COVID-19 lockdown and the rate of central precocious puberty

PURPOSE

The aim of our study was to compare the incidence of idiopathic central precocious puberty (CPP) in our highly specialized Endocrinological Center before and after the onset of COVID-19 lockdown; we also aimed to identify any potential difference between girls with CPP from the two different time periods.

METHODS

We retrospectively analyzed the auxological profile of 49 girls with idiopathic CPP: 30 with pre-lockdown onset and 19 with post-lockdown onset of the disease. We collected patients' characteristics (medical history, physical examination, baseline and dynamic hormonal assessment, bone age, pelvic ultrasound) and compared them between the two groups.

RESULTS

We registered an almost threefold increase in CPP incidence in the 2020-2021 period compared to the previous six years. In post-lockdown patients we found a trend for an earlier diagnosis in terms of both chronological age (p 0.0866) and days between the onset of first pubertal signs and diagnosis (p 0.0618). We also found that post-lockdown patients had a significantly lower hypothalamus-pituitary-gonadal axis activation (lower ∆LH% after GnRH test, p 0.0497), a significantly lower increase in bone age calculated at RUS with TW3 method (p 0.0438) and a significantly reduced ovarian activation in females (lower delta-4-androstenedione levels, p 0.0115). Interestingly, post-lockdown patients were born from mothers with an older age at menarche (p 0.0039).

CONCLUSIONS

Besides confirming a significant increase in new diagnoses of CPP in the post-lockdown period, our findings among Post-lockdown girls also suggest a less progressive form of CPP and a stronger environmental influence compared to genetic background in determining the timing of pubertal onset.

JS06.4.A Intracranial ependymomas of the adult: outcome and response to treatments across molecular subtypes

Background

The 2021 WHO Classification lists two molecularly defined types of supratentorial ependymomas (STEs), i.e., ZFTA and YAP1 fusions, and posterior fossa ependymomas (PFEs), i.e, PFA and PFB. Based on retrospective data, the presence of the ZFTA fusion (for STEs) and the PFA subtype (for PFEs) seem to correlate with a poorer outcome. However, prospective data on large cohorts of adult patients are lacking, and the role of treatments is uncertain. The aim of our study is to investigate the clinical characteristics, response to treatment, and outcome of a cohort of adult patients with supratentorial and posterior fossa ependymomas across different molecular subtypes.

Patients and Methods

Clinical data of patients ≥18 years with STEs and PFEs were retrospectively collected from 2 Italian Centres (Turin, Treviso). ZFTA and YAP1 fusions were detected by FISH, while PFA and PFB subtypes were defined by anti-H3K27me3 immunohistochemistry.

Results

We collected 42 adult patients with STEs (11, 26.2%) and PFEs (31, 73.8%) diagnosed between 1984 and 2021. Median age was 45 years. ZFTA and YAP1 fusions were found in 5 (45.5%) and 1 (9.1%) case of STEs. PFA and PFB subtypes accounted for 9 (29.0%) and 22 (71.0%) cases of PFEs. Extent of resection (EOR) was gross-total (GTR) in 6/11 (54.8%) STEs and 17/31 PFEs (54.8%). 4/11 (36.4%) STEs and 9/31 (29.0%) PFEs received adjuvant radiotherapy (RT). Median progression-free survival (mPFS) and overall survival (mOS) were 172 and 61.6 months for STEs patients, and not reached (NR) and 332 months for PFEs. For patients with STEs, the presence of ZFTA fusion correlated with a significant shorter PFS (64.0 months vs NR, p = 0.05) and with a trend for shorter mOS (168.0 months vs NR, p = 0.307). The only patient with YAP1 fusion had a very long PFS (33 years). In a multivariable analysis, EOR and adjuvant RT did not significantly affect survival of STEs patients.For patients with PFEs, PFA and PFB subtypes did not differ significantly in terms of mPFS (NR vs 137.0 months, p = 0.513) and mOS (NR vs NR, p = 0.132). Conversely, GTR was associated with a significantly longer mPFS (NR vs 63.0 months, p = 0.007) and with a trend for longer mOS (NR vs 332.0 months, p = 0.146). In a multivariable analysis, GTR was associated with a significantly lower risk of disease progression, both in the entire cohort of PFE patients (p = 0.016), and within the PFA subtype (p = 0.013). Similarly, GTR was associated with a trend for better PFS within the PFB subtype.

Conclusion

Our preliminary data on a real-life cohort of adult patients confirm the worse prognosis of STEs harbouring the ZFTA fusion and suggest an impact of the EOR among PFEs regardless of molecular subtypes. Larger populations of patients are needed to better define the role of treatment modalities within molecular subrogups. The study is still ongoing in a multicentric setting.

Hospital hand hygiene monitoring: internal audits and the role of public health residents

Background

Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions.

Methods

San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication.

Results

8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data.

Conclusions

Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19.

Key messages

Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.

Living with heart failure during the COVID-19 pandemic: an interpretative phenomenological analysis

Funding Acknowledgements

Type of funding sources: None.

Background

The COVID-19 outbreak has presented significant challenges for healthcare systems worldwide, which are responsible for guaranteeing access to care for all patients and limiting the spread of the virus. The necessary changes in the healthcare systems have deeply impacted not only people affected by the novel coronavirus, but also those with chronic conditions, such as heart failure. Since the beginning of the pandemic, a reduction of routine visits and use of emergency services by patients with heart failure has been observed, and these patients have tended to visit the hospital only when their symptoms were severe. The consequences of the COVID-19 pandemic on heart failure patients’ lives have not yet been investigated.

Purpose

To explore the lived experiences of patients with heart failure during the COVID-19 pandemic.

Methods

A qualitative investigation based on interpretative phenomenological analysis was conducted. Fourteen patients with heart failure (12 males and 2 females with a median age of 68 years) completed in-depth, semi-structured interviews. Triangulation, journaling and member checking were used to improve the rigour of the study.

Results

Three themes describing the lived experience of patients were identified: "being vulnerable", "hanging in the balance", and "coping strategies". Patients reported feeling particularly vulnerable to the novel coronavirus due to their clinical conditions, and therefore they experienced fear and anxiety. Changes in the healthcare systems due to the COVID-19 pandemic created a sense of uncertainty that patients described as a feeling of hanging in the balance. However, despite these relevant difficulties, heart failure patients have managed to deal with the situation using various coping strategies, such as acceptance, recreational activities, family reorganization, and use of technology.

Conclusions

The COVID-19 outbreak deeply affected the lives of patients with heart failure, and our results highlight the relevant difficulties they have faced. We point out that there is a great need for targeted interventions, and these could be developed taking into consideration the coping strategies described in the study.

The lived experience of patients with a left ventricular assist device during the COVID-19 pandemic: a qualitative study

Funding Acknowledgements

Type of funding sources: None.

Background

During the COVID-19 pandemic, the healthcare delivery systems have undergone significant alterations to prioritize access to care for patients affected by the novel coronavirus, while treatments and check-ups for chronic patients have often been postponed. Among chronic patients, people with a left ventricular assist device (LVAD) have been particularly affected by the COVID-19 pandemic since they require frequent medical check-ups to detect any initial complications. So far, no studies investigating the lived experiences of LVAD patients during the COVID-19 pandemic have been conducted.

Purpose

This study explored the lived experiences of people with an LVAD during the COVID-19 pandemic.

Methods

A qualitative analysis was conducted based on the interpretative phenomenological analysis (IPA) methodology. Eight men with an LVAD (median age 72.5, range 65-82 years) participated in audio-recorded, semi-structured, in-depth interviews exploring changes in their daily lives during the pandemic and how they responded to them. Journaling and triangulation were used to enhance the rigour of the study.

Results

Two main themes were extracted from the data: psychological distress and moving forward. Initially, LVAD patients experienced distress because they feared being infected and were worried that they could not receive adequate treatment in case of emergency due to changes in the healthcare delivery system. However, they employed different coping strategies (i.e. taking control of their health, keeping a positive attitude, seeking support) that allowed them to deal with this difficult situation and to move forward.

Conclusions

This study provides the first insights into the experiences of LVAD patients during the COVID-19 pandemic. Our findings could help clinicians identify LVAD patients’ needs and develop targeted interventions.

The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review

The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

Multidrug-resistant organism infections and mortality: estimates from a large Italian hospital

Background

Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO.

Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital.

Methods

We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes.

Results

A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality.

Conclusions

Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others.

Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections.

Key messages

Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.

Narrative medicine in the cancer care: implementation and impact

Issue

National and international health authorities have described Narrative-based medicine (NBM) in clinical practice as a fundamental tool for acquiring, understanding and integrating the different points of view of those involved in the disease and its treatment, promoting more effective and appropriate care.

Description of the problem

The use of NBM is part of the strategic project to improve patient-engagement in San Raffaele Hospital in Milan. Its implementation started, using the 'DNM-Digital Narrative Medicine' web-based platform, with the pilot prostate cancer path in March 2019.

Results

A 10-item questionnaire was sent to all 47 patients and 45 doctors involved, to evaluate: benefits perceived by the care team in terms of communication support, personalization of therapy, observation of cognitive elements not otherwise evident; benefits perceived by the patient (support, communication, self-management, identification of emotional, relational, social elements of daily life); patient and medical staff opinions in terms of compliance, accessibility, ease of use. The overall rating was 4.3/5 for doctors and 4.2/5 for patients. Patients valued the most the platform supporting them in the decision on what treatment to undergo (4.8/5), for the doctor the platform has been important in considering unknown aspects of the patient and understanding the patient's point of view (4.4/5). Patients, more than doctors, perceived platform usability positively. 43% of the patients who decided not to participate reported to prefer a direct approach with the doctor.

Lessons

The oncologic field represents an optimal setting for the implementation of methods aimed at strengthening communication and relationship of care. NBM offers the possibility of exploring elements as adherence to treatment, perception of illness, socio-psychological impact, sometimes missed during the visit, enhancing the conversation between patient and care team and stimulating the co-construction of care.

Key messages

NBM has proven to be a useful tool and a good communication channel in the oncologic setting. The NBM platform demonstrated good acceptability and ease of use by doctors and patients.

COVID-19: knowledge and attitudes of hospital staff of a large Italian teaching hospital

Background

During infectious disease emergencies, fully aware healthcare workers (HCWs) and public services staff are unique resources to keep health systems active and tackle epidemics. Aim of the study was to assess concern, general and health-related knowledge (case management and Infection Prevention and Control [IPC] measures) among hospital staff on SARS-CoV-2 in Lombardy region (Italy).

Methods

One week after WHO declared COVID-19 a public health emergency we developed and online administered a 7-item questionnaire to all staff of San Raffaele Hospital, a referral and teaching hospital in Milan, exploring knowledge and attitudes on COVID-19. The survey remained accessible online for 72 hours.

Results

A total of 2,046, including HCWs and other staff, answered the survey (response rate 25%). Among the 2,027 responders included in the analysis, 1,102 were HCWs (54%), also in training, and 924 non-HCWs (46%). 60% of responders reported being worried or extremely worried about the epidemic. Concerning knowledge, the survey asked about modes of transmission, clinical forms, preventive measures in everyday life in Italy and cough etiquette. There were uniform trends in the two groups: HCWs were more aware and answered more properly (mean of correct answers 71,6%) than non-HCWs (mean 61,2%). HCWs were asked about IPC precautions, with only 41% providing correct answers, while over 74% knew only supportive therapy is currently available against COVID-19.

Conclusions

We were among the first to explore hospital staff knowledge on COVID-19 reporting data from a large study population. HCWs were slightly less concerned but more knowledgeable than general staff. Last questions showed that among HCWs there is generally good knowledge on the topic. However, most of the responders missed the recommendations to adopt simultaneously standard, contact and airborne precautions plus eye protection managing suspected and confirmed cases, as proposed by national and international authorities.

Key messages

During the ongoing emergency, it is of utmost importance that hospital staff is adequately trained to implement the best IPC measures and limit the spread of the infection.

Our data can inform planning of these preventive measures.

Laparoscopic Liver Resection: A South American Experience with 2887 Cases

BACKGROUND

Laparoscopic liver resections (LLR) have been increasingly performed in recent years. Most of the available evidence, however, comes from specialized centers in Asia, Europe and USA. Data from South America are limited and based on single-center experiences. To date, no multicenter studies evaluated the results of LLR in South America. The aim of this study was to evaluate the experience and results with LLR in South American centers.

METHODS

From February to November 2019, a survey about LLR was conducted in 61 hepatobiliary centers in South America, composed by 20 questions concerning demographic characteristics, surgical data, and perioperative results.

RESULTS

Fifty-one (83.6%) centers from seven different countries answered the survey. A total of 2887 LLR were performed, as follows: Argentina (928), Brazil (1326), Chile (322), Colombia (210), Paraguay (9), Peru (75), and Uruguay (8). The first program began in 1997; however, the majority (60.7%) started after 2010. The percentage of LLR over open resections was 28.4% (4.4-84%). Of the total, 76.5% were minor hepatectomies and 23.5% major, including 266 right hepatectomies and 343 left hepatectomies. The conversion rate was 9.7%, overall morbidity 13%, and mortality 0.7%.

CONCLUSIONS

This is the largest study assessing the dissemination and results of LLR in South America. It showed an increasing number of centers performing LLR with the promising perioperative results, aligned with other worldwide excellence centers.

Essential strategies in HAI prevention and control: performance assessment through the implementation of the HAI-CoSIP tool of the GISIO-SItI group. A pilot study in a sample of Italian Organizations

BACKGROUND

Healthcare-Associated Infections are a great concern for worldwide healthcare systems and represent a considerable threat to patient safety, leading to adverse clinical outcomes. A defined panel of indicators represents a key element to guide Healthcare Organizations towards identification of main gaps, implementation of effective actions and continuous improvements on Healthcare-Associated Infections prevention and control activities. A review on accreditation systems conducted by the Italian Study Group of Hospital Hygiene of the Italian Society of Hygiene Preventive Medicine and Public Health revealed a substantial heterogeneity of implemented standards and led to the development of a core set of indicators and requirements for Healthcare-Associated Infections' prevention and control within the hospital setting. The main aim of the study was to test the feasibility of the Healthcare-Associated Infections' prevention and control within the hospital setting tool to calculate performance scores on a sample of Italian Healthcare Organizations and to identify major critical issues. The potential benefits of the possibility of future implementation of the tool within Institutional Accreditation Programs is discussed.

STUDY DESIGN

Cross sectional pilot survey.

METHODS

The Healthcare-Associated Infections' prevention and control within the hospital setting included 96 criteria and 20 key areas including an area for outcomes indicators. For applicable criteria, standards fulfilment was evaluated according to a 4 point Likert scale. A composite score was calculated for each Healthcare Organization and five performance levels were identified. Data were further analysed by computing performance scores at the level of each area and requirement.

RESULTS

20 Healthcare Organizations agreed to take part in this pilot study including two rehabilitative Healthcare Organizations. Among the whole sample a mean of 12.20% of requirements resulted not fulfilled, leaving space for further improvements. Critical areas were easily identified and the instrument was able to capture substantial differences between Healthcare Organizations. Only a few number of standards resulted "Not Applicable" (Mean = 4.71%) and most of them regarded Rehabilitative Healthcare Organizations. Mean composite performance index resulted 74.06% (SD = 16.96, range 36.30 - 94.27%); area of outcome indicators obtained a mean score of 56.17.

CONCLUSION

The Healthcare-Associated Infections' prevention and control within the hospital setting resulted an useful tool to assess Healthcare Organizations' performance in the field of Healthcare-Associated Infections prevention and control and to identify necessary actions for further improvements. The distribution of total scores by Healthcare Organizations showed a high heterogeneity. Implementation of the Healthcare-Associated Infections' prevention and control within the hospital setting tool as an institutional accreditation tool may help to drive the required harmonization at a national level of Healthcare-Associated Infections management and control strategies and overcome current substantial regional differences.

Definition of criteria and indicators for the prevention of Healthcare-Associated Infections (HAIs) in hospitals for the purposes of Italian institutional accreditation and performance monitoring

BACKGROUND

Healthcare-associated infections (HAIs) are an important issue in terms of quality of care. HAIs impact patient safety by contributing to higher rates of preventable mortality and prolonged hospitalizations. In Italy, analysis of the currently available accreditation systems shows a substantial heterogeneity of approaches for the prevention and surveillance of HAIs in hospitals. The aim of the present study is to develop and propose the use of a synthetic assessment tool that could be implemented homogenously throughout the nation.

METHODS

An analysis of nine international and of the 21 Italian regional accreditation systems was conducted in order to identify requirements and indicators implemented for HAI prevention and control. Two relevant reviews on this topic were further analyzed to identify additional evidence-based criteria. The project team evaluated all the requirements and indicators with consensus meeting methodology, then those applicable to the Italian context were grouped into a set of "focus areas".

RESULTS

The analysis of international systems and Italian regional accreditation manuals led to the identification respectively of 19 and 14 main requirements, with relevant heterogeneity in their application. Additional evidence-based criteria were included from the reviews analysis. From the consensus among the project team members all the standards were compared and 20 different thematic areas were identified, with a total of 96 requirements and indicators for preventing and monitoring HAIs.

CONCLUSIONS

The study reveals a great heterogeneity in the definition of accreditation criteria between the Italian regions. The introduction of a uniform, synthetic assessment instrument, based on the review of national and international standards, may serve as a self-assessment tool to evaluate the achievement of a minimum standards set for HAIs prevention and control in healthcare facilities. This may be used as an assessment tool by the Italian institutional accreditation system, also useful to reduce regional disparities.

Sleep apnea in patients reporting insomnia or restless legs symptoms

OBJECTIVE

Insomnia and restless legs syndrome (RLS) are defined by self-reported symptoms, and polysomnography (PSG) is not routinely indicated. Occult obstructive sleep apnea (OSA), common even in asymptomatic adults, may complicate management of patients presenting with insomnia or restless legs. To this end, we investigated objective sleep apnea metrics in a large retrospective cohort according to self-reported symptom profiles.

METHODS

We compared sleep apnea findings in patients referred to our center according to self-reported symptoms associated with insomnia, sleep apnea, and restless legs. The cohort included over 1900 adults who underwent diagnostic (n = 1418) or split-night (n = 504) PSGs and completed a symptom and medical history questionnaire.

RESULTS

More than 30% of patients who did not endorse any OSA symptoms, but did endorse insomnia or restless legs symptoms, were found to have OSA based on apnea-hypopnea index (AHI) >5 during overnight laboratory testing. Regression models of the full cohort showed that the risk of OSA was related, as expected, to older age, male sex, elevated body mass index, and presence of OSA symptoms. The presence of insomnia symptoms did not alter the risk of OSA. The presence of restless legs symptoms showed a small odds ratio for lowered OSA risk.

CONCLUSIONS

Objective evidence of OSA occurs similarly in those with insomnia or restless legs symptoms, even among those without self-reported OSA symptoms. Providers should be aware of the potential for occult OSA in populations with insomnia and restless legs, which may complicate their management in addition to presenting an independent medical risk itself.

[Functional echocardiography in neonatal intensive care: 1 year experience in a unit in Spain]

INTRODUCTION

Several publications highlight the usefulness of functional echocardiography (FnECHO) in neonatal intensive care. Data is lacking on its use in units neonatal in Spain.

OBJECTIVES

To evaluate frequency of use, patient characteristics, indications, measurements, and impact on patient management of FnECHO in a neonatal intensive care unit (NICU) in Spain over a 1 year period.

METHODS

A retrospective study conducted in NICU patients during 1 year.

VARIABLES

gestational age, birthweight, admission criteria, days of life at examination, indication for FnECHO, parameters assessed, and treatment modifications.

RESULTS

168 echocardiographic studies were performed in 50 patients (mean 3,4. SD 2,83). The most frequent indication was patent ductus (PDA) assessment (58.3%), followed by hemodynamic instability (22.2%). The results of FnECHO modified treatment in 62 cases (36.9%). In 17.4% of them treatment with ibuprofen was initiated, and in 1.2% it was discontinued. In 10.8% of the cases, the results of FnECHO modified hemodynamic support. Echocardiographic evaluation included: assessment of presence/hemodynamic significance of PDA (100%); myocardiac function: ejection fraction/shortening fraction (EF/SF) 23.8%, left ventricular output 24.4%, right ventricular output 21.4%, systemic blood flow 42.3%; and signs of pulmonary hypertension 7.7%.

CONCLUSIONS

FnECHO is frequently used in the NICU, and in many cases it guides treatment. PDA assessment and hemodynamic instability are the most frequent indications. It still needs to be elucidated if the use of FnECHO modifies patient outcomes.

[Health personnel assessment about medical order entry systems of pharmacologic treatments in hospitalized patients]

OBJECTIVE

to evaluate health personnel perceptions about medical order entry systems concerning the effect on workflow, medication errors risk and assessment of its potential advantages.

MATERIAL AND METHODS

A cross-section opinion interview was conducted in a tertiary care hospital. Questionnaire consisted of three sections: perception of its effect on workflow, influence on medication error risk and assessment of potential advantages. We also asked them to assess drawbacks and provide suggestions about this prescription system.

RESULTS

76 health professionals were interviewed (58 physicians, 9 pharmacists and 9 nurses). They were satisfied mainly due to decrease the workload (85.5%; IC 95%: 75.58-92.55). They thought that the main characteristics that contribute to reduce medication errors are clinical decision supports related to predefined aspects which the program provided by default. Among potential benefits of medical order entry systems, legibility and warnings triggered by the program (98.7%; IC 95%: 92.90-99.97 and 97,4%; IC 95%: 90.81-99.68 respectively) were the most valuable. High technology dependence, IT failures and lack of infrastructure and medication therapy discontinuities at times of transition between different hospitals' units were the main drawbacks considered. The most repeated suggestion was related to the improvement of links between other health informatics applications used in the hospital.

CONCLUSION

health personnel were highly satisfied with the CPOE system, which is considered to be effective and safe. Technology dependence and IT failures were the main disadvantages reported. According to them, a greater coordination and unification of all software applications available in the hospital would be desirable.

Prevalence of anti-legionella antibodies among Italian hospital workers

This study evaluated the prevalence of anti-legionella antibodies in workers at hospitals with a long-term history of legionella contamination. The hospitals are located in Milan and Turin, northern Italy, and in Naples and Bari, southern Italy. Antibody prevalence and titres of healthcare workers, medical and dental students and blood donors were assessed. In total 28.5% of subjects were antibody positive, most frequently to L. pneumophila serogroups 7-14. Major differences were observed in seroprevalence and type of legionella antibody in persons from different geographic areas. Healthcare workers had a significantly higher frequency of antibodies compared with blood donors in Milan (35.4 vs 15.9%, P<0.001), whereas in Naples both groups exhibited high antibody frequency (48.8 vs 44.0%) and had a higher proportion of antibodies to legionella serogroups 1-6. Dental workers had a higher seroprevalence than office staff in Bari, but not in Turin, where daily disinfecting procedures had been adopted to avoid contamination of dental unit water. No association was found between the presence of antibodies and the presence of risk factors for legionellosis, nor with the occurrence of pneumonia and/or flu-like symptoms. In conclusion, the presence of legionella antibodies may be associated with occupational exposure in the hospital environment, but there was no evidence of any association with disease.

Adiponectin receptors gene expression in lymphocytes of obese and anorexic patients

AIM

Two adiponectin receptors (ADIPORs), ADIPOR1 and ADIPOR2, are widely expressed in tissues. Whether changes in the expression of ADIPORs are associated with obesity and insulin resistance in humans is still unclear. The aim of this study was to explore whether lymphocyte ADIPOR1 and ADIPOR2 mRNA expression is associated with obesity, insulin resistance, first-phase insulin secretion and serum adiponectin levels.

METHODS

Using reverse transcription-polymerase chain reaction, we measured ADIPOR1 and ADIPOR2 mRNA levels in the lymphocytes of 59 obese patients, of whom 39 had normal glucose tolerance, 8 had impaired glucose tolerance or impaired fasting glucose, and 12 had type 2 diabetes, and of 21 women with restrictive anorexia nervosa.

RESULTS

In all subjects, ADIPOR1 expression was 2.2-fold higher than that of ADIPOR2 (p < 0.0001). The mRNA expression level of both receptors correlated with each other (p < 0.0001). After adjustment for age and sex, lymphocyte ADIPORs mRNA expression (ADIPOR1, p < 0.005; ADIPOR2, p < 0.05) and serum adiponectin (p < 0.0001) were significantly lower in obese patients than in anorexic subjects. In a multivariate analysis with ADIPOR1 as the dependent variable and body mass index (BMI), blood pressure and adiponectin as the independent variables, only serum adiponectin remained positively and independently correlated with ADIPOR1 (p < 0.05). Adiponectin was independently and negatively related to BMI and sex.

CONCLUSIONS

We have demonstrated in this study that lymphocytes express ADIPORs and that, similar to serum adiponectin, ADIPORs expression is markedly reduced in obese subjects. ADIPORs expression is not independently related to BMI, insulin resistance and beta-cell function.

Liver resection for non-colorectal, non-neuroendocrine metastases: analysis of a multicenter study from Argentina

BACKGROUND AND AIM

Resection of colorectal liver metastases has become a standard of care, although the value of this procedure in non-colorectal non-neuroendocrine (NCRNNE) metastases remains controversial and is still a matter of debate. The aim of the study was to determine the utility of liver resection in the long-term outcome of patients with NCRNNE metastases.

MATERIAL AND METHODS

The records of 106 patients who underwent liver resection for NCRNNE metastases in the period 1989 to 2006 at 5 HPB Centers in Argentina were analyzed. Patient demographics, tumor characteristics, type of resection, long-term outcome and prognostic factors were analyzed. Depending on primary tumor sites, a comparative analysis of survival was performed.

RESULTS

Mean age was 54 (17-76). Hepatic metastases were solitary in 62.3% and unilateral in 85.6%. Primary tumor sites: Urogenital (37.7%), sarcomas (21.7%), breast (17.9%), gastrointestinal (6.6%), melanoma (5.7%), and others (10.4%). Fifty-one major hepatectomies and 55 minor resections were performed. Twenty patients underwent synchronous resections. An R0 resection could be achieved in 89.6%. Perioperative mortality was 1.8%. Overall, 1-year, 3-year, and 5-year survival rates were 67%, 34%, and 19%, respectively. Survival was significantly longer for metastases of urogenital (p=0.0001) and breast (p=0.003) origin. Curative resections (p=0.04) and metachronous disease (p=0.0001) were predictors of better survival.

CONCLUSIONS

Liver resection is an effective treatment for NCRNNE liver metastases; it gives satisfactory long-term survival especially in metachronous disease, in patients with metastases from urogenital and breast tumors and when R0 procedures can be performed.

Neuroprotective effect of L-arginine in a newborn rat model of acute severe asphyxia

The left common carotid artery was ligated in anaesthetized 7-day-old Wistar rats (P7), prior to asphyxia by inhaling 100% nitrogen for 9 min. Pups recovered from asphyxia received i.p. saline (n = 16), or L-Arg 300 mg/kg (n = 14). Pups undergoing sham operation remained as controls (n = 12). At day 14, the amount of surviving or degenerating neurons was quantified under optical microscopy by Nissl technique or by Fluoro-Jade B (FJB) in CA1 area of hippocampus and in parietal cortex. In these areas, asphyxia reduced the neuronal density by 23.6 and 30%, and increased the proportion of degenerating neurons two and four times, respectively. L-Arg administration to asphyxiated pups reduced the neuronal loss and the proportion of degenerating neurons by 50% (p < 0.05). We conclude that L-Arg administration after acute severe asphyxia in newborn rats is neuroprotective, reducing early and delayed neuronal loss.

[Environmental diffusion of Legionella spp and legionellosis frequency among patients with pneumonia: preliminary results of a multicentric Italian survey]

A multicentric Italian investigation on legionnaires' disease is in course to clarify host factors as well as pathogen associated characteristics involved in the infection/disease. The main goal of the research plan is to account for some critical aspects concerning identification and prevention of legionellosis. To improve knowledge on factors associated with Legionella spp colonisation in hot waters, to detect cases and to characterize risk factors in subjects which develop pneumonia are specific objectives of the research programme. Preliminary results show that hot waters of houses and hotels are frequently contaminated (22.6% and 54.6%, respectively), mainly by L. pneumophila. Microbial concentrations were low in domestic waters (<1.000 ufc/l), but higher in samples from the hotels (geom. mean 1.85 x 10(3) ufc/l). Warming system, age of the plant, type of building were risk factors significantly associated with Legionella spp positivity. The active surveillance on patients affected by pneumonia with search for Legionella urinary antigen allowed the identification of 34 cases, 3 of which of nosocomial origin, corresponding to 4.2% of the screened pneumonia. After informed consent, 26 subjects were recruited for a case-control-study to clarify risk factors for the disease.

Effects of dopamine d2 receptor agonists in a pituitary transplantation-induced hyperprolactinaemia/anovulation model in rats

1. In the present study, we investigated the effects of hyperprolactinaemia, induced by transplantation of anterior pituitary glands under the kidney capsule in female rats, on the relationship between serum and pituitary concentrations of the gonadotropins and on the oestrous cycle. 2. Rats with pituitary transplants showed increased serum prolactin concentrations and decreased serum concentrations of gonadotropins and increased pituitary concentrations of gonadotropins. Moreover, these rats showed persistent dioestrous and anovulation from 3 to 6 days after transplantation. 3. A single oral administration of cabergoline (at doses between 0.001 and 0.1 mg/kg) dose-dependently inhibited the elevated serum prolactin concentrations in hyperprolactinaemic rats. At 0.1 mg/kg, cabergoline induced a continuous reduction in serum prolactin concentrations for 5 days after administration. Terguride (0.1 mg/kg) and bromocriptine (10 mg/kg) also reduced serum prolactin concentrations at 1 and 3 days after administration. All three dopamine D2 receptor agonists increased serum gonadotropin concentrations and ovarian weight at 3 days after administration. 4. In rats exhibiting anovulation, a single oral administration of any one of the three dopamine D2 receptor agonists dose-dependently restored ovulation and a normal oestrous cycle appeared. Oral administration of cabergoline (0.03 mg/kg) or terguride (0.1 mg/kg) restored ovarian function and abolished the anovulation following a reduction in serum prolactin concentrations. However, bromocriptine (10 mg/kg) did not completely abolish anovulation. Following administration of terguride (0.3 mg/kg) or bromocriptine (30 mg/kg), only one normal oestrous cycle appeared; however, following cabergoline (0.1 mg/kg), two normal oestrous cycles appeared. 5. These results suggest that cabergoline has a potent and long-lasting action as a dopamine D2 receptor agonist and, thus, should be a useful drug for the treatment of galactorrhoea and hyperprolactinaemic amenorrhoea and/or anovulation in humans.