117,903 research outputs found
TIAMINA AI PAZIENTI CON DISTURBO DA USO DI ALCOL VISITATI IN PRONTO SOCCORSO: IN ITALIA ABBIAMO LA FORMULAZIONE ADATTA?
No full textLa tiamina dovrebbe essere somministrata ai pazienti con disturbo da uso di alcol (AUD) durante le loro visite nei reparti di emergenza (EDs), sia come profilassi che per il trattamento la carenza di tiamina. Tuttavia, i pazienti con AUD molto spesso non ricevono la tiamina. Ad esempio, uno studio recente ha stimato che, nel 2017, in due ospedali universitari urbani di New York City, la tiamina era stata prescritta solo nel 2,2% delle visite correlate all'alcol in EDs. Considerando che la carenza di tiamina è comune tra i pazienti con AUD, che le conseguenze della mancata somministrazione di tiamina sono gravi e spesso irreversibili, che la somministrazione di tiamina è efficace, sicura e poco costosa e che la via endovenosa è facile da impiegare nei EDs, noi consigliamo vivamente di somministrare 200 mg, tre volte al giorno, preferibilmente per via endovenosa, a tutti i pazienti con AUD visitati in EDs. Tuttavia, in Italia, oltre alle barriere dovute allo stigma e alla limitata formazione in materia di dipendenza da parte degli operatori sanitari, esiste un problema oggettivo relativo alla mancanza di formulazioni di tiamina idonee alla sua somministrazione per via endovenosa
Association of mitral annulus calcification, aortic valve calcification with carotid intima media thickness.
No full textAssociation of mitral annulus calcification, aortic valve calcification with carotid intima media thickness
No full textAbstract Background Mitral annular calcification (MAC) and aortic annular calcification (AVC) may represent a manifestation of generalized atherosclerosis in the elederly. Alterations in vascular structure, as indexed by the intima media thickness (IMT), are also recognized as independent predictors of adverse cardiovascular outcomes. Aim To examine the relationship between the degree of calcification at mitral and/or aortic valve annulus and large artery structure (thickness). Methods We evaluated 102 consecutive patients who underwent transthoracic echocardiography and carotid artery echoDoppler for various indications; variables measured were: systemic blood pressure (BP), pulse pressure (PP=SBP-DBP), body mass index (BMI), fasting glucose, total, HDL, LDL chlolesterol, triglycerides, cIMT. The patients were divided according to a grading of valvular/annular lesions independent scores based on acoustic densitometry: 1 = annular/valvular sclerosis/calcification absence; 2 = annular/valvular sclerosis; 3 = annular calcification; 4 = annular-valvular calcification; 5 = valvular calcification with no recognition of the leaflets. Results Patient score was the highest observed for either valvular/annulus. Mean cIMT increased linearly with increasing valvular calcification score, ranging from 3.9 ± 0.48 mm in controls to 12.9 ± 1.8 mm in those subjects scored 5 (p 0.0001). Conclusion MAC and AVC score can identify subgroups of patients with different cIMT values which indicate different incidence and prevalence of systemic artery diseases. This data may confirm MAC-AVC as a useful important diagnostic parameter of systemic atherosclerotic disease.</p
Baclofen in the treatment of patients with alcohol use disorder and other mental health disorders
No full textA limited number of medications are approved to treat Alcohol Use Disorder (AUD). Furthermore, the magnitude of their therapeutic effect is relatively modest, suggesting the potential for subtypes of patients who respond to a specific medication. The use of these medications is also limited in clinical practice by a series of contraindications such as medical comorbidities and/or concurrent use of other medications.
In recent years, animal and human studies have been conducted to evaluate the efficacy of baclofen, a GABAB receptor agonist approved for clinical use as a muscle relaxant, in the treatment of AUD. However, these studies have yielded contrasting results. Despite this discrepancy, baclofen is often used off-label to treat AUD, especially in some European countries and Australia. Recently, several factors have been considered to try to shed light on the potential reasons and mechanisms underlying the inconsistent results obtained until now.
The presence of a psychiatric comorbidity may be amongst the abovementioned factors playing a role in explaining different responses to baclofen treatment in terms of alcohol drinking outcomes. Therefore, the aim here was to conduct a narrative review of the scientific literature related to the use of baclofen in AUD, both in patients with and without concomitant psychiatric disorders. All clinical studies (randomized and controlled, open-label, retrospective, human laboratory studies, and case reports) were analyzed and discussed, bearing in mind other potential factors that may have influenced baclofen response, including dose administered, severity of AUD, use of other psychosocial therapies, and the presence of physical disorders.
This review indicates that the most frequent psychiatric comorbidities in patients affected by AUD undergoing baclofen treatment are anxiety and mood disorders. Unfortunately, no definitive conclusions can be drawn due to the lack of specific analyses on whether baclofen efficacy is different in AUD patients with comorbid psychiatric disorders versus those without. Therefore, it will be critical that psychiatric comorbidities are considered in the planning of future studies and in the analysis of the data, with the ultimate goal of understanding whether subtypes of AUD patients may respond best to baclofen
Clinical functional topography in cognition
No full textIn the last few decades, there have been an increasing number of studies focusing on better characterizing the cerebellar functions beyond motor control, including emotional and social domains. Anatomical and functional evidence strongly contributes to delineating the cerebellar functional subdivisions and their integration with cerebral functional networks strictly related to emotional regulation and social functioning, thus suggesting a model of cerebellar organization that resembles that of the cerebral cortex. Overcoming the traditional segregation of cerebro-cerebellar networks in sensorimotor/cognitive functional modules, during emotional/social processes, the cerebellar activity reflects a domain-specific mentalizing functionality that is strongly connected with corresponding mentalizing networks in the cerebrum. Additionally, the cerebro-cerebellar organization has been shown to have a specific functional and maturational trajectory that is only in part dependent on a structural maturational process and that is protracted from an early stage of life through adolescence and adulthood, when the mature control networks involve both segregation and integration of the brain regions that comprise them. Altogether, these findings underscore the importance of regional functional differences within the cerebellum in relation to emotional and social processing and raise questions about the clinical implication of cerebellar injury on emotional/social behaviours, both in the developing and the adult brai
Trattamento della dipendenza da alcol e oppiacei in donne in gravidanza: una mini-review
No full textResponsabilità disciplinare e obblighi di ricerca e insegnamento: il "rendimento accademico”
No full textIl Consiglio di Stato, in riforma della sentenza in primo grado, si è pronunciato sulla legittimità della sanzione inflitta dal Rettore, sulla base del parere offerto dal Collegio di disciplina, a un ricercatore a tempo definito per violazione dei doveri di didattica e di ricerca sanciti dagli artt. 32, d.P.R. n. 382/1980, 7, L. n. 28/1980 e 6, comma 3, L. n. 240/2010 e puntualizzati con Regolamento didattico dall’Ateneo. Nell’accogliere l’appello proposto dall’Università, il Consiglio di Stato ha offerto una ricostruzione del quadro giuridico di riferimento dei doveri di didattica e di ricerca scientifica dei docenti universitari, giungendo alla conferma del provvedimento sanzionatorio che contestava l’abituale mancanza ai doveri d’ufficio e irregolarità della condotta del docente ai sensi dell’art. 89, R.D. n. 1592/1933.The Council of State, overturning the first instance ruling, declared the legality and proportionality of the sanction imposed by a University Dean, supported by the Disciplinary Board’s opinion, on an assistant professor for the violation of teaching and research duties stated by Art.32, d.P.R.n.382/1980, Art.7, L. n. 28/1980 and Art. 6, paragraph 3, L. n. 240/2010 and specified by the University. Within the ruling, the Council of State offers a reconstruction of the legal framework of university professors’ teaching and scientific research duties, confirming the sanction issued for the habitual failure to the duties of office and irregularity of the professor’s conduct under Art. 89, R.D.n.1592/1933
The NMDA receptor antagonist CGS 19755 disrupts recovery following cerebellar lesions
No full textAbstract
PURPOSE:
To test whether activation of NMDA receptors is required for the maintenance of the posture and motor behavior recovered from cerebellar lesions, an NMDA antagonist (CGS 19755) was systemically administered to totally or partially cerebellectomized rats.
METHODS:
Three groups of animals were tested: rats that had undergone a total cerebellectomy four months before drug administration; rats that had undergone a right hemicerebellectomy four months before drug administration; intact control animals.
RESULTS:
Under drug action in the control animals the postural pattern was slightly influenced, showing a light worsening, and motor skills requiring coordinated motor performance and subtle balance control were markedly worsened. Conversely, in the lesioned groups the cerebellar symptomatology dramatically worsened, and both groups of animals looked like they had just been operated, exhibiting the whole repertoire of postural and motor behaviors of cerebellar origin. In particular, limb hyperflexion, wide-based locomotion and the tendency to side falls were prevalent in the cerebellectomized animals, while tremor and body tilt were prevalent in the hemicerebellectomized group.
CONCLUSION:
The reappearance of severe postural and motor symptomatology has to be interpreted as a "decompensation" evoked by the NMDA-receptor antagonist, suggesting the involvement of NMDA receptors in the maintenance of compensation of disturbances of cerebellar origin.Abstract
PURPOSE:
To test whether activation of NMDA receptors is required for the maintenance of the posture and motor behavior recovered from cerebellar lesions, an NMDA antagonist (CGS 19755) was systemically administered to totally or partially cerebellectomized rats.
METHODS:
Three groups of animals were tested: rats that had undergone a total cerebellectomy four months before drug administration; rats that had undergone a right hemicerebellectomy four months before drug administration; intact control animals.
RESULTS:
Under drug action in the control animals the postural pattern was slightly influenced, showing a light worsening, and motor skills requiring coordinated motor performance and subtle balance control were markedly worsened. Conversely, in the lesioned groups the cerebellar symptomatology dramatically worsened, and both groups of animals looked like they had just been operated, exhibiting the whole repertoire of postural and motor behaviors of cerebellar origin. I
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