Success and pitfall of anticlotting therapy Fiori, Patrizia; Allegorico, Lia; Capaldo, Guglielmo ...
Journal of the neurological sciences,
October 2021, 2021-10-00, Letnik:
429
Journal Article
Wrong or right decision making? Fiori, Patrizia; Allegorico, Lia; Capaldo, Guglielmo ...
Journal of the neurological sciences,
October 2021, 2021-10-00, Letnik:
429
Journal Article
Neuron specific enolase in a SARS CoV2 patient Fiori, Patrizia; Allegorico, Lia; Capaldo, Guglielmo ...
Journal of the neurological sciences,
October 2021, 2021-10-00, 20211001, Letnik:
429
Journal Article
Central Genesis of Dysrhythmia Patrizia, Fiori; Marielisa, Alberico; Annamaria, Bellizzi ...
Neurology and Neurobiology,
04/2020
Journal Article
Introduction: The central nervous system is the generator of the dynamic balance between cholinergic and
noradrenergic activity. Different behavioral tendencies are observed in subjects with ...prevalent parasympatic
tone (defense strategy, energy sparing, dissociation) compared to those with sympathic one (relational
interaction, high energy expenditure). These responses may influence susceptibility and vulnerability to
diseases. The aim of our study was to examine cardiovascular function from the heart to the periphery by
24 hours detection of both heart and pulse rate in cerebrovascular conditions.
Materials and Methods: We recruited 113 Acute Ischaemic Syndromes (AIS, age 73,43 sd 12,34), 32
Chronic Cerebro-Vascular Diseases (CCVD, age 75,95 sd 8,06), 30 Other Neurological Diseases (OND,
age 50,09 sd 15,05). Cardiovascular reactivity (CR) was defined by beat indices, ratio (R) or difference (D)
between higher maximal or minimal heart rate (HR) on higher maximal or minimal pulse rate (PR). A value
< 1 or > 1 were considered as negative (NCR) or positive CR (PCR), respectively.
Results: Max PR was significantly higher in CCVD and AIS compared to OND. Max CR was lower in
CCVD and AIS compared to OND. Increased levels of glycosylated hemoglobin, cardiac biomarkers,
abnormal findings at Holter ECG and Echocardiography were particularly observed in case of NCR.
Conclusions: NCR may interfere with normal activity of daily living. Higher Hachinski ischaemic scores
in these patients point out a higher ischaemic load. Moreover, NCR identified a category of acute patients
with worst outcomes, requiring prompt intensive care because of higher risk of complications and mortality.
Our observations may be useful for better choosing among therapeutical options, planning rehabilitation
and health enhancing physical activity in aging. Moreover, they may reduce the risk of injuries for training
overload in athletes.
Is it well-known that one of the major drawbacks of Lupus Anticoagulant (LA) test is their sensitivity to anticoagulant therapy, due to the coagulation based principle. In this study we aimed to ...assess the reproducibility of LA testing and to evaluate the performance of solid assay phosphatidylserine/prothrombin (aPS/PT) antibodies.
We included 60 patients that fulfilled the following inclusion criteria: (I) diagnosis of thrombotic antiphospholipid syndrome (APS); (II) patients with thrombosis and (a) inconstant previous LA positivity and/or (b) positivity for antiphospholipid antibodies (aPL) at low-medium titers defined as levels of anti-β2Glycoprotein-I or anticardiolipin (IgG/IgM) 10-30 GPL/MPL with no previous evidence of LA positivity. aPL testing was performed blindly in 4 centers undertaking periodic external quality assessment.
The 60 patients enrolled were distributed as follows: 43 (71.7%) with thrombotic APS, 7 (11.7%) with thrombosis and inconstant LA positivity and 10 (16.7%) with low-medium aPL titers. Categorical agreement for LA among the centers ranged from 0.41 to 0.60 (
coefficient; moderate agreement). The correlation determined at the 4 sites for aPS/PT was strong, both quantitatively (Spearman rho 0.84) and when dichotomized (
coefficients = 0.81 to 1.0). Discordant (as defined by lack of agreement in ≥3 laboratories) or inconclusive LA results were observed in 27/60 (45%) cases; when limiting the analysis to those receiving vitamin K antagonist (VKA), the level of discordant LA results was as high as 75%(15/20). Conversely, aPS/PT testing showed an overall agreement of 83% (up to 90% in patients receiving VKA), providing an overall increase in test reproducibility of +28% when compared to LA, becoming even more evident (+65%) when analyzing patients on VKA. In patients treated with VKA, we observed a good correlation for aPS/PT IgG testing (
coefficients = 0.81-1; Spearman rho 0.86).
Despite the progress in the standardization of aPL testing, we observed up to 45% of overall discrepant results for LA, even higher in patients on VKA. The introduction of aPS/PT testing might represent a further diagnostic tool, especially when LA testing is not available or the results are uncertain.
Abstract Objective The objective of this review was to define a core set of recommendations for the treatment of HCV-associated mixed cryoglobulinemia syndrome (MCS) by combining current evidence ...from clinical trials and expert opinion. Methods Expert physicians involved in studying and treating patients with MCS formulated statements after discussing the published data. Their attitudes to treatment approaches (particularly those insufficiently supported by published data) were collected before the consensus conference by means of a questionnaire, and were considered when formulating the statements. Results An attempt at viral eradication using pegylated interferon plus ribavirin should be considered the first-line therapeutic option in patients with mild–moderate HCV-related MCS. Prolonged treatment (up to 72 weeks) may be considered in the case of virological non-responders showing clinical and laboratory improvements. Rituximab (RTX) should be considered in patients with severe vasculitis and/or skin ulcers, peripheral neuropathy or glomerulonephritis. High-dose pulsed glucocorticoid (GC) therapy is useful in severe conditions and, when necessary, can be considered in combination with RTX; on the contrary, the majority of conference participants discouraged the chronic use of low–medium GC doses. Apheresis remains the elective treatment for severe, life-threatening hyper-viscosity syndrome; its use should be limited to patients who do not respond to (or who are ineligible for) other treatments, and emergency situations. Cyclophosphamide can be considered in combination with apheresis, but the data supporting its use are scarce. Despite the limited available data, colchicine is used by many of the conference participants, particularly in patients with mild–moderate MCS refractory to other therapies. Careful monitoring of the side effects of each drug, and its effects on HCV replication and liver function tests is essential. A low-antigen-content diet can be considered as supportive treatment in all symptomatic MCS patients. Although there are no data from controlled trials, controlling pain should always be attempted by tailoring the treatment to individual patients on the basis of the guidelines used in other vasculitides. Conclusion Although there are few controlled randomised trials of MCS treatment, increasing knowledge of its pathogenesis is opening up new frontiers. The recommendations provided may be useful as provisional guidelines for the management of MCS.
Purpose
The onset of the coronavirus disease 19 (COVID-19) pandemic in Italy induced a dramatic increase in the need for intensive care unit (ICU) beds for a large proportion of patients affected by ...COVID-19-related acute respiratory distress syndrome (ARDS). The aim of the present study was to describe the health-related quality of life (HRQoL) at 90 days after ICU discharge in a cohort of COVID-19 patients undergoing invasive mechanical ventilation and to compare it with an age and sex-matched sample from the general Italian and Finnish populations. Moreover, the possible associations between clinical, demographic, social factors, and HRQoL were investigated.
Methods
COVID-19 ARDS survivors from 16 participating ICUs were followed up until 90 days after ICU discharge and the HRQoL was evaluated with the 15D instrument. A parallel cohort of age and sex-matched Italian population from the same geographic areas was interviewed and a third group of matched Finnish population was extracted from the Finnish 2011 National Health survey. A linear regression analysis was performed to evaluate potential associations between the evaluated factors and HRQoL.
Results
205 patients answered to the questionnaire. HRQoL of the COVID-19 ARDS patients was significantly lower than the matched populations in both physical and mental dimensions. Age, sex, number of comorbidities, ARDS class, duration of invasive mechanical ventilation, and occupational status were found to be significant determinants of the 90 days HRQoL. Clinical severity at ICU admission was poorly correlated to HRQoL.
Conclusion
COVID-19-related ARDS survivors at 90 days after ICU discharge present a significant reduction both on physical and psychological dimensions of HRQoL measured with the 15D instrument.
Trial Registration:
NCT04411459.
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