Search Results for: Long COVID: principali risultati, meccanismi e raccomandazioni

Objective
For every 100 women having a vaginal birth, approximately four will experience a severe (third-degree or fourth-degree) perineal tear. Severe perineal tears are associated with significant short-term and long-term consequences if not recognised and repaired. There are global efforts to reduce incidence of severe perineal tears including initiatives to strengthen education and training of clinicians in perineal anatomy and perineal tear assessment and classification. This systematic review aimed to describe and evaluate the effectiveness of these initiatives.

Design
Systematic review, reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Data sources
Medline (Ovid), CINAHL Complete (EBSCO), MIDIRS and EMBASE (Ovid) were searched through 15 February 2024.

Eligibility criteria
Studies reporting simple or complex interventions aimed at improving the skills and knowledge of clinicians in perineal anatomy and/or the clinical assessment and classification of perineal tears were eligible.

Data extraction and synthesis
Two reviewers independently screened studies for eligibility and appraised the quality of individual studies using the Cochrane Risk of Bias (RoB) 2.0 tool or Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool.

Results
In total, 7645 citations were screened and 39 studies included. We identified nine unique interventions including training programmes, short workshops and senior obstetrician supervision. Many studies were from high-income countries, in primary care settings and at high risk of bias.

Conclusions
Effective education included practical components, such as hands-on skills and training in perineal anatomy, assessment and classification, rather than senior supervision alone. Ongoing review of practice appears to be crucial for maintaining knowledge and skills. Future research should focus on interventions tailored to limited-resource settings, and the optimal length and intensity of training programmes to assess and classify perineal tears.

PROSPERO registration number
CRD42020185431.

Objectives
To evaluate factors associated with clinic follow-up after traumatic spinal injury (TSI) in Tanzania, focusing on demographic, injury-related and hospital variables. We hypothesised that socioeconomic and injury-specific factors would predict follow-up adherence.

Design
Retrospective observational cohort study.

Setting
Tertiary government referral centre for neurosurgery and orthopaedics in Dar es Salaam, Tanzania.

Participants
443 adults with TSI admitted between September 2016 and October 2021. Inclusion criteria included survival to discharge and availability of the discharge date. Patients with missing data were excluded.

Primary and secondary outcome measures
Primary outcomes were any clinic follow-up and 1-year follow-up post-discharge. Secondary outcome was time to loss of follow-up. Logistic regression was used to identify factors associated with follow-up, and Kaplan-Meier survival analysis assessed follow-up duration.

Results
Of 443 patients (85.8% male, median age 34 years), 52.4% returned for follow-up. Independent factors associated with return included private insurance (adjusted OR (aOR) 2.69, 95% CI 1.38 to 5.45, p=0.005), involvement in a road traffic accident (aOR 2.15, 95% CI 1.22 to 3.83, p=0.009), lumbar injuries (aOR 2.26, 95% CI 1.30 to 4.00, p=0.004), neurological improvement at discharge (aOR 3.52, 95% CI 1.72 to 7.64, p=0.001) and hospital stays shorter than 24 days (aOR 1.63, 95% CI 1.07 to 2.47, p=0.022). Among those who returned, only 25.4% completed 1 year of follow-up. Predictors of 1-year follow-up included being female (aOR 4.87, 95% CI 2.31 to 10.56, p

Atrofia muscolare spinale, risultati positivi da studio fase 1

Stroke, Ahead of Print. BACKGROUND:Spontaneous aneurysmal subarachnoid hemorrhage induces early blood-brain barrier permeability dysfunction, although its clinical relevance and underlying mechanisms remain poorly understood. We aimed to evaluate the association between blood-brain barrier disruption, quantified with dynamic contrast–enhanced magnetic resonance imaging at the end of the early brain injury period, circulating neuroinflammatory mediators, and long-term clinical outcomes.METHODS:We analyzed a prospective cohort of subarachnoid hemorrhage patients who underwent dynamic contrast–enhanced magnetic resonance imaging at a median (interquartile range) of 4 (2–6) days after clinical onset. Permeability maps were used to obtain K-trans values as a measure of increased blood-brain barrier permeability in the whole brain, gray matter, and white matter. Circulating neuroinflammatory molecules, including IL (interleukin) 8 and PDGF (platelet-derived growth factor), were measured using Multiplex-ELISA in blood samples collected concurrently with magnetic resonance imaging acquisition. Poor clinical outcome was defined as a modified Rankin Scale score of >2 at 90 days. Associations between K-trans values, neuroinflammatory mediators, and clinical outcomes were assessed using univariate and multivariate regression models.RESULTS:From 153 patients initially screened, 96 were finally included (63% females; median age, 55 years; 43% premorbid hypertension; 32% World Federation of Neurosurgical Societies grade 4–5; 31% poor outcome). In adjusted linear regression analyses, higher K-trans values were significantly associated with increased IL-8 (P=0.001) and PDGF (P=0.018) levels. In univariate analysis, K-trans values in white matter were significantly higher in patients with poor clinical outcome (median [interquartile range], 2.5 [2.07–6.09] ×10−3·min−1) compared with good clinical outcome (median [interquartile range], 2.0 [1.60–2.42] ×10−3·min−1;P

Stroke, Ahead of Print. Stroke significantly impacts mortality and long-term disability, necessitating effective rehabilitation strategies to enhance recovery. This review examines the roles of vagus nerve stimulation (VNS) and fastigial nucleus stimulation (FNS) in facilitating ischemic stroke recovery through brain-body interactions. VNS enhances ischemic stroke recovery by reprogramming microglia from proinflammatory (M1) to neuroprotective (M2) phenotypes, reducing neuroinflammation and promoting tissue repair via neurotrophic factors. It has shown promise in clinically improving chronic upper limb deficits when combined with rehabilitation therapies. Conversely, FNS provides cerebellar-mediated neuroprotection by mainly mitigating excitotoxic damage and inflammatory responses independent of cerebral blood flow alterations, as evidenced by preclinical models of middle cerebral artery occlusion. By integrating VNS-driven immunomodulation with FNS-mediated excitotoxicity suppression, this review highlights their synergistic potential to improve rehabilitation outcomes for ischemic stroke survivors. Biomarker-guided protocols: VNS for cortical/subcortical ischemic deficits and FNS for cerebellar network recovery are advocated to address postischemic disability via anti-inflammatory rewiring, neuroplasticity enhancement, and cerebellar-thalamocortical circuit stabilization. Critical gaps remain in hemorrhagic stroke, where FNS’s excitotoxicity suppression may destabilize clots, necessitating subtype-specific safety validations.

Peggioramento dal 2010, fatale il Covid

Objectives
The increasing prevalence of chronic conditions and multimorbidity places a significant burden on patients and leads to increasing challenges for healthcare systems, especially in primary care. Recognising the multifaceted nature of chronic conditions, the Assessment of Burden of Chronic Conditions (ABCC) tool was developed to support person-centred care, by facilitating shared decision-making and self-management. This study aims to evaluate the cost-effectiveness of the ABCC tool in primary care.

Design and setting
This cost-effectiveness analysis was conducted over 18 months alongside a clustered, two-arm quasi-experimental study in primary care in the Netherlands.

Participants
The study included 231 participants diagnosed with chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes mellitus (T2DM) and/or chronic heart failure (CHF). Of these, 173 were assigned to the intervention group and 58 to the control group.

Interventions
The intervention group was intended to incorporate the ABCC tool into routine consultations, while the control group had to continue care as usual.

Outcome measures
Outcomes were assessed from a societal perspective, including quality-adjusted life years (QALYs) derived via the EuroQol-5D-5L (EQ-5D-5L) questionnaire. Costs were measured using adapted versions of the Productivity Costs Questionnaire (PCQ) and Medical Consumption Questionnaire (MCQ). Sensitivity analyses (SAs) included a healthcare perspective, per-protocol analysis (to account for disruptions caused by COVID-19) and exclusion of home care costs (to address extreme outliers). Moreover, all analyses were performed for well-being-adjusted life years (WALYs), derived from the ICEpop CAPability measure for Adults (ICECAP-A) questionnaire.

Results
The ABCC tool was more expensive and effective than usual care, with an incremental cost-effectiveness ratio (ICER) of 64 525 per QALY and a 29% probability of cost-effectiveness. With the exception of the healthcare perspective, the SAs yielded more favourable outcomes in terms of cost-effectiveness, with ICERs (probability of cost-effectiveness) of 41 484 (31%), 8683 (58%) and 23 905 (48%) for a healthcare perspective, per-protocol analysis and exclusion of home care costs, respectively. Outcomes for QALY and WALY were comparable.

Conclusion
While the primary analysis suggested a relatively low probability of cost-effectiveness, the SAs showed higher probabilities. The per-protocol analysis suggested that the ABCC tool can be cost-effective when actually used.

Trial registration number
NCT04127383.

Objective
Prognostic nutritional index (PNI) is an index for assessing nutritional and immune status. The aim of this study is to investigate the predictive value of PNI for long-term major adverse cardiac and cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) patients with type 2 diabetes mellitus (T2DM).

Design, setting and participants
This retrospective cohort study analysed 1582 STEMI patients with T2DM who underwent percutaneous coronary intervention from January 2015 to June 2023 in Urumqi, China. Patients were followed up for MACCE.

Primary and secondary outcome measures
The primary endpoint was new-onset MACCE including all-cause death, non-fatal MI and non-fatal stroke.

Results
This study ultimately included 1582 patients for analysis with a median follow-up period of 48 months (IQR: 24–84 months) and 282 patients (17.8%) developed MACCE. Of them, 138 (8.7%), 84 (5.3%) and 60 (3.8%) patients developed all-cause death, a non-fatal MI and a non-fatal stroke, respectively. Incidences of MACCE and all-cause death conversely correlated with PNI. Kaplan-Meier curves showed a significant difference in all components of MACCE between PNI quartiles (p

We found that TAS-102 concurrent with preoperative radiotherapy led to a high pCR rate (32%) with acceptable toxicity among patients with stage Ⅱ/Ⅲ rectal cancer. Prospective randomized controlled trials comparing fluoropyrimidine-based and TAS-102-based TNT are warranted.

Per pazienti di nuova diagnosi non idonei alla chemioterapia

Pooled clinical trial data support P2Y12 inhibitors over aspirin as monotherapy after DAPT discontinuation.

The landscape of chronic obstructive pulmonary disease (COPD) is changing rapidly. Thanks to long-term studies tracking lung function and the integration of advanced imaging and analytic tools, we now have a much deeper understanding of how COPD presents in different patients. The emergence of multiomic technologies has further allowed researchers to uncover distinct biological subtypes—or etiotypes—of the disease.

As immunization programs face ongoing disruptions across the globe, the threat of preventable disease outbreaks is growing, the World Health Organization (WHO) recently cautioned. Factors include potential funding cuts, misinformation, and humanitarian crises as countries attempt to recover from COVID-19 pandemic disruptions.

Approximately 13 million newborns were preterm (born before 37 weeks of gestation) across all member states of the World Health Organization in 2020. In 2023, the US preterm birth rate was 10.4%. Nearly all preterm infants require specialized in-hospital care to support their immature respiratory, cardiovascular, central nervous, digestive, and immune function. The length of the initial hospital stay depends on the duration of gestation, the medical condition at birth, and the development of complications such as infections or chronic lung disease. The main determinant of discharge readiness is the infant’s physiological maturity, defined as adequate control of breathing, respiratory stability, full oral feeding with appropriate weight gain, and good temperature control in a crib. In addition, the preparedness of the family and the suitability of the home environment should be confirmed. Most very preterm infants (those born between 28 and

As studies suggest empathy in medicine continues to decline, mirroring the trend seen in other societal realms, poetry remains an important medium for questioning why, and reclaiming it. In the poem “20 Marlboro Reds,” smoking, both a communal bonding ritual and noisome health risk, becomes a complex metaphor for our vexed attempts to connect with others. The desire to belong and the harmful effects of smoking are simultaneously evoked when the speaker first experiences nausea after trying cigars offered by a friend. Colloquial, almost irreverent language belies the speaker’s nagging aloneness: as the stanzas wryly move through his adolescence and young adulthood, two “black cigarillos” at parties (accompanied by “thick liquor,” another fraught social lubricant) seem a jaunty rallying cry for teenage rebelliousness; and later, smoking marijuana because “a girl wanted me to” and finding “nothing happened” suggests that genuine human connection remains elusive. The irony in the search for shared feeling deepens when eventually, we infer, the speaker becomes a physician and a patient with metastatic lung cancer is craving a cigarette, so the speaker offers to fetch some. With roles reversed and the speaker and would-be healer now supplying the cigarettes, long-sought empathy is never really kindled, as the request is forgotten and instead they watch a wholesome television show together. Any facile notion of empathy is critiqued, however, as in the final lines, the speaker ruefully smokes the cigarettes himself after the patient dies, ever alone in his frustrated quest, “while I contemplated what/was killing me.”