Smoking cessation in patients requiring bronchoscopy: The Bronchoscopy AntiSmoking Study (BASIS)

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Pattern and quality of care of cancer pain management. Results from the Cancer Pain Outcome Research Study Group

Most patients with advanced or metastatic cancer experience pain and despite several guidelines, undertreatment is well documented. A multicenter, open-label, prospective, non-randomised study was launched in Italy in 2006 to evaluate the epidemiology, patterns and quality of pain care of cancer patients. To assess the adequacy of analgesic care, we used a standardised measure, the pain management index (PMI), that compares the most potent analgesic prescribed for a patient with the reported level of the worst pain of that patient together with a selected list of clinical indicators. A total of 110 centres recruited 1801 valid cases. 61% of cases were received a WHO-level III opioid; 25.3% were classified as potentially undertreated, with wide variation (9.8–55.3%) according to the variables describing patients, centres and pattern of care. After adjustment with a multivariable logistic regression model, type of recruiting centre, receiving adjuvant therapy or not and type of patient recruited (new or already on follow-up) had a significant association with undertreatment. Non-compliance with the predefined set of clinical indicators was generally high, ranging from 41 to 76%. Despite intrinsic limitations of the PMI that may be considered as an indicator of the poor quality of cancer pain care, results suggest that the recourse to WHO third-level drugs still seems delayed in a substantial percentage of patients. This delay is probably related to several factors affecting practice in participating centres and suggests that the quality of cancer pain management in Italy deserves specific attention and interventions aimed at improving patients' outcomes

La Ricerca Cardiologica in Campania 2005

Abstract di ANMCO CAMPANIA 2005 13° Congresso Regionale di Cardiologi

ANÁLISE DA EVOLUÇÃO DA COVID-19 E NÚMERO DE LEITOS DE UTI NOS ESTADOS BRASILEIROS NO PRIMEIRO SEMESTRE DE 2020

The new Coronavirus pandemic affects thousands of people day after day. Once installed in the body, COVID-19 manifests itself through non-specific symptoms in the respiratory, gastrointestinal or sensory systems. As the number of infected people grows and the demand for special care becomes more expressive, it is extremely important to check the number of ICU beds created in the country and their distribution in the Brazilian territory. The objective of this study was to analyze the evolution of COVID-19 and the number of ICU beds in Brazilian states and capitals in the first half of 2020. The study was observational, ecological, descriptive and analytical, using DATASUS and Oswaldo Cruz Foundation (FIOCRUZ) as databases. The present research found a significant increase in the number of ICU II COVID-19 beds, mainly adult subtype, due to the lower involvement of children and the greater need of the adult population. In addition, there was a greater concentration of these beds in the south and southeast regions, when analyzing absolute numbers. Finally, the north/northeast regions were the most affected by the heterogeneity of bed distribution, concentrating practically all new beds in the capitals of their respective states. There was no significant correlation between the supply of beds and accumulated cases of COVID-19 in the country.A pandemia do novo Coronavírus afeta milhares de pessoas dia após dia. Uma vez instalado no corpo, o COVID-19 se manifesta através de sintomas inespecíficos nos sistemas respiratório, gastrointestinal ou ainda sensorial. Com o crescente número de infectados e a expressiva demanda por cuidados especiais, é de suma importância verificar o número de leitos UTI criados no país e a sua distribuição no território brasileiro. O objetivo deste trabalho foi analisar a evolução da COVID-19 e número de leitos de UTI nos estados e capitais brasileiras no primeiro semestre de 2020. O estudo foi observacional de tipo ecológico, descritivo e analítico, utilizando como bases de dados o DATASUS e Fundação Oswaldo Cruz (FIOCRUZ). A presente pesquisa verificou um aumento expressivo dos leitos de UTI II COVID-19, principalmente subtipo adulto, devido ao menor acometimento das crianças e maior necessidade da população adulta. Ademais, houve maior concentração destes leitos nas regiões sul e sudeste, quando analisados números absolutos. Por fim, as regiões norte/nordeste foram as mais afetadas pela heterogeneidade da distribuição de leitos, concentrando praticamente todos os novos leitos nas capitais de seus respectivos estados. Não houve correlação significativa entre a oferta de leitos e casos acumulados de COVID-19 no país

La "Galleria" di palazzo in Età Barocca dall'Europa al Regno di Napoli

none25noopenMarco Leone, Rosaria Antonioli, Daniela Caracciolo, Daniela Castaldo, Marcello Fagiolo, Francesco Del Sole, Raffaele De Giorgi, Andrea Zezza, Elena Fumagalli, Stefano Piazza, Massimiliano Marafon Pecoraro, Riccardo Lattuada, Rossana Torlontano, Mario Panarello, Francesco Lofano, Vita Basile, Vincenzo Cazzato, Daniela De Lorenzis, Mario Cazzato, Angelo Maria Monaco, Francesca Cannella, Raffaele Casciaro, Virginia Valzano, Fabio Negro, Gabriele RossiMarco, Leone; Antonioli, Rosaria; Caracciolo, Daniela; Castaldo, Daniela; Fagiolo, Marcello; DEL SOLE, Francesco; DE GIORGI, Raffaele; Zezza, Andrea; Fumagalli, Elena; Piazza, Stefano; Marafon Pecoraro, Massimiliano; Lattuada, Riccardo; Torlontano, Rossana; Panarello, Mario; Lofano, Francesco; Basile, Vita; Cazzato, Vincenzo; DE LORENZIS, Daniela; Cazzato, Mario; Monaco, ANGELO MARIA; Cannella, Francesca; Casciaro, Raffaele; Valzano, Virginia; Negro, Fabio; Rossi, Gabriel

Síndrome de apneia obstrutiva do sono e risco cardiovascular

A doença cardiovascular é uma das principais causas de mortalidade no mundo. Vários aspectos contribuem para a génese da aterosclerose e suas complicações clínicas como: tabagismo, níveis elevados de colesterol de lipoproteína de baixa densidade, baixos níveis de colesterol de lipoproteína de alta densidade, diabetes, hipertensão arterial, história familiar, obesidade, sedentarismo e ingestão de álcool. Além desses factores tem sido observado recentemente um aumento da taxa de mortalidade cardiovascular em doentes com Síndrome de Apneia Obstrutiva do Sono. Existe uma evidência entre a Síndrome de Apneia Obstrutiva do Sono e as doenças cardiovasculares, nomeadamente hipertensão arterial, doença cardíaca isquémica, acidente vascular cerebral, insuficiência cardíaca, fibrilhação auricular e morte súbita cardíaca. A patogénese da doença cardiovascular na Síndrome de Apneia Obstrutiva do Sono não está completamente esclarecida, mas provavelmente existe uma multiplicidade de factores, envolvendo uma série de mecanismos diversos, incluindo a hiperactividade do sistema nervoso simpático, a activação das vias inflamatórias, a disfunção endotelial, as alterações da coagulação, a disfunção metabólica e por fim a resistência à insulina e a alteração do metabolismo lipídico. Estudos efectuados em grande escala, definiram a população de doentes com Síndrome de Apneia Obstrutiva do Sono, sendo necessário um controlo adequado para evitar factores confundidores. Tais estudos têm por objectivo avaliar as interacções entre os diferentes mecanismos básicos que actuam na Síndrome de Apneia Obstrutiva do Sono e na doença cardiovascular, e as interacções com outros distúrbios, tais como a obesidade, a diabetes e a dislipidémia. Neste trabalho foi analisada a relação entre a Síndrome de Apneia Obstrutiva do Sono e o risco cardiovascular, bem como o impacto da terapêutica, com pressão positiva contínua na via aérea, na redução do risco cardiovascular. Concluíu-se que indivíduos com esta síndrome apresentam maior risco de desenvolver doença cardiovascular e que a terapêutica com pressão positiva contínua na via aérea poderá vir a reduzir este risco.Cardiovascular disease is a major cause of mortality worldwide. Several aspects contribute to the genesis of atherosclerosis and its clinical complications such as smoking, high lowdensity lipoprotein cholesterol, low high-density lipoprotein cholesterol, diabetes, systemic arterial hypertension, family history, obesity, sedentary lifestyle and intake of alcohol. Besides these factors we have recently observed an increased rate of cardiovascular mortality in patients with Obstructive Sleep Apnoea Syndrome. There is growing evidence of Obstructive Sleep Apnoea Syndrome determining cardiovascular diseases, including hypertension, ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death. The pathogenesis of cardiovascular disease in this syndrome is not completely understood, but likely to be multifactorial, involving a diverse range of different mechanisms including sympathetic nervous system overactivity, activation of inflammatory pathways, endothelial dysfunction, abnormal coagulation, metabolic dysregulation, insulin resistance and disordered lipid metabolism. Large scale studies have defined a population of patients with Obstructive Sleep Apnoea Syndrome, and controlling is needed to avoid confounding factors. Such studies aim to assess the interactions between different basic mechanisms operating in this syndrome and in cardiovascular disease, as well as interactions with other disorders such as obesity, diabetes and dyslipidaemia. This study examined the relationship between Obstructive Sleep Apnoea Syndrome and cardiovascular risk, as well as the impact of therapy with continuous positive airway pressure, in reducing cardiovascular risk. It is shown that individuals with this syndrome have a higher risk of developing cardiovascular disease and treatment with continuous positive airway pressure may reduce this risk

FIRST LINE AVELUMAB IN PD-L1+VE METASTATIC OR LOCALLY ADVANCED UROTHELIAL CANCER (AUC) PATIENTS UNFIT FOR CISPLATIN (CIS): THE ARIES TRIAL

Background: Avelumab (ave) was approved as maintenance therapy after platinum-based first line (1L) therapy for patients (pts) with aUC based on ph. 3 Javelin Bladder 100 study (NCT02603432), showing significant overall survival (OS) improvement. Here we tested the activity of ave as 1L of therapy in pts with aUC and PD-L1+ve expression. Methods: ARIES is a single-arm, multi-site, open-label phase II trial. Enrolled pts had aUC, were cis-unfit (at least one of: ECOG-PS=2, CrCl <60 mL/min, grade ⩾2 peripheral neuropathy/hearing loss, progression within 6-mos before the end of neo/adj chemo), had not previously received chemo for aUC and PD-L1⩾5% (SP263) centrally assessed. Pts received ave 10 mg/Kg IV Q2W until progression, unacceptable toxicity and withdrawal, whichever occurred first. The primary endpoint was the 1-year OS. Key secondary endpoints were median-OS, -PFS, ORR, DOR and safety. The outcome based on PDL1 expression >10 has also been investigated. Results: A total of 198 eligible cis-unfit pts have been tested for PD-L1 and 71 (35.6%) have been found positive. Among enrolled patients (N=71), median age was 75 y, 35 (49.3%) had visceral disease, and 22 (31.0%) had ECOG-PS=2; 50 (70.4%) had CrCl <60 mL/min and 9 (12.7%) progressed within 6-mos from the end of neo/adj chemo. At the cut-off data (Feb 2, 2022), median follow up was 10.0 mos and 14 patients are still on treatment. The median OS was 10.0 mos (95% CI, 5.5-14.5), and 43.0% of patients were alive at 1-year. The ORR for all patients was 24.0%; complete response, 8.5% (n=6); partial response, 15.5% (n=11). Clinical benefit was 43.6% (n=31). Median PFS was 2.0 mos (95% CI, 1.7-2.3). Among the 17 pts who had tumour response 13 had DOR > 1y and 5 > 2y. A total of 67 patients have been evaluated for CPS and among these 56 (83.6%) have been classified as high expression. The median OS was 11.0 mos (95%CI, 0.1 – 22.9) for those with high CPS and 7.0 mos (95%CI 2.8 – 11.2) for low CPS (p=0.13). The median PFS was 2.0 mos for both high and low CPS (p=0.34). Five (7.0%) grade 3 ave-related adverse events, and no treatment-related death were reported. Conclusions: Ave is active and safe in pts with cis-unfit, PD-L1+ve aUC and poor baseline characteristics