Search Results for: Linee guida ESC/ERS 2022 per la diagnosi e il trattamento dell'ipertensione polmonare

Stroke, Ahead of Print. BACKGROUND:This study aimed to investigate neurophysiological mechanisms underlying functional impairment and recovery after acute ischemic stroke using transcranial magnetic stimulation combined with electroencephalography, focusing on interhemispheric interactions and oscillatory dynamics.METHODS:This single-center case-control study (December 2022 to May 2024) included 19 ischemic stroke patients within 14 days of symptom onset (mean age, 47.95±12.41 years; 15 [79%] males) with 3-month poststroke follow-up. Sixteen age-matched healthy controls (53.56±9.83 years; 12 [80%] males) were included. Transcranial magnetic stimulation-evoked electroencephalography potentials, local mean field power during 25 ms and 35 ms (local mean field power25–35 ms), and power spectral density of the ipsilesional primary motor cortex (ilM1) were calculated when single-pulse transcranial magnetic stimulation was sequentially applied to the contralesional M1 (clM1) and ilM1. Spearman correlation analysis evaluated associations between transcranial magnetic stimulation combined with electroencephalography parameters and clinical outcomes: Fugl-Meyer assessment, Fugl-Meyer assessment-upper extremity subscale, National Institutes of Health Stroke Scale, and National Institutes of Health Stroke Scale changes from baseline to 3 months poststroke.RESULTS:Stroke patients exhibited simplified transcranial magnetic stimulation-evoked electroencephalography potential waveforms with reduced amplitudes compared with healthy controls. The contralesional resting motor threshold of stroke patients was significantly lower compared with healthy controls (t=−2.79;P=0.009). The contralesional resting motor threshold was positively associated with the local mean field power25–35 msof ilM1 with stimulation on ilM1 (r=0.482;P=0.018). The power and power spectral density of β oscillations were negatively associated with the Fugl-Meyer assessment (r=−0.557,P=0.014;r=−0.417,P=0.038, respectively) and Fugl-Meyer assessment-upper extremity (r=−0.503,P=0.014;r=−0.389,P=0.05, respectively), but the power of β oscillations was positively associated with changes in the National Institutes of Health Stroke Scale (r=0.507;P=0.027) with stimulation on clM1.CONCLUSIONS:Increased excitability of the clM1 is associated with decreased excitability of the ilM1. The inhibition of β oscillations in the ilM1 by the clM1 serves as a biomarker for poststroke functional impairment and recovery. Neuromodulation of the clM1 to enhance the β oscillations of ilM1 may be a promising treatment strategy.

Stroke, Ahead of Print. BACKGROUND:There is uncertainty about whether patients with M2 occlusion benefit from endovascular therapy (EVT) in the late (6–24-hour) time window. We evaluated the clinical outcomes of patients with M2 occlusion selected for EVT compared with those who received medical management (MM) in the late window.METHODS:This multinational cohort study was conducted at 66 sites across 10 countries (January 2014 to May 2022). We included consecutive patients with late-window stroke due to M2 occlusion, baseline National Institutes of Health Stroke Scale score of ≥5, and premorbid modified Rankin Scale score of ≤2 who received EVT or MM alone. The primary end point was 90-day ordinal shift in the modified Rankin Scale score. Safety end points were symptomatic intracranial hemorrhage and 90-day mortality. Differences in outcomes were determined using inverse probability of treatment weighting–adjusted logistic regression models.RESULTS:Among 5098 patients, 496 met inclusion criteria (median [interquartile range] age, 74 years [62–81 years]; baseline National Institutes of Health Stroke Scale score, 12 [8–17]), of whom 394 (79.4%) received EVT and 102 (20.6%) MM. In inverse probability of treatment weighting adjusted analyses, there was no favorable 90-day ordinal modified Rankin Scale shift (odds ratio, 1.39 [95% CI, 0.92–2.12]) and no difference of functional independence rates (modified Rankin Scale score of 0–2; odds ratio, 1.72 [95% CI, 0.93–3.15]) with EVT compared with MM. Moreover, symptomatic intracranial hemorrhage risk (odds ratio, 3.46 [95% CI, 0.50–23.92]) and 90-day mortality (odds ratio, 1.11 [95% CI, 0.66–1.87]) were not statistically different between treatment groups.CONCLUSIONS:In patients with M2 occlusion in the 6- to 24-hour time window, there was no difference in disability outcomes or symptomatic intracranial hemorrhage risk between patients treated with EVT compared with MM. Results of ongoing randomized trials will provide further insight.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT04096248.

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Objective
To assess the effectiveness of random capillary blood glucose as a diagnostic tool for type 2 diabetes and determine optimal cut-off values for adults in Bangladesh.

Design
Cross-sectional diagnostic accuracy study.

Setting
16 diabetes centres were selected randomly from all eight administrative divisions of Bangladesh.

Participants
A total of 3200 adults aged 18 years and older were recruited using systematic random sampling between May and September 2022.

Primary and secondary outcome measures
The primary outcome was the diagnostic accuracy of random capillary blood glucose compared to fasting plasma glucose, 2-hour plasma glucose after a 75-gram glucose load and glycated haemoglobin. Secondary outcomes included sensitivity, specificity, area under the curve and agreement with the other diagnostic tests.

Results
Random capillary blood glucose showed a strong positive correlation and high concordance with fasting plasma glucose, 2-hour plasma glucose and glycated haemoglobin. A cut-off value of ≥8.7 mmol/L demonstrated improved diagnostic performance compared with the currently used cut-off of ≥11.1 mmol/L. This new threshold yielded higher sensitivity, specificity, area under the curve and agreement with other standard diagnostic tests. Notably, hyperglycaemic symptoms were not required for diagnosis. The number needed to screen to identify one case of type 2 diabetes using the ≥8.7 mmol/L cut-off was 2.74, lower than that for fasting plasma glucose (2.86) and random capillary blood glucose ≥11.1 mmol/L (4.68).

Conclusions
Random capillary blood glucose may be an effective and affordable diagnostic tool for type 2 diabetes in resource-limited settings. The proposed cut-off of ≥8.7 mmol/L offers improved diagnostic accuracy and reflects the population’s glucose distribution pattern.

Objectives
Hearing loss (HL) affects 20% of the world’s population, with shortages of audiologists and audiometric sound booths unable to meet demand for hearing care services. We aimed to assess the accuracy of tablet-based audiometry (TA) to screen for HL at standard (0.25–8 kHz) and extended high frequencies ( >8 kHz).

Design
Diagnostic accuracy study.

Setting
Two secondary care audiology and ear, nose and throat outpatient clinics in the UK between April 2022 and September 2023.

Participants
Adults aged≥16 years undergoing sound booth audiometry (SBA).

Interventions
TA, hearing-related questionnaires and patient usability questionnaires.

Outcome measures
Sensitivity, specificity and accuracy of TA compared with SBA for detecting HL. Patient usability assessment of TA and SBA.

Results
129 patients were enrolled with 127 patients (254 ears) included in the final analysis. Median age was 43 years (IQR 33–56), 55% (70/127) were women. 76% (96/127) and 68% (86/127) of patients had HL defined by British Society of Audiology (BSA) and American Speech–Language–Hearing Association (ASHA) criteria. Age was significantly associated with HL (p85%, respectively, between 0.25 and 12.5 kHz. In terms of patient usability, TA showed significantly higher scores in attractiveness (p

Background
Cardiovascular disease (CVD) is a major cause of death globally. In advanced stages, patients with CVD often require palliative care due to reduced health-related quality of life from physical, psychological and spiritual symptoms, along with physical disability.

Objectives
To investigate (1) the symptom and function burden of patients with CVD on their first admission to specialist palliative care services and (2) how these care burdens, and other clinical characteristics, affected patients’ utilisation of community-based versus inpatient services.

Design
A national population-based observational study using point-of-care outcomes sourced from the Australian palliative care outcomes and collaboration (PCOC).

Settings
Community-based and inpatient Specialist palliative care services across Australia registered in the PCOC.

Participants
Patients who required specialist palliative care principally for CVD, and whose death occurred between 1 January 2013 and 31 December 2022.

Methods
Five validated clinical instruments were used to collect point-of-care outcomes on each individual’s function (Resource Utilisation Groups – Activities of Daily Living (RUG) & Australia-modified Karnofsky Performance Status (AKPS)), symptom distress (Symptoms Assessment Scale & Palliative Care Problem Severity Score) and other clinical characteristics (Palliative Care Phases). Multivariable logistic regression was applied to evaluate how patients’ functional and symptom burden influenced their use of inpatient versus community-based palliative care services.

Results
Our analysis included 17 002 patients with CVD, with 7539 (44.3%) receiving community palliative care services and 9463 (55.7%) accessing inpatient palliative care services. On admission to palliative care services, patients often exhibit significant physical functional impairments and substantial symptom burdens, particularly related to fatigue and breathing difficulties. In comparison, patients accessing inpatient services tended to have greater functional impairment (p

Introduction
Recessive dystrophic epidermolysis bullosa (RDEB) is a severe genetic mucocutaneous fragility disorder characterised by chronic blistering, slow wound healing and increased risk of squamous cell carcinoma. Current management options are very limited.

Methods
This is a randomised (1:1), placebo-controlled, double-blinded crossover (A/B) trial with an internal phase I dose de-escalation (4+5 design) in the first 3 months and a 12-month continued treatment follow-on open-label study if 3-month outcome data from the crossover trial indicate safe and beneficial effects. RDEB is a rare condition, so we expect to recruit a maximum of 36 participants based on feasibility and not formal power considerations. Participants aged >6 months and

This JAMA Clinical Guidelines Synopsis summarizes the 2022-2023 recommendations on evaluation and management of chronic venous disease of the lower extremities from the Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society.

Objective
To explore the association between perioperative SARS-CoV-2 infection and the postoperative complications during the breakout of the Omicron epidemic wave.

Design
Observational retrospective cohort study. Multivariable logistic regression was performed to explore the association between the duration from surgery to COVID-19 diagnosis and the likelihood of postoperative complications.

Setting
A general hospital in China.

Participants
7927 patients aged 18 years and older who underwent surgical treatment between 1 December 2022 and 28 February 2023.

Primary outcome measures
The outcome was a composite of postoperative adverse events that occurred within the initial 30 postoperative days.

Results
Of all patients, 420 (11.76%) experienced postoperative complications. Compared with No COVID-19, preoperative COVID-19 within 1 week (pre-1w) exhibited a high risk of postoperative complications (adjusted OR (aOR), 2.67; 95% CI 1.50 to 4.78), followed by patients with pre-2w (aOR, 2.14; 95% CI 1.20 to 3.80). For patients with postoperative COVID-19 within 1 week (post-1w), the aOR was 2.48 (95% CI 1.48 to 4.13), followed by patients with post-2w (aOR 1.95; 95% CI 1.10 to 3.45), and those with post-3w (aOR 2.25; 95% CI 1.27 to 3.98). The risks of postoperative complications decreased roughly with the increase of the time interval between the surgery date and SARS-CoV-2 infection. Stratification analyses suggested that perioperative COVID-19 increased the risk of postoperative complications in older patients, smokers, those with comorbidities or experiencing moderate or severe COVID-19 symptoms.

Conclusions
Our findings reveal a significant time-dependent relationship between perioperative COVID-19 and postoperative complications, highlighting the importance of tailored preoperative risk evaluations, enhanced postoperative surveillance, and the implementation of effective postoperative COVID-19 prevention measures.

Trial registration number
ChiCTR2300072473.

Objective
To explore the perceived acceptability, barriers and enablers in implementing mobile phone messaging-based message-framing interventions to improve maternal and newborn care in Jimma Zone, Ethiopia.

Design
A qualitative study employing thematic analysis of data collected through in-depth interviews (IDIs) and key informant interviews (KIIs).

Setting
The study was conducted in Dedo, Shabe Sombo and Manna districts of Jimma Zone.

Participants
We conducted 12 IDIs and 14 KIIs with pregnant women, male partners, health extension workers, healthcare providers and Ethio-Telecom experts across the three districts. Thematic analysis was used to identify patterns and themes in the data.

Intervention
Mobile phone messaging-based interventions using gain-framed and loss-framed messages were explored for their potential to promote maternal and newborn health practices.

Key areas of exploration
The study explored participants’ awareness, perceived relevance, acceptability, and barriers and enablers, as well as participants’ engagement with mobile health messaging interventions.

Results
Participants were generally aware of the potential benefits of mobile phone messaging for maternal and newborn health. Mobile phone-based messaging was perceived as highly relevant and useful by most participants. However, many had limited prior experience using mobile messaging for health information. Despite this, participants expressed a strong willingness and readiness to receive and actively engage with the maternal and newborn mobile messaging intervention. The study also identified various barriers and enablers affecting the implementation of message-framing interventions through mobile phone messaging.

Conclusions
Participants in this study generally recognised and accepted the benefits of mobile phone messaging for improving maternal and newborn health. Although rural women faced challenges in reading and understanding short messages, they demonstrated a strong willingness to engage with mobile health messaging interventions. The identified barriers were categorised as technological, social, cultural, behavioural and contextual. To maximise the impact of mobile health messaging and ensure broad and effective reach, it is crucial to address these barriers while leveraging existing enablers.

Trial registration number
This study was conducted as part of a larger cluster randomised controlled trial at Clinical trials PACTR202201753436676, 4 January 2022.

Objective
To assess the magnitude of clinical inertia and its associated factors among adult patients with asthma on chronic follow-up at Jimma Medical Center, Ethiopia, from December 2021 to May 2022.

Design and setting
A hospital-based prospective observational study was conducted in Jimma Medical Center from 1 December 2021 to 30 May 2022.

Participants
135 patients with asthma who fulfilled the inclusion criteria were enrolled in the study consecutively and followed for 3 months.

Results
Of 148 patients, 135 patients’ data were analysed. The mean (SD) age of the patients was 52.03 (±15.75) years. More than half (54.1%) of the study participants were men. Most of the study participants (68.9%) at the first and (70.4%) at the second visit, which is 3 months after the first visit, had clinical inertia, respectively. Comorbidity (adjusted OR (AOR) 3.35, 95% CI (1.15, 9.81), p

Objective
This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness.

Design
Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

Data sources
We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature.

Eligibility criteria for study selection
We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention.

Methods
Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results
We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention.

Conclusion
Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.

PROSPERO registration number
PROSPERO (CRD42021296618).

Objectives
We aimed to establish a diagnostic system using retrospective data to predict difficult wean from mechanical ventilation.

Design
A multicentre retrospective study

Setting
Five tertiary hospitals from China.

Participants
Critically ill patients received mechanical ventilation between January 2018 and December 2022.

Primary and secondary outcome measures
The primary endpoint was success weaning from mechanical ventilation ( >48 hours), reintubation or death, whichever occurred first.

Results
Among 1365 initially screened patients, 703 patients (median age: 69 years; 63.02% male) were included. From 42 factors, 22 (p≤0.10) were identified for multivariate analysis. Subsequently, the lung injury score, brain natriuretic peptide level at 24 hours, 24 hour fluid balance, use of dexmedetomidine, spontaneous breathing trial (continuous positive airway pressure vs other) and endotracheal tube reinsertion were included in the predictive model. The area under the curve value was 0.8888 (95% CI: 0.8382, 0.9394). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratio (LR)+ and LR– were 0.7559, 0.875, 0.9746, 0.3608, 0.7721, 6.0743 and 0.279, respectively. We established a nomogram model based on the optimal model.

Conclusions
A model with six factors was established to predict difficult wean from mechanical ventilation in critically ill patients. However, the model should be verified in future well-designed studies before being extended to other populations.

Trial registration
ChiCTR1900021432. Registered on February 21, 2019; Post-results.

Introduction
Vast empirical evidence highlights the importance of early identification, diagnosis and support for autistic children. Caregivers of autistic children often experience high levels of psychological distress; hence there is a need for parallel child and caregiver support. Autism New Zealand’s Let’s Play programme is a caregiver-mediated, community-based programme based on the principles of developmental and relational interventions (henceforth, developmental). Developmental interventions are evidence-based supports designed to enhance children’s learning within the context of developmentally appropriate, naturalistic settings (eg, everyday routines, play). We aim to evaluate the effects of the Let’s Play programme on autistic children’s engagement and caregiver stress.

Methods and analysis
This study will be a single-blind (rater) randomised controlled trial with two parallel arms: immediate programme access (intervention) versus a waitlist control. Participants will be 64 caregivers of children aged 0–5 years with diagnosed or suspected autism, allowing for 20% attrition, based on power calculations. The Let’s Play programme will be delivered over 9 weeks using a combination of small group workshops and in-home coaching. Primary outcome variables include child engagement and caregiver stress. Caregivers will complete measures at three time points (baseline, immediately post-programme and at the 6-month follow-up), and effectiveness will be analysed using generalised estimating equation models and intention-to-treat and per protocol analyses.

Ethics and dissemination
This trial was approved by Aotearoa New Zealand Ministry of Health’s Health and Disability Ethics Committee (2022 FULL 13041). Findings will be communicated nationally and internationally via conferences, journal publications and stakeholder groups (eg, service providers for autistic children). Results will be shared regardless of magnitude or direction of effect.

Trial registration number
ACTRN12622001139763.