Ruolo della CPFA nella terapia dello shock settico

La sepsi rappresenta la principale causa di morbidità e mortalità nelle terapie intensive, con percentuali di mortalità variabili dal 20% al 70% a seconda della severità del quadro clinico e del coinvolgimento plurisistemico. I processi fisiopatologici alla base di questa entità clinica sono il risultato dell’interazione tra meccanismi che determinano una liberazione di mediatori a prevalente azione pro-infiammatoria come TNF-α, IL-1, IL-6, IL-8, e citochine ad azione anti-infiammatoria come IL-10 e IL-4. I mediatori infiammatori determinano danno endoteliale, inducono vasoparalisi, e sono responsabili della scomparsa di permeabilità selettiva con importanti ripercussioni sull’assetto emodinamico. L’impiego dei trattamenti di depurazione extracorporea vede il suo razionale nella rimozione non molecola-specifica, di vari mediatori; in particolare lo scopo di questo studio è valutare l’impatto sulla morbidità e sulla mortalità di soggetti con shock settico, ricoverati in terapia intensiva, di una tecnica di depurazione extracorporea che associa alla plasma filtrazione e allo scambio diffusivo-convettivo, l’adsorbimento su cartuccia, definita con l’acronimo CPFA (Coupled Plasma Filtration Adsorption). Per questo scopo sono stati analizzati retrospetticamente 8 pazienti, 4 uomini e 4 donne, età media 63,88 anni (50-72 anni), ricoverati in shock settico nel periodo Gennaio 2009 - Giugno 2010 presso la 4° U.O. Anestesia e Rianimazione Univ. sottoposti a tale trattamento: sono stati considerati i parametri emodinamici, respiratori, renali, ematochimici, il punteggio SAPS II all’ingresso in terapia intensiva, ed il punteggio SOFA giornaliero. Tutti i pazienti sono stati trattati seguendo le linee guida della Surviving Sepsis Campaign oltre all’uso della CPFA. Tutti i dati sono stati statisticamente analizzati. Dai risultati emerge che la mortalità al 28° giorno risulta del 12,5% a fronte di una predetta probabilità media di morte intraospedaliera del 67%, stimata secondo il sistema di classificazione SAPS II. L’uso della CPFA sembra pertanto migliorare l’outcome dei pazienti con shock settico

La peridurale eco-assistita in chirurgia generale

La valutazione ecografica del canale vertebrale permette di ridurre il numero di tentativi di posizionamento del catetere peridurale, e riduce la difficolta della manovra nei pazienti valutati difficili dallo score predittivo

Existence of isoperimetric regions in contact sub-Riemannian manifolds

We prove existence of regions minimizing perimeter under a volume constraint in contact sub-Riemannian manifolds such that their quotient by the group of contact transformations preserving the sub-Riemannian metric is compact.Comment: 24 pages, no figure

Results From a Network Meta-Analysis

CONTEXT: Secondary hyperparathyroidism (SHPT) is a complication of chronic kidney disease (CKD) affecting mineral and bone metabolism and characterized by excessive parathyroid hormone (PTH) production and parathyroid hyperplasia. OBJECTIVE: The objective of this analysis was to compare the efficacy and adverse effects of extended-release calcifediol (ERC) and paricalcitol (PCT) by assessing their effect on the biomarkers PTH, calcium, and phosphate in patients with non-dialysis CKD (ND-CKD). METHODS: A systematic literature research was performed in PubMed to identify randomized control trials (RCTs). Quality assessment was done with the GRADE method. The effects of ERC vs PCT were compared using random effects in a frequentist setting. RESULTS: Nine RCTs comprising 1426 patients were included in the analyses. The analyses were performed on 2 overlapping networks, due to nonreporting of outcomes in some of the included studies. No head-to-head trials were identified. No statistically significant differences in PTH reduction were found between PCT and ERC. Treatment with PCT showed statistically significant increases in calcium compared with ERC (0.2 mg/dL increase; 95% CI, -0.37 to -0.05 mg/dL). No differences in effects on phosphate were observed. CONCLUSION: This network meta-analysis showed that ERC is comparable in lowering PTH levels vs PCT. ERC displayed avoidance of potentially clinically relevant increases in serum calcium, offering an effective and well-tolerated treatment option for the management of SHPT in patients with ND-CKD.publishersversionpublishe

Does preterm birth increase the initiation of antidepressant use during the postpartum? A population-based investigation

Background:Preterm birth may affect maternal mental health. We explored the relationship between preterm birth and the risk of initiating antidepressant use during the year after birth.Methods:We conducted a population-based investigation using regional healthcare utilization databases. The exposure considered was preterm birth. The outcome was having at least one prescription for antidepressant medications during the year after birth. We used a log-binomial regression model including terms for maternal age at birth, nationality, educational level, parity, modality of conception, modality of delivery, use of other psychotropic drugs, and diabetes to estimate relative risk (RR) and 95% confidence intervals (CI) for the association between preterm birth and the initiation of antidepressant use. In addition, the absolute risk differences (ARD) were also computed according to the timing of birth.Results:The cohort included 727,701 deliveries between 2010 and 2020 in Lombardy, Northern Italy. Out of these, 6,522 (0.9%) women had at least one prescription for antidepressant drugs during the year after birth. Preterm births were related to a 38% increased risk of initiation of antidepressant use during the year after birth (adjusted RR = 1.38; 95% CI: 1.25–1.52) for moderate to late preterm and to 83% (adjusted RR = 1.83; 95% CI: 1.46–2.28) for extremely and very preterm. Excluding women with only one antidepressant prescription, the association was consistent (adjusted RR = 1.41, 95%CI: 1.23–1.61 for moderate to late preterm and adjusted RR = 1.81, 95% CI: 1.31–2.49 for extremely and very preterm). Also, excluding women who used other psychotropics, the association remained consistent (adjusted RR = 1.39, 95%CI: 1.26–1.54 and adjusted RR = 1.91, 95% CI: 1.53–2.38, respectively for moderate to late and extremely and very preterm).Conclusion:Women who delivered preterm may have an excess risk of initiation of antidepressant consumption during the first year after birth

Trends in the incidence of major birth defects after assisted reproductive technologies in Lombardy region, northern Italy

Purpose: The incidence of birth defects is increased in children born after assisted reproductive technologies (ART). However, changes in ART over time could influence this incidence. To investigate this issue, we present the frequency and trends of birth defects in ART and natural pregnancies in Lombardy, Northern Italy, during the period 2014-2020. Methods: This is a population-based study using automated system of healthcare utilization (HCU) databases. ART pregnancies included only those obtained with conventional IVF or ICSI. After identifying the total number of deliveries, the rate of newborns with birth defects was compared between natural and ART pregnancies. A logistic regression model was used to calculate the adjusted odd ratio (OR). Analyses were repeated for every calendar year. Results: Overall, 508,421 deliveries were identified, of which 14,067 (2.8%) were achieved after IVF-ICSI. A decreasing trend in birth defects over time was highlighted. The adjusted OR dropped from 1.40 (95%CI: 1.03-1.91) in 2014 to 0.92 (95%CI: 0.69-1.22) in 2020. During the study period, a significant reduction in multiple pregnancy and in the ratio of ICSI to conventional IVF was also observed, explaining at least in part the positive trend observed for birth defects. Conclusion: The increased risk of birth defects in children born after IVF-ICSI is not steady over time. A decline of this risk emerged in our region. Policy changes in ART may explain this beneficial effect