Taken together, for this patient, these results lead to the conclusion that the whole chlorhexidine molecule is complementary to the IgE antibody combining sites and that the 4-chlorophenol, biguanide and hexamethylene structures together comprise the allergenic determinant. Hence, like one of the trimethoprim determinants identified, but unlike most drug allergenic determinants identified so far, the chlorhexidine allergenic determinant identified here encompasses the entire molecule.

Cardiovascular diseases are a leading cause of death in Europe. Outcomes in terms of mortality and health equity in the management of patients with ST-Elevation Myocardial Infarction (STEMI) are influenced by health care service organization. The main aim of the present study was to examine the impact of the new organizational model of the Veneto Region’s network for Acute Myocardial Infarction (AMI) to facilitate primary percutaneous coronary intervention (PCI) on STEMI, and its efficacy in reducing health inequities. A retrospective cohort study was conducted on HDRs in the Veneto Region for the period 2007–2016, analyzing 65,261 hospitalizations for AMI. The proportion of patients with STEMI treated with PCI within 24 h increased significantly for men and women, and was statistically much higher for patients over 75 years of age (APC, 75–84: 9.8; >85: 12.5) than for younger patients (APC, <45: 3.3; 45–64: 4.9), with no difference relating to citizenship. The reduction in in-hospital, STEMI-related mortality was only statistically significant for patients aged 75–84 (APC: −3.0 [−4.5;−1.6]), and for Italians (APC: −1.9 [−3.2;−0.6]). Multivariate analyses confirmed a reduction in the disparities between socio-demographic categories. Although the new network improved the care process and reduced health care disparities in all subgroups, these efforts did not result in the expected survival benefit in all patient subgroups.

Evasion from imminent threats and prey attack are opposite behavioral choices critical to survival. Curiously, the lateral periaqueductal gray (LPAG) has been implicated in driving both responses. The LPAG responds to social threats and prey hunting while also drives predatory attacks and active defense. However, the LPAG neural mechanisms mediating these behaviors remain poorly defined. Here, we investigate how the LPAG mediates the choices of predatory hunting and evasion from a social threat. Pharmacogenetic inhibition in Fos DD-Cre mice of neurons responsive specifically to insect predation (IP) or social defeat (SD) revealed that distinct neuronal populations in the LPAG drive the prey hunting and evasion from social threats. We show that the LPAG provides massive glutamatergic projection to the lateral hypothalamic area (LHA). Optogenetic inhibition of the LPAG-LHA pathway impaired IP but did not alter escape/attack ratio during SD. We also found that pharmacogenetic inhibition of LHAGABA neurons impaired IP, but did not change evasion during SD. The results suggest that the LPAG control over evasion to a social attack may be regarded as a stereotyped response depending probably on glutamatergic descending projections. On the other hand, the LPAG control over predatory behavior involves an ascending glutamatergic pathway to the LHA that likely influences LHAGABA neurons driving predatory attack and prey consumption. The LPAG-LHA path supposedly provides an emotional drive for prey hunting and, of relevance, may conceivably have more widespread control on the motivational drive to seek other appetitive rewards.

Background The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged &gt;65 years. A recent study also found that almost 75% of adults with diabetes have two or more comorbid conditions. The aim of the study was to investigate the impact of comorbidities on health care service use and health care costs of an elderly diabetes cohort with high health care needs (HHCN), based on real-world data. Methods For the purposes of the present study, people with a diagnosis of diabetes, residing in the area served by the ex-ULSS4-Veneto LHU, and characterized as having HHCN, corresponding to ACG-RUBs 4 and 5 were considered. The comorbidities was assessed using clinical diagnoses that the ACG System assigns to single patients by combining different information flows. The presence of correlation between comorbidity classes and total annual health care costs and use was tested with Spearman Test. Moreover, the association between above mentioned variables was tested with a appropriate regression, adjusting for age and sex. Results Mean overall cost and drug cost ranged respectively from 6284 euro, 525 euro in a patient with only 1 comorbidity to 10752 euro and 1764 euro for a patient with more than 8 comorbidities. The study shows that all measures of health care services use (as emergency care accesses; number of outpatients visits; number of inpatients admissions) have a statistically significant correlation with comorbidities class. However, multivariate analyses revealed that no different use in hospitalization was associated with comorbidity class. A significant correlation was also detected among costs variables (total annual costs and pharmacy costs) and comorbidity classes. Conclusions The increase in total healthcare services use and costs due to the increased number of comorbidities was seen mainly for primary care services, highlighting the need of primary care to be strengthen in an ageing and multi-morbid population. Key messages Overall cost and drug cost for patients with more than 8 comorbidities are respectively almost doubled and more than threefold greater than those with only one comorbidities. The study revealed an increase in primary care services, suggesting an implementation of these services giving the aging population and the increase prevalence of comorbid diabetic patients worldwide.

The development of powerful new technological tools (especially in the field of molecular biology and the neurosciences) on the one hand, and of our potential for digitally recording huge amounts of information in every field (medicine included) on the other, is rapidly challenging the classic course of a diagnostic process based on the onset of symptoms prompting physical and instrumental exams and ultimately leading to a clinical diagnosis. The particular cases of screening and of incidental findings are also considered and discussed. Nowadays, the definition of a disease is increasingly related to the particular tools used to diagnose it more or less reliably and consistently across time and populations. This new and constantly evolving situation inevitably poses important ethical issues, such as individuals' right to keep their health-related information confidential, but also the responsibility of National Health Systems to the communities they serve. Lifelong longitudinal studies based on electronic healthcare archives have been recommended for the purposes of exploring the impact of new technologies on the health profile of the general population, and the underlying unknown dimension of the real distribution of diseases in said population. An example of birth-cohort from NorthEast of Italy using electronic health archives is presented and discussed.