Backgrounds and Aims: Since the start of the SARS-CoV-2 pandemic, healthcare workers have been at elevated risk of contracting COVID-19. Although COVID-19 vaccines have contributed to the eradication of, or substantial decreases in, the incidence of lethal diseases, the major determinant of COVID-19 vaccine hesitancy is a fear of associated adverse effects. Here, we performed a survey assessing the reactogenicity and safety of BNT162b2 in a real-world setting. Methods: Data were collected from March 1 and June 14, 2021. A total of 206 hospital employees undergoing BNT162b2 mRNA vaccination completed the survey. These hospital workers received a questionnaire to collect the common and uncommon adverse effects developing 2–6 days after the second dose of the Pfizer-BioNTech vaccine. Results: After the second dose, female sex was found to be associated with a higher risk of vaccine-related severe systemic adverse effects than male sex (odds ratio [OR] 3.116, 95% CI 2.365–7.113). We also observed that the anti-SARS-CoV-2 receptor-binding domain titer, determined on the day when the second dose of the Pfizer-BioNTech vaccine was administered, was significantly higher in participants with severe systemic effects than those without such effects (OR 1.017, 95% CI 1.001–1.034). Conclusion: Our study suggested that healthy female healthcare workers had a three-fold higher risk than healthy male healthcare workers of developing severe adverse effects after the second dose of the Pfizer-BioNTech vaccine. Further research is warranted to determine whether a high anti-SARS-CoV-2 RBD titer determined at the time of the second vaccination might indicate a disproportionate inflammatory systemic reaction leading to severe adverse effects. Our findings might contribute to a decrease in the disappearance of COVID-19 vaccine hesitancy.
Ascending aorta (AA) dilatation in patients with bicuspid aortic valve (AV) is related both to genetic and haemodynamic factors. The aim of this study is to compare late progression of AA dilatation in bicuspid AV patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI).
Introduction: COVID-19 pandemia determined a reduction of healthcare offer to the general population. Hypothesis: COVID-19 pandemia increased the number of emergency operations and in particular of life-saving procedures because of the diagnostic delay due to missed follow-up or unwillingness to present to Emergency Departments for the fear of contracting the coronavirus. Methods: Retrospective analysis of surgical activity in a large Cardiac Surgery Department from 01 March to 31 May 2020 (study period) compared to the same months of 2019 (control period). Results: During the study period there were 191 operations (14% elective and 86% urgent/emergency) versus 225 (44% elective and 56% urgent/emergency) in the control period. Moreover, during the study period four patients presented acutely due to delay of diagnosis: one with ventricular septal defect and free wall rupture due to an evolving acute myocardial infarction (MI) with late presentation; another, who suffered an acute inferior MI several months earlier and did not attend regular follow-up, was operated for a ruptured pseudoaneurysm who was not previously diagnosed; another was operated for aortic and mitral valve endocarditis complicated by cardiogenic shock due to delay caused by a misdiagnosed COVID-19 pneumonia; last patient, previously operated for an acute type A aortic dissection (ATAAD), refused to attend the Emergency Department after the acute onset of back pain and was later diagnosed with severe dilatation (1.4 cm over 6 months) of the thoracic aorta and underwent endovascular stent-grafting. The first patient (who suffered a cardiac arrest after induction of anesthesia) survived with neurological deficit, the second died in the operating room, the third and fourth survived without complications. There were no similar cases in the control period. Finally, two patients were operated for an ATAAD (one COVID-19 positive died of hemorrhagic shock) in the study period versus nine in the control period. Conclusions: COVID-19 pandemia resulted in a significant reduction of cardiac surgical activity, mainly related to decrease of elective surgery and an increased number of surgical procedures for life-threatening conditions caused by delayed presentation of acute patients.
Abstract Long COVID refers to persistent symptoms following SARS-CoV-2 infection for at least 2 months with no other clear cause. Symptoms can occur after initial infection or during recovery and include chest pain, fatigue, breathlessness and cough. The exact causes are being investigated and may involve organ damage, inflammation or an immune response. COVID-19 can cause severe respiratory damage and is different from classic ARDS. Radiological assessment is recommended for those with dyspnoea after COVID. Clinical outcomes are variable and permanent lung damage is not fully understood. Vaccination is effective against severe infection, but its effect on respiratory function in mild cases remains uncertain. This retrospective study aims to analyse changes in lung function in HCWs who had COVID-19 between 2020 and 2022, comparing their spirometric test results before and after the pandemic and taking into account their vaccination status. 321 HCWs were included in the study. The study examined spirometric parameters both before and after the pandemic, and all measured outcomes except the FEV1/FVC ratio showed a significant decrease during the study period. We then assessed the association between COVID-19 infection and changes in lung function parameters, analysing infections in 2020, 2021 and 2022 separately. We found a statistically significant difference in Forced vital capacity (FVC) between infected and non-infected subjects in 2020 and 2021, but not in 2022. To evaluate the protective effect of SARS-CoV-2 vaccination on respiratory function, a linear regression analysis was performed using changes in FVC, Forced expiratory volume in 1 second (FEV1), FVC/FEV1 ratio and Peak expiratory flow (PEF) as dependent variables. The analysis showed that the decline in FVC was significantly lower in subjects who had been vaccinated prior to infection. The study concludes that subclinical COVID-19 infections in 2020 and 2021 worsened respiratory parameters (FVC and FEV1), but vaccination protected against these effects. Even healthy individuals with previous infections showed respiratory changes, with vaccination providing protection, especially for FVC decline. This highlights the importance of vaccinating healthcare workers against COVID-19.
Clinical benefits of minimally invasive cardiac valve surgery (MIVS) have been reported. Improved postoperative mental status was never analyzed with dedicated psychological tests. In the present study we intend to investigate potential benefits of MIVS for patient psychological well-being, with special attention to the relevance of the patient perception of the chest surgical scar, of the self body image and cosmetic aspects.Between 2016 and 2017, 87 eligible patients, age 66.5 ± 14.5 years, operated on for heart valve surgery, underwent either conventional full sternotomy (CS; n = 48) or MIVS by V-shape hemi-sternotomy approach (n = 39). Before selection of the surgical approach, patients had undergone preoperative evaluation of their psychological status using Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory Form Y (STAI-Y), and EuroQol-5D (EQ-5D) psychological tests. Six months postoperatively, patients filled in dedicated questionnaires to assess their psychological status, quality of life, and subjective perception, thus repeating the above-mentioned tests and adding the Body Image Questionnaire (BIQ) and Patient and Observer Scar Assessment Scale (POSAS) v2.0 tests for scar-healing process evaluation.No patient died during the study.The 4 post-test scales of psychological well-being (BDI-II P = 0.04, STAI-Y P = 0.04, 2 indices of EQ-5D P = 0.03, P = 0.01) showed significant differences between the MIVS group and CS group, with MIVS-small incision patients having lower level of depression and anxiety symptoms and better quality of life. Mean score differences of scar perception (BIQ and POSAS v2.0) were significant, with MIVS patients having evaluated the scar quality significantly better than CS patients.MIVS appears associated with significant esthetical and related psychological benefits, as documented by technical tests. These findings should be considered when selecting the most appropriate technique for heart valve surgery.
The growing burden of valvular heart disease in Western countries represents a challenge for the daily clinical practice, especially in the light of the ever-increasing number of therapeutic options. The Euro Heart Survey showed that, among elderly subjects with severe, symptomatic valve dysfunction, surgery is denied for 33% of patients with aortic stenosis and for 50% of patients with mitral regurgitation. Current management (from diagnosis to follow-up) is often fragmented in multiple-sometimes unnecessary-steps. Such a "patchy" approach may translate into a suboptimal management, especially in the geriatric population. New healthcare models exist that can coordinate care, reduce fragmentation, limit costs and, ultimately, improve outcomes: the clinical pathways.
