Search

In May 2023 WHO declared the end of the COVID-19 pandemic, and it is now time to make a balance of what happened and to evaluate what is going to happen in the future. It is estimated that COVID-19 caused over 7 million deaths worldwide. Mortality was significantly reduced with vaccine use, but it remains high in the elderly. Even hospital admissions, and in particular in intensive care, were declining with vaccine diffusion; in the first half of the current year the reduction was progressively evident. It is however wrong to think that COVID-19 is like a flu: mortality remains significantly higher than flu, and in the year after the disease there is an increased risk of death, cardiovascular problems, neurological events, worsening of neurocognitive status and alterations in lipid metabolism. The pandemic has represented a significant increase in the volume of tests for laboratory medicine, with several organizing problems that should be appropriately managed in the event of future emergencies. Even if the worst scenario of COVID-19 is over, both for vaccine protection and for the diffusion of less aggressive variants of the virus, the SARS-CoV-2 is and will be a persisting presence. There is a need for a monitoring of its diffusion, a surveillance on new and potentially worse variants, to avoid the repeating of a tragedy or the rise of a new one. [ABSTRACT FROM AUTHOR]

Background: Congestive heart failure (CHF) associated with worsening renal function is a very common disorder, and, as well known, the goal of the treatment is reducing venous congestion and maintaining a targeted extracellular volume. The objective of the study is to evaluate regular peritoneal ultrafiltration treatment compared to a standard conservative approach in NYHA III–IV CHF patients. In particular, the primary endpoints of the study were the major event-free survival and the total days of medical care per month (which consist of the days of hospitalization and the number of outpatient visits). Material and Methods: This is a retrospective case-control study. Twenty-four patients were included in the present study. Twelve consecutive patients were treated with peritoneal treatment (group A) and 12 matched for age, gender, and severity of disease with a standard approach. Patients were observed over a maximum period of 18 months. Information on events, hospitalizations, and number of visits was collected during follow-up. Results: During the follow-up, we observed a major event in 4 patients in group A (33.3%) and in 8 patients in group B (66.7%). In group B, we observed 7 deaths and 1 ICD shock, while in group A, 3 deaths and 1 ICD shock. The number of visits per month was significantly lower in patients treated with the peritoneal method (1.2 [0.4–4.1] vs. 2.5 [2.0–3.1]; p = 0.03). The total days of medical care was significantly lower in group A (2.0 [1.1–5.5] vs. 4.4 [3.0–8.7]; p = 0.034). A multiple event analysis according to the Andersen-Gill model showed a significant event-free survival for group A. During the follow-up, we did not observe any episode of peritonitis in the treated group. Conclusions: Our study shows that the peritoneal technique is a good therapeutic tool in well-selected patients with CHF. In accordance with prior experience, this intervention has not only an important and significant clinical impact but also potential economic and social consequences. [ABSTRACT FROM AUTHOR]

Aims: To address the following questions: (1) Which words are preferred by different groups of orofacial pain patients to describe their pain experience? (2) Is it possible, based on such descriptions, to obtain a clinical differential diagnosis in these patients? (3) Is there any relationship between the verbal description of pain and self-rated quality of life (QOL)? (4) Can a pattern of modulation of pain language by affective variables diffusion model) be recognized in orofacial pain patients, as it has in other chronic pain patients? and (5) If so, what might be the clinical usefulness of assessing pain language in these patients? Methods: A total of 332 consecutive orofacial pain patients filled out an Italian Pain Questionnaire (the Italian analog of the McGill Pain Questionnaire) and were then divided into 6 diagnostic subgroups (sample 1) based on history and clinical findings. In a double-blind setting, the distribution of pain descriptors and indexes was statistically evaluated. From sample 1, a randomly selected sample of 121 patients (sample 2) also filled out a QOL categorical scale. The results of both tests in this sample were compared statistically. Results: Some significant differences among diagnostic subgroups were found for choice of descriptors and for pain intensity. When a patient's pain description was compared to the corresponding self-evaluation of QOL, a self-perceived worsening of QOL revealed a good correlation with an increase in the number of words chosen, pain intensity, and affective and sensory pain descriptors. A similar significant association was found between self-assessed anxiety and/or depression and the same items. Conclusion: Although trends in patients' choice of descriptors were evident, differential diagnosis based on only a pain questionnaire was not possible in the different groups of orofacial pain patients examined in this study. The present study suggests the presence of a phenomenon of diffusion in the language of those patients who were experiencing a worsening of their QOL as a result of pain and consequent psychologic distress. This observation can be of clinical usefulness by enhancing the sensitivity of the clinician to the suffering and affective distress experienced by the patient, and it also can be helpful in refining the herapeutic approach for each individual patient [ABSTRACT FROM AUTHOR]

Background Sympathetic activation in heart failure patients favors the development of ventricular arrhythmias, thus leading to an increased risk of sudden cardiac death. β1- and β2-adrenergic receptor polymorphisms have been linked to the risk of sudden death. Implantable cardioverter-defibrillators (ICD) are implanted in a large percentage of heart failure patients, and beyond preventing sudden cardiac death they provide a continuous monitoring of major ventricular arrhythmias and of their own interventions. We investigated whether functionally relevant β1- and β2-adrenergic receptor polymorphisms are associated with risk of ICD shocks, as evidenced in ICD memory. Methods 311 patients with systolic heart failure were enrolled, and number and timing of shocks in ICD memory were recorded. Four selected polymorphisms were determined: β1-adrenergic receptor polymorphisms Ser49Gly and Arg389Gly and β2-adrenergic receptor polymorphisms Arg16Gly and Gln27Glu. Results Only Ser49Gly was significantly correlated with time free from ICD shocks, both considering time to the first event in a Cox model (hazard ratio 2.117), and modeling repeated events with the Andersen-Gill method (hazard ratio 2.088). Gly allele carriers had a higher probability of ICD shock. The relationship remained significant even after adjusting for ejection fraction and beta-blocker dosage (hazard ratio 1.910). Conclusions Data from our study suggest that the β adrenoreceptor Gly 49 allele of the β1-adrenergic receptor Ser49Gly polymorphisms may increase the risk of ICD shock in patients with heart failure, independent of beta-blocker dosage. [ABSTRACT FROM AUTHOR]