1,721,134 research outputs found
Seasonal variation in the occurrence of delirium in patients admitted to medical units of a general hospital in Italy
No full textObjective
Delirium syndrome is common in the hospitalized population. However, data on its etiological factors are scarce. Clinical observations suggest a relationship between delirium occurrence and seasons. The aim of study was to determine whether a seasonal variation exists in the occurrence of delirium events in-hospital patients.
Methods
The study included all admissions to the Medical Units of the Hospital of Ferrara, Italy, between January 2002 to December 2010. On the basis of date admission, cases have been analysed for seasonal variation (4 three-month intervals by seasons) by means of conventional statistics. Moreover, cases categorized into 12 one-month intervals were also analyzed by means of a validated chronobiologic inferential method (single cosinor) to search for cyclic variability.
Results
During the analyzed period, the hospital database contained 74,379 records referring to 42,625 subjects (52.7% females). Delirium diagnoses were 1,300 (1.7% of total sample), 668 of whom in females (51,4%), and 632 in males (48,6%). Events of delirium were more frequent in winter and autumn (26.6% and 26.5%, respectively) than in spring (23.5%) and summer (23.4%). Chronobiological analysis yielded a significant peak of delirium events in January, when considering both the total raw number of cases or the percent of admissions.
Conclusions
The study seems to indicate in patients hospitalized in Medical Units, a higher rate of occurrence of delirium in autumn-winter, similar to that reported for acute medical diseases. The role of possible underlying favoring or triggering factors deserves further research
Temporal variation of cardiovascular diseases: an internal biological rhythm disruption may play a role?
No full textA growing body of evidence has accumulated showing that fall and especially winter months represent a high-risk temporal frame for occurrence of various cardiovascular diseases. The possibility that a molecular circadian clock intrinsic to the cardiomyocyte, may contribute to cardiovascular disease secondary to a rhythm dyssinchrony, driven by either external and internal cues, and represents an innovative way of thinking about cardiovascular diseases
Thrombolysis and pulmonary embolism presenting with cardiac arrest
No full textThis letter to the editor discusses the opportunity of thrombolysis in patients with pulmonary embolism presenting with cardiac arrest
Seasonal variation in herpes zoster infection
No full textThis original letter first report the existence of a seasonal pattern in the occurrence of herpes zoster infection
La forma e l'armonia come strumenti per liberare l'individualità
No full textL’apprendimento dei Kanji richiese percorsi di formazione pluriennali uniti ad uno sforzo sovraumano, dovuti al fatto che, ai tempi, la lingua cinese era del tutto sconosciuta alla maggior parte della popolazione giapponese. I suddetti percorsi di formazione vennero affidati alla prima generazione di docenti di scrittura della storia nipponica, ovvero ai discendenti di immigrati cinesi e coreani di stanza in Giappone detti Fumihito (“scribi”) che per primi si posero come intermediatori linguistici tra la lingua cinese e quella giapponese13. Ai fini della didattica della lingua, gli scribi dovettero creare nuovi percorsi di adattamento degli ideogrammi per fare in modo che le esigenze della nuova scrittura incontrassero quelle del giapponese antico. Fu in quel particolare momento storico che il concetto di modularità dell’apprendimento si rivelò imprescindibile. Al fine di poter interiorizzare la scrittura, infatti, si rese necessario operare in due direzioni: quella della forma e dello stile
Flumazenil-induced seizures in ignored chronic benzodiazepine use and concomitant severe hyponatremia. A case report
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Therapeutic potential of apixaban in the prevention of venous thromboembolism in patients undergoing total knee replacement surgery
No full textAnticoagulant prophylaxis for preventing venous thromboembolism (VTE) is a worldwide established procedure in hip and knee replacement surgery. Despite available anticoagulant prophylaxis, patients who undergo total knee arthroplasty (TKA) have a high incidence of venous VTE. In spite of their proven efficacy, the currently available anticoagulants have limitations that driven to develop new oral agents that directly target specific factors in the coagulation cascade, such as direct thrombin inhibitors and direct Factor Xa inhibitors, in an attempt to overcome some of the drawbacks with the traditional agents. Apixaban is a potent, selective direct inhibitor of the coagulation factor Xa, recently approved in Europe for the prevention of venous thromboembolism (VTE) in adult patients after total hip replacement (THR) or total knee replacement (TKR) surgery. Apixaban has been extensively studied worldwide in about 12,000 patients in four clinical studies that have demonstrated the efficacy and safety of apixaban respect to enoxaparin for the prevention of thromboembolism after major orthopedic surgery. Three of these trials involved 7,337 patients who undergo TKR: one phase II trial (APROPOS Study) and two large phase III trials (ADVANCE 1 and ADVANCE 2 Studies). ADVANCE 1 demonstrated that when compared with enoxaparin 30 mg twice daily for efficacy, apixaban did not meet the prespecified statistical criteria for noninferiority, but its use was associated with lower rates of clinically relevant bleeding. ADVANCE 2 showed that apixaban was superior to the European standard dose of enoxaparin of 40 mg once daily in term of efficacy, with a similar incidence of major bleeding. This review focuses the clinical efficacy and tolerability of oral apixaban for the prevention of VTE in adult patients following TKR surgery
ABO blood groups and venous thromboembolism in a cohort of 65,402 hospitalized subjects.
No full textSeveral studies documented an association between thrombosis and ABO blood groups. In particular, non-O blood groups showed a higher risk of myocardial infarction, angina, peripheral vascular disease, cerebral ischemia, and venous thromboembolism (VTE) than O group. We sought to investigate, in a large sample of hospital admissions, the possible association between blood groups and VTE. The study was based on the discharge hospital sheets (DSOs) of patients admitted to the Hospital of Ferrara, region Emilia-Romagna (RER), Italy, 2000 and 2011. We selected all patients with first or second discharge ICD-9-CM diagnosis code of: acute pulmonary heart disease (APHD); pulmonary embolism (PE); phlebitis and thrombophlebitis (PVT); other venous embolism and thrombosis (OVET).Total population was divided into subgroups by gender, age, and presence of risk factors: arterial hypertension, diabetes, overweight-obesity, dyslipidemia, homocystinemia, coagulation defects, gout, and cancer. Moreover, we considered all patients in whom a blood group determination was recorded. There were 345,607 admissions, regarding 164,438 different patients. Of these, 65,402 had their blood group determination. Among these patients, 1,270 had a PE, 828 had a PVT, and 923 had an OVET. In the multivariate analysis, patients with non O blood group, and with A-allele, had a significantly higher risk for VTE (p=0.001) whereas the presence of group O appeared to be protective (p=0.001). This study shows an increased VTE risk in subjects with non O-groups genotypes, ranging from 20% to 35%. In the real world of everyday medical practice, the decision of whether to test for thrombophilia patients with VTE is controversial, due to organizational and economic constraints. Given the social utility of having one’s own blood group determination, and considering the prevalence of non-O blood groups, this could provide general practioners a valid, and relatively inexpensive, first-line tool to evaluate thrombophilic risk
Interventional Approaches in VTE Treatment (Vena Cava Filters, Catheter-Guided Thrombolysis, Thrombosuction)
No full textVenous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular pathology after coronary disease and cerebrovascular diseases and is responsible for significant morbidity and mortality in the general population. Full-dose anticoagulation is the standard therapy for VTE, both the acute phase and the prolonged treatment. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractionated heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA), or systemically administered thrombolytics for most of the patients with objectively confirmed VTE. Catheter-guided thrombolysis and thrombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences, despite optimal anticoagulation. This review summarizes the currently available literature regarding interventional approaches in VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction), discusses their efficacy and safety, and reviews the appropriate indications for their use in daily clinical practice
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