21 research outputs found
Cardiovascular health in migrants: current status and issues for prevention. A collaborative multidisciplinary task force report.
OBJECTIVES:
To review information on cardiovascular health and migration, to stress the attention of researchers that much needs to be done in the collection of sound data in Italy and to allow policy makers identifying this issue as an important public health concern.
BACKGROUND:
In Italy, the rate of immigrants in the total number of residents increased from 2.5% in 1990 to 7.4% in 2010, and currently exceeds 10% in regions such as Lombardia, Emilia Romagna and Toscana.
METHODS:
A consensus statement was developed by approaching relevant Italian national scientific societies involved in cardiovascular prevention. Task force members were identified by the president and/or the boards of each relevant scientific society or working group, as appropriate. To obtain a widespread consensus, drafts were merged and distributed to the scientific societies for local evaluation and revision by as many experts as possible. The ensuing final draft was finally approved by scientific societies.
RESULTS:
In several western European countries, the prevalence of hypertension, diabetes, chronic kidney disease, obesity and metabolic syndrome was found to be higher among immigrants than in the native population. Although migrants are often initially healthier than non-migrant populations in their host countries, genetic factors, and changing environments with lifestyle changes, social exclusion and insufficient medical control may expose them to health challenges. Cultural reasons may also hamper both the dissemination of prevention strategies and migrant communication with healthcare providers. However, great diversity exists across and within different groups of migrants, making generalizations very difficult and many countries do not collect registry or survey data for migrant's health.
CONCLUSIONS:
In the present economic context, the European Union is placing great attention to improve data collection for migrant health and to support the implementation of specific prevention policies aimed at limiting the future burden of cardiovascular and renal disease, and the consequent load for health systems. Wider initiatives on the topic are awaited in Italy
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28â2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65â3·22], p\textless0·0001), American Society of Anesthesiologists grades 3â5 versus grades 1â2 (2·35 [1·57â3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01â2·39], p=0·046), emergency versus elective surgery (1·67 [1·06â2·63], p=0·026), and major versus minor surgery (1·52 [1·01â2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research
Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial
Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials.
Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure.
Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen.
Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049
Antivasospastic and brain-protective effects of a hydroxyl radical scavenger (AVS) after experimental subarachnoid hemorrhage.
USE AND TOLERABILITY OF NEWER ANTIPSYCHOTICS AND ANTIDEPRESSANTS: A CHART REVIEW IN A PAEDIATRIC SETTING
Objective To analyse the prescribing pattern
and the safety profile of different atypical antipsychotics
and selective serotonin reuptake inhibitors (SSRIs) during
the years 2002\u20132003 in paediatric setting. Setting Two
Child Neurology and Psychiatry Divisions of Southern
Italy (University of Messina and \u2018\u2018Oasi Institute for
Research on Mental Retardation and Brain Aging\u2019\u2019 of
Troina). Methods A retrospective chart review of all children
and adolescents starting an incident treatment with
atypical antipsychotics or SSRIs was performed. Within
the first 3 months of therapy, any potential adverse drug
reaction (ADR) was identified and the clinical outcome of
psychotropic drug treatment was assessed. Main Outcome
Measure Rate of ADR in the first 3 months of therapy with
atypical antipsychotics and SSRIs in children and adolescents.
Results On a total of 97 patients\u2019 charts being
reviewed, 73 (75%) concerned atypical antipsychotics and
24 (25%) SSRIs. Risperidone (N = 45, 62%) was the most
frequently prescribed antipsychotic drug, followed by
olanzapine (24, 32%). Overall, 50 (68%) antipsychotic
users reported a total of 108 ADRs during the first
3 months of therapy, leading to drug discontinuation in 23
patients (31%). Among 24 users of SSRI, 12 (50%)
received paroxetine, 6 (25%) sertraline, 5 (21%) citalopram
and 1 (4%) fluoxetine. Only paroxetine users (21%)
reported at least one ADR, however, none of SSRI users
withdrew drug treatment within first 3 months. Conclusions
ADRs occurred frequently during first 3 months of
treatment with atypical antipsychotics and, to a lesser
extent, with SSRIs in children and adolescents. Further
investigations are urgently needed to better define the
benefit/risk ratio of psychotropic medications in paediatric
setting
Trasposizione microchirurgica controlaterale di lembo muscolare di gran dorsale in un caso di aplasia mammaria, esito di radioterapia
Gametic embryogenesis through isolated microspore culture in mandarin (Citrus reticulata Blanco), Mandarino Tardivo Di Ciaculli: effect of meta-Topolin and temperature treatments
Haploid technology, allowing the single-step development of complete homozygous genotypes from heterozygous plants through gametic embryogenesis, has already an enormous impact on breeding programs of many important crops. Microspore embryogenesis can be carried out through in vitro culture of anther or isolated microspore. Experiments have been carried out via isolated microspore culture in Citrus reticulata (Blanco), Mandarino Tardivo di Ciaculli, investigating the influence of two culture media, of two plant growth regulator types and of two temperature treatments applied before the culture or just after the culture. After ten months of culture, for all the media tested, different structural features have been observed and registered: uninucleated, binucleated, multinucleated microspores, and, for the first time in mandarin isolated culture, calli and microspore-derived embryos. These results represent advancement in the knowledge of microspore embryogenesis in mandarin. Actually, this is the first time that embryo regeneration from isolated microspore cultures has been reported in mandarin, a genotype very recalcitrant to microspore embryogenesi
Resezione dei gliomi di alto grado in area rolandica guidata da imaging funzionale integrato
Introduzione. La chirurgia dei tumori cerebrali in area
rolandica rappresenta, ancora oggi, una sfida per il
neurochirurgo a causa della morbilit\ue0 legata all\u2019alta
incidenza di deficit motori post-operatori. Tale sfida \ue8
ancora pi\uf9 difficile nel caso dei gliomi cerebrali di alto
grado, quando \ue8 necessario ottenere un compromesso
tra radicalit\ue0 chirurgica e rischio di deficit neurologici
post-operatori. Negli ultimi anni, diverse tecniche di
mappaggio pre- ed intra-operatorio sono state introdotte
per identificare con esattezza l\u2019area motoria. La
stimolazione corticale diretta (DCS) rappresenta il \u201cgold
standard\u201d per l\u2019individuazione intra-operatoria della
corteccia motoria e dei suoi rapporti con la lesione
neoplastica. Recentemente, altre due tecniche quali la
stimolazione magnetica transcranica navigata (nTMS) e
la trattografia si sono imposte come metodiche noninvasive
efficaci ed affidabili nell\u2019identificare pre- ed
intra-operatoriamente i rapporti tra tumore e la via
motoria nella sua interezza (rispettivamente la corteccia
motoria funzionalmente attiva e il fascio corticospinale).
Obiettivo. L\u2019obiettivo di questo studio \ue8 descrivere la
nostra esperienza nell\u2019utilizzo integrato di DCS, nTMS e
trattografia del fascio cortico-spinale nella chirurgia
dei gliomi cerebrali di alto grado in area rolandica.Materiali e metodi. Nel periodo compreso tra Dicembre
2011 ed Aprile 2013, 20 pazienti affetti da gliomi
cerebrali di alto grado in sede rolandica sono stati sottoposti
ad intervento chirurgico presso la Clinica Neurochirurgica
dell\u2019Universit\ue0 degli Studi di Messina, integrando
DCS, nTMS e trattografia del fascio cortico-spinale
basata sulla nTMS.
Risultati e conclusioni. L\u2019approccio integrato basato
su DCS, nTMS e trattografia del fascio cortico-spinale si
\ue8 dimostrato in grado di aggiungere indispensabili informazioni
anatomo-funzionali circa i rapporti tra la via
motoria e la neoplasia cerebrale nella maggioranza dei
casi. Tali informazioni sono state utilizzate dal chirurgo
sia per il planning pre-operatorio, sia intra-operatoriamente
grazie alle tecniche di neuronavigazione. Inoltre,
alla dimissione, in nessuno dei pazienti trattati attraverso
questo nuovo approccio integrato, si \ue8 osservato
un deterioramento della performance motoria preoperatoria.
L\u2019approccio chirurgico combinato basato
su DCS, nTMS e trattografia del fascio cortico-spinale,
pertanto, rappresenta una nuova strategia integrata
nella chirurgia dei gliomi cerebrali di alto grado, utile
nel fornire informazioni aggiuntive al chirurgo ed efficace
nell\u2019evitare l\u2019insorgenza di deficit motori postoperatori
Human leukocyte antigen frequency in human high-grade gliomas: a case-control study in Sicily
OBJECTIVE: Human leukocyte antigens (HLAs) are widely expressed cell surface molecules that present antigenic peptides to T lymphocytes and modulate immune response against inflammatory and malignant diseases. The aim of this study was to compare HLA distribution in patients with newly diagnosed high-grade gliomas (HGGs) and 2 control groups from a restricted geographic area (eastern Sicily). METHODS: HLA allele frequency, as determined from peripheral blood of 56 adult patients with HGGs, was compared with that of 2 different control groups: 140 healthy bone marrow donors (group A) and 69 virtually brain tumor-free patients (group B). HLA expression was evaluated using a reverse transcriptase polymerase chain reaction-sequence-specific oligonucleotide probe. RESULTS: There was significant expression of HLA-A*11 in patients with HGGs compared with control groups A and B (P < 0.003 and P < 0.018, respectively). Significant expression of HLA genotypes in patients with HGGs was also identified for HLA-DQB1*06 (P = 0.005), HLA-DRB1*14 (P = 0.001), and HLA-DRB3*01 (P = 0.007) compared with control group B. In HGG patients, there was statistically significantly decreased expression, compared with control groups A and B, of HLA-B*07 (P = 0.002 and P = 0.03, respectively) and HLA-C*04 (P = 0.007 and P = 0.016, respectively). There was statistically significant lower expression of HLA-C*05 in the HGG group compared with group B (P < 0.03). CONCLUSION: This is the first study to describe the frequency of distribution of HLAs in a population from a restricted geographic area. The findings suggest a possible correlation between HLA allele distribution and the occurrence of newly diagnosed malignant astroglial brain tumors