Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and...Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.展开更多
Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are ...Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are recognised. Although most of the described genetic alterations have been observed in both types, different genetic pathways have been hypothesized. Genetic and epigenetic events, including 1q loss of heterozygosity (LOH), microsatellite instability and hypermethylation, have mostly been reported in intestinal-type gastric carcinoma and its precursor lesions, whereas 17p LOH, mutation or loss of E-cadherin are more often implicated in the development of diffuse-type gastric cancer.In this review, we summarize the sometimes contradictory findings regarding those markers which influence the progression of gastric adenocarcinoma.展开更多
Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult...Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures;heart rate (HR);stroke volume (SV);systemic vascular resistance (SVR);dP/dtmax;cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dtmax decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002;1738 ± 241 to 1450 ± 253, p = 0.022;1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (?0.25 ± 0.23 to ?0.01 ± 0.12,展开更多
Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic dis...Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and fromother cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.展开更多
The risk of nosocomial infection due to Staphylococcus aureus in full term newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection contro ltechniques. We report on a...The risk of nosocomial infection due to Staphylococcus aureus in full term newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection contro ltechniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21,2000) and the measures undertaken to bring the epidemic under control. These measures included:separating neonates already present in the nursery on August 23,2000 from ones newly arriving by creating two different cohorts,one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus-infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns,gloves,and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions,microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can,in retrospect,be assessed to have been very effective.展开更多
文摘Intensive care in Africa is available only in teaching or referral hospitals. Here we report the experience of a multidisciplinary collaboration between physicians and nurses of the Emergency Department (First Aid and Intensive Care Unit) of a tertiary referral hospital (Careggi Teaching Hospital, Florence, IT) and physicians and nurses of Orotta National referral Hospital in Asmara, Eritrea. The project was aimed at performing clinical assistance and training on the job to the local staff to improve the standard of care in the local Emergency Department. The duration of the project was initially planned to be 30 months, but unfortunately it was interrupted after 18 months because of lack of funds. The Italian staff was composed of two physicians and two nurses per period. To monitor local ICU activity, a retrospective survey of 36 months was performed. During the 36 months of data collection, 1169 patients were admitted to the ICU. Intra-ICU mortality rate resulted comparable before, during, and after Italian presence. On the contrary, the 28-day mortality resulted significantly lower bo th during and after the Italian stay. After project interruption, the Italian staff maintained contact with the Eritrean ICU personnel, who were invited to attend the Italian ICU for one month per year, and collected information about Orotta ICU activities.
文摘Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are recognised. Although most of the described genetic alterations have been observed in both types, different genetic pathways have been hypothesized. Genetic and epigenetic events, including 1q loss of heterozygosity (LOH), microsatellite instability and hypermethylation, have mostly been reported in intestinal-type gastric carcinoma and its precursor lesions, whereas 17p LOH, mutation or loss of E-cadherin are more often implicated in the development of diffuse-type gastric cancer.In this review, we summarize the sometimes contradictory findings regarding those markers which influence the progression of gastric adenocarcinoma.
文摘Objective: Few studies are available on the hemodynamic changes acutely determined by Primary Percutaneous Coronary Intervention (PCI) in ST-Elevation Myocardial Infarction (STEMI) patients, probably for the difficult evaluation of hemodynamic variables in this acute setting. Therefore, the paper is to evaluate the variations of several hemodynamic parameters determined by PCI using PRAM (Pressure Recording Analytical Method), minimally invasive hemodynamic monitoring. Methods: We analyzed in 20 STEMI patients submitted to PCI several hemodynamic variables, assessed with PRAM from radial/ femoral artery, 3-minute before PCI and at endprocedure. Variables measures were: systolic, diastolic, dicrotic and mean arterial pressures;heart rate (HR);stroke volume (SV);systemic vascular resistance (SVR);dP/dtmax;cardiac cycle efficiency (CCE). Results: In our patients HR, SVR and dP/dtmax decreased significantly (85 ± 6.3 to 77 ± 4.5, p = 0.002;1738 ± 241 to 1450 ± 253, p = 0.022;1.22 ± 0.11 to 1.11 ± 0.12, p = 0.007, respectively) while CCE and SV increased significantly (?0.25 ± 0.23 to ?0.01 ± 0.12,
文摘Aim: The problem of kernicterus in infants with bronze baby syndrome (BBS) has been reviewed on the basis of cases reported in the literature. In addition, a new case concerning an infant with severe Rh haemolytic disease, who presented with BBS and who has developed neurological manifestations of kernicterus with magnetic resonance images showing basal ganglia abnormalities, is presented. In this patient, the total serum bilirubin (TSB) concentration ranged from 18.0 to 22.8 mg/dl (306 to 388 μmol/l) and the bilirubin/albumin (B/A) ratio was 6.0 (mg/g) (6.8 is the value at which an exchange transfusion should be considered). The case presented is important due to the fact that kernicterus appeared after an exchange transfusion was performed when the TSB level reached 22.8mg/dl (388 μmol/l) on 6th day of life while the haematocrit was 30%. From this case and fromother cases reported in the literature, we must stress that, even if the level at which hyperbilirubinemia poses a threat remains undefined, BBS may constitute an additional risk of developing kernicterus. Conclusion: The possible strategies for implementing an approach to the management of hyperbilirubinemia (especially the haemolytic kind) in the presence of BBS may include an exchange transfusion carried out at lower TSB concentration than previously recommended or an early administration of Sn-mesoporphyrin.
文摘The risk of nosocomial infection due to Staphylococcus aureus in full term newborns is higher under hospital conditions where there are overcrowded nurseries and inadequate infection contro ltechniques. We report on an outbreak of skin infection in a Maternity Nursery (May 21,2000) and the measures undertaken to bring the epidemic under control. These measures included:separating neonates already present in the nursery on August 23,2000 from ones newly arriving by creating two different cohorts,one of neonates born before this date and one of neonates born later; restricting healthcare workers caring for S. aureus-infected infants from working with non-infected infants; disallowing carrier healthcare workers from caring for patients; introducing contact and droplet precautions (including the routine use of gowns,gloves,and mask); ensuring appropriate disinfection of potential sources of contamination. A representative number of isolates were typed by genomic DNA restriction length polymorphism analysis by means of pulsed-field gel electrophoresis (PFGE). Among the 227 cases of skin lesions,microbiological laboratory analyses confirmed that 175 were staphylococcal infections. The outbreak showed a gradual reduction in magnitude when the overcrowding of the Nursery was reduced by separating the newborns into the two different Nurseries (two cohorts). The genotyping of the strains by PFGE confirmed the nurse-to-newborn transmission of S. aureus. The measures adopted for controlling the S. aureus outbreak can,in retrospect,be assessed to have been very effective.
