Search Results for: Terapia antibiotica: breve durata vs. lunga durata

Autism is a heterogeneous condition characterized by differences in social, communication, ritualistic or repetitive, and sensory behaviors that have lifelong impacts on the lived experiences of the 2% to 3% of the US population who are affected. Decades of work capitalizing on autism’s high heritability by following up younger siblings of autistic children from infancy have demonstrated that differences in brain development are present in the first years of life, well before the defining symptoms of a diagnosis are appreciable, cementing autism as a quintessential developmental condition. Yet, few studies to date have accounted for a fundamental truth about brain development in their analytic approaches: cortical areas do not develop in isolation but are instead part of a complex coordinated system. It may in fact be the coordination of development across cortical areas, and their impact on circuit function, that differentiates autism from typical development and gives rise to its heterogeneous clinical-behavioral phenotype.

This multicenter randomized clinical trial investigates the efficacy and safety of acupuncture compared with sham acupuncture in patients with chronic sciatica from herniated disk.

In Reply We appreciate the thoughtful comments to this Viewpoint by Karahan et al that emphasize the importance of considering additional predictive parameters when determining immunotherapy treatment strategies for patients with advanced melanoma. In patients with treatment-naive unresectable or metastatic melanoma and no central nervous system metastases, various clinical and molecular biomarkers, including programmed cell death ligand 1 (PD-L1) status (1% cut-off), liver metastases, BRAF mutational status, and the number of involved metastatic organs may help guide the shared decision-making process for dual checkpoint inhibition with ipilimumab plus nivolumab vs anti–programmed cell death 1 (PD-1) monotherapy. In addition, acknowledging the challenges in precisely defining this population in clinical trials and clinical studies, patients with rapidly progressing and/or symptomatic disease, very high tumor burden, or disease localization in organs at high risk (eg, close to critical anatomic structures like the spinal cord or upper airways) might obtain superior benefit from combination therapy with ipilimumab plus nivolumab due to the fast kinetics of response. To our knowledge, no defined biomarkers, other than PD-L1 at the 1% cut-off, exist for guiding the choice between the combination of relatlimab plus nivolumab and anti-PD-1 monotherapy.

To the Editor We read with great interest the article “Pneumonia Risk, Antipsychotic Dosing, and Anticholinergic Burden in Schizophrenia” in this issue of JAMA Psychiatry by Luykx et al. The study provided evidence that antipsychotic monotherapy, especially with clozapine, quetiapine, and olanzapine, was dose-dependently associated with an increased risk of pneumonia, and it suggested an involvement of the medications’ anticholinergic characteristics. However, we believe that the conclusion that antipsychotic polytherapy was not significantly associated with an increased risk of pneumonia should be interpreted with caution. In a study from Finland, medium to high doses of clozapine and high doses of olanzapine accounted for a large proportion of monotherapy, which made the pneumonia risk with monotherapy statistically detectable. However, high-dose (ie, defined daily dose [DDD] ≥1.1) polytherapy includes a considerably wider range of antipsychotic combinations, from high to low risk of pneumonia, which can dilute the risk. The authors pointed to the reduced doses per drug as a potential reason for the relative safety of polytherapy. Theoretically, additional antipsychotics should add pneumonia risk factors via additional anticholinergic load or other pharmacological mechanisms. The study by Luykx et al may suggest a potential risk of polytherapy consisting of high doses of clozapine, quetiapine, or olanzapine combined with other antipsychotics, which remains to be evaluated. Assessing the risk of pneumonia with polytherapy for higher DDD categories (eg, DDD ≥2.0) and evaluating the efficacy and safety of specific antipsychotic combinations and doses are important issues to be addressed.

This randomized clinical trial examines the effect of a benzodiazepine taper plus augmented cognitive behavioral therapy for insomnia program vs an unmasked taper plus standard cognitive behavioral therapy for insomnia.

To the Editor The randomized clinical trial by Tuisku et al evaluating electronic cigarettes vs varenicline for smoking cessation in adults lacked relevant data that were important for interpreting the study’s results. The article did not report the number of participants who continued to use electronic cigarettes or other noncigarette nicotine products, or individuals who used both combustible and electronic cigarettes (ie, dual use), at follow-up. Although 12 weeks of treatment were prescribed, the main article did not report actual product use. A single point estimate at week 4 was reported in eTable 3 in Supplement 2. The outcome reported was combustible cigarette use at follow-up, as measuring exhaled carbon monoxide to confirm abstinence would only detect the use of combustible products. Furthermore, although the Results section in the main article reported superior sustained smoking cessation at 52 weeks in the varenicline group compared to the electronic cigarette group, the article’s abstract does not address this.

This randomized clinical trial compares the effectiveness of home- vs office-based narrowband UV-B phototherapy embedded in routine care of patients with psoriasis.

Introduction
Despite their exponential use, intra-articular (IA) injections of platelet-rich plasma (PRP) are not part of the recommended treatments for knee osteoarthritis (OA) by most international scientific societies. The most recent clinical trials have shown conflicting results, and some did not find any clinical benefit of PRP injections. The PRP In Knee OsteoArthritis (PIKOA) trial was designed to assess the clinical efficacy and structural benefit of IA injections of PRP vs saline solution (placebo) in symptomatic knee OA.

Methods and analysis
PIKOA is an academic phase 3, superiority, triple-blind (patients, investigators and injectors), multicentre, randomised placebo-controlled trial (1:1 ratio). It compares the efficacy of 1 weekly IA injection of 5 mL PRP or placebo (saline solution) for 3 weeks with a 6-month follow-up. The trial will enrol 210 participants ≥40 years old with symptomatic and moderate radiographic knee OA (Kellgren and Lawrence grade 2 or 3). PRP is prepared with the A-CP-Kit-T (20 mL) kit and its cellular composition is characterised for each patient. The main objective is to compare change in pain on a 0 mm to 100 mm visual analogue scale (VAS) between W0 and W14. The secondary objectives are to compare the two groups in terms of decrease in VAS pain, Western Ontario and McMaster Universities Osteoarthritis Index total score and subscores, analgesics consumption, OMERACT-Osteoarthritis Research Society International responder rate and improvement in quality of life measured by the EQ-5D-5L score. All these criteria are assessed at W8, W14 and W26. The decrease in serum Coll2-1 and Coll2-1 NO2 levels (catabolic markers, reflecting cartilage destruction or joint inflammation) and increase in N-propeptide of cartilage IIA level (reflecting cartilage formation) are assessed at W8 and W14. Adverse events and study withdrawals are collected during the study.

Ethics and dissemination
Ethics approval was obtained from the Nord Ouest ethical committee (2021-A00742-39). All participants need to provide written informed consent. The findings will be published in peer-reviewed journals.

Trial registration number
NCT05378815 (ClinicalTrials.gov); pre-results.
Protocol version and number: V.3 of 17 July 2023.

Objective
The aim of this study was to determine how the COVID-19 pandemic affected patient demographics, injury mechanisms, interhospital transfers and mortality of patients with traumatic brain injuries (TBIs) treated in US emergency departments (EDs).

Design
This cross-sectional study analysed 2016–2020 Nationwide Emergency Department Sample (NEDS) data.

Setting
US EDs contained in the NEDS.

Participants
Participants were patients with moderate and severe TBI who visited the ED.

Primary and secondary outcome measures
Probability sampling design and survey weights generated nationally representative estimates of ED visits by patient demographics, hospital characteristics and COVID-19 diagnosis and the top four leading TBI causes. To assess COVID-19 impact, we calculated the per cent change of estimated TBI ED visits and disposition outcomes from 2016 to 2019 and 2019 to 2020, and proportion and 95% CI of injury severity groups and admitted/transfer by hospital type and trauma centre level. A multivariable logistic regression model identified the mortality OR by patient demographics, injury severity, hospital characteristics and COVID-19 positive diagnosis.

Results
In 2020, there were 527 123 ED visits nationally for TBI, 4.3% higher than 2016 but 1.0% lower than 2019. Patients with TBI transferring to short-term hospitals and other facilities increased by 16.0% and 18.2%, respectively, from 2016 to 2019 and were 3.7% and 14.1% higher in 2020 than in 2019. An estimated 3317 patients with TBI died (in ED or later in hospital) in 2020, which is 9.8% higher than 2019. Firearm-related TBI proportion was 15.1% higher in 2020 than in 2019. Patients with TBI with injury severity scores 25–75 were significantly higher at nontrauma (29.4% vs 31.9 %) and level III trauma centres (34.9% vs 38.2%) in 2020 than in 2019. Patients with TBI treated at rural hospitals had significantly higher odds of mortality (OR=1.95, CI=1.58–2.40) than those at urban hospitals.

Conclusions
TBI patient mortality was higher at all US hospital types and almost all trauma centre levels in 2020 than in 2019. Patients with TBI treated at rural hospitals had a significantly higher mortality risk.

High-intensity noninvasive ventilation was first used more than 20 years ago in patients with chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. High-intensity noninvasive ventilation aims to achieve normocapnia or to reduce elevated Paco2 levels to the maximally achievable extent. For this purpose, the driving pressure, mainly achieved by modifying the inspiratory positive airway pressure, is individually titrated by a stepwise increase until normocapnia is established or the tolerated maximum pressure is reached (20-30 cm H2O). This approach is in clear contrast to the classic approach of low-intensity noninvasive ventilation (

This randomized clinical trial compares the effect of high-intensity noninvasive positive pressure ventilation (NPPV) vs low-intensity NPPV on the need for endotracheal intubation in patients with an acute exacerbation of chronic obstructive pulmonary disease and hypercapnia.

Introduction
Over half of patients who spend >48 hours in the intensive care unit (ICU) are fed via a nasogastric (NG) tube. Current guidance recommends continuous delivery of feed throughout the day and night. Emerging evidence from healthy human studies shows that NG feeding in an intermittent pattern (rather than continuous) promotes phasic hormonal, digestive and metabolic responses that are important for effective nutrition. It is not yet known whether this will translate to the critically ill population. Here, we present the protocol for a proof-of-concept study comparing diurnal intermittent vs continuous feeding on hormonal and metabolic outcomes for patients in the ICU.

Methods and analysis
The study is a single-centre, prospective, randomised, open-label trial comparing intermittent enteral nutrition with the current standard practice of continuous enteral feeding. It aims to recruit participants (n=30) needing enteral nutrition via an NG tube for >24 hours who will be randomised to a diurnal intermittent or a continuous feeding regimen with equivalent nutritional value. The primary outcome is peak plasma insulin/c-peptide within 3 hours of delivering the morning intermittent feed on the second study day, compared with that seen in the continuous feed delivery group at the same time point. Secondary outcomes include feasibility, tolerability, efficacy and metabolic/hormonal profiles.

Ethics and dissemination
We obtained ethical approval from the Wales Research Ethics Committee 3 prior to data collection (reference 23/WA/0297). We will publish the results of this study in an open-access peer-reviewed journal.

Trial registration number
NCT06115044.