Search Results for: Diagnosi di COVID-19: dal sospetto alla conferma

Objectives
Explore what is known about the impact of changes made at a national level to UK postgraduate medical education during COVID-19.

Design
A scoping review, following Arksey and O’Malley’s framework, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist.

Data sources
Ovid MEDLINE, Ovid Embase and ERIC were searched for peer-reviewed literature, and grey literature was searched via DuckDuckGo. The initial search was conducted on 17 January 2023 and updated on 5 June 2024. Forward citation tracking was performed.

Eligibility criteria
English-language studies of any design examining national-level adaptations to postgraduate medical education (eg, curricula, examinations and Annual Review of Competency Panels (ARCPs)) within the UK during the COVID-19 pandemic. Studies were excluded, which focused solely on undergraduate education, international settings, grassroots-level changes (eg, to individual teaching sessions), or where full text was unobtainable.

Data extraction and synthesis
Data were extracted using a piloted charting form and analysed thematically to identify recurring patterns across studies. Basic numerical data were collected to describe study characteristics.

Results
Of 1067 records screened, 30 studies met inclusion criteria. Most were cross-sectional surveys, with a strong representation from surgical and craft specialties. Four themes were identified: (1) impact on career development (including concerns about career delays and shifts in aspirations); (2) impact on trainee progression (highlighting delays due to ARCP outcomes 10.1/10.2 and reduced procedure accreditation); (3) changes in teaching and learning (such as a shift to online learning and cancelled rotations) and (4) supervision and support (revealing mixed experiences, with reports of burnout and inadequate organisational guidance). The systemic impact was uneven across specialties and training stages.

Conclusions
National-level changes mitigated immediate educational disruptions but are beginning to reveal long-term consequences for career development, workforce planning and trainee well-being, highlighting the need for resilient and equitable future frameworks.

Objectives
This study examined the relationship between primary care patients’ psychosocial problems, other patient characteristics that are associated with satisfaction with overall care and satisfaction with general practitioner (GP) communication.

Design
A cross-sectional survey was conducted. Patients filled an anonymous two-page questionnaire on various socio-demographic, medical characteristics and their satisfaction with GP communication. Structural equation modelling evaluated associations of various patient characteristics, including psychosocial problems with GP communication.

Setting
General practices in Germany.

Participants
A total of 813 patients from 12 GP practices participated. The survey was conducted in summer 2020 during a COVID-19 lockdown.

Results
The estimated response rate was 24.1%. The prevalence of psychosocial problems in the sample was 30%. The three most frequent problems were excessive stress at work (19%), financial problems/debts (9%) and loneliness (8%). Most patients agreed that their GP takes their problems seriously (71%), feeling comfortable talking about sensitive things (66%), having enough space in communication (62%) and being asked by their GP about personal strains (53%). Higher social support, preference to solve one’s problem without GP help, higher age and better health status predicted more satisfaction with physician–patient communication, while the number of psychosocial problems, gender, years with physician, chronic stress and depression had no influence. According to the Bentler Comparative Fit Index, the pooled structural equation model had a 97.6% better fit than the corresponding model without covariate effects.
Higher social support, preference to solve one’s problem without GP help, higher age and better health status but not the number of psychosocial problems predicted more satisfaction with physician–patient communication.

Conclusions
GPs should be aware of the high occurrence of patients’ psychosocial problems and actively address patients’ social support and self-management preferences which influence patients’ satisfaction with GP communication.

Trial registration number
The General Practice Care-1 study was registered in the German Clinical Trials Register (DRKS00022330).

Stroke, Ahead of Print. BACKGROUND:Persistent upper extremity (UE) impairment is common after stroke. Durable treatment benefits for chronic ischemic stroke are needed. The purpose of this report is to determine the long-term effects of vagus nerve stimulation paired with rehabilitation on impairment, activity, and participation in people with UE impairment after ischemic stroke.METHODS:This is a post hoc analysis of data from the VNS-REHAB (A Pivotal Randomized Study Assessing Vagus Nerve Stimulation [VNS] During Rehabilitation for Improved Upper Limb Motor Function After Stroke) randomized clinical trial. Here, we report unblinded, partial crossover, and pooled 1-year outcomes. Initially, 108 participants across 19 sites with chronic ischemic stroke and moderate-to-severe UE impairment were enrolled in VNS-REHAB. Participants received 18 sessions of in-clinic intensive task-specific rehabilitation and 3 months of self-initiated home-based exercise with either real (active) or sham (control) vagus nerve stimulation. Thereafter, Control participants crossed over to receive in-clinic therapy paired with active stimulation. All participants performed home-based exercises paired with self-initiated active stimulation for 1 year. The Fugl-Meyer Assessment UE, Wolf Motor Function Test, and participation outcomes were assessed through 12 months.RESULTS:Seventy-four participants (69%; 51 male; age, mean±SD, 59.6±8.9) completed 1-year follow-up and provided pooled data through 1 year. At 1 year, compared with baseline, there were improvements in impairment (Fugl-Meyer Assessment UE, 5.23 [95% CI, 4.08–6.39];P

Background
Treatment strategies for Crohn’s disease (CD) suppress diverse inflammatory pathways but many patients remain refractory to treatment. Autologous haematopoietic stem cell transplantation (SCT) is an emerging therapy for medically refractory CD though the mechanisms through which it circumvents refractory pathophysiology are unknown.

Objective
The objective of this study is to understand how the immune system reconstitutes post-SCT and whether SCT may function as a cellular therapy restoring appropriately responsive immune cell populations from haematopoietic stem cells (HSCs).

Design
Adults with CD with active clinical and endoscopic disease who failed available medical therapies were enrolled in a phase II study of SCT for refractory CD (n=19). Blood and intestinal samples were collected longitudinally and analysed using CyTOF and scRNA-seq. Stem cell autografts were functionally assayed in mouse xenograft models.

Results
scRNA-seq and CyTOF analyses reveal that SCT predominantly affected the intestinal myeloid lineage with loss of inflammatory populations and return of macrophages capable of supporting mucosal healing. Xenograft models using patient HSCs suggested that HSCs support the early reconstitution of the myeloid lineage and reveal an impairment of short and long-term HSC engraftment that may determine SCT outcomes.

Conclusions
This study suggests SCT functions as a myeloid-directed cellular therapy reinforcing the critical role of macrophages in refractory CD pathophysiology and as a target for cellular therapies. Furthermore, we report an unrecognised functional heterogeneity among HSC subpopulations in CD that may be relevant to our understanding of CD treatment and pathophysiology.

Background and objective
Gastric cancer (GC) remains a prevalent and preventable disease, yet accurate early diagnostic methods are lacking. Exosome non-coding RNAs (ncRNAs), a type of liquid biopsy, have emerged as promising diagnostic biomarkers for various tumours. This study aimed to identify a serum exosome ncRNA feature for enhancing GC diagnosis.

Designs
Serum exosomes from patients with GC (n=37) and healthy donors (n=20) were characterised using RNA sequencing, and potential biomarkers for GC were validated through quantitative reverse transcription PCR (qRT-PCR) in both serum exosomes and tissues. A combined diagnostic model was developed using LASSO-logistic regression based on a cohort of 518 GC patients and 460 healthy donors, and its diagnostic performance was evaluated via receiver operating characteristic curves.

Results
RNA sequencing identified 182 candidate biomarkers for GC, of which 31 were validated as potential biomarkers by qRT-PCR. The combined diagnostic score (cd-score), derived from the expression levels of four long ncRNAs (RP11.443C10.1, CTD-2339L15.3, LINC00567 and DiGeorge syndrome critical region gene (DGCR9)), was found to surpass commonly used biomarkers, such as carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9) and CA72-4, in distinguishing GC patients from healthy donors across training, testing and external validation cohorts, with AUC values of 0.959, 0.942 and 0.949, respectively. Additionally, the cd-score could effectively identify GC patients with negative gastrointestinal tumour biomarkers and those in early-stage. Furthermore, molecular biological assays revealed that knockdown of DGCR9 inhibited GC tumour growth.

Conclusions
Our proposed serum exosome ncRNA feature provides a promising liquid biopsy approach for enhancing the early diagnosis of GC.

Background
A large proportion of individuals with coeliac disease (CeD) remain undiagnosed.

Objective
The aim of this study was to assess serological screening for CeD in the adult general population.

Design
The study was based on the fourth Trøndelag Health Study, a population-based study performed 2017–2019 in Nord-Trøndelag County, Norway, including 56 042 participants >20 years of age (54% participation rate). Serum samples were analysed with a dual antitransglutaminase 2 (TG2) IgA and IgG assay and seropositive participants were invited to endoscopy with duodenal biopsies. A CeD diagnosis was given if mucosal damage (Marsh grade 3) was found.

Results
Histological evaluation of 657 seropositive participants confirmed CeD in 423. The positive predictive value (PPV) of a positive TG2 IgA was 73.3% (95% CI 69.7% to 77.0%) for biopsy-confirmed CeD. TG2 IgA ≥10 times the upper limit of normal (ULN), as used in the no-biopsy approach in children, increased the PPV to 88.1% (95% CI 84.8% to 91.4%). Primary TG2 IgG response was found in 87 participants, five of whom had biopsy-confirmed CeD. One of the participants with CeD primarily responding with TG2 IgG was IgA deficient. The PPV of a positive TG2 IgG was 5.8% (95% CI 1.9% to 12.9%) and of TG2 IgG ≥10x ULN was 9.5% (95% CI 1.2% to 30.4%) for biopsy-confirmed CeD in TG2 IgA-negative individuals.

Conclusion
The TG2 IgA assay showed excellent abilities as a screening tool for CeD in the adult general population. However, the diagnostic accuracy of TG2 IgG was too poor for selectively identifying individuals with CeD.

Objectives
To codevelop (with children and young people with diabetes (CYPD)) an intervention to improve diabetes control and future health outcomes of CYPD from ‘underserved’ groups, to reduce treatment outcome inequalities between different socioeconomic and ethnic groups. To follow Medical Research Council guidance for complex interventions and the COM-B (Capability, Opportunity, Motivation, Behaviour) model for behaviour change intervention development.

Design
In phase 1 (previously reported), we established the evidence base, conducted literature reviews and analysed data from semistructured interviews with CYPD and their carers. In phase 2 (this report), we applied the COM-B framework to identify intervention components; in phase 3 (this report), we evaluated these components, including focus groups with CYPD, their carers’ and healthcare practitioner (HCP) surveys, using the Acceptability, Practicability, Effectiveness, Affordability, Spill-Over Effects, Equity criteria.

Setting
Secondary care; children, young people and their carers’ were approached from two large paediatric diabetes services in England, both with socioeconomically and ethnically diverse underserved populations; paediatric diabetes HCPs were surveyed across four English regions.

Participants
N=69 underserved CYPD (aged 5–19 years) and/or family members took part in interviews; N=48 paediatric diabetes HCP survey respondents (survey 1); N=34 paediatric diabetes HCP survey respondents (survey 2); N=3 young people’s advisory group participants; N=17 underserved CYPD/carers focus group participants; N=9 wider stakeholder participants.

Results
The codevelopment process and integration of COM-B established four elements for an intervention package: (1) an enhanced peer support/mentoring programme; (2) provision of a health and well-being coach to CYPD/families; (3) family/community support to address social and community issues and (4) training for HCPs, including cultural competence, poverty proofing and to emphasise the need for increased sensitivity and better supported communication in work with CYPD from underserved groups.

Conclusions
The Diversity in Diabetes codevelopment work informed an intervention to improve diabetes care in underserved groups, reflecting sociocultural contexts and plausible support options at the individual, community and clinical levels. The ‘Diversity in Diabetes’ programme will next test feasibility and further refine the intervention package in two more paediatric diabetes centres in England.

Ogni anno 15mila casi, fondamentale la diagnosi precoce

Objectives
To compare the incidence and drivers of major adverse kidney events (MAKEs) between COVID-19 and non-COVID-19 acute respiratory distress syndrome (ARDS) patients, with a focus on long-term kidney outcomes.

Design
Retrospective cohort study.

Setting
Single-centre intensive care unit in the Midlands, UK.

Participants
708 ARDS patients (458 COVID-19, 250 non-COVID-19).

Primary and secondary outcome measures
The primary outcome was MAKE at 365 days (MAKE-365), defined as new renal replacement therapy (RRT), estimated glomerular filtration rate (eGFR)

The deluge of invasive group A streptococcal (GAS) disease reported in many countries following the upheaval of the COVID-19 pandemic has been a poignant reminder of the deadly infections lurking in our midst. In any of its forms, from skin and soft tissue infections, pneumonia, bone and joint infections, or sepsis without a clear clinical focus, invasive GAS can be insidious and unpredictable, testing the lifesaving capacity of even the world’s most advanced medical facilities. Surges of invasive and noninvasive GAS disease in 2022 and 2023 have been reported in countries spanning the Northern and Southern Hemispheres, with new reports of the same phenomenon still coming to light.

This study examines post–COVID-19 pandemic cancer screening rates in 2023 relative to previously documented declines through 2021.

In Italia ne soffrono circa 40mila persone, soprattutto donne

Giovedì 8 maggio una giornata dedicata a prevenzione e diagnosi

Objectives
To monitor the safety and utilisation of AZD1222 under real-world use in the UK.

Design
A non-interventional post-authorisation active surveillance study.

Setting
Vaccination sites in the UK.

Participants
A total of 17 945 participants were eligible and provided consent to participate in the study between 1 March 2021 and 6 April 2023. Participants were followed up at weeks 1, 4 and 14 and at months 6, 9, 12 and 18 after the first dose of AZD1222 vaccination and prompted to complete electronic data capture forms. A total of 11 219 participants submitted a Follow-Up 1 form and 5189 participants submitted a Follow-Up 7 form (at 18 months).

Primary and secondary outcome measures
The safety of AZD1222, including the identification, assessment and quantification of serious adverse events (SAEs) and adverse events of special interest (AESI), was examined. The utilisation of AZD1222 was described and characterised, including populations with missing information.

Results
The majority of participants were women (n=10 845; 60.4%) and the median age (IQR) was 50 (43, 62) years. Most participants were from white ethnic groups (n=13 112; 73.1%). Headache and fatigue had the highest reported incidence rate (421.28 cases per 1000 person years and 386.00 cases per 1000 person years, respectively). The most frequently reported AESI was anosmia (6.25 cases per 1000 person years). An increased Observed versus Expected (O:E) ratio was seen for anaphylaxis (O:E 7.38 (95% CI 2.80 to 11.95); based on 10 observed cases (expected cases: 1.36)) and anosmia and/or ageusia (O:E 39.23 (95% CI 29.13 to 49.32), based on 58 observed cases (expected cases: 1.48)).

Conclusions
The most frequent vaccinee-reported adverse events (AEs) were headache and fatigue. An increased O:E ratio was seen for the AEs of anaphylaxis and anosmia and/or ageusia. No safety signals were identified throughout the course of this study.

Trial registration number
This study is registered with the HMA-EMA Catalogue of RWD studies (EUPAS44035).

Introduction
Autism spectrum disorder (ASD) is often accompanied by a variety of comorbidities. A high prevalence of patients has difficulties with food intake, which can lead to malnutrition, obesity and dyslipidaemia. Although several factors influencing dietary intake in this population have been investigated in the literature, the lack of standardised assessment protocols has led to heterogeneous results across studies. This study protocol describes the methodology used to assess nutritional aspects such as feeding problems, food intake and biochemical variables in children and adolescents with ASD.

Methods and analysis
The clinical protocol for nutritional screening in autism is a clinically based cross-sectional study design that focuses on the assessment of nutrition in children and adolescents with ASD aged 2 to under 19 years. Participants and caregivers are assessed in three clinical steps by a team of dietitians. Nutritional aspects are assessed, such as feeding behaviour (Brief Autism Mealtime Behavior Inventory, Children’s Eating Behavior Questionnaire), food intake (3 non-consecutive days of 24-hour food record), anthropometric measurements to calculate nutritional indicators according to WHO standards and blood samples (analysis of fasting glucose, triglycerides, total cholesterol and its subfractions). The data collected have the potential for descriptive and multivariate analyses to investigate associations among clinical, dietary difficulties, nutritional and biochemical variables.

Ethics and dissemination
The study protocol was approved by the institutional review board of the Federal University of Pelotas (CAEE: 94253518.0.0000.5317). The results will be disseminated through peer-reviewed publications and conferences.