48 research outputs found
Comparison of diuretic strategies in diuretic-resistant acute heart failure: A systematic review and network meta-analysis
OBJECTIVE: Up to 50% of patients hospitalized for acute heart failure (AHF) show resistance to diuretics. This condition contributes to a prolonged hospital length of stay and a higher risk of death. This review aimed to investigate whether a diuretic therapeutic approach more effective than furosemide alone exists for patients with diuretic-resistant AHF. MATERIALS AND METHODS: We identified all randomized controlled trials (RCTs) evaluating diuretic therapy in patients with diuretic-resistant AHF. We searched Pubmed, BioMed Central, and Cochrane CENTRAL databases. RESULTS: Six RCTs were identified, involving a total of 845 patients. The P-score ranges from 0.6663 for furosemide to 0.2294 for the tolvaptan-furosemide. We found no significant differences in efficacy for any drug comparison. CONCLUSIONS: None of the diuretics considered in RCTs performed to date (tolvaptan, metolazone, hydrochlorothiazide, indapamide) appear to be more effective than furosemide therapy alone for the treatment of patients with diuretic-resistant AHF
Ruling out coronavirus disease 2019 in patients with pneumonia: The role of blood cell count and lung ultrasound
Coronavirus disease 2019 (COVID-19) is characterized by a distinctive blood leucocyte pattern and B-lines on lung ultrasound (LUS) as marker of alveolar-interstitial syndrome. We aimed to evaluate the accuracy of blood leucocyte count alone or in combination with LUS for COVID-19 diagnosis. We retrospectively enrolled consecutive patients diagnosed with community acquired pneumonia (CAP) at hospital admission to derive and validate cutoff values for blood cell count that could be predictive of COVID-19 before confirmation by the nucleic acid amplification test (NAAT). Cutoff values, generated and confirmed in inception (41/115, positive/negative patients) and validation (100/180, positive/negative patients) cohorts, were ≤17 and ≤10 cells/mm3 for basophils and eosinophils, respectively. Basophils and/or eosinophils below cutoff were associated with sensitivity of 98% (95%CI, 94–100) and negative likelihood ratio of 0.04 (95%CI, 0.01–0.11). In a subgroup of 265 subjects, the sensitivity of B-line on LUS was 15% lower (p < 0.001) than that of basophils and/or eosinophils below cutoff. The combination of B-lines with basophils and eosinophils below cutoff was associated with a moderate increase of the positive likelihood ratio: 5.0 (95%CI, 3.2–7.7). In conclusion, basophil and eosinophil counts above the generated cutoff virtually rule out COVID-19 in patients with CAP. Our findings can help optimize patient triage pending the NAAT results
Are Baseline Levels of Gas6 and Soluble Mer Predictors of Mortality and Organ Damage in Patients with Sepsis? The Need-Speed Trial Database
Soluble tyrosine kinase receptor Mer (sMer) and its ligand Growth arrest-specific protein 6 (Gas6) are predictors of mortality in patients with sepsis. Our aim is to clarify whether their measurement at emergency department (ED) presentation is useful in risk stratification. We reanalyzed data from the Need-Speed trial, evaluating mortality and the presence of organ damage according to baseline levels of sMer and Gas6. 890 patients were eligible; no association with 7-and 30-day mortality was observed for both biomarkers (p > 0.05). sMer and Gas6 levels were significantly higher in acute kidney injury (AKI) patients compared to non-AKI ones (9.8 [4.1–17.8] vs. 7.9 [3.8–12.9] ng/mL and 34.8 [26.4–47.5] vs. 29.8 [22.1–41.6] ng/mL, respectively, for sMer and Gas6), and Gas6 also emerged as an independent AKI predictor (odds ratio (OR) 1.01 [1.00–1.02]). Both sMer and Gas6 independently predicted thrombocytopenia in sepsis patients not treated with anticoagulants (OR 1.01 [1.00–1.02] and 1.04 [1.02–1.06], respectively). Moreover, sMer was an independent predictor of both prothrombin time-international normalized ratio (PT-INR) > 1.4 (OR 1.03 [1.00–1.05]) and sepsis-induced coagulopathy (SIC) (OR 1.05 [1.02–1.07]). An early measurement of the sMer and Gas6 plasma concentration could not predict mortality. However, the biomarkers were associated with AKI, thrombocytopenia, PT-INR derangement and SIC, suggesting a role in predicting sepsis-related organ damage
Cognitive and affective changes in mild to moderate Alzheimer's disease patients undergoing switch of cholinesterase inhibitors: a 6-month observational study.
Food, flavouring and feed plant traditions in the Tyrrhenian sector of Basilicata, Italy
BACKGROUND: Research was carried out in the years 2002–2003 into food, flavouring and feed folk traditions of plants in the Tyrrhenian part of the Basilicata region (southern Italy). This area was colonized in ancient times by Greeks. Data was collected through field interviews, especially of farmers. METHODS: Field data were collected through structured interviews. The informants, numbered 49, belonged to families which had strong links with the traditional activities of the area. RESULTS: 61 taxa are cited, belonging to 26 botanical families, amongst which 44 used as food or flavouring and 22 for animal alimentation. Besides 7 taxa are involved in rituals especially connected with agriculture and plant growth. CONCLUSION: The preservation of some rituals especially concerning agricultural plants is noteworthy in the area, together with a certain degree of continuity in food uses. Knowledge and rediscovery of recipes in human and animal diet could represent an economic potential for the area
The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry
Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes
Integrating ASMs into the Software Development Life Cycle
State Machines (ASMs) into a complete software development life cycle. We present a structured software engineering method which allows the software engineer to control efficiently the modular development and the maintenance of well documented, formally inspectable and smoothly modifiable code out of rigorous ASM models for requirement specifications. We show that the code properties of interest (like correctness, safety, liveness and performance conditions) can be proved at high levels of abstraction by traditional and reusable mathematical arguments which -- where needed -- can be computer verified. We also show that the proposed method is appropriate for dealing in a rigorous but transparent manner with hardware-software co-design aspects of system development. The approach is illustrated by developing a C ++ program for the production cell control problem posed in [Lewerentz, Lindner 95]. The program has been validated by extensive experimentation with the FZI production cell simulator in Karlsruhe an
NATIVE AND EXOTIC FISH SPECIES IN THE TIBER RIVER WATERSHED (UMBRIA – ITALY) AND THEIR RELATIONSHIP TO THE LONGITUDINAL GRADIENT
In this study we examine the spatial variations in the fish communities in the Tiber River watershed, including both native and exotic species. Its main objectives were to assess the quality of fish communities of this area and to verify if factors of fish community disturbance are constant over the basin or if they change along the river gradient. The level of degradation was evaluated according to the ratio between the number of native fish species and total number of species (ZIC = Zoogeographic Integrity Coefficient). A total of 37 fish species was found, 13 native and 24 exotic (64.86%). Cyprinid is the prevailing family with 15 species (7 native, 8 exotic). The species most frequently introduced are cyprinids, followed by salmonids (4 species) and gobids (3 species). Of the 24 exotic species only 11 (45.83%) can be considered intentionally introduced by man: the proportion of intentionally introduced transplanted species (66.67%) is considerably higher than the translocated species (33.33%). There is a correlation between the longitudinal gradient of the river, the morphological evolution of the riverbed and decline in water quality. High ZIC values were related to higher elevation, greater slope and better water quality. As the size of the river increases the fish communities appear to be ever-more dominated by species of exotic origin, whose number progressively increases with the worsening of the water quality and downstream movement. The number of native species is the greatest in the middle reaches of the rivers, and decreases both upstream and downstream. Compared to the introduced species, the native species tend to stay upstream and are often the only species found in the headwaters. The number of introduced species increases downstream. We have also found differences among translocated and transplanted species: the first ones tend to favor the middle reaches of the rivers, while transplanted species seem to prefer the downstream sectors. In almost all cases, the sampling station immediately below an impoundment has the lowest ZIC values in comparison to the river stretches above the dam. Our preliminary results suggest that characteristics of fish community alterations depend on the type of river sector involved; the small rivers of the basin are a refuge zone for the native community and are currently of fundamental importance for maintaining biodiversity