P2‐254: RELATION OF SERUM 25‐HYDROXYVITAMIN D TO PULSE PRESSURE IN ALZHEIMER'S DISEASE

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Siguiendo las vias del tren… rescatando el pasado de nuestros ferroviarios

Con este trabajo pretendemos dar a conocer las tareas y resultados efectuados durante el Proyecto “Puesta en valor de la Colección del Museo Ferroviario de Tafí Viejo”. Este Museo se encuentra ubicado dentro de los Talleres Ferroviarios en el Departamento de Tafí Viejo de la Provincia de Tucumán. Nuestro objetivo fue resignificar los restos materiales del pasado priorizando la conservación de los bienes y la posterior transmisión de los resultados a través de la muestra expositiva. Dicho proyecto se llevo a cabo durante el año 2008, entre los meses de mayo y diciembre por un equipo conformado de estudiantes avanzados de las Carreras de Técnico Universitario en Documentación y Museología Arqueológica y Arqueología de la Facultad de Ciencias Naturales de la Universidad Nacional de Tucumán. La colección con la que se trabajó, comprendió objetos relacionados a los ferrocarriles de diferentes materiales, principalmente metales y en menor medida vidrio, plástico, papel, madera y cuero. Considerando la diversidad de los mismos, implementamos medidas técnicas y científicas de conservación adecuadas a cada caso. La metodología de trabajo consistió en diagnosticar el estado de las piezas, identificando aquellas que requerían un tratamiento más urgente. Luego se realizó limpieza mecánica, siglado, registro y documentación fotográfica de cada objeto, tomando para ello medidas preventivas en cuanto a la manipulación y seguridad de los mismos, utilizando elementos adecuados. Estas medidas se aplicaron en objetos expuestos como así también en los que se encontraban en el Área de reserva. Para complementar estas actividades se consideró necesario acondicionar dicha área instalando estanterías y otros mobiliarios para albergar los objetos en forma adecuada y clasificarlos de acuerdo a su función y tipo de material. También se contempló una organización espacial delimitando sectores para el desarrollo de las diferentes actividades. Se aplicaron una serie de medidas técnicas para contrarrestar los efectos de agentes de deterioros, tanto externos como internos. Al finalizar las etapas mencionadas se programó la realización de monitoreos periódicos para observar y evaluar la viabilidad de las actividades desarrolladas. Creemos que las tareas realizadas tienen un alto valor para las acciones siguientes, como la investigación, exhibición y difusión dentro de la institución.Tópico 1: Aspectos teóricos, históricos, legales, económicos y tecnológicos de la restauración y conservación de bienes patrimoniales

Proarrhythmia assessment in treatment with hydroxychloroquine and azithromycin hospitalized elderly COVID-19 patients - our experience

The aim of our study was to characterize the repolarization disorders propensity induced by drug-drug interaction. In this observational retrospective study, we report our experience on all elderly patients with ascertained diagnosis of coronavirus disease 2019 through nasopharyngeal swab with real time-polymerase chain reaction at our Pugliese-Ciaccio hospital in Catanzaro, who received hydroxychloroquine (HCQ), with or without azithromycin (AZY). 33 hospitalized patients were examined. We calculated QT value, cQT, QT dispersion, and cQT dispersion and examined possible progression on the basal electrocardiogram (T0) and after the insertion of the drug (T1). The QT value is increased by T0 vs T1 (370±40.74 vs 420±36.91 ms; P=0.000), as well as the cQT value (408±25.40 vs 451.54±58.81; P=0.003), the QT dispersion (QTd: 36.36±14.53 vs 50.90±13.12 ms; P=0.000); the dispersion of cQTc (cQTd 46.27±18.72 vs 63.18±21.93 ms; P=0.001). The ΔQT was 37.44±44.09 while the ΔcQT was 32.01±56.47). The main determinant of QTc prolongation is the number of drug at risk of prolongation of the QT that could influence the ventricular repolarization phase. The use of HCQ in combination with AZY, in patients suffering from severe acute respiratory syndrome-related coronavirus-2, can favor the onset of serious side effects, even potentially fatal. Finally, the measures of QTd and cQTd confirmed additional electrocardiographic parameters useful in identifying patients being treated with drugs at risk of potential adverse arrhythmic events following drug interaction

Toxic epidermic necrolysis by allopurinol: a case report

Toxic epidermal necrolysis (TEN) or Lyell’s syndrome is a rare but serious potentially fatal autoimmune dermatologic disease. It is characterized by cutaneous damage due to apoptosis of the keratinocytes with consequent dermo-epidermal separation for a >30% extension of the body surface, associated with mucosal lesions. It is due to the activation of the immune system, often following the intake of potentially toxic drugs [antibiotics, antiepileptics, non-steroidal antinflammatory drugs (NSAIDs), allopurinol] or after infection with herpetic viruses or mycoplasma. We describe the case of an 82- year-old man starting therapy of Allopurinol for hyperuricemia. After four days the patient shows an extensive erythematous rash localized to the trunk and upper limbs. The following day the rash also involves the face, tending to the confluence and after another two days, the macules turn into de-epithelized areas because of dermo-epidermal separation and the lesions involve the oral and ocular mucosa, causing dysphagia and difficulty in speaking. He was treated with steroid and antihistamine therapy, suspending the previously undertaken therapy with antibiotic and Allopurinol

Clot characterization by multidisciplinary approach: biochemical and imaging parameters in a hypocoagulative setting. A pilot study.

Background: Clot characterization is, to the present days, a multimodal approach: scanning the clot by electron microscopy (SEM) is helpful for the visualization of fibrin structure along with laboratory parameters such as the clot waveform analysis (CWA) and thrombin generation in different settings of clot abnormalities. This study aimed to assess whether the coagulative parameters were consistent with the clot images texture acquired by SEM, and therefore to propose a more generalist and integrative approach to clots classification.Design and Methods: In this pilot study, the examined population consists of eight healthy subjects, seven patients affected by Acquired Hemophilia A (AHA) and seven patients treated with Vitamin K Antagonists (VKAs), similar for age and gender. We studied the velocity and acceleration (1st and 2nd derivative of the aPTT) of clot formation (CWA), the thrombin generation, and the clots' scanning by SEM. Images acquired with SEM were then analyzed with the MATLAB software with the "Texture Analysis" methods to perform classification. Among the various texture parameters, we reported Contrast and Energy.Results: Significant differences among healthy subjects, patients with AHA and those treated with VKAs were detected for the coagulative parameters. We found no differences between VKAs and AHA patients. Contrast and energy highlighted a significant difference among the three groups in agreement with the laboratory's parameters. We found no significant differences between VKAs and AHA patients.Conclusions: The use of SEM, CWA and thrombin generation parameters may be a starting point for studies aimed to demonstrate the general characteristics of clot formation in different clinical conditions with a multiparametric approach

Delirium accompanies kidney dysfunction in hospitalized elderly patients

Introduction. Delirium, defined as an acute mental status with altered level of consciousness, is a common geriatric syndrome and a typical complication in hospitalized elderly patients. We aimed to assess the occurrence of delirium and the possible relationship with renal impairment. Methods. Patients aged over 65 years admitted consecutively to a Geriatric Unit, were screened for a first diagnosis of delirium. Delirium was evaluated using the validated Assessment Test for Delirium and Cognitive Impairment (4AT). Results. Final analysis included 311 patients (182 women,129 men). Mean eGFR was 62.44 ± 28.84 mL/min/1.73 m2. Prevalence of Cognitive impairment or delirium was 5.4, 84.8 e 9.8% for 0, 1-3 and ≥ 4 4AT scores. At univariate analysis, prevalence of clear delirium was increased with the worsening of CKD, being 3.7% in stage IIIb up to 68% in stage IV-V (p < 0.001). At multivariable logistic analysis, adjusted for gender and smoking habit, higher eGFR levels were associated with a reduced risk for the presence of delirium (OR = 0.86 95% CI 0.82-0.91, p < 0.001) and for developing possible cognitive impairment (OR = 0.87 95% CI 0.83- 0.90, p < 0.001). Discussion. Mild to moderate delirium is a pervasive condition among geriatric patients with manifested renal function impairment

Low-flow veno-venous extracorporeal CO2 removal: first clinical experience in lung transplant recipients

Low-flow extracorporeal CO2 removal devices are easy to setup and manage and may provide valuable ventilation support

Adaptive support ventilation versus synchronized intermittent mandatory ventilation with pressure support in weaning patients after orthotopic liver transplantation

BACKGROUND: The extubation phase is an extremely critical moment in patients who have undergone orthotopic liver transplantation, who do not always have the advantage of long-lasting positive-pressure ventilation and positive expiratory end pressure; these factors can lead to splanchnic venous congestion, and this is why a rapid extubation can represent a great benefit for the graft. METHODS: The aim of this study was to compare the adaptive support ventilation (ASV) mode with the standard mode of weaning in our intensive care unit, synchronized intermittent mandatory ventilation with pressure support (P-SIMV), in patients who received orthotopic liver transplantation. ASV is a positive-pressure mode, in which pressure level and respiratory rate are automatically adjusted according to measured lung dynamics at each breath. Eligible patients were assigned to either ASV or P-SIMV group. The weaning protocol was based on the individual respiratory activity and structured in 4 different phases. RESULTS: The average length of intubation was significantly shorter in the ASV group than in the P-SIMV group (90±13 vs 153±22 minutes, P=.05). The total modifications to the ventilator settings were significantly larger in the P-SIMV group (1.5±1 vs 6±2; P=.003). CONCLUSIONS: Our results suggest that although both procedures are safe and easy to apply, ASV is superior in terms of weaning times, and it simplifies respiratory management. The better patient-machine interaction in ASV has been highlighted by other authors for different clusters of patients

"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