Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform.

Objective: To better understanding the issue of inappropriate pediatric Emergency Department visits in Italy, including the impact of the last National Health System reform. Study design: A retrospective cohort study was conducted with 5 health care providers in Veneto Region (Italy) in a 2 years period (2010-2011). ED visits were considered \u201cinappropriate\u201d evaluating both nursing triage and resource utilization, as addressed by Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal findings: In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period, of these, 76,680 (57.1%) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the Primary Care Provider is not available. Conclusion: The National Health System reform aims to improve efficiency, effectiveness and costs by opening PCP offices 24h a day and 7 days a week. This study highlights the need for a deep reorganization of Italian Primary Care System not only providing a larger time availability, but also treating the parents\u2019 lack of education on children\u2019s health

Bambino affetto da malattie dell'apparato emolinfopoietico

Il capitolo 30 descrive i principi dell'anatomia e della fisiologia dell'apparato emolinfopoietico, le principali malattie della coagulazione, dell'immunit\ue0, della produzione di emoglobina, della produzione di globuli bianchi, piastrine e globuli rossi, i principali tumori solidi, le leucemie, i linfomi, le complicanze della chemioterapia, la terapia di supporto, il trapianto di cellule staminali emopoietiche e i principi di assistenza infermieristica in oncologia ed ematologi

Autonomic dysfunction and endothelial changes in migraine sufferers

AIM: The aims of this study were: 1) to quantify endothelial function by flow-mediated dilation (FMD) and atherosclerotic vascular lesions by intima-media thickness (IMT) in migraine sufferers without any of the common atherosclerotic risk factors, comparing them with paired controls; 2) to evaluate their potential autonomic function impairment; and 3) to seek any correlations with vascular modifications. METHODS: Twenty patients suffering from migraine and 20 matched controls were studied, using echo-color-Doppler imaging to measure IMT in the carotid district and FMD of the brachial artery in the non-dominant arm. Autonomic function was studied using the Tilt, Lying-to-Standing, Valsalva, Hand grip, Deep breath, Stroop and Sweat tests. RESULTS: Migraine sufferers had lower FMD and higher IMT values than controls. The former also had autonomic changes revealed by the Tilt, Valsalva, Hand Grip, Deep Breath and Stroop tests, which correlated with their reduced FMD. CONCLUSION: Autonomic dysfunctions modify vascular reactivity in migraine sufferers and this type of change can probably determine endothelial dysfunction and intima-media thickening

The impact of residual thrombosis on the long-term outcome of patients with deep venous thrombosis treated with conventional anticoagulation.

The impact of residual vein thrombosis (RVT) on the long-term outcome of patients with deep vein thrombosis (DVT) is unknown. We assessed the incidence of recurrent venous thromboembolism (VTE), postthrombotic syndrome (PTS), arterial thrombotic events, and cancer in patients with DVT with and without RVT. For this purpose, we evaluated up to 3 years 869 consecutive patients with acute proximal DVT who had conventional anticoagulation. RVT, defined as ultrasound incompressibility of at least 4 mm in the common femoral and/or the popliteal vein after 3 months, was detected in 429 (49.4%) patients, and was more likely in males (adjusted odds ratio [OR], 1.82; 95% confidence interval [CI], 1.37-2.04), in patients with previous VTE (OR, 1.64; 95% CI, 1.06-2.54), and in those with extensive thrombosis (OR, 3.58; 95% CI, 2.19-5.86). During the 3-year follow-up, recurrent VTE developed in 84 (19.6%) patients with RVT and 43 (9.8%) patients without RVT (adjusted hazard ratio [HR], 2.03; 95% CI, 1.40-2.94); PTS in 225 (52.4%) and 118 (26.8%), respectively (HR, 2.34; 95% CI, 1.87-2.93); arterial thrombosis in 29 (6.7%) and 14 (3.2%), respectively (HR, 2.05; 95% CI, 1.08-3.88); and cancer in 21 (4.9%) and 8 (1.8%), respectively (HR, 3.09; 95% CI, 1.31-7.28). In conclusion, in patients treated with vitamin K antagonists for prevention of recurrent VTE, RVT doubles the risk of recurrent VTE, PTS, arterial thrombosis, and cancer. Males, patients with previous VTE, and those with extensive thrombosis are independent risk factors of RVT development. Studies addressing the impact of the novel direct anticoagulants on the development of RVT as well as the long-term complications of DVT are needed