Dexamethasone in acute cardiopulmonary syndrome with hyperinflammatory state

Abstract Introduction Elderly patient hospitalized due to acute heart failure often have a concomitant acute lung disease (acute bronchitis, pneumonia, chronic obstructive pulmonary disease-COPD- exacerbation). Establishing the role of each disease in a clinical picture of acute cardiopulmonary syndrome can be challenging. Procalcitonin has been used as a guide to antibiotic therapy with contrasting results. A common thread of these diseases is inflammation; a hyperinflammatory response determines more serious symptoms and a worse prognosis. Purpose We evaluated the effectiveness of a treatment with dexamethasone in patients with acute cardiopulmonary syndrome and a strong inflammatory response. Materials and methods We evaluated 157 consecutive HFPEF (heart failure with preserved ejection fraction) patients ≥80 years of age, with concomitant symptoms attributable to acute bronchitis, pneumonia, or COPD exacerbation, hospitalized due to worsening dyspnoea, with an NT-proBNP ≥3,000 pg/ml, and a finding X-ray of lung congestion with or without a consolidation. Reactive C Protein was measured. Patients with SARS-CoV-2, indication to corticosteroids use for other clinical conditions or need for mechanical ventilation were excluded. The 96 patients with values>20 mg/dl were randomized into 2 groups: 48 patients were treated open-label with dexamethasone at a dose of 8 mg iv/day for a maximun of ten days, in addition to the usual therapies for acute heart failure and lung disease, while the same number of patients were treated with the usual therapy. In both groups the antibiotic was administered only if the procalcitonin was≥0.25 μg/L. Clinical recovery time, length of hospitalization, in-hospital mortality, the need for a new hospitalization and mortality at one month were evaluated. Results The mean age of the patients was 88±4 years in the dexamethasone group and 87±5 in the usual therapy group. The results are shown in Table 1. Patients treated with dexamethasone experienced a faster clinical recovery and a shorter length of hospitalization. No significant differences were found regarding either in-hospital mortality or need for rehospitalization and mortality at 30 days. Conclusions Very elderly patients with acute cardiopulmonary syndrome and hyperinflammatory state associated with an excessive increase in Reactive Protein C have a favorable response to dexamethasone therapy in addition to the usual therapy in terms of clinical improvement and length of hospitalization. Our case history is small to evaluate a possible improvement in mortality. These findings need to be consolidated from double-blind randomized controlled trials Funding Acknowledgement Type of funding sources: None. Table

Analisi dell’anisotropia microstrutturale in materiali compositi rinforzati con fibre corte

Synchrotron light microtomography has proved to be particularly efficient in order to analyze the microstructural characteristics in terms of reinforce fibre distribution and orientation in glass fibre reinforced composites. The spatial distribution of fibre within the polymeric matrix could be detected even in case of fibre characterized by a small diameter (10 micrometers average diameter). Differences in orientation distribution within a sample could be measured using the Mean Intercept Length (MIL) and the fabric tensor. The results presented herein refer to a sample of a 30% by weight glass fibre reinforced polyamide 6, extracted form a thin plate

Analisi dell’anisotropia microstrutturale in materiali compositi rinforzati con fibre corte

Synchrotron light microtomography has proved to be particularly efficient in order to analyze the microstructural characteristics in terms of reinforce fibre distribution and orientation in glass fibre reinforced composites. The spatial distribution of fibre within the polymeric matrix could be detected even in case of fibre characterized by a small diameter (10 micrometers average diameter). Differences in orientation distribution within a sample could be measured using the Mean Intercept Length (MIL) and the fabric tensor. The results presented herein refer to a sample of a 30% by weight glass fibre reinforced polyamide 6, extracted form a thin plate

analisi dell anisotropia microstrutturale in materiali compositi rinforzati con fibre corte

Synchrotron light microtomography has proved to be particularly efficient in order to analyze the microstructural characteristics in terms of reinforce fibre distribution and orientation in glass fibre reinforced composites. The spatial distribution of fibre within the polymeric matrix could be detected even in case of fibre characterized by a small diameter (10 micrometers average diameter). Differences in orientation distribution within a sample could be measured using the Mean Intercept Length (MIL) and the fabric tensor. The results presented herein refer to a sample of a 30% by weight glass fibre reinforced polyamide 6, extracted form a thin plate

Caregiver burden on sexual intimacy and marital satisfaction

SUMMARY Objective: This study investigates affective and sexual dimensions in partners involved as caregivers of Alzheimer dementia (AD) subjects. A negative correlation between burden of the caregiver and sexual-affective quality of life was assumed. Design and methods: Hundred participants with AD partner (33 male, 67 female), aged between 55 and 85 years were recruited and data were collected from the Caregiver Burden Inventory scale and a semi-structured interview that included demographic information, medical history, relationship and sexual satisfaction, and current sexual function. AD group was compared with a control group (CG) (N ¼ 100) matched for age, sex, education and marital status on measures of the semi-structured interview. Data were analysed using frequency count, univariate analysis (chi-squared and ANOVA) and bivariate correlation. Results: The findings revealed that mean burden level was 31.59 (SD 19.51). A difference between experimental and CGs was found for sexual and affective marital satisfaction (p < 0.05). The same variables showed a rather negative correlation with total burden levels (r ¼ )0.374, p < 0.001; r ¼ )0.448, p < 0.001). What's known Alzheimer dementia and the global impairment of intellectual function, as well as its physiological correlates, have strong influence on the quality of life with the consequent need of assistance which could determine a high burden level in the caregiver. The attendant cognitive changes that occur in the Alzheimer patient present many, often conflicting, challenges to a couple's sexual functioning 2,

Pressure Modulator Radiometer (PMR) tests

The pressure modulator technique was evaluated for monitoring pollutant gases in the Earth's atmosphere of altitude levels corresponding to the mid and lower troposphere. Using an experimental set up and a 110 cm sample cell, pressure modulator output signals resulting from a range of gas concentrations in the sample cell were examined. Then a 20 cm sample cell was modified so that trace gas properties in the atmosphere could be simulated in the laboratory. These gas properties were measured using an infrared sensor

Do women with venous thromboembolism bleed more than men during anticoagulation? Data from the real-life, prospective START-Register

Background: Venous thromboembolism (VTE) is a frequent and serious disease that requires immediate and long-term anticoagulant treatment, which is inevitably associated with a risk of bleeding complications. Some studies, though not all, reported a higher risk of bleeding in female patients treated with either old anticoagulants [vitamin k antagonists (VKAs)] or recent anticoagulants [direct oral anticoagulants (DOACs)]. Furthermore, analyses of clinical trials reported an abnormal vaginal bleeding in women of reproductive age treated with DOACs. This study aimed at comparing the risk of bleeding in an inception cohort of VTE women and men included in a prospective observational registry. Methods: Baseline characteristics and bleeding events occurring during anticoagulation in patients of both sexes, included in the START-Register after a first VTE, were analyzed. Results: In all, 1298 women were compared with 1290 men. Women were older and more often had renal diseases; their index events were often provoked (often by hormonal contraception and pregnancy), and more frequently presented as isolated pulmonary embolism (PE). The rate of bleeding was similar in women (2.9% patient-years) and men (2.1% patient-years), though it was higher when uterine bleeds were included (3.5% patient-years, p = 0.0141). More bleeds occurred in VKA- than DOAC-treated patients (6.4% versus 2.6%, respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was associated with higher prevalence of bleeds. Conclusion: The occurrence of bleeding was not different between women and men during anticoagulation after VTE. Only after inclusion of vaginal/uterine bleeds, the rate of bleeding was higher in women. The incidence of bleeding was higher in women treated with VKAs. Background: The occurrence of a venous thromboembolic event (VTE, including deep vein thrombosis and pulmonary embolism) necessarily requires a period of at least 3–6 months of treatment with anticoagulant drugs [either vitamin k antagonists (VKA) or, more recently, direct oral anticoagulants (DOACs)]. Anticoagulation therapy, however, is associated with a risk of bleeding that is influenced by several factors. Sex is one of these factors as some authors have hypothesized that women are at higher risk than men. Furthermore, some studies have recently found more vaginal bleeding in VTE women treated with a DOAC compared with those who received VKAs. Methods: The present study aimed to compare the frequency of bleeds occurring in women and in men who were treated with DOACs or VKAs for a first VTE event and followed in real-life conditions. Since the beginning of their anticoagulant treatment, the patients were included in a prospective, multicenter, observational registry (the START-Register), and bleeding events were recorded. Results: A total of 1298 women were compared with 1290 men. Women were older and more often were affected by renal diseases; their VTE events were often associated with risk factors (especially hormonal contraception and pregnancy) and presented as isolated pulmonary embolism. The rate of all bleeding events (including major, non-major but clinically relevant, and minor bleeds) was higher in women (3.5% patient-years) than in men (2.1% patient-years, p = 0.0141); however, the difference was no longer statistically significant after exclusion of uterine bleeds (2.9% patient years). More bleeding occurred in women receiving VKA as anticoagulant drug compared with those treated with a DOAC (6.4% versus 2.6%, respectively; p = 0.0013). At multivariate analysis, age ⩾ 75 years was associated with higher prevalence of bleeds. Conclusion: In conclusion, we found that in real-life conditions, the rate of bleeding events occurring during anticoagulation after a VTE episode is not higher in women than in men. Only after inclusion of vaginal bleeds, the rate of bleeding was higher in women. More bleeds (including vaginal bleeding) occurred in women treated with VKA than DOACs. © The Author(s), 2021

Hormones in breast milk and effect on infants&#8217; growth : A systematic review

Breast milk is characterized by a dynamic and complex composition which includes hormones and other bioactive components that could influence infant growth, development, and optimize health. Among the several beneficial effects associated with prolonged breastfeeding, a 13% decrease in the risk of overweight and obesity has been reported. Recent research has focused on breast milk hormones contributing to the appetite and energy balance regulation and adiposity. Accordingly, we conducted a literature systematic review with the aim to provide an update on the effect of leptin, ghrelin, Insulin Growth Factor 1, adiponectin, and insulin on infants\u2019 and children\u2019s growth and body composition. The revised literature reveals contrasting findings concerning the potential role of all these hormones on modeling growth and fat mass apposition and health outcomes later in life. Further studies are needed to gain further insight into the specific role of these bioactive components in metabolic pathways related to body composition. This could help gain a further insight on infants\u2019 growth, both in physiological and pathological settings

D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants

Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients (\u201ccases\u201d) during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients (\u201ccontrols\u201d) enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs