Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study

Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature

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

Caring for health-care workers. Experience with a psychological support program for nurses working in Internal Medicine

IntroductionNurses working in an Internal Medicine ward must have very specific training and aptitude. Dealing with different types of patients with widely varying ages and different medical issues requires flexibility in managing emergencies and in choosing between various professional interventions, as well as strong communication skills. Because of this variety, the workload is perceived as being particularly heavy.Materials and methodsThe article describes the intervention of a psychologist in support of the nursing staff of an Internal Medicine ward. The intervention was prompted by findings of high staff turnover. The work began with an analysis of the group dynamics in the nursing team, and the psychologist's action was based on a group approach. In this way, specific problems of the group were solved through the instrument of the group itself, which became the true promoter of change.ResultsNurses worked to recognize their professional identity and to strengthen their self-esteem, and this changed their perception of their workload. The team also became more aware of its individual and group resources. These changes decreased staff turnover and reduced arguments between the nurses themselves and between the nurses and patients’ relatives.DiscussionThe nursing team become more solid and better organized. It dealt with emotional problems and has become more receptive to changes in the way the work is organized.</p

Caring for health-care workers. Experience with a psychological support program for nurses working in Internal Medicine

IntroductionNurses working in an Internal Medicine ward must have very specific training and aptitude. Dealing with different types of patients with widely varying ages and different medical issues requires flexibility in managing emergencies and in choosing between various professional interventions, as well as strong communication skills. Because of this variety, the workload is perceived as being particularly heavy.Materials and methodsThe article describes the intervention of a psychologist in support of the nursing staff of an Internal Medicine ward. The intervention was prompted by findings of high staff turnover. The work began with an analysis of the group dynamics in the nursing team, and the psychologist's action was based on a group approach. In this way, specific problems of the group were solved through the instrument of the group itself, which became the true promoter of change.ResultsNurses worked to recognize their professional identity and to strengthen their self-esteem, and this changed their perception of their workload. The team also became more aware of its individual and group resources. These changes decreased staff turnover and reduced arguments between the nurses themselves and between the nurses and patients’ relatives.DiscussionThe nursing team become more solid and better organized. It dealt with emotional problems and has become more receptive to changes in the way the work is organized.</p

Infestazione sottocutanea da Dirofilaria spp.: descrizione di un caso clinico

Dirofilaria spp. causes a common zoonotic filarial infection found in dogs and humans in the tropical, subtropical and temperate areas. After biological development in the mosquito, dogs and humans may be infected with the infective larvae when the mosquito takes a blood meal. In humans, the worms do not reach maturity, and no microfilariae can be detected.A number of species, such as D. tenuis, D. repens, D. immitis have been identified as causative agents of subcutaneous or conjunctival nodules in humans. Diagnosis is made by identifying the worm in biopsies or extracting the worm from the lesion. Surgical removal of the worms is the only known treatment

Association of piperacillin/tazobactam MIC and mortality in a cohort of ceftriaxone-resistant Escherichia coli bloodstream infections treated with piperacillin/tazobactam and carbapenems: a multicentric propensity score-weighted observational cohort study

Objectives To assess the impact of piperacillin/tazobactam MICs on in-hospital 30 day mortality in patients with third-generation cephalosporin-resistant Escherichia coli bloodstream infection treated with piperacillin/tazobactam, compared with those treated with carbapenems.Methods A multicentre retrospective cohort study was conducted in three large academic hospitals in Italy between 2018 and 2022. The study population comprised patients with monomicrobial third-generation cephalosporin-resistant E. coli bloodstream infection, who received either piperacillin/tazobactam or carbapenem therapy within 48 h of blood culture collection. The primary outcome was in-hospital 30 day all-cause mortality. A propensity score was used to estimate the likelihood of receiving empirical piperacillin/tazobactam treatment. Cox regression models were performed to ascertain risk factors independently associated with in-hospital 30 day mortality.Results Of the 412 consecutive patients included in the study, 51% received empirical therapy with piperacillin/tazobactam, while 49% received carbapenem therapy. In the propensity-adjusted multiple Cox model, the Pitt bacteraemia score [HR 1.38 (95% CI, 0.85-2.16)] and piperacillin/tazobactam MICs of 8 mg/L [HR 2.35 (95% CI, 1.35-3.95)] and &gt;= 16 mg/L [HR 3.69 (95% CI, 1.86-6.91)] were significantly associated with increased in-hospital 30 day mortality, while the empirical use of piperacillin/tazobactam was not found to predict in-hospital 30 day mortality [HR 1.38 (95% CI, 0.85-2.16)].Conclusions Piperacillin/tazobactam use might not be associated with increased mortality in treating third-generation cephalosporin-resistant E. coli bloodstream infections when the MIC is &lt;8 mg/L

Simple Parameters from Complete Blood Count Predict In-Hospital Mortality in COVID-19

Introduction. The clinical course of Coronavirus Disease 2019 (COVID-19) is highly heterogenous, ranging from asymptomatic to fatal forms. The identification of clinical and laboratory predictors of poor prognosis may assist clinicians in monitoring strategies and therapeutic decisions. Materials and Methods. In this study, we retrospectively assessed the prognostic value of a simple tool, the complete blood count, on a cohort of 664 patients (F 260; 39%, median age 70 (56-81) years) hospitalized for COVID-19 in Northern Italy. We collected demographic data along with complete blood cell count; moreover, the outcome of the hospital in-stay was recorded. Results. At data cut-off, 221/664 patients (33.3%) had died and 453/664 (66.7%) had been discharged. Red cell distribution width (RDW) (χ2 10.4; p4.68 was characterized by an odds ratio for in-hospital mortality OR=3.40 (2.40-4.82), while the OR for a RDW>13.7% was 4.09 (2.87-5.83); a platelet count>166,000/μL was, conversely, protective (OR: 0.45 (0.32-0.63)). Conclusion. Our findings arise the opportunity of stratifying COVID-19 severity according to simple lab parameters, which may drive clinical decisions about monitoring and treatment