Risultati per: Le cause della polmonite nei bambini

Il progetto promuove corretti stili vita nella scuola primaria

Si pensa a infezione respiratoria e a febbre emorragica. Si cerca di stringere il cerchio ma mancano i dati

Il focolaio di Kebsiella provocato da un nutriente parenterale

Creatine—a natural compound in the body that acts as a fuel reservoir—is often elevated in plasma from people with type 2 diabetes, but whether it influences insulin resistance or is a marker for it hasn’t been known. New findings published in Science Translational Medicine suggest that insulin resistance might influence creatine metabolism rather than the other way around.

Al Bambino Gesù parte la selezione dei pazienti per uno studio

In an observational study, 9% of outpatient COPD exacerbations were caused by RSV infections.

Dal 15 al 22 novembre raccolta medicinali in oltre 2800 realtà

In California una sperimentazione clinica contro una forma considerata letale. Per uno scomparsa la massa

Circulation, Volume 150, Issue Suppl_1, Page A4145877-A4145877, November 12, 2024. Background:Heat exposure is associated with an increase in cardiovascular mortality, particularly among older adults. Climate change has led to an increase in days with hot temperatures. The burden of hospitalizations associated with heat exposure is not well known.Methods:Data on all hospitalizations among Medicare beneficiaries 65 years of age and older in summer months (May through September) for 2016 to 2019 were obtained from Medicare Provider Analysis and Review (MEDPAR) files. Total daily cardiovascular and all-cause hospitalizations in each US county in the contiguous United States (US) were determined and daily county-level maximum heat index levels were obtained from the gridMET dataset. Counties with

Circulation, Volume 150, Issue Suppl_1, Page A4124931-A4124931, November 12, 2024. Background:The AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been introduced to predict all-cause death (ACD) in patients with heart failure. There is no information available on the utility of this score for the prediction of ACD in patients with coronary artery disease (CAD).Hypothesis:The AHEAD score may provide superior predictive value for ACD compared to the CHADS2score, which has been reported to be useful for predicting poor clinical outcomes in patients with acute (ACS) and chronic coronary syndromes (CCS).Methods:This retrospective multicenter cohort study analyzed data of the patients who underwent percutaneous coronary intervention for ACS or CCS between April 2013 and March 2019 using the Clinical Deep Data Accumulation System (CLIDAS) database. The AHEAD score was calculated by assigning 1 point each for atrial fibrillation, hemoglobin 130 μmol/L), and diabetes mellitus. The CHADS2score was calculated as previously reported. The study endpoint was ACD.Results:In total, 9,033 patients were enrolled (median age, 72 years; 77% male; 3,920 with ACS and 5,113 with CCS). Higher AHEAD or CHADS2scores were significantly associated with a higher rate of left main disease or three-vessel disease in both patients with ACS and CCS. In addition, after accounting for multiple variables using Cox multivariate analysis, both the AHEAD (hazard ratio [HR], 1.83 [95% confidence interval, 1.63–2.06] for ACS and 1.66 [1.49–1.85] for CCS) and CHADS2scores (HR 1.27 [1.15–1.40] for ACS and 1.23 [1.12–1.35] for CCS) remained significantly associated with ACD. However, receiver operating characteristic curve analysis for predicting ACD revealed that the predictive value of the AHEAD score was significantly higher than that of the CHADS2score in both ACS and CCS (Figure). A significant difference was found in the rate of ACD among patients stratified by the AHEAD score in both groups (bothP

Circulation, Volume 150, Issue Suppl_1, Page A4145889-A4145889, November 12, 2024. Background:Pulmonary Artery Elastance (PAE) is an echocardiographic value commonly calculated in Heart Failure (HF) patients. It is presumed to be associated with mortality and adverse outcomes. We aim to evaluate pulmonary artery elastance (PAE) as a predictor of all-cause mortality in heart failure (HF) patientsMethods:A comprehensive literature review was conducted on PubMed and Google Scholar from inception till May 2024 for articles relevant to the mortality outcomes in HF patients with respect to pulmonary arterial elastance as one of their predictors. Data were extracted independently by four different reviewers. We used a fixed-effects model meta-analysis model to evaluate and pool the outcomes in association with PAE and all-cause mortality. Further assessment of the outcomes was performed by sensitivity analysis with a one-study removal method and meta-regression analysis.Results:Out of 63 studies, 4 studies with 759 patients were included in our meta-analysis. Mean age ranged from 54 to 65 years. We found there was a statistically significant association between pulmonary artery elastance and all-cause mortality (OR: 1.12, 1.06 – 1.19, p < 0.0001] (Figure 1a). Sensitivity analysis with one-study removal showed overall effects in the meta-analysis still lean towards supporting PAE as the predictor for ACM (Figure 1b). Meta-regression analysis with age (Figure 1c), sex and other supportive variables did not show statistically significant associated confounders.Conclusion:This meta-analysis establishes a significant association between elevated PAE and increased risk for all-cause mortality in HF patients. These results suggest PAE could be a strong predictor for all-cause mortality in HF patients. Further research is needed to provide a more comprehensive understanding of the predictive value of PAE for HF patients. The association between PAE and mortality could provide significant insights that could influence clinical practice and improve patient outcomes in HF.

Circulation, Volume 150, Issue Suppl_1, Page A4144514-A4144514, November 12, 2024. Introduction:Human Immunodeficiency Virus Associated Cardiomyopathy (HIVAC) is characterized by left ventricular (LV) systolic or diastolic dysfunction with or without LV dilatation and heart failure symptoms. The introduction of antiretroviral therapy (ART) has changed the fulminant systolic heart failure presentation of HIV myocarditis to diastolic heart failure. We present a unique case of dilated cardiomyopathy in a young patient without advanced HIV illness which has rarely been documented in the literature. This is a rare presentation of HIVAC in the post-ART era.Case Report:A 32-year-old male with a past medical history (PMH) of the human immunodeficiency virus (HIV) presented with complaints of new onset worsening shortness of breath and lower extremity edema for four weeks. He was diagnosed with HIV seven years ago and was not compliant with ART. Laboratory testing showed a cluster of differentiation 4 (CD4) 823 and HIV load 2550. Myocarditis was ruled out by normal troponin levels and no new changes on the electrocardiogram (ECG). Transthoracic echocardiogram (TTE) showed dilated left ventricle (LV), LV global hypokinesis, LV ejection fraction (LVEF) 10-15%, dilated right ventricle, biatrial dilation, moderate to severe mitral regurgitation, severe tricuspid regurgitation, pulmonary artery (PA) systolic pressure 73 mmHg and no pericardial effusion. Coronary angiography was negative for coronary artery disease (CAD). The patient was started on carvedilol and outpatient evaluation for a left ventricular assistance device.Discussion:Systolic dysfunction in patients with HIVAC carried a poor prognosis in the pre-ART era and was common in patients with elevated c-reactive protein (CRP), tobacco use, and previous myocardial infarction (MI). After the advent of ART, systolic dysfunction is rare and replaced by diastolic cardiomyopathy in the setting of ART use. Diagnosis is usually by excluding other etiologies and biopsy is not necessarily required. Management is usually guideline-directed medical therapy (i.e. beta blocker, renin-angiotensin-aldosterone antagonists, sodium-glucose cotransporter-2) and device-based therapy but there is still data lacking to assess its benefit.

Circulation, Volume 150, Issue Suppl_1, Page A4144973-A4144973, November 12, 2024. Background:Cardiac calcium, which includes coronary and extra-coronary calcification, is often incidentally found in chest CT scans performed for various reasons. Despite its prognostic value, manual quantification of cardiac calcium in non-gated chest CT images is labor-intensive.Goals:This retrospective study aims to perform automatic quantification and scoring of cardiac calcium in non-contrast-enhanced chest CTs. The objective is to determine associations between automatic calcium scoring and outcomes such as all-cause mortality, non-fatal myocardial infarction (MI), and non-fatal stroke.Methods:We conducted a nationwide cohort study using the Taiwan National Health Insurance Research Database (NHIRD) from 2016 to 2022. Patients under 20 years old, with a diagnosis of malignancy, or with outcome events before the CT acquisition were excluded. HeaortaNet 1.0, a validated AI model, was used for cardiac calcium scoring. Comorbidities were determined using ICD diagnostic codes for ≥2 consecutive outpatient visits within the year before the index date. Outcomes were censored at the first occurrence of mortality or relevant ICD codes for MI or stroke.Results:The retrospective cohort included 279,415 patients (56.37% male, mean age 60.31±16.54). All-cause mortality occurred in 12.82% of patients within a 3-year follow-up. The 3-year incidence rates of non-fatal MI and non-fatal stroke were 0.86% and 2.07%, respectively. Multivariate-adjusted Cox hazard ratios (95% confidence intervals) for any composite outcome were 1.51 (1.46-1.57), 2.09 (2.01-2.17), 2.63 (2.53-2.74), and 3.37 (3.24-3.50) for cardiac calcium scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0. Adjusted Cox hazard ratios for all-cause mortality were 1.62 (1.56-1.69), 2.29 (2.19-2.39), 2.91 (2.78-3.04), and 3.80 (3.64-3.96) for scores of 1-100, 101-400, 401-1000, and >1000, compared to a score of 0.Conclusion:AI-enabled opportunistic screening of non-contrast chest CT for cardiac calcium scoring is associated with all-cause mortality and cardiovascular events. This is the first large-scale cohort study to use an AI model for comprehensive cardiac calcium screening.

Circulation, Volume 150, Issue Suppl_1, Page A4139937-A4139937, November 12, 2024. Background:The role of plant-based diet in preventing premature death among patients with cardiovascular disease (CVD) remained unknown. To explore the relationship of plant-based dietary patterns with all-cause and cause-specific mortality among patients with CVD.Methods:A sum of 10,841 participants with CVD at baseline were followed up in the UK Biobank. We constructed three types of plant-based diet indexes [an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI)] by assigning different weights to various food groups from web-based 24-h dietary recall questionnaires. The national death registry documented primary causes of death. The Cox proportional hazards regression models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.Results:Over a median of 11.3-year follow-up, 1,275 death cases were ascertained. After multivariable adjustment, PDI had a negative correlation with all-cause mortality [HRT3vsT1: 0.81 (0.70-0.94), Ptrend=0.005] and CVD mortality [HRT3vsT1: 0.78 (0.61-0.99), Ptrend=0.040], while uPDI displayed a positive correlation with all-cause mortality [HRT3vsT1: 1.33 (1.16-1.53), Ptrend

Circulation, Volume 150, Issue Suppl_1, Page A4140078-A4140078, November 12, 2024. Background:Extreme heat events have increased in frequency and intensity and are projected to continue increasing due to climate change. Extreme heat is associated with an increase in both all-cause and cardiovascular (CV) mortality. However, how extreme heat impacts CV disease related emergency department (ED) visits is not well studied.Methods:Data on all ED visits among adults 20 years and older from 16 US states in summer months (May through September) for 2010 to 2018 were obtained from State ED all-payer claims databases. After determining the monthly number of ED visits in each county, the county-level monthly number of extreme heat days was determined. Extreme heat days were defined as any day with a maximum heat index ≥90°F (32.2°C) and in the 97.5thpercentile based on a county-specific historical period (1979-2007). CV ED visits were identified using ICD-10 diagnostic codes (I00-I99). A Poisson fixed effects regression model with county, year, and month fixed effects was estimated with monthly ED visits as the outcome and the monthly number of extreme heat days as the primary predictor of interest. Environmental, economic, and demographic variables were also included in the model. Excess ED visits were estimated as the difference between the number of visits, in each county, with the observed number of extreme heat days and the estimated number of visits if no extreme heat days had occurred.Results:There were approximately 91 million all-cause and 1.5 million CV ED visits across 985 counties during summer months in 2010 to 2018. The population-weighted, total median number of extreme heat days over the study period was 79 (IQR 63-98). From 2010-2018, each additional extreme heat day per month was associated with a 0.21% (95% CI 0.02-0.41,p=0.03) increase in monthly CV ED visits and a 0.20% (95% CI 0.06-0.35,p=0.006) increase in monthly all-cause ED visits. The estimated number of extreme heat associated excess CV ED visits over the study period was 5658.4 (95% CI 525.0-10791.9). The estimated number of excess all-cause ED visits was 329055.4 (95% CI 95625.4-562485.4)Conclusion:Extreme heat was associated with an increase in CV and all-cause ED visits in 16 states in the US between 2010 and 2018. As extreme heat events continue to increase, understanding how this will impact emergency departments and health systems across the country is important to be able to devise strategies to address the associated increase in utilization.