Risultati per: Approccio pre-rete e Cure Palliative di base

‘Bisogna rivedere il loro ruolo in riforma medicina territorio’

Nuovi corsi per i pediatri, cade il tabù delle segnalazioni

Ridotto del 32% rischio recidiva e del 25% il rischio di morte

Perrone (Aiom): ‘Abolire i Prontuari regionali che allungano i tempi’

Oncologi, “troppa burocrazia, abolire i Prontuari regionali”

Antonini: “interlocutore per politiche salute e qualità vita”

Utile per nuove terapie e diagnosi precoce

Introduction
Undetected high-risk conditions in pregnancy are a leading cause of perinatal mortality in low-income and middle-income countries. A key contributor to adverse perinatal outcomes in these settings is limited access to high-quality screening and timely referral to care. Recently, a low-cost one-dimensional Doppler ultrasound (1-D DUS) device was developed that front-line workers in rural Guatemala used to collect quality maternal and fetal data. Further, we demonstrated with retrospective preliminary data that 1-D DUS signal could be processed using artificial intelligence and deep-learning algorithms to accurately estimate fetal gestational age, intrauterine growth and maternal blood pressure. This protocol describes a prospective observational pregnancy cohort study designed to prospectively evaluate these preliminary findings.

Methods and analysis
This is a prospective observational cohort study conducted in rural Guatemala. In this study, we will follow pregnant women (N =700) recruited prior to 18 6/7 weeks gestation until their delivery and early postpartum period. During pregnancy, trained nurses will collect data on prenatal risk factors and obstetrical care. Every 4 weeks, the research team will collect maternal weight, blood pressure and 1-D DUS recordings of fetal heart tones. Additionally, we will conduct three serial obstetric ultrasounds to evaluate for fetal growth restriction (FGR), and one postpartum visit to record maternal blood pressure and neonatal weight and length. We will compare the test characteristics (receiver operator curves) of 1-D DUS algorithms developed by deep-learning methods to two-dimensional fetal ultrasound survey and published clinical pre-eclampsia risk prediction algorithms for predicting FGR and pre-eclampsia, respectively.

Ethics and dissemination
Results of this study will be disseminated at scientific conferences and through peer-reviewed articles. Deidentified data sets will be made available through public repositories. The study has been approved by the institutional ethics committees of Maya Health Alliance and Emory University.

We welcome the excellent discussion from Mandarino et al regarding whether thermal ablation of resection base is warranted after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps.1 2 We agree with many of the points raised by the authors. Indeed, a perfect resection technique as evidenced by Mandarino et al is likely to reduce the need for base ablation; however, such perfect technique is not always possible be it due to polyp-related or endoscopist-related factors. Furthermore, perfect overlapping resections with wide margins would also theoretically preclude the need for snare tip soft coagulation (STSC) of the margins. However, if the theory of microscopic polyp remnants at the margins despite overlapping and wide resection holds true, then the same should be considered possible for the base. Several Randomised controlled trials (RCTs) comparing hot versus cold snare EMR have recently been presented.3 4

In uno studio la prova dell’efficacia della cura del sorriso

Le richieste per un giro di vite si moltiplicano, anche su pressione del personale sanitario

Liste d’attesa e semplificazione accesso ai servizi le priorità

Liste d’attesa e semplificazione accesso ai servizi le priorità

Introduction
Women engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia.

Methods and analysis
WiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants’ lived experiences.

Ethics and dissemination
WiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.

Objective
To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.

Design
A secondary analysis of a prospective multicountry study.

Setting
Three COVID-19-designated hospitals in Bangladesh.

Participants
Adult patients aged ≥18 years with PCR-positive COVID-19 admitted between 10 October 2020 and 31 July 2021 at participating hospitals.

Outcome measures
In-hospital cardiovascular events and mortality.

Main exposures
Pre-existing comorbidities and cardiovascular risk factors.

Results
In 897 COVID-19 patients, 18.7% developed cardiovascular events and 12.6% died. After adjusting for clinical information and treatment, patients with two comorbidities (excluding CVD risk factors) were significantly associated with cardiovascular events (adjusted (adj.) OR 2.47, 95% CI 1.24 to 4.90). Patients with a higher heart rate at admission (adj. OR 1.03, 95% CI 1.01 to 1.04) and those who were receiving intravenous fluids (adj. OR 2.13, 95% CI 1.23 to 3.70) or antibiotics (adj. OR 4.54, 95% CI 1.47 to 14.01) had significantly higher odds of cardiovascular events. The odds of cardiovascular events were lower in those receiving antiviral medications (adj. OR 0.31, 95% CI 0.18 to 0.53). There were no interactions between comorbidities and other covariates in the models. Comorbidities and cardiovascular risk factors were not significantly associated with 30-day mortality in the Cox regression models after adjusting with clinical information and treatment. The mortality within 30 days of admission was significantly higher in patients receiving corticosteroids (adj. HR 2.82, 95% CI 1.48 to 5.38) and lower in those receiving antiviral treatment (adj. HR 0.53, 95% CI 0.34 to 0.81). Those having cardiovascular events significantly increased mortality hazard.

Conclusions
Clinical factors and treatment affected in-hospital cardiovascular events, which subsequently increased the risk of mortality within 30 days for COVID-19 patients. COVID-19 patients regardless of CVD risk factors and comorbidities require close monitoring for cardiovascular events.

I giorni di incubazione, le eventuali rare complicanze. Nel 2024 14mila casi