Risultati per: Le cause della polmonite nei bambini

Annals of Internal Medicine, Ahead of Print.

Ministero Salute per il 2021, 62% dei cicli effettuati nell’Ssn

Impegno per Holostem. La petizione su Change.org ha raccolto oltre 45.300 firme

Background and objectives
Circulatory system disease (CSD) patterns vary over time and between countries, related to lifestyle risk factors, associated in turn with socioeconomic circumstances. Current global CSD epidemics in developing economies are similar in scale to those observed previously in the USA and Australasia. Australia exhibits an important macroeconomic phenomenon as a rapidly transitioning economy with high immigration throughout the nineteenth and twentieth centuries. We wished to examine how that historical immigration related to CSD patterns subsequently.

Methods and setting
We provide a novel empirical analysis employing census-derived place of birth by age bracket and sex from 1891 to 1986, in order to map patterns of immigration against CSD mortality rates from 1907 onwards. Age-specific generalised additive models for both CSD mortality in the general population, and all-cause mortality for the foreign-born (FB) only, from 1910 to 1980 were also devised for both males and females.

Results
The percentage of FB fell from 32% in 1891 to 9.8% in 1947. Rates of CSD rose consistently, particularly from the 1940s onwards, peaked in the 1960s, then declined sharply in the 1980s and showed a strong period effect across age groups and genders. The main effects of age and census year and their interaction were highly statistically significant for CSD mortality for males (p

Case presentation A 55-year-old man presented with abdominal distension, vomiting, fever for 3 days and weight loss. He smoked 40 cigarettes and drank 100 g of alcohol per day. He had no documented medical or drug history and no history of receptive anal intercourse. Abdominal examination revealed diffuse tenderness. Laboratory values disclosed neutrophilia (13 720/µL), normocytic anaemia (7.4 g/dL), hypoalbuminaemia (25.2 g/L) and elevated inflammatory markers (C reactive protein of 70.27 mg/L, procalcitonin of 5.200 ng/mL), without eosinophilia (140/µL). HIV serology was negative. Stool was positive for occult blood, but parasite examination was negative. CT of the chest indicated diffuse lung inflammation. Contrast-enhanced CT of the abdominal showed air-filled dilated bowel loops with fluid levels and extensive wall thickening suggestive of small bowel obstruction and active enteritis (figure 1). Gastrointestinal endoscopy showed a 0.5×0.6 cm pyloric ulcer (figure 2A), multiple shallow ulcers in the ileocecal junction (figure…

Objectives
This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association.

Design
Observational population study, 1968–2019.

Setting
The Population Study of Women in Gothenburg, Sweden (PSWG).

Participants
In 1968–1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD.

Primary and secondary outcome measures
Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality.

Results
In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65–80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively).

Conclusions
This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results.

Objective
To investigate the association of fat and lean mass in specific regions with all-cause and cardiovascular-related mortality.

Design
Population based cohort study.

Setting
US National Health and Nutrition Examination Survey (2003–2006 and 2011–2018).

Participants
22 652 US adults aged 20 years or older.

Exposures
Fat and lean mass in specific regions obtained from the whole-body dual-energy X-ray absorptiometry.

Main outcome measures
All-cause and cardiovascular-related mortality.

Results
During a median of 83 months of follow-up, 1432 deaths were identified. Associations between body composition metrics and mortality risks were evident above specific thresholds. For all-cause mortality, Android fat mass showed elevated HRs above 2.46 kg (HR: 1.17, 95% CI 1.02 to 1.34), while Android lean mass (ALM) had similar trends above 2.75 kg (HR: 1.17, 95% CI 1.03 to 1.33), and Android total mass above 5.75 kg (HR: 1.08, 95% CI 1.01 to 1.16). Conversely, lower HRs were observed below certain thresholds: Gynoid fat mass (GFM) below 3.71 kg (HR: 0.72, 95% CI 0.56 to 0.93), Gynoid lean mass below 6.44 kg (HR: 0.77, 95% CI 0.64 to 0.92), and Gynoid total mass below 11.78 kg (HR: 0.76, 95% CI 0.70 to 0.84). Notably, below 0.722 kg, the HR of visceral adipose tissue mass (VATM) was 1.25 (95% CI 1.04 to 1.48) for all-cause mortality, and above 3.18 kg, the HR of total abdominal fat mass was 2.41 (95% CI 1.15 to 5.05). Cardiovascular-related mortality exhibited associations as well, particularly for Android fat mass (AFM) above 1.78 kg (HR: 1.22, 95% CI 1.01 to 1.47) and below 7.16 kg (HR: 0.50, 95% CI 0.36 to 0.69). HRs varied for Gynoid total mass below and above 10.98 kg (HRs: 0.70, 95% CI 0.54 to 0.93, and 1.12, 95% CI 1.02 to 1.23). Android per cent fat, subcutaneous fat mass (SFM), AFM/GFM, and VATM/SFM were not statistically associated with all-cause mortality. Android per cent fat, Gynoid per cent fat, AFM/GFM, and VATM/SFM were not statistically associated with cardiovascular-related mortality. Conicity index showed that the ALM/GLM had the highest performance for all-cause and cardiovascular-related mortality with AUCs of 0.785, and 0.746, respectively.

Conclusions
The relationship between fat or lean mass and all-cause mortality varies by region. Fat mass was positively correlated with cardiovascular mortality, regardless of the region in which they located. ALM/GLM might be a better predictor of all-cause and cardiovascular-related mortality than other body components or body mass index.

Nasce progetto Pet Co-therapy, visita dei calciatori del Bologna

Nasce progetto Pet Co-therapy, visita dei calciatori del Bologna

Domani la Giornata Mondiale della Prematurità

Circulation, Volume 148, Issue Suppl_1, Page A13855-A13855, November 6, 2023. Background:The American Heart Association recommended Life’s Essential 8 (LE8) as a simple cardiovascular health (CVH) metric. While optimal LE8 scores are associated with greater CVH and longevity, the mechanisms underlying these associations are unclear.Objective:To characterize the associations between LE8, epigenetic age scores, CVD, and all-cause mortality.Methods:LE8 scores were calculated for 5,669 participants in the Framingham Heart Study. Mixed proportional hazard models were used to evaluate the associations between LE8 score and CVD and all-cause mortality. We conducted mediation analyses to calculate the proportion of the association between LE8 score and CVD and all-cause mortality that is mediated by DNA methylation-based epigenetic age markers (GrimAge and PhenoAge). We performed stratified mediation analyses based on median-dichotomized polygenic risk score (PRS) of epigenetic age markers.Results:Higher LE8 scores, indicating better CVH, were associated with lower risk of CVD. One standard deviation (SD) increase in LE8 score was associated with a 35% decreased risk of CVD (95% CI: 27%, 41%,p=1.8E-15). One SD increase in LE8 was also associated with a 29% decreased risk of all-cause mortality (95% CI: 22%, 35%,p=7.0E-15). These associations were partly mediated by epigenetic age: the mean proportions of mediation by GrimAge and PhenoAge were 21% and 2% (p=0.23) for CVD and 67% and 6% for all-cause mortality, respectively. In our stratified analysis, potential mediation effects of GrimAge and PhenoAge were more profound in participants with a higher PRS. For GrimAge, the proportion of mediation for the association between LE8 and CVD was 39% (95% CI: 14%, 80%,p=8.8E-04) for participants in the upper half of higher GrimAge PRS whereas there was no significant mediation for those with low GrimAge PRS values. For the association between LE8 and all-cause mortality, the proportion of mediation by GrimAge was 81% (95% CI: 48%, 100%,p

Circulation, Volume 148, Issue Suppl_1, Page A13000-A13000, November 6, 2023. Description of Case:A 76-year-old female with a past medical history of chronic atrial fibrillation and symptomatic tachycardia and bradycardia status-post dual-chamber pacemaker with right atrial and ventricular leads who presented with dyspnea on exertion. TTE showed normal biventricular function and no significant valvular abnormalities. Upon further evaluation of her pacemaker, she was found to have a very high ventricular capture threshold suggesting RV lead failure. The patient underwent RV lead replacement. The inspection of the pacemaker pocket during the procedure showed manual dislodgement of both tie-down sleeves and the pacemaker leads required untangling. A new RV lead was subsequently placed. Upon further imaging review, displacement of the previous RV lead was evident from initial placement. In addition, the patient had previously had a history of interval diaphragmatic stimulation as well. Overall, the presentation was felt to be consistent with Twiddler’s Syndrome.Discussion:Twiddler’s or Reel Syndrome occurs when conscious or subconscious self-manipulation and spinning of the pulse generator result in lead dislodgement and loss of pacing and pacemaker malfunction. The reeling of the leads around the generator can also cause stimulation of the brachial plexus or phrenic nerve stimulation and subsequent rhythmic arm twitching or diaphragmatic pacing, respectively. It has previously been reported in cases of single- and dual-chamber ICDs, deep brain stimulators, and spinal nerve stimulators with varying presentation. The diagnosis requires clinical suspicion based on history, physical exam, imaging, or surgical inspection suggesting the displacement of leads with evidence of coiling of the wires around the pacemaker. Treatment often requires revision and focus should be maintained on patient education for both primary and secondary prevention of Twiddler’s Syndrome.

Circulation, Volume 148, Issue Suppl_1, Page A18280-A18280, November 6, 2023. Background:Selecting good lower extremity bypass (LEB) surgery candidates for chronic limb threatening ischemia (CLTI) is important to optimize risk-benefit ratios for amputation and death. As mortality risks may be different across age groups, we aimed to examine whether amputation risks across age groups differ by their differential competing risk of death.Methods:Individuals with CLTI undergoing infrapopliteal LEB from 2014 to 2019 in the Medicare linked Vascular Quality Initiative registry were included. The cumulative incidence Function (CIF) for 5-year mortality and major amputation in age groups