Comorbidity and in-hospital mortality in peritoneal dialysis patients: data of the Emilia Romagna region of Italy

OBJECTIVE

Kidney failure increases in-hospital mortality (IHM); however, comorbidity is crucial for predicting mortality in dialysis patients. Our aim was to evaluate the impact of comorbidity, assessed by modified Elixhauser index (mEI), Charlson Comorbidity Index (CCI), and age-adjusted CCI, on IHM in a cohort of peritoneal dialysis patients admitted to hospitals of the Emilia Romagna region (ERR) of Italy.

PATIENTS AND METHODS

All hospital admissions of peritoneal dialysis patients recorded between 2007 and 2021 in the ERR database were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) was used for detecting diagnoses and procedures, and the inclusion criterion was code 5498. Comorbidity burden was evaluated by three different scores, and hemodialysis (HD) treatment need was considered. IHM was our outcome.

RESULTS

During the 15 years of the study, 3,242 hospitalized peritoneal dialysis patients (62.7% males) were evaluated. Mean age was 62.8±20.6 years, 9.6% underwent HD, and IHM was 5.9% (n=192). IHM mortality was stable throughout the study period. Deceased subjects were older, were hospitalized longer, had a higher comorbidity burden, and had a higher percentage of HD treatment needs than survivors. Age, male sex, comorbidity burden, and HD treatment were predictors of IHM. Receiver operating characteristics (ROC) analysis confirmed the impact of comorbidity burden on IHM, especially when age was considered.

CONCLUSIONS

We conclude that in male, elderly hospitalized peritoneal dialysis patients with failing dialysis technique, comorbidity burden should be considered being a predictor of IHM.

[Survey on the ability to prescribe antibiotic therapy among Italian residents in geriatrics and internal medicine]

Antibiotic therapy is a crucial and often life-saving strategy. This study assessed the ability to prescribe antibiotic therapy among a series of Italian postgraduate students in geriatrics and internal medicine. Participants were administered an anonymous questionnaire consisting of self-assessment of their ability to prescribe antibiotics and then manage a case of community-acquired pneumonia. The Wilcoxon test for comparisons between two independent samples was used for statistical analysis. Almost half the 70 students considered their knowledge of antibiotic therapy insufficient and were not satisfied with the notions received during their studies. Indeed, the change in antibiotic therapy required to control acute exacerbation of pneumonia was correctly identified by only 36% of students. Moreover, 38% of them gave the correct answer on factors influencing the duration of antibiotic therapy in the presence of definite improvement of pneumonia. No significant difference was found between the responses of residents in geriatrics and internal medicine. Overall, our study shows that nearly half of our students think they have inadequate antibiotic prescribing skills. This is confirmed by a low ability to establish the best management of the clinical case. To repair this severe shortcoming, different training methods need to be compared and more effective forms of instruction adopted.

Non-occupational malignant pleural mesothelioma due to asbestos and non-asbestos fibres

BACKGROUND AND AIM

The occurrence of malignant pleural mesothelioma (MPM) has been reported among population groups with no documented professional exposure to asbestos fibres living in different geographic areas. This paper reviews existing data related to non occupational MPM including its occurrence in the province of Catania (Sicily, Italy).

METHODS

An electronic search of literature related to non occupational MPM was performed including the year 2005.

RESULTS

Non occupational MPM in subjects living in areas contaminated by a variety of asbestos and non asbestos fibres has been well documented through a number of epidemiologic studies including cases series, case-control studies, and a cohort study. In addition, the observation of familial clustering of MPM, suggests that genetic factors may play a role in the pathogenesis of this malignancy. The epidemiological evidence also suggests that MPM may occur as a result of the interaction between environmental carcinogens, genetic factors, and virus infection.

CONCLUSION

It is likely that genetic predisposition and non-occupational exposure to low doses of asbestos and asbestos-like fibres may concur to the development of malignant mesothelioma. However, additional epidemiological and laboratory studies are needed to further understand the relationship between environmental exposure and individual susceptibility to this malignancy.

[Smoking habits in health care workers: experience in two general hospitals of Eastern Sicily]

PURPOSE

The aim of our study was to assess the smoking habits in health care workers.

MATERIALS AND METHODS

In concomitance with a medical examination for Health Care Surveillance requested by the Italian Laws (D. Lgs. 626/94), our operative units interviewed 2,000 persons (47.9% males, 52.1% females, mean age = 45 yrs (SD+/-9.41 yrs) working in two General Hospitals of Eastern Sicily.

RESULTS

The prevalence of smokers was found to be higher in men (34.5%) than in women (33.6%), in Health Care Operators (36.4%) and professional nurses (36.2%) than in medical doctors (27.7%), in night-time workers (34,5%) then in day-time-workers (28,7%). The compliance with smoking restriction was found to be poor; in fact, 60% out of smokers declared to smoke during the working hours.

CONCLUSIONS

This investigation has revealed the significant prevalence of tobacco smoking among the health care workers in general. We think that the inclusion of an anonymous questionnaire on smoking habits within the Services of Sanitary Surveillance may help in the national campaign against cigarette smoking.

[Adverse reaction following suspected inhalation of nickel tetracarbonyl: case report]

BACKGROUND

Nickel tetracarbonyl (Ni(CO)4) is a highly toxic chemical that is produced as an intermediate compound in the Mond process of nickel refining. Occupational poisoning due to Ni(CO)4 is not frequent, and up to now about 300 cases have been reported in the medical literature worldwide.

OBJECT

A clinical case is reported of an industrial worker who developed clinical symptoms of respiratory distress probably due to accidental exposure to Ni(CO), METHODS: Clinical examination, chest X-ray data, history of exposure to nickel in the presence of carbon monoxide (CO) from a production plant that was located close to the reactor containing nickel, led to diagnosis of respiratory distress due occupational poisoning.

RESULTS

Patient history, clinical symptoms that were characteristic of Ni(CO)4 poisoning: mild transient initial symptoms followed within 24 hours by more severe life-threatening events environmental data, history of exposure to nickel near a carbon monoxide (CO) production plant that was located close to the nickel containing reactor, indicated a putative causal relationship between diagnosis and exposure to nickel tetracarbonyl.

CONCLUSIONS

The accident that without adequate respiratory therapy might have had fatal consequences, could have been avoided if the rules of technical and procedural prevention had been carefully observed.

Unilateral retinal vasculitis associated with hairy cell leukaemia: immunogenetic study

This report describes a case of retinal vasculitis which occurred in hairy cell leukaemia and was localized only in the right eye. An immunogenetic study investigates the possible genetic association between vascular uveitis and hairy cell leukaemia.

Natural interferon therapy: optic nerve ischemic damage?

The purpose of this study was the evaluation of retinal abnormalities during a treatment with natural interferon (IFN-alpha for chronic hepatitis C. Retinal hemorrhages and optic disk edema were found in a 40-year-old woman during IFN-alpha therapy. The disk edema and retinopathy resolved after the INF was discontinued. Although retinal abnormalities correlated with IFN therapy have been described recently by some authors, the pathogenesis is still unclear. Anterior ischemic optic neuropathy occurring in a patient treated with IFN is a probable complication of the therapy.

Anterior uveitis associated with Mycoplasma pneumoniae pneumonia: a case report

The authors report a case of bilateral uveitis following Mycoplasma pneumoniae pneumonia verified by IgM and rising IgG antibodies against the organism. Uveitis is a rare manifestation of Mycoplasma pneumoniae pneumonia and since it is a common pathogen, it should be considered in the differential diagnosis, even in the absence of respiratory symptoms or neurological findings. Immunobiological hypotheses are briefly discussed.

Iris cyst in aphakic patient: improvement of visual acuity after excision

Postsurgical or spontaneous iris cyst is a rare finding. Unfortunately, all treatments are complicated and the results may be disappointing. We report a case of postsurgical iris cyst treated by sector iridectomy with satisfactory recovery of visual acuity.

[Echographic study of cryptorchidism]

The authors, after a nosologic review of cryptorchidism, illustrate their positive diagnostic experience with ultrasound. Limits as well as clinical advantages, in relation to the diagnosis and follow-up, are also described.

[Pre-hospital resuscitation and transport of cardiac patients. Apropos of 107 cases of primary transport]

Report of 107 cases of primary transportation in ambulances especially equipped for coronary patients monitoring. The various delays of admission were studied and the complications occuring during transportation were analyzed, together with the various therapeutic methods applied. On the basis of this personal experience, and to attempt at diminishing the mortality at the acute stage of myocardial infarction, it was advised: --a careful information of the public, --a systematic training of the physicians, --a logic organization of emergency care. Only a coherent set up of fixed and mobile units might result in improvement of the prognosis of the first hours after myocardial infarction.