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Efficacy of Calcipotriol/Betamethasone Ointment in Facial Discoid Dermatosis
No full textFacial Discoid Dermatosis (FDD) is a rare chronic skin condition characterised by persistent, annular erythematous and desquamative papules on the face. Its aetiology is unclear, making differential diagnosis challenging. Key clinical features include pink-orange, minimally scaling lesions limited to the face, sudden onset with long-term stability, and resistance to treatment. We report a new case of FDD in a patient in his late 30's, unresponsive to various treatments until improvement with topical calcipotriol/betamethasone ointment. A review of 22 cases reveals a female predominance and broad age range. Histopathology consistently shows hyperkeratosis, parakeratosis, acanthosis, psoriasiform hyperplasia, follicular plugging, and perivascular lymphocytic infiltrate. Many cases, including ours, also reported the presence of abundant Demodex folliculorum
An integrated approach to monitor disease activity in inflammatory idiopathic myopathies (IIM)
No full textinflammatory idiopathic myopathies (IIM)Ingles
Evaluating the impact of artificial intelligence in antimicrobial stewardship: a comparative meta-analysis with traditional risk scoring systems
Get PDFObjectives: The growing challenge of antimicrobial resistance (AMR) has underscored the urgent need for robust antimicrobial stewardship programs (AMS). Artificial intelligence (AI) and machine learning (ML) have emerged as promising tools to support enhanced decision-making in AMS. This systematic review and meta-analysis aims to evaluate the impact of AI in AMS and compare its effectiveness with traditional risk systems. Methods: PubMed/MEDLINE, Scopus, EMBASE, and Web of Science were searched to identify studies published up to July 2024. Any studies that evaluated the use of AI/ML in AMS compared with conventional decision-making approaches were eligible. Outcomes of interested were predictive performance metrics and diagnostic accuracy. The meta-estimate was performed pooling standardized mean difference, and effect size (ES) measured as Cohen's d with a 95% confidence interval (CI). The risk of bias was assessed using the QUADAS-AI tool. Results: Out of 3,458 studies, 27 were included, demonstrating that ML models outperform traditional methods in terms of sensitivity [1.93 (0.48–3.39) p = 0.009], and negative predictive value [1.66 (0.86–2.46), p < 0.001] but not in terms of area under the curve, accuracy, specificity, positive predictive value, when random effect models were applied. Conclusions: Our results revealed that ML tools offer promising enhancements to traditional AMS strategies. However, high heterogeneity, inconsistent results between fixed and random effect models, and limited use of external validation in retrieved studies raise concerns about the generalizability of the findings. Furthermore, the lack of representation from outpatient and pediatric settings highlights a critical equity gap in the application of these technologies
Intravenous amino acids for renal protection in patients receiving temporary mechanical circulatory support: a secondary subgroup analysis of the PROTECTION study
No full textObjectives: In cardiac surgery patients, acute kidney injury (AKI) frequently occurs in the setting of haemodynamic instability and treatment with temporary mechanical circulatory support (tMCS). Recent evidence suggests amino acids (AA) infusion may reduce AKI rate. However, the effect of AA infusion in patients requiring tMCS may be less effective. Methods: We performed a secondary analysis of the PROTECTION multicentre randomized controlled trial including all patients treated with tMCS. Patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive 2 g/kg ideal body weight/day of intravenous AA to a maximum of 100 g/day or matching placebo from operating room admission until up to 3 days, receipt of renal-replacement therapy, discharge from ICU or death. The primary outcome of the PROTECTION study was the rate of AKI, as in this secondary analysis. A total of 3511 patients were randomized in the study. Results: We studied 232 patients who received tMCS, 112 randomized to AA infusion and 120 to placebo. The median preoperative serum creatinine value was significantly higher among AA group patients (AA: 1.08, interquartile range 0.90-1.26; placebo: 0.98, interquartile range 0.85-1.15; P = 0.02). The rate of AKI, however, was lower in patients randomized to AA (44.6% vs 60.8%; relative risk 0.73; 95% confidence interval (0.57-0.94); P = 0.01; number needed to treat = 6). We found no significant differences in secondary outcomes. Conclusions: Short-term AA infusion appears to reduce rate of AKI among patients requiring tMCS. Use of AA in this population at high-risk for renal failure appears justified. Clinical trial registration number: ClinicalTrials.gov NCT03709264.OBJECTIVES: In cardiac surgery patients, acute kidney injury (AKI) frequently occurs in the setting of haemodynamic instability and treatment with temporary mechanical circulatory support (tMCS). Recent evidence suggests amino acids (AA) infusion may reduce AKI rate. However, the effect of AA infusion in patients requiring tMCS may be less effective. METHODS: We performed a secondary analysis of the PROTECTION multicentre randomized controlled trial including all patients treated with tMCS. Patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomized to receive 2 g/kg ideal body weight/day of intravenous AA to a maximum of 100 g/day or matching placebo from operating room admission until up to 3 days, receipt of renal-replacement therapy, discharge from ICU or death. The primary outcome of the PROTECTION study was the rate of AKI, as in this secondary analysis. A total of 3511 patients were randomized in the study. RESULTS: We studied 232 patients who received tMCS, 112 randomized to AA infusion and 120 to placebo. The median preoperative serum creatinine value was significantly higher among AA group patients (AA: 1.08, interquartile range 0.90-1.26; placebo: 0.98, interquartile range 0.85-1.15; P = 0.02). The rate of AKI, however, was lower in patients randomized to AA (44.6% vs 60.8%; relative risk 0.73; 95% confidence interval (0.57-0.94); P = 0.01; number needed to treat = 6). We found no significant differences in secondary outcomes. CONCLUSIONS: Short-term AA infusion appears to reduce rate of AKI among patients requiring tMCS. Use of AA in this population at high-risk for renal failure appears justified
Critique and utopia. From Kant to the Frankfurt School
No full textThis book has two main objectives: the first is to propose a new and different classification of the forms of critique as developed by the so-called Frankfurt School (or School of Frankfurt), closely related to the classic authors of this School; the second is to outline the profile of an innovative version of critique, the utopian critique, which is offered as a complement to the others. The two objectives are respectively pursued in the two parts of the volume, which present a natural logical connection. The reasons that led me to propose a utopian form of critique derive from the perception of a certain incompleteness of its prevalent forms, that is, a limited propositional capacity, which contrasts with the inescapable practical attitude of critical thought. Thus, the classification of the forms of critique that I propose aims to frame the attempt to integrate these with the dimension of utopia, often evoked but very rarely articulated constructively. I did not intend to make an exhaustive historical reconstruction of the concept of critique in Frankfurt theory, but only to highlight some recurring models of the critical method, in order to identify some limits and articulate a method that seems to me to be underdeveloped but useful for an effective critique
Registries on transcatheter edge-to-edge repair in heart failure: Current evidence and future perspectives
No full textAims: Secondary mitral regurgitation (SMR) and tricuspid regurgitation (TR) are the most common valvular heart diseases in patients with heart failure (HF). Transcatheter edge-to-edge repair (TEER) devices designed for treating MR and TR have been successfully tested in randomized controlled trials, but methodological issues have often challenged their interpretation. This manuscript aimed to provide an overview of TEER registries on SMR and TR in HF, highlighting their key features, describing clinical characteristics and outcomes of patients receiving these devices, and exploring the available data limitations. Methods and results: PubMed, Web of Science, and EMBASE were searched for registries reporting on TEER in SMR or TR. Registries were excluded if single-centre and with <100 patients. Twenty-six registries (46% prospective, 12% ongoing), including a total cohort of 18 925 patients, were retrieved for TEER in SMR, and six registries (50% retrospective, 33% ongoing) reported on the use of TEER for TR in a total cohort of 1412 patients. Limited geographical representativity outside North America and Europe, high number of missing values, and inconsistency in data reporting were the main existing evidence limitations. Conclusion: Registries on TEER represent a key data source in a setting where it is difficult to conduct randomized controlled trials. However, limitations in design, patient characterization, and outcomes reporting restrain their use. A novel conceptual framework for future prospective TEER registries, as proposed in this document, might inform current practice, address relevant clinical questions and future trial design
Endoscopic ultrasound-guided choledochoduodenostomy versus hepaticogastrostomy combined with gastroenterostomy in malignant double obstruction (CABRIOLET_Pro): A prospective comparative study
Get PDFObjectives: Malignant double obstruction, defined as the simultaneous presence of biliary and gastric outlet obstruction, represents a challenging clinical scenario. Previous retrospective experiences have demonstrated shorter dysfunction-free survival (DyFS) of endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) versus EUS-hepaticogastrostomy (EUS-HGS) in this setting, but no prospective evidence is available. Methods: Twenty consecutive patients with malignant double obstruction, treated with EUS-gastroenterostomy (and EUS-guided biliary drainage, following a previously failed ERCP, were enrolled in a prospective observational study (ClinicalTrials.gov NCT04813055) comparing EUS-CDS versus EUS-HGS. Efficacy and safety were evaluated, with Biliary Dysfunctions as the primary outcome and DyFS using Kaplan-Meier estimates as a primary measure. Results: Twenty patients (75% with pancreatic cancer, 50% with metastatic disease) with EUS-gastroenterostomy were included (seven EUS-CDS and 13 EUS-HGS). No significant difference was detected at baseline. Technical success was 100% in both groups. EUS-CDS compared to EUS-HGS showed similar clinical success (100% vs. 92.3%, p = 0.5), a higher rate of post-procedural adverse events (42.9% vs. 7.7%, p = 0.067, mostly related to severe/fatal cholangitis in the EUS-CDS group) and a higher rate of biliary dysfunctions during follow-up (71.4% vs. 16.7%, p = 0.002). DyFS was significantly shorter in the EUS-CDS group (39 [15–62] vs. 268 [192–344] days, p = 0.0023), with a 30-days DyFS probability of 57.1% vs. 100% (hazard ratio = 7.8 [1.4–44.2]). Conclusions: In this prospective comparison of patients with malignant double obstruction undergoing EUS-gastroenterostomy, treating jaundice with EUS-CDS versus EUS-HGS resulted in a reduced probability of survival without biliary events and an increased risk of biliary dysfunctions (number needed to harm = 1.8), with detection of severe/fatal cholangitis
Statistical Analysis of fMRI Data
No full textfMRI is a powerful tool used in the study of brain function. It can noninvasively detect signal changes in areas of the brain where neuronal activity is varying. This chapter is a comprehensive description of the various steps in the statistical analysis of fMRI data. This will cover topics such as the general linear model (including orthogonality, hemodynamic variability, noise modeling, and the use of contrasts), multi-subject statistics, and statistical thresholding (including random field theory and permutation methods, as well as a discussion of some recent controversies about correction for multiple comparisons of statistical models)
Early bevacizumab dose and time modifications may affect efficacy of atezolizumab plus bevacizumab for advanced hepatocellular carcinoma treatment
No full textBackground: Atezolizumab (1200 mg) plus bevacizumab (15 mg/kg) every 3 weeks (AtezBev) became a standard-of-care first-line treatment for advanced hepatocellular carcinoma (aHCC) following IMbrave150. However, real-world data suggest milder efficacy. Early bevacizumab interruption due to adverse events (AEs) is a frequent occurrence in real-world scenario associated with poor prognosis. Additionally, early bevacizumab dose/time modifications (eBEVmod) may negatively impact outcome. Materials and methods: Data from AtezBev-treated aHCC patients (n = 100) in five Italian institutions were retrospectively analyzed. Cumulative bevacizumab dose (mg/kg) received in the first 3 months of treatment was analyzed by receiver operating characteristic (ROC) to identify a cut-off value to estimate survival and dichotomize the variable. Baseline clinical and laboratory characteristics were analyzed with uni-/multivariate models to explore potential differences on overall survival (OS), objective response rate (ORR) and disease control rate (DCR) based on eBEVmod. Progression-free survival (PFS) was a secondary endpoint. Results: In the overall population, the median (m) follow-up was 11.4 months, mOS was 20.5 months, mPFS was 10.4 months, ORR was 31% and DCR was 75%. ROC on 3-month cumulative bevacizumab dose revealed an area under the curve of 0.74 (P = 0.001) and eBEVmod cut-off of <45 mg/kg/3 months (i.e. 10.5 mg/kg/3 weeks) having 73% sensitivity and specificity in predicting death. Twenty-three percent of patients had eBEVmod (of which 39.1% had treatment delay, 39.1% discontinuation and 21.7% dose reduction), with no differences in baseline characteristics nor second-line treatments compared with non-eBEVmod, except for sex. eBEVmod patients had inferior ORR/DCR (14%/48% versus 36%/82%) and increased risk of death [hazard ratio (HR) 4.2, P = 0.0049], with a 12-month survival probability of 53.3% versus 77.4%. eBEVmod was an independent negative prognostic factor of survival at multivariate analysis (HR 3.3, P = 0.0125). Patients with eBEVmod also had a trend in worse PFS, although not statistically significant (mPFS 3.8 versus 12.6 months, HR 1.8, P = 0.0774). Conclusions: eBEVmod is an independent unfavorable prognostic factor of response and survival in AtezBev-treated aHCC patients. Optimization of bevacizumab AE management to reduce eBEVmod may substantially improve treatment outcome in real-world practice
