Search Results for: Le cause della polmonite nei bambini

Stroke, Ahead of Print. BACKGROUND:The mechanism of the lipid paradox remains uncertain, and malnutrition may be 1 explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.METHODS:Patients with ischemic stroke in a single-center prospective cohort (Shanghai, China) from January 2018 to December 2022 were studied. Individuals were classified into 3 groups based on their Controlling Nutritional Status score. Poor outcome and all-cause mortality during up to 3 months of follow-up were compared among patients with varied nutritional status and RC levels utilizing multivariate logistic regression analyses, RC splines, and subgroup analyses.RESULTS:A total of 6892 patients with ischemic stroke were enrolled in the cohort, of which 5257 patients were included in the present study (without malnutrition: 2418 [46.0%]; mild malnutrition: 2516 [47.9%]; moderate-severe malnutrition: 323 [6.1%]). The median age was 69±12 years, and 3398 (64.6%) were male. Patients with moderate-severe malnutrition had the highest risks of poor outcome (198 [61.3%];P

Stroke, Ahead of Print. BACKGROUND:Stroke survivors are highly sedentary and engage in minimal physical activity. This study aimed to investigate the independent and joint effects of daily sitting time and leisure-time physical activity on survival among stroke survivors.METHODS:The nationally representative cohort included 1446 stroke survivors (weighted population, 6 968 723) from the National Health and Nutrition Examination Survey from 2007 to 2018. Mortality data were obtained through December 31, 2019. Leisure-time physical activity was categorized as inactive (0 min/wk), insufficiently active (1 to

Background
Chest pain is a major cause of emergency ambulance calls, often linked to acute myocardial infarction (AMI), a critical condition requiring immediate hospitalisation. Current diagnostic methods, such as history taking and ECG, have limitations, especially for non-ST-elevation myocardial infarction. High-sensitivity cardiac troponin (cTn) assays are more diagnostically sensitive, but the downside is that it needs hospital-based testing, which can delay diagnosis and the necessary treatment protocol. Point-of-care cTn testing, on the other hand, is much faster and done nearer to the patient; hence, it may fundamentally change the prehospital care pathway in terms of diagnostic accuracy, clinical utility and related safety.

Objective
To present a protocol for a systematic review and meta-analysis that will assess the diagnostic accuracy, clinical utility and safety of point of care (POC) troponin tests, with or without clinical decision aids, for ruling out AMI in adults presenting with cardiac chest pain to emergency ambulance services in prehospital settings.

Methods
This protocol follows BMJ guidelines and adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 reporting standards. It is registered with PROSPERO (ID: CRD42024533117). A comprehensive search strategy will identify relevant studies in MEDLINE, EMBASE and CINAHL, focusing on literature from 2000 onwards. Eligibility criteria include adults with chest pain suspected of AMI, excluding those with ST-elevation myocardial infarction. The primary target is type 1 AMI, with secondary outcomes including major adverse cardiac events at 30 days. Risk of bias assessment will be performed using tools such as Quality Assessment of Diagnostic Accuracy Studies version 2, Risk of Bias 2, and Risk of Bias in Non-randomised Studies of Interventions, while the quality of the economic evaluations will be appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data items extracted will include patient demographics, test characteristics and outcomes. Where possible, meta-analyses will be conducted by fitting hierarchical models for diagnostic accuracy and random effects models for clinical and cost-effectiveness estimates. Subgroup analyses are proposed to quantify the effect of variables such as gender, ethnicity and type of troponin assay on the estimated parameters.

Ethics and dissemination
Ethical approval is not required. The results will be published in a peer-reviewed journal and presented at international conferences.

PROSPERO registration number
This protocol is registered with PROSPERO, the International Prospective Register of Systematic Reviews, under the ID CRD42024533117. Any future amendments will be updated in the PROSPERO record.

Introduction
Adverse events during paediatric anaesthesia are common, with hypoxaemia during the induction period being a leading cause, as infants and children are particularly vulnerable to hypoxaemia during periods of apnoea. The administration of supplementary oxygen, referred to as apnoeic oxygenation, has been shown to prolong safe apnoea times and increase first-pass intubation success rates. Despite these benefits, apnoeic oxygenation is not routinely used in paediatric anaesthesia. Low-flow apnoeic oxygenation, delivered via a standard nasal cannula, is a simple approach to provide supplementary oxygen during paediatric airway management without requiring additional equipment. However, its efficacy in airway management during elective surgeries has not been adequately studied.

Methods and analysis
The ApOx-Pedi-Trial is a single-centre, cluster randomised, controlled clinical trial comparing the use of low-flow apnoeic oxygenation during the induction of general anaesthesia in infants and children up to 6 years of age undergoing elective surgery at the Department of Pediatric Surgery at Heidelberg University Hospital to standard of care (no apnoeic oxygenation). Randomisation is conducted using a weekly cluster randomisation method, where all patients presenting for surgery in a given week either receive apnoeic oxygenation or standard of care during the induction of general anaesthesia, based on the week’s group allocation.
The study population will consist of two independent, age-stratified cohorts (24 months to 6 years), each including 100 patients. Statistical analysis of study endpoints will be conducted separately for each cohort to allow for age-specific assessment of outcomes.
The primary objective of this trial is to evaluate whether apnoeic oxygenation can prevent a decrease in transcutaneous haemoglobin saturation (SpO2) during the induction of general anaesthesia in infants and children. The primary outcome measure will be the lowest recorded SpO2 value throughout the apnoeic period.

Ethics and dissemination
The ApOx-Pedi-Trial received permission from the local ethics committee (Ethics Committee of the medical faculty at Heidelberg University, Heidelberg, Germany) under the registration number S-074–2024. The study is following institutional Guidelines and the Declaration of Helsinki of 1975 in its most recent version. Trial results will be submitted to peer-reviewed journals and presented at national and international conferences.

Trial registration number
The trial is prospectively registered on ClinicalTrials.gov with the number NCT06576596.

Introduction
Diet and nutrition play a vital role in all stages of chronic kidney disease (CKD) prevention, treatment and management. In particular, dietary interventions are essential to manage hyperphosphataemia, a common metabolic complication in CKD consistently associated with an increased risk of cardiovascular disease and all-cause morbidity and mortality. Unfortunately, dietary management of any kind in this cohort of patients also comes with the added challenge of limited and variable access to renal dietitians, logistical difficulties and multiple medical appointments. Given the complexity of managing diet in patients on dialysis, there is a need for novel interventions that not only help patients navigate daily challenges but could also be integrated into clinical practice to support the work of dietitians. We are testing if the use of digital health (via a new, specifically designed smartphone App) plus standard care compared to standard care alone is a feasible and effective method of delivering nutritional advice to patients with elevated phosphate levels undertaking dialysis.

Methods and analysis
This is a multicentre codesigned randomised controlled trial (RCT) that will recruit individuals aged 18 years or over on maintenance dialysis for a minimum of 3 months who have a serum phosphate level of ≥1.6 mmol/L. Participants will be recruited from 23 different dialysis sites across Australia. They will be block randomised into two groups in a 1:1 ratio that will either be the intervention group (receive the TeleKinesis App for 3 months in addition to standard care) or the control group (standard care alone). The primary outcome of the study is to assess the effect of this intervention on the change in patients’ serum phosphate levels. The RCT will assess the effectiveness of the programme by comparing serum phosphate at baseline, 3 months and follow-up at 6 months. A total recruitment target of n=180 participants is expected.

Ethics and dissemination
Ethics approval was received from the Sir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee on 5 December 2022 (reference RGS0000005559). Informed consent will be given by participants once they have read and signed the patient information and consent form. The results are expected to be published in scientific journals and presented at clinical research conferences and to the consumers who have taken part in the trial. This is protocol 1.0 dated 10 November 2024.

Trial registration number
ACTRN12621000746831.

Introduction
Cardiovascular diseases, a leading cause of death globally, impose significant health and economic burdens, particularly in countries like Iran. Coronary artery bypass grafting (CABG) is a common intervention for ischaemic heart disease, yet it entails a long recovery process with potential complications and psychological impacts. This study aims to evaluate the effectiveness of a prehabilitation programme (pre-CABG) on postoperative outcomes and discharge readiness in patients undergoing elective CABG.

Methods and analysis
This randomised controlled trial involves 60 patients diagnosed with coronary artery disease at Imam Khomeini Hospital Complex, Tehran. Participants will be randomly assigned to either the intervention group, receiving the pre-CABG programme, or the control group, receiving standard care. The pre-CABG programme includes patient education, stress management techniques, respiratory muscle training and nutritional guidance. Primary outcomes include discharge readiness, duration of intubation, Intensive Care Uniy (ICU) stay, occurrence of atelectasis, onset of mobility, hospital stay and levels of anxiety and depression. Secondary outcomes include the rate of 30-day readmissions. Data collection will involve standardised scales and checklists administered at various stages preoperation and postoperation.

Ethics and dissemination
The research study has received approval from the Research Ethics Committee at Tehran University of Medical Sciences’ School of Nursing and Midwifery and Rehabilitation. All participants must provide written consent for their involvement in this study. The findings will be shared with appropriate groups and published in peer-reviewed journals.

Trial registration number
The study is registered with the Iranian Registry of Clinical Trials under the ID IRCT20231019059768N1.

Introduction
Cancer is the second leading cause of death in the USA. Cancer genetics and genomic studies have improved our understanding of risk, onset and progression. However, disparities by race and ethnicity have resulted in a lack of representation for minorities in these studies, contributing to unequal reductions in the cancer burden across populations. Moreover, the reasons why some individuals decline to participate in cancer genetics and/or genomic studies across diverse populations remain unclear. This review will summarise the main reasons (concerns) associated with declining to participate in cancer genetics and/or genomic studies for individuals with a history of cancer living in the USA and Puerto Rico (PR), considering race and ethnicity.

Methods and analysis
We will follow the methodology presented by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews Statement extended to Scoping Reviews to guide manuscript generation. A standardised search strategy developed in collaboration with a health sciences librarian will be deployed in Medline (PubMed), Embase (Ovid) and Scopus from database inception till present. The search strategy consists of three concepts: (1) cancer; (2) genetics and genomic research; (3) declination to participate in research studies. Title and abstract screening, followed by full-text review, will be conducted by independent reviewers to determine study inclusion. Only the peer-reviewed literature in English, conducted in the USA and PR will be considered. Findings will be presented as a numerical summary, graphical presentation and narrative review of the literature.

Ethics and dissemination
Ethical review is not required for scoping reviews. This review aims to facilitate the development of targeted strategies to increase participation in cancer genetics and/or genomic studies across diverse populations. Results will be disseminated through a peer-reviewed publication and conference presentations. The protocol is registered in the Open Science Framework (www.osf.io).

This cohort study investigates associations of butter and plant-based oil intakes with risk of total and cause-specific mortality among US adults.

Approximately 500 000 individuals have survived childhood cancer in the US, and this number is growing each year. Unfortunately, these survivors carry a substantial burden of morbidity. The most prevalent severe or life-threatening chronic health conditions include endocrine disorders, subsequent neoplasms, and cardiovascular disease. These conditions are directly related to chemotherapy and/or radiation therapy used to treat the childhood cancer; examples include anthracycline-related cardiomyopathy, radiation-related breast and central nervous system subsequent neoplasms, and radiation-related coronary-artery disease and stroke. Radiation-related conditions are age- and dose-related, but generally develop within the radiation field. Chemotherapy-related conditions are also dose- and age-related but may affect multiple organs due to the systemic nature of the exposures. The conditions develop at varying intervals after the therapeutic exposures. Whereas chemotherapy-related complications can be seen as early as within 5 years of the exposure, radiation-associated complications are usually delayed and are typically diagnosed after 10 or more years from exposure. These conditions can cause premature death, resulting in a significant gap in life expectancy compared with the general population. The past decade has seen an increasing interest in a phenomenon called accelerated aging primarily from investigators leveraging the resources offered by the Childhood Cancer Survivor Study (CCSS) and the St Jude Lifetime (SJLIFE) Cohorts.

This cross-sectional study compares all-cause and cause-specific mortality rates among physicians, health care workers, and non–health care workers by sex, race, and ethnicity.

In two large cohorts, researchers noted a small excess risk.

New England Journal of Medicine, Volume 392, Issue 17, Page 1684-1697, May 1, 2025.

Objective
The objective is to investigate the association of hyperuricaemia and hyperglycaemia with an increased risk of mortality in acute aortic dissection (AAD).

Design
Retrospective multicentre cohort study.

Setting
De-identified information of patients was collected from electronic medical records between 2010 and 2021 across five hospitals in China.

Participants
A total of 2603 AAD patients from 5337 patients who underwent arterial aortic computed tomographic angiography were selected after three rounds of screening.

Main outcome measure
All-cause in-hospital mortality.

Results
Of the 2603 patients, 20.3% were women, and the mean age was 54 years old. In-hospital mortality risk escalated linearly with increased levels of uric acid (P non-linearity=0.1699) and serum glucose (P non-linearity=0.2423). The per SD of increment in uric acid was associated with 40% (1.40, 1.22 to 1.60) in HR and 95% CI of AAD all-cause in-hospital mortality and 39% (1.39, 1.22 to 1.58) in serum glucose after full adjustment. Patients with a decrease in uric acid and/or serum glucose within the 7 days preceding admission showed significantly lower in-hospital mortality compared with those without a decrease. Notably, patients exhibiting both hyperuricaemia and serum glucose >180.2 mg/dL faced over double mortality risk (2.21, 1.58 to 3.10) compared with those with normal uric acid and normal serum glucose levels.

Conclusions
Hyperuricaemia and hyperglycaemia are significantly associated with an increased risk of mortality among AAD patients in the Han Chinese population. These findings suggest the importance of monitoring and managing uric acid and glucose levels in AAD patients to potentially improve outcomes.

Stroke, Ahead of Print. BACKGROUND:There is debate on the link between dietary fiber intake and stroke risk. The purpose of this study was to look at how it impacts dietary fiber intake and stroke risk, as well as mortality among stroke survivors. Two-sample Mendelian randomization was also used to investigate the causal relationship.METHODS:This research examined information from 1453 patients with stroke participating in the National Health and Nutrition Examination Survey from 1999 to 2018. To assess the incidence of stroke, we conducted a survey-weighted multivariate logistic regression analysis and subgroup analysis. To evaluate the mortality associated with stroke, we used Kaplan-Meier survival analysis combined with survey-weighted Cox regression models. Using 2-sample Mendelian randomization and inverse-variance weighted method, we established a causal relationship between dietary fiber intake and stroke. The article was organized according to Strengthening the Reporting of Observational Studies in Epidemiology and Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization guidelines.RESULTS:In the fully adjusted model, dietary fiber intake was negatively associated with stroke (odds ratio, 0.98 [95% CI, 0.97–0.99];P

La desensibilizzazione per ora è approvata in Usa solo sui bambini

Stroke, Volume 56, Issue 5, Page 1349-1350, May 1, 2025. According to Global Stroke Fact Sheet 2022, stroke is the second leading cause of death and a major cause of disability. Stroke treatment and care need immediate attention and fill the large existing gaps. This article focuses on the gaps in stroke prevention, management, and care. The author has highlighted 2 main facts, time window and watch-and-wait, which play a critical role in the management of patients upon stroke onset.