Search Results for: Gestione della stenosi mitralica reumatica (MVA <= 1,5 cm)

Clinical manifestation A 41-year-old man presented with a 3-year history of acid reflux. Physical examination revealed a head circumference of 61 cm, multiple hyperkeratotic papules on the face and palms, bilateral buccal mucosa hypertrophy and numerous pedunculated tags in the armpits (figure 1A-D). Endoscopy revealed granular mucosa throughout the entire stomach and duodenum with multiple polyps, and the pathology showed tubular adenomas and inflammatory polyps (figure 1E,F). The colonoscopy showed multiple polyps, with the pathology revealing hyperplastic polyps, inflammatory polyps and neurofibroma (figure 1G,H). The capsule endoscopy revealed numerous polyps in the small intestine. He had gallbladder polyps, thyroid nodules and cystic renal lesions and underwent surgeries for throat polyps, acoustic neuroma and multiple haemangiomas. Another patient, a 33-year-old male, complained of satiety and constipation. The patient had a head circumference of 67 cm, neurofibroma on the eyelids, and granular hyperplasia on…

A 6-year-old girl had a slightly sunken red plaque that was observed on the chest, approximately 1.5 cm in diameter, with a smooth surface, associated vascular dilation, well-defined borders, and no scaling or ulceration. What is your diagnosis?

Introduction
Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, readmission and failed nutritional recovery. Current management approaches fail to sufficiently promote convalescence after inpatient nutritional rehabilitation. Novel interventions during the post-discharge period could enhance convalescence to help children survive and thrive.

Methods and analysis
The Co-SAM trial is an adaptive, multicountry, phase III, individually randomised clinical trial, based on the principles that (i) interacting biological and social factors drive multimorbidity in children with SAM, and (ii) both medical and psychosocial interventions may therefore ameliorate underlying causal pathways to reduce morbidity and mortality and improve recovery. Children aged 6–59 months with complicated SAM, who have stabilised and started the transition to ready-to-use therapeutic food (RUTF), will be enrolled and randomised to one of five trial arms (standard-of-care alone; antimicrobials; reformulated RUTF; psychosocial support; or a combination of all strategies). Standard-of-care, which is provided in all trial arms, includes RUTF until nutritional recovery (defined as weight-for-height Z-score >–2, mid-upper arm circumference >12.5 cm and oedema-free since the last study visit), and other management recommended in WHO guidelines. The 12-week antimicrobial package provides daily co-formulated rifampicin and isoniazid (with pyridoxine) and 3 days of azithromycin monthly. The reformulated RUTF, which incorporates medium-chain triglycerides and hydrolysed protein to increase nutrient bioavailability and reduce metabolic stress, is provided at the same dose and duration as standard RUTF. The 12-week psychosocial package includes caregiver problem-solving therapy, educational modules, peer support groups and child play. The combined arm includes all interventions. Children start their intervention package prior to hospital discharge, with follow-up data collection in study clinics at 2, 4, 6, 8, 12 and 24 weeks. The primary composite outcome is death, hospitalisation or failed nutritional recovery within 24 weeks post-randomisation. An interim analysis will allow unpromising arms to be dropped, while the final analysis will be conducted when 1266 children have completed the study. Embedded process evaluation and laboratory substudies will explore the mechanisms of action of the interventions.

Ethics and dissemination
The trial has been approved by ethics committees in Zimbabwe, Zambia, Kenya and UK. Dissemination will be via community advisory boards in each country; Ministries of Health; and dialogue with policymakers including UNICEF.

Trial registration number
Clinicaltrials.gov: NCT05994742; Pan African Clinical Trials Registry: PACTR202311478928378.

Introduction
Child maltreatment (CM) is a major public health issue with lifelong consequences on mental health, quality of life, educational and economic prospects of children who experienced CM. Early identification of maltreated children is important to prevent further CM and ensure that children’s basic needs are met, as well as to address and avoid further consequences. However, above and beyond early identification, it is crucial to avoid the occurrence of CM. This may include the reduction of risk factors at the family and community level as well as creating supportive environments for growing up safely. Therefore, we need to understand the prevention of CM conceptually and view it not only from a medical perspective, but also from a population health perspective. The aim of this scoping review is to identify and describe theories, models or frameworks on the prevention of CM from a broad population health perspective, considering primary, secondary and tertiary prevention strategies.

Methods and analysis
A broad search in four databases (PubMed (NIH NLM), PsycInfo (Ovid), CINAHL Plus (EBSCOhost) and Web of Science (Clarivate)) will be conducted from 2009 to current. Additionally, the grey literature on websites from key public health organisations will be considered. Results will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews: Checklist and Explanation (2018). The review will include articles describing a theory, model or framework on prevention strategies for CM. Studies focussing on single interventions that do not describe prevention strategies conceptually, will be excluded. General characteristics of the frameworks, theories and models and information on types of prevention strategies they describe will be extracted. Findings will be presented in a structured table format as well as narratively.

Ethics and dissemination
As we will not collect any personal, confidential or sensitive data, ethical approval is not required. We will publish our results in a scientific journal, present them at conferences and use them for further knowledge translation activities. The scoping review is registered with the Open Science framework: https://osf.io/49g7z/.

Un quarto ricoveri evitabile con prevenzione e migliore gestione

I read with interest the recent article of Wilkinson-Smith and colleagues on the assessment of colonic motility by means of MRI and high-resolution colonic manometry (HRCM),1 showing that patients with constipation and irritable bowel syndrome (IBS) may display some abnormalities when such investigated. I would like to make some observations on this study. Since HRCM probes were positioned 35 cm from the anal verge, I would be very cautious in claiming that those were ‘colonic’ studies, since (by considering the physiological bending of the large bowel) at the very best only a very limited colonic area was studied. Indeed, the authors in the methods reported that only the sigmoid colon was actually investigated in a systematic manner. Both MRI and HRCM were carried out as short-timed studies (respectively, 2 and 4 hours duration) conducted in a viscus that fully displays its motor activity over a 24-hour time span.

Tra i giovani pazienti cresce l’uso di microinfusori di insulina

Riccardi illustra la norma Partenariato pubblico privato

In Reply We appreciate the opportunity to respond to the Letter regarding our Teachable Moment in which Jolobe advocates for guideline-directed medical therapy (GDMT) in transthyretin amyloid cardiomyopathy (ATTR-CM). Although exploring traditional GDMT in this population is laudable, the evidence presented does not substantiate the conclusions, and it risks misapplication in clinical practice.