Search Results for: Nuovi farmaci per il danno renale acuto (Acute kidney injury – AKI)

Introduction
Pre-eclampsia (PEC) is a morbid and potentially lethal complication of pregnancy and is more common in women with risk factors such as hypertension, diabetes, autoimmune disease, kidney disease or multifetal pregnancies. Low dose aspirin (ASA) is currently the only prophylactic therapy known to decrease PEC in this patient population. However, currently, there is no prospective literature comparing various low-dose ASA formulations in the risk reduction of PEC. In the USA, the currently available low-dose ASA is over-the-counter and found in 81 mg tablets. Therefore, when clinicians initiate low-dose ASA therapy, they may prescribe one or two tablets of 81 mg per day without comparative evidence to guide their decision. Our objective is to prospectively compare pregnant patients on 81 mg vs 162 mg of ASA and determine a possible dose response in the prevention of PEC.

Methods and analysis
We designed a pragmatic phase 3 prospective randomised open label blinded-end point clinical trial with parallel assignment between two groups of pregnant people at high risk for PEC, as defined by the US Preventive Services Task Force and American College of Obstetricians and Gynecologists (ACOG). The primary outcome is the incidence of preterm (

Objective
To assess the incidence, progression and predictors of chronic kidney disease among adult patients living with HIV/AIDS who are receiving antiretroviral therapy.

Design
An institution-based, multicentre retrospective follow-up study was conducted among a randomly selected sample of 535 adult patients. Data were entered into Epi Data version 4.6.0 and analysed using STATA version 14.0. A Cox proportional hazards regression model was fitted to identify independent predictors of chronic kidney disease incidence. Variables with p

Un nuovo farmaco per la colite ulcerosa da moderata a grave e nuove indicazioni di farmaci per la sclerosi multipla e la fibrosi cistica. Sono alcuni dei trattamenti che saranno rimborsati dal Servizio sanitario nazionale (Ssn) a seguito delle decisioni assunte dal Consiglio di Amministrazione dell’Aifa nella seduta dell’8 luglio 2025.
In totale i farmaci interessati sono 7: 1 nuova molecola chimica, 1 medicinale generico e 5 farmaci già rimborsati per altre indicazioni.

Negli adolescenti con diabete di tipo 1, l’aggiunta all’insulina dell’SGLT2 inibitore dapagliflozin a basso dosaggio ha migliorato la funzionalità renale e il controllo glicemico, secondo quanto rilevato dallo studio clinico ATTEMPT presentato al congresso 2025 dell’American Diabetes Association (ADA).

In EMPA-KIDNEY, 2 years treatment with empagliflozin improved QALYs, and reduced use and cost of other healthcare, resulting in high likelihood of cost-effectiveness across a broad range of patients with CKD. The study’s key limitation is its relatively short active treatment period and follow-up duration, which may lead to underestimation of the cost-effectiveness of long-term SGLT2i treatment in CKD.

Censis, con screening, consegna farmaci, e prenotazioni Cup

Il rapporto del Censis, recapito farmaci e screening in testa

Objectives
To investigate the association between triglyceride-glucose (TyG) index levels at hospital admission and the risk of in-hospital adverse events, including all-cause mortality, in patients with acute myocardial infarction (AMI). The primary hypothesis was that higher TyG index levels are associated with greater risk of adverse in-hospital outcomes.

Design
Retrospective cohort study.

Setting
Tertiary hospital inpatient care in China. The study included consecutively hospitalised patients with AMI between 1 August 2011 and 10 January 2022.

Participants
A total of 3458 patients with AMI were included. The mean age was 60.8 years, and 78.4% were men. Patients were excluded if they had incomplete data for TyG index calculation or outcome ascertainment.

Interventions
No therapeutic intervention was assigned; the study was observational. TyG index was calculated using fasting triglycerides and fasting plasma glucose levels at admission.

Primary and secondary outcome measures
The primary outcome was all-cause in-hospital mortality. Secondary outcomes included cardiogenic shock and fatal rapid arrhythmia. Outcomes were identified through standardised clinical records.

Results
Among 3458 patients, 375 (10.84%) died during hospitalisation, 236 (6.84%) developed cardiogenic shock and 147 (4.25%) experienced fatal rapid arrhythmia. After multivariable adjustment, higher TyG index levels were significantly associated with increased odds of all-cause mortality (OR, 1.27; 95% CI, 1.02 to 1.57; p

Objectives
This study conducted a comprehensive probabilistic cost-effectiveness analysis comparing robotic exoskeleton therapy to conventional physiotherapy for stroke rehabilitation in Singapore, focusing on three patient groups categorised by their Functional Ambulation Category (FAC) scores.

Design
A probabilistic cost-effectiveness analysis was conducted alongside a non-randomised controlled study. Costs and Quality-Adjusted Life Years (QALYs) for both interventions were calculated and compared over a 6 month period.

Setting
The study was carried out at Alexandra Hospital, Jurong Community Hospital and St Luke’s Hospital in Singapore.

Participants
Individuals requiring inpatient gait rehabilitation from acute to subacute stages of stroke recovery, with FAC scores of 0–1, were included in the analysis.

Primary outcome measure
The primary outcome measure was QALYs, a composite measure combining the length and quality of life into a single value.

Results
Robotic exoskeleton therapy was found to be cost-effective compared with conventional physiotherapy across all patient groups, with Group 2 (FAC 0) showing the most favourable cost-effectiveness profile (incremental cost-effectiveness ratio (ICER): US$ 28 259.62 per QALY gained). The probabilistic sensitivity analysis demonstrated the robustness of the results, with QALY gains and the cost of the robotic exoskeleton having the largest impact on the ICER.

Conclusion
The findings suggest that robotic exoskeleton therapy is likely to be cost-effective for stroke rehabilitation in Singapore, particularly for patients with severe mobility impairments (FAC 0). The results have important implications for clinical practice, resource allocation and future research in the field of stroke rehabilitation in Singapore.

Trial registeration number
NCT05659121.

Introduction
Patients with total hip arthroplasties and hemiarthroplasties are both subject to hip dislocations. Although the incidence of complications differs, both patient groups suffer immediate high pain and need acute treatment. The purpose of this study is to design a fast-track pathway for patients with a dislocated hip prosthesis primarily to reduce the time from arrival to reduction and the total hospitalisation time. The secondary aim is to investigate whether quicker prosthesis reduction influences subsequent hip function and quality of life, reduces pain experience immediately and in the long term, and increases patient satisfaction.

Methods and analysis
This is a prospective observational cohort study, initiated on 1 December 2024 and continuing for 2 years. During the first year, patients admitted to the University Hospital of Southern Denmark, Esbjerg, will follow the current standard treatment pathway. After 1 December 2025, a newly developed treatment pathway (fast-track) will be adhered to. Based on a sample size calculation, 120 patients will be included. The main clinical outcomes (time to reduction (primary outcome), total hospitalisation) are registered from patient files. The patients are followed up for 1 year to measure patient-reported outcomes.

Ethics and dissemination
The study is conducted as a treatment quality study and is locally approved by the Executive Board at the University Hospital of Southern Denmark. The results will be published in relevant national and/or international journals and presented at relevant congresses.

Trial registration number
NCT06639334.

No medical diagnosis is more fraught than child physical abuse. Implications are grave for the child, family, and community. If abuse is missed in its earliest stages, children may experience further injury, permanent disability, or death. If not present, an abuse diagnosis risks family disruption, lost trust, and delayed medical diagnoses. Abuse is not a single pathophysiological entity with consistent examination findings, laboratory results, natural history, or imaging. Unlike most pediatric illnesses, caregivers may resist diagnostic efforts, perhaps by providing information that is incomplete or misleading. The diagnosis is often challenged in legal proceedings, occasionally by deploying specious theories of causation with limited scientific support. When available, child abuse pediatricians, who have additional training and experience, can provide subspecialist consultation to address these challenges, but the diagnosis is also often first made by frontline clinicians.

This Rational Clinical Examination systematic review aims to identify predictors of physical abuse among young children with a traumatic injury.

10 molecole assorbono 70% consumi. Ampie differenze tra regioni

10 molecole assorbono 70% consumi. Ampie differenze tra regioni

Stroke, Ahead of Print. BACKGROUND:Left atrial (LA) diverticula are focal outpouchings of the LA wall and may increase ischemic stroke risk. We studied recurrent ischemic stroke in patients with acute ischemic stroke and LA diverticula detected on cardiac computed tomography.METHODS:We used data from a prospective cohort study of patients with acute ischemic stroke undergoing cardiac computed tomography acquired during the acute stroke imaging protocol. Cardiac radiologists systematically assessed the presence and characteristics of LA diverticula, defined as LA wall outpouchings with a length/ostium width ratio >0.5 and length ≥3 mm. We compared recurrent ischemic stroke and functional outcome (modified Rankin Scale) after 2 years between patients with and without LA diverticula, adjusting for age, history of atrial fibrillation and ischemic stroke, and anticoagulation use.RESULTS:Of 447 included patients (median age 72 [interquartile range (IQR), 62–81], 59% male), 126 (28%) had LA diverticula: median length 6 mm (IQR, 4–8), width 5 mm (IQR, 4–7), and volume 113 mm3(IQR, 52–254). There was no statistically significant difference in age (median 70 [IQR, 58–79] versus 73 [IQR, 63–81];P=0.06), sex (64% versus 57% male;P=0.28), history of ischemic stroke (21% versus 17%;P=0.48), atrial fibrillation (11% versus 19%;P=0.09), or baseline National Institutes of Health Stroke Scale score (median 5 [IQR, 2–14] versus 5 [IQR, 3–14];P=0.54) between patients with and without LA diverticula, respectively. Recurrent ischemic stroke was more common in patients with LA diverticula (18/124 [15%] versus 24/314 [8%], adjusted hazard ratio, 2.01 [95% CI, 1.08–3.77]), and recurrence risk increased with diverticulum volume (adjusted hazard ratio, 1.02 [95% CI, 1.01–1.03] per 10 mm3). Functional outcome was better in patients with diverticula (median modified Rankin Scale score of 2 [IQR, 1–3] versus 3 [IQR, 1–6], adjusted common odds ratio, 0.62, [95% CI, 0.42–0.92]).CONCLUSIONS:LA diverticula are a common finding on cardiac computed tomography in patients with acute ischemic stroke, and the risk of recurrent ischemic stroke was increased in these patients, particularly in those with larger diverticula. Atrial diverticula may be a risk factor for recurrent ischemic stroke.REGISTRATION:URL:https://www.onderzoekmetmensen.nl/nl/trial/50352; Unique identifier: NL6413901818.

Stroke, Ahead of Print. BACKGROUND:As populations age, there is an increasing need to optimize endovascular treatment (EVT) and to understand country-specific differences in East Asia. We harmonized stroke registries from Korea and Taiwan to enable comparisons of patient characteristics and outcomes, with a particular focus on the impact of age.METHODS:Multicenter prospective stroke registries in Korea (CRCS-K [Clinical Research Collaboration for Stroke in Korea]) and Taiwan (TREAT-AIS [Taiwan Registry of Endovascular Thrombectomy for Acute Ischemic Stroke]) were harmonized to form a unified data set of patients undergoing EVT. Outcomes included 3-month modified Rankin Scale, symptomatic intracranial hemorrhage, and successful recanalization. We assessed the association between age and outcomes in the overall population and those who were aged ≥80 years using logistic regression models, adjusting for relevant covariates.RESULTS:A total of 9934 EVT cases (7835 from Korea and 2099 from Taiwan) were included from 2011 to 2023. Patients had a mean age of 70.1±12.9 years (57.6% male; median National Institutes of Health Stroke Scale score, 14 [interquartile range, 9–19]). Compared with Korean patients, Taiwanese patients had a higher prevalence of risk factors and more severe strokes, contributing to lower rates of favorable 3-month outcomes. Increasing age was associated with poorer EVT results; among patients ≥80 years, 18% achieved a modified Rankin Scale score of 0 to 2, compared with 46% of younger patients. However, the risk of symptomatic intracranial hemorrhage did not significantly increase with age (adjusted odds ratio per year, 1.01 [0.99–1.02]; adjusted odds ratio of ≥80 years, 0.98 [0.75–1.29]). Prestroke functional independence, baseline hemoglobin, and bridging thrombolysis were identified as significant modifiers of outcomes in the oldest patients.CONCLUSIONS:Taiwanese EVT patients had more risk factors and worse outcomes than Korean patients. Advanced age is associated with poorer functional recovery, yet selected older patients, particularly those who were functionally independent before the stroke or received bridging thrombolysis, demonstrated meaningful benefit. These results underscore the importance of individualized treatment strategies and careful patient selection, especially as populations continue to age.