Enterocutaneous fistula management and clinical nutrition in sepsis of abdominal wall incisional hernia. Tips, tricks and literature revision

Background: The Enterocutaneous Fistula (ECF) treatment requires a multidisciplinary approach and high costs, and shows critical morbidity and mortality rates. For these reasons, it is one of the most challenging problems in colorectal and incisional hernia surgery. Methods: This article synopsizes the current classification systems’ successful management and provides an in-depth review of septic source surgical control, Clinical Nutrition, Hyper Baric Oxygen Therapy (HBOT) and negative pressure (VAC), output quantity management, wound care, operative timeline, and considerations such as Inflammatory Bowel Disease (IBD), and Enteroatmospheric Fistula (EAF). Result: We report a 71-year-old septic fistulated male with an incisional hernia, and chronic medullary dysplasia. This study compares our results with the literature. This case concerns a very complex and long-lasting clinical scenario because of erythropoietic and immunity systems default that led the patient to death. The use of negative pressure therapy to manage abdominal fistula is still controversial. Patients suffering from enterocutaneous fistula require adequate nutritional support to fight hypercatabolism due to the fistula’s inflammation, fluids, proteins, and salts loss. Conclusions: An aggressive multidisciplinary approach, including prosthesis explantation are needed. Clinical nutrition starts with TPN (Total Parenteral Nutrition) followed by EN (Enteral Nutrition) as soon as possible. Moreover, VAC and HBOT therapies are useful to treat this life-threatening condition

May Bradykinesia Features Aid in Distinguishing Parkinson's Disease, Essential Tremor, and Healthy Elderly Individuals?

Background: Bradykinesia is the hallmark feature of Parkinson's disease (PD); however, it can manifest in other conditions, including essential tremor (ET), and in healthy elderly individuals. Objective: Here we assessed whether bradykinesia features aid in distinguishing PD, ET, and healthy elderly individuals. Methods: We conducted simultaneous video and kinematic recordings of finger tapping in 44 PD patients, 69 ET patients, and 77 healthy elderly individuals. Videos were evaluated blindly by expert neurologists. Kinematic recordings were blindly analyzed. We calculated the inter-raters agreement and compared data among groups. Density plots assessed the overlapping in the distribution of kinematic data. Regression analyses and receiver operating characteristic curves determined how the kinematics influenced the likelihood of belonging to a clinical score category and diagnostic group. Results: The inter-rater agreement was fair (Fleiss K=0.32). Rater found the highest clinical scores in PD, and higher scores in ET than healthy elderly individuals (p<0.001). In regard to kinematic analysis, the groups showed variations in movement velocity, with PD presenting the slowest values and ET displaying less velocity than healthy elderly individuals (all ps<0.001). Additionally, PD patients showed irregular rhythm and sequence effect. However, kinematic data significantly overlapped. Regression analyses showed that kinematic analysis had high specificity in differentiating between PD and healthy elderly individuals. Nonetheless, accuracy decreased when evaluating subjects with intermediate kinematic values, i.e., ET patients. Conclusion: Despite a considerable degree of overlap, bradykinesia features vary to some extent in PD, ET, and healthy elderly individuals. Our findings have implications for defining bradykinesia and categorizing patients

Use of an anatomical mid-sagittal plane for 3-dimensional cephalometry: a preliminary study

Purpose: Cone-beam computed tomography (CBCT) is widely used for 3-dimensional assessments of cranio-maxillo-facial relationships, especially in patients undergoing orthognathic surgery. We have introduced, for reference in CBCT cephalometry, an anatomical mid-sagittal plane (MSP) identified by the nasion, the midpoint between the posterior clinoid processes of the sella turcica, and the basion. The MSP is an updated version of the median plane previously used at our institution for 2D posterior-anterior cephalometry. This study was conducted to test the accuracy of the CBCT measures compared to those obtained using standard posterior-anterior cephalometry.Materials and Methods: Two operators measured the inter-zygomatic distance on 15 CBCT scans using the MSP as a reference plane, and the CBCT measurements were compared with measurements made on patients' posterior-anterior cephalograms. The statistical analysis evaluated the absolute and percentage differences between the 3D and 2D measurements.Results: As demonstrated by the absolute mean difference (roughly 1 mm) and the percentage difference (less than 3%), the MSP showed good accuracy on CBCT compared to the 2D plane, especially for measurements of the left side. However, the CBCT measurements showed a high standard deviation, indicating major variability and low precision.Conclusion: The anatomical MSP can be used as a reliable reference plane for transverse measurements in 3D cephalometry in cases of symmetrical or asymmetrical malocclusion. In patients who suffer from distortions of the skull base, the identification of landmarks might be difficult and the MSP could be unreliable. Becoming familiar with the relevant software could reduce errors and improve reliability

Health Management in Italian prisons during Covid 19 OUTBREAK: a focus on the second and third wave

The SARS-CoV-2 spread is a threatening and challenging issue for correctional systems worldwide because of many factors, particularly overcrowding and of the intrinsic characteristics of the population. The prevention measures adopted by the Italian Government were aimed to protect and preserve both inmates’ and prison workers’ health. The present study aimed to evaluate the efficacy of the adopted strategies. Methods: Data regarding Italian prisons’ occupation and prisoners’ population from January 2019 to June 2021, as well as the cumulative weekly increase of confirmed cases and the number of doses of vaccine administered among the population of inmates, the prison workers, and Italian population from November 2020 to the end of June 2021, were collected. Results: Prisons’ occupation dropped from 120% to 106% after the beginning of the pandemics. The confirmed cases between inmates were consistently lower than among the Italian population and prison workers. A time-series chart showed a time lag of one week between the peaks of the different population. Conclusions: The containing strategies adopted by the Italian correctional system have proved their effectiveness in terms of the prevention and protection of both inmate and staff health

575 Heart failure as the cancer for the heart: the prognostic role of the new TNM-like classification

Abstract Aims Heart failure (HF) is the pandemic of the third millennium accounting for the highest mortality rate among general population, second only to lung cancer. Beside heart, HF can affect lungs and peripheral organs, such as kidney, liver, brain, erythropoiesis, leading to multiorgan dysfunction. This is similar to spread of cancer. We proposed a new staging system of HF, named HLM, analogous to TNM classification used in oncology, which refers to heart damage (H), instead of T for tumour, lung involvement (L), instead of N for lymphnodes, and malfunction (M) of peripheral organs, instead of M for metastasis. The aim of this study was a comparison of HLM score with NYHA classes, ACC/AHA stages and HF classification by left ventricular ejection fraction (LVEF), to assess the most accurate prognosis tool for HF patients, in terms of a composite endpoint of all-cause death and hospitalization. Methods and results We performed a multicentre observational, prospective study of consecutive patients admitted for HF, or at risk for HF. All parameters for heart, lungs, and peripheral organ function were collected and examined. Each patient was classified according to HLM, NYHA, ACC/AHA scores and LVEF, at hospital admission and at discharge. The composite endpoint was all-cause death and rehospitalization; the secondary endpoints were all-cause death, cardiac death, and rehospitalization. Patients were followed up at 12 months. We enrolled 2152 patients. Among those, 1720 patients completed the 12-months follow-up. Comparing HLM with other nosologies, the area under the ROC curve (AUC) was greater for HLM score than NYHA, ACC/AHA and LVEF scores regarding the composite endpoint (HLM = 0.644; NYHA = 0.580; ACC/AHA = 0.572; EF = 0.572) and all-cause death (HLM = 0.713; NYHA = 0.596; ACC/AHA = 0.594; EF = 0.565). HLM score related AUC showed statistically significant differences compared to LVEF (P &lt; 0.001), ACC-AHA (P &lt; 0.001), and NYHA (P &lt; 0.001) scores' AUC, in terms of all-cause death and the composite of all-cause death and rehospitalization, at 12 months follow-up. Moreover, the AIC and BIC values to predict the composite of all-cause death and rehospitalization, all-cause death, cardiac death and rehospitalization rate at 12 months follow-up were always lower for HLM model compared with the others. Conclusions According to our results, HLM score has greater prognostic power compared to other nosologies, in terms of composite outcome, rehospitalization, and all-cause death, as well as all-cause death, cardiac death, and rehospitalization, at 12 months follow-up in HF patients. HLM score overcomes the cardiocentric view of HF and it addresses the pathophysiological mechanisms underlining heart abnormalities. Such a multivariable, holistic staging system may be used in HF patients, in order to improve clinical management and to reduce healthcare costs

Alternative Bayesian analysis of capture recapture data with behavioral effect modelling

n the context of capture-recapture experiments we consider a generalized version of a model framework recently proposed in Chao and Yang (2005) to better understand behavioural pattern in response to trapping experience. A general order Markov structure allows to incorporate in the analysis flexible behavioural effects on the capture probabilities. We point out that the conditional likelihood approach used in the original work to carry out inference yields unbounded estimates with positive probability. We derive conditions under which pathological inference occurs and connect it to a similar problem highlighted within a different restricted removal sampling framework. To overcome the likelihood failure we investigate alternative Bayesian estimators under different non-informative prior distributions and verify with a simulation study their comparative merits in terms of efficiency and interval estimate coverage

Peripherally inserted central catheter in patients with acute myeloid leukemia. Incidence and risk factors for premature removal

Not availableA reliable intravascular access, such are central venous catheters, is essential for acute myeloid leukemia (AML) patients treatment. The safe administration of chemotherapy and the immediate and intensive supportive care during intensive chemotherapy are critical in this highrisk population

Comparison of flavonoids and centella asiatica for the treatment of chronic anal fissure. A randomized clinical trial

Il presente studio longitudinale randomizzatosi è proposto di valutare comparativamente l'efficacia dell'impiego di Flavonoidi (Fs) e di estratti di Centella asiatica (Ca) studiando il tempo di scomparsa di sanguinamento, dolore, sensazione di peso e tenesmo in pazienti affetti da ragade anale cronica (RA)AIMS: We aim to test and compare the effects of Flavonoids (Fs) and Centella asiatica (Ca), and the traditional treatment to find out which best deals with healing time, bleeding and pain in the treatment of chronic Anal Fissure (AF). Materials of Study: 98 outpatients were divided randomly into treated (either Fs or Ca) and control group. The control group (Group C, n=32) received the traditional treatment along with the other two subgroups which were treated, additionally, with Fs (Group A, n=30) or Ca (Group B, n=36). Patients were observed once weekly over 8 consecutive weeks. RESULTS: The median time to stop bleeding in the group A was 1 week, in the Group B was 3 weeks and in the group C was 4 weeks. There were significant differences between Groups in terms of time to end bleeding (A vs B: p-value= 0.022; A vs C: p-value<0.001; B vs C: p-value=0.070). As for pain score from baseline to the 2nd week were statistically different between Groups A and B on the one hand and Group C on the other hand (A vs C: p-value=0.004; B vs C: p-value 0.035). All patients healed within 8th week. DISCUSSION: Either patients treated with Fs or Ca experienced early pain disappearance. Fs and Ca did not show side effects CONCLUSIONS: The treatment with Fs is the most effective for bleeding. Patients additionally treated with either Fs or Ca experienced an earlier healing and disappearance of pain in comparison with patients underwent to the traditional treatment

Migraine and attachment type in children and adolescents: what is the role of trauma exposure?

Migraine and attachment insecurity in children and adolescents are often associated. The attachment system can significantly affect the emotional experience and clinical presentation of migraine. The prevalence of migraine in children and adolescent is about 7.7–9.1% and there is a recognized association between migraine and psychiatric comorbidities especially with anxiety disorders, mood disorders, and eating and sleep disorders [1]. Children and adolescents with migraine have an increased risk of developing major depressive episodes and consequently suicide. Furthermore, recent studies reported a significant relationship between migraine and insecure style of attachment. Bowlby defined attachment as a behavioral and cognitive system that regulates an individual’s sense of internal security. According to the most recent studies, traumatic experiences occurring to children with insecure attachment could trigger the activation of the stress mechanism due to the disorganization of th

Common Carotid Artery Calcification Impacts on Cognitive Function in Older Patients

Introduction: Cognitive impairment and dementia represent an emerging health problem. Cardiovascular (CV) risk factors contribute to cognitive impairment. Aim: To investigate the effect of vascular calcification on cognitive impairment and dementia, independently of plaque and traditional CV risk factors. Methods: Four hundred and sixty-nine patients (age of 78.6 ± 6.1&nbsp;years, 74.4% women) were studied. Traditional CV risk factors levels, cognitive function (MMSE), brain CT scan, and other vascular parameters were measured. Common Carotid Artery (CCA) plaque and calcification were evaluated by ultrasound. Results: CCA calcification was associated with a lower MMSE score than in subjects with no CCA calcification (23.7 ± 0.3 versus 25.5 ± 0.8; p = 0.015), after controlling for age, sex, education, blood pressure levels, diabetes, creatinine, lipid lowering therapy, neuroimaging alteration, and CCA plaque. Similarly, CCA calcification was associated with higher odds of dementia regardless of the presence of CCA plaque (OR 1.70, 95% CI 1.01–2.94, p &lt; 0.05). This trend was not observed when stratifying patients according to the presence of CCA plaque. Conclusion: CCA calcification is associated with cognitive impairment and dementia, independently of established CV risk factors and CCA plaque. The impact of arterial calcification on cognition seems largely independent of arterial stiffness