43 research outputs found

    Pressure Ulcers due to a Tunneled Central Venous Catheter in a Patient on Chronic Maintenance Hemodialysis

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    We describe a rare complication given by tunneled central venous catheter (CVC) in a 95-years-old woman on chronic maintenance hemodialysis (HD)

    Rethinking Chronic Kidney Disease in the Aging Population

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    The process of aging population will inevitably increase age-related comorbidities including chronic kidney disease (CKD). In light of this demographic transition, the lack of an age-adjusted CKD classification may enormously increase the number of new diagnoses of CKD in old subjects with an indolent decline in kidney function. Overdiagnosis of CKD will inevitably lead to important clinical consequences and pronounced negative effects on the health-related quality of life of these patients. Based on these data, an appropriate workup for the diagnosis of CKD is critical in reducing the burden of CKD worldwide. Optimal management of CKD should be based on prevention and reduction of risk factors associated with kidney injury. Once the diagnosis of CKD has been made, an appropriate staging of kidney disease and timely prescriptions of promising nephroprotective drugs (e.g., RAAS, SGLT-2 inhibitors, finerenone) appear crucial to slow down the progression toward end-stage kidney disease (ESKD). The management of elderly, comorbid and frail patients also opens new questions on the appropriate renal replacement therapy for this subset of the population. The non-dialytic management of CKD in old subjects with short life expectancy features as a valid option in patient-centered care programs. Considering the multiple implications of CKD for global public health, this review examines the prevalence, diagnosis and principles of treatment of kidney disease in the aging population

    Peritoneal dialysis in the time of coronavirus disease 2019

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    In the current setting of global containment, peritoneal dialysis (PD) and home haemodialysis are the best modalities of renal replacement therapy (RRT) to reduce the rate of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Considering the shorter and easier training programme of PD compared to home haemodialysis, PD appears a practical solution for patients with end-stage renal disease to reduce the risk of hospital-acquired infection. PD offers the advantage of minimizing the risk of viral transmission through interpersonal contact that commonly occurs during the haemodialysis session and while travelling from home to the haemodialysis facility using public transport services. To overcome barriers to health care access due to the containment measures for this emerging disease, telemedicine is a useful and reliable tool for delivering health care without exposing patients to the risk of contact. However, novel issues including handling of potentially infected dialysate, caregivers' infectious risk and adequacy of PD in critically ill patients with acute respiratory distress syndrome remain to be clarified. In conclusion, PD should be preferred to the other modalities of RRT during the coronavirus disease 2019 (COVID-19) outbreak because it can be a solution to cope with the increased number of infected patients worldwide

    Prevalence, clinical course and outcomes of COVID-19 in peritoneal dialysis (PD) patients: a single-center experience

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    Introduction There are limited data on the effects of COVID-19 on peritoneal dialysis (PD) patients. This study aimed to describe the impact of COVID-19 on the PD population. Methods A monocentric retrospective observational study was conducted on 146 consecutive PD patients followed from January 2020 to March 2022 at the University Hospital of Modena, Italy. Results Twenty-seven (18.4%) PD patients experienced 29 episodes of SARS-CoV-2 infection, corresponding to an incidence rate of 0.16 episodes/patient-year. Median age of COVID-19 patients was 60.4 (interquartile range [IQR] 50.2-66.5) years. In unvaccinated patients (n. 9), COVID-19 was always symptomatic and manifested with fever (100%) and cough (77.7%). COVID-19 caused hospital admission of three (33.3%) patients and two (22.2%) died of septic shock. COVID-19 was symptomatic in 83.3% of vaccinated subjects (n.18) and manifested with fever (61.1%) and cough (55.6%). Hospital admission occurred in 27.8% of the subjects but all were discharged home. Median SARS-CoV-2 shedding was 32 and 26 days in the unvaccinated and vaccinated groups, respectively. At the end of the follow-up, COVID-19 triggered the shift from PD to HD in two subjects without affecting the residual renal function of the remaining patients. Overall, COVID-19 caused an excess death of 22.2%. COVID-19 vaccination refusal accounted for only 1.6% in this cohort of patients. Conclusion COVID-19 incident rate was 0.16 episodes/patient-year in the PD population. About one-third of the patients were hospitalized for severe infection. Fatal outcome occurred in two (7.4%) unvaccinated patients. A low vaccination refusal rate was observed in this population

    Cerebrospinal Fluid Markers in Sporadic Creutzfeldt-Jakob Disease

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    Sporadic Creutzfeldt-Jakob disease (sCJD) is the commonest form of human prion diseases, accounting for about 85% of all cases. Current criteria for intra vitam diagnosis include a distinct phenotype, periodic sharp and slow-wave complexes at electroencephalography (EEG), and a positive 14-3-3-protein assay in the cerebrospinal fluid (CSF). In sCJD, the disease phenotype may vary, depending upon the genotype at codon 129 of the prion protein gene (PRNP), a site of a common methionine/valine polymorphism, and two distinct conformers of the pathological prion protein. Based on the combination of these molecular determinants, six different sCJD subtypes are recognized, each with distinctive clinical and pathologic phenotypes. We analyzed CSF samples from 127 subjects with definite sCJD to assess the diagnostic value of 14-3-3 protein, total tau protein, phosphorylated181 tau, and amyloid beta (Aβ) peptide 1-42, either alone or in combination. While the 14-3-3 assay and tau protein levels were the most sensitive indicators of sCJD, the highest sensitivity, specificity and positive predictive value were obtained when all the above markers were combined. The latter approach also allowed a reliable differential diagnosis with other neurodegenerative dementias

    "Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

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    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 ± 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

    Cellulose Isolation from Tomato Pomace Pretreated by High-Pressure Homogenization

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    This work proposes a biorefinery approach for the utilization of agri-food residues, such as tomato pomace (TP), through combining chemical hydrolysis with high-pressure homogenization (HPH), aiming to achieve the isolation of cellulose with tailored morphological properties from underused lignocellulose feedstocks, along with the valorization of the value-added compounds contained in the biomass. Cellulose was isolated from TP using sequential chemical hydrolysis in combination with mechanical pretreatment through HPH. The chemical and structural features of cellulose isolated from TP pretreated by HPH were compared with cellulose isolated from untreated TP through light scattering for particle size distribution, optical and scanning electron microscopy, and Fourier-transform infrared spectroscopy (FT-IR) analysis. HPH pretreatment (80 MPa, 10 passes) not only promoted a slight increase in the yield of cellulose extraction (+9%) but contributed to directly obtaining defibrillated cellulose particles, characterized by smaller irregular domains containing elongated needle-like fibers. Moreover, the selected mild chemical process produced side streams rich in bioactive molecules, evaluated in terms of total phenols and reducing activity. The liquors recovered from acid hydrolysis of TP exhibited a higher biological activity than those obtained through a conventional extraction (80% v/v acetone, 25 °C, 24 h at 180 rpm)

    Edible Coatings Containing Oregano Essential Oil Nanoemulsion for Improving Postharvest Quality and Shelf Life of Tomatoes

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    Edible coatings have attracted significant interest in maintaining quality and improving the shelf life of fresh fruit and vegetables. This study aimed to improve tomato storability by using edible coatings, based on alginate cross-linked with calcium chloride, and containing an oregano essential oil (OEO) nanoemulsion as a natural antimicrobial. The coating formulations were preliminary optimized in terms of alginate and calcium chloride concentrations, using response surface methodology, to obtain a thin (~5 µm) and uniform layer on the tomatoes surface. The optimized coating (prepared using sequential dipping in a 0.5% w/w sodium alginate solution and in a 2.0% w/w calcium chloride solution) was enriched by incorporating an OEO nanoemulsion, formulated with lecithin as a natural emulsifier, at an OEO concentration of 0.17% w/w in the alginate solution. The nanoemulsion did not significantly affect the coating thickness and uniformity but improved the wettability of the tomato skin. More specifically, the alginate-based edible coatings exhibited a strong interaction with the hydrophobic tomato skin surface (higher than water), promoting surface adhesion. The addition of OEO nanoemulsion in the coating, by providing more hydrophobic sites, further improved the wetting capability and adhesion of the coating solution on the tomato surface. The developed edible coatings successfully contributed to prolonging the tomato shelf life, by reducing the growth of the endogenous microbial flora (total microbial load, yeasts, and molds) over 14 days at room temperature in comparison with the control, with significantly better performances for the edible coating containing the OEO nanoemulsion
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