Outcome of cardiac surgery in patients with low preoperative ejection fraction

Background: In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. Methods: Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. Results: A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12-48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. Conclusions: We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates; however, mitral valve surgery, was found to be associated with higher mortality rates in this population. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcome

Exploring Outcome Priorities and Real-Life Management of Chemotherapy-Induced Peripheral Neurotoxicity: A Survey of the Italian Association for the Study of Pain members

Introduction: Chemotherapy-induced peripheral neurotoxicity (CIPN) affects nearly 70% of cancer patients after chemotherapy, causing sensory, motor, autonomic dysfunction, and neuropathic pain. The Desirability of Outcome Ranking (DOOR) framework is proposed as a better way to assess preventive or therapeutic interventions for CIPN. Methods: A survey was conducted among Italian healthcare professionals and researchers affiliated to the Italian Chapter of the International Association for the Study of Pain (AISD) to identify the most important outcomes in clinical management and research. Results: Among the 73 respondents, 61 qualified for the survey, with an overall response rate of 1.2%. The vast majority were physicians (77%), most of whom were anesthesiologists (47.5%). The results showed that pain, survival, sensory impairment, motor impairment, and quality of life were consistently ranked as the most important outcomes, but there was significant disagreement in the outcomes relative ranking, making it difficult to develop a DOOR algorithm. The study also revealed that clinicians commonly use structured interviews to evaluate patients with CIPN, and the most prescribed drugs or supplements were palmitoylethanolamide, pregabalin, gabapentin and alpha lipoic acid as preventive agents and pregabalin, palmitoylethanolamide, duloxetine, gabapentin, and amitriptyline as therapeutic agents. However, many of these drugs have not been clinically proven to be effective for CIPN. Discussion: This study suggests that the implementation of a DOOR framework for CIPN using healthcare professionals is more difficult than expected, given the significant disagreement in our respondents' ranking of outcomes. Our work provides interesting topics for future research in CIPN, but its limitations include a small sample size, a low response rate, and a possible selection bias

Rapporto sul fenomeno di uso e abuso di sostanze stupefacenti nella Regione Abruzzo. Anno 2006

Report on the state of legal and illegal substances use in the territory of the Region AbruzzoIl report analizza il fenomeno delle dipendenze nel territorio della ASL Milano 2. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1) uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale; 2) prevalenza d\u27uso problematico delle sostanze psicoattive; 3) domanda di trattamento degli utilizzatori di sostanze; 4) mortalit? degli utilizzatori di sostanze; 5) malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Rapporto sul fenomeno di uso ed abuso di sostanze stupefacenti nella Regione Abruzzo. Anno 2005.

Report on the state of legal and illegal substances use in the territory of Abruzzo RegionIl report analizza il fenomeno delle dipendenze nel territorio della Regione Abruzzo. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Rapporto sul fenomeno di uso e abuso di sostanze stupefacenti nella Regione Abruzzo. Anno 2007.

Report on the state of legal and illegal substances use in the territory of Abruzzo Region.Il report analizza il fenomeno delle dipendenze nel territorio della Regione Abruzzo. La descrizione del fenomeno si sviluppa intorno all\u27analisi degli indicatori individuati dall\u27Osservatorio Europeo delle Dipendenze di Lisbona (OEDT): 1-uso di sostanze nella popolazione generale (questo indicatore va a rilevare i comportamenti nei confronti di alcol e sostanze psicoattive da parte della popolazione generale); 2-prevalenza d\u27uso problematico delle sostanze psicoattive; 3-domanda di trattamento degli utilizzatori di sostanze; 4-mortalit? degli utilizzatori di sostanze; 5-malattie infettive. Altri due importanti indicatori che si stanno sviluppando, e che vengono qui illustrati, sono l\u27analisi delle Schede di Dimissione Ospedaliera (SDO) e gli indicatori relativi alle conseguenza sociali dell\u27uso di droghe (criminalit? droga correlata). Inoltre sono state applicate diverse metodologie standard di stima sia per quantificare la quota parte sconosciuta di utilizzatori di sostanze che non afferiscono ai servizi, sia per identificarne alcune caratteristiche

Prediction of fluid responsiveness in ventilated critically ill patients

In critical care, hemodynamic monitoring has been extensively studied over the last decades as an essential tool to improve patients’ outcomes. Hemodynamic optimization is the key to provide the supply of oxygen and metabolic substrates to tissues according to their metabolic needs. Obtaining hemodynamic stabilization is particularly challenging in the context of circulatory shock. Distinguishing patients which are going to benefit from fluid resuscitation, from others for which administration of large amounts of fluids is detrimental is of paramount importance. Numerous techniques aimed at demonstrate fluid responsiveness in the critically ill patients have been developed over the years. This paper presents a comprehensive review of the various static and dynamic measurements used to study fluid responsiveness in critically ill patients with cardiocirculatory shock

Hypericum scruglii Bacchetta, Brullo & Salmeri, is it a possible natural resource against Fibromyalgia?

Fibromyalgia (FM) is today a serious public health issue. Tested treatments have shown limited efficacy.Oxidative stress probably interacting with the glutamatergic / gamma -Aminobutyric acid balance may play a role.Antidepressants improve sleep and mood especially those with double action on serotonin and norepinephrine, but these are also those with a greater risk of manic switch considering the high frequency of comorbidity with bipolar disorders.This narrative review tries to evaluate, on the basis of in vitro and animal studies, the potential utility in fibromyalgia of Hypericum Scruglii, an endemic species peculiar to the island of Sardinia.The studies that have verified the antidepressant efficacy of Hypericum Perforatum and the first attempts of its use in fibromyalgia are reported as well as the studies that found the phloroglucinol derivatives from Hypericum longistylum (well-known in traditional Chinese medicine) that facilitate the differentiation of neural progenitor cells, and increase the efficiency of differentiation into serotonergic neurons.The advantage of Hypericum Scruglii may be represented by the anti-oxidant potential revealed to be greater than in other species of the same genus.The paper also describes new approaches to improving the oral bioavailability of very poor water-soluble molecules of hypericum extracts.

Hypericum scruglii Bacchetta, Brullo & Salmeri, is it a possible natural resource against Fibromyalgia?

Fibromyalgia (FM) is today a serious public health issue. Tested treatments have shown limited efficacy. Oxidative stress probably interacting with the glutamatergic / gamma -Aminobutyric acid balance may play a role. Antidepressants improve sleep and mood especially those with double action on serotonin and norepinephrine, but these are also those with a greater risk of manic switch considering the high frequency of comorbidity with bipolar disorders. This narrative review tries to evaluate, on the basis of in vitro and animal studies, the potential utility in fibromyalgia of Hypericum Scruglii, an endemic species peculiar to the island of Sardinia. The studies that have verified the antidepressant efficacy of Hypericum Perforatum and the first attempts of its use in fibromyalgia are reported as well as the studies that found the phloroglucinol derivatives from Hypericum longistylum (well-known in traditional Chinese medicine) that facilitate the differentiation of neural progenitor cells, and increase the efficiency of differentiation into serotonergic neurons. The advantage of Hypericum Scruglii may be represented by the anti-oxidant potential revealed to be greater than in other species of the same genus. The paper also describes new approaches to improving the oral bioavailability of very poor water-soluble molecules of hypericum extracts

Sistema Integrato Multicentrico di Indicatori. Rapporto 2005. Provincia di Pescara

The SIMI (Integrated System of Indicators multicenter) Project contributes to the development of an integrated management of informative data streams related to drug addicted persons. This report analyzes the phenomenon of addiction on the territory of Pescara province through a description of the network services that provide care and rehabilitation of those addicted. Besides the characteristics of users of local services for addictions, has been developed the analysis of the subjects reported to the prefectures for use of illegal drugs and any action taken. Standard methods of estimation were also applied to quantify the proportion of users of substances that do not relate to services and to identify certain characteristics.Il Progetto SIMI (Sistema Integrato Multicentrico di Indicatori) intende contribuire allo sviluppo di una gestione integrata e sinergica dei flussi informativi relativi ai consumatori di sostanze stupefacenti afferenti alle diverse amministrazioni dello Stato. In linea con quanto proposto dall\u27Osservatorio europeo di Lisbona, per la descrizione e analisi del fenomeno connesso all\u27uso/abuso di sostanze, risulta di fondamentale importanza la possibilit? di ottenere informazioni esaustive e comparabili sulle persone che usano e/o abusano di sostanze psicotrope. Il presente rapporto analizza il fenomeno delle dipendenze sul territorio della provincia di Pescara attraverso la descrizione della rete dei servizi preposti alla cura e riabilitazione dei soggetti tossicodipendenti. Accanto alle caratteristiche degli utenti dei servizi territoriali per le dipendenze, ? stata sviluppata l\u27analisi dei soggetti segnalati alle Prefetture per uso di sostanze illegali e degli eventuali provvedimenti adottati. Sono state inoltre applicate metodologie standard di stima per quantificare la quota parte di utilizzatori di sostanze che non afferiscono ai servizi e per identificarne alcune caratteristiche