Pleuroparenchymal fibroelastosis in systemic sclerosis: prevalence and prognostic impact

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Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Fluoroquinolone resistance: relation between drug use and evolution of resistance in some Units of the “San Bassiano” hospital from 2007 to 2008

There is substantial evidence that the overuse of antibiotics is a major cause for the emergence in antimicrobial resistance. This study analyzes the evolution of antimicrobial resistance to ciprofloxacin and levofloxacin from 2007 to 2008 in some Units of the “San Bassiano” hospital and compares this evolution among the consumption of the same antibiotics. The study involved the collection of all first isolates in blood, urine and transtracheal samples between 2007 and 2008; three microorganisms were chosen: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Microorganisms investigations concerned Geriatrics, Medicine, Surgery and Intensive Care Unit (ICU) with 48, 48, 44 and 10 beds respectively. Identification and antimicrobial susceptibility testing was performed using the Phoenix automated system (Becton Dickinson). If the ciprofloxacin susceptibility was (S) and levofloxacin susceptibility was (I/R) antimicrobial susceptibility was confirmed by the E-Test method (bioMérieux) on Muller Hilton agar and cell density of 0.5 MacFarland. Control strains were E. Coli ATCC 25922, P. aeruginosa ATCC 27853 and S. aureus ATCC 29213. The antibiotics consumed in the hospital between January 2007 and December 2008 were transformed into Defined Daily Dose (DDD), which corresponds to the quantity of antibiotics consumed by a patient in 24 h. Ciprofloxacin and levofloxacin demonstrated a similar pattern of increasing resistance in some units between 2007 and 2008. Fluoroquinolone resistance increase for E. coli, varies from 10% in Geriatrics to 15% in ICU, for S. aureus varies from 15% in Medicine Unit to 5% in ICU. P. aeruginosa maintained the same percentage of resistance from 2007 to 2008, but there was a significantly increase of strains with intermediate sensitivity (I) up to 30%. The consumption of Ciprofloxacin didn’t increase in any of the units and in some case decreased. The consumption of levofloxacin increased in every units and particularly in ICU it raised from 5100 ev doses in 2007 to 6480 in 2008 and from 0 to 300 doses os (DDD). The increased consumption of levofloxacin in 2008 in ICU could explain the increased of Pseudomonas aeruginosa strains with intermediate sensitivity (I)

Streptococcus salivarius meningitis after dental care: case report

Introduction. Streptococcus salivarius is a common commensal of the oral mucosa, associated with infections in different sites. Meningitis due to this species are described in a few occasions . In this study refer to a case recently diagnosed in our hospital for treatment of a subsequent dental caries. Case report. A man of 35 years, presents to the emergency room with fever, headache, confusion, marked nuchal rigor.Anamnesis is the treatment of dental caries on the previous day.The blood count showed 24.7x109 / L with WBC 22.9x109 / L (92.9%) neutrophils. The lumbar puncture CSF noted cloudy with 15.0 x 109 / L WBC, glicorrachia 5 g / L, protidorrachia 6.5 g / L. Microscopic examination showed numerous granulocytes and prevalence of Gram-positive cocci.The pneumococcal antigen was negative.The blood cultures before starting antibiotic therapy, were negative. CSF was isolated from the culture of a Streptococcus salivarius. To antibiotic therapy started in the ED, after lumbar puncture is associated with the Ampicillin Ceftriaxone and continued for 15 days to improve the patient’s general condition, then resigned in the 17 th day. Materials and methods. From CSF inoculated in blood agar plates and chocolate agar alpha hemolytic colonies were isolated, catalysis negative, optochin resistant. The biochemical identification performed with Phoenix (BD) and confirmed by PCR Pan bacterial (16S rDNA) bacterial strain identified as Streptococcus salivarius.The antibiogram performed with Phoenix (BD) according to the CLSI guidelines indicated sensitivity to penicillin, vancomycin, cefotaxime, cefepime, and chloramphenicol. Conclusions. Meningitis by Streptococcus salivarius was found in a few cases, mainly related to the transmission of health personnel from the oral cavity during lumbar punctures performed without the use of surgical masks. The following bacterial meningitis in dental treatment having a low incidence and often fatal course be suspected by history.The patient should be further investigated because the infection may indicate a compromised immune unknown (Diabetes, HIV...)

Severe asthma: One disease and multiple definitions

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Migrants et migrations en SIC

Ce numéro coordonné par Claire Scopsi, Carsten Wilhelm et Khaled Zouari propose quatre horizons (médiatique, partagé, interculturel, discursif) pour traiter de la question des migrations et des migrants. Quatre horizons pour montrer, s’il en était besoin, que les Sciences de l’Information et de la Communication peuvent s’emparer de cette question brulante autrement qu’à travers le prisme privilégié par les médias.Dans cette perspective, la variété et la densité des contributions proposée permettent d’appréhender les diverses formes de discours produits par les médias, les pratiques médiatiques et sociales des migrants, et la complexité des relations interculturelles à l’œuvre dans ces contextes sociétaux. [En savoir +