Epatocentro Ticino

The distinction of drug-induced liver injury (DILI), drug-induced autoimmune-like hepatitis (DI-ALH), and autoimmune hepatitis (AIH) can be challenging due to overlapping clinical characteristics. Recently, polyreactive immunoglobulin G (pIgG) was identified as a novel biomarker in AIH. This retrospective study aimed to evaluate the diagnostic accuracy of pIgG to distinguish between AIH, DI-ALH, and DILI and thus identify patients in need of immunosuppression. Samples from 120 patients (AIH = 81, DI-ALH = 16, DILI = 23) were compared to a control group (non-AIH-non-DILI-liver disease = 596 and healthy controls = 190). No patient in the DILI-group but 98% in the AIH- and 94% in the DI-ALH-group received immunosuppressive treatment. PIgG levels were significantly higher in the AIH-group 1.9 normalised arbitrary units (nAU) compared to DILI (1.1 nAU, p < 0.001), non-AIH-non-DILI-LD (1.0 nAU, p < 0.001) and healthy controls (0.27 nAU, p < 0.001). PIgG levels for DI-ALH (1.7nAU) were significantly higher compared to DILI (p = 0.044) and non-AIH-non-DILI-LD and healthy controls (both p < 0.001). Highest AUC was seen for pIgG (0.818) compared to conventional autoantibodies. The overall accuracy of pIgG to distinguish AIH from DILI (74%) and liver injuries with and without the need for immunosuppression (73%) was like that of ANA (71%/73%) and SMA (74%/69%) at cut-offs of ≥ 1/40. PIgG was positive in up to 79% of patients with AIH that were negative for a conventional autoantibody and was positive in 90% of DI-ALH cases compared to 25% in DILI that were caused by the same drugs. PIgG may complement current serologic tests to identify patients with liver injury in need of immunosuppressive treatment.

ObjectiveThe infection of the endograft after thoracic endovascular aortic repair (TEVAR) is a rare but potentially life-threatening complication. Unfortunately, clinical reports, large case-series or randomized studies are scarce or not available yet, and the optimal management of this complication is under debate. The aim of this review is collecting and analysing data on current practice and outcomes for the treatment of infected endografts after TEVAR.MethodsA search on PubMed/MEDLINE and EMBASE for studies reporting endograft infections after TEVAR was conducted up to January 2023. Data on study design, patients demographic, infection (time from TEVAR to infection, vascular imaging, bacterial samples), clinical strategies, outcome and follow-up were extracted and analysed. The outcome after surgical and conservative treatment was compared.ResultsThirty-six articles (5 case-series; 31 case reports) were deemed eligible for this review. A total of 57 patients (mean age: 62.5 ± 13.9 years) with endograft infections after TEVAR were included. Fever and pain were the two major clinical presentations. Mean time from TEVAR to diagnosis was 19.7 ± 36.4 months. The top four isolated microorganism were Staphylococcus aureus (25%), Candida albicans (15.6%), Streptococcus (12.5%) and Pseudomonas (7.8%). Patients were treated conservatively (36.8%) or surgically (63.2%). Surgical treatments were extra-anatomic aortic bypass (50%), in-situ aortic replacement (38.9%) and graft preservation (11.1%). Overall hospital mortality was 33.3% (30-day mortality: 26.4%). The mortality was 52.4% after conservative treatment and 22.2% after surgery (p = 0.0397). Among patients who underwent surgery, the mortality was 28.6% after in-situ aortic replacement and 22.2% after extra-anatomic aortic bypass (p = 0.5387). Major in-hospital causes of death after surgery were multiple organ failure and respiratory failure (6/8 patients).ConclusionEndograft infection after TEVAR is rare but it carries a high risk of mortality. In selected patients, the surgical treatment seems to be safer, with a lower mortality rate when compared to alternative conservative options.

BackgroundLittle is known about the distribution and clinical course of patients with inherited arrhythmia syndrome (IAS) and concomitant atrial arrhythmias (AAs).Aim1) To characterize the distribution of AAs in patients with IAS and 2) evaluate the long-term clinical course of these patients.MethodsAn international multicenter study was performed and involved 28 centers in 16 countries. Inclusion criteria were: 1) IAS and 2) ECG documentation of AAs. The primary endpoint was a composite of sudden cardiac death, sustained VAs or appropriate ICD interventions. Strokes, inappropriate ICD shocks due to AAs, and the occurrence of sinus node dysfunction were assessed.ResultsA total of 522 patients with IAS and AAs were included. Most patients were diagnosed with Brugada syndrome (n=355, 68%) and long-QT syndrome (n=93, 18%). The remaining patients (n=71, 14%) presented with short-QT syndrome, early repolarization syndrome (ERS), catecholaminergic polymorphic ventricular tachycardia (CPVT), progressive cardiac conduction diseases, or idiopathic ventricular fibrillation. Atrial fibrillation (AF) was the most prevalent AA (82%), followed by atrial flutter (9%) and atrial tachycardia (9%). AA was the first clinical manifestation of IAS in 52% of patients. More than one type of AAs was documented in 23% of patients. The incidence of the primary endpoint was 1.4% per year, with a twofold increase observed in patients who experienced their first AA before the age of 20 (OR 2.2, p=0.043). This was consistent across the different forms of IAS. Inappropriate ICD shock due to AAs were reported in 2.8% of patients, strokes in 4.4% and sinus node dysfunction in 9.6%.ConclusionsAmong patients with IAS and AAs, AA is the first clinical manifestation in about half of the cases, with more than one form of AAs present in one-fourth of the patients. The occurrence of AA earlier in life is associated with a higher risk of ventricular arrhythmias. The occurrence of stroke and sinus node dysfunction is not-infrequently in this cohort.Figure 1 Figure 2

Sulphonamides and trimethoprim, although generally well-tolerated, have been temporally associated with aseptic meningitis. To address its presentation and outcome, a literature search was performed. We retained articles reporting patients with features of acute aseptic meningitis following intake of trimethoprim, sulfamethoxazole or sulfisoxazole. A cerebrospinal fluid investigation in ≥1 episode was a prerequisite for inclusion. Sixty articles reporting on 74 patients experiencing a total of 155 episodes were retained. Forty-five (61%) patients had one or more recurrences. Median age at first episode was 43 (interquartile range [IQR] 23-61) years. Symptoms presented within 48 (IQR 6-168) hours of intake at the first episode and within 1.3 (IQR 1-5) hours at recurrences (p< .0001). Cerebrospinal fluid analysis revealed a predominantly neutrophilic (82%, IQR 65%-94%) pleocytosis (180, IQR 38-507 106cells/L), without low glucose or high proteins. Recovery took place within 2 (IQR 1-3) days after stopping the suspected agent. All but one patient completely recovered.

The diagnosis of superior vena cava syndrome is always challenging, even more so when it happens intraoperatively. A novel transgastric-transesophageal projection allows for the visualisation of caval flow acceleration, critical in leading to rapid di

Abstract Background Smoking is a major cardiovascular risk factor and of great importance in terms of both primary and secondary prevention. The present study aims to identify patient characteristics associated with smoking cessation within 1 year after acute myocardial infarction (AMI) to inform physician-patient interactions, secondary prevention measures, and public health planning. Methods ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients enrolled between 2012 and 2022 in the AMIS Plus registry who were active smokers at the time of the index event were included. At the 1-year follow-up, patients were questioned about their smoking behaviour via telephone interview and were further classified into those who had quit (stoppers) or continued (continuers) smoking. Patient characteristics were collected at the time of the index event and at follow-up and then compared using descriptive statistics. Results From a total of 4523 patients with AMI, 4242 (93.8%) provided information regarding their smoking status at a median follow-up of 395 days (interquartile range 370 to 469) after the index event. Of 1691 (39.9%) active smokers at the time of AMI, 861 (50.9%) reported quitting whereas 830 (49.1%) were still smoking at the 1-year follow-up. Stoppers were younger (57 vs. 58 years, p&amp;lt;0.001), more likely to be male (82.8% vs. 77.7%, p=0.008) and have presented with STEMI (77.0% vs. 71.0%, p=0.005), and less likely to have had a previous AMI (6.6% vs. 13.3%, p&amp;lt;0.001) than continuers. Smoking cessation was more common in patients with a more severe AMI characterised by a greater extent of myocardial injury (in-hospital median peak creatine kinase level 1291 IU/L vs. 1101 IU/L, p=0.012), at least one in-hospital complication (13.9% vs. 9.9%, p=0.01), and participation in a rehabilitation programme (83.7% vs. 68.8%, p&amp;lt;0.001). Stoppers more frequently implemented other favourable lifestyle changes, such as dietary changes (56.2% vs. 45.2%, p&amp;lt;0.001) and increased physical activity (54.6% vs. 37.7%, p&amp;lt;0.001) than continuers. Self-reported weight gain was more prevalent among those who quit smoking (44.0% vs. 19.7%, p&amp;lt;0.001). Conclusions In Switzerland, half of the patients with AMI who were active smokers at the time of AMI, reported to have stopped smoking 1 year after the index event. Smoking cessation was associated with participation in a rehabilitation programme and occurred more often in patients with larger AMI sizes, higher in-hospital complication rates and more frequent implementation of other favourable lifestyle changes after AMI. The significant weight gain after smoking cessation seems to represent a major issue that should specifically be addressed.