Introducción: Los accidentes de tránsito pueden ser prevenibles y comprensibles. En Chile, representan una grave problemática de salud pública dado que constituye una de las principales causas de mortalidad y discapacidad en la población. Objetivo: Describir la tasa de mortalidad por accidentes de tránsito en Chile entre 2002-2019 y comparar las tasas de mortalidad por sexo y grupo etario. Metodología: Se realizó un estudio descriptivo ecológico longitudinal retrospectivo. Se analizaron datos de mortalidad de accidentes de tránsito entre 2002-2019. Resultado: La tasa de mortalidad cruda total disminuyó un 16,1% durante el periodo. El sexo masculino es el grupo con mayor riesgo de mortalidad en comparación con el femenino, aunque esta diferencia se redujo en el tiempo. En relación al grupo etario, la mortalidad fue más alta en adultos mayores de 75 años y jóvenes de 15 a 24 años. Discusión: Pese a la disminución en la tasa de mortalidad, los accidentes siguen siendo una gran preocupación. Chile muestra tasas inferiores al promedio mundial, pero más altas que las de la Organización para la Cooperación y el Desarrollo Económico. La imprudencia al volante es un factor determinante en la ocurrencia de accidentes. Conclusión: Es crucial implementar intervenciones en seguridad vial para reducir muertes y su impacto socioeconómico en la población.
It is now widely understood that in order to respond to the climate emergency and the ongoing planetary crisis, all sectors, including Education and Training, are called to intervene in their activities and, above all, in the way they prepare learners for the future. During the School Year 2021-22, in collaboration between Pediatrics and the Family Health District, IOR, Provincial School Office, Cesena City Council Department, a Peer Education was activated with the students of some high schools in Cesena (more than forty), as a result of which we were able to verify how this issue activates an important interest in the children, both as a personal cultural deepening and as a spillover of knowledge on peers: in fact, more than.
Background The occurrence of ventricular tachyarrhythmias is associated with increased mortality and hospitalizations for heart failure in implantable cardioverter defibrillator (ICD) patients. Nonetheless, the temporal relationship between heart failure worsening and ventricular tachyarrhythmias has been scarcely explored so far. Purpose We hypothesized that in patients with heart failure and reduced ejection fraction with ICDs, physiological sensor-based heart failure status, as reflected in the HeartLogic index, would predict appropriate device therapies for ventricular tachyarrhythmias (shocks and antitachycardia pacing). Methods and results 568 patients implanted with ICDs (n=410, 72%) or cardiac resynchronization therapy-defibrillators (CRT-D, n=158, 28%) endowed with the HeartLogic algorithm were included in this prospective observational multicenter analysis. Over a follow-up of 25 [25th-75th percentile: 15–35] months, 122 (21%) patients received an appropriate device therapy (shock, n=74, 13%), while the HeartLogic index crossed the threshold value 1200 times (0.71 alerts/patient-year) in 370 subjects (65%). The occurrence of at least one HeartLogic alert was significantly associated with both appropriate shocks (HR: 2.44, 95% CI: 1.49–3.97, p=0.003) and any ICD therapies (HR: 1.95, 95% CI: 1.37–2.85, p=0.003). Using a time-dependent Cox model, the weekly IN-alert state was the strongest predictor of ICD shocks (HR: 2.94, 95% CI: 1.73–5.01, p<0.001), after correction for age, secondary prevention, and use of CRT. As compared to clinically stable subjects with no therapies, patients experiencing shocks had significantly higher baseline values of the HeartLogic index, third heart sound amplitude, and respiratory rate. Beginning about one month prior to the arrhythmic event, we noticed further increase of the combined index and the third heart sound amplitude, a decrease of thoracic impedance, and higher resting heart rate (Figure 1). Conclusions The HeartLogic index is an independent predictor of appropriate defibrillator therapies. The combined index and its individual physiological components change well before the arrhythmic event, suggesting the existence of a window of opportunity to prevent shocks. Funding Acknowledgement Type of funding sources: None.
Abstract AIM: to examine the role of FDG PET/CT for assessing response to immunotherapy in patients with solid tumors. MATERIALS AND METHODS: data recorded in a multicenter (n=17), retrospective database between March and November 2021 were analyzed. The sample included patients with a confirmed diagnosis of a solid tumor who underwent serial FDG PET/CT (before and after one or more cycles of immunotherapy), who were >18 years of age, and had a follow-up of at least 12 months after their first PET/CT scan. Patients enrolled in clinical trials or without a confirmed diagnosis of cancer were excluded. The authors classified cases as having a complete or partial metabolic response to immunotherapy, or stable or progressive metabolic disease, based on a visual and semiquantitative analysis according to the EORTC criteria. Clinical response to immunotherapy was assessed at much the same time points as the serial PET images, and the two were compared. RESULTS: The study concerned 311 patients (median age: 67; range: 31-89 years) in all. The most common neoplasm was lung cancer (n=177, 56.9%), followed by malignant melanoma (n=101, 32.5%). Nivolumab was administered in 144 of the former patients (46.3%), and pembrolizumab in 126 of the latter (40.5%). Baseline PET and a first PET scan performed a median 3 months after starting immunotherapy were available for all 311 patients, while subsequent PET scans were obtained after a median 6, 12, 16, and 21 months for 199 (64%), 102 (33%), 46 (15%), and 23 (7%) patients, respectively. Clinical response to therapy was recorded at around the same time points after starting immunotherapy for 252 (81%), 173 (56%), 85 (27%), 40 (13%), and 22 (7%) patients, respectively. At successive time points, the consistency between PET scans and clinical findings was 37%, 54%, 26%, 37%, and 29%, respectively. After a median 18 (1-137) months, 113 (36.3%) patients had died. On Kaplan-Meier analysis, metabolic responders on two or more PET scans after starting immunotherapy had a better prognosis than non-responders (all p<0.001), while clinical response became prognostically informative from the second assessment after starting immunotherapy onwards. CONCLUSIONS: FDG PET/CT should have a role in the assessment of response to immunotherapy in patients with solid tumors. It can provide prognostic information and thus contribute to a patient’s appropriate treatment.
