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Mazya M.V.,Karolinska University Hospital | Bovi P.,Azienda Ospedaliera Universitaria Integrata | Castillo J.,University of Santiago de Compostela | Jatuzis D.,Vilnius University | And 3 more authors.
Stroke | Year: 2013

Background and Purpose.The SEDAN score is a prediction rule for assessment of the risk of symptomatic intracerebral hemorrhage (SICH) per the European Cooperative Acute Stroke Study (ECASS) II definition in patients with acute ischemic stroke treated with intravenous thrombolysis. We assessed the performance of the score in predicting SICH per the ECASS II and Safe Implementation of Treatments in Stroke Monitoring Study (SITS-MOST) definitions in the SITS.International Stroke Thrombolysis Register (SITS-ISTR). Methods.We calculated the SEDAN score in 34 251 patients with complete data, enrolled into the SITS-ISTR. The risk for SICH by both definitions was calculated per score category. Odds ratios for SICH per point increase of the score were obtained using logistic regression. The predictive performance was assessed using area under the curve of the receiver operating characteristic (AUC-ROC). Results.The predictive capability for SICH per ECASS II was moderate at AUC-ROC=0.66. With rising scores, there was a moderate increase in risk for SICH per ECASS II (odds ratio, 1.65 per point; 95% confidence interval,; P<0.001), with SICH rates between 1.6% for 0 points and 16.9% for.5 points, average 5.1%. The predictive capability for SICH per SITS.MOST was weaker, AUC-ROC=0.60, with lower increase per score point (odds ratio, 1.36 per point; 95% confidence interval,; P<0.001), and SICH rates between 0.8% for 0 points and 5.4% for.5 points, average 1.8%. Conclusions.In this very large data set, the predictive and discriminatory performances of the SEDAN score were only moderate for SICH per ECASS II and low for SICH per SITS.Monitoring Study. © 2013 American Heart Association, Inc.

Obstructive sleep apnea (OSA) is a chronic disease characterized by repetitive partial or complete closure of the upper airway during sleep. OSA tends to be associated with components of metabolic syndrome sharing a common ground of metabolic changes with metabolic syndrome itself. Recent studies showed that subjects with OSA were 6-9 times more likely to have metabolic syndrome than subjects without OSA. Intermittent hypoxia and sleep fragmentation in OSA can initiate intermediary mechanisms (oxidative stress, neurohumoral changes, inflammation) leading to the components of metabolic syndrome. OSA has been suggested to be a novel risk factor, inside the metabolic syndrome, contributing to increased cardiovascular risk. Several studies report that continuous positive airway pressure (CPAP) treatment can reverse pathophysiological changes in OSA, increasing insulin sensitivity and reducing blood pressure. Recent evidences show that CPAP treatment reduces the risk of cardiovascular events and mortality in subjects with OSA. Some subjects with metabolic syndrome can be affected by undiagnosed OSA: CPAP treatment could significantly reduce cardiovascular risk in this subgroup of patients. © 2010 AIM Publishing Srl.

The IMWG has recently updated the disease definition of multiple myeloma, by adding validated biomarkers to the existing requirements of organ damage (hypercalcemia, renal insufficiency, anemia, bone lesions). These changes are based on the identification of biomarkers able to detect the subset of patients with smouldering multiple myeloma at imminent risk of developing organ damage and should, therefore, be considered for therapy. Considering that the clinical laboratory is involved in the measurement of these new markers, this paper is aimed to illustrate the proposed changes giving at the same time some indications for their accurate measurements. As for the organ damage, the major change is related to the evaluation of renal function: the new criteria include the estimation of the glomerular filtration rate using established formulas (eGFR) rather than the use of serum creatinine concentrations alone, as previously indicated. The diagnosis of renal insufficiency requires an eGFR <40 mL/min/1.73 m2. The criteria for anemia and hypercalcemia remain unchanged. As biomarker of malignancy, a ratio >100 of involved to uninvolved serum free light chains is recognized. Another relevant modification is the elimination of the monoclonal protein quantification; it is based on the consideration that an important percentage of patients with multiple myeloma does not show a serum or urine monoclonal protein. Other changes based on imaging techniques or bone marrow examination do not involve the clinical laboratory and are not discussed in this paper. Additional biomarkers will probably be indentified in the near future, but they need to be validated by more independent studies. © 2015 Biochimica Clinica.

Burgel P.-R.,Cochin Hospital | Burgel P.-R.,University of Paris Descartes | Bellis G.,Institute National dEtudes Demographiques | Olesen H.V.,Aarhus University Hospital | And 13 more authors.
European Respiratory Journal | Year: 2015

Median survival has increased in people with cystic fibrosis (CF) during the past six decades, which has led to an increased number of adults with CF. The future impact of changes in CF demographics has not been evaluated. The aim of this study was to estimate the number of children and adults with CF in 34 European countries by 2025. Data were obtained from the European Cystic Fibrosis Society Patient Registry. Population forecasts were performed for countries that have extensive CF population coverage and at least 4 years of longitudinal data by modelling future entering and exiting flows in registry cohorts. For the other countries, population projections were performed based on assumptions from knowledge of current CF epidemiology. Western European countries' forecasts indicate that an increase in the overall number of CF patients by 2025, by approximately 50%, corresponds to an increase by 20% and by 75% in children and adults, respectively. In Eastern European countries the projections suggest a predominant increase in the CF child population, although the CF adult population would also increase. It was concluded that a large increase in the adult CF population is expected in the next decade. A significant increase in adult CF services throughout Europe is urgently required. Copyright © ERS 2015.

Mazzariol A.,University of Verona | Lo Cascio G.,Azienda Ospedaliera Universitaria Integrata | Kocsis E.,University of Verona | Maccacaro L.,Azienda Ospedaliera Universitaria Integrata | And 2 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2012

We report an outbreak of linezolid-resistant Staphylococcus haemolyticus strains (MIC 32 mg/L) in patients admitted to the Verona University Hospital Intensive Care Unit. The strains proved to be clonally related at pulsed field gel electrophoresis. All the strains showed the G2576T mutation responsible for linezolid-resistance and retained their resistance even after several passages on antibiotic-free medium. After a decade of linezolid use, multifocal emergence of linezolid resistance in coagulase-negative staphylococci has become an important matter of concern and mandates stricter control over the use of this antibiotic in order to preserve its clinical utility. © Springer-Verlag 2011.

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