NOAC in "real world" patients with atrial fibrillation in Italy: results from the ISPAF-2 (Indagine Sicoa Paziente Con Fibrillazione Atriale) survey study

In the past few years, new oral anticoagulants (NOACs) targeting directly a single activated clotting factor, have been developed for the treatment of non-valvular atrial fibrillation (AF), which are currently recommended as first-line therapy in AF. The aim of this study is to provide an overall picture on the extent to which oral anticoagulation (OAC) with NOACs correspond to actually prescribed OAC therapy in an unselected, real world, population of consecutive patients with AF in Italy. Compliance with the therapy and quality of life were also assessed. A 50 cardiology unit network located in different geographic areas of Italy enrolled a total of 1742 consecutive outpatients with AF (54.6% males, 45.4% females, mean age 72.5 years). NOACs were prescribed in 56.1% patients and VKA in 43.9% (P < 0.0001). NOACs were significantly more prescribed than VKA in patients with high thrombo-embolic risk score (i.e., CHA₂DS₂-VASc > 2) (78.2 vs 67.3%, P < 0.0001), but also patients at low risk (i.e., CHA₂DS₂-VASc < 1 and HAS-BLED < 3) were still under OAC therapy with either NOACs (27%) or VKA (73%). Adherence to therapy (Morisky test) was greater in patients taking NOACs as was the quality of life. The ISPAF-2 study shows that in an Italian population of real-world patients with AF the prescription of OAC according to current guidelines and stroke-risk scoring system is rather high although it still needs to be improved. Contrary to recommendations, in a high proportion of low-risk patients, anticoagulation therapy, with either NOACs and VKA is still prescribed, and this exposes patients to unjustified risks.

Comprehensive drug screening in decision making of patients attending the emergency department for suspected drug overdose

OBJECTIVES

This study aimed to evaluate the usefulness of a comprehensive drug screening method as a first line diagnostic tool on clinical decision making in patients attending an emergency department for suspected drug overdose in terms of agreement between physicians on patients' disposal.

METHODS

Five emergency physicians retrospectively evaluated the records of 142 adult patients, admitted to the emergency department of a community hospital for suspected drug overdose. They were asked for an expert opinion on patients' disposal at the end of the observation period, based on paired records, with/without the results of a comprehensive drug screening.

RESULTS

In the absence of the drug screening, a very poor agreement (kappa statistics) was observed between physicians. When the drug screening was available, the interobserver agreement for decision on patients' disposal increased to the fair to good range (global agreement: from 0.238 (0.019) to 0.461 (0.020) (mean(SE)); p<0.001). The agreement also increased when admission to an intensive care unit, to a general ward, and discharge from hospital were separately analysed. The availability of drug screening would have saved 21.7% of hospital admissions and 53.3% of high dependency and/or intensive care unit admissions.

CONCLUSION

Comprehensive drug screening adds to decision making for patients attending an emergency department for suspected drug overdose, improving agreement among physicians on patients' disposal and potentially saving hospital resources.

137Cs and 40K soil-to-plant relationship in a seminatural grassland of the Giulia Alps, Italy

To examine the soil-to-plant transfer of 137Cs and 40K, we performed a study based on sampling of natural soil and plants from an alpine pasture site situated in the Giulia Alps, Italy, during July 1997. High 137Cs activity was present in the upper most soil layer, and decreased one order of magnitude at a depth of 10 cm. An opposite gradient was observed for 40K. Simultaneous sampling of soil and plant material was performed in order to analyse transfer factor (TF) values. In spite of homogeneous 137Cs activities in soil, grass samples showed a high variability. A negative correlation was detected between 40K- and 137Cs-activities in plants. TF values for 137Cs were highly variable, thus suggesting that this parameter would be independent of 137Cs soil activity. Lower variability was observed for 40K TFs values. Our results suggest that TFs are highly variable parameters that appear to be independent on radionuclide soil activity. Because soil and plant characteristics strongly affect TF values, caution is necessary when TF values are used as the sole parameter to predict radionuclide uptake by plants in semi-natural ecosystems.

Primary idiopathic optic neuritis in U.S. Air Force Aviators

The records of 31 male aviators seen at the Ophthalmology Branch of the USAF Aeromedical Consultation Service (formerly the USAF School of Aerospace Medicine) for a diagnosis of primary idiopathic optic neuritis (PION) were reviewed. Each subject received comprehensive ophthalmologic and neurologic examinations. The long-term follow-up data were collected through repeat examinations and by survey. Despite 39% of aviators being grounded due to complications of their PION or multiple sclerosis (MS), many aviators diagnosed with PION may be safely returned to flying duties. However, any aviator diagnosed with PION has a risk of recurrence or a potential to develop systemic MS and must be carefully reevaluated and followed to ensure they remain a viable asset and do not compromise flight safety or mission completion.

Anionic versus cationic immunoglobulin clearance in normal subjects: a novel approach to the evaluation of charge permselectivity

The excretion of proteins differing in charge (the different immunoglobulin subclasses) and/or size (albumin, immunoglobulins) were investigated in normal subjects in a number of physiological conditions aiming at the evaluation of renal charge permselectivity. In 101 randomly selected normal subjects the urinary excretion rates of albumin, IgG4 (anionic proteins) and of total IgG (mostly cationic) were evaluated in basal conditions; the protein/creatinine urinary ratio and protein clearances were assessed in part of them. In addition, the intra- and interday variations of protein excretion were evaluated. Protein clearances were measured in a sample group after standardized physical exercise, after an amino acid load, and in orthostatism. Albumin, IgG4 and IgG were assayed using sensitive methods developed in our laboratories. The excretion rate values of albumin, IgG4 and total IgG (median, interquartile range) were 4.36 micrograms/min, (2.58-6.59), 4.25 ng/min (2.6-7.6), and 1.47 micrograms/min (0.85-2.44), respectively. The clearances of the three proteins (mean +/- SD) were 0.13 +/- 0.07, 0.017 +/- 0.012 and 0.14 +/- 0.08 ml/min x 10(-3), respectively. The IgG4/IgG ratio averaged 0.1 and was always below 0.25. Protein excretion rates showed a noticeable variation during the day and from day to day. Physical exercise, the change of posture and the amino acid load significantly increased proteinuria but did not significantly modify the anionic/cationic immunoglobulin ratio. Thus, the anionic/cationic immunoglobulin ratio of about one tenth, substantially stable during dynamic tests, in normal subjects may be considered an index of physiological renal protein charge permselectivity.

Effects of cannabis resin on learning by repetition in the rat

Studies were made of the effects of cannabis resin in differing doses on a type of learning by repetition, using the water-filled maze technique, and on the conditioned avoidance reflex in the rat. When administered at a dose corresponding to 0.5 mg of delta9-THC per kg, the resin led to improved learning in both the types of test employed; opposite effects were observed with the higher dose (corresponding to 5 mg of delta9-THC per kg). These effects are probably attributable to complex reciprocal action between the active constituents of the resin, particularly THC, and the metabolisms of the cerebral monoamines and c-AMP.