Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Tono dell'umore nei bambini con disturbo da deficit dell'attenzione e iperattività (ADHD)

INTRODUZIONE Studi su bambini con ADHD hanno riscontrato labilità emotiva nel 38% dei casi con un aumento della prevalenza nella popolazione adulta ADHD fino al 70% dei casi. È ormai noto che la disregolazione emotiva è associata a una riduzione del tono dell’umore; tuttavia, gli studi pubblicati si riferiscono a misurazioni indirette riportate da genitori e insegnanti. Il nostro studio si propone di valutare il tono dell’umore direttamente nei bambini con ADHD attraverso scale visuoanalogiche. METODO Hanno partecipato allo studio 158 bambini di scuola primaria e secondaria di primo grado (età media 10.6 anni) con diagnosi di ADHD (N=79) e normotipici (N=79). Le scale visuoanalogiche (VAS) sono state utilizzate per la misurazione quantitativa di: Stanchezza, Calma, Energia, Contentezza, Sonnolenza, Concentrazione, Attenzione, Tristezza, Noia, Irritabilità, Rabbia. RISULTATI Delle analisi della varianza (ANOVA) hanno valutato le differenze tra ADHD e Normotipici) per ciascuna dimensione valutata dalle VAS. I bambini con ADHD presentavano punteggi inferiori rispetto ai controlli nei livelli di Concentrazione (F=10.85; p<0.024;) e Attenzione (F=9.99; p<0.002), mentre, riportavano punteggi più elevati nelle sottoscale Noia (F=16.81; p<0.001), Tristezza (F=4.83; p<0.03), Stanchezza (F=1.16; p<0.04) e Sonnolenza (F=9.53; p<0.02). CONCLUSIONI I bambini con ADHD, a differenza dei normotipici, riferiscono elevati livelli di Noia e Tristezza accompagnati dalla sensazione di Sonnolenza e Stanchezza, confermando la compromissione del tono affettivo e dell’attivazione energetica. Non si osserva invece una differenza significativa tra i bambini con ADHD e i normotipici per le sensazioni di Rabbia e Irritabilità, contrariamente a studi precedenti in cui, tuttavia, il tono dell’umore era ottenuto da interviste a genitori e insegnanti. Appaiono necessarie ulteriori indagini che integrino interviste indirette e misurazioni self-report per comprendere il ruolo dell’umore nei bambini con ADHD, poichè questa componente sembra avere una funzione essenziale per lo sviluppo delle abilità sociali e relazionali, spesso compromesse nei bambini con ADHD

IL BIAS ATTENZIONALE NELL’ANSIA SOCIALE: IL RUOLO DEGLI STIMOLI EMOZIONALI

Il disturbo d’ansia sociale è caratterizzato da una paura intensa e persistente di essere giudicati negativamente dagli altri, per il timore di svelare una personalità globalmente inadeguata. Numerosi autori hanno evidenziato che individui con ansia sociale presentano un bias attenzionale (BA) verso stimoli minacciosi. Tuttavia, sono presenti risultati contrastanti. Mentre alcuni autori non hanno osservato un BA, somministrando un compito con stimoli lessicali, altri hanno evidenziato un BA verso stimoli minacciosi con l’uso di stimoli pittorici. Lo studio si propone di confrontare con un paradigma di Emotional Spatial Cueing tre tipologie di stimoli: pittorici (immagini e volti) e lessicali. Studenti con bassa ansia sociale (N=42; BAS) e con alta ansia sociale (N=42; AAS) hanno completato l’Emotional Spatial Cueing e la Liebowitz Social Anxiety Scale. Sono stati utilizzati tre tipi di stimolo: immagini, selezionate dall’International Affective Picture System; volti, selezionati dal database di Maccari et al. (2014); parole, valutate da 20 studenti universitari, secondo un valore di emozionalità e minaccia. Un’ANOVA 2 (Gruppo: BAS, AAS) x 3 (Esperimento: Immagini, Parole, Volti) x 2 (Validità: prova valida, prova invalida) x 2 (Emozione: neutra, minacciosa) sui tempi di reazione (TR) ha evidenziato effetti significativi dell’Esperimento (F2,164=4,10; p=.018), della Validità (F1,82=289,69; p=.0001), dell’Emozione (F1,82=12,70; p=.0001) e le interazioni Esperimento x Emozione (F2,164=15,49; p=.0001) e Gruppo x Esperimento x Emozione (F2,164=3,03; p=.05). Dei confronti pianificati hanno indicato nell’Esperimento Volti una differenza tra il gruppo BAS e AAS (F1,82=7,19; p=.0001), con TR minori verso i volti neutri (531,18ms), rispetto ai volti minacciosi (537,48ms) solo nel gruppo AAS (F1,82=3,98; p=.04). Questo è il primo studio che confronta differenti tipi di stimolo in persone con ansia sociale, suggerendo una maggiore sensibilità delle persone con ansia sociale verso immagini di volti minacciosi. Questo risultato assume particolare rilevanza nell’ambito dello sviluppo di training volti alla riduzione del bias attenzionale

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia

Objectives: Few studies have analyzed factors associated with delirium subtypes. In this study, we investigate factors associated with subtypes of delirium only in patients with dementia to provide insights on the possible prevention and treatments. Design: This is a cross-sectional study nested in the \u201cDelirium Day\u201d study, a nationwide Italian point-prevalence study. Setting and Participants: Older patients admitted to 205 acute and 92 rehabilitation hospital wards. Measures: Delirium was evaluated with the 4-AT and the motor subtypes with the Delirium Motor Subtype Scale. Dementia was defined by the presence of a documented diagnosis in the medical records and/or prescription of acetylcholinesterase inhibitors or memantine prior to admission. Results: Of the 1057 patients with dementia, 35% had delirium, with 25.6% hyperactive, 33.1% hypoactive, 34.5% mixed, and 6.7% nonmotor subtype. There were higher odds of having venous catheters in the hypoactive (OR 1.82, 95% CI 1.18-2.81) and mixed type of delirium (OR 2.23, CI 1.43-3.46), whereas higher odds of urinary catheters in the hypoactive (OR 2.91, CI 1.92-4.39), hyperactive (OR 1.99, CI 1.23-3.21), and mixed types of delirium (OR 2.05, CI 1.36-3.07). We found higher odds of antipsychotics both in the hyperactive (OR 2.87, CI 1.81-4.54) and mixed subtype (OR 1.84, CI 1.24-2.75), whereas higher odds of antibiotics was present only in the mixed subtype (OR 1.91, CI 1.26-2.87). Conclusions and Implications: In patients with dementia, the mixed delirium subtype is the most prevalent followed by the hypoactive, hyperactive, and nonmotor subtype. Motor subtypes of delirium may be triggered by clinical factors, including the use of venous and urinary catheters, and the use of antipsychotics. Future studies are necessary to provide further insights on the possible pathophysiology of delirium in patients with dementia and to address the optimization of the management of potential risk factors

Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care