Search Results for: Le cause della polmonite nei bambini

Introduction
Antipsychotics are likely to cause weight gain owing to increased appetite and other metabolic disturbances in patients with schizophrenia on prolonged medication. Conventional high-frequency repetitive transcranial magnetic stimulation has been employed to treat people with obesity and has shown certain effectiveness. The goal of this clinical trial is to evaluate the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating appetite increase and weight gain induced by antipsychotics in patients with schizophrenia.

Methods and analysis
In this randomised, double-blind, sham-controlled trial, 60 participants will be enrolled and allocated (1:1) to receive active or sham iTBS on the dorsolateral prefrontal cortex for 5 consecutive days. Appetite, body mass index, clinical symptoms, cognitive function and laboratory indicators will be assessed at baseline, after 5 days of treatments, and at 2 weeks and 4 weeks after all treatments. MRI examination will be conducted to detect brain structure, perfusion and functional connectivity. Data analysis will be conducted in a modified intention-to-treat population. The results of the study will provide evidence on the effectiveness and feasibility of iTBS in improving increased appetite induced by antipsychotics and explore the underlying neuroendocrine pathway affected by the intervention. The primary objective is to evaluate the efficacy of iTBS in weight gain in patients with schizophrenia taking antipsychotics. The secondary objective is to identify the neuroendocrine changes related to appetite in response to iTBS by assessing the variables of cognitive control, glucolipid metabolism and brain activity.

Ethics and dissemination
The study protocol has been approved by the National Clinical Medical Research Center Ethics Committee of The Second People’s Hospital of Dali Bai Autonomous Prefecture (no: 2023YN3) and The Second Xiangya Hospital (no: 2024K008). Written informed consent will be obtained voluntarily before enrolment. The results will be disseminated through publication in peer-reviewed journals and presentation at international conferences.

Trial registration number
NCT05783063.

Uniamo, ‘decreto Lea ancora fermo. Intanto i bambini muoiono’

Headaches, a common malady for many adults, can cause such excruciating pain and impaired daily functioning that they may increase the odds of attempting suicide, a study has found.

Opioid overdose continues to be the leading cause of death due to injury in the US. Recent data from the Drug Abuse Warning Network estimated 882 000 emergency department (ED) opioid-related visits in 2023, a rate of 263 per 100 000 visits, with the highest rates among Black individuals (425 per 100 000). Access to treatment with medications for opioid use disorder, specifically buprenorphine, continues to be challenging for patients in active addiction, and these disparities by race are widening. Geographic disparities also exist. In many states, rural patients with opioid use disorder have worse outcomes than urban patients. Rural hospitals are also less likely to offer treatments, such as addiction medicine consultation and medications for opioid use disorder. Thus, the ED is a logical setting to provide equitable substance use treatment access and medication initiation, yet it continues to be underused and underfunded.

Sindrome Vexas, al San Raffaele di Milano ambulatorio dedicato

Stroke, Ahead of Print. BACKGROUND:The true incidence of visuospatial neglect, impaired attention toward contralesional space, remains unclear. Common variability sources are sensitivity differences of conventional assessments and the exclusion of patients with language, motor, and other cognitive impairments. We aimed to determine the incidence of visuospatial neglect in an unselected cohort of patients with acute stroke using video oculography during free visual exploration, a newly established assessment overcoming the aforementioned biases.METHODS:Single-center, prospective, observational cohort study. We screened every patient admitted to a representative Swiss stroke center over 1 year (n=626). Two hundred eighty-five patients were eligible (first-ever stroke within 72 hours), and 221 were included. The incidence of visuospatial neglect was determined with conventional paper-pencil assessments and video oculography during free visual exploration. Demographic, risk, and stroke-related factors, as well as stroke localization, were also considered. Feasibility and ability to detect visuospatial neglect of the assessments were evaluated.RESULTS:The overall incidence of visuospatial neglect was ≈38%: widely varying location-specifically: ≈61% and ≈22% for stroke in the right and left cerebral hemispheres, respectively, and ≈14% to ≈37% for some less commonly affected infratentorial areas or multifocal stroke. In hemispheric stroke, visuospatial neglect was most common when the middle (≈64% right and ≈21% left) and posterior (≈53% right and ≈25% left) cerebral artery territories were affected. Neglect patients had higher National Institutes of Health Stroke Scale scores, more commonly atrial fibrillation and thrombectomy, and less commonly an undetermined stroke cause. They were older, with ≈4% yearly increase in the odds of having visuospatial neglect. Video oculography during free visual exploration was administrable and detected visuospatial neglect more often than conventional paper-pencil assessments.CONCLUSIONS:The incidence of visuospatial neglect in an unselected cohort, using a highly sensitive assessment, is considerably higher than previously assumed and can also occur after less typically localized strokes. These results can enhance the awareness of visuospatial neglect in the acute setting, potentially facilitating earlier identification and therapy of this disabling disorder.

Circulation, Ahead of Print. BACKGROUND:Despite reported racial disparities between Black and White adults in short-term outcomes after abdominal aortic aneurysmal intervention, there is a paucity of literature aimed at understanding long-term disparities. The present study aims to characterize racial disparities in long-term outcomes, perioperative outcomes, and health care use after endovascular aortic aneurysm repair.METHODS:We conducted a retrospective cohort study from 2011 to 2019 with outcome assessment through 2020. Using a 100% sample of national Medicare data, we identified beneficiaries ≥66 years of age who underwent intact infrarenal endovascular aortic aneurysm repair. The primary outcome was a composite of endovascular or open aortic reintervention, late aneurysm rupture, and all-cause mortality. Secondary outcomes included other reinterventions, perioperative outcomes, and annual rates of health care use.RESULTS:A cohort of 107 636 Black (3.9%) and White (96.1%) beneficiaries was identified. The cumulative incidence of the primary outcome was 72.9% (95% CI, 71.8%–73.9%) in White patients versus 80.0% (95% CI, 76.4–83.0) in Black patients (P

Objectives
The association between the duration from the emergency department (ED) to the intensive care units (ICUs) and in-hospital mortality among patients admitted directly to the ICUs from the ED remains controversial. This study aimed to use data from the Medical Information Mart for Intensive Care-IV database to explore the relationship between the ED to ICUs time and patient outcomes.

Design
Retrospective observational study.

Setting
Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019.

Participants
A total of 15 246 adult patients were identified as admitted directly from the ED to the ICUs during their first hospitalisation. After excluding those without recorded ED registration times and those with a hospital-to-ICU admission interval exceeding 6 hours (n=2432), the final analysis cohort comprised 12 703 patients.

Primary and secondary outcome measures
The primary outcome was in-hospital all-cause mortality. Secondary outcomes included 28-day all-cause mortality and length of stay in ICU and hospital.

Results
The median ED to ICUs time was 3.98 hours. Longer ED to ICUs times were associated with lower in-hospital mortality, decreasing from 17.6% in the shortest to 12.2% in the longest interval group, and shorter ICU stays. After propensity score weighting, adjusted logistic regression models confirmed the inverse association between longer ED to ICUs time and in-hospital mortality (OR: 0.75, 95% CI: 0.69 to 0.82, p

Concluso progetto pilota per anticipare diagnosi

Circulation, Ahead of Print. BACKGROUND:Shared genetic and lifestyle risk factors may underlie the development of both coronary artery disease (CAD) and dementia. We examined whether an increased genetic risk for CAD is associated with long-term risk of developing all-cause, Alzheimer’s, or vascular dementia, and investigated whether differences in potentially modifiable lifestyle factors in the mid- to late-life period may attenuate this risk.METHODS:A prospective cohort study of 365 782 participants free from dementia for at least 5 years after baseline assessment was conducted within the UK Biobank cohort. Genetic risk was assessed using a genomewide polygenic risk score (PRS) for CAD and lifestyle risk using a modified version of the American Heart Association’s Life’s Essential 8 Lifestyle Risk Score (LRS). Higher values for both scores were deemed to represent increased risk. Primary outcomes were incident all-cause, Alzheimer’s, and vascular dementia diagnoses obtained from electronic health records. Secondary outcomes were neuroimaging phenotypes measured in 32 028 participants recalled for magnetic resonance imaging. Sensitivity analyses were conducted to test the extent by which biological and behavioral risk factors contributed to observed associations.RESULTS:A total of 8870 cases of all-cause dementia were observed over a median 13.9-year follow-up. Both genetic (PRS) and lifestyle (LRS) risk scores for CAD were associated with a modestly elevated risk of all-cause dementia (subhazard ratio per SD increase, 1.10 [1.08, 1.12],P

Findings from a large cohort suggest the answer is yes.

Introduction
Pancreatic cancer is a devastating disease and one of the top causes of cancer death worldwide. Over 30% of cases are potentially avoidable, and while screening for this disease should be possible, the current methods, without risk stratification to detect high-risk groups, are unlikely to detect these individuals. A tailored screening pathway could be applied to individuals with a germline genetic cause of pancreatic cancer, which may account for around 10% of cases.

Methods and analysis
EUROPAC, although having international reach, is described here in relation to the UK only. This national prospective observational study has run for several decades but was modified into the current trial in 2019, which aims to recruit and screen 10 000 individuals with either familial pancreatic cancer or hereditary pancreatitis (HP). Applicants are assessed for eligibility by generating an individual pedigree and by attributing a family risk score (FR). Individual risk is assessed according to age. Individuals over 40 with an FR >30 are offered baseline imaging and then three yearly triplets of annual endoscopic ultrasound (EUS) and an MRI (in the third year). Those with an FR >60 are offered both EUS and MRI yearly. HP patients are screened by CT and/or MRI dependent on risk stratification using the presence of diabetes, smoking or alcohol consumption. Low-risk (absence of these factors) patients have a CT every 2 years, and high-risk (one or more of the above factors) patients have alternate yearly screening with CT, then MRI. Biospecimens are collected at pragmatic intervals with first sampling at registration to support future biomarker development to detect pancreatic cancer early. Detection of early-stage pancreatic cancer and actionable lesions will be evaluated.

Ethics and dissemination
The EUROPAC study has been reviewed and approved by the Yorkshire and Humber Research Ethics Committee (Ref 19/YH/0250). Study results will be disseminated through national and international symposium presentations and published in peer-reviewed, open-access journals. All participants provided informed consent prior to entering the study.

Trial registration number
ISRCTN62546421

Objectives
Glaucoma is a major cause of irreversible blindness in India; however, if detected early, its progression can be either prevented or stabilised through appropriate medical or surgical treatment. We aim to evaluate the cost–utility of various models for population-based glaucoma screening at primary health centres in India. We also assess the potential impact of the implementation of a population-based screening programme on overall costs of care for glaucoma.

Design
Cost–utility analysis using a mathematical model comprising a decision tree and Markov model was conducted to simulate relevant costs and health outcomes over a lifetime horizon.

Setting
Screening services were assumed to be delivered at primary health centres in India.

Participants
A hypothetical cohort of different target population groups in terms of age groups and risk of glaucoma (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma) were included in comparative screening strategies.

Interventions
The exclusive intervention scenarios were 12 screening strategies based on different target population groups (age group 40–75 years, 50–75 years, 40–75 years age group at high risk of glaucoma, 50–75 years age group at high risk of glaucoma), screening methods (face-to-face screening and artificial intelligence-supported face-to-face screening) and screening frequencies for 40–75 years aged population (annual vs once every 5 years screening), in comparison to usual care scenario. The usual care scenario (current practice) implied opportunistic diagnosis by the ophthalmologists at higher levels of care.

Primary and secondary outcomes
The primary outcome was the incremental cost–utility ratio for each of the screening strategies in comparison to usual care. The secondary outcomes were per person lifetime costs, lifetime out-of-pocket expenditures, life years and quality-adjusted life-years (QALYs) in all screening scenarios and usual care.

Findings
Depending on the type of screening strategy, the gain in QALY per person ranged from 0.006 to 0.046 relative to usual care. However, the screening strategies, whether adjusted for specific age groups, patient risk profiles, screening methods or frequency, were not found to be cost-effective. Nonetheless, annual face-to-face screening strategies for individuals aged 40–75 years could become cost-effective in a scenario of strengthened public financing and provisioning, such that at least 67% of those seeking care for confirmatory diagnosis and treatment use government-funded facilities, in conjunction with 60% availability of medications at government hospitals.

Conclusions
Enhancing continuity of care following screening through either strengthening of public provisioning or strategic purchasing of care could make glaucoma screening interventions not only cost-effective, but also potentially cost-saving.

È un dispositivo temporaneo, utile soprattutto nei bambini

Stroke, Ahead of Print. BACKGROUND:Recent randomized control trials have demonstrated the efficacy and safety of middle meningeal artery embolization (MMAE) as an adjunct to conventional management for patients with nonacute subdural hematoma (SDH); however, a large majority of trial participants received surgical evacuation as part of the standard of care. Thus, the efficacy and safety of standalone MMAE compared with conservative management (CM) for patients with nonsurgical SDH are unclear.METHODS:This was a retrospective cohort study of the 2019 to 2021 Nationwide Readmissions Database in the United States. Patients with nonsurgical nontraumatic SDH were identified, and MMAE patients were matched with similar CM patients using propensity score matching calculated from demographics, comorbidities, and initial hospitalization outcomes. Patients were followed up to 300 days. The primary end point was composite surgical rescue or death, and secondary end points included surgical rescue and all-cause mortality by 180 days.RESULTS:24 465 patients with nonsurgical nontraumatic SDH were identified; 2228 (9.1%) underwent MMAE. After propensity score matching, 6675 patients remained in the CM group and 2217 in the MMAE group. At 180 days, MMAE patients had a significantly lower risk of surgery or death compared with CM (8.2% versus 10.9%; relative risk, 0.75 [95% CI, 0.59–0.96];P=0.022) and lower risk of death (1.1% versus 3.0%; relative risk, 0.38 [95% CI, 0.17–0.86];P=0.020). Rates of surgical rescue among MMAE and CM patients at 180 days were similar (7.1% versus 8.4%; relative risk, 0.85 [95% CI, 0.63–1.14];P=0.27). Time-to-event analyses for the entire 300-day study follow-up period confirmed that while MMAE was associated with a lower cumulative risk of all-cause mortality (hazard ratio, 0.55 [95% CI, 0.35–0.87];P=0.010), it was not associated with a different risk of surgical rescue (hazard ratio, 1.00 [95% CI, 0.76–1.31];P=1.00).CONCLUSIONS:Standalone MMAE may be beneficial for patients with nonsurgical nontraumatic SDH by reducing the long-term risk of all-cause mortality.