Archivio Istituzionale della Ricerca- Università degli Studi di Foggia
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Wernicke’s encephalopathy after emergency cholecystectomy and hepatic arterial embolization: A radiological and critical care challenge
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Ten questions on hormone replacement therapy and cardiovascular risk
No full textThe impact of hormone replacement therapy (HRT) on the cardiovascular (CV) system in menopausal women has been the subject of significant debate for many years. After a phase marked by restrictive use following the outcomes of the first randomized trials in the 2000s, the last decade has witnessed a significant reassessment of the risks and benefits of therapy, especially CV risk. Thanks to new studies conducted in more selected populations and sub-analyses of earlier trials, there is now ample evidence regarding the high safety profile of HRT, and even protection on the CV system, for young women with a low CV risk profile in the early menopausal phase. This evidence has been incorporated into all national and international menopausal guidelines and, recently, also in a consensus document by the European Society of Cardiology. Therefore, the cardiologist assumes a central role in the risk assessment and treatment of modifiable CV risk factors during the menopausal transition, a critical period for women as it is associated with significant changes in the glycometabolic balance. This article summarises current knowledge on the subject and provides practical guidance for the cardiological management of such patients
SIEVE: Generating a cybersecurity log dataset collection for SIEM event classification
No full textEffective cyber threat monitoring relies on deploying robust Security Information and Event Management (SIEM) systems. SIEM applications receive security events generated by different devices, systems, and applications. They should properly correlate them to identify potential cyber threats based on tactics, techniques, and procedures (TTP), bypassing other security mechanisms (e.g., firewall, IDS, etc.). Given that logs are primarily generated to notify relevant system events and activities in a human-readable format, supervised Natural Language Processing (NLP) techniques could be used to train models that complement conventional parsing methodologies by automatically suggesting event classification into pre-defined categories. Training such models requires a substantial amount of pre-classified (labeled) data of different types to provide the learning patterns and nuances needed to make accurate predictions. Since the number of security event datasets is scarce due to privacy or availability reasons, and the few publicly available ones are often limited in terms of event diversity, number of labels, or simply unfit for the task at hand, an effective synthetic dataset for training SIEM-related machine learning event classification algorithms could be very useful. For these reasons, this paper proposes the generation of a synthetic dataset specifically designed to train SIEM systems for log-type classification. This research paper, starting from an in-depth methodological analysis of the prominent Cybersecurity related datasets available in the literature, introduces SIEVE (Siem Ingesting EVEnts), a synthetic dataset collection built from publicly available log samples using SPICE (Semantic Perturbation and Instantiation for Content Enrichment), a novel text augmentation and perturbation technique. SPICE is shown to be effective in generating realistic logs. Each instance of the dataset collection displays different levels of augmentation. Subsequent performance assessments were conducted through comprehensive benchmarking against various NLP classification models. Tests were conducted by training the classifiers using SIEVE and testing them on both the same SIEVE logs and real logs. The results of the experiments show that the best model among those tested is SVM (MaF1 0.9323 - 0.9737), which maintains its performance with slight degradation, even in tests on real logs (MaF1 0.9477 - 0.9636). BERT, on the other hand, performs better than SVM in most of the tests on SIEVE (MaF1 0.9528 - 0.9730) but does not show robustness when tested on real logs (MaF1 0.8864 - 0.9182)
How to handle polypharmacy in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC
No full textThe multiplicity of coexisting comorbidities affecting patients with heart failure (HF), together with the availability of multiple treatments improving prognosis in HF with reduced ejection fraction, has led to an increase in the number of prescribed medications to each patient. Polypharmacy is defined as the regular use of multiple medications, and over the last years has become an emerging aspect of HF care, particularly in older and frailer patients who are more frequently on multiple treatments, and are therefore more likely exposed to tolerability issues, drug–drug interactions and practical difficulties in management. Polypharmacy negatively affects adherence to treatment, and is associated with a higher risk of adverse drug reactions, impaired quality of life, more hospitalizations and worse prognosis. It is important to adopt and implement strategies for the management of polypharmacy from other medical disciplines, including medication reconciliation, therapeutic revision and treatment prioritization. It is also essential to develop new HF-specific strategies, with the primary goal of avoiding the use of redundant treatments, minimizing adverse drug reactions and interactions, and finally improving adherence. This clinical consensus statement document from the Heart Failure Association of the European Society of Cardiology proposes a rationale, pragmatic and multidisciplinary approach to drug prescription in the current era of multimorbidity and ‘multi-medication’ in HF
Impact of immunosuppressive therapy on pulmonary perfusion in kidney transplant recipients after COVID-19 illness
No full textIntroduction: Patients who have received kidney transplants (KTR) are considered to be more susceptible to the severity of COVID-19-related illness. The transplanted patient’s respiratory outcome worsened because of the ventilation-perfusion mismatch that occurs during the infection, which has been linked to endothelial damage. In this context, a reduction in immunosuppressive therapy is advisable to improve patient outcomes. However, the prognosis and suggested treatment for these types of patients are still debated. Methods: We retrospectively analyzed 48 KTRs with stable graft function on calcineurin inhibitor therapy who underwent transient modification of the maintenance immunosuppressive regimen with withdrawal of mycophenolic acid/mycophenolate mofetil or mTOR inhibitor (mTORi) during COVID-19 infection and their reintroduction after healing. Pulmonary functional tests (EGA and spirometry) and DECT (Dual-energy CT) scans were performed 1 month following the negative nasopharyngeal swab (T0) and then after 6 months (T6). Results: The presence an mTOR inhibitor in immunosuppressive therapy was associated with a significant increase in lung perfusion for the entire lung parenchyma of the mTORi-treated group, both in each lung segment considered separately and all of them together. Conclusion: Our findings are consistent with the observation that the use of mTORi could play a potentially beneficial role in improving pulmonary perfusion