Risultati per: Case report: porpora di Schonlein-Henoch in una giovane adulta in ambulatorio di Medicina Generale

Objectives
The emergence of drug-resistant tuberculosis (DR-TB) complicates TB management and poses significant challenges to achieve favourable treatment outcomes. Treating DR-TB is more complex and costly, requiring extended treatment durations and consideration of drug toxicity and side effects. This study aims to identify the determinants of unfavourable treatment outcomes among DR-TB patients in Malaysia.

Design
Retrospective case–control study.

Setting
Secondary data from the National Tuberculosis Registry (NTBR) across two states in Malaysia.

Participants
All reported DR-TB cases in the NTBR between 2016 and 2020 from Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Cases still undergoing treatment at the time of analysis were excluded. A total of 403 cases were analysed, with 181 (44.9%) experiencing unfavourable treatment outcomes and 222 (55.1%) having favourable treatment outcomes. The case group consists of individuals with DR-TB who experienced unfavourable treatment outcomes, while the control group comprises individuals with DR-TB who achieved favourable treatment outcomes.

Outcome measures
Unfavourable treatment outcomes, defined as death, treatment failure or loss to follow-up, were assessed. Predictors of these outcomes were identified through multiple logistic regression analysis.

Results
Significant determinants of unfavourable treatment outcomes included being male (adjusted OR (aOR) 2.38, 95% CI 1.44 to 3.94), being single or divorced (aOR 1.61, 95% CI 1.03 to 2.49), having no formal education (aOR 3.09, 95% CI 1.49 to 6.41), people living with HIV (aOR 2.87, 95% CI 1.40 to 5.87) and having DR-TB categorised as rifampicin-resistant tuberculosis (aOR 3.34, 95% CI 1.90 to 5.86) or multidrug-resistant/pre-extensively drug-resistant/extensively drug-resistant-TB (aOR 2.57, 95% CI 1.52 to 4.33).

Conclusion
The findings reveal a high proportion of DR-TB cases with unfavourable treatment outcomes and identify their key determinants. Targeted interventions addressing these factors are essential to improve treatment outcomes.

A recent study of a large internal medicine residency program found that exposure to cases varied greatly between residents, among hospitals, and over time. Because medical residents rely heavily on hands-on experiences to gain clinical skills, understanding such discrepancies could help inform efforts to tailor curriculum and close potential knowledge gaps, the authors of an accompanying commentary stated.

Worldwide, the rate of deaths from drowning decreased by 38% over the past 2 decades, from 6.1 to 3.8 per 100 000 people. The first-ever status report on drowning prevention from the World Health Organization (WHO) estimated that 300 000 people died from drowning in 2021, down from 375 000 in 2000.

Children with well-regulated type 1 diabetes show early vascular changes in radial and DP arteries. Regression analyses indicate significant links between IT and hyperglycaemia and type 1 diabetes diagnosis respectively, indicating that structural arterial changes start in the intima. Our findings further emphasise increased time in normoglycemia as the most crucial action to prevent cardiovascular complications in type 1 diabetes. Additional larger studies are needed to confirm and further interpret the meaning of these results.

New England Journal of Medicine, Volume 392, Issue 7, Page 699-709, February 2025.

This Viewpoint discusses changes needed at local, state, and national levels to improve child health care.

Objectives
Aortic dissection (AD) is a life-threatening condition that requires intensive care and management. This paper explores the role of fluid management in the clinical care of AD patients, which has been unclear despite the substantial existing research that has been conducted on the treatment of AD.

Design
A retrospective case-control study using data for AD patients from public databases.

Setting
Two public intensive care unit (ICU) databases with hospital courses from the USA, Medical Information Mart for Intensive Care (MIMIC)-IV critical care dataset and the eICU Collaborative Research Database, with data from 2008 to 2019.

Participants
A total of 751 adult AD patients with detailed fluid management records from two databases were included.

Interventions
The mean 24-hour intake and output were calculated by dividing the total amount of intake and output by the number of days in the ICU, respectively. The mean 24-hour fluid balance was generated by subtracting the output from the intake.

Outcome measures
The relationship between the mean 24-hour fluid management and all-cause in-hospital death was assessed through univariate and multivariable regression analyses.

Results
A positive correlation was found between mean 24-hour fluid intake and in-hospital mortality among AD patients (OR 1.029, 95% CI (1.018, 1.041), p

Il libro di Claudio Giorlandino, ‘da diagnosi per le malattie rare alle cure su misura’

A hospitalized patient in Louisiana has the nation’s first severe illness with highly pathogenic avian influenza A(H5N1) virus, or H5N1 bird flu, the US Centers for Disease Control and Prevention (CDC) announced in mid-December. Testing revealed that the virus that infected the patient is related to those circulating in wild birds and poultry. The person had contact with sick and dead birds in backyard flocks and, according to news reports, was an older adult with underlying medical conditions.

Objectives
Cement and most other materials used by bricklayers and brick masons for construction purposes could heighten the risk for occupational skin diseases (OSDs) which mostly include occupational contact dermatitis (OCD) and others. The activities of the bricklayers or brick masons are essentially manual as they work as artisans involving mixing sands and gravels with cement and water for building and block moulding, respectively. This can lead to a significant decline in the quality of life and psychosocial function. We determined the prevalence of OSDs and their correlates among bricklayers and brick masons.

Design
This was a comparative case–control study which involved 200 bricklayers/brick masons and 200 healthy non-bricklayers/non-brick masons.

Settings
This study was carried out in two local governments (LGAs) in Ogbomoso community.

Methods
Respondents were selected using a multistage random sampling technique. Interviewer–administer semi-structured questionnaire was used to collect data. Data were analysed using descriptive statistics, the prevalence of OCD and other OSD were determined, 2 test and logistic regression were obtained. A p

Researchers describe three CPPD disease “phenotypes.”

Stroke, Volume 56, Issue Suppl_1, Page ATMP69-ATMP69, February 1, 2025. Introduction:Cerebral Amyloid Angiopathy (CAA) is caused by the progressive deposition of β-amyloid in the walls of small to medium-sized cerebral vessels. Although seizures represent a debilitating manifestation of CAA, little is known about their prevalence or associated factors. We aim to fill this gap by determining the prevalence of seizures in CAA and identify factors associated with an increased risk of seizures.Methods:We identified consecutive patients with CAA, evaluated within the Mayo Clinic health system between January 2010 and December 2023 using the ICD-10 code. Data on demographics and comorbidities were compared between those with and without seizures using the chi-square test for categorical variables and independent samples t-test for continuous variables. Odds ratios (OR) were estimated after adjusting for age, sex, and race in multivariable logistic regression.Results:We included 1,914 patients with CAA with a mean age of 75.4 ± 8.6 years, of whom 52.3% were female and 87.5% were white. Seizures were observed in 347 patients (18.1%). Individuals with seizures were significantly younger (mean age 67.7 ± 9.1 vs. 77.2 ± 7.5 years, p < 0.001). Multivariable modeling identified alcohol abuse (OR 1.92, 95% CI 1.03-3.56, p=0.04), diabetes mellitus (OR 2.14, 95% CI 1.13-4.06, p=0.02), hypertension (OR 1.79, 95% CI 1.33 - 2.41, p=

Stroke, Volume 56, Issue Suppl_1, Page ATMP109-ATMP109, February 1, 2025. Background:The Stroke Preclinical Assessment Network (SPAN), a multi-center network consisting of a coordinating center and testing laboratories, was created to enhance the rigor of preclinical research, including testing of potential therapies in animals of different species, sex, age, and co-morbidities, with blinding and randomization. SPAN evaluated six potential therapies with the goal of identifying one or more efficacious agents to advance toward a clinical trial. Remote ischemic post-conditioning (RIC) was selected as a candidate therapy for testing.Methods:In Stage I, young, healthy mixed-sex mice were randomized into treatment groups by the coordinating center. In Stage II, aged mice, mice with high-fat diet-induced obesity, and spontaneously hypertensive rats were utilized. Each stage included 25% of the study population and efficacy/futility was determined after each stage. RIC was bilaterally administered as the first session occurred immediately after reperfusion, and the second session occurred as close as possible to 12 ± 2 hours at post-MCAo, using an automated blood pressure cuff that delivered 200-mmHg to the hindlimbs for 4 cycles x 5 minutes/cycle and then once per day x 5 days under anesthesia. Sham-conditioned animals were treated with a cuff that did not inflate. The primary outcome measure was a modified corner test on days 7 and 30 post-stroke. MRI was performed at 48 hours and 30 days. Probabilistic index models, which adjusted for covariates of interest, were fit to estimate the probability of a lower corner test index (better outcome) between sham and RIC.Results:A total of 266 mice (132 sham, 134 RIC) were enrolled in the study, with 50 sham and 51 RIC-treated mice dying within 5 days of stroke. Analysis of all data revealed no significant differences in day 30 alternative corner test index between sham and RIC-treated mice after stroke in young, healthy mice (p=0.449), aged mice (p=0.079), mice with diet-induced obesity (p=0.135), or in spontaneously hypertensive rats (p=0.807). The secondary analysis found that RIC improved day 30 tissue infarction volume by MRI in young, healthy mice (p=0.024 vs. sham) but not in other co-morbid conditions.Conclusions:After advancing through Stages I and II, RIC was deemed futile at the end of Stage II, as determined by the modified corner test on day 30. The requirement for repeated daily general anesthesia during RIC administration may have been a complicated factor.