinic for paroxysmal nocturnal dyspnea and chills for one week. He had multiple surgical interventions for rheumatic mitral valve disease (percutaneous mitral valvuloplasty in 2008, and mitral valve replacement and tricuspid annuloplasty in October 2019).
At admission, the diagnosis of prosthetic valve thrombosis was established taking into account the clinical context (low INR values for the last two months), the patient symptoms and the echocardiographic findings. IV unfractionated heparin was administered. One week after admission the patient’s clinical status further deteriorated. TEE reevaluation showed partial thrombus regression with elements suggestive for concomitant infectious endocarditis. The diagnosis key is the clinical evolution and repeated TEE evaluations. In our case, they enabled the probable diagnosis of a sequential association of thrombosis and infectious endocarditis on mechanical PV. The therapeutic approach requires a high clinical suspicion and a prompt management, emergent surgery being the only lifesaving strategy in unstable patients with obstructive mechanical pathology.
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