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This study aimed to establish whether the modified 12-hour Scottish and Newcastle Antiemetic Protocol (SNAP) for paracetamol poisoning is associated with improvement in hospital length of stay (LoS), as well as to validate the performance of the protocol for the prevention of anaphylactoid reactions and total infusion duration.

Retrospective chart review from 25 March 2019 to 25 September 2020. Patients aged 16 or older with a diagnosis of suspected or confirmed paracetamol overdose were included in the analysis if they received treatment for paracetamol poisoning, and the protocol used could be identified. Data were collected for LoS, number of extended treatment infusions used and evidence of anaphylactoid reaction.

1167 records were assessed for eligibility, and 294 were included for analysis. Use of the SNAP was associated with a statistically significant reduction in LoS of -8.8 hours (95% CI -12.6 to -2.0), and a reduced risk of anaphylactoid reaction (Number Needed to Treat=10).

In this retrospective study, use of the SNAP reduced the duration of inpatient admissions and rate of anaphylactoid reactions.

In this retrospective study, use of the SNAP reduced the duration of inpatient admissions and rate of anaphylactoid reactions.The existence of coronaviruses has been known for many years. These viruses cause significant disease that primarily seems to affect agricultural species. Human coronavirus disease due to the 2002 outbreak of Severe Acute Respiratory Syndrome and the 2012 outbreak of Middle East Respiratory Syndrome made headlines; however, these outbreaks were controlled, and public concern quickly faded. This complacency ended in late 2019 when alarms were raised about a mysterious virus responsible for numerous illnesses and deaths in China. As we now know, this novel disease called Coronavirus Disease 2019 (COVID-19) was caused by Severe acute respiratory syndrome-related-coronavirus-2 (SARS-CoV-2) and rapidly became a worldwide pandemic. Luckily, decades of research into animal coronaviruses hastened our understanding of the genetics, structure, transmission, and pathogenesis of these viruses. Coronaviruses infect a wide range of wild and domestic animals, with significant economic impact in several agricultural species. Their large genome, low dependency on host cellular proteins, and frequent recombination allow coronaviruses to successfully cross species barriers and adapt to different hosts including humans. The study of the animal diseases provides an understanding of the virus biology and pathogenesis and has assisted in the rapid development of the SARS-CoV-2 vaccines. Here, we briefly review the classification, origin, etiology, transmission mechanisms, pathogenesis, clinical signs, diagnosis, treatment, and prevention strategies, including available vaccines, for coronaviruses that affect domestic, farm, laboratory, and wild animal species. We also briefly describe the coronaviruses that affect humans. Expanding our knowledge of this complex group of viruses will better prepare us to design strategies to prevent and/or minimize the impact of future coronavirus outbreaks.

The clinical course of patients with moderate aortic stenosis (AS) remains incompletely defined.

This study sought to analyze the clinical course of moderate AS and compare it with other stages of the disease.

Multiple electronic databases were searched to identify studies on adult moderate AS. Random-effects models were used to derive pooled estimates. The primary endpoint was all-cause death. The secondary endpoints were cardiac death, heart failure, sudden death, and aortic valve replacement.

Among a total of 25 studies (12,143 moderate AS patients, 3.7 years of follow-up), pooled rates per 100 person-years were 9.0 (95%CI 6.9 to 11.7) for all-cause death, 4.9 (95%CI 3.1 to 7.5) for cardiac death, 3.9 (95%CI 1.9 to 8.2) for heart failure, 1.1 (95%CI 0.8 to 1.5) for sudden death, and 7.2 (95%CI 4.3 to 12.2) for aortic valve replacement. Meta-regression analyses detected that diabetes (P = 0.019), coronary artery disease (P = 0.017), presence of symptoms (P< 0.001), and left ventricle (LV) dysfuncfurther investigation.

It is unknown whether the sex difference whereby female transcatheter aortic valve replacement (TAVR) candidates had a lower risk profile, a higher incidence of in-hospital complications, but more favorable short-and long-term survival observed in tricuspid cohorts undergoing TAVR would persist in patients with bicuspid aortic valves(BAVs).

The aim of this study was to reexamine the impact of sex on outcomes following TAVR in patients withBAVs.

In this single-center study, patients with BAVs undergoing TAVR for severe aortic stenosis from 2012 to 2021were retrospectively included. Baseline characteristics, aortic root anatomy, and in-hospital and 1-year valve hemodynamic status and survival were compared between sexes.

A total of 510 patients with BAVs were included. At baseline, women presented with fewer comorbidities. Men had a greater proportion of Sievers type 1 BAV, higher calcium volumes (549.2 ± 408.4mm

vs 920.8 ± 654.3mm

 ; P< 0.001), and larger aortic root structures. Women experienced es favored men, with fewer complications except for the need for second valve implantation, but 1-year survival was comparable between sexes.

Contrast-induced nephropathy (CIN) can occur after cardiovascular procedures using contrast media, which is associated with increased morbidity and mortality. RenalGuard is a closed-loop system designed to match intravenous hydration withdiuretic-induced diuresis that has shown mixed results in the prevention of CIN in previous randomized controlled trials.

The STRENGTH (Study Evaluating the Use of RenalGuard to Protect Patients at High Risk of AKI) study assessed whether RenalGuard (PLC Medical Systems) is superior to standard intravenous hydration for CIN prevention in patients with chronic kidney disease undergoing complex cardiovascular procedures.

STRENGTH is a multicenter, international, open-label, postmarket, prospective, randomized (11) study monitored by the Cardiovascular European Research Center (Massy, France) that included a total of 259 patients with moderate to severe chronic kidney disease (estimated glomerular filtration15-40mL/min/m

) requiring a complex coronary, structural, or peri at 12 months compared with conventional intravenous hydration.

Post-percutaneous coronary intervention (PCI) residual disease is associated with clinical outcomes. Nevertheless, the prognostic value of residual disease patterns remains unknown.

This study aimed to evaluate clinical implications of 2-dimensional residual disease patterns after PCI.

One thousand six hundred seven vessels that underwent successful PCI were included. Two-dimensional residual disease patterns were determined by visual assessment or the quantitative flow ratio (QFR)-derived pull back pressure gradient index (with a cutoff value of 0.78 to define predominant focal versus diffuse disease) and instantaneous QFR gradient per unit length (with a cutoff value of≥0.005/mm to define a major gradient). The clinical outcome was the 2-year vessel-oriented composite outcome (VOCO).

Residual disease patterns were classified into 4 groups predominant focal without and with a major gradient (group 1 [n=1,058] and group 2 [n=63], respectively) and predominant diffuse without and with a major gradient iated with VOCO at 2 years.

Aortic stenosis and coronary artery disease (CAD) frequently coincide. However, the management of coexisting CAD in patients undergoing transcatheter aortic valve replacement (TAVR) remains controversial.

This study sought to determine whether the presence of CAD, its complexity, and angiography-guided percutaneous coronary intervention (PCI) are associated with outcomes after TAVR.

All patients undergoing TAVR at a tertiary referral center between 2008 and 2020 were included in a prospective observational study. Baseline SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score (SS) and, whenever applicable, a residual SS after PCI were calculated. A multivariate analysis was performed to determine the effect of CAD, stratified according to complexity, and PCI on 5-year outcomes.

In 604 patients, the presence of CAD and its complexity were significantly associated with worse 5-year survival (SS 0 67.9% vs SS 1-22 56.1% vs SS >22 53.0%; log-rank P=0.027) and increased cardiovascular mortality (SS 0 15.1% vs SS 1-22 24.0% vs SS >22 27.8%; log-rank P=0.024) after TAVR. Having noncomplex CAD (SS 1-22) was an independent predictor for increased all-cause mortality (HR 1.43; P=0.046), while complex CAD (SS >22) increased cardiovascular mortality significantly (HR 1.84; P=0.041). Angiography-guided PCI or completeness of revascularization was not associated with different outcomes.

The presence of CAD and its anatomical complexity in patients undergoing TAVR are associated with significantly worse 5-year outcomes. However, angiography-guided PCI did not improve outcomes, highlighting the need for further research into physiology-guided PCI.

The presence of CAD and its anatomical complexity in patients undergoing TAVR are associated with significantly worse 5-year outcomes. However, angiography-guided PCI did not improve outcomes, highlighting the need for further research into physiology-guided PCI.

Post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR)<0.90 is common and has been related to impaired patient outcome.

The authors sought to evaluate if PCI optimization directed by intravascular ultrasound (IVUS) in patients with post-PCI FFR<0.90 could improve 1-year target vessel failure (TVF) rates.

In this single-center, randomized, double-blind trial, patients with a post-PCI FFR<0.90 at the time of angiographically successful PCI were randomized to IVUS-guided optimization or the standard of care (control arm). The primary endpoint was TVF (a composite of cardiac death, spontaneous target vessel myocardial infarction, and clinically driven target vessel revascularization) at 1 year.

A total of 291 patients with post-PCI FFR<0.90 were randomized (IVUS-guided optimization arm n = 145/152 vessels, control arm n = 146/157 vessels). The mean post-PCI FFR was 0.84 ± 0.05. A total of 104 (68.4%) vessels in the IVUS-guided optimization arm underwent additional optimization including additional stenting (34.9%) or postdilatation only (33.6%), resulting in a mean increase in post-PCI FFR in these vessels from 0.82 ± 0.06 to 0.85 ± 0.05 (P< 0.001) and a post-PCI FFR≥0.90 in 20% of the vessels. The 1-year TVF rate was comparable between the 2 study arms (IVUS-guided optimization arm 4.2%, control arm 4.8%; P = 0.79). There was a trend toward a lower incidence of clinically driven target vessel revascularization in the IVUS-guided optimization arm (0.7% vs. 4.2%, P = 0.06).

IVUS-guided post-PCI FFR optimization significantly improved post-PCI FFR. Because of lower-than-expected event rates, post-PCI FFR optimization did not significantly lower TVF at the 1-year follow-up.

IVUS-guided post-PCI FFR optimization significantly improved post-PCI FFR. RGDpeptide Because of lower-than-expected event rates, post-PCI FFR optimization did not significantly lower TVF at the 1-year follow-up.