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1.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33305554

RESUMO

Coronavirus Disease-2019 (COVID-19) is the worst worldwide pandemic with more than 12,000,000 cases and 560,000 deaths until 14th July 2020. Men were more infected by COVID-19 than women, and male subjects with underlying conditions, including diabetes, hypertension, and cardiovascular diseases developed a severe form of the affection, with increased mortality rate. Many factors can contribute to the disparity in disease outcomes, such as hormone-specific reaction and activity of X-linked genes, which modulate the innate and adaptive immune response to virus infection. Until now, only the Remdesivir was approved by FDA (Food Drug Administration) for COVID-19 treatment, although several clinical trials are ongoing worldwide also on other drugs. In this review, we analyzed published studies on several drugs (chloroquine or hydroxychloroquine, remdesivir, favipiravir, lopinavir-ritonavir in combination, tocilizumab, plasma, and immunoglobulins) with some efficacy to COVID-19 in humans, and evaluated if there were a gender analysis of the available data. In our opinion, it is essential to report data about COVID-19 disaggregated by sex, age, and race, because the knowledge of gender differences is fundamental to identify effective and customized treatments to reduce hospitalizations, admissions to intensive care units, and mortality.

3.
Monaldi Arch Chest Dis ; 90(2)2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449614

RESUMO

In December 2019 a novel coronavirus emerged in Wuhan, China causing many cases of severe pneumonia. World Health Organization (WHO) named this disease Coronavirus Disease 2019 (COVID-19). The infection has rapidly spread across China to many other countries, and on March 12, 2020 the WHO declared pandemic outbreak of COVID-19. As of May 16, 2020, COVID-19 has been diagnosed in more than 4,490,000 patients, associated to 305,976 deaths worldwide; in Italy 224,760 COVID-19 cases have been reported with 31,763 deaths. The main routes of transmission are respiratory droplets and direct contact with infected people, so numerous prevention strategies are employed to mitigate the spread of disease, including social distancing and isolation. The aim of this narrative review is to underline gender differences in epidemiology, etiopathogenesis, risk factors, clinical presentation, diagnosis, prognosis and mortality of patients infected with SARS-CoV-2. Currently data on the sex indicators for admitted or deceased patients are only available, but there is no analysis about other gender indicators. The data considered in our study are the only currently available in the literature, but it is appropriate to implement a specific analysis with all gender indicators to identify appropriate strategies. Moreover, the evaluation of a health service efficiency is a key element to define gender outcomes. Knowing the gender differences in COVID-19 outbreak would be a fundamental tool to understand the effects of a health emergency on individuals and communities as well as to carry out effective and equitable policies, public health measures and targeted solutions.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Animais , Betacoronavirus/genética , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Humanos , Imunidade Inata , Pandemias , Peptidil Dipeptidase A/metabolismo , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Prevalência , Prognóstico , Fatores de Risco , Serina Endopeptidases/metabolismo , Fatores Sexuais , Ligação Viral
4.
Pharmacogenomics J ; 20(3): 451-461, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31801992

RESUMO

We assessed the predictive accuracy of the Warfarin Pharmacogenetics Consortium (IWPC) algorithm in a prospective cohort of 376 high-risk elderly patients (≥65 years) who required new treatment with warfarin for either medical (non valvular atrial fibrillation) or surgical conditions (heart valve replacement), had ≥1 comorbid conditions, and regularly used ≥2 other drugs. Follow-up visits were performed according to clinical practice and lasted for a maximum of 1 year. Two hundred and eighty-three (75%) patients achieved a stable maintenance dose. Warfarin maintenance doses were low on average (median 20.3 mg/week, interquartile range, 14.1-27.7 mg/week) and were substantially overestimated by the IWPC algorithm. Overall the percentage of patients whose predicted dose of warfarin was within 20% of the actual stable dose was equal to 37.5%, (95% CI 32.0-43.3%). IWPC algorithm explained only 31% of the actual warfarin dose variability. Modifications of the IWPC algorithm are needed in high-risk elderly people.

5.
Artigo em Inglês | MEDLINE | ID: mdl-33383855

RESUMO

Parkinson's disease has been found to significantly affect health-related quality of life. The gender differences of the health-related quality of life of subjects with Parkinson's disease have been observed in a number of studies. These differences have been reported in terms of the age at onset, clinical manifestations, and response to therapy. In general, women with Parkinson's disease showed more positive disease outcomes with regard to emotion processing, non-motor symptoms, and cognitive functions, although women report more Parkinson's disease-related clinical manifestations. Female gender predicted poor physical functioning and socioemotional health-related quality of life, while male gender predicted the cognitive domain of health-related quality of life. Some studies reported gender differences in the association between health-related quality of life and non-motor symptoms. Depression and fatigue were the main causes of poorer health-related quality of life in women, even in the early stages of Parkinson's disease. The aim of this review was to collect the best available evidence on gender differences in the development of Parkinson's disease symptoms and health-related quality of life.


Assuntos
Doença de Parkinson , Qualidade de Vida , Fatores Sexuais , Atividades Cotidianas , Depressão , Fadiga , Feminino , Humanos , Masculino , Doença de Parkinson/epidemiologia
6.
COPD ; 13(5): 555-60, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27027547

RESUMO

The chronic course and evolution of chronic obstructive pulmonary disease (COPD) is often characterized by periods of exacerbation of symptoms, which have a negative impact on the quality of life of patients, as well as on the evolution of COPD, and represent a significant cause of medical intervention and hospitalization. Very few data are available on the efficacy of rescue antibiotics in patients with acute exacerbation of COPD (AECOPD) unresponsive to previous treatment. The aim of this study was to evaluate the efficacy of two fluoroquinolones in AECOPD previously treated without success. The FADOI-FLOR study is a randomized, single-blind, non-inferiority comparison between levofloxacin and prulifloxacin. Primary end-point was "therapeutic success" at Day 10 of treatment, defined as disappearance of signs/symptoms or decrease of at least three points of a global score of symptomatology (maximum score = 15). 258 patients were enrolled (128 levofloxacin and 130 prulifloxacin), in 25 centers. A very high proportion of patients in the two groups had therapeutic success at Day-10 (levofloxacin 93.0% vs prulifloxacin 96.7%, population intention-to-treat; 94.6% vs 99.1%, population per-protocol). Earlier therapeutic success (within 7 days) was achieved in 32.0% and 36.2% of patients receiving levofloxacin or prulifloxacin, respectively. At 3-month follow-up, re-exacerbations occurred in 17.8% of patients treated with levofloxacin and 14.2% of those receiving prulifloxacin (p = 0.44). In conclusion, fluoroquinolones are very effective in the treatment of AECOPD resistant to other antibiotics.


Assuntos
Antibacterianos/uso terapêutico , Dioxolanos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Levofloxacino/uso terapêutico , Piperazinas/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Recidiva , Retratamento , Método Simples-Cego , Avaliação de Sintomas , Exacerbação dos Sintomas , Falha de Tratamento
7.
Nutrition ; 30(9): 1045-9, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24993749

RESUMO

OBJECTIVES: The aim of this study was to determine the long-term effects of a moderate protein diet (MPD) on renal function, low-grade inflammation, and oxidative stress in older adults with type 2 diabetes, which to date are unclear. METHODS: Seventy-four older adults with type 2 diabetes and chronic kidney disease (stage G3b-G4) were enrolled in the study. During the 4-wk baseline period (T0), all patients were asked to follow a normal protein diet regimen, providing 1.1 g/kg daily. Successively, all patients were asked to follow an MPD, for 36 mo, providing 0.7 g/kg daily, for only 6 d/wk. Patients who refused to follow an MPD treatment were included in the control (NPD [normal protein diet] group). During the 36 mo of the study, creatinine clearance, blood urea nitrogen, proteinuria, blood pressure, glycated hemoglobin (Hb)A1c, fat-free mass, low-grade inflammation (interleukin-6 and C-reactive protein) were evaluated monthly and oxidative stress (urinary 8-epiprostaglandin [Epi-PG]F2α) was evaluated every 3 mo. RESULTS: During T0, mean creatinine clearance, proteinuria, blood urea nitrogen, blood pressure, HbA1c, fat free mass, low-grade inflammation, and oxidative stress were similar in both groups. After 36 mo, a significant reduction in decline of renal function was observed in the MPD group but not in controls (2.4 ± 0.2 versus 5.7 ± 0.5 mL·min·y, respectively; P < 0.05 versus control). Similarly, a significant reduction in proteinuria, serum interleukin-6, serum C-reactive protein, and urinary 8-Epi-PGF2α excretion, was observed in the MPD group (P < 0.05 versus NPD). CONCLUSION: In older adults with type 2 diabetes, long-term effects of an MPD regimen are associated with a significant decline of renal function, proteinuria, low-grade inflammation, and oxidative stress without a change in fat-free mass.


Assuntos
Diabetes Mellitus Tipo 2 , Nefropatias Diabéticas , Dieta , Proteínas na Dieta/administração & dosagem , Inflamação , Rim/efeitos dos fármacos , Insuficiência Renal Crônica , Idoso , Proteína C-Reativa/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/etiologia , Dieta com Restrição de Proteínas , Proteínas na Dieta/efeitos adversos , Dinoprosta/análogos & derivados , Dinoprosta/sangue , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Interleucina-6/sangue , Rim/fisiopatologia , Masculino , Estresse Oxidativo/efeitos dos fármacos , Cooperação do Paciente , Proteinúria/etiologia , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/etiologia , Fatores de Tempo
9.
Ig Sanita Pubbl ; 63(2): 137-50, 2007.
Artigo em Italiano | MEDLINE | ID: mdl-18216889

RESUMO

Acute stroke patients in the Molise region (Italy) are generally admitted to an Internal Medicine or Geriatrics hospital ward. In this study all 446 acute stroke admissions which occurred in Molise in 2004 were evaluated by analysing the following data: time from symptom onset to admission, diagnosis, acute care treatment, comorbidities, disease severity, complications, disability level, mortality, discharge modality and adherence to current guidelines. Mortality was very low in the study population (approximately 8% vs. 15-17% for the rest of Italy) and was found to be related to age above 80 years, disease severity, presence of dysphagia and to being admitted to the hospital of Campobasso (a sub-analysis of this population showed an equal degree of risk in the Geriatrics and Internal Medicine Units). Forty-two percent of survivors had a moderately severe to severe level of disability (Rankin score 4-5) and went home immediately after discharge (with a major part of the burden of care resting on families). At all study hospitals, computed tomography scan was performed within 48 hours of symptom onset, as per current guidelines for the management of acute stroke. On the other hand, adherence to current guidelines regarding other components of management such as evaluation for dysphagia, placement of a urinary catheter, aspirin therapy, rehabilitation, and performance of diagnostic procedures (e.g. doppler, echocardiogram) was not uniform in all study hospitals. Several aspects of stroke management should certainly be improved, in accordance with current international guidelines, in order to provide optimal acute stroke care in the Molise region. These include: time to hospital admission (e.g. by improving the emergency service "118"), standard treatment and diagnostic procedures, physical rehabilitation services and involvement of family physicians.


Assuntos
Alta do Paciente , Acidente Vascular Cerebral , Hospitalização , Hospitais , Humanos , Itália , Acidente Vascular Cerebral/epidemiologia
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