"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 \ub1 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

The NBT test in various juvenile virus diseases

L'NBT-test in alcune virosi dell'infanzia. Vengono riportati i risultati del test al nitroblu di tetrazolio eseguito in una casistica di bambini affetti da epatite infettiva e varicella. Per quanto concerne i granulociti neutrofili la percentuale di positività non si discosta sensibilmente dai valori ottenuti nei soggetti sani di controllo; una elevata positività si riscontra invece a carico delle cellule mononucleate. Un tale comportamento potrebbe dipendere dal tipo di leucocita interessato nella reazione con l’agente infettante. Il contributo di A. Faga è consistito nella collaborazione concreta all’attività di laboratorio. Il lavoro è stato effettuato nell’ambito della collaborazione con l’Istituto di Clinica delle Malattie Infettive di Pavi

The spectrum of chronic hepatitis in the last two decades in a university hospital for infectious diseases

During the last eighteen years (1970-1987) at the Infectious Diseases Clinic of the University of Pavia, Ospedale Policlinico S. Matteo, IRCCS, Pavia (referral Center for hepatitis in our district: 502534 inhabitants) we observed 4238 patients (2706 M=63,8%; 1532 F = 36,2%) admitted with presumptive diagnosis of hepatitis. The male to female sex ratio was 1.78 and average age was 38 (1-90) years. Acute viral hepatitis was diagnosed in 3238 patients (76,4%), 1960 of which were males (60,5%) and 1278 (39,5%) females, with an average age of 35 (1-88) years. The possible route of transmission was: drug addition in 486 patients (15%), blood transfusion in 464 (14.3%), other (sexual, professionale, familiar) in 332 (10.3%), unknown in 1955 (60.4%). Chronic hepatitis (CH) was diagnosed according to the European Association for the Study of the Liver (EASL) and to the International Association for the Study of the Liver (IASL) in 848 patients (20%), 704 M (83%) and 144 F (17%) with an average age of 48 (2-90) years. 463 patients (54,5%) were biopsied durign admission, 385 (45,5%) received definitive diagnosis by clinical and previous histologic records. CAH was found in 268 (57,9%), CPH in 161 (34,8%) and CLH in 20 (4.3%) patients. Other liver diseases (steatosis, cirrhosis, HCC) were identified in 152 subjects (3%). The prevalence of A, B, NANB and Delta hepatitis virus in HI virus in the acute disease was respectively of 5.4%, 54,8%, 33,9%, 0,28% and 0,77%. In CH the HBV aetiology accounted for 49,1%, NANB virus fro 44,5%, co/super infection with HDV for 15%. Among factors involved in pathogenesis of chronic hepatitis we focused attention on drug addition which was found in 129 (28,7%) petients, blood transfusion in 70 (15,6%), HIV infection in 35 of 166 (21,1%). The data still demonstrate the high prevalence of HBV aetiology of CH and existence of co-factors in the pathogenesis of chronicity. The lack of markers of NANB infection persists as the main problem in the diagnosis of liver disease. This work was supported by grand 40% from M.P.I. "Epatiti virali acute e croniche"..

Valutazione della sicurezza d’impiego di un’apparecchiatura elettromedicale ad emissione di radiofrequenza

Sono stati valutati i parametri fisici indicatori della sicurezza di impiego di un’apparecchiatura ad emissione di radiofrequenza bipolare per uso estetico. In osservanza delle direttive nazionali ed europee, sono stati valutati i livelli di emissione ambientale del campo elettromagnetico, la corrente indotta negli arti dell’operatore, l’esposizione dell’operatore, il Rateo di Assorbimento Specifico (SAR) del campo a radiofrequenza nei tessuti trattati. Le misurazioni sono state effettuate con sensori isotropici e misuratore di correnti indotte. I risultati delle misurazioni hanno evidenziato ottimi livelli di sicurezza dell’apparecchiatura sia per l’ambiente che per l’operatore e per il paziente, pur rendendone incompatibile l’utilizzo con portatori di pace-makers, neurostimolatori e altri dispositivi che presidiano a funzioni vital