The dialogue engages with the challenge of materialising absence related to the theme of migration, be it the absence of voices, documentary evidence, historical accounts, archives, investigative ...access, and so forth—including the absence of access to the conditions of possibility for knowing or evaluating the truth.
•Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a wide spectrum of clinical manifestations, including acute respiratory distress syndrome (ARDS).•Continuous ...positive airway pressure (i.e., non-invasive ventilation) and invasive ventilatory support are often required to manage the acute respiratory failure in patients with coronavirus disease 2019 (COVID-19).•Temperature >38 °C, lactate dehydrogenase >250 U/l, and d-dimer >1000 ng/mL were found to be independent risk factors associated with the requirement for non-invasive/invasive ventilator support.•Early inflammatory screening is warranted in order to stratify the illness severity and provide appropriate treatment.
To investigate risk factors for non-invasive/invasive ventilatory support (NI/I-VS) in patients with coronavirus disease 2019 (COVID-19).
All consecutive patients admitted to the Infectious Diseases Unit and Intensive Care Unit (ICU) of Santa Maria Annunziata Hospital (Florence, Italy), from February 25 to April 25, 2020, with a confirmed COVID-19 diagnosis were enrolled in this retrospective cohort study. NI/I-VS was defined as the need for continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BPAP) (non-invasive ventilation) or mechanical ventilation, not including low-flow systems of oxygen therapy such as the Venturi mask or nasal cannula.
Ninety-seven patients were enrolled; 61.9% (60/97) were male and the median patient age was 64 years. The in-hospital mortality was 9.3%. Thirty-five of the 97 patients (36%) required ICU admission and 94.8% (92/97) were prescribed oxygen therapy: 10.8% (10/92) by nasal cannula, 44.5% (41/92) by Venturi mask, 31.5% (29/92) by CPAP, 2.2% (2/92) by BPAP, and 10.8% (10/92) by mechanical ventilation following intubation. On univariate analysis, patients with a body mass index >30, type II diabetes mellitus, and those presenting with dyspnoea, asthenia, SOFA score ≥2 points, PaO2/FiO2 <300, temperature >38 °C, increased levels of lactate dehydrogenase (LDH), alanine aminotransferase, and C-reactive protein, and a d-dimer >1000 ng/mL at admission more frequently underwent NI/I-VS. Multivariate logistic regression analysis confirmed temperature >38 °C (odds ratio (OR) 21.2, 95% confidential interval (95% CI) 3.5–124.5, p = 0.001), LDH >250 U/l (OR 15.2, 95% CI 1.8–128.8, p = 0.012), and d-dimer >1000 ng/mL (OR 4.5, 95% CI 1.2–17.3, p = 0.027) as significantly associated with the requirement for NI/I-VS. A non-significant trend (p = 0.051) was described for PaO2/FiO2 <300.
Temperature >38 °C, LDH > 250 U/l, and d-dimer >1000 ng/mL were found to be independent risk factors for NI/I-VS in COVID-19 patients. In order to quickly identify patients likely at risk of developing a critical illness, inflammatory markers should be assessed upon hospital admission.
Risk-reducing-salpingo-oophorectomy (RRSO) inevitably leads BRCA mutation carriers to premature menopause.
To evaluate the existing evidence for use of postmenopausal hormone therapy (HT) in BRCAmc, ...after RRSO or menopause occurring naturally, for both breast cancer (BC) survivors and those without BC.
All BC survivors are excluded from any HT treatment: in other BRCAmc, before 51 years of age the benefits of HT overcome the risks after RRSO and/or premature ovarian insufficiency (POF). After 51 years of age, it is important to treat only women with important vasomotor symptoms, after the failure of alternative therapies. Estrogens-only therapy plays a key role in hysterectomized women (HW). In the case of an intact uterus (UW), associations with the lowest dose of progestins/natural progesterone derivatives have to be preferred, as progestins has been shown to play an important role in BC transformation, especially in BRCA1mc. No studies have been performed in BRCAmc with regard to 'progestin-free' HT, in particular the old tibolone (both in HW and UW) and the new tissue-selective estrogen complex (in UW). However, preliminary data obtained from the general population are reassuring about the use of these 'progestin-free' preparations and BC safety.
PDF
