Efficacy and safety of two different tolvaptan doses in the treatment of hyponatremia in the Emergency Department

Hyponatremia (plasma sodium concentration or P[Na(+)] <136 mEq/L) is the most common electrolyte unbalance in clinical practice. Although it constitutes a negative prognostic factor, it frequently remains underdiagnosed and undertreated. Tolvaptan is an oral V2-receptor antagonist which produces aquaresis. Given its emerging role in the treatment of dilutional hyponatremia, we aimed to compare the efficacy and safety of two different doses of this drug in an Emergency Department (ED) setting. Consecutive patients with moderate-severe euvolemic or hypervolemic hyponatremia were sequentially assigned to the 15 mg Group and to the 7.5 mg Group, and were revaluated at 6, 12 and 24 h. Further evaluations and administrations were scheduled daily until P[Na(+)] correction was achieved or the maximum period of 72 h was exceeded. A 1-month follow-up was performed. Twenty-three patients were enrolled: 12 were included in the 15 mg Group, 11 in the 7.5 mg Group. Both doses significantly elevated the P[Na(+)] over 24 h, although the 15 mg Group showed faster corrections than the 7.5 mg Group (12 vs 6 mEq/L/24 h; P = 0.025). An optimal correction rate (within 4-8 mEq/L/24 h) was observed in 45.4 % of the 7.5 mg Group against 25.0 % (P n.s.). The standard dose led to dangerous overcorrections (>12 mEq/L/24 h) in 41.7 % of the patients, while the low dose did not cause any (P = 0.037). No osmotic demyelination syndrome was observed. A 7.5 mg tolvaptan dose can be considered both effective and safe in treating hyponatremia in the ED, while a 15 mg dose implicates too high risk of overcorrection

Contributi alla flora vascolare di Toscana. VII (357-439)

New localities and/or confirmations concerning 83 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 71 genera and 33 families are presented: Carpobrotus (Aizoaceae), Alternanthera (Amaranthaceae), Leucojum (Amaryllidaceae), Anacyclus, Andryala, Carduus, Centaurea, Cichorium, Erigeron, Helichrysum, Helminthotheca, Hieracium, Limbarda, Pilosella, Scolymus, Sonchus, Tagetes, Urospermum, Xanthium (Asteraceae), Mahonia (Berberidaceae), Myosotis (Boraginaceae), Biscutella, Ionopsidium, Raphanus, Rapistrum (Brassicaceae), Buxus (Buxaceae), Vaccaria (Caryophyllaceae), Cistus (Cistaceae), Calystegia, Cuscuta (Convolvulaceae), Cymodocea (Cymodoceaceae), Cyperus (Cyperaceae), Amorpha, Emerus, Lathyrus, Lotus, Ononis, Trifolium, Vicia (Fabaceae), Quercus (Fagaceae), Geranium (Geraniaceae), Myriophyllum (Haloragaceae), Malva (Malvaceae), Epipogium, Himantoglossum (Orchidaceae), Orobanche (Orobanchaceae), Osyris (Santalaceae), Oxalis (Oxalidaceae), Pinus (Pinaceae), Anisantha, Avellinia, Avena, Corynephorus, Crypsis, Cutandia, Elytrigia, Lolium, Panicum, Polypogon, Sporobolus (Poaceae), Rumex (Polygonaceae), Lysimachia (Primulaceae), Eranthis, Ranunculus (Ranunculaceae), Rubus (Rosaceae), Crucianella, Galium (Rubiaceae), Verbascum (Scrophulariaceae), Solanum (Solanaceae), Tamarix (Tamaricaceae), Viola (Violaceae). In the end, the conservation status of the units and eventual protection of the cited biotopes are discussed

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

"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

The association of indwelling urinary catheter with delirium in hospitalized patients and nursing home residents: an explorative analysis from the "Delirium Day 2015"

Backround: Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium. Aim: This analysis, from the "Delirium Day 2015", a nationwide multicenter prevalence study, aim to evaluate the association of IUC with delirium in hospitalized and Nursing Homes (NHs) patients. Methods: Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1-3: possible cognitive impairment). Results: Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%) delirium and 675 (36.1%) cognitive impairment. IUC was significantly associated with cognitive impairment (OR 1.60, 95% CI 1.19-2.16) and delirium (2.45, 95% CI 1.73-3.47), this latter being significant also in the subset of patients without dementia (OR 2.28, 95% CI 1.52-3.43). Inattention and impaired alertness were also independently associated with IUC. Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and 653 (44.9%) a 4AT score 1-3. The multivariate logistic regression analysis did not show a significant association between 4AT test or its specific items with IUC, neither in the subset of patients without dementia. Discussion: We confirmed a significant association between IUC and delirium in hospitalized patients but not in NHs residents. Conclusion: Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence

The text of Silvio Pellico's "Francesca da Rimini"

Questo lavoro tenta di fare ordine nella ricca tradizione della tragedia di Silvio Pellico Francesca da Rimini, rappresentata a teatro dal 1815. L’analisi si concentra sui tre manoscritti autografi e sulle prime due edizioni. Di due manoscritti sono messe in risalto la presenza di postille di altre mani (Ugo Foscolo è fra gli annotatori) e la loro rilevanza sulle successive stesure dell’opera; del terzo manoscritto si propone una nuova datazione, che ne colloca la trascrizione in un periodo lontano dall’epoca della prima messa in scena. Nel 1818 furono stampate un’edizione non autorizzata da Pellico e la prima edizione ufficiale, entrambe in due emissioni; dal confronto fra le due pubblicazioni e dalla collazione di più esemplari della princeps si può stabilire una cronologia delle emissioni di quest’ultima, e così anche l’ultima volontà dell’autore. The text of Silvio Pellico's "Francesca da Rimini"The aim of this piece is to bring order to the rich tradition of Silvio Pellico’s tragedy Francesca da Rimini, brought to stage since 1815. The analysis focuses on three autograph manuscripts and on the first two editions. The occurrence of marginalia, which are not in the author’s hand (among them, Ugo Foscolo’s), in two manuscripts, has been investigated and placed in relation to the tragedy’s following drafts; a new dating is proposed for the third manuscript, as transcribed far in time from the first theatrical performance. In 1818 two editions were printed, both in two issues: a non-authorized one, and the one approved by Pellico. The comparison between these two editions and the collation of several copies of the princeps allowed to determine its issues’ chronological sequence, and the final authorial intention.The aim of this piece is to bring order to the rich tradition of Silvio Pellico’s tragedy Francesca da Rimini, brought to stage since 1815. The analysis focuses on three autograph manuscripts and on the first two editions. The occurrence of marginalia, which are not in the author’s hand (among them, Ugo Foscolo’s), in two manuscripts, has been investigated and placed in relation to the tragedy’s following drafts; a new dating is proposed for the third manuscript, as transcribed far in time from the first theatrical performance. In 1818 two editions were printed, both in two issues: a non-authorized one, and the one approved by Pellico. The comparison between these two editions and the collation of several copies of the princeps allowed to determine its issues’ chronological sequence, and the final authorial intention

La variation prosodique dialectale en français : données et hypothèses

cote interne IRCAM: Avanzi12bNone / NoneInternational audienceDans cet article, nous comparons la prosodie de 6 variétés de français parlées en France (Paris et Lyon), en Belgique (Tournai et Liège) et en Suisse (Genève et Neuchâtel). L’objectif est de voir si les 6 variétés considérées peuvent être discriminées sur la base de critères exclusivement prosodiques. Les enregistrements du même texte lu par 4 locuteurs pour chacune des variétés sont transcrits, alignés et codés pour l’étude de l’accentuation, du phrasé et du rythme. Les résultats d’une méthode de classification non- supervisée guidée par les hypothèses (top-down) aboutissent à des résultats cohérents avec une classification a priori des variétés sur une échelle d’éloignement dialectal, alors qu’une méthode de classification non-supervisée émergente (bottom-up) donne lieu à des résultats plus contrastés

Nouveaux regards sur la variation dialectale – New Ways of Analyzing Dialectal Variation

International audienc

Étude sur la variation régionale de la vitesse d’articulation en français

L’objectif de cet article est d’étudier la variation régionale en français sous l’angle de la vitesse d’articulation. Notre étude porte sur l’analyse d’un texte lu par 48 locuteurs originaires de 6 points d’enquête réalisés dans le cadre du projet Phonologie du Français Contemporain : Paris pour la France ; Genève, Martigny et Neuchâtel pour la Suisse ; Tournai et Liège pour la Belgique. Les données sont alignées automatiquement en phonèmes, syllabes et mots graphiques, puis segmentées manuellement en groupes accentuels (syntagmes ponctués d’une proéminence accentuelle perçue sur leur bord droit). La vitesse d’articulation (ms/syll) est calculée pour chaque groupe accentuel de plus d’une syllabe, en excluant les syllabes disfluentes. Sur la base de ce matériel, des tests statistiques sont conduits en vue d’évaluer l’existence de différences significatives entre la vitesse d’articulation des 6 variétés. Les résultats confirment en partie les résultats obtenus dans les études antérieures : on constate ainsi que les locuteurs suisses articulent globalement plus lentement que les locuteurs belges et parisiens, alors que Belges et Parisiens ne se distinguent pas les uns des autres. Par ailleurs, notre étude montre que l’âge et le sexe des locuteurs ont un effet sur la vitesse d’articulation, et que cet effet n’est pas similaire dans toutes les régions