Donor and recipient risk factors for the development of primary graft dysfunction following lung transplantation

Primary Graft Dysfunction (PGD) is a major cause of both short-term and long-term morbidity and mortality following lung transplantation. Various donor, recipient, and technical risk factors have been previously identified as being associated with the development of PGD. Here, we present a comprehensive review of the current literature as it pertains to PGD following lung transplantation, as well as discussing current strategies to mitigate PGD and future directions. We will pay special attention to recent advances in lung transplantation such as ex-vivo lung perfusion, thoracoabdominal normothermic regional perfusion, and up-to-date literature published in the interim since the 2016 ISHLT consensus statement on PGD and the COVID-19 pandemic.

Gender-related differences in the impact of COVID-19 pandemic in cardiometabolic patients in Latin America: The CorCOVID LATAM Gender sub-study

COVID-19 pandemic and lockdown measures have disrupted lifestyle habits and self-care. Gender differences in health behavior during the pandemic have not yet been fully elucidated. The aim of this study was to evaluate gender related differences in the impact of COVID-19 pandemic on patients with cardiometabolic diseases. A cross-sectional survey was administered to cardiometabolic patients in 13 Latin American countries between June 15th and July 15th, 2020. The study included 4216 participants, of which 2147 (50.9%) were women. Women reported healthier eating habits as well as lower tobacco and alcohol consumption than men but exercised less and reported increased symptoms of depression. Low income and symptoms of depression were associated with sedentarism in women. The interplay between psychological factors and sedentarism could increase the risk of cardiovascular events in this population.

Gender differences in objective measures of adult patients presenting for pectus excavatum repair

BACKGROUND

Women have a reported incidence of pectus deformities 4-5 times less than men. Gender differences have not been well studied.

METHODS

A retrospective review was performed of adult patients (≥18 years) who underwent a pectus excavatum repair at Mayo Clinic in Arizona (January 1, 2010-December 31, 2019).

RESULTS

In total, 776 adults underwent pectus repair with 30% being women. Women presented older (mean age 35 vs 32 years, p=0.007) and more symptomatic. Despite this, women performed better on cardiopulmonary exercise testing (higher VO2 max and O2 pulse). Women had more severe deformities (Haller index 5.9 vs 4.3, p<0.001). However, in 609 patients undergoing attempted primary minimally invasive pectus repair, intraoperative fractures/osteotomies occurred equally between genders with the majority occurring in patients ≥30 years of age (11.5% in ≥30, 1.7% in <30, total 7%). Women were also less likely to require 3 bars for repair (12% vs 42%, p<0.001). Hospital length of stay and postoperative complication rates were not significantly different. Postoperatively women reported a greater daily intensity of pain, but only on the initial postoperative day used significantly more opioids than men. Cardiopulmonary exercise testing in 142 patients undergoing baseline and postoperative evaluation at bar removal showed equal and significant benefits in both genders.

CONCLUSIONS

Women presented for pectus excavatum repair older and with greater symptoms and severity. Despite this, women required fewer bars, with no significant differences in length of stay or complications. Cardiopulmonary benefits of repair were significant and equal for both genders.

Dengue and the heart

Dengue is a neglected viral arthropod-borne tropical disease transmitted by the bite of infected Aedes spp. mosquitoes. It is responsible for a significant global burden of disease and corresponding socio-economic implications. There are four different virus serotypes, all of which are found predominantly in countries with tropical climates. Patients with dengue may present with cardiovascular (CV) manifestations, contributing to associated death and disability. A systematic review was conducted to identify CV manifestations of dengue, wherein 30 relevant studies were identified in the MEDLINE and PubMed databases. CV complications of dengue include rhythm abnormalities, hypotension, myocarditis, pericarditis and deterioration in myocardial function. Prompt recognition and treatment of CV complications of dengue are essential to reduce morbidity and mortality in these patients, who are at risk of progressing to cardiogenic shock and heart failure.

Human African trypanosomiasis & heart

INTRODUCTION

Human African Trypanosomiasis is a neglected tropical disease resulting from the infection with the parasite Trypanosoma brucei. Neurological compromise often dominates, and the impact of cardiovascular involvement has not been fully investigated. Recently, publications indicate that cardiovascular compromise is more frequent than previously thought. Early detection of cardiac complications may be of utmost importance for healthcare teams.

AREA COVERED

As a part of the 'Neglected Tropical Diseases and other Infectious Diseases involving the Heart' (the NET-Heart Project), the purpose of this article is to review all the information available regarding cardiovascular implications of this disease, focusing on diagnosis and treatment, and proposing strategies for early detection of cardiac manifestations. An electronic systematic literature review of articles published in MEDLINE, PubMed and EMBASE was performed. From 50 initial studies, 18 were selected according to inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for conducting and reporting this review.

EXPERT OPINION

Cardiovascular compromise through infiltrative and inflammatory mechanisms seems to be frequent, and includes a wide spectrum of severity. Conventional 12-lead electrocardiogram could be a useful test for screening cardiovascular manifestations and used as a guide for considering specific treatments or more sophisticated diagnostic tools.

Effect of neurotensin on glucose and insulin portal blood levels in hyperglycemic rats

A new multiple sampling technique for obtaining blood from the portal vein has been used to investigate the effects of neurotensin on insulin and glucose portal blood levels in rats rendered hyperglycemic by a constant glucose infusion. The peptide has been first injected acutely (2 microgram/rat iv), and then constantly infused (0.5 microgram/min for 55 min). The preliminary results indicate that no effect of the acute injection could be observed, but hyperglycemia and hyperinsulinemia were induced by the constant infusion of the peptide. It is suggested that neurotensin may stimulate the release of insulin probably through a direct mechanism.

Studies on the dynamics and mechanism of glibenclamide-induced insulin secretion

Sustained, 60-minute perfusion of glibenclamide (0.5, 1.5 and 10 mug/ml) elicits a one-phase insulin release profile, formed by a rapid secretion peak followed by a second peak with lower insulin levels than the former. Basal insulin secretion values are observed during the period comprised between 13 and 60 minutes of perfusion. Concurrent stimulation with glucose (100, 150, 200 and 300 mg%) plus glibenclamide (1 mug/ml) causes a marked rise in both phases of insulin secretion. The addition of glibenclamide does not modify the biphasic secretion pattern caused by maximal glucose concentration (400 mg%). The maximal values of both phases of secretion in the dose-response curve elicited by different glucose concentrations shift to the left when glibenclamide is added to the perfusate. The increase in insulin secretion caused by glibenclamide is not inhibited by puromycin. Both theophylline and phentolamine modify and increase the glibenclamide-induced insulin release pattern. Propranolol and imidazole inhibit glibenclamide-induced insulin release. Our results suggest that: 1. Glibenclamide increases beta cell sensitivity to glucose stimulation. 2. Glibenclamide and glucose induce secretion of insulin originating in the same compartment. 3. Modification of alpha and beta adrenergic receptors may modify glibodulate the beta cell response to glibenclamide.

Evidence for a hypophyseal factor that stimulates insulin secretion by the pancreas (insulotrophine?)

The continuous infusion of glucose (1 mg/kg/min) via the carotid artery in anesthetized dogs produced a biphasic pattern of insulin secretion. The first peak reached a maximum 3 min after glucose infusion and decreased to basal level at 7 min. As long as glucose infusion persisted a slow and maintained increase in insulin level in the pancreatico-duodenal vein was observed. The same amount of glucose infused in to the carotid arteries of hypophysectomized dogs, failed to induce any change in plasma insulin level. Plasma sample obtained from the jugular vein of dogs receiving glucose via the carotid arteries were infused into a second dog via the pancreatico-duodenal artery. One minute after the onset of infusion a rise in insulin was observed in the pancreatico-duodenal vein. The stimulating effect was not due to the high blood glucose level present in the jugular vein of dogs undergoing the cephalic glucose infusion. Infusion through the pancreatico-duodenal artery of a glucose solution at a concentration equal to the highest blood glucose level observed in the jugular vein did not evoke insulin secretion. Plasma samples obtained from the jugular vein of dogs receiving saline via the carotid arteries did not evoke insulin secretion when receiving into the pancreatico-duodenal arteries of dogs. Pancreatic infusion of plasma obtained from the jugular vein of hypophysectomized dogs infused glucose through the carotid arteries did not evoke any pancreatic response. These findings are demonstrative of the presence of a hypophyseal humoral insulin stimulating factor in the jugular vein of dogs receiving a cephalic glucose load.

Effect of cephalic glucose infusion on insulin secretion

The continuous infusion of glucose (1 mg/kg/min) via the carotid artery in anesthetized dogs produces a biphasic pattern of insulin secretion. The first peak reaches a maximum 3 min after glucose infusion and drops to basal level at 7 min. As long as the glucose infusion persists a slow and mantained increase in insulin level in the pancreaticoduodenal vein can be observed. The same amount of glucose infused in the general circulation via the jugular vein provoked a different pattern of insulin secretion. Cerebral glucose infusion to vagotomized dogs also produced a two phase response to insulin secretion, but the levels reached in the first phase were lower that those observed in the normal dogs. The infusion of glucose, via the jugular vein, in vagotomized dogs, failed to induce any change in plasma insulin levels. Our data suggest that a glucose load to the brain induces pancreatic insulin secretion mediated partially by the vagus nerves. These results are also compatible with the hypothesis that a humoral factor could be involved in the pancreatic response.