30 research outputs found
Chronic Contained Rupture of an Abdominal Aortic Aneurysm: From Diagnosis to Endovascular Resolution
A male patient, 69 years old, presented with
fever, leucocytosis, and persistent low back pain; he also
had an abdominal aortic aneurysm (AAA), as previously
diagnosed by Doppler UltraSound (US), and was admitted
to our hospital. On multislice computed tomography
(msCT), a large abdominal mass having no definite border
and involving the aorta and both of the psoas muscles was
seen. This mass involved the forth-lumbar vertebra with
lysis, thus simulating AAA rupture into a paraspinal collection;
it was initially considered a paraspinal abscess.
After magnetic resonance imaging examination and culture
of the fluid aspirated from the mass, no infective organisms
were found; therefore, a diagnosisof chronically contained
AAA rupture was made, and an aortic endoprosthesis was
subsequently implanted. The patient was discharged with
decreased lumbar pain. At 12-month follow-up, no evidence
of leakage was observed. To our knowledge, this is
the first case of endoprosthesis implantation in a patient,
who was a poor candidate for surgical intervention due to
renal failure, leucocytosis and high fever, having a chronically
contained AAA ruptured simulatingspodilodiscitis
abscess. Appropriate diagnosis and therapy resolved
potentially crippling pathology and avoided surgical graftrelated
complications.
Keywords Abdominal aortic aneurysm
Endoprosthesis implantation Vertebral erosio
The Effect of coronavirus (COVID-19) on breast cancer teamwork: A multicentric survey
Background/Aim: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). Patients and Methods: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. Results: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. Conclusion: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial wellbeing. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP
Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.
Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG)
QT-prolonging properties are combined is generally supposed but not well studied. Based on
available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT)
classification defines the risk of QT prolongation for exposure to single drugs. We aimed to
investigate how combining AZCERT drug categories impacts QT duration and how relative drug
exposure affects the extent of pharmacodynamic drugâdrug interactions.
Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether
AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed
rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other
QTc-prolonging risk factors. We concurrently considered administered drug doses and
pharmacokinetic interactions modulating drug clearance to calculate individual weights of
relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we
estimated individual drug exposure with these drugs and included this information as weights
in weighted regression analyses.
Results: Drugs attributing a âknownâ risk for clinical consequences were associated with the
largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging
drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with
95% confidence intervals for âknownâ risk drugs + 0.93 ms (â8.88;10.75)]. Estimates for
the âconditionalâ risk class increased upon refinement with relative drug exposure and coadministration of a âknownâ risk drug as a further risk factor.
Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging
drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation
caused by drug combinations strongly depends on the nature of the combination partners and
individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also
for the risk prediction of combination therapies with QT-prolonging drugs
High-resolution multicontrast-weighted MR imaging from human carotid endarterectomy specimens to assess carotid plaque components
The American Heart Association modified classification for atherosclerotic plaque lesions has defined vulnerable plaques as those prone to rupture. The aim of our study was to assess the sensitivity and specificity of 1.5-T magnetic resonance imaging (MRI) in the evaluation of the characteristics of plaque components. Twelve carotid endarterectomy specimens were imaged by ex-vivo high-resolution 1.5-T MRI. Thirty-four cross-section axial images were selected for pixel-by-pixel basis analysis to demonstrate the most significant tissue features. Data were then submitted for histopathological examination and each specimen analysed in the light of the histological components (lipid core, fibrous tissue, fibrous/loose connective tissue, calcifications). The overall sensitivity and specificity rates for each tissue type were, respectively, 92% and 74% for the lipid core, 82% and 94% for the fibrous tissue, 72% and 87% for the fibrous/loose connective tissue, and 98% and 99% for calcification. The use of 1.5-T MRI appears to be a reliable tool to characterise plaque components and could help in the screening of patients with high risk of plaque rupture. The possibility of applying MRI in clinical daily practice may change the non-invasive approach to carotid artery diagnostic imaging, thus allowing an early identification of patients with vulnerable plaques
The deadly quartet (Covid-19, old age, lung disease, and heart failure) explains why coronavirus-related mortality in northern Italy was so high
Since its outbreak in China at the end of 2019, the new coronavirus disease (COVID-19) was characterized by both easy spreading and high mortality. The latter proved to be way more elevated in the North of Italy -with a peak of 18.4% in region Lombardia and even 31% in the city of Bergamo and surrounding county- than in the rest of the world. In an attempt to conceptualize the reasons for such a dramatic situation, four key elements have been identified: COVID-19 itself, old age, lung disease, and heart failure. Their harmful combination has been named âThe deadly quartetâ. The underlying risk factors, among which a lot of them are distinctive features of the population in northern Italy, have been summarized as âunmodifiableâ, âpartially modifiableâ, and âmodifiableâ, for the sake of clarity. Up-to-date scientific evidence in this field has been described in the form of a narrative and easy-to-read review
Lack of systemic side effects of long-term inhaled fluticasone propionate use in a cohort of asthmatic children
Inhaled corticosteroids (ICS) are established as first-line therapy for persistent asthma in children. Fluticasone propionate (FP) has been used because it has equivalent efficacy when used at half-dose of older-generation ICS and has a comparable safety profile. However, concerns persist about the potential risk of adverse effects of long-term FP therapy on childhood growth, bone, adrenal function and immune system. To evaluate the potential adverse effects of FP, we analyzed growth, glucidic metabolism, hypothalamic-pituitary-adrenal axis, bone metabolism, bone mass density and immune system in a cohort of 19 children (average 102à ñ18 months), with asthma who were in treatment with FP (average duration: 14 months, range: 11-17 months). Of these, 11 children homogenous for control of asthma symptoms, and compliance to therapy, were selected for a prospective study during which they were treated with FP 250 mg/day for further 6 months (total period of treatment average duration: 22 months, range: 18-23 months). In all children, no alterations of growth, glucidic metabolism, hypothalamicpituitary-adrenal axis, bone metabolism, bone mass density, immune system nor severe exacerbation of the disease were observed. Our study, showing that FP was able to control the symptoms of asthma and confirming the lack of systemic side effects at the recommended doses, supports its long-term use in children with asthma
Lack of systemic side effects of long-term inhaled fluticasone propionate use in a cohort of asthmatic children
Inhaled corticosteroids (ICS) are established as first-line therapy for persistent asthma in children. Fluticasone propionate (FP) has been used because it has equivalent efficacy when used at half-dose of older-generation ICS and has a comparable safety profile. However, concerns persist about the potential risk of adverse effects of long-term FP therapy on childhood growth, bone, adrenal function and immune system. To evaluate the potential adverse effects of FP, we analyzed growth, glucidic metabolism, hypothalamic-pituitary-adrenal axis, bone metabolism, bone mass density and immune system in a cohort of 19 children (average 102à ñ18 months), with asthma who were in treatment with FP (average duration: 14 months, range: 11-17 months). Of these, 11 children homogenous for control of asthma symptoms, and compliance to therapy, were selected for a prospective study during which they were treated with FP 250 mg/day for further 6 months (total period of treatment average duration: 22 months, range: 18-23 months). In all children, no alterations of growth, glucidic metabolism, hypothalamicpituitary-adrenal axis, bone metabolism, bone mass density, immune system nor severe exacerbation of the disease were observed. Our study, showing that FP was able to control the symptoms of asthma and confirming the lack of systemic side effects at the recommended doses, supports its long-term use in children with asthma
High body mass index and night shift work are associated with COVID-19 in health care workers
Objective To assess the magnitude of COVID-19 spread and the associated risk factors among health care workers (HCWs), we conducted an in-hospital survey in a central Italian COVID Hospital. Methods Participants underwent nasopharyngeal swab and/or serum collection for SARS-CoV-2 IgG examination. We divided participants according to working status, into rotating-night shift workers (r-NSW) and day-workers. Results We found 30 cases of COVID-19 infection in a total of 1180 HCWs (2.5%). Most COVID-19-positive hospital employees were r-NSWs with significantly higher BMI than that of individuals who tested negative. After adjustment for covariates, night work and BMI > 30 were associated with a markedly greater risk of COVID-19 diagnosis (OR 3.049 [95%CI 1.260-7.380] and OR 7.15 [95%CI 2.91-17.51], respectively). Conclusions Our results describe a low prevalence of COVID-19 infection among HCWs at a central Italian COVID Hospital. COVID-19 infection risk appears to be associated with obesity and night shift work, thus supporting the need for careful health surveillance among frontline HCWs exposed to COVID-19