The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca' Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care

Insight from an Italian Delphi Consensus on EVAR feasibility outside the instruction for use: the SAFE EVAR Study

BACKGROUND: The SAfety and FEasibility of standard EVAR outside the instruction for use (SAFE-EVAR) Study was designed to define the attitude of Italian vascular surgeons towards the use of standard endovascular repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) outside the instruction for use (IFU) through a Delphi consensus endorsed by the Italian Society of Vascular and Endovascular Surgery (Societa Italiana di Chirurgia Vascolare ed Endovascolare - SICVE). METHODS: A questionnaire consisting of 26 statements was developed, validated by an 18 -member Advisory Board, and then sent to 600 Italian vascular surgeons. The Delphi process was structured in three subsequent rounds which took place between April and June 2023. In the first two rounds, respondents could indicate one of the following five degrees of agreement: 1) strongly agree; 2) partially agree; 3) neither agree nor disagree; 4) partially disagree; 5) strongly disagree; while in the third round only three different choices were proposed: 1) agree; 2) neither agree nor disagree; 3) disagree. We considered the consensus reached when >70% of respondents agreed on one of the options. After the conclusion of each round, a report describing the percentage distribution of the answers was sent to all the participants. RESULTS: Two -hundred -forty-four (40.6%) Italian Vascular Surgeons agreed to participate the first round of the Delphi Consensus; the second and the third rounds of the Delphi collected 230 responders (94.3% of the first -round responders). Four statements (15.4%) reached a consensus in the first rounds. Among the 22 remaining statements, one more consensus (3.8%) was achieved in the second round. Finally, seven more statements (26.9%) reached a consensus in the simplified last round. Globally, a consensus was reached for almost half of the proposed statements (46.1%). CONCLUSIONS: The relatively low consensus rate obtained in this Delphi seems to confirm the discrepancy between Guideline recommendations and daily clinical practice. The data collected could represent the source for a possible guidelines' revision and the proposal of specific Good Practice Points in all those aspects with only little evidence available

Mixed gold and platinum nanostructured layers for all-solid-state ion sensors

The great interest in portable and wearable monitoring systems has promoted in recent years a major expansion of all-solid-state Ion-Selective Electrodes (ISEs). Nanostructured Solid-Contacts (SCs) have shown a promising potential in order to eliminate the inherent potential drift of these systems. Notably the use of nanostructured layers offers some considerable advantages with respect to conductive polymers thanks to their hydrophobic behaviour, large surface area and absence of side-reactions. In this work, we develop for the first time mixed gold and platinum nanostructured SCs which show among the highest capacitance values reported in literature, while allowing a simple and fast (less than 6 minutes) deposition by electrochemical means. Cyclic Voltammetry (CV) and Current Reversal Chronopotentiometry (CRC) were employed to characterize the high performance and potential stability of these systems. The fabrication and calibration of Li+ ISEs corroborate the possibility to use these novel SCs to build highly stable and accurate ion sensors

A case of allergic enterocolitis to milk protein in a down baby

Anna, a term baby born by Caesarean section, firstborn, Apgar 8/9, born SGA 2.630 g weight; performed in karyotype of Down syndrome suspected ’free trisomy of chromosome 21’, echocardiography and abdominal ultrasound normal, ABR REFER, discharged in 8th day of life with diet of mother’s milk integrated with zero infant formula. Hospitalisation at one month of life due to serious clinical conditions (dehydration, hypovolemic shock, metabolic acidosis, PCR 67,4 mg/L, PCT 4,45 ng/ml, leukocytosis 63870/microL, weight 2447 g); negative blood, liquor, urine and stool cultures; Chest and Abdomen X-ray showed meteoric distension of the intestinal loops. She began antibiotic (Ampicillin+Sulbactam, Netilmicin, Ceftazidime) and immunoglobulin therapy with improvement and reduction of inflammatory markers; feeding with zero infant formula. After the fourth day of hospitalisation spontaneous emission of greenish bloody stools and then liquid stools, hypotonus, metabolic acidosis, bulbous abdomen, fever, increased inflammatory markers and leukocytosis occurred despite antibiotic therapy. New negatives cultures tested, negative parasitological faecal examination, positive faecal calprotectin (702.59 mg/kg); lymphocyte subpopulations and normal immunoglobulins. Anaemia with need of blood transfusion. Therapy replaced with Meropenem and Vancomycin and diet with hydrolyzed infant formula with slight improvements. The appearance of two similar to previous episodes in the following days suggested to treat with antibiotics and immunoglobulins. After gastroenterological consulting, in allergic enterocolitis to milk protein suspect, it replaced diet with hydrolyzed infant formula with amino acids. The following days progressive clinical improvement noted, weight increase, normal inflammatory markers, good conditions and subsequently discharge. Three weeks later, during medical check-up, she appeared in good clinical condition, increase in weight of 650

The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit

This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca’ Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care

Also adipose tissue pays consequencies of perinatal asphyxia

D.R. is born at term of physiological pregnancy by caesarean section. Birth weight was 3520 g, APGAR 7/9. At birth he presented axial hypotonia, hyporeactivity, groan, mild respiratory distress. Started Non Invasive Ventilation for 2 days with good improvement of outcome. At 4 day life, we started antimicrobial therapy and immunoglobulins ev because of elevated inflammatory markers and low platelet counts (PLT 47000/mcl) confirmed at the blood smear. After 2 weeks, on the neck and on the right cheek, finding of erythematous nodules of a few millimetres of diameter. In the days after, the lesions are also extended to the left cheek and became larger up to about 3 cm. At the ultrasound they appeared as ‘delimited echogenic areas of 19 × 14 mm at left, 17 × 12 mm at right whit intrinsic vascularisation and of irregular structure. Laboratory pannels (hepatic, renal, coltural exams, procalcitonin) were negative, ESR 24 mm/h, CRP 23.6 mg/L. About 30 days after, we see a reduction of the lesions in spite of a persistent increase of inflammatory markers. Therefore, a bacterial aetiology appeared ulikely saw that antimicrobial therapy so soon established, had no effects on them. Subcutaneous fat necrosis of the newborn is a relatively rare and transient condition that appeared in the first weeks of life in term infants with a perinatal suffering. This condition is caractherized by single or multiple subcutaneous nodules, isolated or confluent in plaques, erythematous/purplish, sometimes with little depressions, calcifications or necrosis inside; symmetrically distributed on the back, shoulders, buttocks, cheeks and at the root of the limbs; often painful at palpation. These nodules grow for some weeks and completely resolve within few months. Etiopathogenesis is probably linked to ischaemic injury, hypoxia, hypothermia and/or stress damage on the immature adipose tissue in infants with perinatal asphyxia. Maternal hypertension, gestational diabetes, family history of thrombophilia and dyslipidemia are considered risk factors. The diagnosis is clinical; the cutaneous biopsy is of support. Important for diagnosis are also the Ultrasonography and RMN. Hypercalcemia is the most dangerous complication; less frequent consequencies are thrombocytopenia, metabolic disorders (hypertriglyceridemia, hypoglycemia) and atrophic development of the nodular lesions