Comparative Analysis of Long-Term Outcomes in Valve-Sparing Aortic Root Reimplantation: Full Sternotomy versus Mini-Sternotomy Approach

Background: Aortic valve-sparing aortic root replacement (VSARR) David procedure has not been routinely performed via minimally invasive access due to its complexity. Methods: We compared our results for mini-VSARR to sternotomy-VSARR from another excellence center. Results: Eighty-four patients, 62 in the sternotomy-VSARR group and 22 in the mini-VSARR group, were included. A baseline, the aneurysm dimensions were higher in the mini-VSARR group. Propensity matching resulted in 17 pairs with comparable characteristics. Aortic cross-clamp and cardiopulmonary bypass times were significantly longer in the mini-VSARR group, by 60 and 20 min, respectively (p < 0.001). In-hospital outcomes were comparable between the groups. Drainage volumes were numerically lower, and hospital length of stay was, on average, 3 days shorter (p < 0.001) in the mini-VSARR group. At a median follow-up of 5.5 years, there was no difference in mortality (p = 0.230). Survival at 1, 5 and 10 years was 100%, 100%, and 95% and 95%, 87% and 84% in the mini-VSARR and sternotomy-VSARR groups, respectively. No repeat interventions on the aortic valve were documented. Echocardiographic follow-up was complete in 91% with excellent durability of repair regardless of the approach: no cases of moderate/severe aortic regurgitation were reported in the mini-VSARR group. Conclusions: The favorable outcomes, reduced drainage, and shorter hospital stays associated with the mini-sternotomy approach underscore its potential advantages expanding beyond cosmetic outcome.

EACVI survey on radiation exposure in interventional echocardiography

AIMS

The European Association of Cardiovascular Imaging (EACVI) Scientific Initiatives Committee performed a global survey on radiation exposure in interventional echocardiography. The survey aimed to collect data on local practices for radioprotection in interventional echocardiography and to assess the awareness of echocardiography operators about radiation-related risks.

METHODS AND RESULTS

A total of 258 interventional echocardiographers from 52 different countries (48% European) responded to the survey. One hundred twenty-two (47%) participants were women. Two-thirds (76%) of interventional echocardiographers worked in tertiary care/university hospitals. Interventional echocardiography was the main clinical activity for 34% of the survey participants. The median time spent in the cath-lab for the echocardiographic monitoring of structural heart procedures was 10 (5-20) hours/month. Despite this, only 28% of interventional echocardiographers received periodic training and certification in radioprotection and 72% of them did not know their annual radiation dose. The main adopted personal protection devices were lead aprons and thyroid collars (95% and 92% of use, respectively). Dedicated architectural protective shielding was not available for 33% of interventional echocardiographers. Nearly two-thirds of responders thought that the radiation exposure of interventional echocardiographers was higher than that of interventional cardiologists and 72% claimed for an improvement in the radioprotection measures.

CONCLUSION

Radioprotection measures for interventional echocardiographers are widely variable across centres. Radioprotection devices are often underused by interventional echocardiographers, portending an increased radiation-related risk. International scientific societies working in the field should collaborate to endorse radioprotection training, promote reliable radiation dose assessment, and support the adoption of radioprotection shielding dedicated to interventional echocardiographers.

What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

PURPOSE OF THE REVIEW

To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population.

RECENT FINDINGS

MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.

The Role of Autochthonous Levilactobacillus brevis B1 Starter Culture in Improving the Technological and Nutritional Quality of Cow's Milk Acid-Rennet Cheeses-Industrial Model Study

In the study, an attempt was made to develop an innovative technology for cheese manufacturing. It was hypothesized that selected autochthonous lactic acid bacteria as a starter culture are more suitable for the production of acid-rennet cheeses of good technological and sensory quality. The study aimed to assess the possibility of using the strain Levilactobacillus brevis B1 (L. brevis B1) as a starter culture to produce acid-rennet cheeses using raw cow's milk. Two variants of cheese were manufactured. The control variant (R) was coagulated with microbial rennet and buttermilk, and the other variant (B1) was inoculated with rennet and L. brevis B1 starter culture. The effect of the addition of these autochthonous lactic acid bacteria on selected physicochemical characteristics, durability, the composition of fatty acids, cholesterol, Iipid Quality Indices, and microbiological and sensory quality of acid-rennet cheeses was determined during a 3-month period of storage. The dominant fatty acids observed in the tested cheeses were saturated fatty acids (SFA) (68.43-69.70%) and monounsaturated fatty acids (MUFA) (25.85-26.55%). Significantly higher polyunsaturated fatty acid (PUFA) content during storage was observed for B1 cheeses. The B1 cheeses were characterized by lower cholesterol content compared to cheese R and showed better indexes, including the Index of atherogenicity, Index of thrombogenicity, DFA, OFA, H/H, and HPI indexes, than the R cheese. No effect of the tested L. brevis B1 on sensory quality was observed in relation to the control cheeses during 3 months of storage. The results of the research indicate the possibility of using the L. brevis B1 strain for the production of high-quality, potentially probiotic acid-rennet cheeses.

Inclusion of functional measures and frailty in the development and evaluation of medicines for older adults

The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) E7, the guidance for the conduct of clinical trials in people older than age 65 years, dates from 1994. Since then, the inclusion of older people in clinical trials has hardly improved, particularly for the oldest old age group (individuals older than age 75 years), which is the fastest growing demographic bracket in the EU. Even though most medications are taken by this group, relevant endpoints and safety outcomes for this cohort are rarely included and reported, both in clinical trials and regulatory approval documents. To improve the critical appraisal and the regulatory review of medicines taken by frail older adults, eight recommendations are presented and discussed in this Health Policy. These recommendations are brought together from different perspectives and experience of the treatment of older patients. On one side, the perspective of medical practitioners from various clinical disciplines, with their direct experience of clinical decision making; on the other, the perspective of regulators assessing the data submitted in medicine registration dossiers, their relevance to the risk-benefit balance for older patients, and the communication of the findings in the product information. Efforts to improve the participation of older people in clinical trials have been in place for more than a decade, with little success. The recommendations presented here are relevant for stakeholders, authorities, pharmaceutical companies, and researchers alike, as the implementation of these measures is not under the capacity of a single entity. Improving the inclusion of frail older adults requires awareness, focus, and action on the part of those who can effect a much needed change.

The Use of Apple Vinegar from Natural Fermentation in the Technology Production of Raw-Ripened Wild Boar Loins

Wild boar meat is difficult to process, mainly due to its hardness and stringiness. Three types of raw-ripened wild boar loins were produced (C-control treatment, R1 and R2-treatments with the addition of apple vinegar in various production variants). The research aimed to develop a new innovative technology for the production of wild boar loin using apple vinegar for marinating and to determine the impact of apple vinegar on the microbiological and sensory quality, and physico-chemical parameters of the product. As part of the research, a technology for the production of ripened wild boar products was developed and the composition of fatty acids, cholesterol content, pH value, oxidation-reduction potential, thiobarbituric acid reactive substances (TBARS) index, color, microbiological, sensory, and statistical analysis were determined. It was found that the loins were characterized by a high content of saturated, monounsaturated, and polyunsaturated fatty acids (20.18-43.37%), a low content of trans fatty acids (0.30-0.57%), and a high cholesterol content (75.13-85.28 mg/100 g of the product). Samples with apple vinegar (R1 and R2) were characterized by a lower pH value (5.10-5.70; p < 0.05), a comparable oxidation-reduction potential (409.75-498.57 mV), and a low TBARS index (0.461-1.294 mg malondialdehyde/kg of product). Their color was lighter (L* 38.25-40.65). All the tested loins were characterized by appropriate microbiological quality guaranteeing the storage durability of the product. R1 and R2 treatments were characterized by the greatest juiciness. The highest overall quality was achieved by R1 loins (7.36-7.76 c.u.). The apple vinegar used to marinate the loins had a positive effect on their microbiological and sensory quality as well as physico-chemical parameters. Moreover, the technology guarantees the appropriate quality and health safety of the products.

Prognostic Relevance of the Lung Ultrasound Score: A Multioutcome Study in Infants with Respiratory Distress Syndrome

OBJECTIVE

 There is growing evidence for the usefulness of the lung ultrasound score (LUS) in neonatal intensive care. We evaluated whether the LUS is predictive of outcomes in infants with respiratory distress syndrome (RDS).

STUDY DESIGN

 Neonates less than 34 weeks of gestational age were eligible for this prospective, multicenter cohort study. The outcomes of interest were the need for mechanical ventilation (MV) at <72 hours of life, the need for surfactant (SF), successful weaning from continuous positive airway pressure (CPAP), extubation readiness, and bronchopulmonary dysplasia. Lung scans were taken at 0 to 6 hours of life (Day 1), on Days 2, 3, and 7, and before CPAP withdrawal or extubation. Sonograms were scored (range 0-16) by a blinded expert sonographer. The area under the receiver operating characteristic curve (AUC) was used to estimate the prediction accuracy of the LUS.

RESULTS

 A total of 647 scans were obtained from 155 newborns with a median gestational age of 32 weeks. On Day 1, a cutoff LUS of 6 had a sensitivity (Se) of 88% and a specificity (Sp) of 79% to predict the need for SF (AUC = 0.86), while a cutoff LUS of 7 predicted the need for MV at <72 hours of life (Se = 89%, Sp = 65%, AUC = 0.80). LUS acquired prior to weaning off CPAP was an excellent predictor of successful CPAP withdrawal, with a cutoff level of 1 (Se = 67%, Sp = 100%, AUC = 0.86).

CONCLUSION

 The LUS has significant predictive ability for important outcomes in neonatal RDS.

KEY POINTS

· Lung ultrasound has significant prognostic abilities in neonatal RDS.. · Early sonograms (0-6 h of life) accurately predict the requirement for SF and ventilation.. · Weaning off CPAP is effective when the LUS (range 0-16) is less than or equal to 1..

Position of the Polish Cardiac Society on therapeutic targets for LDL cholesterol concentrations in secondary prevention of myocardial infarctions

Cardiovascular diseases account for 43% of deaths in Poland. The COVID-19 pandemic increased the number of cardiovascular deaths by as much as 16.7%. Lipid metabolism disorders are observed in about 20 million Poles. Lipid disorders are usually asymptomatic, they cause a significant increase in the risk of cardiovascular diseases. Up to 20% of patients who experience an acute coronary syndrome (ACS) may experience a recurrence of a cardiovascular event within a year, and up to 40% of these patients may be re-hospitalized. Within 5 years after a myocardial infarction, 18% of patients suffer a second ACS and 13% have got a stroke. Lipid-lowering therapy is an extremely important element of comprehensive management, both in primary and secondary prevention, and its main goal is to prevent or extend the time to the onset of heart or vascular disease and reduce the risk of cardiovascular events. A patient with a history of ACS belongs to the group of a very high risk of a cardiovascular event due to atherosclerosis. In this group of patients, low-density lipoprotein cholesterol levels should be aimed below 55 mg/dl (1.4 mmol/l). Many scientific guidelines define the extreme risk group, which includes not only patients with two cardiovascular events within two years, but also patients with a history of ACS and additional clinical factors: peripheral vascular disease, multivessel disease (multilevel atherosclerosis), or multivessel coronary disease, or familial hypercholesterolemia, or diabetes with at least one additional risk factor: elevated Lp(a) >50 mg/dl or hsCRP >3 mg/l, or chronic kidney disease (eGFR <60 ml/min/1.73 m²). In this group of patients, the LDL-C level should be aimed at below 40 mg/dl (1.0 mmol/l). Achieving therapeutic goals in patients after ACS should occur as soon as possible. For this purpose, a high-dose potent statin should be added to the therapy at the time of diagnosis, and ezetimibe should be added if the goal is not achieved after 4-6 weeks. Combination therapy may be considered in selected patients from the beginning. After 4-6 weeks of combination therapy, if the goal is still not achieved, adding a proprotein convertase subtilisin/kexin type 9 protein inhibitor or inclisiran should be considered. In order to increase compliance with the recommendations, Polish Cardiac Society and Polish Lipid Society propose to attach in the patient's discharge letter a statement clearly specifying what drugs should be used and what LDL-C values should be achieved. It is necessary to cooperate between the patient and the doctor, to follow the recommendations and take medicines regularly, to achieve and maintain therapeutic goals.

Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy: a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One

The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.

Meat Microflora and the Quality of Meat Products

Meat and meat products are not only a source of nutrients for humans [...].

The Influence of the Apple Vinegar Marination Process on the Technological, Microbiological and Sensory Quality of Organic Smoked Pork Hams

The effect of marinating pork hams in apple vinegar on the technological, microbiological, and sensory quality was verified. Three variants of pork hams were produced: S1-ham with curing salt, without apple vinegar; S2-ham with curing salt and 5% apple vinegar; S3-ham with salt and 5% apple vinegar. The tests were carried out immediately after production, after 7 and 14 days of storage. The products did not differ significantly in their chemical composition, salt content, fatty acid composition, and water activity (p > 0.05). During storage, a significant increase in the cholesterol content was observed (64.88-72.38 mg/100 g of the product). The lowest levels of nitrites and nitrates were recorded for treatment S3 (<0.10 and 4.73 mg/kg of product, respectively). The samples with the addition of apple vinegar (S2 and S3) were characterized by a lower pH value, higher oxidation-reduction potential, and TBARS (thiobarbituric acid reactive substances). Hams S3 were significantly brighter (L* 68.89) and less red (a* 12.98). All of the tested pork hams were characterized by very good microbiological quality (total number of microorganisms, number of lactic acid bacteria, number of acetic bacteria, number or presence of pathogenic bacteria). Significantly the lowest TVC (total viable counts) was found in the ham S3 (2.29 log CFU/g after 14 days). The S3 hams during storage were characterized by greater juiciness (6.94 c.u.) and overall quality (7.88 c.u.), but a lower intensity of smell and taste than the cured ham (S1). To sum up, it is possible to produce pork hams without the addition of curing salt, using natural apple vinegar as a marinade. Apple vinegar has a positive effect on the storage stability of the products, without losing their sensory properties.

Synergistic Effect of Combination of Various Microbial Hurdles in the Biopreservation of Meat and Meat Products—Systematic Review

The control of spoilage microorganisms and foodborne pathogens in meat and meat products is a challenge for food producers, which potentially can be overcome through the combined use of biopreservatives, in the form of a mix of various microbial hurdles. The objective of this work is to systematically review the available knowledge to reveal whether various microbial hurdles applied in combination can pose an effective decontamination strategy for meat and meat products. PubMed, Web of Science, and Scopus were utilized to identify and evaluate studies through February 2023. Search results yielded 45 articles that met the inclusion criteria. The most common meat biopreservatives were combinations of various starter cultures (24 studies), and the use of mixtures of non-starter protective cultures (13 studies). In addition, studies evaluating antimicrobial combinations of bacteriocins with other bacteriocins, BLIS (bacteriocin-like inhibitory substance), non-starter protective cultures, reuterin, and S-layer protein were included in the review (7 studies). In one study, a biopreservative mixture comprised antifungal protein PgAFP and protective cultures. The literature search revealed a positive effect, in most of the included studies, of the combination of various bacterial antimicrobials in inhibiting the growth of pathogenic and spoilage bacteria in meat products. The main advantages of the synergistic effect achieved were: (1) the induction of a stronger antimicrobial effect, (2) the extension of the spectrum of antibacterial action, and (3) the prevention of the regrowth of undesirable microorganisms. Although further research is required in this area, the combination of various microbial hurdles can pose a green and valuable biopreservation approach for maintaining the safety and quality of meat products.

Real world evidence: Perspectives from a European Society of Cardiology Cardiovascular Round Table with contribution from the European Medicines Agency

Real world data (RWD) refers to healthcare information that is routinely collected in electronic healthcare records (EHR), hospital and pharmacy records, patient and disease registries, and health insurance databases. The collection and analysis of this vast amount of data is an important complement to that obtained from conventional randomised controlled trials (RCT). Real world data has been used for healthcare quality improvements, to conduct clinical trials, to support drug and device development, and to inform medical guidelines. The utility of RWD may be facilitated by common data models, which standardise format and content, and allow data from different health systems to be analysed together. The European Society of Cardiology (ESC) supports the use of RWD in collaboration with national cardiac societies, regulatory authorities, and industry to encourage continuous quality of care improvements at the hospital and country level, to conduct registry-based randomised clinical trials (R-RCT) and to facilitate safety surveillance of novel drugs and devices. The European Medicines Agency (EMA) is developing systems and processes to enable the use of RWD that can help in trial planning, defining clinical contexts, and enhancing outcome assessments. RWD can also contribute to the measurement of the impact of regulatory actions, such as contraindications or restriction of indications by looking at medicines use patterns over time across European Member States. A number of other initiatives from the European Commission and the EMA are underway to strengthen the EU's health security framework, and foster the collection and utilisation of RWD.

Application of Density Measurements for Discrimination and Evaluation of Chemical Composition of Different Types of Mechanically Separated Meat (MSM)

At present, the problem of identifying and controlling different types of Mechanically Separated Meat (MSM) is a very important practical issue in the meat industry. To address this challenge, the authors propose a new, analytical method for the discrimination and characterization of MSM that uses density measurements. The method proposed by the authors, in contrast to the analytical methods existing so far, is rapid, non-destructive, relatively simple and can be computerized. The density measurements of meat samples were conducted with a modified pycnometric method. Statistically significant (p<0.01) differences were found in the evaluated mean values of density for all investigated types of meat. Subsequently, the density measurements were correlated with the physicochemical properties of meat samples. A high correlation coefficient was found between the density of meat samples and the content of protein, sodium and fat. The authors have proven that density measurements allow for rapid discrimination of various types of MSM, and can also be effectively used to determine the chemical composition of MSM samples, e.g., the content of protein, fat and sodium.

Clinical profile and outcome of recurrent infective endocarditis

AIMS

Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE).

METHODS

Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode.

RESULTS

3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE.

CONCLUSIONS

In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.

Risk factors for long-term survival in patients with ypN+ M0 rectal cancer after radical anterior resection

Background

Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection.

Methods

112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan–Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.

Results

In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01–9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74–19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09–22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12–0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44–12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082–0.586, p = 0.002).

Conclusions

The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

The Use of Unique, Environmental Lactic Acid Bacteria Strains in the Traditional Production of Organic Cheeses from Unpasteurized Cow's Milk

The aim of this study was to use local LAB cultures for the production of organic acid-rennet cheeses from unpasteurized cow’s milk. Under industrial conditions, three types of cheese were produced, i.e., traditionally with acid whey (AW), with starter culture L. brevis B1, or with starter culture L. plantarum Os2. Strains were previously isolated from traditional Polish cheeses. Chemical composition, physico-chemical, microbiological, and sensory studies during 2 months of storage were carried out. As a result of this research, it was found that the basic composition was typical for semi-hard, partially skimmed cheeses. Mainly saturated fatty acids were detected. The cheeses were rich in omega-3, -6, and -9 fatty acids and conjugated linoleic acid (CLA), and were characterized by good lipid quality indices (LQI). All of the cheeses were characterized by a high number of lactic acid bacteria, with Enterobacteriaceae, yeast, molds, and staphylococci contaminants, which is typical microbiota for unpasteurized milk products. Water activity, pH, and total acidity were typical. A lower oxidation-reduction potential (ORP) of cheeses with the addition of strains and stability of the products during storage were observed. The B1 and Os2 cheeses were lighter, less yellow, had a more intense milk and creamy aroma, were softer, moister, and more elastic than AW cheese. The research results indicate the possibility of using environmental LAB strains in the production of high-quality acid-rennet cheeses, but special attention should be paid to the production process due to the microbiological quality of the cheeses.

Assessment of the Microbiological Quality of Ready-to-Eat Salads-Are There Any Reasons for Concern about Public Health?

Ready-to-eat food products can be readily consumed without further preparation and are convenient for busy on-the-go consumers. The objective of the study was to assess the microbiological quality of ready-to-eat salads. Thirty RTE salads were tested for the presence of bacteria, yeasts, and molds using the TEMPO and agar plate method. The study demonstrated that most of the tested products were characterized by varying microbiological quality. The total number of mesophilic microbiotas was about 6 log CFU g^-1. The high number of microorganisms was due to yeast and molds or Enterobacteriaceae. Half of the salads were contaminated with E. coli and three salads were contaminated with S. aureus. LAB were also found, which can be explained mainly by a dairy ingredient. In some salads, Salmonella spp. and L. monocytogenes were detected (26.7% and 33.3% of the samples, respectively). Based on the conducted tests, it was found that the microbiological quality was not satisfactory. The results presented in this study indicate that there is a significant problem of the presence of pathogens. Manufacturers should strive to reduce the possibility of microbial contamination through the use of widely understood hygiene of the production process, using hurdle technology, including the modified atmosphere and refrigerated storage.

Treatment of Oesophagojejunostomy Leakage With the Use of Fibrin Glue: Case Report

Oesophagojejunostomy leakage after total gastrectomy with D2 lymphadenectomy remains a significant clinical issue. In this paper, we present a case of a 63-year-old female patient who, on the first day after surgery, was diagnosed with oesophagojejunostomy leakage in the chest. The general condition of the patient was stabilized by the implementation of conservative treatment and thoracic drainage. Thanks to covered oesophageal stents, the leakage from the fistula between the anastomotic connection, pleura, and skin was reduced. In the subsequent step, treatment with fibrin glue resulted in complete closure of the fistula. The complementary use of fibrin glue may be effective in the treatment of small oesophagojejunostomy leakages when other endoscopic methods are not sufficient.

Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices)

In the European Union (EU), the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent ‘conformity assessment’ organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the Medical Device Directive, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details – which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE–MD project (Coordinating Research and Evidence for Medical Devices) will run until March 2024. Here, we describe how it may contribute to the development of regulatory science in Europe.

Cite this article: EFORT Open Rev 2021;6:839-849. DOI: 10.1302/2058-5241.6.210081

Percutaneous tricuspid edge-to-edge repair - patient selection, imaging considerations, and the procedural technique. Expert opinion of the Working Group on Echocardiography and Association of CardioVascular Interventions of the Polish Cardiac Society

Tricuspid regurgitation (TR) is a common acquired valvular heart disease (VHD). TR has progressive character and is associated with impaired long-term survival in both symptomatic and asymptomatic subjects. Despite this knowledge, the overall number of tricuspid valve surgeries is very low worldwide and many patients with clear indications for intervention are left untreated. The development of less invasive transcatheter techniques may offer new treatment options in this growing population of patients. Out of various percutaneous methods proposed, tricuspid edge-to-edge repair has recently gained considerable attention. The article summarizes available data regarding this new treatment method.

Improved clinical investigation and evaluation of high-risk medical devices: the rationale and objectives of CORE-MD (Coordinating Research and Evidence for Medical Devices)

In the European Union (EU) the delivery of health services is a national responsibility but there are concerted actions between member states to protect public health. Approval of pharmaceutical products is the responsibility of the European Medicines Agency, while authorising the placing on the market of medical devices is decentralised to independent 'conformity asssessment' organisations called notified bodies. The first legal basis for an EU system of evaluating medical devices and approving their market access was the medical device directives, from the 1990s. Uncertainties about clinical evidence requirements, among other reasons, led to the EU Medical Device Regulation (2017/745) that has applied since May 2021. It provides general principles for clinical investigations but few methodological details ‒ which challenges responsible authorities to set appropriate balances between regulation and innovation, pre- and post-market studies, and clinical trials and real-world evidence. Scientific experts should advise on methods and standards for assessing and approving new high-risk devices, and safety, efficacy, and transparency of evidence should be paramount. The European Commission recently awarded a Horizon 2020 grant to a consortium led by the European Society of Cardiology and the European Federation of National Associations of Orthopaedics and Traumatology, that will review methodologies of clinical investigations, advise on study designs, and develop recommendations for aggregating clinical data from registries and other real-world sources. The CORE‒MD project (Coordination of Research and Evidence for Medical Devices) will run until March 2024; here we describe how it may contribute to the development of regulatory science in Europe.

Echocardiographic guidance for HARPOON beating-heart mitral valve repair

The HARPOON mitral valve (MV) repair system has been shown to safely and effectively treat a degenerative MV prolapse with transventricular implantation of artificial cords on a beating heart. The low profile system is introduced and precisely steered under 3D TEE guidance towards the previously selected target on a prolapsing MV segment. It allows puncture and deployment of a knot on the leaflet. The procedure is repeated until desired number of knots are implanted and the cords are optimally tensioned to restore coaptation. The cords are then tied down on the epicardium over a felt pledget.

State of the art echocardiographic imaging is a crucial part of the procedure. It starts from patients screening, pre-procedural analysis and planning, access selection, navigation, deployment, optimal cordal tensioning, and final MV assessment and is continued during the follow-up assessment.

This article illustrates the specific echocardiographic aspects of the HARPOON procedure including 2D and advanced 3D TEE techniques. The echocardiographic protocol was developed based on initial experience in 60 procedures. Detailed training of the echocardiographer and surgical team, is mandatory to achieve excellent results of this procedure, being now introduced in the clinical practice.

Echocardiography during the coronavirus disease 2019 pandemic - the impact of the vaccination program. A 2021 update of the expert opinion of the Working Group on Echocardiography of the Polish Cardiac Society

The coronavirus disease 2019 (COVID-19) pandemic resulted in an urgent need to reorganize the work of echocardiography laboratories in order to ensure the safety of patients and the protection of physicians, technicians, and other staff members. In the previous Expert Opinion of the Working Group on Echocardiography of Polish Cardiac Society we provided recommendations for the echocardiographic services, in order to ensure maximum possible safety and efficiency of imagers facing epidemic threat. Now, with much better knowledge and larger experience in treating COVID-19 patients and with introduction of vaccination programs, we present updated recommendations for performing transthoracic and transesophageal examinations, including information on the potential impact of personnel and the patient vaccination program, and growing numbers of convalescents on performance of echocardiographic laboratories, with the goal of their ultimate reopening.

Dynamics of humoral response to coronavirus antigens among employees of a designated COVID‑19 hospital: an observational study

INTRODUCTION

During the COVID‑19 pandemic studies on workplace safety of hospital staff taking care of patients with this disease are a high priority. We decided to analyze the results of opportunistic screening for anti-SARS‑CoV-2 antibodies among employees of a designated COVID-19 center.

OBJECTIVES

The aim of the study was to investigate whether potential exposition to SARS‑CoV-2 antigens is reflected in the results of serological studies.

PATIENTS AND METHODS

Every employee who performed at least a single test between April 21 and July 20, 2020 was included in the study. The tests assessed the levels of immunoglobulin (Ig) G and IgM+IgA. Employees working in direct contact with COVID‑19 patients and those participating in aerosol‑generating procedures were identified.

RESULTS

The results of 2455 tests taken by 1572 employees were analyzed. A total of 357 participants (22.7%) had at least 1 positive or equivocal result during the study period. Linear mixed models revealed gradual increases in mean levels of both IgG and IgM+IgA antibodies among employees with all negative results. The rate of change was higher among persons who had direct contact with COVID‑19 patients and the highest rate of change was observed among individuals participating in aerosol‑generating procedures.

CONCLUSIONS

We detected developing humoral immune response to a new set of coronavirus antigens among the study group. It is possible that employees of designated COVID‑19 centers are regularly exposed to noninfectious doses of SARS‑CoV-2 or its antigens.

Association between calcifications of mitro-aortic continuity and mitral regurgitation in patients undergoing transcatheter aortic valve replacement

BACKGROUND

The presence of mitral annular calcification (MAC) affects prognosis in patients undergoing transcatheter aortic valve implantation (TAVI). MAC frequently coexists with calcifications of mitro-aortic continuity (CMAC).

AIMS

We aimed at qualitative and semi-quantitative analysis of calcifications of the mitral complex - MAC and CMAC in multi-slice computed tomography, in order to assess their impact on the occurrence and dynamics of mitral regurgitation (MR) following TAVI.

METHODS

The study group consisted of 94 patients (mean [SD] age was 79.9 [8.02] years; 67.1% female). Agatston scale - Calcium Score was used for quantitative analysis. MAC and CMAC were also assessed semi-quantitatively as either non-severe or severe. MR following TAVI was defined as unchanged, improved or worsened by at least one degree.

RESULTS

Patients with MAC (59.6%) had higher mean aortic gradients (P = 0.02) and smaller left ventricular diastolic diameter (P = 0.002). Patients with CMAC (48.9%) had higher Calcium Score aortic valve (P = 0.006). After TAVI MR improved in 17 (18.1%) patients and worsened in 7 (7.5%) patients. In multivariable logistic regression analysis MR worsening was associated with higher CMAC (OR, 1.092; 95% CI, 1.006-1.185; P = 0.03), as well as bicuspid aortic valve (OR, 6.348; 95% CI, 1.048-38.436; P = 0.04).

CONCLUSIONS

CMAC was associated with MR worsening following TAVI. This is of relevance in procedural planning in patients with severe aortic stenosis (AS) and coexisting MR in whom arguments for and against surgical repair of concomitant mitral insufficiency are considered.

Pregnancy-related, nonelective cardiac hospitalizations and pregnancy outcomes: a tertiary referral cardiac center experience

BACKGROUND

Pregnant women with cardiovascular diseases (CVD) and their offspring are at increased morbidity and mortality.

AIMS

To provide data on pregnancy outcomes among women with different typesof CVD requiring non-elective cardiac hospitalization in atertiary referral cardiac center.

METHODS

We identified all records of non-elective hospitalizations of pregnant women hospitalized between January 2009 through March 2018, at our institution-a tertiary referral cardiaccentre. The incidence and type of cardiac complications during pregnancy as well as the pregnancy and offspring outcomeswere determined.

RESULTS

161 out of 328 pregnancy-related hospitalizations in140 pregnancies were non-elective. Cardiac complications occurred in 62 (44%) of pregnancies, with the most frequent being: episodesof arrhythmia (22.1% pregnancies), followed by heart failure exacerbations(6.4% pregnancies). Maternal mortality reached 2.1% and affected only women with primary cardiomyopathies (CMP). Offspring mortality was 2.8%. Newborns of mothers with cardiac complications had significantly lower Apgar scoresand gestational age at delivery,compared to mothers without cardiac complications.

CONCLUSIONS

In our series mortality and morbidity among pregnant women with CVD hospitalizations werehigh. An unfavorable maternal outcome mainly affected women with CMP. Offspringof mothers with cardiovascular complications are prone to have a lowergestational age and Apgar score.

Modified lung ultrasound score predicts ventilation requirements in neonatal respiratory distress syndrome

Background

We propose a modified lung ultrasound (LUS) score in neonates with respiratory distress syndrome (RDS), which includes posterior instead of lateral lung fields, and a 5-grade rating scale instead of a 4-grade rating scale. The purpose of this study was to evaluate the reproducibility of the rating scale and its correlation with blood oxygenation and to assess the ability of early post-birth scans to predict the mode of respiratory support on day of life 3 (DOL 3). As a secondary objective, the weight of posterior scans in the overall LUS score was assessed.

Methods

We analyzed 619 serial lung scans performed in 70 preterm infants < 32 weeks gestation and birth weight < 1500 g. Assessments were performed within 24 h of birth (LUS₀) and on days 2, 3, 5, 7, 10, 14, 21 and 28. LUS scores were correlated with oxygen saturation over fraction of inspired oxygen (S/F) and mode of respiratory support. Interrater agreement was determined with the intraclass correlation coefficient (ICC) and Cronbach’s alpha. Probabilities of the need for various respiratory support modes on DOL 3 were assessed with ordinal logistic regression. Least square (ls) means of the posterior and anterior pulmonary field scores were compared.

Results

The LUS score correlated significantly with S/F (Spearman rho = −0.635; p < 0.0001) and had excellent interrater agreement (ICC = 0.94, 95% CI 0.93–0.95; Cronbach’s alpha = 0.99). Significant predictors of ventilation requirements on DOL 3 were LUS₀ (p < 0.016) and birth weight (BW) (p < 0.001). In the ROC analysis, LUS₀ had high reliability in prognosing invasive ventilation on DOL 3 (AUC = 0.845 (95% DeLong CI: 0.738–0.951; p < 0.001)). Invasive ventilation was the most likely mode of respiratory support for LUS₀ scores: ≥7 (in infants with BW 900 g), ≥ 10 (in infants with BW 1050 g) and ≥ 15 (in infants with BW 1280 g). Posterior fields exhibited significantly higher average scores than anterior fields. Respective ls means (confidence levels) were 4.0 (3.8–4.1) vs. 2.2 (2.0–2.4); p < 0.001.

Conclusions

Post-birth LUS predicts ventilation requirements on DOL 3. Scores of posterior pulmonary fields have a predominant weight in the overall LUS score.

The effect of selected lactic acid bacterial strains on the technological and microbiological quality of mechanically separated poultry meat cured with a reduced amount of sodium nitrite

The aim of the research was to estimate the effect of selected lactic acid bacterial strains on the technological quality and microbiological stability of mechanically separated poultry meat (MSPM) cured with a reduced amount of sodium nitrite. The 5 different treatments of MSPM batters were prepared: C150 - control cured with sodium nitrite at 150 mg/kg, C50 - control cured with sodium nitrite at 50 mg/kg, PL1 - cured with sodium nitrite at 50 mg/kg and inoculated Lactobacillus plantarum SCH1 at about 107 cfu/g, PL2 - cured with sodium nitrite at 50 mg/kg and inoculated Lactobacillus brevis KL5 at about 107 cfu/g, and PL3 - cured sodium nitrite at 50 mg/kg and inoculated L. plantarum S21 at about 107 cfu/g. The MSPM batters were tested at 1, 4 and 7 d of being in refrigerated storage. The scope of the research was as follows - physicochemical determinations: pH and redox, nitrates and nitrites as well as nitrosyl pigments levels, color estimation with a Comission Internationale de l'Eclairage Lab system and microbiological determinations: the total viable counts, the mesophilic lactic acid bacteria counts, Escherichia coli and Enterobacteriaceae counts. The inhibitory effect of L. plantarum SCH1 isolated from the ecological raw fermented meat product on E. coli in cured MSPM batters during refrigerated storage was proved (P < 0.05). The use of lactic acid bacterial strains in cured batters that were prepared and based on mechanically separated poultry meat did not have a negative effect on their technological quality. The positive effect of L. brevis KL5 on the level of nitrosyl pigments in the cured MSPM batters was observed (P < 0.05). The conducted research suggested the possibility of using the selected bacterial strains of the Lactobacillus genus to improve the microbiological quality of MSPM cured with a reduced amount of sodium nitrite.

Identification and investigation of mechanically separated meat (MSM) with an innovative ultrasonic method

An innovative analytical ultrasonic method for identification and investigation of Mechanically Separated Meat (MSM) samples is presented. To this end, the ultrasonic wave velocity (f=5MHz) in the investigated meat samples was measured. The measured ultrasonic velocity ranged from 1553.4 to 1589.9 m/s. The investigations were performed for: 1) minced hand deboned chicken fillets, 2) low pressure MSM from chicken carcasses, 3) low pressure MSM from chicken collarbones, 4) high pressure MSM from chicken carcasses and 5) high pressure MSM from chicken collarbones. Statistically significant (p<0.001) differences in the ultrasonic velocity were observed for each of investigated kinds of meat. High significant correlations were found between the ultrasonic velocity and the content of protein, fat, sodium and density of the investigated meat. The applicability of the developed ultrasonic method for identifying various kinds of meat and to determine the content of protein, fat, sodium and density was demonstrated.

Laparoscopic cortical-sparing adrenal surgery in pheochromocytomas associated with hereditary neoplasia syndromes

INTRODUCTION

Pheochromocytomas in hereditary syndromes tend to grow multifocal with adrenal involvement on both sides. Surgical treatment with bilateral adrenalectomy inevitably leads to life-long hormonal dependence, which significantly affects quality of life. The development of minimally invasive adrenal surgery has created a chance to preserve adrenal cortex function in these patients. The aim of the present study was to evaluate the safety of laparoscopic cortical-sparing adrenal surgeries and their efficacy in the prevention of postoperative adrenal insufficiency in patients with hereditary pheochromocytomas.

MATERIAL AND METHODS

We retrospectively analysed the medical histories of 10 patients, who underwent 10 laparoscopic cortical sparing adrenal surgeries from January 2015 to January 2019 in our centre. The decision to perform sparing surgery was based on preoperative diagnosis of hereditary syndrome in line with the result of DNA analysis or its diagnosis based on the clinical appearance. All surgeries were performed laparoscopically from transperitoneal access in the lateral decubitus position, with preserving 1/3-1/4 adrenal tissue. The sufficiency of remnant adrenal tissue was assessed in all patients. The median time of follow-up was three years (ranged 0.5-4 years).

RESULTS

No intraoperative complications were observed. One case of acute heart failure was the only early postoperative adverse event. There were no late postoperative complications and no local recurrences observed. In one out of three patients undergoing sparing surgery as a second procedure after former total adrenalectomy, adrenal cortex failure occurred. In all patients after unilateral surgery or after bilateral surgery performed simultaneously (total adrenalectomy at one side and sparing surgery contralaterally), function of remnant adrenal tissue was preserved.

CONCLUSIONS

In hereditary pheochromocytomas, with minimal risk of malignant process, laparoscopic cortical sparing adrenal surgeries are the safe approach and provide the chance to preserve adrenal cortex function.

On the search for the right definition of heart failure with preserved ejection fraction

The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based "diagnosis of exclusion" to definitions focused on objective evidence of diastolic dysfunction and/or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particular - invasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HFpEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H2FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF.

Usefulness of FRAIL Scale in Heart Valve Diseases

Background

The frailty syndrome is a serious health problem for an aging population. The occurrence of frailty in the group of symptomatic patients undergoing heart valve surgery may have additional clinical implications. The predictive ability of the FRAIL scale in patients undergoing heart valve surgery during a 30-day follow-up has not yet been described.

Patients and Methods

A prospective study was conducted on a group of consecutive patients with hemodynamically significant valve disease (aortic stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) that underwent elective valve surgery in 2014–2019. The primary endpoint was 30-day mortality. Univariate analysis, followed by multivariate regression analysis, was performed.

Results

The study group included 672 consecutive patients (aortic valve stenosis, aortic regurgitation, mitral stenosis and mitral regurgitation) who underwent replacement or repair of the valve. Twenty-five patients died during the 30-day follow-up. At multivariate analysis, FRAIL scale result (OR 2.802; 95% CI 1.275–6.157; p=0.01) and red cell distribution width (RDW) (OR 1.810; 95% CI 1.181–2.775; p=0.006) remained independent predictors of the primary endpoint.

Conclusion

The presented study showed the predictive ability of the FRAIL scale result in patients undergoing heart valve surgery for 30-day mortality.

Assessing the usefulness of dense sensor network for PM2.5 monitoring on an academic campus area

Low-cost sensors provide an opportunity to improve the spatial and temporal resolution of air quality measurements. Networks of such devices may complement the traditional air quality monitoring and provide some useful information about pollutants and their impact on health. This paper describes the network of 20 nodes for ambient PM_2.5 monitoring on a campus area of Wrocław University of Science and Technology (Wrocław, Poland). Sensor nodes were equipped with optical sensors PMS A003 (Plantower), which showed high reproducibility between units. The distribution of the sensor nodes was characterised by both high density (14 devices on the main campus area) and wide spread across the city (6 devices on peripheral campuses). During the measurement campaign, signals from sensor nodes were consistent with results from regulatory monitoring stations and sensor devices were capable of indicating elevated levels of PM_2.5 concentrations. A great advantage of this system was the ability to provide up-to-date air quality information to the public. Furthermore, air quality messaging was site-specific because of the observed differences in PM_2.5 concentrations. Data analysis was aimed at assessing variability between locations using Kendall's τ metric and assessing the statistical significance of the differences in measurement results from neighbouring sensor nodes using the Kolmogorov-Smirnov test. The analysis showed high importance of the nodes in the middle of the main campus and variations of signals from nodes on the peripheries. Differences in signals from sensors located in close proximity to each other were in some cases significant, but only for short-term averaged data. Nevertheless, highly visible variation in PM_2.5 signals was observed in the case of nodes arranged vertically on two buildings. PM_2.5 concentrations were even 2-4 times greater near the top parts of the buildings than near the ground. The effect of stratification of PM_2.5 levels was observed under conditions of temperature inversion.

Transformation of a large multi-speciality hospital into a dedicated COVID-19 centre during the coronavirus pandemic

INTRODUCTION

The article describes the process of converting a large multi-specialized hospital into one dedicated to COVID-19 patients, and present established standards of work organization in all the wards and training system of the medical and supporting staff. The several weeks pandemic of the COVID-19 disease has forced the healthcare systems of numerous countries to adjust their resources to the care of the growing number of COVID-19 patients. Managers were presented with the challenge of protecting the healthcare workers from transmission of the disease within medical institutions, and issues concerning the physical and psychological depletion of personnel.

MATERIAL AND METHODS

Based on analyses of the structure and work processes in Central Clinical Hospital (CCH) reconstructive strategic plan was developed. It included: division of existing wards into observation and isolation wards; installing locks; weekly plan for supplying personal protection equipment (PPE); designating new access to the hospital and communication routes; training of medical and supporting staff. The plan was implemented from the first days of conversion of the hospital.

RESULTS

The wards of the CCH were converted for observation and isolation, and each one was fitted with sanitary locks. There was a big improvement in the supply of PPE for the medical staff. Separation of the 'dirty' and 'clean' parts of the CCH were attained, and widespread intensive training not only protected personnel against infections, but also diminished unrest which was discernable at the beginning of conversion.

CONCLUSIONS

The transformation efforts will ultimately be appraised at the end of the epidemic, but the data looks encouraging. Two weeks after conversion, the testing of hospital Staff was started and by the end of April, 459 tests were had been conducted, of which only 11 were positive.