RETROSPECTIVE STUDY ON THE COMPARISON OF OUT-OF-HOSPITAL AND IN-HOSPITAL SUDDEN CARDIOVASCULAR DEATHWritten by Giovanni Bartoloni et al.
A retrospective study of forensic autopsies was carried out in the time interval January 2007 to December 2012 at the Forensic Pathology Service, Catania, south Italy, with a reference population of 3 000 000 inhabitants. During the study period, 1346 forensic autopsies were performed, including 223 (16.57%) sudden/unexpected deaths. Among the latter, 116 fulfilled the criteria of out-of-hospital (Group A) and 107 were in-hospital (Group B) sudden/unexpected deaths with suspected medical malpractice and/or a professional liability claim.
In Group A, coronary artery disease was the most common cause of death (N=67; 57.65 %), followed by cardiomyopathies (N=19, 16.38%) and myocarditis (N= 6; 17%). In Group B, coronary artery disease (N=32, 29.91%), post-procedural or post-surgical complications (N=30, 28.04%), pulmonary thromboembolism (N= 17; 15.89%) and aortic dissection (N=7, 6.54%) were the main causes of death.
Milk thistle is a herbaceous plant and is part of the characteristic vegetation of all those lands that overlook the Mediterranean Sea. The plant is known for its use as a herbal medicine. This medicinal plant is known for its beneficial properties for the treatment of liver disorders and other diseases. Such effects are related to its ability to act as free radical scavenger as well as to the activation of antioxidant enzymatic system (i.e. heme oxygenase-1). The aim of the present review is to provide a tool for the clinicians in order to exploit the beneficial effects of milk thistle expecially for those conditions in which the modern pharmacology has not yet developed a success-fult strategy of treatment (i.e. Nonalcoholic Liver Disease).
NEOADJUVANT IMATINIB AND RADIOTHERAPY IN GASTROINTESTINAL STROMAL TUMOR OF THE RECTUM: A CASE REPORTWritten by Rocco Luca Emanuele Liardo et al.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rectal localization is rare. The gold standard for treat-ment is: surgery and tyrosine kinase inhibitors (TKIs) for metastatic or unresectable disease.
We report a case of a 62 year-old woman who underwent a gastroenterology visit for abdominal pain, tenesmus and constipation. After GIST diagnosis and staging, the pa-tient started induction therapy with imatinib followed by concomitant radio and tar-geted therapy before a sphincter-saving anterior resection, with a regular postopera-tive course.
The rationale of neoadjuvant treatment is lesion downsizing for an easier surgery. In epithelial cancers treated through concomitant therapies, the goal is also to preserve the functional integrity of organs, lowering the risk for salvage therapies. Also in GISTs, there is a direct correlation between downsizing, downstaging and outcomes.
COMMUNICATION IN THE HEALTHCARE RELATIONSHIP: SOME ASPECTS OF PATIENTS’ PERSPECTIVES IN THE CONTEXT OF PERCEIVED QUALITY OF CARE IN THE VERONA UNIVERSITY HOSPITAL IN 2013Written by Valentina Mecchi et al.
INTRODUCTION: Medical practice should be carried out in a sensible and respectful manner. This study aimed to assess the levels of patient satisfaction regarding the right to be informed, listened to and involved in care decisions, with the intention of contributing to the implementation of a better quality of care..
METHOD: Between October 7th and November 3rd 2013, anonymous questionnaires were distributed to hospitalized patients.
RESULTS: 46.14% stated they had felt involved in decisions about their treatment, and 82.94% reported that they had been directly informed about their health or treat-ment to an appropriate extent. 85.13% of patients had felt they were being treated with respect and dignity at all times.
DISCUSSION: Quality of communication between physicians and patients positively influences outcomes. Measuring the perceived quality of care, in AOUI Verona, trig-gered an increasing awareness of these issues, a drive for improvement, productive involvement in the project and the active participation of service users.
CONSERVATIVE TREATMENT AND PERCUTANEOUS“K”WIRE FIXATION OF CHILDHOOD SUPRACONDYLAR HUMERUS FRACTURESWritten by Liborio Miccichè et al.
Supracondylar humeral fractures are frequent lesions during childhood. Treatment consists in a conservative approach for the compound and stable fractures; the unsta-ble fractures are treated with a closed reduction surgery using percutaneous K-wire fixation. The authors considered 62 cases of supracondylar humerus fractures in pa-tients between the ages of 2 and 11 years old, which occurred between 2000 and 2013. The surgical results were analyzed through post-operative X-ray examinations. The functional results were evaluated afterwards by observing the alteration of the elbow’s anatomical profile, the presence or absence of a vascular-nervous deficit, the pain management, the muscular strength (MRC scale) and any eventual functional limitation. The mean follow-up was 7 years. According to the authors’ experience, both the conservative treatment and the percutaneous "k" wire fixation guarantee good results and a low complication rate. For this reason, surgeon experience is cru-cial in relation to the fracture’s nosologic overview and to the osteosynthesis surgery abilities.
RESULTS: 16,725 participants (aged 18-64) met inclusion criteria; 44.28% of workers were overweight or obese (56.36% of males vs 27.24% of females, p<0.001). Ac-cording to the logistic regression analysis, female (OR 0.28, 95% CI 0.26-0.31) and highly educated workers (OR 0.70, 95% CI 0.65-0.75) showed less risk of being overweight/obese compared to male and less educated workers. Aging was associated with an elevated risk (those aged >64 yrs compared to younger colleagues: OR 4.02, 95% CI 2.91-5.58) as well as artisans compared to employees (OR 1.11, 95% CI 1.01-1.23) and shift-work compared to daytime-work (OR 1.14, 95% CI 1.03-1.26).
DISCUSSION: Our analysis in the Italian context is consistent with the existing knowl-edge, suggesting that overweight is significantly associated with shift work, even when controlling for important covariates, such as education, age, gender, civil status, BMI category.
Background: Hospital-acquired infections (HAIs) pose a significant clinical and eco-nomic burden worldwide. Surveillance has been associated with a reduction of HAI rates in Intensive Care Unit (ICU) patients, although the particular reasons for this decrease are still difficult to determine. The present study was conducted in order to report HAI surveillance data during an eight-year period in five ICUs in Catania.
Methods: A patient-based HAI surveillance was conducted in the framework of the first four surveys of the Italian Nosocomial Infections Surveillance in ICUs network (SPIN-UTI) of the GISIO-SItI. Each survey consisted in a six-months surveillance con-ducted in: 2006-2007; 2008-2009; 2010-2011 and 2012-2013. During the study pe-riod, HAI cumulative incidence, incidence density and mortality were calculated overall and for each survey.
Findings: From 2006 to 2013, a total of 2070 patients were admitted in the five par-ticipating ICUs and were included in the study. The cumulative incidences of infected patients in each survey were: 13.3, 17.0, 18.9 and 8.9 per 100 patients, respectively. Accordingly, the risk of ICU-acquired infections increased in the third survey compared with the first (RR: 1.43; 95%CI: 1.06-1.92) but it decreased in the fourth survey compared with the second (RR: 0.64; 95%CI: 0.47-0.86) and the third (RR: 0.57; 95%CI: 0.43-0.76). A similar trend was observed considering incidence of infections and incidence density. Although mortality did not show a significant trend between the four surveys, the risk of death increased for infected patients.
Conclusions: The patient-based cohort design allowed us to analyze HAI indicators during an eight-years period, in five ICUs in Catania. Particularly, the risk of ICU-acquired infections increased in the third survey compared with the first, whereas it decreased in the fourth survey compared with the second and the third surveys. Fur-thermore, mortality remained unchanged, however the risk of death significantly in-creased for infected patients, in each survey. Surveillance data are useful to support policymakers and leaders to make evidence-based decisions in the healthcare setting, to plan and improve programs, services and interventions for preventing, managing and treating HAIs.
The Authors evaluate the role of dextromethorphan as heroin adulterant. From De-cember 2010 through April 2013, in our Laboratory of Forensic Toxicology of Universi-ty of Catania, eight fatal overdose of heroin cut with dextromethorphan were ob-served. Our first case (December 2010) was the earliest report in Italy. For these rea-sons we focused our interest on this cutting substance, studying its pharmacological interaction with the depressive morphine action on central nervous system.
Anthracycline is often used for treatment of hematologic malignancies and solid tu-mors, and the damage it causes to the heart muscle has long been known; therefore, the cardiac toxicity, one of the treatment-related co-morbidities, has become an issue for cancer survivors. Cardiotoxicity has been defined using various classifications. In this paper we report the case of a man affected by follicular non-Hodgkin’s lymphoma, which was first diagnosed in 2006 and had a second recurrence in 2012 with a medi-astinal mass: the patient was subjected to a new cycle of chemotherapy with anthra-cycline, the follow-up exam showed a significant reduction of the mass, but the clinical condition worsened and the ejection fraction of the left ventricle had a progressive re-duction, as seen in the cardiac-MRI test. Then, it was decided to discontinue therapy with anthracycline, resulting in a clear recovery of systolic function of the left ventri-cle, as seen in the following echocardiogram.
Material and Methods: Prospective study of consecutive patients undergoing fat plug myringoplasty under local anesthesia. Minimum follow-up considered was 6 months, which included several microscopic examinations. All data were recorded and analyzed statistically.
Results: 33 patients matched the inclusion criteria; the mean perforation size was 2.8 mm. No change in PTA was noted after surgery in the whole series. Recurrence of per-foration was detected in 7 cases (21%), which was statistically related with the cause of perforation rather than location or size (p-value <0.01).
Conclusions: Fat plug myringoplasty is a safe procedure with very low rate of compli-cations, and it is an office-based procedure well tolerate by all patients. Results in case of primary surgery are excellent, with a high success rate (90%). In case of recurrent perforation after traditional surgery, success rate get decreased.