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Echocardiographic features of post−transcatheter aortic valve implantation thrombosis and endocarditis 下载免费PDF全文
Marco Spartera MD Francesco Ancona MD Marta Barletta MD Isabella Rosa MD Stefano Stella MD Claudia Marini MD Leonardo Italia MD Matteo Montorfano MD Azeem Latib MD Ottavio Alfieri MD Alberto Margonato MD Antonio Colombo MD Eustachio Agricola MD 《Echocardiography (Mount Kisco, N.Y.)》2018,35(3):337-345
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Therapeutic plasma exchange for thrombotic thrombocytopenic purpura with refractory thrombocytopenia 下载免费PDF全文
Nolan Maloney Isabella Martin Zbigniew M. Szczepiorkowski Nancy M. Dunbar 《Journal of clinical apheresis》2018,33(3):436-438
Thrombotic thrombocytopenic purpura (TTP) is an acute, life‐threatening illness with disseminated platelet‐rich thromboses of small vessels that variably presents with the classic clinical “pentad” of microangiopathic hemolytic anemia, thrombocytopenia, fever, altered mental status, and acute kidney injury. Most cases are caused by an acquired autoantibody to ADAMTS13, a metalloproteinase that cleaves large von Willebrand Factor (vWF) multimers. The mainstay of treatment is daily therapeutic plasma exchange (TPE), sometimes with adjunctive pharmacologic immunosuppression. TPE is generally continued until the platelet count is greater than 150 × 103/µL and the lactate dehydrogenase is near normal for 2‐3 consecutive days. Unfortunately, there is no clear guidance for when thrombocytopenia is refractory for a prolonged period of time. The following case describes such a scenario in which consecutive ADAMTS13 activity and inhibitor levels were used to guide the decision to stop treatment with TPE in a patient who failed to recover their platelet count. 相似文献
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Patient organizations are increasingly involved in national and international bioethical debates and health policy deliberations. In order to examine how and to what extent cultural factors and organizational contexts influence the positions of patient organizations, this study compares the positions of German and Israeli patient organizations (POs) on issues related to end-of-life medical care. We draw on a qualitative pilot study of thirteen POs, using as a unit of analysis pairs comprised of one German PO and one Israeli PO that were matched on the basis of organizational category. Bioethical positions that emanated from the interviews concerned advance directives—general views, recent legal framework, and formalization; as well as active and passive euthanasia, withholding and withdrawing of treatment, and physician-assisted suicide. In addition to the unifying, within-country impact of cultural factors, we found that constituency-based organizations and partner organizations in both countries often share common views, whereas disease-based support organizations have very heterogeneous positions. We conclude by discussing how organizational contexts provide a source of uniformity as well as diversity in the positions of POs. 相似文献
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Joanna d'Arc Lyra Batista Maria de Fátima Pessoa Milit?o de Albuquerque Marcela Lopes Santos Demócrito de Barros Miranda-Filho Heloísa Ramos Lacerda Magda Maruza Libia Vilela Moura Isabella Coimbra Ricardo Arraes de Alencar Ximenes 《Revista do Instituto de Medicina Tropical de S?o Paulo》2014,56(2):127-132
Despite the effectiveness of combination antiretroviral therapy in the
treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has
become a major threat to its effectiveness. This study aimed to estimate the
prevalence of self-reported irregular use of antiretroviral therapy and the factors
associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who
attended two referral centers in the city of Recife, in Northeastern Brazil, between
June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors,
social service support and personal habits associated with nonadherence to
antiretroviral therapy, adjusted by multivariable logistic regression analysis. The
prevalence of PLWHA who reported irregular use of combination antiretroviral therapy
(cART) was 25.7%. In the final multivariate model, the irregular use of cART was
associated with the following variables: being aged less than 40 years (OR =
1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or
former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR
= 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each
of the following groups: individuals aged less than 40 years, smokers, former smokers
and crack cocaine users. Measures for giving up smoking and crack cocaine should be
incorporated into HIV-control programs in order to promote greater adherence to
antiretroviral drugs and thus improve the quality of life and prolong life
expectancy. 相似文献
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Dietary and fluid restriction perceptions of patients undergoing haemodialysis: an exploratory study 下载免费PDF全文
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Stefania Milione Isabella Mercurio Paola Melai Veronica Agostinelli Nicola Nante 《The Australian journal of forensic sciences》2017,49(6):679-686
Wastewater analysis is a direct and objective method used to measure human consumption of illicit drugs. In the last few years these have become a new class of environmental contaminants. The aim of our study was the identification of drugs in Tiber River waters. We collected 20 water samples from May to June 2012, at six points of the river: at the source, near Perugia, near Rome and at the mouth. Samples were analysed using gas chromatography with a mass detector. Basic analytes were extracted using the method of Varian Certify. For acidic analytes we proceed to direct extraction using organic solvents. The most detected drug was ecstasy. We also identified traces of methadone, morphine, heroine, methylamphetamine and tetrahydrocannabinol (THC). The highest concentration of cocaine was found near Perugia with a peak in the weekend (4744 ng/ml). Psychoactive substances had constant concentrations in the week. Ecstasy (MDMA) was the most detected drug. The most interesting finding was the increased concentration of cocaine and heroin in waters near Perugia showing the alarming phenomenon of weekend use of these substances. 相似文献