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Cartella di rilevazione dati relativi a soggetti esposti a rumore in ambiente lavorativo
No full textProposta di una cartella clinica computerizzata per soggetti esposti a rumore in ambiente industriale
No full textA new hypothesis of computerized case sheet for factory worker.
The aim of our study is to unify the reliability of pathogenetical attribution concerning the possible effects of acoustic pollution, with the help of a data filing system connected with each of the examined subjects.
We have planned a software by which we'll be able to manage a matching between a factory workers group and a reference group, in order to evaluate the audiological damage of the elements concerning socioacusy, as well as the possible hearing
loss of the single subject due to the industrial noise via O.N.E.S.T. (Oto-Neural Efficiency Stress Test)
Results of antihypertensive treatment by primary and secondary care physicians as assessed by ambulatory blood pressure monitoring
No full textBackground We present data from a cross-sectional study on consecutive non-randomized drug-treated mild-to-moderate essential hypertensives, whose blood pressure was ambulatorily monitored for 24 h to evaluate the presence of adequate control. Design Primary and secondary care physicians were invited to send to our clinic drug-treated patients with essential hypertension (JNC VI stages 1 - 2) to undergo 24-h ambulatory blood pressure monitoring (ABPM) while continuing their prescribed medications. Methods The 436 enrolled patients (255 males, 181 females, age 61 +/- 11 years) were left on their therapeutic regime: monotherapy in 208 patients (47.7%) and combination therapy in 228 patients (52.3%). All the patients were divided into two care groups: primary care, 238 patients (54.6%) and secondary care, 198 patients (45.4%). A mean daytime blood pressure less than or equal to 135/85 mmHg was chosen as a definition of adequate blood pressure control. Results Adequate blood pressure control was found in 196/436 total patients (45%); 112/238 patients in primary care (47%) and 84/198 patients in secondary care (42.4%) (P = NS); 94/208 patients (45.2%) in monotherapy and 102/228 patients (44.7%) in combination therapy (P = NS); 125/255 male patients (49%) and 71/181 female patients (39.2%) (P = 0.0428). In the logistic regression model, female sex was associated with a higher risk of inadequate blood pressure control of about 50%. Conclusions Adequate blood pressure control, as assessed by ABPM, is not different in the two settings of family doctor's office and specialist's clinic and is predicted by male gender. The figures of adequate blood pressure control remind us of the rule of halves, regardless of treatment regimes and medications. (C) 2000 Lippincott Williams & Wilkins
Is there still a role for Glycoprotein IIb/IIIa antagonists in acute coronary syndromes?
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Kidney dysfunction and long-term outcome in post-PCI acute coronary syndrome patients treated by high-dose tirofiban: the role of creatinine clearance.
No full textLong-term efficacy of high-dose tirofiban versus double-bolus eptifibatide in patients undergoing percutaneous coronary intervention
No full textDecline in platelet count and long-term post-PCI ischemic events: implication of the intra-aortic balloon pump.
No full textThrombocytopenia (TC) following a percutaneous coronary intervention (PCI) has been associated not only with hemorrhagic, but also with ischemic outcomes. The purpose of this study was to re-examine the relationship of TC with ischemic events at a 1-year follow-up, and investigate the possible associations.We studied a real-world, unselected population of ischemic patients undergoing PCI, totaling 861 patients-year, and divided into two groups: with TC (delta platelet count ≥25\% from baseline to post-PCI during the hospital admission) and without TC. Compared with patients without TC, patients with TC had a higher and earlier incidence of both hemorrhagic and ischemic events. In them, the use of intra-aortic balloon pump (IABP) was ten-fold higher. In Kaplan-Meier curves assessing the contribution of both TC and IABP to outcome, IABP was a univariate detrimental factor additive to the role of TC. In a forced Cox model, the relative decline (delta) in platelet count (p=0.05) and the use of IABP (p=0.0001) were both associated with ischemic outcomes. After excluding all patients with IABP, the delta platelet count was no longer significantly associated with ischemic outcomes (p=0.66). After excluding all patients with shock and all those who undergone thrombolysis, there was still a relationship (p=0.0042) between the delta platelet count and ischemic events.In this patient population the use of IABP, but not thrombocytopenia per se, is a possible primary cause of worse ischemic outcomes
The role of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes and the interference with anemia
No full textThe role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowed. However, GPI may still have a role. Several criteria were proposed to define post-PCI anemia which is strictly related to bleeding and transfusion. In ACS, it should be important to define anemia in comparative terms versus baseline levels: ≥ 15% of red blood cell decrease should be a practical cut-off value. If one wishes to concentrate on hemoglobin (Hb), a≥2g/dl Hb decrease from baseline should be considered. It is important to recognize post-PCI anemia in the setting of ACS. There are sub-populations exposed to short-term hemorrhagic and/or long-term ischemic risks. Ischemic and hemorrhagic risks need to be carefully evaluated along with thrombocytopenia and its prognostic significance in order to put all these blood and rheological parameters into a clinically oriented perspective on which therapeutical decisions should be based. Definition of high risk procedures (complexity, angiographic characteristics and patient's risk profile, regardless whether STEMI or NSTEMI) may help selecting GPI. There are positive elements in GPI use: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration. All these elements should be evaluated when selecting these agents for therapeutics
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