Perioperative nutritional support or perioperative fasting? A narrative review.

Traditionally, overnight fasting before elective surgery has been Romathe routine in medical practice for risk reduction of pulmonary aspiration of gastric contents. Several original study and international societies recommend a 2h preoperative fast for clear fluids and a 6h fast for solids in most elective patients. We conducted a narrative review of the literature, searching electronic databases (Medline and CINAHL). We used PICO approach. The results of our review suggest that nutrition support in the perioperative period is very important to reduce length of hospital stay and reduced postoperative complication.

Evaluation of a model to improve collection of blood cultures in patients with sepsis in the emergency room.

Sepsis begins outside of the hospital for nearly 80% of patients and the emergency room (ER) represents the first contact with the health care system. This study evaluates a project to improve collection of blood cultures (BCs) in patients with sepsis in the ER consisting of staff education and completion of the appropriate BC pre-analytical phase. A retrospective observational study performed to analyse the data on BC collection in the ER before and after a three-phase project. The first phase (1 January to 30 June 2015) before the intervention consisted of evaluation of data on BCs routinely collected in the ER. The second phase (1 July to 31 December 2015) was the intervention phase in which educational courses on sepsis recognition and on pre-analytical phase procedures (including direct incubation) were provided to ER staff. The third phase (1 January to 30 June 2016; after the intervention) again consisted of evaluation. Before the intervention, out of 24,738 admissions to the ER, 103 patients (0.4%) were identified as septic and had BCs drawn (359 BC bottles); 19 out of 103 patients (18.4%) had positive BCs. After the intervention, out of 24,702 admissions, 313 patients (1.3%) had BCs drawn (1,242 bottles); of these, 96 (30.7%) had positive BCs. Comparing the first and third periods, an increase in the percentage of patients with BCs collected (from 0.4% to 1.3% respectively, p < 0.0001) and an increase in the percentages of patients with true-positive BCs (from 0.08% to 0.39% of all patients evaluated respectively, p < 0.0001) were observed. The isolation of bacteria by BCs increased 3.25-fold after project implementation. These results can be principally ascribed to an improved awareness of sepsis in the staff associated with improved pre-analytical phase procedures in BC collection.

Gokyo Khumbu/Ama Dablam Trek 2012: effects of physical training and high-altitude exposure on oxidative metabolism, muscle composition, and metabolic cost of walking in women.

PURPOSE: We investigated the effects of moderate-intensity training at low and high altitude on VO2 and QaO2 kinetics and on myosin heavy-chain expression (MyHC) in seven women (36.3 yy ± 7.1; 65.8 kg ± 11.7; 165 cm ± 8) who participated in two 12- to 14-day trekking expeditions at low (598 m) and high altitude (4132 m) separated by 4 months of recovery. METHODS: Breath-by-breath VO2 and beat-by-beat QaO2 at the onset of moderate-intensity cycling exercise and energy cost of walking (Cw) were assessed before and after trekking. MyHC expression of vastus lateralis was evaluated before and after low-altitude and after high-altitude trekking; muscle fiber high-resolution respirography was performed at the beginning of the study and after high-altitude trekking. RESULTS: Mean response time of VO2 kinetics was faster (P = 0.002 and P = 0.001) and oxygen deficit was smaller (P = 0.001 and P = 0.0004) after low- and high-altitude trekking, whereas ˙ QaO2 kinetics and Cw did not change. Percentages of slow and fast isoforms of MyHC and mitochondrial mass were not affected by low- and high-altitude training. After training altitude, muscle fiber ADP-stimulated mitochondrial respiration was decreased as compared with the control condition (P = 0.016), whereas leak respiration was increased (P = 0.031), leading to a significant increase in the respiratory control ratio (P = 0.016). CONCLUSIONS: Although training did not significantly modify muscle phenotype, it induced beneficial adaptations of the oxygen transport-utilization systems witnessed by faster VO2 kinetics at exercise onset.

Toscana virus meningitis case in Switzerland: an example of the ezVIR bioinformatics pipeline utility for the identification of emerging viruses.

Toscana virus (TOSV) represents a frequent cause of viral meningitis in the Mediterranean Basin that remains neglected in neighbouring countries. We report a documented TOSV meningitis case in a traveller returning from Tuscany to Switzerland. While routine serological and PCR assays could not discriminate between TOSV and Sandfly fever Naples virus infection, a high-throughput sequencing performed directly on the cerebrospinal fluid specimen and analysed with the ezVIR pipeline provided an unequivocal viral diagnostic. TOSV could be unequivocally considered as the aetiological agent, proving the potential of ezVIR to improve standard diagnostics in cases of infection with uncommon or emerging viruses.

Effect of baclofen on oesophageal motility and transient lower oesophageal sphincter relaxations in GORD patients: a 48-h manometric study.

Little is known about prolonged effect of baclofen on oesophageal and lower oesophageal sphincter (LOS) motility. We aimed at investigating the oesophageal motility in gastro-oesophageal reflux disease (GORD) patients 24 h before and after the administration of multiple doses of baclofen. Twenty-one GORD patients underwent a 48-h manometry recording the swallows, the oesophageal and the LOS motility. During the second 24-h period, patients received baclofen 10 mg or placebo four times per day in a double-blind randomized fashion. Baclofen increased the LOS basal tone in comparison with baseline (P = 0.02), with a concomitant reduction in the number of transient LOS relaxations (TLOSRs) (P = 0.01). Moreover, baclofen induced a decrease of the swallows (P = 0.02) and of primary oesophageal body waves (P = 0.04) with no changes in the amplitude. Multiple doses of baclofen determine a reduction in the number of TLOSRs and an increase in the LOS tone throughout the 24 h. The concomitant decreased number of swallows and of primary peristalsis could depend on the well-known lower amount of reflux episodes induced by the drug. The potential therapeutic effect of baclofen could be expressed not only postprandially, but also in the fasting state when reflux episodes are present as well.

Ethical questions in the treatment of subjects with dementia. Part I. Respecting autonomy: awareness, competence and behavioural disorders.

The document deals with some ethical issues raised by the treatment of demented people. In particular the conceptual and empirical aspects of the assessment of awareness and competence of these patients are analysed, as well as the dilemmas related to the treatment of behavioral disorders.

Dual task effects of walking when talking in Alzheimer's disease.

Previous studies with Alzheimer Disease (AD) patients have suggested that speed and accuracy in walking can be dramatically affected by a simultaneous secondary cognitive task, such as holding a conversation. Two experiments examined the impact on AD patients and age matched elderly controls of cognitive demands while walking. In Experiment 1 walking for AD patients was more affected than it was for the normal elderly by a concurrent cognitive demand. Experiment 2 demonstrated that both groups were equally impaired under dual task conditions when the demands of the cognitive tasks were adjusted for individual levels of ability. We conclude that walking may draw on general executive resources, that walking relies more heavily on these executive resources in the elderly, and on a damaged executive system for AD patients.

Dietary pattern and usual nutrient intakes of Peruvian women during pregnancy.

OBJECTIVE: To describe dietary intakes and nutrient adequacy during pregnancy in a sample of Peruvian women. DESIGN: Descriptive, observational prospective study, nested within a double-masked, controlled, zinc-supplementation trial during pregnancy. SETTING: Hospital Materno-Infantil 'Cesar Lopez Silva', in Villa El Salvador, an impoverished shantytown in Lima, Peru. SUBJECTS: A subsample of women enrolled in the larger trial. These women all had low-risk singleton pregnancies and were receiving prenatal care at the study hospital. A total of 168 24-h dietary recalls were collected at 10-24 weeks gestation and 120 recalls were collected at 28-30 weeks gestation. RESULTS: Median intakes of protein, riboflavin, niacin, vitamin C and phosphorus met the current US RDA for pregnancy, whereas intakes of thiamin, folate, vitamin A, calcium, iron and zinc were well below the recommendations at both time periods. Dietary intake of energy (mostly from carbohydrates) showed a significant increase from 10-24 to 28-30 weeks gestation, as did intakes of folate and vitamin A. The nutrients with the highest estimated prevalences of inadequacy at both points in pregnancy were iron (93%), zinc (88-80%), folate (87-74%) and calcium (86-82%). CONCLUSION: Usual dietary intakes were found to be relatively adequate in terms of their energy and protein contents. However, high prevalences of inadequate intakes were estimated, particularly for iron, zinc and calcium.

How many camels are there in Italy? Cognitive estimates standardised on the Italian population.

OBJECTIVE: We provided the standardisation of a new Cognitive Estimation Task (CET). PARTICIPANTS: the test was administered to 175 healthy subjects. RESULTS: performance on the Cognitive Estimation Task (CET) is associated with gender (where women show poorer performance than men) and education (where more highly educated individuals show better performance compared to individuals with lower levels of education). However,CET performance is not associated with age. DISCUSSION: the lack of age effects on the CET may be explained by the task dependence on "crystallised intelligence", which is less affected by healthy adult ageing than "fluid intelligence".

General Knowledge of the World: a standardised assessment.

An entirely verbal enquiry of "General Knowledge of the World" made up by 168 questions exploring 14 domains of knowledge (12 questions each) has been standardised on 175 (97 women and 78 men) healthy Italian subjects with at least 8 years of formal education. Norms for each set of questions are provided. An unexpected finding is that age did not play an influential role on performance, whereas education did: the higher it was, the better the score. Women proved to fare significantly worse than men. A feasibility check on 30 Alzheimer patients with very mild overall cognitive impairment showed that the general knowledge enquiry was relatively easy to administer. The discrimination power between normal controls and Alzheimer patients for each subtest has been calculated.

Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries.

INTRODUCTION: Recent estimates suggest that malnutrition (measured as poor anthropometric status) is associated with about 50% of all deaths among children. Although the association between malnutrition and all-cause mortality is well documented, the malnutrition-related risk of death associated with specific diseases is less well described. We reviewed published literature to examine the evidence for a relation between malnutrition and child mortality from diarrhoea, acute respiratory illness, malaria and measles, conditions that account for over 50% of deaths in children worldwide. METHODS: MEDLINE was searched for suitable review articles and original reports of community-based and hospital-based studies. Findings from cohort studies and case-control studies were reviewed and summarized. RESULTS: The strongest and most consistent relation between malnutrition and an increased risk of death was observed for diarrhoea and acute respiratory infection. The evidence, although limited, also suggests a potentially increased risk for death from malaria. A less consistent association was observed between nutritional status and death from measles. Although some hospital-based studies and case-control studies reported an increased risk of mortality from measles, few community-based studies reported any association. DISCUSSION: The risk of malnutrition-related mortality seems to vary for different diseases. These findings have important implications for the evaluation of nutritional intervention programmes and child survival programmes being implemented in settings with different disease profiles.

Hepatitis C virus infection and alanine transaminase levels in the general population: a survey in a southern Italian town.

BACKGROUND/AIM: The aim of the study was to estimate the prevalence, risk factors and genotype distribution of hepatitis C virus (HCV) in the general population older than 5 years of age in a southern Italian town. The positive predictive value of alanine transaminase (ALT) screening in identifying HCV positive subjects was also assessed. METHODS: Cluster random sampling from the census of the general population was used. ELISA and RIBA tests assessed the presence of anti-HCV; nested reverse transcription polymerase chain reaction (RT-PCR) was used to identify HCV-RNA; genotyping was performed by INNO-LIPA III. The association linking anti-HCV seropositivity with potential risk factors was assessed by multiple logistic regression analysis. RESULTS: Among the 488 subjects enrolled, 79 (16.2%) were anti-HCV positive. The prevalence increased from 1.2% in subjects 6-29 years of age to 42.1% in those > or = 60 years. Forty percent of these positive subjects also had abnormal ALT level and 54.4% were HCV RNA positive by PCR. The positive predictive value of the ALT test in identifying anti-HCV positive subjects was 65%; however, it was 46.7% in subjects younger than 60 years of age and 90.5% in those 60 or older. Genotype 1b was detected in 74% of subjects, type 2c in 23.3%, and type 1a in 2.3%. The only two variables significantly associated with HCV seropositivity in multivariate analysis were age older than 45 years (O.R. 8.5; CI 95%=3.0-24.1) and past use of glass syringes (O.R. 3.4; CI 95%=1.5-7.6). CONCLUSIONS: These findings confirm that HCV infection is endemic in southern Italy, particularly among the elderly. Percutaneous exposure, such as injections with nondisposable, multiple-use, glass syringes used in the past for medical purposes may have played a major role in the spread of HCV infection. ALT screening is not useful in detecting HCV positive subjects in the general population, particularly among subjects who could benefit from antiviral therapy.

Temporal constraints on the McGurk effect.

Three experiments are reported on the influence of different timing relations on the McGurk effect. In the first experiment, it is shown that strict temporal synchrony between auditory and visual speech stimuli is not required for the McGurk effect. Subjects were strongly influenced by the visual stimuli when the auditory stimuli lagged the visual stimuli by as much as 180 msec. In addition, a stronger McGurk effect was found when the visual and auditory vowels matched. In the second experiment, we paired auditory and visual speech stimuli produced under different speaking conditions (fast, normal, clear). The results showed that the manipulations in both the visual and auditory speaking conditions independently influenced perception. In addition, there was a small but reliable tendency for the better matched stimuli to elicit more McGurk responses than unmatched conditions. In the third experiment, we combined auditory and visual stimuli produced under different speaking conditions (fast, clear) and delayed the acoustics with respect to the visual stimuli. The subjects showed the same pattern of results as in the second experiment. Finally, the delay did not cause different patterns of results for the different audiovisual speaking style combinations. The results suggest that perceivers may be sensitive to the concordance of the time-varying aspects of speech but they do not require temporal coincidence of that information.

Learning from experience. A mental health response to the northeaster of 1992.

The lessons learned from one tragedy can be used to ease the trauma of another. VNA Home Care drew upon its experience with a 1990 fire to help the victims of the 1992 northeaster cope with their losses and fear.

MMPI correlates of Exner's Egocentricity Index in an adolescent psychiatric population.

This research examined the relationship between Exner's Egocentricity Index (EI) and Minnesota Multiphasic Personality Inventory (MMPI) Scales 2, 4, and 9 in an adolescent psychiatric population. Subjects with a low EI had significantly higher MMPI Depression (D) scale elevations compared to those with a high EI. Furthermore, of the adolescents who had Scale 2 scores in the clinical range, 68% also had an EI in the bottom half of the distribution. There was no relationship between the EI and MMPI scales 4 and 9. These findings are discussed in light of the generally poor correlations between MMPI and Rorschach variables.