Myalgia, Obtundity and Fever in a Patient with a Prosthesis

Objective: We describe a rare case of group G streptococcus (GGS) sepsis complicated by bacterial toxin myopathy. Case: A 65-year-old man, with a history of infection of his shoulder prosthesis, presented with multiorgan failure and notable myalgia likely caused by toxins. The patient was treated successfully with antibiotics and prosthesis removal. Conclusion: This case suggests infection by GGS should be considered in a patient presenting with myalgia associated with sepsis

Effects of clockwise and counterclockwise job shift work rotation on sleep and work-life balance on hospital nurses

Rotational shift work is associated with sleep disturbances, increased risk of cardiovascular and psychological disorders, and may negatively impact work\u2013life balance. The direction of shift rotation (Clockwise, CW or counterclockwise, CCW) and its role in these disorders are poorly understood. The aim of the study was to investigate the effect of the shift schedule direction on sleep quantity and quality, alertness and work performance, and on work\u2013life balance on hospital nurses. One-hundred female nurses, working a continuous rapid shift schedule in hospitals in the north of Italy, participated in this cross-sectional study. Fifty worked on CW rotation schedule (Morning: 6 a.m.\u20132 p.m., Afternoon: 2 p.m.\u201310 p.m., Night: 10 p.m.\u20136 a.m., 2 rest days) and fifty on CCW rotation (Afternoon, Morning, Morning, Night, 3 rest days). Data were collected by ad hoc questionnaire and daily diary. During the shift cycle CW nurses slept longer (7.40 \ub1 2.24 h) than CCW (6.09 \ub1 1.73; p < 0.001). CW nurses reported less frequently than CCW awakening during sleep (40% vs. 80%; p < 0.001), attention disturbance during work (20% vs. 64%; p < 0.001), and interference with social and family life (60% vs. 96% and 20% vs. 70%, respectively; p < 0.001). CCW rotating shift schedule seems to be characterized by higher sleep disturbances and a worse work\u2013life balance

Syncope in a Working-Age Population: Recurrence Risk and Related Risk Factors

Syncope in a worker undertaking risky tasks may result in fatalities for the individual or for third parties. We aimed at assessing the rate of syncope recurrence and the risk factors underlying the likelihood of syncope relapse in a working-age population. A prospective cohort of all patients aged 18\u207b65 years consecutively admitted to the Emergency Department for syncope was enrolled. Risk of syncope relapse was assessed at a six-month, 1-year, and 5-year follow-up. Predictors of syncope recurrence have been evaluated at six months and 1 year from the syncope index by a multivariable logistic regression analysis. 348 patients were enrolled. Risk of syncope relapse was 9.2% at 6 months, 11.8% at 1 year, and 23.4% at 5 years. At 6-month follow-up, predictor of syncope recurrence was 653 prior lifetime syncope episodes. At 1-year, 653 prior lifetime syncope episodes, diabetes mellitus, and anaemia were risk factors for syncope relapse. There was an exceeding risk of recurrence in the first 6 months and a reduced risk of 3.5% per year after the first year. Anaemia, diabetes mellitus, and prior lifetime syncope burden are of importance when giving advice about the resumption of "high risk" jobs following a syncope episode

Effects of prolonged head-down bed rest on sympathetic baroreflex control and orthostatic tolerance

Orthostatic intolerance has been described after prolonged bed confinement in several clinical settings. This may impact patients’ quality of life and increase risk of falls. Standing is associated with unloading of baroreceptor activity controlling heart rate (HR) and sympathetic vasomotor discharge assessed by muscle sympathetic nerve activity (MSNA). In the present study we evaluated the changes in baroreceptor response and in orthostatic tolerance induced by controlled long lasting bed rest in healthy volunteers. As part of the European Space Agency Medium-term Bed Rest protocol, eight volunteers (33 ±1yrs) were studied before and after 21-days of -6º head down bed rest (HDBR). Subjects underwent ECG, beat-by-beat blood pressure, respiratory activity and MSNA recordings during 15-minutes of 80 head-up tilt (HUT) followed by a 3-minute –10mmHg stepwise increase of lower body negative pressure, up to pre-syncope. The α index obtained in the low frequency band (0.1 Hz) by cross-spectrum analysis of RR and systolic arterial pressure (SAP) variability quantified the cardiac baroreflex sensitivity. The percentage of MSNA burst occurrence for different diastolic pressure values (grouped in bins of 1 mmHg) was assessed. The slope of the regression line between MSNA Bursts % and diastolic pressure was assumed to represent the gain of sympathetic baroreflex control (sBRS). the subjects orthostatic tolerance was decreased after HDBR(12±0.6min) compared to baseline (21±0.6min). In the supine position HR, SAP and α index were unchanged before and after HDBR. During HUT, HR and SAP were unmodified, α index was lower after (3.4±0.7) compared to before HDBR (6.4±1.0). While supine, sBRS was lower after (-2.9±1.5 %mmHg) compared to before HDBR (-6.0±1.1 %/mmHg). Similarly, during HUT sBRS was lower after HDBR (-2.2±0.6 %/mmHg) compared to before (-4.4±0.4%mmHg). These data suggest that prolonged bed confinement decreased the overall baroreceptor sensitivity.These alterations may be involved in the reduction of orthostatic tolerance

Introduzione

l'introduzione affronta in modo riassuntivo le problematiche presenti nel volume

A new simplified single-filter assay for &quot;in vitro&quot; evaluation of chemotaxis of 51Cr-labeled polymorphonuclear leukocytes

A new simplified radioassay for measuring polymorphonuclear leukocyte (PMN) chemotaxis is proposed using 51Cr-labeled cells and a single-filter system. The technique offers all the advantages described for the double-filter radioassay and permits a reproducible measurement of random locomotion, chemokinesis and chemotaxis. Moreover the single-filter radioassay utilizes commercially available and disposable chambers gathered in a multichamber apparatus; this makes the method very easy to learn and rapid to perform