L’Organizzazione sanitaria al tempo delle Due Sicilie (1816-1861)

La civiltà e l’efficacia governativa di un popolo e dei suoi governanti viene valutata considerando la loro impostazione legiferativa espressa dai loro atti a vantaggio della collettività. I Borbone sono stati , in tal senso , dei governanti illuminati in quanto il loro modo di governare il Regno delle Due Sicilie aveva permesso di raggiungere allo stesso , nell’ Europa geografica di allora, lusinghieri primati e eccellenze in ambito economico, sanitario, della scuola , dei trasporti . Il Regno delle Due Sicilie era uno dei più ricchi stati d’Europa e veniva preso a modello da numerosi stati che ne apprezzavano gli aspetti politico-sociali. Le iniziative sanitarie dei Borbone, nell’ambito delle quali si raggiunsero eccellenze invidiate dagli altri stati, costituirono aspetti sanitari tuttora presenti nell’organizzazione sanitaria italiana. Durante il loro periodo di Regno furono emanate leggi e regolamenti anche a vantaggio dei più poveri che così potevano accedere alle cure necessarie. Vennero creati numerosi ospedali che a Napoli tuttora rappresentano l’80 % dell’attuale rete sanitaria. I Borbone organizzarono la Sanità a carico dello Stato, garantirono ad ogni famiglia un alloggio, furono i primi a creare un ufficio vaccinazioni e a stabilire programmi obbligatori di vaccinazione. Essi posero attenzione anche alla programmazione del numero dei medici nel Regno ove operavano 9390 medici per 9 milioni di abitant

Intervista a Vincenzo Savica

Abstract non disponibil

Comment on: Hemodiafiltration in a critical dialysis patient with H1N1 influenza A

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Autonomic function in elderly uremics studied by spectral analysis of heart rate

Autonomic function in elderly uremics studied by spectral analysis of heart rate.BackgroundAging determines an altered response of the autonomic nervous system (ANS) to physiologic stresses. A widespread autonomic damage is well recognized in chronic renal failure (CRF).MethodsWe studied 30 CRF patients, aged 19 to 85 years, who were on bicarbonate hemodialysis. Surface electrocardiogram was recorded on lying and 65° head-up tilt standing positions. A dedicated software, using an autoregressive modeling technique, allowed to calculate power spectral analysis (PSA) of heart rate variability, assessing a low-frequency band in the range 0.03 to 0.15 Hz, and a high-frequency band in the range 0.15 to 0.33 Hz. Low-frequency and high-frequency components are regarded, but not invariably, as specific markers of sympathetic and parasympathetic activities, respectively, and the low-frequency/high frequency ratio as an index of sympathovagal balance.ResultsIn normal controls, low-frequency band value and low-frequency/high-frequency ratio on standing resulted significantly reduced in the group older than 65 years when compared with those younger than 65 years; an opposite finding was seen in high-frequency band value on standing. In uremic patients, low-frequency band on lying resulted significantly lower only in elderly uremics when compared with elderly controls, whereas low-frequency band on standing was significantly lower in elderly than in younger uremics. Regression analysis showed a significant inverse relationship between aging and most low-frequency band values, especially in uremics. The comparison of linear regression models confirmed that a sympathetic autonomic derangement is greatly present in older uremics, in particular after 50 years of age.ConclusionOur data support assertion that combination of aging and CRF increases the chance of autonomic derangement being present

Sevelamer carbonate in the treatment of hyperphosphatemia in patients with chronic kidney disease on hemodialysis

Sevelamer carbonate is an anion exchange pharmaceutical, developed to improve on the performance of the non-absorbable, non-calcium, and metal-free phosphate binder sevelamer hydrochloride. Sevelamer carbonate is expected not to worsen metabolic acidosis, as previously reported during long-term treatment with sevelamer hydrochloride in hemodialysis (HD) patients. Carbonate is the alternate counterion to chloride on the sevelamer polymeric backbone, but the active poly(allylamine) responsible for phosphate (PO4) binding remains unaltered. Therefore, sevelamer carbonate is expected to reduce elevated serum phosphorus level, similarly to sevelamer hydrochloride. Sevelamers are prescribed in uremic HD patients to control hyperphosphatemia, but the carbonate has also been proposed for the treatment of chronic kidney disease (CKD) non-dialysis patients. Although hyperphosphatemia is regarded as a main contributor to increased mortality in the HD population because of cardiovascular calcification, metabolic acidosis has also been advocated as a major player in the increased mortality in this population, by engendering malnutrition, negative nitrogen balance, and inflammation. This paper reviews the evidence showing that sevelamer carbonate is as good as sevelamer hydrochloride in terms of hyperphosphatemia control in CKD, but with a better outcome in serum bicarbonate balance

FP906PHOSPHORUS IN CHRONIC KIDNEY DISEASE PATIENTS FROM 1669 TO 2014

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SOCIO-ECONOMIC FACTORS, FOOD HABITS AND PHOSPHORUS LEVELS IN PATIENTS ON HEMODIALYSIS

Background: Hyperphosphoremia is one of the most important risk factors for morbidity and mortality for chronic kidney disease (CKD) patients, and also, for the general population. Excessive dietary intake of phosphate (P) is one of the key factors. In particular, P in its inorganic form, which is contained in food additives, is more readily absorbed. Unfortunately, these food additives are mostly present in convenience so called "fast foods" (pre-cooked), soft drinks, which represent the typical food consumed by our hemodialysis (HD) population, composed by elderly people, mostly low-socio economic class, who often live alone. Objectives: We performed an observational retrospective multicenter study to find any association between social, cultural and economic situation, as well as food habits, and P levels in a cohort of patients on HD. Secondarily; we also examined the association between the fast food consumption and increased P levels, as well as patient compliance for P binding products. Patients and Methods: To explore the association between socio-economic factors and serum P levels, we enrolled 100 patients on periodic HD treatment from three different units. Information on social, cultural, economic, diet habits, therapy for hyperphosphoremia and hematological and clinical parameters had been collected through specific questionnaires, administered by a physician. Results: Results showed serum P level was reduced in patients who live alone compared to patients in family (P = 0.04), in self-sufficient (P = 0.05) and in patients belonging to middle-upper class, versus low-class (P = 0.003). Fast foods intake correlates with increase in P serum levels (P = 0.002), whilst the same correlation was not found for cheese intake. Our data show that socio-economic status and food habits are useful predictors of P serum levels. Conclusions: In conclusion, dietary counseling of patients on HD is mandatory. Interventions that consider the socio-economic situation allow delivering important messages on foods with the least amount of P and adequate protein content, and they may be a successful strategy in targeting patients at a higher risk of hyperphosphoremia

Storia dell’urina attraverso i secoli e future implicazioni

Parlare dell’interesse verso l’urina da parte dei popoli nell’ antichita’ non puo’ prescindere dal considerare l’attrazione che la stessa suscitava nelle cerimonie Hindu e nelle tradizioni religiose tantrich

Effects of manidipine and nifedipine on blood pressure and renal function in patients with chronic renal failure: a multicenter randomized controlled trial.

Several studies suggest the distinctive advantages of ACE-inhibitors and calcium-channel blockers in protecting the residual renal function in hypertensive patients. Pre-clinical and clinical studies have shown rare adverse events in the treatment with manidipine, which is commonly used as antihypertensive drug. We therefore decided to compare the effects of manidipine and nifedipine, on blood pressure, and renal function. One hundred and one hypertensive patients with chronic renal failure were randomly assigned to receive either manidipine 20 mg daily or nifedipine 60 mg daily, respectively. Patients were assessed every two weeks during the active treatment period with the final follow-up after three months. The primary endpoint was the achievement of DBP < or = 90 mmHg or a 10 mmHg DBP reduction from the baseline values, whilst the secondary endpoints was the improvement of the renal function assessed through the creatinine clearance, creatinine blood levels, protein and sodium urine excretion. Significant reduction in SBP (p < 0.001) and DBP (p < 0.001), compared to the baseline values, was reached in both treatments. Creatinine blood levels (p < 0.05) and creatinine clearance (p < 0.01) significantly increased in the manidipine group. Protenuria did not significantly change in the manidipine group but increased in the nifedipine group (p < 0.05). The number of patients with severe adverse reactions differed significantly (p < 0.01) between the groups with the highest frequency for nifedipine (14.5%) compared to manidipine (8.5%). The withdrawal rate was not significantly different between the groups. Manidipine is equally safe and effective as nifedipine and it may have more activity on renal function and less severe side effects compared to nifedipine