Panminerva medica最新文献

Background: Prompt reperfusion is critical for patients with ST-segment elevation myocardial infarction (STEMI) to improve outcomes. Yet, variability in regional healthcare delivery may influence treatment times and patient outcomes. We thus aimed at evaluating differences in management and outcomes of STEMI patients across Northern, Central, and Southern Italy, focusing on time-dependent reperfusion and in-hospital logistics.

Methods: A prospective observational study conducted from September 1^st to 25^th, 2023, including 554 STEMI patients treated at high-volume hub centers operating 24/7. Data were collected through structured surveys completed by catheterization laboratory directors across different Italian regions. Primary outcomes included door-to-balloon (DTB) time, time from symptom onset to balloon inflation, and regional disparities in pre- and post-PCI management. Secondary outcomes included in-hospital mortality, discharge destinations, and medication regimens.

Results: The median DTB time was consistent across regions (30 minutes; IQR: 20-50 minutes). Significant regional disparities were however noted in time from symptom onset to balloon inflation, with Southern and Island regions experiencing longer median times (180 minutes) compared to Central (170 minutes) and Northern (154 minutes) regions (P<0.01). We also found a significant reduction in DTB time associated with ECG teletransmission from ambulances (mean reduction of 25 minutes, P=0.03). In-hospital mortality rates were similar across regions (P=0.83).

Conclusions: This comprehensive nationwide analysis highlights significant regional disparities in the management and treatment timelines of STEMI patients in Italy. Despite these differences, in-hospital care was consistently timely across regions, suggesting that pre-hospital logistics critically influence overall treatment times. Enhanced pre-hospital ECG teletransmission could further optimize reperfusion times, potentially improving patient outcomes.

Introduction: Despite advancement of therapeutic approaches to recurrent pericarditis, it poses notable challenges to its' management. As per the current guidelines, colchicine is the first line therapy, although, non-conventional treatments like interleukin-1 (IL-1) antagonists (rilonacept, anakinra, goflikicept) are progressively utilized for refractory cases.

Evidence acquisition: A comprehensive electronic search identified relevant literature across multiple databases, focusing on recurrence rates and adverse effects associated with each treatment regimen.

Evidence synthesis: Eleven studies (6 on colchicine, 5 on IL-1 antagonists) involving 1053 patients were included. Colchicine significantly reduced recurrence risk by 63% (OR 0.37, 95% CI 0.27-0.52). IL-1 antagonists demonstrated superior efficacy: anakinra reduced recurrence by 98% (OR 0.02, 95% CI 0.01-0.07), rilonacept by 98% (OR 0.02, 95% CI 0.01-0.07), and goflikicept by 99% (OR 0.01, 95% CI 0.00-0.05). Adverse effects were comparable between colchicine and IL-1 antagonists except for rilonacept, which showed a higher risk (OR 5.70, 95% CI 2.13-15.27).

Conclusions: IL-1 antagonists significantly reduce recurrent pericarditis episodes compared to colchicine, with anakinra, rilonacept, and goflikicept demonstrating high efficacy and acceptable safety profiles. These findings support their consideration as alternative therapies in colchicine-refractory cases of recurrent pericarditis. Further studies are warranted to refine treatment guidelines and optimize patient outcomes.

Background: About 20% of adults and between 6% and 13% of children experience mild to moderate anxiety and stress-related symptoms. Benzodiazepines (BZDs) are considered the referring medications for early-stage anxiety and stress-related symptoms management. Nevertheless, BZDs must be managed carefully because their use, especially chronic, could be linked with some adverse effects, and can promote the onset of psychological and physical dependence. They also often show progressive tolerance, necessitating an increase in dosage, and therefore their use should be discouraged. In the clinical management of patients with pathological/dysfunctional anxiety, one of the main issues related to the discontinuation of BZDs treatment is the occurrence of rebound effects and withdrawal syndrome, especially in subjects with certain personality disorders and poly-drug users. The deprescription of BZDs is advisable with the availability of other therapies and interventions, especially in elderly subjects. Therefore, an effective and safe alternative pharmacological tool for mild to moderate anxiety and stress-related symptoms is needed. After the identification of potentially new medications to flank BZDs, it is mandatory to revise and improve good clinical practices even through a consensus process.

Methods: Taking into consideration all the above-mentioned premises, the present Delphi Consensus Study has explored whether there is agreement about the use of the low-dose multicomponent natural medication Ignatia-Heel in overlapping with BZDs is appropriate for the reduction and potential discontinuation of BZDs intake in patients on chronic BZDs treatment.

Results: The Consensus Study also explored the possibility to maintain symptom remission or low disease activity with the long-term use of Ignatia-Heel in patients with pathological/dysfunctional anxiety, after clinical remission achieved with BZDs. For each questionnaire statement, consensus was achieved (being based on the agreement of at least 66.6% of the Consensus Panel and the acceptance of the scientific committee).

Conclusions: Ignatia-Heel can be considered a valid opportunity for the treatment of pathological anxiety favoring the deprescription of BZDs in patients under chronic BZDs treatment and the maintenance of a good control of symptomatology, i.e., a good low disease activity.

Background: Sustainability in medicine is gaining increasing importance. In interventional pulmonology only few studies demonstrated the impact of mechanisms involved in CO2 equivalent production; moreover, operators' sensitivity to sustainability and each center's recycling processes are highly variable. We conducted a national survey among interventional pulmonologists on perception of sustainability resulting from their work, and how endoscopic activity impacts the production of recyclable material.

Methods: A 26-item questionnaire was sent to each AIPO member registered in the interventional pulmonology study group. Items were divided in four topics: demographic data, perception of the problem, measures in place to improve sustainability and potentially feasible measure to improve the problem.

Results: We obtained a 16.2% response rate and majority of participants work in high volume centers. Climate change was perceived as an important problem but responders though that physicians are few involved mainly due to lack of awareness of the problem. Recycling programs are widely available with differentiation between recyclable and potentially contaminated material. The disposable bronchoscopes use was perceived to increase carbon footprint. Most critical interventions to improve sustainability suggested were: optimization of separate waste collection, instrument reprocessing procedures, adherence to guidelines to reduce unnecessary procedures and improving staff awareness. Most participants believed that scientific societies should establish a working group on climate change.

Conclusions: The sustainability of daily activity in interventional pulmonology is a cause for concern among interventional pulmonologists while the lack of awareness remains the main reason for the poor perception of the problem; sustainability represents a need and an opportunity for interventional pulmonologists to align with other disciplines, but this concept can also be extended to all areas of pneumology.

Background: The finding of mutations that activate epidermal growth factor receptor (EGFR) in people with lung adenocarcinoma resulted in the creation of a new class of biological treatments called tyrosine kinase inhibitors (TKI). These medications have changed how patients with EGFR mutations are clinically managed, nearly doubling their survival rate compared to standard chemotherapy. Though 1st and 2nd generation EGFR TKIs are initially highly effective, typically within 9-14 months all tumors with the mutation progress due to secondary resistance mutations involving alternative molecular pathways. In most cases (up to 60%), this is due to the T790M mutation emerging in the EGFR gene.

Methods: The study included 85 patients with NSCLC with progression of the disease after treatment with TKI 1st and 2nd generation. The T790M mutation was determined by digital polymerase chain reaction (PCR) on the QIAcuity One 5plex digital PCR system and traditional real-time PCR. Real-time PCR analysis of the presence of the T790M mutation was performed using the Therascreen EGFR Plasma RGQ PCR Kit (Qiagen). Using a digital PCR system in QIAcuity One (Qiagen) nanoplanets, the T790M mutation was analysed by digital PCR. The age of the patients ranged from 37 to 85 years.

Results: Of 85 patients with NSCLC with disease progression after TKI treatment, T790M mutations were detected during digital PCR in 30 of 85 patients, which is 35.2% of the sample, and with traditional real-time PCR, positive mutations came out only in 3 out of 85 patients.

Conclusions: Thus, completed study can assert that digital PCR is able to replace traditional real-time PCR as a more preferable method of high-performance quantitative determination of target nucleic acids and has a relatively high sensitivity without compromising high specificity. Results of this research also show that a liquid biopsy using digital PCR provides an opportunity to avoid repeated tissue biopsy in patients who cannot provide a tumor tissue sample suitable for molecular analysis.