Abstract The patient with neuromuscular disability (spinal muscular atrophy, muscular dystrophy, myopathy, amyotrophic lateral sclerosis, post-poliomyelitis syndrome or neuropathy) represents a ...typical example of a child with chronic respiratory disease requiring either hospitalisation or domiciliary assistance. For these patients, respiratory disease represents the main cause of morbidity and mortality, due primarily to weakness of the respiratory muscles, an ineffective cough and abnormal swallowing. A multidisciplinary approach, with the aim of improving the patient's quality of life, is therefore required. Such an approach involves various strategies, for example use of the cough-assist machine (a non-invasive respiratory physiotherapy that safely and consistently removes secretions in patients with an ineffective ability to cough), monitoring of nutritional status, the prevention of chest deformities, and the use of mechanically assisted ventilation – both non-invasive and invasive ventilation via a tracheotomy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background: The goal of antihypertensive therapy is to provide good blood pressure (BP) control without eliciting adverse effects.
Objective: This study compared the risk-benefit profile of the ...angiotensin II receptor blocker valsartan with that of the angiotensin-converting enzyme inhibitor lisinopril in patients with mild to severe hypertension. The primary objective was to show that the equipotent BP-lowering effect of the valsartan-based treatment is accompanied by a better tolerability profile.
Methods: This 16-week, randomized, double-blind, parallel-group study was conducted at 88 outpatient centers across Italy. After a 2-week placebo run-in period, patients aged ≥ 18 years with mild to severe hypertension (systolic BP SBP, 160–220 mm Hg; diastolic BP DBP, 95–110 mm Hg) were eligible. Patients were randomized to receive once-daily, oral, self-administered treatment with valsartan 160-mg capsules or lisinopril 20-mg capsules under double-blind conditions for 4 weeks. Responders continued monotherapy, whereas nonresponders had hydrochlorothiazide 12.5 mg added for the final 12 weeks of the study. The 2 primary variables used to assess the equivalence of therapeutic efficacy of the 2 regimens were sitting SBP and sitting DBP, which were measured at weeks 0 (baseline), 4, 8, and 16. The rate of drug-related adverse events (AEs) was used to assess whether 1 treatment had a better tolerability profile than the other. Tolerability was assessed by collecting information about AEs by means of questioning the patient or physical examination at each visit.
Results: A total of 1213 patients were enrolled (635 men, 578 women; mean SD age, 54.5 10.1 years range, 28–78 years). The study was completed by 1100 patients (553 receiving valsartan and 547 receiving lisinopril). Fifty-one patients (8.4%) treated with valsartan and 62 (1.2%) treated with lisinopril withdrew, mainly because of AEs (9 1.5% and 23 patients 3.8%, respectively). The valsartan- and lisinopril-based treatments were similarly effective in reducing sitting BP, with mean SBP/DBP reductions of 31.2/15.9 mm Hg and 31.4/15.9 mm Hg, respectively. At the end of the study, BP was controlled in 82.7% of the patients receiving valsartan and 81.6% of those receiving lisinopril. AEs were experienced by 5.1% of the patients treated with valsartan and 10.7% of those treated with lisinopril (
P = 0.001), with dry cough observed in 1.0% and 7.2% of patients, respectively (
P < 0.001).
Conclusions: Valsartan and lisinopril were both highly effective in controlling BP in these patients with mild to severe hypertension, but valsartan was associated with a significantly reduced risk for AEs, especially cough.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
To assess the health-related quality of life (HRQoL) in young diabetic patients.
We studied 30 consecutive (16 male, 14 female; mean age 15.8 years) out-patients affected by Type 1 diabetes mellitus ...(T1DM). We used validated clinical, metabolic (HbA1c) and patient-oriented (Short Form-36) measurements.
Patient-oriented physical scores were significantly related to several clinical and habit features (daily glycaemia and number of insulin administration, dosage of HbA1c, number of snacks). Interestingly, the number of snacks is associated with better social functioning; furthermore, the mother's educational level is related with physical and mental aspects of the patient's quality of life.
The patient-oriented measure provides an important perspective of the severity of the disease and suggests new interpretations to conventional biological measurements. This multidimensional study shows that HRQoL is influenced by the metabolic picture. During adolescence a "constant attendance" of the disease, through strict self-control and the high number of therapy administrations, can deteriorate the patient's quality of life. Interestingly, this study indicates the mother's crucial role in the management of the disease during adolescence: the higher the mother's educational level the better the patient's HRQoL probably because she is able to help the child to manage and accept the disease.
Laboratory studies suggest applying positive pressure without endotracheal suction during cuff deflation and extubation. Although some studies reported better physiological outcomes (e.g. arterial ...blood gases) with this technique, the safety of positive pressure extubation technique has not been well studied. The aim of this study was to determine the safety of the positive-pressure extubation technique compared with the traditional extubation technique in terms of incidence of complications.
Adult subjects who were critically ill and on invasive mechanical ventilation who met extubation criteria were included. The subjects were randomly assigned to positive-pressure extubation (
= 120) or to traditional extubation (
= 120). Sequential tests for noninferiority and, when appropriate, for superiority were performed. Positive pressure was considered noninferior if the upper limit of the CI for the absolute risk difference did not exceed a threshold of 15% in favor of the traditional group, both in per protocol and intention-to-treat analyses. A
value of <.05 was considered significant.
A total of 236 subjects were included in the primary analysis (per protocol) (119 in the positive-pressure group and 117 in the traditional group). The incidence of overall major and minor complications, pneumonia, extubation failure, and reintubation was lower in the positive-pressure group than in the traditional group, with statistical significance for noninferiority both in the per protocol (
< .001) and intention-to-treat (
< .001) analyses. The lower incidence of major complications found in the positive-pressure group reached statistical significance for the superiority comparison, both in per protocol (
= .03) and intention-to-treat (
= .049) analyses. No statistically significant differences were found in the superiority comparison for overall complications, minor complications, pneumonia, extubation failure, and reintubation.
Positive pressure was safe and noninferior to traditional extubation methods. Furthermore, positive pressure has shown to be superior in terms of a lower incidence of major complications. (ClinicalTrials.gov registration NCT03174509.).
We have performed a prospective study on 291 male non alcoholic-patients admitted in the General Hospital of Arezzo, drinkers of more than 100 ml of alcohol for day. We have evaluated the toxic ...effects on the liver and we found a direct correlation between dose and hepatic lesions. The factors body weight, period of drinking, way of drinking (during eating or not) seem to have no value to determinate the hepatic damage. The Authors think that this kind of investigation is important to elaborate preventive program not only for the "psichiatric" alcoholism, but for the danger of the excessive amount of wine normally consumed in the diet from high percentage of Italian people.
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