An Atypical Presentation of Crohn Disease in the Elderly. A Case report and Literature review

The Authors present a case of an insidious onset of Crohn Disease (CD) in an elderly patient. Diagnosis complicated by extraintestinal manifestation properly of old age could be delayed and often made after surgery on the histological specimen as in our case. CD is uncommon as primary manifestation in old age, often unsuspected, incorrectly diagnosed and in many case the clinical fea - tures may lead to late diagnosis. Differential diagnosis of CD in elder people with fever, diarrhoea and abdominal pain is difficult and other symptoms affecting intestinal tract can closely mimic CD symptoms, although the pattern of clinical presentation in older patient resemble those in younger

“BEHAVIOURAL STUDY OF PRIMATES IN A ZOO SETTING IN MONTEVIDEO (URUGUAY)”.

En una búsqueda permanente de innovación educativa, surge el presente proyecto de trabajo interinstitucional, que contó con apoyo de la Facultad de Ciencias (UDELAR). El objetivo principal del mismo es que los estudiantes conozcan y se familiaricen con una investigación científica de comportamiento animal y de esa forma intentar responder a la pregunta: “Todos somos primates, pero ¿qué tan primates somos?”El proyecto se basa en el estudio del comportamiento en cautiverio de dos especies de primates, Papio hamadryas  y Lemur catta, en el Zoológico “Villa Dolores”, Montevideo, Uruguay. Se realizó una valoración de aspectos positivos y negativos (tipo de recinto, ambientación y cuidados, estructura de grupo), habilitando una nueva dimensión de análisis: el “Enriquecimiento ambiental”. A partir de la construcción conjunta de un Etograma (entre estudiantes de los diferentes Centros Educativos de Secundaria) se realizó un análisis de los comportamientos más frecuentes registrados, en una comparación con el comportamiento humano. La Evaluación, considerada un aspecto fundamental, ha sido continua y coordinada durante el proceso. El trabajo deja abierto el debate sobre los objetivos y los roles que deberían cumplir los Parques Zoológicos, las Reservas. ¿Podríamos hablar de “Centros de Recuperación de Fauna”? ¿Quiénes deberían participar en la toma de decisiones al respecto

Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients

Clinical features and natural history of coronavirus disease 2019 (COVID-19) differ widely among different countries and during different phases of the pandemia. Here, we aimed to evaluate the case fatality rate (CFR) and to identify predictors of mortality in a cohort of COVID-19 patients admitted to three hospitals of Northern Italy between March 1 and April 28, 2020. All these patients had a confirmed diagnosis of SARS-CoV-2 infection by molecular methods. During the study period 504/1697 patients died; thus, overall CFR was 29.7%. We looked for predictors of mortality in a subgroup of 486 patients (239 males, 59%; median age 71 years) for whom sufficient clinical data were available at data cut-off. Among the demographic and clinical variables considered, age, a diagnosis of cancer, obesity and current smoking independently predicted mortality. When laboratory data were added to the model in a further subgroup of patients, age, the diagnosis of cancer, and the baseline PaO2/FiO2 ratio were identified as independent predictors of mortality. In conclusion, the CFR of hospitalized patients in Northern Italy during the ascending phase of the COVID-19 pandemic approached 30%. The identification of mortality predictors might contribute to better stratification of individual patient risk

Two-stage hepatectomy in two regional district community hospitals: perioperative safety and long-term survival

Introduction - Surgical resection offers the best chance of cure for patients with colorectal liver metastases (CRLMs). Two-stage hepatectomy (TSH) has been demonstrated to be safe and effective to obtain curative resection in patients with multiple, bilobar CRLMs that are unresectable in a single procedure. Up to now TSH has been the prerogative of dedicated liver surgery centers. The aim of this study was to assess the safety and effectiveness of TSH also in community hospitals. Methods - Of 294 patients operated on for CRLMs between September 1997 and June 2012 in 2 district community hospitals (belonging to the same regional healthcare district), 43 (14.6%) were scheduled for TSH. Thirty-eight/43 received neoadjuvant and/or bridge chemotherapy (2 neoadjuvant only, 4 neoadjuvant and bridge, 32 bridge only). Results - The mean follow-up was 35.74 \ub1 29.53 months. Five-year overall survival (OS) was 31.4%, with a median survival time of 31 months. Twenty-nine patients completed the planned procedure (OS: 42.9%; median 47 months), while 14 did not because of disease progression (OS: 0%; median 13 months). No operative mortality occurred within the first 90 days either after the first or second stage. Conclusions - Our results suggest good efficacy and safety of TSH even when performed in a community hospital setting. Shifting patient selection from neoadjuvant to bridge chemotherapy had no impact on outcome once the clearing of the liver had been achieved. In patients presenting with synchronous CRLMs, simultaneous colorectal resection and clearing of the less involved hemiliver as the first surgical step is feasible without any negative impact on outcome

Empirical first-line treatment with tigecycline for febrile episodes following abdominal surgery in cancer patients

International audienceCancer patients with complicated infections following abdominal surgery represent one of the worst clinical scenarios that is useful for testing the efficacy of empirical antimicrobial therapy. No study so far has evaluated the performance of tigecycline (TIG) when administered as empirical first-line treatment in a homogeneous population of surgical cancer patients with a febrile episode. An observational review of the data records of 24 sequential patients receiving TIG for a febrile episode following a major abdominal procedure in a single cancer institute was performed. Large bowel surgery represented 68% of all procedures, followed by gastric surgery (16%) and urinary-gynaecologic-biliary surgery (16%). Complications following surgery were observed in 68% of febrile episodes, with peritonitis and sepsis accounting for 59% and 24% of complications, respectively. Eight patients needed repeat surgery for source control. The mean duration of TIG treatment was 8 days. Causative pathogens were detected in 16 episodes (64%), and a total of 44 microorganisms were recovered (29% , 9% and 9% coagulase-negative staphylococci). TIG was effective in 12 episodes (48%). The success rate was 67% when infectious episodes sustained by intrinsically resistant bacteria and fungi were excluded. Treatment failure was associated with the presence of complications and with microbiologically documented infection. TIG may be useful as a first-line treatment option in cancer patients requiring antibiotic treatment following surgery when complications are not present or suspected on clinical grounds and when local microbial epidemiology shows a low incidence of primary resistant bacteria

Primary hyperparathyroidism: epidemiology, clinical features, diagnostic tools and current management

Primary hyperparathyroidism (PHPT) is a clinical condition characterized by overactive parathyroid gland secretion of parathyroid hormone with concurrent alteration of the phosphocalcemic metabolism. We present a literature review on primary hyperparathyroidism addressing key on clinical presentation, causes, medical and surgical treatment at the best of our knowledge. Based on this review we confirm the role of serum calcium and serum level examination, as well as we define the definitive treatment for PHPT being parathyroidectomy. In case of contraindication for surgery, medical treatment can play a relevant role

18 months computed tomography follow-up after Covid-19 interstitial pneumonia

Background: Our aim is to evaluate the possible persistence of lung parenchyma alterations, in patients who have recovered from Covid-19. Design and methods: We enrolled a cohort of 115 patients affected by Covid-19, who performed a chest CT scan in the Emergency Department and a chest CT 18 months after hospital discharge. We performed a comparison between chest CT scan 18 months after discharge and spirometric data of patients enrolled. We obtained quantitative scores related to well-aerated parenchyma, interstitial lung disease and parenchymal consolidation. A radiologist recorded the characteristics indicated by the Fleischner Society and “fibrotic like” changes, expressed through a CT severity score ranging from 0 (no involvement) to 25 (maximum involvement). Results: 115 patients (78 men, 37 women; mean age 60.15 years old ±12.52). On quantitative analysis, after 18 months, the volume of normal ventilated parenchyma was significantly increased (16.34 points on average ±14.54, p<0.0001). Ground-glass opacities and consolidation values tend to decrease (-9.80 and -6.67 points, p<0.0001). On semiquantitative analysis, pneumonia extension, reactive lymph nodes and crazy paving reached statistical significance (p<0.0001). The severity score decreased by 2.77 points on average (SD 4.96; p<0.0001). There were not statistically significant changes on “fibrotic-like” changes correlated with level of treatment and there was not a statistically significant correlation between CT lung score and spirometric results obtained 18 months after discharge. Conclusions: Patients recovered from Covid-19 seem to have an improvement of ventilated parenchyma and “fibrotic-like” alterations. The level of treatment does not appear to influence fibrotic changes

Diagnostic Accuracy of the Magnetic Resonance Imaging in Adult Post-Ganglionic Brachial Plexus Traumatic Injuries: A Systematic Review and Meta-Analysis

BACKGROUND: Traumatic brachial plexus injuries are rare but serious consequences of major traumas. Pre-ganglionic lesions are considered irreparable, while post-ganglionic injuries can be potentially treated if an early diagnosis is available. Pre-surgical diagnosis is important to distinguish low-grade from high-grade lesions and to identify their location. The aim of the review is to evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in the identification of adult post-ganglionic lesions due to traumatic brachial plexus injuries, compared to intraoperative findings.METHODS: Research on the main scientific electronic databases was conducted. Studies of adults with traumatic post-ganglionic brachial plexus injuries were included. The index test was preoperative MRI and the reference standard was surgical exploration. Pooled sensitivity and specificity were calculated.RESULTS: Four studies were included for the systematic review, of which three articles met the inclusion criteria for the meta-analysis. Pooled sensitivity and pooled specificity values resulted high. The sensitivity value is associated with a high heterogeneity index of the selected literature.CONCLUSION: MRI can be considered, despite the limits, the gold standard exam in morphological evaluation of brachial plexus injuries, particularly in the diagnosis of post-ganglionic traumatic injuries