Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

Dermoscopic findings in female androgenetic alopecia Achados dermatoscópicos na alopecia androgenética feminina

BACKGROUND: Androgenetic alopecia is the most common form of hair loss. It is a clinical entity of relevant interest and presents a significant psychosocial impact as it undermines self-esteem and quality of life in female patients due to the importance of the hair for people's facial balance. OBJECTIVE: The purpose of the present study is to evaluate dermoscopic signs in women clinically diagnosed with androgenetic alopecia. METHOD: Observational study with 34 women between 17 and 68 years old who were diagnosed with androgenetic alopecia. All of them underwent photographic sessions with a 10x magnification dermoscope and a digital camera zoom set to 20x magnification and 40x magnification on the scalp frontal midline. RESULTS: All patients showed miniaturization. A peripilar brown halo was found in 22 patients, honeycomb-like scalp pigmentation was found in 14 and yellow dots in only 1 patient. Recent studies show dermoscopy as the new tool for diagnosis assistance and treatment follow up in scalp disorders. Our study used an ordinary dermoscope and we evaluated several findings reported in the literature with significant clarity and easiness. CONCLUSION: The dermoscope, which is used by dermatologists on a daily basis, is an excellent tool to assist in early diagnosis and assessment of therapeutic response in androgenetic alopecia.<br>FUNDAMENTOS: Alopecia androgenética é forma mais comum de queda de cabelo. Constitui entidade clínica de interesse relevante e acarreta grande impacto psicossocial por comprometer a auto-estima e a qualidade de vida das pacientes. OBJETIVO: Procurar os sinais dermatoscópicos comuns em mulheres com diagnóstico clínico de alopecia androgenética, visando diagnóstico precoce e melhor resposta terapêutica. MÉTODOS: Estudo observacional em 34 mulheres com idades entre 17 e 68 anos, com diagnóstico clínico de alopecia androgenética. Todas pacientes foram avaliadas e submetidas a registros fotográficos com o dermatoscópio no aumento de 10x e câmera digital no aumento de 20x e 40x na linha média frontal do couro cabeludo. RESULTADOS: Todas as pacientes apresentaram miniaturização dos fios na área examinada. Halo castanho peripilar foi encontrado em 22 pacientes, pigmentação em favo de mel em 14 e pontos amarelos em apenas 1 paciente. Estudos recentes mostram a dermatoscopia como uma nova ferramenta no auxílio diagnóstico e acompanhamento do tratamento das desordens do couro cabeludo. Em nosso estudo utilizamos um dermatoscópio comum e avaliamos vários achados relatados na literatura com facilidade e clareza significativas. CONCLUSÃO: O dermatoscópio, instrumento de uso diário dos dermatologistas, é excelente ferramenta para auxílio no diagnóstico precoce e avaliação da resposta terapêutica na alopecia androgenética e é capaz de mostrar de forma simples sinais precoces de miniaturização capilar

What changed in the Italian internal medicine and geriatric wards during the lockdown

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Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome : a Randomized Clinical Trial

IMPORTANCE The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES The primary outcomewas all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stayventilator-free days through day 28pneumothorax requiring drainage within 7 daysbarotrauma within 7 daysand ICU, in-hospital, and 6-month mortality. RESULTS A total of 1010 patients (37.5% femalemean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.2095% CI, 1.01 to 1.42P =.041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%HR, 1.1895% CI, 1.01 to 1.38P =.04), decreased the number of mean ventilator-free days (5.3 vs 6.4difference, -1.195% CI, -2.1 to -0.1P =.03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%difference, 2.0%95% CI, 0.0% to 4.0%P =.03), and the risk of barotrauma (5.6% vs 1.6%difference, 4.0%95% CI, 1.5% to 6.5%P =.001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. (C) 2017 American Medical Association. All rights reserved.Brazilian Ministry of HealthBrazilian Ministry of HealthHCor Res Inst, Sao Paulo, BrazilUniv Sao Paulo, Cardiopulmonary Dept, Div Pulm, Heart Inst Incor, Sao Paulo, BrazilHosp Moinhos de Vento, Porto Alegre, RS, BrazilIrmandade Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, BrazilFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilUniv Sao Paulo, Dept Epidemiol, Sch Publ Hlth, Sao Paulo, BrazilHosp Maternidade Sao Vicente Paulo, Barbalha, BrazilHosp Nereu Ramos, Florianopolis, SC, BrazilHosp Unimed Vitoria, Vitoria, BrazilHosp & Prontosocorro 28 Agosto, Manaus, Amazonas, BrazilUniv Sao Paulo, Unidade Emergencia Hosp Clin FMRP, Ribeirao Preto, BrazilHosp Estadual Dr Jayme Santos Neves, Serra, BrazilFundacao Univ Fed Grande Dourados, Univ Hosp, Dourados, BrazilUniv ICESI, Fdn Valle Lili, Dept Intens Care Med, Cali, ColombiaHosp Univ Oeste Parana, Cascavel, BrazilHosp Pablo Tobon Uribe, Medellin, ColombiaHosp Clin Porto Alegre, Porto Alegre, RS, BrazilHosp Reg Hans Dieter Schmidt, Joinville, BrazilUniv Malaya, Med Ctr, Kuala Lumpur, MalaysiaJagiellonian Univ, Med Coll, Dept Intens Care & Perioperat Med, Krakow, PolandHosp Nacl Alejandro Posadas, Moron, ArgentinaFed Univ Sao Paulo UNIFESP, Anesthesiol Pain & Intens Care Dept, Sao Paulo, BrazilWeb of Scienc

Haploinsufficiency of TBK1 causes familial ALS and fronto-temporal dementia

Copyright © 2015, Nature Publishing Group, a division of Macmillan Publishers Limited. All Rights Reserved.Amyotrophic lateral sclerosis (ALS) is a genetically heterogeneous neurodegenerative syndrome hallmarked by adult-onset loss of motor neurons. We performed exome sequencing of 252 familial ALS (fALS) and 827 control individuals. Gene-based rare variant analysis identified an exome-wide significant enrichment of eight loss-of-function (LoF) mutations in TBK1 (encoding TANK-binding kinase 1) in 13 fALS pedigrees. No enrichment of LoF mutations was observed in a targeted mutation screen of 1,010 sporadic ALS and 650 additional control individuals. Linkage analysis in four families gave an aggregate LOD score of 4.6. In vitro experiments confirmed the loss of expression of TBK1 LoF mutant alleles, or loss of interaction of the C-terminal TBK1 coiled-coil domain (CCD2) mutants with the TBK1 adaptor protein optineurin, which has been shown to be involved in ALS pathogenesis. We conclude that haploinsufficiency of TBK1 causes ALS and fronto-temporal dementia.info:eu-repo/semantics/publishedVersio