Panminerva medica最新文献

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder affecting over 90% of diabetes patients worldwide. The condition is driven by genetic predispositions, environmental factors, obesity, and physical inactivity. Pharmacological treatments range from metformin to newer agents, including GLP-1 analogues and SGLT-2 inhibitors, which target different aspects of glucose metabolism. The review highlights advancements in clinical trials for T2DM treatments, focusing on recent and ongoing research. Clinical trial data were sourced from ClinicalTrials.gov, and the search criteria focused on trials that were published with monotherapy of T2DM having results within the last six years, specifically from 2019 to 2024. The clinical trials of the patients under the age group of adults (18 to 64 years) and older adults (>64 years) were included. The data are mentioned in inverse chronological order with respect to study duration. The clinical trial data suggest promising results in managing hemoglobin A1c and body weight. However, adverse events such as cardiovascular, gastrointestinal, and bone-related issues and other issues such as diabetic ketoacidosis and pancreatitis were reported in some cases. Dulaglutide, tripeptide, and oral insulin showed promising therapeutic effects in clinical trials. Despite significant progress, the management of T2DM remains challenging, emphasizing the need for ongoing innovation in treatment approaches to improve patient quality of life and reduce the global burden of the disease.

Acute pain is a common symptom experienced by all children. Pain may be due to different causes, but inflammatory pain is the most common. In addition, infectious diseases are characterized by an inflammatory reaction. As a result, inflammatory pain, including pain associated with infections, should be preferably relieved by non-steroidal anti-inflammatory drugs (NSAIDs). In this regard, ketoprofen and ketoprofen lysine salt represent a valuable option also in children with mild-moderate acute pain. This paper presents and discusses the comparative studies between ketoprofen or KLS and other analgesics, mainly concerning ibuprofen and acetaminophen. The results showed that ketoprofen and KLS are an effective, safe, and rapid strategy in relieving mild-moderate acute pain in children.

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.

With the formal designation of obesity as a primary disease process, early detection of its end-organ consequences and the prognostication of long-term risk will become an important aspect of its clinical management. Obesity is increasingly recognized as a treatable risk factor for chronic kidney disease. However, profiling of kidney health and estimation of renal risk remain relatively underemphasized in obesity and nephrology care guidelines. The establishment of clinical protocols that facilitate the detection of early-stage renal impairment in obesity and incorporate profiling of an individual's risk of progression, could help guide strategies to break the causal association between obesity and chronic kidney disease. Currently, checks on kidney health in patients with obesity are prompted due to the presence of obesity complications such as cardiovascular and/or metabolic disease and routine screening relies upon the use of estimated glomerular filtration rate equations. Ample evidence exists to demonstrate that these equations are of limited utility in the setting of excess body weight and intentional weight loss. The present article presents the case that an expanded model of renal risk profiling should be developed for obesity medicine, suggesting feasible means of incorporating important risk factors and biomarker profiling alongside a more targeted assessment of directly measured GFR and renal functional reserve in at risk patients. The development of such a model or variation thereof should be prioritized to guide the targeted deployment of obesity treatments with proven reno-protective effects.

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.