Parvovirus B19 (B19V) is the predominant cardiotropic virus found in endomyocardial biopsies (EMBs). Nevertheless, direct evidence showing a causal relationship between B19V cardiac presence and disease progression of B19V‐associated dilated inflammatory cardiomyopathy (DCMi) were still missing. Parvovirus B19 NS1 and VP1/2 mRNA expression indicates viral activity. Aim of this study was - To established qRT-PCR to detect B19V viral RNA of capsid (VP1) and non-structural (NS1) sequences - to analyse the influence of actively replicating B19V and inflammation upon long-term mortality in a large cohort of adult patients with inflammatory cardiomyopathy. The study group comprised 871 consecutive B19V-positive patients (mean ejection fraction (LVEF) =48.6±20.0%) who underwent EMB after exclusion of ischemic or valvular heart disease. EMB analysis confirmed inflammation in 436 (50.1%) B19V-positive patients. The patients were followed for 60 months. Information on vital status was obtained from official resident data files. Patients with inflammation and replicative active B19V infection revealed the poorest prognosis compared to patients without/with inflammation without B19V replicative intermediates (p=0.0002/p=0.045). Viral load had no significant influence on the patient’s outcome (p=0.079), contrary to inflammation (p=0.028) and replicative status (0.034).
Conclusion This is the first study investigating the pathogenic clinical importance of B19V in a large cohort of patients. Transcriptional active cardiotropic B19V infection with positive replication intermediates and inflammation are unfavourable prognostic triggers of adverse long term-mortality, whereas B19 virus genomes without transcriptional activity has no effect on mortality. Our findings are of high clinical relevance, as they indicate for the first time that a selection of specific characterized B19V positive patients may profit from innovative tailored anti-viral immunomodulatory treatment strategies.

Medication reconciliation is the process for creating and initiation the most complete and the accurate list possible of a patient’s with current medications and comparing the list to those in the patient medical record or medication orders that According to the Joint Commission5 (p. 1), Medication reconciliation is the process of the comparing a patient's medication orders to all of the medications that the patient has been taking medicine. This reconciliation is done to avoid medication errors such as dose or medication omissions, therapeutic duplications , inappropriate dosing, or drug - drug interactions. It should be done at every transition of care in which new medications are ordered by prescriber or existing orders are re ordered , Transitions in care include changes in the care setting, the service provided , practitioner, or level of care. This process comprises five steps: (1) a list of current medications shall be developed; that include the Medication Prior to admission (2) a list of medications that to be prescribed; (3) compare the medications on the two mentioned lists in step 1 and 2; (4) make clinical decisions based on the comparison; and clinical needed for patient (5) communicate the new list to appropriate caregivers and to the patient. The steps in medication reconciliation are the following for a newly hospitalized patient, the steps include obtaining and verifying the patient’s medication history prior to admission, documenting the patient’s medication history, writing the medication orders for the hospital medication regimen that clinically needed to patient, and creating a medication administration record. At discharge, the steps include determining the post discharge medication regimen, developing discharge instructions for the patient for home medications, educating and counseling the patient, and transmitting the medication list to the follow-up physician. For patients in ambulatory settings and outpatient, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed and the list shall be given to patient.