Pattern electroretinogram detects localized glaucoma defects

Purpose: We evaluated the clinical ability of pattern electroretinogram (PERG) to detect functional losses in the affected hemifield of open-angle glaucoma patients with localized perimetric defects. Methods: Hemifield (horizontally-defined) steady-state PERGs (h-PERGs) were recorded in response to 1.7 c/deg alternating gratings from 32 eyes of 29 glaucomatous patients with a perimetric, focal one-hemifield defect, 10 eyes of 10 glaucomatous patients with a diffuse perimetric defect, and 18 eyes of 18 age-matched normal subjects. Standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SD-OCT) for retinal nerve fiber layer (RNFL) thickness also were performed. h-PERG amplitudes and ratios, calculated corresponding hemifield perimetric deviations, as well as hemiretina RNFL thicknesses were analyzed. Results: h-PERG amplitudes, perimetric deviations, and RNFL thicknesses showed losses (P < 0.001) when comparing affected with unaffected hemifields of localized glaucomatous eyes. No differences were found in h-PERG amplitudes between hemifields of normal or diffuse glaucomatous eyes. h-PERG amplitude ratios (affected/ unaffected hemifield) in localized glaucoma were lower (P < 0.001) than the ratios from normal or diffuse glaucomatous eyes. The areas under the receiver operating characteristic curves for h-PERG amplitude ratios, comparing localized-defect glaucomatous eyes with normal or diffuse glaucomatous eyes, were 0.93 and 0.91, respectively. Conclusions: h-PERG assessment showed good diagnostic accuracy to confirm localized glaucomatous defects detected perimetrically. This test may be particularly useful in cognitively impaired patients or young/nonverbal patients unable to provide reliable visual fields. Translational Relevance: h-PERG provides a sensitive objective measure to confirm

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The use of the first industrial X-ray CT scanner increases the lumber recovery value: case study on visually strength-graded Douglas-fir timber

Key message: Industrial computed tomography scanning of logs provides detailed information on timber quality prior to sawing. A sawing simulation—considering log rotation angle and knot size accuracy—revealed an average value increase of up to 20% for the best angle compared to the conventional horns-up position. Context: Computed tomography (CT) scanning has the potential to improve the value of products sawn from logs and meets the increasing demands of the wood industry for detailed information on log quality prior to processing. Aims: In a validation step, automated measurements of knot cluster variable DAB (DIN 4074-1:2012-06) using CT were compared with manual measurements. In a second optimization step, the hypothesis that the value of the sawn products is increased by sawing at the best rotation angle as opposed to the horns-up position was tested. Methods: A sample of 36 Douglas-fir logs were scanned in an industrial CT scanner, and sawn into boards. Knots on the boards were manually measured, and compared with the corresponding knots on virtual boards created from the CT data. The error of the DAB was measured by comparing CT data to manual measurements. An optimized sawing simulation was performed, using the measured DAB error to account for CT measurement errors, as well as a rotational error to account for errors in the log turning equipment. Using the results of the sawing simulation, Monte Carlo simulations were performed to show the potential and benefit of an industrial CT scanner. Results: The three largest DABs measured by the CT showed good correlation to the measurements on the manual boards. The simulation revealed an average increase of value from 4 to 20% compared to the conventional horns-up position depending on the relative price differences between the strength grades. Conclusion: By using a CT scanner to optimize sawing, sawmill owners can process logs in a better way to produce final products with increased added value

Procedura per la comunicazione di eventi avversi al paziente e alla famiglia.

La comunicazione trasparente ed onesta degli eventi avversi e delle loro conseguenze realizza un principio etico ed deontologico che permette di rafforzare la relazione di fiducia tra operatori sanitari e pazienti ed i loro familiari, e favorisce l'apprendimento dall'errore e il miglioramento della pratica clinica. Saper comunicare e' una componente indispensabile di una sanita' che pone la persona al centro dei propri interessi

Surveillance of infections in hospital: Agents and antibiotic-resistance

The surveillance system for Hospital Acquired Infections (HAI) implemented in the S. Eugenio hospital of Rome allows to monitor the distribution of the micro-organisms by service and their resistance to antibiotics. It is based upon the data collected by the Central Analysis Laboratory of the hospital. The data of four high-risk departments (Surgical service, Intensive Care Unit, Haematology, Burn Unit) are reported. In the period October 1992 - September 1993, 3909 samples have been analyzed; 1603 (43.1%) were found positive to the microbiologic analysis. The results of the antibiotic resistance concerning four micro-organisms, agents of HAI are reported and discussed. Surveillance systems are necessary to limit the frequency of HAI

Observations concerning an unusual presentation in a case of intestinal duplication

Duplications of the alimentary canal are an infrequent pathology and may be localised in any part of the digestive tract. According to reports by several authors, the jejunoileal localisation is the most frequent. The authors report the case of a 13-year-old patient with a duplicate ileal tract which remained asymptomatic until hospitalisation was required, whose symptoms at onset resembled the clinical manifestations of acute appendicitis

Is the adjuvanted influenza vaccine more effective than the trivalent inactivated vaccine in the elderly population? Results of a case-control study<subtitle>Vittoria Colamesta</subtitle>

Background Influenza illness is an important public health problem and annual vaccination is globally recommended for high risk populations. In the elderly the vaccine effectiveness is lower, compared with younger adults, due to the diminished immune response. The aim of the present study is to compare the effectiveness of two influenza vaccines in reducing hospitalizations for influenza or pneumonia in the elderly and to determine which formulation is more appropriate. Methods A case-control study was performed by selecting subjects at least 65 years old from the administrative database of a Local Health Unit in Rome. The cases were hospitalized for influenza or pneumonia during influenza season in the years 2010-2011 and 2011-2012. The controls were hospitalized in the same period for different pathologies. The sample was immunized with the trivalent inactivated vaccine (TIV) in the first flu season (2010-2011) and with the adjuvanted vaccine MF59 (ATIV) in the second season (2011-2012). Results A total of 269 cases and 1247 controls were included for the 2010-2011 flu season, and 365 cases and 1227 controls for the year 2011-2012. Up to 171 (63.6%) cases and 667 (53.5%) controls in the 2010-2011 season and 287 (78.6%) cases and 786 (64.1%) controls in the 2011-2012 season have not been vaccinated. Females are less likely to be hospitalized than males especially in 2010-2011: adjusted OR (AOR) = 0.36, 95% CI = 0.21-0.64. High educational level is also a protective factor for hospitalization, especially in 2011-2012 (AOR = 0.54, 95% CI = 0.41-0.70). Subjects over 75 years were at high risk of hospitalization compared to 65-74 year olds, mostly in the second season (AOR = 1.93, 95% CI = 1.45-2.58). In subjects with 65-74 years, TIV reduces more hospitalizations (AOR = 0.49, 95% CI = 0.24-0.97) than ATIV (AOR = 0.70, 95% CI = 0.40-1.23). In those over 75 years old, ATIV is more effective (AOR = 0.43, 95% CI = 0.31-0.59) compared to TIV (AOR = 0.64, 95% CI = 0.47-0.88). Conclusions TIV and ATIV reduce hospitalization for influenza or pneumonia with a variable degree of protection in different age groups: ATIV is more effective in individuals over-75 years old. The use of ATIV in the very elderly persons would provide important clinical benefit compared to nonadjuvanted vaccines