Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries : Analysis from the RIETE registry

publishersversionPeer reviewe

The Seduction of Thanatos : Gabriele D’Annunzio and the Decadent Death

Peer reviewe

Istituzioni e partiti politici prima e dopo la Rivoluzione francese in Il modello politico giacobino e le Rivoluzioni

Il rifiuto del sistema parlamentare nel pensiero politico del giacobinism

Intensity of daily activity may affect exercise capacity and peripheral muscle function in adults with cystic fibrosis

ABSTRACT Introduction. Data obtained in young cystic fibrosis (CF) patients suggest that daily physical activity (PA) may have a positive impact on exercise tolerance, on nutritional status and on the rate of decline of FEV1. There is also evidence that in CF patients improving physical activity increases sputum clearance, improves respiratory muscle strength and ultimately leads to better quality of life. To date, less is known in adult patients about the role that physical activity intensity play to the patients’ functional status. Methods. Twenty stable CF patients (mean age 33±8SD yrs; FEV1 2.6±0.6 l; FEV1 68±16 % predicted, BMI 22±2) were studied at rest and during symptom-limited incremental exercise test (CPET). We measured hand-grip strength using a hydraulic hand dynamometer and we assessed daily physical activity using SenseWear (SW) accelerometer that subjects wore for 5 consecutive days from waking until going to bed. Results. We found a good relationship between SW activities of moderate intensity vs V’O2peak (r=0.5; p=0.02) and vs V’E peak (r=0.436, p=0.05) measured at CPET. A close relathionship was observed between vigorous SW activities and both V’O2peak and Watt max (r=0.545; p=0.01; (r=0.547, p=0.01). There was a good relationship between hand-grip strength and SW daily physical activity of moderate (r=0.431; p=0.05) and vigorous (r=0.508; p=0.02) intensity. SW mild physical activity was not correlated to muscle and exercise variables. Conclusions: In adult CF patients with mild to moderate lung obstruction, PA levels of moderate intensity and above are strongly related to exercise capacity. Specifically, only daily life activity above moderate intensity seems to maintain physical fitness and peripheral muscle function. Encouraging exercise of moderate intensity to be a part of the therapy is important

Assessment of the risk of bleeding in patients undergoing surgery or invasive procedures: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)

SYNOPSIS OF RECOMMENDATIONS: The Italian Society for Thrombosis and Haemostasis (SISET: Societa Italiana per lo Studio dell' Emostasi e della Trombosi) promoted the development of a series of guidelines which would adopt evidence-based medicine methodology on clinically relevant problems in the field of haemostasis and thrombosis. The objective of the present guidelines is to provide recommendations for the pre-operative and pre-procedural assessment of the bleeding risk with the aim of reducing the incidence of preventable bleeding complications and limiting laboratory tests to the those necessary. The predictive value of haemostatic tests for bleeding complications after surgery or invasive procedures has been evaluated in prospective or retrospective cohort studies only. All retrieved studies were of low methodological quality with a high potential for bias because none conducted a blinded outcome assessment. In addition, different criteria for the severity of bleeding events and different reference values of the laboratory tests were adopted. The low methodological quality limits the validity of the results of these studies. Some of the clinical queries proposed by the working group were not addressed by the studies available in the literature. The areas with evidence, although of low quality, are the following: general surgery in adults (for history, PT, APTT, platelet count and bleeding time), neurosurgery in adults (for history, PT, APTT, platelet count), adenotonsillectomy in children (for history, PT, APTT, platelet count and bleeding time), invasive procedures in adults (for PT, APTT, platelet count), dental extractions (for the bleeding time only), cataract extraction (for platelet count). No studies are available in children for major surgery other than adenotonsillectomy, neurosurgery and invasive procedure

Valutazione del livello di intensitànell’attività fisica quotidiana in pazienti adulti affetti da fibrosi cistica

ABSTRACT Introduzione. Dati ottenuti in adolescenti affetti da Fibrosi Cistica (FC) mostrano come l’attività fisica nella vita quotidiana ha un impatto positivo sulla tolleranza all’esercizio, sullo stato nutrizionale e sul declino del FEV1. Inoltre, è stato dimostrato che il miglioramento dell’attività fisica influenza la clearance delle secrezioni bronchiali, la forza dei muscoli respiratori e infine la qualità della vita. Tuttavia, ad oggi poco è conosciuto circa il ruolo che il livello d’intensità dell’attività fisica nella vita quotidiana svolge sullo stato funzionale dei pazienti adulti affetti da FC. Metodi. 20 pazienti clinicamente stabili (età 33±8DS anni; FEV1 2.6±0.6 l; FEV1 68±16 % predetto, BMI 22±2), hanno eseguito un test da sforzo incrementale massimale al cicloergometro (CPET). La forza muscolare è stata valutata utilizzando un dinamometro manuale e l’attività fisica nella vita quotidiana è stata studiata utilizzando un accelerometro biassiale (SenseWear Armband, SW), che i pazienti hanno indossato per 5 giorni consecutivi. Risultati. Abbiamo osservato una buona relazione tra le attività di moderata intensità registrate dall’accelerometro e VO2 peak (r=0.5; p=0.02) e V’E peak (r=0.436, p=0.05). Inoltre abbiamo riscontrato una stretta relazione tra le attività vigorose e VO2peak e Watt max (r=0.545; p=0.01; r=0.547, p=0.01 rispettivamente). E’ stata individuata una buona relazione tra la forza muscolare e l’attività fisica quotidiana di moderata (r=0.431; p=0.05) e vigorosa (r=0.508; p=0.02) intensità. Non abbiamo riscontrato correlazioni significative tra l’attività fisica di lieve intensità e le variabili dell’esercizio e della forza muscolare. Conclusioni: Nei pazienti adulti affetti da Fibrosi Cistica i livelli di attività fisica quotidiana di moderata e vigorosa intensità sono strettamente legati alla tolleranza all’esercizio fisico. In particolare, solo l’attività quotidiana al di sopra di una moderata intensità sembra mantenere una buona forma fisica e una buona funzione muscolare periferica

Assessment of the risk of bleeding in patients undergoing surgery or invasive procedures : Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET)

Synopsis of recommendations: The Italian Society for Thrombosis and Haemostasis (SISET: Societ\ue0 Italiana per lo Studio dell' Emostasi e della Trombosi) promoted the development of a series of guidelines which would adopt evidence-based medicine methodology on clinically relevant problems in the field of haemostasis and thrombosis. The objective of the present guidelines is to provide recommendations for the pre-operative and pre-procedural assessment of the bleeding risk with the aim of reducing the incidence of preventable bleeding complications and limiting laboratory tests to the those necessary. The predictive value of haemostatic tests for bleeding complications after surgery or invasive procedures has been evaluated in prospective or retrospective cohort studies only. All retrieved studies were of low methodological quality with a high potential for bias because none conducted a blinded outcome assessment. In addition, different criteria for the severity of bleeding events and different reference values of the laboratory tests were adopted. The low methodological quality limits the validity of the results of these studies. Some of the clinical queries proposed by the working group were not addressed by the studies available in the literature. The areas with evidence, although of low quality, are the following: general surgery in adults (for history, PT, APTT, platelet count and bleeding time), neurosurgery in adults (for history, PT, APTT, platelet count), adenotonsillectomy in children (for history, PT, APTT, platelet count and bleeding time), invasive procedures in adults (for PT, APTT, platelet count), dental extractions (for the bleeding time only), cataract extraction (for platelet count). No studies are available in children for major surgery other than adenotonsillectomy, neurosurgery and invasive procedures.1-1-All recommendations by the multidisciplinary working group (MWG) are of grade D, as they are derived from expert consensus obtained with the RAND corporation method. The following criteria were considered for each consensus: prudential attitude for the necessity of a baseline value in case of subsequent unexpected abnormal bleeding, possibility to detect bleeding disorders especially in children.2-2-The MWG recommended that a detailed personal and family history for bleeding, preferably with locally designed structured questionnaires, and physical examination should be considered good practice procedures before any surgical or invasive intervention.3-3-The MWG consistently recommended that PT, APTT and platelet count should be performed routinely before surgery or invasive procedures (except for diagnostic endoscopies) both in adults and children even in case of a negative history of bleeding. This recommendation differs from those of previously published guidelines which did not recommend pre-operative haemostatic tests in subjects with a negative history of bleeding, although with a grade C. The MWG of this guideline ascribed a relatively higher value to preventing bleeding events and a relatively limited value to cost.4-4-The MWG consistently recommended that the bleeding time, plasma fibrinogen, PFA -100, thromboelastography and platelet aggregation tests should not be performed routinely before surgery or invasive procedures either in adults or children with a negative history of bleeding

Immunogenicity of influenza vaccine (1993-94 winter season) in HIV-seropositive and -seronegative ex-intravenous drug users

The humoral response (haemagglutination inhibiting antibodies) to trivalent split influenza vaccine for the 1993-94 winter season (A/Beijing/32/92(H3N2), A/Singaporel 6/86(H1N1) and B/Panama/45/90) was evaluated in a group of young HIV-seropositive ex-intravenous heroin users and compared with responses measured in HIV-seronegative individuals with a similar history. HIV-negative volunteers showed an overall positive response suggesting that previous heroin use did not influence their humoral response to influenza vaccine, Comparable results were obtained in HIV-positive subjects with CD4+ lymphocyte counts >500 mu l(-1), whereas impaired reactivity was found in HIV-positive volunteers with CD4+ counts <500 mu l(-1). Booster vaccination did not increase antibody levels in any of the groups studied, although the data did not exclude a positive influence of a second vaccine dose on persistence of antibody at 120 days after the first dose, No significant changes were observed in p24 antigenemia levels in HIV-positive individuals after vaccination. Copyright (C) 1997 Elsevier Science Ltd