Translational Medicine @ UniSa. Volume 16 (jan.-jun. 2017)

Dexmedetomidine: current role in burn ICU

2025-04-30T15:28:18Z

Dexmedetomidine: current role in burn ICU Scibelli, Gennaro; Maio, Lucia; Sasso, Maiara; Lanza, Alessandro; Savoia, Giorgio Dexmedetomidine (DEX) is a relatively recent a2-adrenergic agonist which provides sedation, anxiolysis and analgesia with much less respiratory depression than other sedatives. These characteristics have implemented the use of the drug in the ICUs in order to achieve the target of a “arousable sedation”, thanks to its significant manageability. Its sedative-analgesic properties are also particularly suitable for use in burn ICUs, both adult and pediatric, which is why the current Guidelines have recognized a central role in the management of these categories of patients. Finally, DEX has showed significant anti-inflammatory effect both in animal models and in preliminary clinical trials, reducing vasopressor requirements and main mediators levels of the systemic inflammatory response involved in sepsis and similar processes, suggestingits use for improved outcome in ICU septic patients.

Obesity and obesity related diseases, sugar consumption and bad oral health: a fatal epidemic mixture. The pediatric and odontologist point of view

2025-04-30T15:28:35Z

Obesity and obesity related diseases, sugar consumption and bad oral health: a fatal epidemic mixture. The pediatric and odontologist point of view Delli Bovi, Anna Pia; Di Michele, Laura; Laino, Giuliana; Vajro, Pietro Obesity and dental caries are increasingly widespread pathologies. The former is growing so rapidly that the WHO classified its trend as an “epidemic”. Both are triggered by a number of well known common etiologic factors sharing also the high added sugar amount since childhood. Because of its fermentation and pH lowering, dietary sugar allows the cariogenic bacteria to damage the tooth enamel provoking the carious lesions. WHO guidelines recommend reducing sugar intake to 10% of the total daily energy need, and highlight that there is evidence which suggests cuttingthis value down to 5% at least. The American guidelines addressing paediatric age put the limit to 25gr a day with a total ban on sugar in those aged 2 or less.

Larger blood pressure reduction by fixed-dose compared to free dose combination therapy of ace inhibitor and calcium antagonist in hypertensive patients

2025-04-30T15:28:16Z

Larger blood pressure reduction by fixed-dose compared to free dose combination therapy of ace inhibitor and calcium antagonist in hypertensive patients Visco, Valeria; Finelli, Rosa; Pascale, Antonietta Valeria; Giannotti, Rocco; Fabbricatore, Davide; Ragosa, Nicola; Ciccarelli, Michele; Iaccarino, Guido The introduction of fixed combination of ACEi+CCB (Fixed) has significantly increased patients compliance and adherence to therapy. At the moment, however, there are no data suggesting the better control of once-daily fixed (Fixed) over free doses in separate administrations combination therapy in hypertensives. In a population of 39 consecutive outpatient patients referred to the departmental Hypertension clinic of the University Hospital of Salerno Medical School with the first diagnosis of arterial hypertension, we tested the hypothesis that the Fixed achieve a better control of blood pressure than the Free combination. Patients were randomized to either strategy and after 3 months patients underwent a clinical assessment to evaluate the antihypertensive effect. The two groups, matched for anthropometric and clinical parameters, received Amlodipine (5-10 mg/daily) and Perindopril (5-10 mg/daily). Perindopril and Amlodipine doses did not significantly differ between the two groups. After 3 months BP control was improved in both groups and BP targets were similarly reached in both groups (SBP; Fixed: 61.54%; Free 69.23%; n.s. DPB; Fixed: 80.77%; Free 84.62%; n.s.). The reduction in systolic blood pressure was similar in both groups (Fixed:7.64±2.49%; Free: 7.81±4.00%, n.s.), while the reduction of diastolic blood pressure was greater in the Fixed group (Fixed: 14.22±2.03%; Free: 4.92±5.00%, p<0.05). Although both strategies are effective in reducing BP, the use of Fixed dose has an advantage in the reduction of BP. The present study does not allow to identify the mechanisms of this difference, which can be assumed to be due to the pharmacokinetics of the drugs administered in once-daily fixed combination.

Implementing an ict-based polypharmacy management program in Italy

2025-04-30T15:28:14Z

Implementing an ict-based polypharmacy management program in Italy Arcopinto, Michele; Cataldi, Mauro; De Luca, Vincenzo; Orlando, Valentina; Simeone, Giuseppe; D’Assante, Roberta; Postiglione, Alfredo; Guida, Antonella; Trama, Ugo; Illario, Maddalena; Coscioni, Enrico; Iaccarino, Guido; Cuccaro, Paula; D’Onofrio, Gaetano; Vigorito, Carlo; Cittadini, Antonio; Ferrara, Nicola; Menditto, Enrico Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed.