Risultati per: Saper prescrivere un antibiotico nelle infezioni acute delle vie respiratorie

Objectives
This study aimed to assess the knowledge, attitudes and practices (KAP) of intensive care unit (ICU) physicians in China towards acute respiratory distress syndrome (ARDS).

Design
A cross-sectional study was conducted between September and November 2022.

Participants
A total of 497 ICU physicians participated, with 258 (51.91%) being male and the majority aged 30–40 years (56.74%).

Interventions
Participants were surveyed to evaluate their KAP regarding ARDS, with mediation analysis employed to elucidate the association between demographic characteristics and KAP scores.

Primary and secondary outcome measures
The mean scores for KAP were 11.89±2.64 (range: 0–17), 44.73±4.85 (range: 12–60) and 18.26±3.43 (range: 1–48), respectively. Pearson correlation analysis showed positive correlations between knowledge and attitude (0.367), knowledge and practice (0.582) and attitude and practice (0.314) (all p

Introduction
Long-term care (LTC) residents are frequently transferred to acute care hospitals. Transfer decisions should align with residents’ wishes and goals. Decision to transfer to hospital, when not aligned with the resident’s wishes, can result in transfers that are harmful to residents, leaving residents in a state of disability that could be considered worse than death. We aim to examine whether transfer to an acute care hospital is associated with subsequent new onset of severe permanent physical and cognitive disability in LTC residents.

Method and analysis
We will conduct a retrospective cohort study of all LTC residents ≥65 admitted to LTC homes between 1 April 2013 and 31 March 2018 in Ontario, Canada. We will use health administrative data from the Continuing Care Reporting System (CCRS), National Ambulatory Care Reporting System (NACRS) and Registered Persons Databases (RPDB), which include data on emergency department visits, hospitalisations, demographic information and mortality. All participants will be followed until 31 March 2023. The exposure is any transfer from LTC to an emergency department or acute care hospital. The outcomes are (1) subsequent new permanent physical disability, (2) subsequent new permanent cognitive disability and (3) all-cause mortality. Due to the time-varying nature of the exposure and confounders, we will use an extended cause-specific Cox regression model to explore this relationship. We will fit marginal structural models (MSMs) to account for the known shortcomings of traditional regression modelling, such as collider bias. Lastly, we will use a preference-based instrumental variable approach to address unmeasured confounders.

Ethics and dissemination
Ethics approval was obtained through Bruyère Research Institute Ethics Committee (REB#M16-23-030). Study findings will be submitted for publication in a peer-reviewed journal. Findings will be disseminated in conferences and seminars.

Trial registration
Open Science Framework (https://doi.org/10.17605/OSF.IO/JCDEY).

Porcari S, Ingrosso MR, Maida M, et al. Prevalence of irritable bowel syndrome and functional dyspepsia after acute gastroenteritis: systematic review and meta-analysis. Gut 2024;73:1431-40.
Figure 2 has been replaced with the correct figure in the online version only.

Background
It is unknown which maintenance therapy is the most effective option for patients admitted for an acute severe ulcerative colitis (ASUC) episode responding to intravenous steroids.

Methods
We conducted a multicentre, parallel-group, open-label randomised controlled trial among 23 French centres in thiopurine and biologics-naïve adults admitted for ASUC responding to intravenous steroids. Eligible patients were randomly assigned to receive infliximab (IFX) and azathioprine (AZA) with a 7-day steroid tapering scheme (IFX+AZA arm) or AZA and conventional standardised steroid tapering regimen (AZA arm). The primary composite endpoint was treatment failure at week 52, defined as the absence of steroid-free clinical remission, the absence of endoscopic response, the use of a prohibited treatment for relapse, severe adverse event leading to treatment interruption, colectomy or death. Multiple imputation for missing data was performed.

Findings
Among the 64 patients randomised (Lichtiger score 13.5±2.0; median age of 34.5 (P25–P75 26.3–50.3) years, median C reactive protein of 29.0 (12.8–96.8) mg/L at baseline): 32 were assigned to the IFX+AZA arm and 32 to the AZA arm. In the ITT population, treatment failure at week 52 was observed in 22/27 (81.5%) in the AZA arm and 16/30 (53.3%) in the IFX+AZA arm (risk ratio 3.85, 95% CI (1.15 to 12.88), p=0.03). 29 adverse events were severe, including 13 disease exacerbations, 6 severe infections without any difference between both arms.

Interpretation
Combination therapy with IFX+AZA was more effective at 1 year than AZA alone to avoid treatment failure in patients with ASUC responding to intravenous steroids.

Trial registration number
NCT02425852.

Objective
Acute intermittent porphyria (AIP) is a rare metabolic disorder caused by haploinsufficiency of hepatic porphobilinogen deaminase (PBGD), the third enzyme of the heme biosynthesis. Individuals with AIP experience neurovisceral attacks closely associated with hepatic overproduction of potentially neurotoxic heme precursors.

Design
We replicated AIP in non-human primates (NHPs) through selective knockdown of the hepatic PBGD gene and evaluated the safety and therapeutic efficacy of human PBGD (hPBGD) mRNA rescue.

Results
Intrahepatic administration of a recombinant adeno-associated viral vector containing short hairpin RNA against endogenous PBGD mRNA resulted in sustained PBGD activity inhibition in liver tissue for up to 7 months postinjection. The administration of porphyrinogenic drugs to NHPs induced hepatic heme synthesis, elevated urinary porphyrin precursors and reproduced acute attack symptoms in patients with AIP, including pain, motor disturbances and increased brain GABAergic activity. The model also recapitulated functional anomalies associated with AIP, such as reduced brain perfusion and cerebral glucose uptake, disturbances in hepatic TCA cycle, one-carbon metabolism, drug biotransformation, lipidomic profile and abnormal mitochondrial respiratory chain activity. Additionally, repeated systemic administrations of hPBGD mRNA in this AIP NHP model restored hepatic PBGD levels and activity, providing successful protection against acute attacks, metabolic changes in the liver and CNS disturbances. This approach demonstrated better efficacy than the current standards of care for AIP.

Conclusion
This novel model significantly expands our understanding of AIP at the molecular, biochemical and clinical levels and confirms the safety and translatability of multiple systemic administration of hPBGD mRNA as a potential aetiological AIP treatment.

The data are relatively convincing for hypoxemic respiratory failure but are less so for COPD exacerbations with hypercarbia.

Background
COVID-19 disease results in disparate responses between individuals and has led to the emergence of long coronavirus disease (Long-COVID), characterised by persistent and cyclical symptomology. To understand the complexity of Long-COVID, the importance of symptom surveillance and prospective longitudinal studies is evident.

Methods
A 9-month longitudinal prospective cohort study was conducted within Scotland (n=287), using a mobile app to determine the proportion of recovered individuals and those with persistent symptoms and common symptoms, and associations with gender and age.

Results
3.1% of participants experienced symptoms at month 9, meeting the criteria for Long-COVID, as defined by the National Institute for Health and Care Excellence terminology. The random effects model revealed a significant time (month) effect for infection recovery (p

Objectives
To assess the association between the intensity of statin therapy and the level of physical activity in patients 1 year after an acute coronary syndrome (ACS).

Design
Prospective cohort study from the Special Program University Medicine-Acute Coronary Syndromes.

Setting
Four university hospital centres in Switzerland.

Participants
2274 patients with a main diagnosis of ACS between 2009 and 2017 who were available for a 1-year follow-up visit 1 year after hospital discharge.

Outcome measures
Self-reported physical activity was assessed with the International Physical Activity Questionnaire. The level of physical activity in metabolic equivalent-minutes per week (MET-min/week) was first stratified into sedentary and physically active categories and then analysed continuously among physically active patients. Analyses were performed using a propensity score weighting approach.

Results
One year after ACS, 1222 (53.7%) patients were on high-intensity statin therapy, 890 (39.1%) were on low/moderate-intensity statin therapy and 162 (7.1%) were not on statin therapy. Compared with non-statin users, low-/moderate-intensity statin users and high-intensity statin users were more likely to be physically active than sedentary, with a fully adjusted OR of 2.86 (95% CI 1.12 to 7.26) and 4.52 (95% CI 1.68 to 12.20), respectively. Among physically active patients, physical activity level was similar across all statin user categories, with median levels of 2792.5, 2712.0 and 2839.5 MET-min/week in non-statin, moderate/low-statin and high-statin users, respectively (p=0.307).

Conclusions
One year after ACS, neither low-/moderate-intensity nor high-intensity statin uses were associated with reduced self-reported physical activity compared with non-statin use. The concern that statin therapy may impair physical activity among ACS patients was not confirmed in this study.

Objective
To examine healthcare-seeking delays among immigrant patients with acute ischaemic stroke (AIS), identifying key factors contributing to these delays and proposing evidence-based interventions for policy formulation and research.

Design
A retrospective observational study analysing healthcare-seeking behaviours and delay times among immigrant patients with AIS treated at the Department of Neurology, Longhua District People’s Hospital, Shenzhen, from December 2021 to October 2023. The study included 1356 patients with AIS, all part of the immigrant population as defined by Shenzhen Statistical Yearbook criteria. The study investigated sociodemographic, clinical data and stroke-specific scales (modified Rankin Scale, National Institutes of Health Stroke Scale, Glasgow Coma Scale) to identify factors influencing delays.

Setting
The study was conducted in Shenzhen, a city characterised by a significant immigrant population, providing insights applicable to urban regions with similar demographics.

Results
Of the 1356 patients studied, 82.6% (n=1120) experienced healthcare-seeking delays, with a median delay of 12.67 hours (IQR: 3.5–28.8). Factors associated with prolonged delays included lack of stroke awareness (92.96% delay rate), low educational attainment, self-transportation to the hospital (adjusted OR (aOR): 2.36, 95% CI: 1.57 to 3.54) and wake-up strokes (aOR: 4.37, 95% CI: 2.28 to 8.36). Conversely, factors associated with shorter delays included cardioembolic strokes (aOR: 0.50, 95% CI: 0.28 to 0.90) and atrial fibrillation (aOR: 0.45, 95% CI: 0.23 to 0.89). Delay rates were significantly lower among patients referred by emergency medical services compared with those self-transporting. These findings highlight the influence of clinical, socioeconomic and demographic factors on delays in seeking care.

Conclusion
Healthcare-seeking delays in stroke care among immigrants, shaped by awareness, socioeconomic and clinical factors, necessitate urgent educational, policy and healthcare reforms. Enhancing early symptom recognition and promoting emergency service utilisation are essential for improving access to care and outcomes in this vulnerable group.

Introduction
Patients undergoing surgical procedures are often prone to developing acute stress disorder (ASD) postoperatively. Presently, oxytocin nasal spray has shown significant potential in the treatment of stress-related neuropsychiatric diseases. However, there are few reports on the use of oxytocin nasal spray in postoperative ASD, a condition that can potentially develop into a high-risk factor for post-traumatic stress disorder. This study aims to investigate the effect of pretreatment with oxytocin nasal spray on postoperative ASD in patients with accidental trauma and fracture to provide new clinical insights for the prevention of postoperative ASD.

Methods and analysis
This study is a single-centre, double-blind, randomised controlled clinical trial. The trial aims to recruit 328 patients with accidental traumatic fractures who underwent surgical treatment. Participants will be randomly categorised into two groups: a control group (0.9% normal saline nasal spray, 1 mL) and an oxytocin group (oxytocin nasal spray, 1 mL/40 IU) at a ratio of 1:1 using the random number table method. The primary outcome is the incidence of ASD on postoperative days 1–3. Secondary outcomes include patient resilience, anxiety, depression and pain scores on postoperative days 1–3. The exploratory results include the concentrations of stress response indicators such as malondialdehyde, cortisol and superoxide dismutase in the saliva before the first intervention and on days 1–3 after surgery.

Ethics and dissemination
The trial was approved by the clinical research ethics committee of the General Hospital of the Western Theater Command (identifier: 2024EC3-ky014). The findings of this trial will be disseminated in a peer-reviewed journal and in national or international paediatric research to guide future practice.

Trial registration number
ChiCTR2400082612.

Stroke, Ahead of Print. BACKGROUND:We performed a prespecified subgroup analysis of the CATIS-2 trial (China Antihypertensive Trial in Acute Ischemic Stroke II) to compare the effect of early versus delayed antihypertensive treatment on death and disability in patients with and without medical history of hypertension.METHODS:CATIS-2 is a multicenter randomized clinical trial conducted in 106 hospitals in China. The trial randomized 4810 patients with acute ischemic stroke within 24 to 48 hours of symptom onset and elevated systolic blood pressure between 140 and

Stroke, Ahead of Print. BACKGROUND:Synthetic magnetic resonance imaging (MRI) is an innovative MRI technology that enables the acquisition of multiple quantitative values, including T1 and T2 values, proton density, and myelin volume, in a single scan. Although the usefulness of myelin measurement with synthetic MRI has been reported for assessing several diseases, investigations in patients with stroke have not been reported. We aimed to explore the utility of myelin quantification using synthetic MRI in predicting outcomes in patients with acute ischemic stroke.METHODS:Patients with acute ischemic stroke (n=101) with a premorbid modified Rankin Scale score ≤2 were enrolled. We performed MRI with a 3 T scanner, acquiring synthetic MRI data in addition to data acquired using the routine protocol; we measured total myelin volume (TMV) using synthetic MRI software. After hospitalization, a synthetic MRI was performed when the patient’s condition was stable, with a median of 7 days from onset to MRI. We examined the factors related to good stroke outcomes (defined by a modified Rankin Scale score of ≤2 at 3 months).RESULTS:Patients with larger TMV were younger, were more frequently male, and had higher body mass index. In addition, TMV was associated with the severity of white matter hyperintensities and total small vessel burden scores. The patients with good outcomes (n=66) had larger TMVs than those without (144.85±22.19 versus 126.62±21.81 mL,P

The rates of health care–associated infections (HAIs) at US hospitals fell in 2023, which reflects a continuing downward trend following significant increases amid the COVID-19 pandemic.

Objectives
To investigate the safety and efficacy outcomes of intravenous thrombolysis (IVT) in patients aged >80 years with acute ischaemic stroke (AIS) after IVT was approved in this patient population in several European and non-European countries during 2018–2019.

Design
This is an observational registry study using prospectively collected data from the Safe Implementation of Treatment in Stroke (SITS) registry. Comparisons will be performed between patients treated post-approval (July 2018 to December 2021) period with those treated pre-approval (June 2015 to June 2018) period using propensity score matching (PSM).

Setting
This is a multicentre international study in hospitals treating AIS with IVT.

Participants
Patients aged >80 years who otherwise followed the IVT Summary of Product Characteristics of European countries as part of the mutual recognition procedure.

Primary and secondary outcomes
The main outcomes were symptomatic intracerebral haemorrhage per SITS monitoring study definition, death and functional independency as defined by a modified Rankin Scale score of 0–2 at 90 days.

Results
After PSM, 614 patients remained in each group (mean age 87 years, 39% males). All baseline data were well balanced after PSM. There were no statistically significant differences in outcomes between pre- and post-approval patients for SICH (2.5% vs 2.3%, risk ratio (RR) 1.064, 95% CI 0.345–1.784), death (25.3% vs 28.4%, RR 0.889, 0.699–1.08) and functional independency at 90 days (40.3% vs 37%, RR 1.089, 0.942–1.237).

Conclusions
In this observational study of IVT treatment in patients >80 years of age with AIS before and after formal approval for this treatment, we did not find any difference in outcomes between the pre- and post-approval periods.

Objective
The aim of this study was to assess associations between endostatin levels and short-term mortality in unsorted acute hospitalised dyspnoea patients with or without congestive heart failure (CHF), adjusted for common cardiovascular risk factors.

Design, setting and participants
In this prospective observational study, 723 hospitalised patients who visited the emergency department at Skåne University Hospital, Sweden, between 2013 and 2018 were included. Of these, 276 had a history of CHF. The association between endostatin levels and 1 month and 3-month mortality was evaluated, stratified by whether patients had a history of CHF or not.

Results
Patients with prior CHF had higher endostatin levels, higher short-term mortality and were more likely to have CHF as discharge diagnosis. In a fully adjusted model, endostatin was independently associated with 3-month mortality (HR=1.01 per 1 ng/mL increment of endostatin; 95% CI 1.00 to 1.02; p=0.016). No evidence of association was identified with 1-month mortality.

Conclusions
Endostatins are potential biomarkers for 3 months’ mortality in patients hospitalised with CHF seeking emergency care with acute dyspnoea. Further studies are needed in different settings to assess the predictive value of endostatins in patients with CHF.

QoC is lower in lower-than higher-income countries and lower QoC is associated with worse outcomes. Improving QoC by addressing structural barriers and quality improvement programs may improve the outcomes of patients with HF.