Advanced COPD patients under home mechanical ventilation and/or long term oxygen therapy: italian health care costs.

Introduction. Little information is available on health care costs for patients with very severe chronic obstructive pulmonary disease The aim of the current work was to evaluate Italian health care costs in these patients. Patients and Methods. Prospective 1-year analysis were assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on long-term oxygen therapy (n= 41). Acute costs for care were a sum of fees for doctor\u2019s consultations, admissions to hospital (ward and intensive care unit) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Results. Mean cost/day/patient was 96\ub1112 \u20ac (range 9-526 \u20ac), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normally distribution (range 0 to 510 \u20ac) with cost for hospitalization being the highest cost burden with greater than 30 % of acute care costs were attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p=0.006), with home oxygen supply being the highest cost burden. Conclusions. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalizations and home oxygen supply

Synthesis of novel epibatidine-related derivatives through 1,3-dipolar cycloaddition of pyridinenitrile oxides

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Advanced COPD patients under Home Mechanical Ventilation and/or Long Term Oxygen Therapy: Italian Healthcare Costs

Background and Aim. Little information is available on healthcare costs for patients with very severe chronic obstructive pulmonary disease. The aim of the current work was to evaluate Italian healthcare costs in these patients. Methods. Prospective 1-year analysis was assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on longterm oxygen therapy (n=41). Acute costs for care were a sum of fees for doctor’s consultations, admissions to hospital (ward and intensive care units) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Results. Mean cost/day/patient was 96±112€ (range 9-526€), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normal distribution (range 0 to 510€) being cost for hospitalisation the highest cost burden with more than 30% of acute care costs attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p=0.006), being home oxygen supply the highest cost burden. Conclusions. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalisations and home oxygen supply

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

Cefuroxime induced lymphomatoid hypersensitivity reaction

An 84 year old women developed erythematous blotchy erythema and purpuric rashes over the lower limbs three days after being started on intravenous cefuroxime for acute diverticulitis. A skin biopsy specimen showed a mixed infiltrate of lymphoid cells and eosinophils; many of the lymphocytes were large, pleomorphic, and showed a raised mitotic rate. Immunohistochemistry showed the infiltrate to be T cell rich, with all the large cells being CD30 positive. Typical mycosis fungoides cells, marked epidermotropism, and Pautrier's abscesses were not seen. The rash disappeared 10( )days after cessation of cefuroxime and the patient remained asymptomatic 15 months later. This apparent cutaneous T cell lymphoma-like reaction is best described as lymphomatoid vascular reaction. The drug induced immune response with an atypical cutaneous lymphoid infiltrate mimics a cutaneous pseudolymphoma.


Keywords: cefuroxime; atypical cutaneous lymphomatoid infiltrate; cutaneous T cell lymphom

Preparation and Application of Sodium Percarbonate as Bleaching Agent for Cotton Fabric

151-153<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "times="" new="" roman";mso-fareast-theme-font:minor-fareast;mso-hansi-theme-font:="" minor-latin;mso-bidi-font-family:"times="" roman";mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">A new method has been developed for the preparation of sodium percarbonate for use as a bleaching agent for coloured and white textiles. The maximum stabilization of sodium percarbonate is obtained with 2.2% crystalline magnesium sulphate and 1.2% sodium silicate.</span

Fatal myocardial damage due to zinc phosphide intentional ingestion

We present a case of fatal myocardial damage caused by zinc phosphide ingestion. It is a highly toxic poison that causes life-threatening complications (cardiac and respiratory acute failure above all) by its active metabolite phosphine. Phosphine toxicity’s case reports from Europe (and Italy), United States and western countries are rare. A 69-year-old man drunk a great amount of alcohol and unspecified amount of diluted zinc phosphide and was admitted to emergency department with a mild metabolic acidosis and acute respiratory failure. After gastro-intestinal decontamination, a transient improvement of his clinical conditions was observed. In the emergency medicine unit a sudden onset of severe bradycardia and hypotension appeared, electrocardiogram showed an increase in QRS duration with STelevation in many leads; 2 min later a thirddegree atrio-ventricular block was evident. Bradycardia went into asystole and the patient had cardiac arrest. Despite all resuscitative maneuvers, 6 h after zinc phosphide ingestion the patient died. No antidote or specific therapy or management of this potentially lifethreatening poison are actually available, but only supportive and resuscitative measures