Is this a seizure?

We describe a case of a 65-year-old woman admitted to the hospital for suspected of epileptic crisis. She was affected by diabetes and hiatal hernia for which she was taking Proton Pump Inhibitors (PPIs) for about 8 years. She showed hypocalcaemia, hypomagnesaemia, hyperparathyroidism and severe hypovitaminosis D. We exclude malabsorption and magnesium loss. After restored vitamin D levels, stopped use of PPI, start calcium and magnesium supplementation normal values of the ions were restored. This case underlies the importance of evaluate magnesium routinely, other than calcium and vitamin D, and use PPI more carefully

MOLECULAR AND SEROLOGICAL DIVERSITY OF NEISSERIA MENINGITIDIS CARRIER STRAINS ISOLATED FROM ITALIAN STUDENTS AGED 14-22 YEARS.

Neisseria meningitidis is an obligate human commensal that commonly colonizes the oropharyngeal mucosa. Carriage is age dependent and very common in young adults. The relationships between carriage and invasive disease are not completely understood. In this work, we performed a longitudinal carrier study in adolescents and young adults (173 subjects). Overall, 32 subjects (18.5%) had results that were positive for meningococcal carriage in at least one visit (average monthly carriage rate, 12.1%). Only five subjects tested positive at all four visits. All meningococcal isolates were characterized by molecular and serological techniques. Multilocus sequence typing, PorA typing, and sequencing of the 4CMenB vaccine antigens were used to assess strain diversity. The majority of positive subjects were colonized by capsule null (34.4%) and capsular group B strains (28.1%), accounting for 23.5% and 29.4% of the total number of isolates, respectively. The fHbp and nhba genes were present in all isolates, while the nadA gene was present in 5% of the isolates. The genetic variability of the 4CMenB vaccine antigens in this collection was relatively high compared with that of other disease-causing strain panels. Indications about the persistence of the carriage state were limited to the time span of the study. All strains isolated from the same subject were identical or cumulated minor changes over time. The expression levels and antigenicities of the 4CMenB vaccine antigens in each strain were analyzed by the meningococcal antigen typing system (MATS), which revealed that expression can change over time in the same individual. Future analysis of antigen variability and expression in carrier strains after the introduction of the MenB vaccine will allow for a definition of its impact on nasopharyngeal/oropharyngeal carriage

I tutor per la formazione nel Servizio sanitario regionale dell'Emilia Romagna. Rapporto preliminare. [RAPPORTO]

Il rapporto propone i risultati del Gruppo di lavoro regionale composto da esperti della formazione del Servizio sanitario dell’Emilia-Romagna e coordinato dall’Agenzia sanitaria e sociale regionale, costituito per studiare la funzione formativa dei tutor, cioè di operatori che dedicano parte del proprio tempo allo svolgimento di funzioni formative di tipo tutoriale nell’ambito dei servizi del sistema sanitario regionale emiliano-romagnolo. Alcune precedenti indagini promosse dalla Regione avevano fatto emergere la percezione di come la funzione formativa dei tutor esercitata nelle Aziende sanitarie fosse un fenomeno diffuso, complesso nella sua articolazione, ma poco visibile nonostante le risorse utilizzate. Inoltre, l’esplicito riconoscimento del ruolo di formazione e di ricerca al Servizio sanitario regionale, le modifiche introdotte per la formazione universitaria di base, post-laurea e per la formazione continua in medicina hanno determinato modalità di pensare e realizzare la formazione nelle quali il tutor assume un ruolo di rilevo. Il progetto Sulla base di queste premesse, il lavoro del Gruppo ha perseguito i seguenti obiettivi: • identificare la pluralità di tipologie di tutor per la formazione del personale sanitario, operanti presso le Aziende sanitarie della regione Emilia-Romagna; • descrivere le funzioni e le attività specifiche di guida e facilitazione dell’apprendimento proprie di ciascuna tipologia tutoriale; • definire le funzioni identificative del ruolo di tutor che appartengono al dominio dei processi cognitivi, relazionali, organizzativi e di apprendimento e che sono trasversali e comuni alle diverse tipologie tutoriali; • realizzare una stima quantitativa della diffusione del fenomeno. Una ricognizione condotta dal Gruppo regionale ha individuato l’uso corrente di 38 diverse denominazioni per identificare i tutor. Il rapporto illustra - con l’ausilio di tabelle - le 20 tipologie di tutor a cui le diverse denominazioni sono state ricondotte e presenta una mappa dei tutor delle Aziende sanitarie della regione articolata per livello di formazione e contesto didattico: a. formazione di base universitaria (laurea nelle professioni sanitarie, in medicina e chirurgia ed abilitazione, in altre lauree) e non universitaria (formazione OSS, scuola secondaria superiore); b. formazione post-laurea (specialistica, master, perfezionamento, scuole di specializzazione, formazione specifica in medicina generale); c. formazione continua. L’ultima sezione del rapporto è dedicata alla complessiva quantificazione della diffusione dei tutor nel Servizio sanitario regionale, attraverso una stima riferita all’anno 2007. Finora erano infatti disponibili a questo riguardo solo i dati emersi da un sondaggio coordinato dalla Regione Emilia-Romagna nel 2006, che aveva evidenziato una percentuale variabile dal 20% al 45% di operatori che dedicano una parte del proprio tempo allo svolgimento di funzioni formative. Lo sforzo del Gruppo di lavoro di costruire e condividere un sistema di classificazione delle tipologie e funzioni di tutor ha consentito di realizzare una stima comparabile tra le diverse Aziende della regione, superando l’ostacolo della pluralità di denominazioni con le quali i tutor erano identificati. La raccolta dei dati è avvenuta attraverso una scheda corredata di istruzioni per la rilevazione e di una sinossi descrittiva delle varie tipologie di tutor. A causa della complessità con la quale si articola la funzione tutoriale, non è stato possibile ottenere tutti i dati richiesti. Dalla stima emerge comunque che complessivamente gli operatori delle Aziende sanitarie dell’Emilia-Romagna impegnati a vario titolo in qualità di tutor sarebbero oltre 10.000; si tratta di un valore certamente cospicuo, probabilmente anche inferiore alla realtà. I dati di stima evidenziano altri aspetti rilevanti che meritano di essere approfonditi. In tal senso, il rapporto va considerato come un documento preliminare

NIZATIDINE 150 MG AT NIGHT IN THE PROPHYLAXIS OF GASTRIC-ULCER RELAPSE - A 12-MONTH PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND MULTICENTER STUDY VERSUS PLACEBO

Objective: To evaluate the safety and efficacy of nizatidine 150 mg as a maintenance therapy for gastric ulcer. Design: A 1-year prospective, multicentre, randomized, double-blind study versus placebo. All patients were examined every 3 months with endoscopy, clinical check-ups and blood tests. Setting: Outpatients followed-up by 22 endoscopic units in north-eastern Italy. Patients: Adult patients with an endoscopically documented healed gastric ulcer, obtained within 8 weeks by nizatidine 300 mg. Two hundred and forty-one patients entered the study: 123 treated with nizatidine 150 mg, 118 with placebo; one was excluded. Thirty-eight patients withdrew during follow-up, 202 concluded the study. Main outcome measures: Age, gender, height, weight, family history of ulcer disease, smoking habit, alcohol consumption, length of gastric ulcer history, previous ulcer treatment, number of ulcers, ulcer size and location, current drug therapy and common laboratory tests were taken into account. Results: Nizatidine proved significantly better than placebo in preventing gastric ulcer relapse, i.e. remission rate was 94 versus 79%, 81 versus 68%, 79 versus 640/o and 77 versus 52% after 3, 6, 9 and 12 months, respectively (P = 0.001). Antacid consumption, symptoms, compliance and adverse events were comparable in both groups; cigarette smoking was the major relapse risk factor in both treatment groups. Conclusion: Long-term nizatidine 150 mg per day proved safe and effective in containing gastric ulcer relapse compared with placebo: smoking habit is the most important risk factor in gastric ulcer relapse

LONG-TERM TREATMENT OF PATIENTS WITH GASTRIC-ULCER - SUCRALFATE VERSUS RANITIDINE VERSUS NO TREATMENT - AN INTERIM-REPORT AT THE END OF YEAR-1 OF A 3-YEAR MULTICENTER, RANDOMIZED STUDY

This multicenter, prospective, randomized, open, long-term study compared the efficacy of sucralfate (1 g twice daily) versus ranitidine (150 mg once daily) versus no therapy in patients with gastric ulcer. The results at the end of the first of a scheduled 3-year follow-up are reported. Two hundred ninety patients with healed GU entered the 3-year, open study. Ninety patients were randomly assigned to receive sucralfate, 105 to receive ranitidine, and 95 to receive no treatment. The three groups proved well matched in terms of standard clinical data. Fifty patients were withdrawn from the study during the first year; a gastric neoplasm was diagnosed in four patients. At months 3, 6, and 12 of therapy, the remission rates were, respectively, 94.8%, 86.2%, and 79.6% with sucralfate; 98.9%, 91.6%, and 82.5% with ranitidine; and 89.3%, 80.7%, and 66.9% with no treatment. Sucralfate was as effective as ranitidine (P = NS), and both drugs produced higher cumulative remission rates than no treatment (P < 0.06 and P < 0.01, respectively). We conclude that 1 g of sucralfate twice daily was as effective as 150 mg of ranitidine once daily in maintaining GU remission for 1 year; both treatments led to a better outcome than no treatment

SUCRALFATE, RANITIDINE AND NO TREATMENT IN GASTRIC-ULCER MANAGEMENT - A MULTICENTER, PROSPECTIVE, RANDOMIZED, 24-MONTH FOLLOW-UP WITH A STUDY OF RISK-FACTORS OF RELAPSE

This multicenter, prospective, randomized, open, long-term study compares sucralfate (2 g daily) with ranitidine (150 mg daily) and no treatment in gastric ulcer (GU). We report the results of the second year of a scheduled 3-year follow-up, the outcome of the 1 st year has been reported earlier. The 24-month follow-up was completed by 142 patients who were continuously either treated with the drug randomly assigned at the beginning of the study or left untreated (i.e. 32 patients took 150 mg ranitidine at bedtime, 29 took 1 g sucralfate twice daily and 81 were left untreated, 23 of whom came from the ranitidine group, 19 from the sucralfate group and 39 from the untreated group). Seven patients dropped out and 26 subjects relapsed (5 under ranitidine, 4 under sucralfate and 17 untreated cases). Ranitidine versus previous ranitidine, sucralfate versus previous sucralfate and each one versus no treatment showed comparable relapse rates. An additional study, using Cox's models, showed that three variables have a significant correlation with relapse during the 1 st year of follow-up: therapy carried out (p = 0.0025), symptoms (p = 0.0047) and family history of ulcer (p = 0.0392). In conclusion, both ranitidine 150 mg and sucralfate 2 g proved effective in reducing GU relapse as compared with no treatment, an effect which does not seem to persist during the 2nd year of therapy, when the 'no treatment' option may be taken into account