Aims: Commercially available integrated software for echocardiographic measurement of stroke work (SW) is increasingly used for the right ventricle, despite a lack of validation. We sought to assess the validity of this method [echo-based myocardial work (MW) module] vs. gold-standard invasive right ventricular (RV) pressure–volume (PV) loops. Methods and results: From the prospectively recruiting EXERTION study (NCT04663217), we included 42 patients [34 patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) and 8 patients with absence of cardiopulmonary disease] with RV echocardiography and invasive PV catheterization. Echocardiographic SW was assessed as RV global work index (RVGWI) generated via the integrated pressure–strain MW software. Invasive SW was calculated as the area bounded by the PV loop. An additional parameter derived from the MW module, RV global wasted work (RVGWW), was correlated with PV loop measures. RVGWI significantly correlated with invasive PV loop-derived RV SW in the overall cohort [rho = 0.546 (P < 0.001)] and the PAH/CTEPH subgroup [rho = 0.568 (P < 0.001)]. Overall, RVGWW correlated with invasive measures of arterial elastance (Ea), the ratio of end-systolic elastance (Ees)/Ea, and end-diastolic elastance (Eed) significantly. Conclusions: Integrated echo measurement of pressure–strain loop-derived SW correlates with PV loop-based assessment of RV SW. Wasted work correlates with invasive measures of load-independent RV function. Given the methodological and anatomical challenges of RV work assessment, evolution of this approach by incorporating more elaborated echo analysis data and an RV reference curve might improve its reliability to mirror invasively assessed RV SW.

The purpose of this study was to evaluate the etiology, clinical characteristics and outcome of non-traumatic coma (NTC) among children admitted to a Pediatric Intensive Care Unit (PICU). A total of 159 children with NTC were included in the study. The Modified Glasgow Coma Scale (GCS) was used to assess consciousness. Patients were classified with regard to etiology. For each patient, demographic and clinical characteristics, survival and degree of disability at PICU discharge were recorded. Median age was 55 months (IQR: 17.0 - 109.0). The most common cause of NTC was neuroinfection (31.4%) followed by toxic-metabolic conditions (25.8%) and epileptic disorder (15.1%). There was no significant relationship between the level of encephalopathy at admission and NTC etiology. A total of 13 patients died (8.2%). Among the survivors, 61.6% were discharged without any neurologic deficit, 2.8% had severe neurologic disability and 3.4% were in a vegetative state. Complete neurological recovery was significantly more common in patients with toxic metabolic disease, whereas neurological deficits were more frequent in patients with tuberculous meningo-encephalitis (P = 0.01 and P = 0.04, respectively). Higher Pediatric Risk of Mortality III (PRISM III) score at PICU admission (Odds ratio: 1.51, 95% CI: 1.19 - 1.92; P < 0.001) was the only variable that was independently associated with mortality. The LOS at hospital (Odds ratio: 0.73, 95% CI: 0.58 -0.91; P = 0.006) were associated with improved odds of survival. Although results obtained from this single-center study cannot be generalized to the pediatric population, the contribution to the literature in terms of the relationships between NTC etiology and outcome can be crucial for clinical decision-making. We report neuroinfection as the most common cause of NTC, and the only factor that was closely associated with mortality was PRISM III score. Length of hospital stay was inversely correlated to patient mortality.

Introduction: The interaction between nasopharyngeal pneumococcal carriage (NPC) and respiratory viral infections (RVI) is poorly understood. This study aimed to investigate the prevalence and epidemiology of NPC, and its correlation with RVI. Methodology: This retrospective study included patients aged < 18 years who presented with RVI symptoms between 1 February and 30 June 2023. Naso-oropharyngeal swabs were tested using quantitative polymerase chain reaction (PCR) for Streptococcus pneumoniae and respiratory viruses. Patients were grouped by NPC status and compared for viral detection, and clinical and demographic characteristics. Results: NPC was detected in 15.7% (n = 1,185) of the 7,522 samples analyzed. The mean age was 56.5 ± 49.3 months, being significantly lower in NPC-positive patients (p < 0.001). Most (82%) were fully vaccinated against pneumococcus; 16% had underlying conditions. The most frequent viruses were adenovirus (17.2%), influenza B (9.0%), severe acute respiratory syndrome coronavirus 2 (5.3%), respiratory syncytial virus (4.9%), and influenza A (2.8%). Adenovirus (19.7%) and influenza B (11.0%) were significantly more frequent in NPC-positive patients than in NPC-negative patients (p < 0.001 for both). Overall, 20.5% were hospitalized, and 2.4% required intensive care. Intensive care admission was higher among NPC-positive patients, whereas mortality did not differ. Conclusions: NPC was epidemiologically associated with the detection of certain respiratory viruses, particularly adenovirus and influenza B. Given the retrospective design and lack of pneumococcal serotype data, these findings should be interpreted as associations rather than evidence of causality. Further prospective studies are warranted to clarify the bacterial–viral interactions and their clinical relevance.