In Securing Oblivion

In lieu of an abstract, below is the essay\u27s first paragraph. It was once just an old sand lot sitting in nothing and surrounded by other sand lots. The lot lay content in doing nothing. Large grains of sand shifted; water spilled over rocks and stones and filtered into deep crevices. But nothing moved under its own power, for power was as of now, not. Only passive parts, waiting

How best to capture the respiratory consequences of prematurity?

Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions

Epilepsy and suicide: a narrative review

The epilepsy represents a challenge for life expectancy and quality of life either for social and relational consequences due to stigma and for the consequences of the disorder itself. Suicidal behaviors are more frequent in the persons with epilepsy than in the general population. In addition to those shared with other chronic diseases, the condition of a person with epilepsy recognizes particular risk factors related to the clinical characteristics, demographic, socioeconomic and relational conditions. The frequent comorbidity with psychiatric disorders, first of all depression, complicates the clinical picture both because of neurobiological underpinnings underlying the two disorders and the negative interaction on the quality of life. The hopelessness is strongly correlated to suicidal ideation and its evaluation can be considered a relevant and reliable tool for measuring suicidal ideation. A careful evaluation of suicidal ideation, taking into account demographic and psychological conditions of patients, as well as clinical, social, economic situations, is warranted. The diagnosis and treatment of the disease has to take into account a bio-psycho-social approach that allows the integration of medical, psychological and social aspects

Emotional dysregulation, affective status and personality traits in a sample of migraine patients

Background: Several studies hypothesize emotional dysregulation in subjects with migraine related to a generalized hyperexcitability both to sensory and emotional stimuli, involving the cortical-limbic system. The aim of the study was to investigate Emotional Reactivity by means of the International Affective Picture System (IAPS), in a sample of migraineurs in order to evaluate differences between the patients and a healthy reference group and the relationships with clinical evaluations: personality traits, psychopathological symptoms, empathy, affective status, coping and resilience strategy and with the severity of the headache disorder. Methods Twenty patients with migraine (14 females, 6 males) and fifteen healthy subjects (9 females, 6 males) matched for age and gender were recruited. Emotional Reactivity was tested using International Affective Picture System (IAPS); Clinical Global Impression evaluated behavioral disturbances. Clinical evaluation, by using the Zung Self-Rating Anxiety Scale, the Beck Depression Inventory II, the Empathy Quotient, the brief TEMPS-M temperament questionnaire, the Millon Clinical Multiaxial Inventory III, the Symptom Check List 90, the Brief Cope, the Resilience Scale 14 and the Migraine Disability Assessment, was performed. Results: The mean arousal ratings of the clinical group were significantly higher than those of the control group for unpleasant and socially unpleasant pictures. The arousal scores of socially unpleasant pictures showed numerous significant correlations with psychometric scores, since higher arousal is associated with higher migraine disability. Valence to unpleasant images was similarly related to migraine disability, while arousal was inversely related to the Brief Cope score. Conclusions: The association between personality traits and emotional dysregulation in migraine patients is worth of attention because it could represent the cause of an increased susceptibility to many negative stimuli, may worsen the course and prognosis of the headache disorder and may amplify the vulnerability to psychopathology

High Flow Nasal Cannulae in preterm infants

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as an efficient, better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. The aim of this review is to discuss the available evidence of effectiveness and safety of HFNC in preterm newborns with respiratory distress syndrome (RDS). It is known that distending pressure generated by HFNC increases with increasing flow rate and decreasing infant size and varies according to the amount of leaks by nose and mouth. The effects of HFNC on lung mechanics, its clinical efficacy and safety are still insufficiently investigated. In conclusion, there is a growing evidence of the feasibility of HFNC as an alternative mode of NIV. However, further larger randomized trials are required, before being able to recommend HFNC in the treatment of moderate respiratory distress of preterm infants

Emotional arousal and valence in patients with fibromyalgia: a pilot study

The pathogenesis of pain in fibromyalgia is still not completely understood. A disrupted emotional modulation could affect the physiology of nociception and contributes to an altered perception of pain. The aim of this study was to test the role of emotional arousal and valence in pain susceptibility in fibromyalgia using the International Affective Picture System (IAPS) paradigm and the Fibromyalgia Severity Scale (FSS). The study focused on comparing emotional arousal and valence between patients with fibromyalgia and the control group. The secondary objective was to examine the correlation between emotional indices and scores on the FSS and the duration of the disease. The 20 patients with fibromyalgia enrolled showed a higher mean arousal score for all the stimuli, including a higher score for unpleasant and socially unpleasant stimuli. The valence scores for social-relevant stimuli were also higher. Increased arousal to unpleasant and socially unpleasant images and increased valence of them correlated with the duration of the disease and the severity of symptoms and could reflect impairment in social cognition and marked sensitivity to pain in interaction with central nociceptive dysregulation

Comparison between two different modes of non-invasive ventilatory support in preterm newborn infants with respiratory distress syndrome mild to moderate: preliminary data

Despite of improved survival of premature infants, the incidence of long term pulmonary complications, mostly associated with ventilation-induced lung injury, remains high. Non invasive ventilation (NIV) is able to reduce the adverse effects of mechanical ventilation. Although nasal continuous positive airway pressure (NCPAP) is an effective mode of NIV, traumatic nasal complications and intolerance of the nasal interface are common. Recently high flow nasal cannula (HFNC) is emerging as a better tolerated form of NIV, allowing better access to the baby's face, which may improve nursing, feeding and bonding. HFNC may be effective in the treatment of some neonatal respiratory conditions while being more user-friendly for care-givers than conventional NCPAP. Limited evidence is available to support the specific role, efficacy and safety of HFNC in newborns and to demonstrate efficacy compared with NCPAP; some studies suggest a potential role for HFNC in respiratory care of the neonate as a distinct non invasive ventilatory support. We present the preliminary data of a randomized clinical trial; the aim of this study was to assess efficacy and safety of HFNC compared to NCPAP in preterm newborns with mild to moderate respiratory distress syndrome (RDS)

Risk of recurrent venous thromboembolism and bleeding in patients with acute isolated subsegmental pulmonary embolism

Introduction: Approximately 10 % of all diagnosed pulmonary embolism are isolated to the subsegmental vessels. The risk of recurrent venous thromboembolism (VTE) in patients with an acute subsegmental pulmonary embolism (SSPE) managed with or without anticoagulant therapy remains poorly understood. Methods: This is an observational cohort study including consecutive adult patients diagnosed with acute isolated SSPE between June 01, 2019, and August 31, 2022. We excluded patients with a concomitant diagnosis of deep vein thrombosis and those who had an indication for long-term anticoagulation. The primary outcome was objectively confirmed recurrent VTE. Results: Overall, 118 patients with acute SSPE were included in the analysis. The mean ( +/- standard deviation [SD]) age of the participants was 59 +/- 17 years and 44 % of them had active cancer. Mean ( +/- SD) duration of follow-up was 438 +/- 426 days. Seventy-seven patients (65 %) were initially treated with anticoagulation, whereas 41 patients (35 %) were not. Of the 77 patients receiving anticoagulant therapy, 23 (30 %) received extended -duration anticoagulation (beyond 3 months) for secondary prevention. Overall, recurrent VTE events occurred in 6/118 (5 %, 95 % CI 2.4 to 10.7) patients. Four events (4/77 = 5.2 %, 95 % CI 2.0 to 12.6) occurred in initially treated patients. Two recurrent VTE occurred in patients initially left untreated (2/41 = 4.9 %, 95 % CI 1.4 to 16.1). Half of the recurrent VTE occurred in patients with active cancer. Conclusions: Most patients diagnosed with an acute SSPE received anticoagulation. The incidence of recurrent VTE detected over time was relatively high, especially in patients with cancer