F. Giofrè, V. Trapanese, Maria Resilde Natale, Clara Vatalaro, Francesca Cosentino, Melania Melina, M. Pelle, Nazareno Carullo, Maria Capria, Franco Arturi
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RAs) approved for the treatment of type 2 diabetes mellitus (T2DM) and chronic weight management in obesity. GLP-1RAs are being investigated to slow the decline of kidney function in type 2 diabetics with chronic kidney disease. These agents prevent renal complications and have proven beneficial effects on cardiac outcomes. We describe a rare case of semaglutide-induced acute kidney injury (AKI) in a young woman with obesity, T2DM, hypertensive cardiomyopathy, and no pre-existing chronic kidney disease (CKD). This case is relevant as GLP1-RAs is used frequently in patients with and without kidney disease. Currently, only 3 cases of AKI ascribed to semaglutide of which only 1 without CKD have been described. Only in this case, kidney function improves after semaglutide discontinuation. However, because GLP1-RAs will be prescribed more and more frequently, we sought to highlight this possible, serious adverse effect of semaglutide.
{"title":"Semaglutide and kidney function: friends or enemies?","authors":"F. Giofrè, V. Trapanese, Maria Resilde Natale, Clara Vatalaro, Francesca Cosentino, Melania Melina, M. Pelle, Nazareno Carullo, Maria Capria, Franco Arturi","doi":"10.4081/itjm.2024.1694","DOIUrl":"https://doi.org/10.4081/itjm.2024.1694","url":null,"abstract":"Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RAs) approved for the treatment of type 2 diabetes mellitus (T2DM) and chronic weight management in obesity. GLP-1RAs are being investigated to slow the decline of kidney function in type 2 diabetics with chronic kidney disease. These agents prevent renal complications and have proven beneficial effects on cardiac outcomes. We describe a rare case of semaglutide-induced acute kidney injury (AKI) in a young woman with obesity, T2DM, hypertensive cardiomyopathy, and no pre-existing chronic kidney disease (CKD). This case is relevant as GLP1-RAs is used frequently in patients with and without kidney disease. Currently, only 3 cases of AKI ascribed to semaglutide of which only 1 without CKD have been described. Only in this case, kidney function improves after semaglutide discontinuation. However, because GLP1-RAs will be prescribed more and more frequently, we sought to highlight this possible, serious adverse effect of semaglutide.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139802703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Giofrè, V. Trapanese, Maria Resilde Natale, Clara Vatalaro, Francesca Cosentino, Melania Melina, M. Pelle, Nazareno Carullo, Maria Capria, Franco Arturi
Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RAs) approved for the treatment of type 2 diabetes mellitus (T2DM) and chronic weight management in obesity. GLP-1RAs are being investigated to slow the decline of kidney function in type 2 diabetics with chronic kidney disease. These agents prevent renal complications and have proven beneficial effects on cardiac outcomes. We describe a rare case of semaglutide-induced acute kidney injury (AKI) in a young woman with obesity, T2DM, hypertensive cardiomyopathy, and no pre-existing chronic kidney disease (CKD). This case is relevant as GLP1-RAs is used frequently in patients with and without kidney disease. Currently, only 3 cases of AKI ascribed to semaglutide of which only 1 without CKD have been described. Only in this case, kidney function improves after semaglutide discontinuation. However, because GLP1-RAs will be prescribed more and more frequently, we sought to highlight this possible, serious adverse effect of semaglutide.
{"title":"Semaglutide and kidney function: friends or enemies?","authors":"F. Giofrè, V. Trapanese, Maria Resilde Natale, Clara Vatalaro, Francesca Cosentino, Melania Melina, M. Pelle, Nazareno Carullo, Maria Capria, Franco Arturi","doi":"10.4081/itjm.2024.1694","DOIUrl":"https://doi.org/10.4081/itjm.2024.1694","url":null,"abstract":"Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1 RAs) approved for the treatment of type 2 diabetes mellitus (T2DM) and chronic weight management in obesity. GLP-1RAs are being investigated to slow the decline of kidney function in type 2 diabetics with chronic kidney disease. These agents prevent renal complications and have proven beneficial effects on cardiac outcomes. We describe a rare case of semaglutide-induced acute kidney injury (AKI) in a young woman with obesity, T2DM, hypertensive cardiomyopathy, and no pre-existing chronic kidney disease (CKD). This case is relevant as GLP1-RAs is used frequently in patients with and without kidney disease. Currently, only 3 cases of AKI ascribed to semaglutide of which only 1 without CKD have been described. Only in this case, kidney function improves after semaglutide discontinuation. However, because GLP1-RAs will be prescribed more and more frequently, we sought to highlight this possible, serious adverse effect of semaglutide.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139862312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gordana Dželetović, Aleksandar Jovanovic, Tatjana Novakovic, Snežana R. Markovic-Jovanovic, Emilija Novaković, Anja Dzeletovic, Milena Lukić, Biljana Kostic-Inic, Sanja Jovanovic, Miljan Jankovic
The link between obesity, diabetes and bone metabolism is quite complex and not entirely clear. Although many clinical and epidemiological studies demonstrate that obesity enhances bone mineral density, its effect on bone microarchitecture is uncertain. The objective of this study was to examine the bone microarchitecture in obese patients with and without diabetes. The study included 119 individuals with ages from 30 to 50. Participants were divided into three groups: obese patients, obese diabetic patients, and a healthy control group. Results showed that obesity has a positive effect on trabecular bone score (TBS). Diabetes and obesity have a significant interactive impact on bone microarchitecture (TBS). Furthermore, HbA1c influences TBS in both obese diabetic patients and obese non-diabetic subjects. In contrast to the majority of studies, we found that obesity positively influenced TBS. TBS was inversely related to HbA1c levels in obese type 2 diabetics. Diabetes and obesity have a significant interactive impact on bone structure, in particular on bone microarchitecture.
{"title":"Trabecular bone score in obese patients with and without diabetes","authors":"Gordana Dželetović, Aleksandar Jovanovic, Tatjana Novakovic, Snežana R. Markovic-Jovanovic, Emilija Novaković, Anja Dzeletovic, Milena Lukić, Biljana Kostic-Inic, Sanja Jovanovic, Miljan Jankovic","doi":"10.4081/itjm.2024.1696","DOIUrl":"https://doi.org/10.4081/itjm.2024.1696","url":null,"abstract":"The link between obesity, diabetes and bone metabolism is quite complex and not entirely clear. Although many clinical and epidemiological studies demonstrate that obesity enhances bone mineral density, its effect on bone microarchitecture is uncertain. The objective of this study was to examine the bone microarchitecture in obese patients with and without diabetes. The study included 119 individuals with ages from 30 to 50. Participants were divided into three groups: obese patients, obese diabetic patients, and a healthy control group. Results showed that obesity has a positive effect on trabecular bone score (TBS). Diabetes and obesity have a significant interactive impact on bone microarchitecture (TBS). Furthermore, HbA1c influences TBS in both obese diabetic patients and obese non-diabetic subjects. In contrast to the majority of studies, we found that obesity positively influenced TBS. TBS was inversely related to HbA1c levels in obese type 2 diabetics. Diabetes and obesity have a significant interactive impact on bone structure, in particular on bone microarchitecture.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139803031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Moroni, V. Vannucchi, Costanza Vinci, Simone Bianchi, Alessandra Giuello, Francesco Prosperi Iovi, Michele Lanigra, Angela Konze, Giancarlo Landini
Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.
{"title":"A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate","authors":"F. Moroni, V. Vannucchi, Costanza Vinci, Simone Bianchi, Alessandra Giuello, Francesco Prosperi Iovi, Michele Lanigra, Angela Konze, Giancarlo Landini","doi":"10.4081/itjm.2024.1693","DOIUrl":"https://doi.org/10.4081/itjm.2024.1693","url":null,"abstract":"Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139821170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Moroni, V. Vannucchi, Costanza Vinci, Simone Bianchi, Alessandra Giuello, Francesco Prosperi Iovi, Michele Lanigra, Angela Konze, Giancarlo Landini
Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.
{"title":"A new stroke mimic prediction scale in a stroke center with a high thrombolysis rate","authors":"F. Moroni, V. Vannucchi, Costanza Vinci, Simone Bianchi, Alessandra Giuello, Francesco Prosperi Iovi, Michele Lanigra, Angela Konze, Giancarlo Landini","doi":"10.4081/itjm.2024.1693","DOIUrl":"https://doi.org/10.4081/itjm.2024.1693","url":null,"abstract":"Patients reaching the emergency department (ED) with symptoms of acute ischemic stroke (AIS) may be affected by a stroke mimics (SMs). A prompt clinical diagnosis could avoid unnecessary thrombolysis. We evaluated a new and rapid approach, the Santa Maria Nuova-Stroke Mimic (SMN-SM) scale, to improve a prompt clinical diagnosis. 340 consecutive patients admitted to the ED with suspected AIS were evaluated. The final diagnosis was: AIS in 267 (78,5%) and SMs in 73 (21,5%) patients. Multivariate logistical analysis showed that the following features – lack of facial paralysis, dizziness, migraine, seizure disorders, blood pressure <150, cognitive impairment, and female sex – were significantly more abundant in patients with SMs than in AIS. To each of these features we assigned a numerical score and we performed a receiver operating characteristic analysis. When the score of the scale was above 8 (cut-point), we obtained a specificity of 93% and a sensitivity of 56% for a SM diagnosis. Thus, the SMN-SM scale seems a rather useful tool to improve SMs diagnosis.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139880961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anita Huparikar, Silky Kothiwal, Sai Ashrita Kanala, Halah Saeed Ahmed Habib, B. Akondi
Background. Abnormal uterine bleeding is a broad term involving various irregularities of the menstrual cycle. Previously various terms were used to define abnormalities in menstrual bleeding. To create a universally accepted system of nomenclature, the Federation of Obstetrics and Gynecology proposed the new terminology PALM-COIEN. The current study is aimed to classify cases of abnormal uterine bleeding as per PALM-COEIN. Materials and Methods. It is a retrospective, observational study using the data from 110 patients, who underwent hysteroscopic evaluation and endometrial biopsy and were categorized based on PALM-COIEN. Patients were grouped under these categories after detailed history, examination, investigations, hysteroscopic findings, and histopathology. Results. Polyp was the commonest group (n=45, 40.9%) in our study, which was followed by leiomyoma (n=30, 27.27%), ovulatory disturbances (n=28, 25.45%), adenomyosis (n=5, 4.54%), malignancy (n=2, 1.81%) respectively. Conclusions. Hysteroscopic evaluation is a simple and useful tool to find out the structural pathologies of PALM-COIEN classification. Further histopathological confirmation of clinical diagnosis can enhance the diagnosis and treatment modalities.
{"title":"Role of hysteroscopy in categorization of abnormal uterine bleeding in a multispecialty hospital in Bahrain","authors":"Anita Huparikar, Silky Kothiwal, Sai Ashrita Kanala, Halah Saeed Ahmed Habib, B. Akondi","doi":"10.4081/itjm.2024.1692","DOIUrl":"https://doi.org/10.4081/itjm.2024.1692","url":null,"abstract":"Background. Abnormal uterine bleeding is a broad term involving various irregularities of the menstrual cycle. Previously various terms were used to define abnormalities in menstrual bleeding. To create a universally accepted system of nomenclature, the Federation of Obstetrics and Gynecology proposed the new terminology PALM-COIEN. The current study is aimed to classify cases of abnormal uterine bleeding as per PALM-COEIN. Materials and Methods. It is a retrospective, observational study using the data from 110 patients, who underwent hysteroscopic evaluation and endometrial biopsy and were categorized based on PALM-COIEN. Patients were grouped under these categories after detailed history, examination, investigations, hysteroscopic findings, and histopathology. Results. Polyp was the commonest group (n=45, 40.9%) in our study, which was followed by leiomyoma (n=30, 27.27%), ovulatory disturbances (n=28, 25.45%), adenomyosis (n=5, 4.54%), malignancy (n=2, 1.81%) respectively. Conclusions. Hysteroscopic evaluation is a simple and useful tool to find out the structural pathologies of PALM-COIEN classification. Further histopathological confirmation of clinical diagnosis can enhance the diagnosis and treatment modalities.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139606457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Argjend Shala, Afrim Blyta, N. Shala, D. Boshnjaku, P. Ibrahimi, F. Jashari
Background. Early seizures (ES) following stroke are prevalent among the elderly population, representing the most common type of acquired seizures. This study aimed to determine the incidence of ES and investigate potential associations with various clinical and radiological factors. Materials and Methods. 260 stroke patients (mean age 72±13.2, 48.5% females) were prospectively enrolled and followed. Baseline demographic data, clinical data, stroke subtype, ES occurrence, National Institutes of Health Stroke Scale (NIHSS) scores, and Alberta Stroke Program Early CT Score (ASPECT) were collected and analyzed. Results. ES was observed in 11.6% of patients with ischemic stroke compared to 7.1% among patients with hemorrhagic stroke. ES occurred more frequently in those with posterior circulation stroke (18.5% vs. 7.1%, P=0.008) and those with NIHSS >15 (19.4% vs. 8.4%, P=0.04). In a logistic regression analysis that adjusted for vascular risk factors and NIHSS, posterior circulation stroke remained significantly associated with ES, with an odds ratio of 3.14 (95% CI 1.20 to 7.73, P=0.012). Conclusions. This study revealed that ES following stroke is more common in patients with posterior circulation lesions. These findings emphasize the need for further investigation into additional factors that may influence ES occurrence and its impact on stroke management and patient outcomes.
背景。中风后早期癫痫发作（ES）在老年人群中很普遍，是获得性癫痫发作中最常见的类型。本研究旨在确定 ES 的发病率，并调查与各种临床和放射学因素的潜在关联。材料和方法。对 260 名脑卒中患者（平均年龄为 72±13.2，女性占 48.5%）进行了前瞻性登记和随访。收集并分析了基线人口统计学数据、临床数据、卒中亚型、ES发生率、美国国立卫生研究院卒中量表（NIHSS）评分和阿尔伯塔省卒中计划早期CT评分（ASPECT）。结果11.6%的缺血性脑卒中患者观察到ES，而出血性脑卒中患者仅为7.1%。后循环卒中患者（18.5% 对 7.1%，P=0.008）和 NIHSS >15 的患者（19.4% 对 8.4%，P=0.04）ES 发生率更高。在对血管风险因素和 NIHSS 进行调整的逻辑回归分析中，后循环卒中仍与 ES 显著相关，几率比为 3.14（95% CI 1.20 至 7.73，P=0.012）。结论本研究显示，脑卒中后ES在后循环病变患者中更为常见。这些发现强调有必要进一步研究可能影响 ES 发生的其他因素及其对卒中管理和患者预后的影响。
{"title":"Posterior circulation lesions are more frequently associated with early seizures after a stroke","authors":"Argjend Shala, Afrim Blyta, N. Shala, D. Boshnjaku, P. Ibrahimi, F. Jashari","doi":"10.4081/itjm.2024.1683","DOIUrl":"https://doi.org/10.4081/itjm.2024.1683","url":null,"abstract":"Background. Early seizures (ES) following stroke are prevalent among the elderly population, representing the most common type of acquired seizures. This study aimed to determine the incidence of ES and investigate potential associations with various clinical and radiological factors. Materials and Methods. 260 stroke patients (mean age 72±13.2, 48.5% females) were prospectively enrolled and followed. Baseline demographic data, clinical data, stroke subtype, ES occurrence, National Institutes of Health Stroke Scale (NIHSS) scores, and Alberta Stroke Program Early CT Score (ASPECT) were collected and analyzed. Results. ES was observed in 11.6% of patients with ischemic stroke compared to 7.1% among patients with hemorrhagic stroke. ES occurred more frequently in those with posterior circulation stroke (18.5% vs. 7.1%, P=0.008) and those with NIHSS >15 (19.4% vs. 8.4%, P=0.04). In a logistic regression analysis that adjusted for vascular risk factors and NIHSS, posterior circulation stroke remained significantly associated with ES, with an odds ratio of 3.14 (95% CI 1.20 to 7.73, P=0.012). Conclusions. This study revealed that ES following stroke is more common in patients with posterior circulation lesions. These findings emphasize the need for further investigation into additional factors that may influence ES occurrence and its impact on stroke management and patient outcomes.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139619164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nathan Artom, Paola Maineri, Luca Paris, Chiara Lagasio, Francesco Artom, P. Artom, Alberto Artom
Traumatic pneumothorax is traditionally treated with tube thoracostomy. We report a case of conservative management of a large traumatic pneumothorax, due to the close collaboration between the physician, a Thoracic Surgeon and the patient, a retired Internist.
{"title":"Management of large traumatic pneumothorax: when the patient is an experienced Internist","authors":"Nathan Artom, Paola Maineri, Luca Paris, Chiara Lagasio, Francesco Artom, P. Artom, Alberto Artom","doi":"10.4081/itjm.2024.1677","DOIUrl":"https://doi.org/10.4081/itjm.2024.1677","url":null,"abstract":"Traumatic pneumothorax is traditionally treated with tube thoracostomy. We report a case of conservative management of a large traumatic pneumothorax, due to the close collaboration between the physician, a Thoracic Surgeon and the patient, a retired Internist.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct-Acting Oral Anticoagulants (DOACs) have revolutionized the management of Atrial Fibrillation (AF) and Venous Thromboembolism (VTE). However, recent audits reveal a significant burden of inappropriate dosages in the prescribing of direct-acting oral anticoagulants. Our aim is to identify the prevalence and predictors of such inappropriate dosing in our patients. This retrospective study was conducted from June 2016 to January 2018. Patients who received dabigatran, rivaroxaban, or apixaban for treatment of venous thromboembolism or atrial fibrillation were included. Appropriateness of direct-acting oral anticoagulants dosing was assessed using US Food and Drug Administration guidelines. Data was analyzed using IBM® SPSS Version 26. 337 patients were included, with a mean age of 62.9±18.7 years. The majority were female (196, 58.3%). Of the patients, 194 (57.6%) received apixaban, 99 (29.4%) received rivaroxaban, and 44 (13.1%) received dabigatran. A total of 242 (71.8%) patients were prescribed direct-acting oral anticoagulants appropriately. Under-dosing and over-dosing were identified in 74 (22%) and 21 (6.2%) patients, respectively. Predictors of inappropriate dosing were age greater than 75 years (OR: 2.76, 95% CI: 1.67-4.56, p<0.001) and creatinine clearance less than 50 ml/minute (OR: 0.38, 95% CI: 0.19-0.74, p: 0.005). Inappropriate dosing was significantly associated with mortality (p=0.010).One-third of our patients received an inappropriate dose of direct-acting oral anticoagulants, mostly from underdosing. Elderly age and low creatinine clearance are significant predictors of inappropriate dose administration.
{"title":"Assessment and predictors of inappropriate dose of direct oral anticoagulants","authors":"M. Almegren","doi":"10.4081/itjm.2024.1679","DOIUrl":"https://doi.org/10.4081/itjm.2024.1679","url":null,"abstract":"Direct-Acting Oral Anticoagulants (DOACs) have revolutionized the management of Atrial Fibrillation (AF) and Venous Thromboembolism (VTE). However, recent audits reveal a significant burden of inappropriate dosages in the prescribing of direct-acting oral anticoagulants. Our aim is to identify the prevalence and predictors of such inappropriate dosing in our patients. This retrospective study was conducted from June 2016 to January 2018. Patients who received dabigatran, rivaroxaban, or apixaban for treatment of venous thromboembolism or atrial fibrillation were included. Appropriateness of direct-acting oral anticoagulants dosing was assessed using US Food and Drug Administration guidelines. Data was analyzed using IBM® SPSS Version 26. 337 patients were included, with a mean age of 62.9±18.7 years. The majority were female (196, 58.3%). Of the patients, 194 (57.6%) received apixaban, 99 (29.4%) received rivaroxaban, and 44 (13.1%) received dabigatran. A total of 242 (71.8%) patients were prescribed direct-acting oral anticoagulants appropriately. Under-dosing and over-dosing were identified in 74 (22%) and 21 (6.2%) patients, respectively. Predictors of inappropriate dosing were age greater than 75 years (OR: 2.76, 95% CI: 1.67-4.56, p<0.001) and creatinine clearance less than 50 ml/minute (OR: 0.38, 95% CI: 0.19-0.74, p: 0.005). Inappropriate dosing was significantly associated with mortality (p=0.010).One-third of our patients received an inappropriate dose of direct-acting oral anticoagulants, mostly from underdosing. Elderly age and low creatinine clearance are significant predictors of inappropriate dose administration.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blerim Myftiu, E. Komoni, Edita Malazogu, F. Jashari, Shpresa Beqiri Rashiti, Melihate Pushka, Adnan Biqku, Syzana Aliçkaj Prebreza, Valbona Rrahmani Spanca, Jehona Rrustemi Bytyqi, N. Shala, Afrim Blyta
Background. Because of side effects, adherence to the treatment with β interferons in multiple sclerosis (MS) is low, leading to decreased treatment efficacy. This can be challenging, especially in healthcare systems where these medications are the only therapeutic option for the treatment of MS. Materials and Methods. The number of missed doses was calculated as a difference between the number of doses a patient had to withdraw from the treatment start to the cut-off date and the real number of doses taken from the MS unit. Missed doses were compared to gender, age, time since the diagnosis, time from the diagnosis to the treatment start, clinical type of MS, expanded disability status scale (EDSS), and duration of the treatment. Results. The adherence rate during the follow-up period was 73.8%. Patients above 40 years of age (P<0.005), higher EDSS (P<0.001), longer duration of the disease (P<0.001), longer waiting time from the diagnosis to the treatment initiation (P<0.001), and longer time on interferons (P<0.001) had lower adherence rates to the treatment. Conclusions. The findings were in correlation with studies that have used similar criteria for the determination of adherence and supported reports that adherence rate decreases with time and poses a challenge to the overall efficacy of the treatment.
{"title":"Adherence to interferon β treatment in Kosovan multiple sclerosis registry","authors":"Blerim Myftiu, E. Komoni, Edita Malazogu, F. Jashari, Shpresa Beqiri Rashiti, Melihate Pushka, Adnan Biqku, Syzana Aliçkaj Prebreza, Valbona Rrahmani Spanca, Jehona Rrustemi Bytyqi, N. Shala, Afrim Blyta","doi":"10.4081/itjm.2024.1672","DOIUrl":"https://doi.org/10.4081/itjm.2024.1672","url":null,"abstract":"Background. Because of side effects, adherence to the treatment with β interferons in multiple sclerosis (MS) is low, leading to decreased treatment efficacy. This can be challenging, especially in healthcare systems where these medications are the only therapeutic option for the treatment of MS. Materials and Methods. The number of missed doses was calculated as a difference between the number of doses a patient had to withdraw from the treatment start to the cut-off date and the real number of doses taken from the MS unit. Missed doses were compared to gender, age, time since the diagnosis, time from the diagnosis to the treatment start, clinical type of MS, expanded disability status scale (EDSS), and duration of the treatment. Results. The adherence rate during the follow-up period was 73.8%. Patients above 40 years of age (P<0.005), higher EDSS (P<0.001), longer duration of the disease (P<0.001), longer waiting time from the diagnosis to the treatment initiation (P<0.001), and longer time on interferons (P<0.001) had lower adherence rates to the treatment. Conclusions. The findings were in correlation with studies that have used similar criteria for the determination of adherence and supported reports that adherence rate decreases with time and poses a challenge to the overall efficacy of the treatment.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：