Death connected to paralytic ileus due to the intake of antipsychotic drugs. Case report

Abstract: The aim of this article is to enlarge furtherly the case-studies on the potentially lethal side-effects of second generation atypical antipsychotic drugs. We report the case of a 40-years-old man, under treatment with quietiapine and clozapine because of a psychotic upset, presenting persistent constipation, who died few hours after his arrive at the ER. The autopsy, together with toxicological an histologic exams, allowed to hail the cause of the death from a cardiac upset, fostered by hydroelectric imbalance connected to the sub-occlusion context. This evaluation has been related to the side-effects of these drugs -even if used with therapeutic dosages -that are able to cause in predisposed people, the onset of disorder within the cardiac rhythm, provoking ventricular fibrillation and death. Because of this reason, a constant patients' monitoring -from the first treatment administration through all the therapy -is beneficial, to prevent the onset of these potential lethal episodes

Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review

Background: Influenza vaccination is an important public health intervention for controlling disease burden, but coverage rates are still low also in risk groups. In order to identify non-vaccinating subgroups, deprivation and socio-economic indices, i.e. measures used to synthetically describe people\u2019s socio-economic status while taking into account several dimensions, may be used. We aimed to synthetize evidence from studies investigating association between deprivation/socio-economic indices and influenza vaccination coverage in population at risk\u2014 persons 65 years of age, individuals with comorbidities, pregnant women and health-care workers. Methods: We searched PubMed, ISI WoS, CINAHL and Scopus to identify observational studies published up to October 10th 2017 in English or Italian. Studies reporting quantitative estimates of the association between deprivation/socioeconomic indices and influenza vaccination coverage in populations at risk were included. Results: A total of 1474 articles were identified and 12 were eventually included in the final review. Studies were mostly cross-sectional, performed in European countries, from 2004 to 2017. Seven studies focussed on deprivation and five on socioeconomic indices. Studies on deprivation indices and vaccination coverage showed that people from the most deprived areas had lower coverage. Regarding socio-economic condition, results were contrasting, even though it may also be concluded that people from lower groups have lower vaccination coverage. Conclusions: Our work supports the possibility to identify people likely to have lower influenza vaccination coverage based on deprivation/socio-economic indices. Efforts should be performed in order to further strengthen robustness, transferability and suitability of these indices in addressing public health problems

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Death connected to paralytic ileus due to the intake of antipsychotic drugs. Case report

Abstract: The aim of this article is to enlarge furtherly the case-studies on the potentially lethal side-effects of second generation atypical antipsychotic drugs. We report the case of a 40-years-old man, under treatment with quietiapine and clozapine because of a psychotic upset, presenting persistent constipation, who died few hours after his arrive at the ER. The autopsy, together with toxicological an histologic exams, allowed to hail the cause of the death from a cardiac upset, fostered by hydroelectric imbalance connected to the sub-occlusion context. This evaluation has been related to the side-effects of these drugs -even if used with therapeutic dosages -that are able to cause in predisposed people, the onset of disorder within the cardiac rhythm, provoking ventricular fibrillation and death. Because of this reason, a constant patients' monitoring -from the first treatment administration through all the therapy -is beneficial, to prevent the onset of these potential lethal episodes

Primary pulmonary arteries atherosclerosis: discovering an unusual cause of death in forensic practice

Background: In the literature, there are few studies on atherosclerosis in the pulmonary artery in human beings and no cases similar to the one presented has been reported until now. The aim of the study is to describe a particularly unusual case of primary severe pulmonary atherosclerosis, in a 40-year old man, reporting its pathological aspects associated with interstitial lung disease as a cause of a mild pulmonary fibrosis. Case presentation: The patient had marked atherosclerosis in the pulmonary trunk and its branches, probably caused by a series of hemodynamic and endothelial changes, subsequent to the pulmonary hypertension. An autopsy was performed a few days after death in order to explain the reasons of the sudden death. Despite the typical pattern of pulmonary atherosclerosis is generally associated with many co-morbidities, we have found only a significant right ventricular hypertrophy. A complete forensic approach led to attribute the cause of death to cardiorespiratory failure due to severe pulmonary atherosclerosis. Conclusion: in the light of the limited number of reports in the literature, this paper seeks to widen knowledge in the area of atherosclerosis in the pulmonary artery

Transitional care models for chronic patients: preliminary results from an umbrella review

Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p < 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform

Theranostic designed near-Infrared fluorescent poly (lactic-co-glycolic acid) nanoparticles and preliminary studies with functionalized VEGF-nanoparticles

Poly-lactic-co-glycolic acid nanoparticles (PLGA-NPs) were approved by the Food and Drug Administration (FDA) for drug delivery in cancer. The enhanced permeability and retention (EPR) effect drives their accumulation minimizing the side effects of chemotherapeutics. Our aim was to develop a new theranostic tool for cancer diagnosis and therapy based on PLGA-NPs and to evaluate the added value of vascular endothelial growth factor (VEGF) for enhanced tumor targeting. In vitro and in vivo properties of PLGA-NPs were tested and compared with VEGF-PLGA-NPs. Dynamic light scattering (DLS) was performed to evaluate the particle size, polydispersity index (PDI), and zeta potential of both preparations. Spectroscopy was used to confirm the absorption spectra in the near-infrared (NIR). In vivo, in BALB/c mice bearing a syngeneic tumor in the right thigh, intravenously injected PLGA-NPs showed a high target-to-muscle ratio (4.2 T/M at 24 h post-injection) that increased over time, with a maximum uptake at 72 h and a retention of the NPs up to 240 h. VEGF-PLGA-NPs accumulated in tumors 1.75 times more than PLGA-NPs with a tumor-to-muscle ratio of 7.90 ± 1.61 (versus 4.49 ± 0.54 of PLGA-NPs). Our study highlights the tumor-targeting potential of PLGA-NPs for diagnostic and therapeutic applications. Such NPs can be conjugated with proteins such as VEGF to increase accumulation in tumor lesions