Development and validation of a delirium risk assessment tool in older patients admitted to the Emergency Department Observation Unit.

BACKGROUND: Delirium is frequent though undetected in older patients admitted to the Emergency Department (ED). AIMS: To develop and validate a delirium risk assessment tool for older persons admitted to the ED Observation Unit (OU). METHODS: We used data from two samples of 65 + year-old patients, one admitted to the ED of Brescia Hospital (n = 257) and one to the ED of Desio Hospital (n = 107), Italy. Data from Brescia were used as training sample, those collected in Desio as testing one. Delirium was assessed using the 4AT and patients' characteristic were retrieved from medical charts. Variables found to be associated with delirium in the training sample were tested for the creation of a delirium risk assessment tool. The resulting tool's performances were assessed in the testing subsample. RESULTS: Of all possible scores tested, the combination with the highest discriminative ability in the training sample included: age ≥ 75 years, dementia diagnosis, chronic use of neuroleptics, and hearing impairment. The delirium score exhibited an AUC of 0.874 and 0.893 in the training and testing samples, respectively. For a 1-point increase in the score, the odds of delirium increased more than twice in both samples. DISCUSSION: We propose a delirium risk assessing tool that includes variables that can be easily collected at ED admission and that can be calculated rapidly. CONCLUSION: A risk assessment tool could help improving delirium detection in older persons referring to ED.

Absolute quantitative PCR for detection of molecular biomarkers in melanoma patients: a preliminary report.

BACKGROUND: Malignant melanoma is the most malignant tumours of skin and mucous membranes mainly due to its aggressive biological behaviour and tendency to generate early metastases. Unfortunately, the mechanisms underlying the development, progression and the expression of an aggressive melanoma phenotype still remain largely unknown. OBJECTIVES: The purpose of this study was to determine whether a multi-panel of molecular transcripts can be predictive for risk of recurrent disease in malignant melanoma patients. RESULTS: Peripheral blood was collected from 31 malignant melanoma patients in follow-up for melanoma and from 30 healthy volunteers randomly selected. Each specimen was examined by qRT-PCR analysis for the expression of six markers: PAX3d, TYR, MITFm, MCAM, TGFß2 and ABCB5. Malignant melanoma patients expressed an important number of markers, with a median value of four markers. Only PAX3d displayed a trend in terms of differences when the levels of gene expression were made in function of Breslow index. Furthermore, PAX3d showed the best diagnostic capacity among the remaining residual markers or in combination with TGFß2 and MTIF. CONCLUSIONS: We demonstrated the usefulness of multimarker qRT-PCR to detect circulating melanoma cells in blood and to potentially assessing patient disease status or progression, especially when PAX3d was used in combination with MTIFm and TGFß2.

Stroke in paced patients with sick sinus syndrome: relevance of atrial mechanical function, pacing mode and clinical characteristics.

Patients with sick sinus syndrome have a high prevalence of cerebral ischemia and emboli of the viscera and extremities. The present study was designed to establish the prevalence of stroke in patients with sick sinus syndrome, with specific attention to pacing mode, atrial function (evaluated using Doppler echocardiography) and the clinical condition of the patients. The prospective study analyzed 80 consecutive patients with sick sinus syndrome who received either atrial, dual chamber or ventricular pacemakers. Patients underwent a cranial CT scan at the time of enrollment and again at the end of the study 24 months later. End points of the study were cerebral ischemia or emboli of the viscera or extremities. Clinical and echocardiographic features were assessed at the beginning of the study. A multivariate regression analysis was applied to all variables that had at least a marginal univariate predictive value. Cerebral ischemia occurred in 13 patients and emboli of the viscera or extremities were observed in 2 patients. Univariate predictors for embolism consisted of a prior history of cerebrovascular disease (p < 0.001), low atrial ejection force (p < 0.01) and a dilated left atrium with spontaneous echo contrast (p < 0.05). Independent risk factors for stroke included a history of previous cerebral ischemia, age > 65 years, left atrial echo contrast on an echocardiogram and a depressed atrial ejection force. These findings identified patients at high risk for the development of peripheral embolism among the group of patients paced for sick sinus syndrome.

[Stroke in pacemaker users for sinus node disease. Relevance of atrial function and clinical characteristics]. / Lo stroke nei portatori di pacemaker per malattia del nodo del seno. Rilevanza della funzione meccanica atriale e delle caratteristiche cliniche.

Several studies reported that the annual incidence of stroke in patients with sick sinus syndrome ranges from 6 to 10% while the incidence of stroke in patients with atrial fibrillation is about 2-4% and about 0.1% in the normal population. We evaluated the prevalence of cerebral ischemia and peripheral embolism and investigated the predictor factors in a population of 80 patients paced for sick sinus syndrome. The implanted pacemakers were 40 ventricular and 40 physiological stimulation mode was based on the physicians judgement. All patients had cerebral computed tomography scan at the time of implant and after 24 months. Statistical analysis included log-rank test and actuarial curve calculated with Mantel-Haenszel method. At the end of follow-up the end-point occurred in 15 patients: 2 patients had asymptomatic cerebral infarction, 2 had fatal stroke, 2 developed peripheral embolysm, 1 to the lower limb and 1 abdominal; in 4 patients a transient ischemic attack occurred, in 2 a minor stroke and in 3 a non invalidant stroke. No statistically significant difference was found among the subgroups; with different pacing modality. In conclusion, multivariate analysis underlines the role of age > 65 years, history of cerebral ischemia, low atrial ejection force and spontaneous echo contrast in the development of embolic episodes.

[The colorectal restoration. When should it be done?]. / La riconversione colo-rettale. Quando effettuarla?

The authors report a series of 10 reconnections, 4 after Hartmann operations for cancer, 3 after Mikulicz for diverticular disease, 1 after Hartmann for diverticular disease, 2 after Hartmann for traumatic perforation of sigma. Neither surgical complications nor death are reported. To reduce the risk of complication it is necessary to execute colorectal restoration with careful fiming. After the Hartmann operation you must operate in the shortest time. After operations for diverticular disease, you must operate after the lowest period of 6 months.

[Infarction of the sigmoid. Clinical considerations]. / Infarto del sigma. Considerazioni cliniche.

The authors present a case of sigma infarction. They examine the etiopathogenesis, underline the clinical and instrumental signs and discurs the vascular anatomy and diagnostic difficulties. Operation is considered to be necessary to reduce the severe of prognosis.