Indicazioni alla pH-metria esofagea. Abbiamo modificato il nostro comportamento negli ultimi 18 anni?

Aims: We reviewed the procedures performed during the last 18 years at the Pediatric Department of the University of Verona (Italy) to investigate how the clinical use of esophageal pH monitoring (EpHM) to diagnose gastroesophageal reflux disease has changed in our practice. Methods: Data of EpHM from January 1990 to December 2007 were reviewed and the year in which the procedure was done, age of patients, clinical indication to the procedure and EpHM outcome were recorded. Results: Eight hundred and twenty-two procedures were performed in 775 children. Children < 1 year of age were 39.6%, but they decreased from 72% in 1990-92 to 27% in 2005-07 (p < 0.001). Indications to EpHM were gastrointestinal in 55%, respiratory in 40% and different in 5% of children. EpHM was more frequently abnormal (54%) in children with gastrointestinal than in those with respiratory symptoms (35%, p < 0.001). A significant increase in the indications to EpHM due to respiratory symptoms was observed between 1990-92 (25%) and 2005-07 (63%) (p < 0.001). A strong decrease in abnormal EpHM was observed between 1990-92 (63%) and 2005-07 (19%, p < 0.001) and this decrease was inversely related to the yearly percentage of respiratory indications. Conclusions: Our data show that significant modifications in patients\u2019 age and indication to EpHM have occurred in our institution during the last two decades and that respiratory symptoms are today the most frequent indication to EpHM

A Low Cost and Easy to Use Setup for Foot Scanning

We present a low cost acquisition setup for the accurate reconstruction of feet and shoe lasts geometry. It is based on the use of a single close range depth sensor (Primesense Carmine 1.09) that is moved around the object using a PC-controlled mobile robot. The mobile robot is built using a simple electric car constrained to move in a circular guide and controlled by an Arduino Uno board allowing the custom software to control the engine's speed. In the acquisition phase multiple point clouds are captured and registered in a common reference frame. The vehicle trajectory has been designed to maximize the reconstruction accuracy and robustness against changes in the scene illumination. Registered point clouds are filtered in order to remove the floor, reduce the noise and refine the alignment, and are finally merged in an unique simplified cloud that can be triangulated with standard techniques. The resulting foot model is then aligned in a standard way and segmented identifying relevant landmarks for measuremen

How the use of esophageal PH monitoring in investigating gastroesophageal reflux disease has changed r a 18-year experience in a pediatric department.

Use of esophageal PH monitoring in investigating gastroesophageal reflux disease has changed r a 18-year experience in a pediatric department

Celiac disease and obesity: need for nutritional follow-up after diagnosis.

More than 20 years of serological approach to diagnosis of celiac disease (CD) has deeply changed the classical clinical presentation of the disease, and some reports indicate that CD and obesity can coexist in both childhood and adolescence. We reviewed clinical records of 149 children with CD followed in our institution between 1991 and 2007, considering weight, height and body mass index (BMI), both at diagnosis and after at least 12 months of gluten-free diet (GFD). In all, 11% of patients had BMI z-score >+1 and 3% were obese (z-score >+2) at presentation. In our population, there was a significant (P=0.008) increase in BMI z-score after GFD and the percentage of overweight (z-score >+1) subjects almost doubled (11 vs 21%, P=0.03). Our data suggest the need for a careful follow-up of nutritional status after diagnosis of CD, especially addressing those who are already overweight at presentation

Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network

Background: Although preventive strategies have been proposed against catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate. Aim: To distinguish patients according to their characteristics at ICU admission, and to identify clusters of patients at higher risk for CAUTIs. Methods: A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project. Findings: Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the community. Cluster 2 comprised patients who were more likely to come from other wards/hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P<0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P=0.033). Conclusion: To the authors' knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies

Cluster analysis identifies patients at risk of catheter-associated urinary tract infections in intensive care units: findings from the SPIN-UTI Network

Background: Although preventive strategies have been proposed against catheter-associated urinary tract infections (CAUTIs) in intensive care units (ICUs), more efforts are needed to control the incidence rate. Aim: To distinguish patients according to their characteristics at ICU admission, and to identify clusters of patients at higher risk for CAUTIs. Methods: A two-step cluster analysis was conducted on 9656 patients from the Italian Nosocomial Infections Surveillance in Intensive Care Units project. Findings: Three clusters of patients were identified. Type of admission, patient origin and administration of antibiotics had the greatest weight on the clustering model. Cluster 1 comprised more patients with a medical type of ICU admission who came from the community. Cluster 2 comprised patients who were more likely to come from other wards/hospitals, and to report administration of antibiotics 48 h before or after ICU admission. Cluster 3 was similar to Cluster 2 but was characterized by a lower percentage of patients with administration of antibiotics 48 h before or after ICU admission. Patients in Clusters 1 and 2 had a longer duration of urinary catheterization [median 7 days, interquartile range (IQR) 12 days for Cluster 1; median 7 days, IQR 11 days for Cluster 2] than patients in Cluster 3 (median 6 days, IQR 8 days; P<0.001). Interestingly, patients in Cluster 1 had a higher incidence of CAUTIs (3.5 per 100 patients) compared with patients in the other two clusters (2.5 per 100 patients in both clusters; P=0.033). Conclusion: To the authors' knowledge, this is the first study to use cluster analysis to identify patients at higher risk of CAUTIs who could gain greater benefit from preventive strategies

Epidemiology of intensive care unit-acquired sepsis in Italy: results of the SPIN-UTI network

none139BACKGROUND: Sepsis is the major cause of mortality from any infectious disease worldwide. Sepsis may be the result of a healthcare associated infection (HAI): the most frequent adverse events during care delivery especially in Intensive Care Units (ICUs). The main aim of the present study was to describe the epidemiology of ICU-acquired sepsis and related outcomes among patients enrolled in the framework of the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project. STUDY DESIGN: Prospective multicenter study. METHODS: The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. RESULTS: During the five editions of the SPIN-UTI project, from 2008 to 2017, 47.0% of HAIs has led to sepsis in 832 patients. Overall, 57.0% episodes were classified as sepsis, 20.5% as severe sepsis and 22.5% as septic shock. The most common isolated microorganisms from sepsis episodes were Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. The case fatality rate increased with the severity of sepsis and the mean length of ICU-stay was significantly higher in patients with ICU-acquired sepsis than in patients without. CONCLUSION: Our study provides evidence that ICU-acquired sepsis occurs frequently in Italian ICU patients and is associated with a high case fatality rate and increased length of stay. However, in order to explain these findings further analyses are needed in this population of ICU patients.noneAgodi A, Barchitta M, Auxilia F, Brusaferro S3, D'Errico MM, Montagna MT, Pasquarella C, Tardivo S, Arrigoni C, Fabiani L, Laurenti P, Mattaliano AR, Orsi GB, Squeri R, Torregrossa MV, Mura I, Aiello MR, Alliani C, Amatucci MR, Antoci M, Antonelli M, Astuto M, Arnoldo L, Arru B, Baccari G, Barbadoro P, Barbara A, Barilaro C, Battaglia P, Bellocchi P, Bernasconi MO, Bianco A, Bissolo E, Bocchi A, Bruno A, Brusaferro M, Buccheri M, Campanella F, Canino R, Cannistrà A, Carini SA, Catalano S, Castellani P, Castiglione G, Coniglio S, Consolante C, Conte C, Contrisciani R, Corallini R, Crollari P, Damiani G, Denaro C, De Remigis S, Diana F, Di Bartolo R, Di Benedetto A, Di Fabio G, Di Falco C, Digeronimo V, Di Gregorio P, Distefano R, Egitto G, Falciani E, Farruggia P, Fenaroli S, Ferlazzo G, Garofalo G, Girardis M, Giovanelli L, Giubbini G, Graceffa A, Guadagna A, Gregu G, Ingala F, Innocenzi L, La Camera G, La Rosa MC, Lesa L, Longhitano AM, Luppino G, Maida CM, Manta G, Marino G, Masia MD, Maviglia R, Mazzetti M, Maugeri A, Megna MT, Mella LM, Milazzo M, Milia M, Minari C, Minerva M, Mordacci M, Murgia P, Oliveri P, Olori MP, Pagliarulo R, Palermo R, Pandiani I, Pappalardo F, Papetti C, Partenza A, Pascu D, Pasculli M, Pavia M, Pavone ML, Pellegrino MG, Pelligra F, Pillon D, Pintaudi S, Pitzoi L, Pinto A, Piotti P, Pupo S, Quattrocchi R, Righi E, Rigo A, Rigo A, Romeo A, Rosa E, Rutigliano S, Sarchi P, Scimonello G, Seminerio A, Stefanini P, Sticca G, Taddei S, Tessari L, Tetamo R, Ticca M, Tribastoni S, Vallorani S, Venturoni F, Vitagliano E, Vitali P, Zappone A, Zei E, Zeoli MP.Agodi, A; Barchitta, M; Auxilia, F; Brusaferro, S3; D'Errico, Mm; Montagna, Mt; Pasquarella, C; Tardivo, S; Arrigoni, C; Fabiani, L; Laurenti, P; Mattaliano, Ar; Orsi, Gb; Squeri, R; Torregrossa, Mv; Mura, I; Aiello, Mr; Alliani, C; Amatucci, Mr; Antoci, M; Antonelli, M; Astuto, M; Arnoldo, L; Arru, B; Baccari, G; Barbadoro, P; Barbara, A; Barilaro, C; Battaglia, P; Bellocchi, P; Bernasconi, Mo; Bianco, A; Bissolo, E; Bocchi, A; Bruno, A; Brusaferro, M; Buccheri, M; Campanella, F; Canino, R; Cannistrà, A; Carini, Sa; Catalano, S; Castellani, P; Castiglione, G; Coniglio, S; Consolante, C; Conte, C; Contrisciani, R; Corallini, R; Crollari, P; Damiani, G; Denaro, C; De Remigis, S; Diana, F; Di Bartolo, R; Di Benedetto, A; Di Fabio, G; Di Falco, C; Digeronimo, V; Di Gregorio, P; Distefano, R; Egitto, G; Falciani, E; Farruggia, P; Fenaroli, S; Ferlazzo, G; Garofalo, G; Girardis, M; Giovanelli, L; Giubbini, G; Graceffa, A; Guadagna, A; Gregu, G; Ingala, F; Innocenzi, L; La Camera, G; La Rosa, Mc; Lesa, L; Longhitano, Am; Luppino, G; Maida, Cm; Manta, G; Marino, G; Masia, Md; Maviglia, R; Mazzetti, M; Maugeri, A; Megna, Mt; Mella, Lm; Milazzo, M; Milia, M; Minari, C; Minerva, M; Mordacci, M; Murgia, P; Oliveri, P; Olori, Mp; Pagliarulo, R; Palermo, R; Pandiani, I; Pappalardo, F; Papetti, C; Partenza, A; Pascu, D; Pasculli, M; Pavia, M; Pavone, Ml; Pellegrino, Mg; Pelligra, F; Pillon, D; Pintaudi, S; Pitzoi, L; Pinto, A; Piotti, P; Pupo, S; Quattrocchi, R; Righi, E; Rigo, A; Rigo, A; Romeo, A; Rosa, E; Rutigliano, S; Sarchi, P; Scimonello, G; Seminerio, A; Stefanini, P; Sticca, G; Taddei, S; Tessari, L; Tetamo, R; Ticca, M; Tribastoni, S; Vallorani, S; Venturoni, F; Vitagliano, E; Vitali, P; Zappone, A; Zei, E; Zeoli, Mp