Depression is associated with increased disease activity and higher disability in a large Italian cohort of patients with rheumatoid arthritis

Depression is a quite common comorbidity in patients with rheumatoid arthritis (RA) and is thought to influence its severity. This study aims to estimate, in a large cohort of Italian patients with RA, the prevalence of depression and to investigate the clinical correlates of depression in terms of disease activity and disability

Arresto cardiaco extraospedaliero: le competenze degli studenti dell’Università degli Studi di Trieste sulle manovre rianimatorie e l’utilizzo del defibrillatore automatico esterno

Razionale. L’arresto cardiaco extraospedaliero è la terza principale causa di morte nei paesi industrializzati. Sebbene la maggior parte degli arresti cardiaci sia testimoniata, la sopravvivenza è solo del 2-10%, poiché gli astanti spesso non sono in grado di eseguire correttamente la rianimazione cardiopolmonare (RCP). Questo studio si propone di valutare le conoscenze teoriche e pratiche della RCP e dell’uso del defibrillatore automatico esterno negli studenti universitari. Materiali e metodi. Lo studio ha coinvolto 1686 studenti di 21 diverse facoltà dell’Università di Trieste, 662 studenti di facoltà sanitarie e 1024 di facoltà non sanitarie. I corsi di Basic Life Support e defibrillazione precoce (BLS-D) e di retraining ogni 2 anni, sono obbligatori per tutti gli studenti appartenente a facoltà sanitarie dell’Università di Trieste durante gli ultimi 2 anni di corso. Attraverso la piattaforma “EUSurvey” da marzo a giugno 2021 è stato loro somministrato un questionario online di 25 domande a scelta multipla per indagare le conoscenze del BLS-D. Risultati. Complessivamente dal campione emerso che il 68.7% sapeva come riconoscere un arresto cardiaco e il 47.5% conosceva il lasso di tempo che intercorre tra l’arresto cardiaco ed un danno cerebrale irreversibile. Le conoscenze pratiche sono state analizzate valutando le risposte corrette a tutte e quattro le domande sull’esecuzione della RCP (ovvero, posizione delle mani durante le compressioni, frequenza delle compressioni, profondità delle compressioni e rapporto ventilazioni-compressioni). È emerso che gli studenti delle facoltà sanitarie hanno una migliore conoscenza teorica e pratica della RCP rispetto ai loro colleghi delle facoltà non sanitarie, con una migliore conoscenza complessiva su tutte e quattro le domande pratiche (11.2% vs 4.3%; p<0.001). Gli studenti di medicina dell’ultimo anno dell’Università di Trieste, che hanno frequentato il corso BLS-D e si sono sottoposti a retraining dopo 2 anni, hanno ottenuto risultati migliori rispetto agli studenti di medicina del primo anno (non in possesso della certificazione BLS-D) (38.1% vs 2.7%; p<0.001). Conclusioni. L’obbligatorietà della formazione BLS-D e relativi retraining portano a una migliore conoscenza della gestione dell’arresto cardiaco e di conseguenza a un migliore esito per i pazienti. Per migliorare la sopravvivenza dei pazienti, la formazione (BLS-D per i laici) dovrebbe essere obbligatoria in tutti i corsi universitari

Development and Validation of a Scoring System to Predict Response to Obeticholic Acid in Primary Biliary Cholangitis

Background &amp; aims: Obeticholic acid (OCA) is the only licensed second-line therapy for primary biliary cholangitis (PBC). With novel therapeutics in advanced development, clinical tools are needed to tailor the treatment algorithm. We aimed to derive and externally validate the OCA response score (ORS) for predicting the response probability of individuals with PBC to OCA. Methods: We used data from the Italian RECAPITULATE (N&nbsp;= 441) and the IBER-PBC (N&nbsp;= 244) OCA real-world prospective cohorts to derive/validate a score including widely available variables obtained either pre-treatment (ORS) or also after 6 months of treatment (ORS+). Multivariable Cox regressions with backward selection were applied to obtain parsimonious predictive models. The predicted outcomes were biochemical response according to POISE (alkaline phosphatase [ALP]/upper limit of normal [ULN]&lt;1.67 with a reduction of at least 15%, and normal bilirubin), or ALP/ULN&lt;1.67, or normal range criteria (NR: normal ALP, alanine aminotransferase [ALT], and bilirubin) up to 24 months. Results: Depending on the response criteria, ORS included age, pruritus, cirrhosis, ALP/ULN, ALT/ULN, GGT/ULN, and bilirubin. ORS+ also included ALP/ULN and bilirubin after 6 months of OCA therapy. Internally validated c-statistics for ORS were 0.75, 0.78, and 0.72 for POISE, ALP/ULN&lt;1.67, and NR response, which raised to 0.83, 0.88, and 0.81 with ORS+, respectively. The respective performances in validation were 0.70, 0.72, and 0.71 for ORS and 0.80, 0.84, and 0.78 for ORS+. Results were consistent across groups with mild/severe disease. Conclusions: We developed and externally validated a scoring system capable to predict OCA response according to different criteria. This tool will enhance a stratified second-line therapy model to streamline standard care and trial delivery in PBC

High PEEP with recruitment maneuvers versus Low PEEP During General Anesthesia for Surgery -a Bayesian individual patient data meta-analysis of three randomized clinical trials

Background: The influence of high positive end-expiratory pressure (PEEP) with recruitment maneuvers on the occurrence of postoperative pulmonary complications after surgery is still not definitively established. Bayesian analysis can help to gain further insights from the available data and provide a probabilistic framework that is easier to interpret. Our objective was to estimate the posterior probability that the use of high PEEP with recruitment maneuvers is associated with reduced postoperative pulmonary complications in patients with intermediate-to-high risk under neutral, pessimistic, and optimistic expectations regarding the treatment effect. Methods: Multilevel Bayesian logistic regression analysis on individual patient data from three randomized clinical trials carried out on surgical patients at Intermediate-to-High Risk for postoperative pulmonary complications. The main outcome was the occurrence of postoperative pulmonary complications in the early postoperative period. We studied the effect of high PEEP with recruitment maneuvers versus Low PEEP Ventilation. Priors were chosen to reflect neutral, pessimistic, and optimistic expectations of the treatment effect. Results: Using a neutral, pessimistic, or optimistic prior, the posterior mean odds ratio (OR) for High PEEP with recruitment maneuvers compared to Low PEEP was 0.85 (95% Credible Interval [CrI] 0.71 to 1.02), 0.87 (0.72 to 1.04), and 0.86 (0.71 to 1.02), respectively. Regardless of prior beliefs, the posterior probability of experiencing a beneficial effect exceeded 90%. Subgroup analysis indicated a more pronounced effect in patients who underwent laparoscopy (OR: 0.67 [0.50 to 0.87]) and those at high risk for PPCs (OR: 0.80 [0.53 to 1.13]). Sensitivity analysis, considering severe postoperative pulmonary complications only or applying a different heterogeneity prior, yielded consistent results. Conclusion: High PEEP with recruitment maneuvers demonstrated a moderate reduction in the probability of PPC occurrence, with a high posterior probability of benefit observed consistently across various prior beliefs, particularly among patients who underwent laparoscopy