Risultati per: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

New England Journal of Medicine, Ahead of Print.

Objectives
Worldwide, a number of studies have been conducted to assess the prevalence of adherence to secondary antibiotic prophylaxis and to identify the associated factors (reasons) for poor adherence among patients with rheumatic heart disease or acute rheumatic fever (RHD/ARF). However, results were highly inconsistent with a prevalence ranging from 10% to 93%; and the reported reasons or associated factors have not been systematically reviewed. Therefore, this study aimed to assess the prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD/ARF; and to review the associated factors (reasons) for poor adherence.

Design
Systematic review and meta-analysis.

Data sources
PubMed/Medline, Google Scholar, Cochrane Review and African Journals Online databases.

Eligibility criteria
Articles published in English from 1 January 2005 to 1 December 2022 and reported the prevalence of adherence using ≥80% cut-off points were included.

Data extraction and synthesis
Data were extracted using the Microsoft Excel and analysed by STATA V.11.0. A meta-analysis was conducted using the weighted inverse-variance random-effects model. Reasons for poor adherence were identified through thematic analysis.

Results
33 articles with a total sample size of 7158 patients were included. The pooled prevalence of adherence to secondary antibiotic prophylaxis among patients with RHD/ARF was found to be 58.5% (95% CI: 48.2% to 68.7%; I2=99.2%; p

Sitd, crescita fenomeni preoccupa soprattutto tra i giovani

Introduction
Traumatic brain injury (TBI) is one of the prevalent critical illnesses encountered in clinical practice, often resulting in a spectrum of consciousness disorders among survivors. Prolonged states of impaired consciousness can significantly elevate the susceptibility to complications such as urinary tract infections and pulmonary issues, consequently leading to a compromised prognosis and substantially impacting the quality of life for affected individuals. Clinical studies have reported that median nerve electrical stimulation (MNES) may have a therapeutic effect in the treatment of disorders of consciousness (DOC). We plan to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of MNES in the management of DOC subsequent to TBI.

Methods and analysis
We will conduct a comprehensive literature search in the following electronic databases: Web of Science, Embase, PubMed, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database. The search will be performed from the inception of the databases until 30 September 2024. Furthermore, we will search for relevant ongoing trials in the International Clinical Trial Registry Platform, ClinicalTrials.gov and China Clinical Trial Registry. Grey literature will also be sourced from reputable sources like GreyNet International, Open Grey and Google Scholar. We will include eligible randomised controlled trials. The primary outcome of interest will be the assessment of consciousness disorder severity. To ensure rigour and consistency, two independent reviewers will screen the studies for inclusion, extract relevant data and assess the risk of bias. Any discrepancies will be resolved through discussion or consultation with a third reviewer. The quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data synthesis and meta-analysis will be conducted using STATA 15.1 software.

Ethics and dissemination
This systematic review and meta-analysis do not involve the collection or use of any individual patient data, thereby obviating the necessity for ethical review. The research findings will be disseminated through publication in peer-reviewed scientific journals.

PROSPERO registration number
CRD42024533359.

Medicinali più consumati sono per cuore, intestino e sangue

To the Editor In the research and operations niche of hospital capacity strain and preparedness, although surges have historically been defined according to an unexpected large number of patients (eg, a mass casualty event), many have argued for a more nuanced definition that also includes any number of patients with high acuity (or higher acuity than the norm for the treating location) or with unique care needs (such as enhanced personal protective equipment or specialized personnel), or any isolated or simultaneous loss of resources (such as during a natural disaster), and any combination of these, locally or regionally.

This clinical trial compares fever prevention targeted to 37.0 °C for 14 days vs standardized tiered fever treatment on functional outcomes in critically ill patients with stroke.

How to manage fever in the neurocritical care unit in patients with acute stroke was clearly a question in need of an answer. The association of fever burden with poor outcome for diverse conditions in the neurocritical care unit has been well described. However, distinguishing association from causation has been difficult, with prior randomized trials of hypothermia in various neurologic injuries showing neither clear benefit nor harm. Additionally, while it might seem nuanced to those unfamiliar with this field, fever control requires an entirely different approach from interventions to achieve hypothermia. Guidelines are available to support the logistics of providing this therapy and the neurocritical care community who manage these patients have gained expertise in temperature control over the past 20 years, while testing targeted temperature management in a wide variety of neurologic injuries, including cardiac arrest, traumatic brain injury, severe stroke, and spinal cord injury.

In Reply We appreciate Dr Anesi’s interest in our Research Letter, which reported that ransomware attacks disrupting care delivery in targeted hospitals in California from 2014 to 2020 led to an increase in emergency department visits at nearby facilities.

This narrative review explores the use of maintenance hemodialysis and peritoneal dialysis in the treatment of dialysis-dependent chronic kidney failure, including diagnosis, pathophysiology, and disease management.

We write in response to the Letter to the Editor by van den Berg et al1 commenting on our recent article ‘Gut microbiota predicts severity and reveals novel metabolic signatures in acute pancreatitis’.2 We greatly appreciate the interest in our work and are grateful to clarify some aspects of the study. The primary endpoint of our study investigated whether microbial compositions can be employed as early predictors for severity of acute pancreatitis (AP). Patients with revised Atlanta classification III (RAC III) showed highly significant microbial differences compared with RAC I and RAC II. Further analysis revealed a higher abundance of species that are known producers of short-chain fatty acids (SCFA) in severe AP. Van den Berg et al mention the lack of a healthy control cohort, however, it is already known from previous studies that the microbial composition in stool samples of patients with AP…

With great interest, we read the paper by Ammer-Hermenau et al, which features a multicentre microbiome study that included buccal and rectal samples taken at admission from 450 patients with acute pancreatitis.1 Severe acute pancreatitis was post hoc defined as persistent organ failure and/or collections that required drainage. These patients were propensity score matched with patients with mild acute pancreatitis. Remarkedly, over-representation of 10 known short-chain fatty acid (SCFA)-producing bacteria was found in the severe group. The authors conclude that SCFAs might be associated with worse outcomes and speculate that the increased mortality that was observed in the intervention group of the Probiotics in Pancreatitis Trial (PROPATRIA) could be explained by SCFA producers in the probiotics formula.2 There are, however, some limitations to this study, and we believe the author’s statements are in need of nuance. First, the authors did not include a control group…

We read with great interest the paper by Bang et al,1 reporting their single-centre retrospective experience in 25 patients with acute cholecystitis, who were deemed at increased surgical risk and treated by EUS-guided gallbladder drainage (EUS-GBD) using LAMS. Three patients underwent surgery because of persistent biliary-type symptoms, but the presence of LAMS precluded successful laparoscopic cholecystectomy (LC) and open or subtotal cholecystectomy was required. Diverging from the recent guidelines of the European Society of Gastrointestinal Endoscopy and the American Gastroenterological Association,2 3 the authors concluded that EUS-GBD should only be considered in patients for whom surgery would never be an option. We thank Bang et al, for sharing their experience with these unfortunate surgical outcomes, which encourages further discussion on how to use this technique. However, some of the points raised in their study deserve further considerations. First, a clear-cut definition on how…

Circulation, Volume 150, Issue Suppl_1, Page A4144554-A4144554, November 12, 2024. INTRODUCTION:Coronary CT angiography (CCTA) is a powerful noninvasive tool for identifying high-risk plaque, such as low-density non-calcified plaque (LD-NCP). Though, the optimal treatment of patients with LD-NCP remains unclear. This study explored the association of revascularization in the setting of LD-NCP with the occurrence of acute coronary syndrome (ACS).Methods:This was a post-hoc analysis of the ICONIC study. A subset of 234 patients that underwent CCTA with subsequent ACS were matched to 234 control patients who also underwent CCTA but did not have ACS during follow-up. Patients were also followed for occurrence of revascularization, either coronary artery bypass graft or percutaneous coronary intervention. Atherosclerosis imaging-enabled quantitative CT (AI-QCT) was used to measure diameter stenosis, and LD-NCP, non-calcified plaque, and calcified plaque volumes from each CCTA. LD-NCP was defined as plaque with -190 to 30 Hounsfield Units. Patients were stratified based on the presence of LD-NCP. Subgroup analysis was conducted to compare the occurrence of ACS with the rate of revascularization. Kaplan-Meier survival curves and extended Cox regression analysis were used to evaluate the effect size of revascularization and LD-NCP on occurrence of ACS.Results:AI-QCT was completed in 448/468 subjects (follow-up time [MEAN±SD] 2.44±2.48 years). The median of LD-NCP was 1.2 mm3for patients with >0 mm3LD-NCP. There were 85 patients with LD-NCP >1.2 mm3and 363 patients with LD-NCP ≤1.2 mm3. In patients with LD-NCP >1.2 mm3, the rate of revascularization in patients with and without ACS was 3/52 (5.8%) versus 14/33 (42.4%) (p1.2 mm3and revascularization were less likely to have ACS during follow-up (adjusted HR: 0.20 [0.07, 0.61]; p=0.005). Additionally, patients with LD-NCP >1.2 mm3who did not undergo revascularization were more likely to have ACS (adjusted HR: 1.47 [1.03, 2.12]; p=0.036). Hazard ratios were adjusted for diameter stenosis, and non-calcified and calcified plaque volume. Time-dependent coefficients were included for diameter stenosis.Conclusion:Revascularization of patients with LD-NCP >1.2 mm3identified on CCTA with AI-QCT was associated with less risk for ACS.

Circulation, Volume 150, Issue Suppl_1, Page A4140142-A4140142, November 12, 2024. Background:Cardiovascular-kidney metabolic (CKM) syndrome is exacerbated among individuals experiencing chronic exposure to both environmental and psychosocial stressors. Both neighborhood and individual-level stressors increase chronic inflammation resulting in worsened CKM factors, such as hypertension, diabetes, and dys/hyperlipidemia. However, associations between neighborhood perceptions (NP) and lipid profiles remain understudied. Therefore, we examined associations between NP domains and lipid profiles among African-American (AA) women with ≥Stage 1 CKM syndrome (overweight/obesity) residing in resource-limited neighborhoods within the Washington, DC area.Methods:Participants were enrolled in Step It Up, a technology-enabled, community-engaged physical activity (PA) intervention. Fasting blood samples were drawn at baseline to measure lipoproteins using Nuclear Magnetic Resonance (NMR) spectroscopy. Factor analysis of overall NP identified four perception sub-scores: disorder, social cohesion, violence, and safety (higher score=favorable perception). Associations between NP domains and lipoprotein particles were analyzed using multivariable regression adjusting for BMI, ASCVD 10-year risk score, and lipid-lowering therapy.Results:Participants (n=169) had mean age=57.16 ± 12.00 and BMI 35.99 ± 6.57. Perceptions of safety were positively associated with LDL concentrations (LDLc) and large LDL particles (L-LDLp) (β=4.70 [SD=2.41], p=0.05, β= 43.75 [17.70], p= 0.01), respectively). Perceptions about neighborhood violence were positively associated with L-LDLp (marginally) and very-low-density lipoprotein size (VLDLz) (β= 7.10 [3.96], p=0.08, β= 0.31 [0.14], p= 0.02, respectively). No associations were found between disorder and social cohesion with lipid biomarkers.Conclusions:After adjusting for BMI, ASCVD risk, and lipid-lowering therapy, there were significant associations between neighborhood perceptions of safety and violence with lipid profiles among AA women with CKM syndrome. Greater perceived safety was associated with higher LDLc and L-LDLp while more favorable perception about neighborhood violence was associated with higher L-LDLp. Future work should examine whether improving neighborhood resources and perceptions may improve CKM health among urban AA women.

Circulation, Volume 150, Issue Suppl_1, Page ASa1101-ASa1101, November 12, 2024. Aim:Quantitative analysis of hypoxic-ischemic brain injury (HIBI) using apparent diffusion coefficient (ADC) values from brain magnetic resonance imaging (MRI) is used to predict poor neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. Our study aimed to determine the association between changes in HIBI and neurological outcomes in OHCA survivors using two types of MRI.Methods:This observational study used data collected prospectively from a tertiary academic hospital. The study included adult comatose OHCA survivors who underwent targeted temperature management (TTM) and brain MRI within 6 hours (first) and 72–96 hours (second) using the same MR scanner. We analyzed the neurological outcomes based on brain volumes below a specific ADC value using 10-step intervals within the range of 200–1200 × 10-6mm2/s for the first and second MRIs. ADC-R(x) represents the proportion of total brain volume occupied by voxels, with ADC values ranging from 200 × 10-6mm2/s to each threshold. Additionally, ADC(x) represents the proportion of total brain volume occupied by voxels that are “threshold – 10” at each threshold.Poor neurological outcomes were categorized as cerebral performance levels 3–5, observed 6 months after OHCA.Results:Overall, 122 patients (25% female) were included in the analysis, of whom 61 (50%) showed poor neurological outcomes. Higher ADC-R(x) were observed in the poor neurological outcome group on both the first and second MRI scans at all ADC intervals (all P < 0.05) (Figure 1). In the Good Neurological Outcome group, the ADC-R values ranged between 370 and 940, with the second MRI value being smaller than that of the first (right shift, P < 0.05). In contrast, the Poor Neurological Outcome group showed ADC-R values ranging between 340 and 1190, with the second MRI value being higher than that of the first (left shift, P < 0.05) (Figure 2). The difference in ADC(x) between the second and first MRI based on neurological outcome showed a positive change in ADC below 620 for a poor neurological outcome and a positive change in ADC above 740 for a good neurological outcome (Figure 3).Conclusions:In this cohort study, we observed that the initial HIBI that occurred during OHCA worsened or returned to normal depending on the neurological outcome after TTM. Prospective multicenter studies are required to generalize our findings.