265 research outputs found
Dabigatran anticoagulation and Stanford type A aortic dissection: not a lethal coincidence.
No full textDear Sir,
We appreciate the opportunity to comment on the Letter to the Editor concerning “Dabigatran and Stanford type A dissection: not a lethal coincidence” by Marchetti et al.[1] They refer to a female patient with a Stanford type A dissection and therapeutic dabigatran anticoagulation. In our original case report,[2] the patient died due to uncontrolled bleeding in the context of therapeutic plasma levels of dabigatran even after multiple exchange transfusions and more than 24 h after the last oral dabigatran intake.
Marchetti et al.'s patient had a favourable outcome with a change in management in that they treated the patient pre-operatively with haemodialysis and only operated when the dabigatran plasma concentration decreased below 100 ng/ml. We proposed this procedure to avoid exsanguination due to severe coagulopathy at high dabigatran plasma concentration, but never had the chance to test the efficacy of this by ourselves.
Interestingly, dabigatran plasma levels also started to increase due to redistribution after stopping the haemodialyis, as we had observed,[2] and also Chang et al[3] had described. Therefore, continuous haemodialysis is necessary to maintain dabigatran clearance and stable plasma levels.
At a dabigatran plasma concentration of 100 ng/ml, Marchetti et al. used FEIBA to improve blood coagulation. However, FEIBA is neither designed nor sufficiently tested in the context of dabigatran-induced coagulopathy, and the coagulation boost can be lethal during extracorporeal circulation, which jeopardizes indication and timing of its application. Moreover, in a very similar case FEIBA neither normalized clinical bleeding nor corrected altered coagulation measurements in conjunction with high dabigatran plasma levels.[4]
Fortunately, idarucizumab[5] has been approved by the FDA[6] and the EMA,[7] and we should have this antidote available early in 2016.
Until then and probably even beyond the introduction of idarucizumab, timing of “emergency” interventions in relation to the last intake of dabigatran and the patient's renal function will be very important
Allostatic overload in patients with atrial fibrillation
No full textAtrial fibrillation (AF) is a chronic illness complicating both mental health and quality of life. Individuals with AF have been reported to experience greater psychological distress than the general population. Nevertheless, assessment strategies did not allow to evaluate fundamental information, such as type, extent and consequences of stress. Recently, according to the clinimetric approach, Fava and colleagues have introduced specific criteria for evaluating the allostatic overload (AO) in clinical setting. It refers to a state due to the cumulative interactions of life events and chronic life stressors that, by exceeding the individual resources, may constitute a danger to health.
Our study aimed to evaluate the feasibility of this new definition of AO in a sample of 62 patients suffering from AF. Specifically, our goal was to verify if such definition of AO may discriminate AF patients at high risk for clinical psychological distress.
Results showed no differences between AF participants with and without AO in socio-demographic and health variables. Concerning psychiatric variables, patients with AO were more likely to be diagnosed with minor depression, GAD and panic disorders than subjects without AO. Also, they were more likely to suffer from DCPR syndromes of health anxiety and demoralization than AF individuals without AO.
Our findings support the hypothesis that clinimetric indexes may help physicians to identify distress manifestations and clinically relevant information more easily than diagnostic criteria do
Author reply to “ Can renin predict mortality of patients in intensive care unit?”
No full textCan renin predict mortality of patients in intensive care unit
Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality improvement
No full textThe most popular method of training in basic life support and AED remains instructor-led training courses. Recent reviews provide good evidence to support alternative methods of training including lay instructors, self-directed learning (web, video, poster) and CPR feedback/prompt devices
Well-being, ill-being and symptoms of atrial fibrillation
No full textObjective. The aim of this study was to compare patientswith
symptomatic and asymptomatic atrial fibrillation, in terms of
medical variables, self-rated psychological distress and well
being, and to evaluate possible correlations among these
variables.
Methods. Sixty-two outpatients with documented atrial
fibrillation (34 with symptomatic atrial fibrillation and 28
without) were evaluated by self-report instruments: the
Psychological Well being Scale (PWB) and the Symptom
Questionnaire to detect psychological distress. The two
groups were compared by means of the t-test and x2-test.
Linear regression was performed to evaluate correlations
between psychological well being and distress in patients
with symptomatic and asymptomatic atrial fibrillation.
Results. Patients with symptomatic atrial fibrillation
showed lower levels of psychological well being and
higher scores of distress than asymptomatic
participants. Only among patients with symptomatic atrial
fibrillation, all the dimensions of PWB were significantly and
negatively associated with the Symptom Questionnaire
scores.
Conclusion. These results suggest peculiar psychological
correlates in the population of patients with symptomatic
atrial fibrillation, which should be taken into account for their
psychological and clinical management
DOSSIER: TEN YEARS
No full textA collection of articles and video essays dedicated to the series of political omnibus films TEN REARS (Hong Kong, Japan, Thailand, Taiwan), with text and video contributions from a variety of international academics, producers, distributors and critics. Author, with Gina Marchetti, of introductory article. International contributions by Clarence Tsui, Andrew Choi, Felix Tsang, Laikwan Pang, K.C. Lo, Ruby Cheung, Jenny Coates, Timmy Cheng, Vivian Lee, Anchalee Chaiworaporn
DOSSIER: TEN YEARS
No full textA collection of articles and video essays dedicated to the series of political omnibus films TEN REARS (Hong Kong, Japan, Thailand, Taiwan), with text and video contributions from a variety of international academics, producers, distributors and critics. Author, with Gina Marchetti, of introductory article. International contributions by Clarence Tsui, Andrew Choi, Felix Tsang, Laikwan Pang, K.C. Lo, Ruby Cheung, Jenny Coates, Timmy Cheng, Vivian Lee, Anchalee Chaiworaporn
The impact of renewable energy systems on local sustainability
No full textThe purpose of the paper is to discuss and assess the impact of renewable energy, RE, generation on sustainable communities, with a specific focus on employment impact. In recent years, local authorities have been involved in the energy planning process due to the site-specific nature of renewable production and thanks to their nearer connection to citizens. Four small and medium-size sustainable communities belonging to Marche region, in central Italy, have been analysed. The work forecasts the employment generated by the RE capacity defined by two different energy scenarios: 1) the 'business as usual' scenario with a 20% CO2 emission reduction target by 2020, where all the energy policies suggested by Sustainable Energy Action Plans have been considered; 2) the 'potential' scenario with a 50% CO2 emission reduction target by 2050. Results show that the spreading of renewable energy, as expected, can increase local jobs, although the high investments required and problems connected to the impact on the grid have to be considered in the analysis of the global economic effect
Prospettive sulla valorizzazione degli olii estratti dalle piante come fonte di materie prime per l'industria chimica: leEuphorbiedella Sardegna
No full textIn the present paper the author describes the research carried out at the University of Sassari on the utilization as fuels or chemical feedstocks of oils derived from plants. Examination of the results obtained with oils derived fromEuphorbiaevegetanting in Sardinia suggests to orient the studies toward the isolation of fine chemicals rather then toward the utilization as fuels, directly
or after pyrolysis. This conclusion is supported by the
comparison of data on three SardinianEuphorbiaeand by considerations on the Sardinian land
Migration and Domestic Work
No full textThis open access short reader offers a systematic overview of the scholarly debate on the experiences of migrant domestic workers at a global level, in the past as well as in present time. It tackles the nexus between migration and domestic work with a multi-layered approach. The book looks into the issue of (paid) domestic work in migratory contexts by investigating the feminization of migration, thereby considering the larger framework within which this specific phenomenon takes place. The author explains notions such as the “international division of reproductive labor” or “global care chains” which emphasize the inequality in the way care and domestic tasks are distributed today between middle-class women in receiving nations and migrant domestic workers. Moreover, the book shows how women migrating to work in the domestic work and private care sector are facing a complex landscape of migration and labor regulations that are extremely difficult to navigate. At the same time, this issue also addresses employers’ households who cannot find appropriate or affordable care among declining welfare states and national workers reluctant to take the job, whilst legal regulations make difficult to hire a domestic worker who is a third country national. As such this book offers an interesting read to academics, policy makers and all those working in the field
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