Risultati per: Quotidianosanita.it

Objectives
To assess the prevalence and severity of paruresis (‘shy bladder syndrome’) in a population of university staff and students and to determine if there was any relationship between demographics, self-esteem, presence of social anxiety disorders and negative toilet experiences and paruresis.

Design
We undertook an anonymised cross-sectional online survey using Microsoft Forms. We invited participants aged 18 and over to complete the survey which included demographic information; any pre-existing medically or self-diagnosed anxiety-related conditions; Shy Bladder Scale (SBS); Rosenberg Self-Esteem Scale (RSES) and questions about using school toilets in their younger life. We defined ‘mild’ and ‘severe’ paruresis based on total SBS cut-off scores of greater than or equal to 31 and greater than or equal to 40. We calculated prevalence of paruresis, and explored differences in self-esteem, school toilet experience and social anxiety disorders between individuals with and without paruresis. Multivariable logistic regression was used to determine which variables had any influence on having a ‘mild’ and ‘severe’ paruresis diagnosis.

Setting
We distributed the survey to all staff and students via their university email address as well as promoting the survey on university social media sites.

Results
We received responses from 356 individuals. Most participants (237, 66.6%) were within the 18–30 year age category and most (277, 77.8%) were white. There were 221 (62.1%) females, 119 (33.4%) males and 16 (4.5%) other genders. The prevalence of ‘mild’ paruresis was 25.8% and of ‘severe’ paruresis 14.9% in this sample. 73.0% indicated that they had at least one medically or self-diagnosed anxiety disorder. There was a statistically significant difference in the total SBS score between individuals with and without an existing anxiety disorder (8 vs 19,

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 A4119744-A4119744, November 12, 2024. Objective:To evaluate neuropsychological development in children with cyanotic and acyanotic congenital heart diseases (CHDs) after surgical treatment and analyze the risk factors.Methods:89 children who received follow-up in Fuwai Hospital after surgical treatment of CHDs were recruited in this study and 90 normal children were recruited as the control group. The children with CHDs were divided into cyanotic CHDs group and acyanotic CHDs group. Neuropsychological development was assessed according to Pediatric-psychological mental test scale and statistical analysis was employed.Results:The acyanotic CHDs group achieved better distribution of development quotient than cyanotic CHDs group (p < 0.05) but worse than the normal control group (p = 0.004). The proportion in cyanotic CHDs group with developmental quotient below the moderate level was higher than that of the normal control group (p < 0.001), but there was no significant difference between the cyanotic CHDs group and acyanotic CHDs group (p = 0.055). Multivariate regression analysis indicated that for cyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower preoperative blood glucose level, lower BIS level, and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale (p < 0.05); for acyanotic CHDs group, younger age at cardiac surgery, lower body mass, lower temperature during surgery and prolonged duration of tracheal intubation after surgery were linked with lower scores in the test scale(p < 0.05).Conclusion:Distinct neuropsychological impairment could be present in children with cyanotic CHDs. Younger age at cardiac surgery, body mass, preoperative blood glucose level, BIS level during surgery, temperature during surgery and duration of tracheal intubation after surgery were perioperative factors that could influence long-time neuropsychological development in children with CHDs.

Circulation, Volume 150, Issue Suppl_1, Page A4140394-A4140394, November 12, 2024. BACKGROUND:REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) was a multinational, double-blind trial that randomized 8,179 statin-treated patients with controlled low-density lipoprotein cholesterol, elevated triglycerides, and cardiovascular (CV) risk, to icosapent ethyl (IPE) 4 g daily or placebo. Randomization was stratified by established CV history (70.7%), or diabetes and other risk factors (29.3%).METHODS/RESULTS:We evaluated IPE in patients with CV history, further characterized as having a documented history of coronary artery disease (CAD), or not. Primary (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, hospitalization for unstable angina) and key secondary (CV death, nonfatal MI, nonfatal stroke) CV endpoints were evaluated. Of the 5,785 (70.7%) REDUCE-IT patients with established CV disease, 4,532 patients had a history of CAD (multi vessel CAD, prior MI, hospitalization for high-risk non-ST-segment elevation acute coronary syndrome) and 1,253 patients did not. IPE reduced primary and key secondary first and total (first plus recurrent) events in patients with and without a history of CAD. In patients with CAD, IPE demonstrated a 25% relative risk reduction in first (HR 0.75; 95% CI 0.66, 0.84;P

Circulation, Volume 150, Issue Suppl_1, Page A4136330-A4136330, November 12, 2024. Introduction:Accurate assessment of pacing thresholds during permanent pacemaker implantation is critical to ensure device function and longevity. A few reports have described rate-related threshold variability during MicraTMleadless pacemaker (Medtronic Inc, Minneapolis, MN) procedures. Postulated mechanisms for this phenomenon include variable myocardial contact or micro-dislodgment, and inflammation-induced phase IV block. In this case series, we demonstrate the use of adenosine to induce transient heart block for accurate threshold assessment in patients with tachycardia during leadless pacemaker placement.Cases:A 69-year-old male with a history of atrial flutter presented with complete atrioventricular (AV) block requiring emergent transvenous pacing. A Micra placement was performed. During the procedure, the patient was tachycardic in rapid atrial flutter despite multiple doses of metoprolol. It was noted that with rapid pacing from the pacemaker at 120 pulses per minute (ppm) the threshold was ≤1V at 0.24 ms. An adequate “tug-test” was performed and at least 2 of 4 tines were noted to be fixated based on fluoroscopic motion. To confirm the capture threshold before final deployment, 12 mg of adenosine was given to induce heart block. However, at a rate of 60 ppm, there was no ventricular capture at 3V at 0.24ms. The device was repositioned and repeat threshold testing with adenosine at 60 ppm was 0.38V at 0.24ms. Pacing parameters were assessed the next day and remained stable.Similarly, a 75-year-old female with ischemic cardiomyopathy was admitted with new atrial fibrillation (AF). She then developed pauses prompting Micra placement. During initial threshold testing, she was in rapid AF despite receiving multiple doses of metoprolol. Heart block was induced with 12mg adenosine to assess the threshold at a lower pacing rate of 60 ppm. The capture threshold achieved was 0.5V at 0.24ms.Discussion:Nusbickel et al., Yoshiyama et al., and Sano et al. have reported rate dependent discrepancies in capture thresholds after Micra implantation. Our cases highlight the importance of capture threshold assessment at lower pacing rates during implantation. In patients who are tachycardic at the time of the procedure, adenosine may be useful to more reliably assess device capture threshold and determine the need for repositioning.

Circulation, Volume 150, Issue Suppl_1, Page A4144382-A4144382, November 12, 2024. Background:Left atrial fibrosis has been shown to be associated with atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). The optimal way to target atrial fibrosis has not been determined still.Purpose:The aim of this study is to determine whether left atrial fibrosis, as detected by late gadolinium enhancement MRI (LGE-MRI), should be covered, encircled, or both, in addition to PVI, to improve ablation success in patients with persistent AF.Methods:We conducted an analysis of DECAAF II participants who were randomized to the PVI plus MRI-guided atrial fibrosis ablation arm. These patients underwent late-gadolinium enhancement MRI (LGE-MRI) before and after AF ablation. Left atrial ablation lesions were collected from intra-procedural electro-anatomical maps and were superposed on 3D left atrial MRI images of fibrosis. We divided the patients into three groups based on whether atrial fibrosis was covered, encircled, or both. After ablation, patients were instructed to provide single-lead smartphone-based ECG strips once daily and following symptoms based on which AF burden and recurrence after ablation was assessed. Uni- and multivariable regression models were developed to assess the association of the technique used with time-to-atrial arrhythmia recurrence.Results:393 patients were included in our analyses. At baseline, patients were similar in comorbidity burden, age, sex, and left atrial volume. However, baseline fibrosis was different amongst the groups (19% vs 18% vs 20%; p-value=0.02). LA volume decrease was higher when atrial fibrosis was both encircled and covered simultaneously (31 mm3 vs 21 mm3 vs 23 mm3; p= 0.006). The primary outcome of atrial arrhythmia recurrence was similar among all the groups as shown in figure A (p=0.17). Even after controlling for possible confounders such as age, body mass index, sex, comorbidities, left atrial volume index, and baseline fibrosis, the technique used to target atrial fibrosis was not associated with recurrence (p=0.07). Moreover, AF burden in the follow-up period was not different across the patient groups as shown in figure B (p=0.63).Conclusion:Among patients with persistent AF, neither covering nor encircling atrial fibrosis in addition to PVI affected atrial arrhythmia recurrence after catheter ablation. More studies should be done to optimize atrial fibrosis targeting and modification.

Circulation, Volume 150, Issue Suppl_1, Page A4147960-A4147960, November 12, 2024. Introduction:Blood pressure targets for the elderly are still controversial, there is a lack of certainty about the benefit and safety of targeting ≤ 130mmHg systolic blood pressure. Evaluate the benefit in important cardiovascular outcomes and safety in elderly patients of a blood pressure control ≤ 130mmHg compared to standard of care.Methods:The research was performed in PubMed, EMBASE, Scielo, LILACS, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1st, 2013 to May 1st, 2023. Randomized controlled trials that were published between January 1st, 2013 and May 1st, 2023 that included hypertensive patients over 60 years old which reported major adverse cardiovascular outcomes (MACE) or all-cause mortality, cardiovascular mortality and safety outcomes were selected. The data extraction was performed independently by two investigators following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A meta-analysis was performed using a fixed-effect model. The results were reported as the pooled results using risk ratio (RR) and a confidence interval (CI) of 95%.Results:The 4 trials included a number of 16,834 patients, the mean age was over 65 years, there was a good balance between genders, 13.3% of patients had cardiovascular disease, 10.9% diabetes, and 15.5% chronic kidney disease. The mean achieved blood pressure was roughly under 130mmHg, only one study was over (135mmHg) and the mean follow-up time was over 32 months. The intensive therapy decreased the outcomes for mortality (RR = 0.75, 95% CI 0.64 – 0.87, p

Circulation, Volume 150, Issue Suppl_1, Page A4144881-A4144881, November 12, 2024. Introduction:Metabolic equivalents (METs), a measure of energy use during a specified exercise intensity, and volume of oxygen consumed (VO2) are key measurements in cardiopulmonary exercise tests (CPETs). METs are traditionally converted to VO2 via multiplying METs by 3.5 ml/kg/min when VO2 data is not available, due to the fact that the latter requires more-expensive, accurate measurements of volume of inspired and expired oxygen and CO2. However, it is unclear which populations have significant variation between peak METs and peak VO2.Research Question:In a general cardiology population, do older women have a weaker relationship between peak METs and peak VO2?Methods:We present a retrospective study analyzing the relationship of peak METs and peak VO2 achieved on a CPET. Patients presenting to the cardiology clinic who received a CPET from 2017-2022 were included. Patients with severe valvular dysfunction, congenital heart disease, prior coronary artery bypass grafting, or ejection fraction < 50% were removed to limit confounding. A Spearman correlation coefficient was calculated for the whole sample comparing peak METs and peak VO2. Subsequently, a subgroup of women age 65 or greater were compared to the general sample by a fisher’s z transformation.Results:1907 patients were included. There was a strong positive correlation between peak VO2 and peak METs in the whole sample (r(1860) = 0.914), p

Circulation, Volume 150, Issue Suppl_1, Page A4144226-A4144226, November 12, 2024. Background and Objectives:Neonatal cardiac surgery requires careful consideration of cardiopulmonary bypass (CPB) priming fluid composition due to small blood volume and immature physiology. This study investigated the impact of allogeneic stored red blood cells (RBCs) processed using an autotransfusion system in CPB priming fluid for neonates.Materials and Methods:We compared perioperative parameters, inflammatory mediators, coagulation indicators, vasoactive-inotropic score (VIS), and clinical outcomes between neonates receiving unwashed (n=56) and washed (n=45) RBCs in CPB priming fluid. Regression models were used to assess the independent association between RBC washing and patient outcomes.Results:The autotransfusion system improved stored RBC quality. The washed group showed higher peak hematocrit (P < 0.01) and hemoglobin levels (P = 0.04) during CPB, an increased oxygen delivery index during rewarming (P < 0.05), and lower postoperative lactate levels and VIS (P < 0.05).Inflammatory (IL-6, IL-8, IL-10) and coagulation parameters (DD, FIB, FDP) fluctuated compared to baseline but did not significantly differ between groups. The washed group had a lower incidence of hyperlactacidemia and delayed sternal closure at CPB weaning.Conclusions:Adding washed allogeneic stored RBCs to neonatal CPB priming fluid reduced postoperative lactate elevation and VIS without early improvement in the inflammatory and coagulation systems.

Circulation, Volume 150, Issue Suppl_1, Page A4137009-A4137009, November 12, 2024. Background:The Danish German Cardiogenic Shock trial (DanGer Shock) recently showed a reduction in all-cause mortality when treating selected patients with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock with a microaxial flow pump (mAFP). Whether there is an age-related differential survival benefit is unknown.Objective:To assess the influence of age on 180-day all-cause mortality in patients with STEMI and cardiogenic shock randomized in DanGer Shock.Methods:In DanGer Shock (an open-label, international, multicenter trial), 355 adult patients (aged ≥18 years with no upper age limit) with STEMI and cardiogenic shock were included and randomized to a mAFP (Impella CP) plus standard care or standard care alone. Patients were stratified in quartiles according to age, and logistic regression analyses were used to assess mortality according to age quartiles, and to evaluate whether age modified the treatment effect of the mAFP.Results:From lowest to highest quartile, patients’ ages ranged from 31-59, 60-69, 70-76, and 77-92, respectively. There were no differences in blood pressure, lactate level, left ventricular ejection fraction and shock severity across age groups. However, the proportion of females (41%) and the prevalence of hypertension (64%) was higher in patients aged ≥77 years (highest quartile), while more patients aged

New England Journal of Medicine, Volume 391, Issue 18, Page 1743-1744, November 7, 2024.

More than half—58%—of US adults aged 18 years or older with uncontrolled hypertension were unaware they had the condition in a study using nationally representative survey data. And 71% of those who were aware and took medication still couldn’t control their blood pressure, researchers found.

Stroke, Ahead of Print. The quotation, attributed to Confucius many centuries ago, in our opinion, applies to the evolving story of defining a primary surgical treatment for spontaneous intracerebral hemorrhage. The precise quote is: “Keep it simple and focus on what matters. Don’t let yourself be overwhelmed.”1The evidence from multiple trials on intracerebral hemorrhage regarding mortality benefit and potential functional benefit directs us toward the simple task of evacuating the clot, similar to our prime focus on opening the artery in ischemic stroke. We need not be overwhelmed by questions about adjustments to patient selection, comparative techniques, and precision timing, for which we do not have conclusive data. We review the consensus results from the recent MISTIE trial (Minimally Invasive Surgery Plus Alteplase in ICH Evacuation) and ENRICH trial (Early Minimally Invasive Removal of Intracerebral Hemorrhage) and articulate remaining questions where further evidence is needed to challenge equipoise and define future practice.

Dr. Paul Sax explains how “PCP” became “PJP” for Pneumocystis jirovecii pneumonia in HIV and ID Observations.

Introduction
Despite several calls to deprescribe benzodiazepine receptor agonists (BZRA) in older adults, their use among nursing home residents (NHRs) remains high. Therefore, we developed an intervention targeting general practitioners’ and healthcare professionals’ behaviours regarding BZRA deprescribing in nursing homes (NHs): The END-IT NH (bENzodiazepines Deprescribing InTerventions Nursing homes) 6-component intervention. Before moving on to a large-scale effectiveness and cost-effectiveness evaluation, this feasibility study aims at: (1) assessing the feasibility of the intervention implementation in NHs, (2) assessing the feasibility of conducting a larger-scale evaluation, in terms of recruitment and data collection and (3) conducting an exploratory cost-effectiveness evaluation.

Methods and analysis
We will conduct a cluster-randomised controlled trial in a sample of 6 NHs, with 10–15 NHRs included per NHs. Four NHs will be randomised into the intervention group, and two NHs will deliver usual care (control group). Data collection will occur at baseline, 3, and 6 months (study end). We will collect information to explore implementation fidelity, mechanisms of impact and contextual factors at patient-level, NH-level and healthcare professional-level, using both quantitative and qualitative measures. The feasibility of the study conduction will be assessed by measuring recruitment and attrition rates and completeness of data collection. An exploratory cost-effectiveness evaluation will be conducted based on quality of life and healthcare use and cost data.

Ethics and dissemination
This study protocol received approval from the ethical committee of CHU UCL Namur on the 20 June 2023. All data are confidential and will be anonymised prior to analysis. De-identified data will be shared on a data depository with a 2-year embargo. The results of the study will be disseminated through a scientific paper and will be communicated to local stakeholders and policymakers through a local symposium.

Trial registration number
NCT05929443.

New England Journal of Medicine, Volume 391, Issue 15, Page 1452-1454, October 17, 2024.