How to reduce erroneous Emergency Department admissions for the frail elderly

Background. Readmission after a first hospitalization is a common occurrence. It may be due to incomplete treatment, poor care for underlying problems or reflect bad coordination with health services at the time of discharge. The aim of this study was to identify the factors and classify the pathologies that expose elderly patients to erroneous access to the Emergency/Urgency Department (EUD).Study design. Retrospective observational study.Materials and methods. From January 2016 to December 2019 we studied patients who had at least one readmission to the EUD in the six months following discharge. All EUD accesses of the same patient that occurred for the problem treated during the previous hospitalization were identified. Data was provided by the University Hospital of Siena. Patients were stratified by age, gender, and municipality of residence. We used an ICD-9-CM coding system to describe health problems. Statistical analysis was carried out with Stata software.Results. We studied 1,230 patients (46.6% females) the mean age was 78.2 +/- 14.3. Most of them, 721 (58.6%) were >= 80 years old, 334 (27.1%) were 65-79, 138 (11.2%) were 41-64, and only 37 (3.0%) were <= 40. Patients who lived in Municipality of Siena had a lower probability to return than to those living in other municipalities (OR 0.76; 95%CI: 0.62-0.93; p<0,05). The main causes of readmission for >= 65 years old were "symptoms, signs and ill-defined conditions" (18.3%), "respiratory diseases" (15.0%), "injury and poisoning" (14.1%), "cardiovascular diseases" (11.8%), "classification of factors influencing health status and contact with health services" (9.8%), "genitourinary diseases" (6.6%) and "digestive diseases (5.7%).Conclusions. We observed that patients residing a greater distance from the hospital facilitates the risk of readmission. The factors that were exposed could be used to identify frequent users and initiate measures to reduce their access

New understandings of the genetic basis of isolated idiopathic central hypogonadism

Idiopathic hypogonadotropic hypogonadism is a rare disease that is characterized by delayed/absent puberty and/or infertility due to an insufficient stimulation of an otherwise normal pituitary-gonadal axis by gonadotrophin-releasing hormone (GnRH) action. Because reduced or normal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) levels may be observed in the affected patients, the term idiopathic central hypogonadism (ICH) appears to be more appropriate. This disease should be distinguished from central hypogonadism that is combined with other pituitary deficiencies. Isolated ICH has a complex pathogenesis and is fivefold more prevalent in males. ICH frequently appears in a sporadic form, but several familial cases have also been reported. This finding, in conjunction with the description of numerous pathogenetic gene variants and the generation of several knockout models, supports the existence of a strong genetic component. ICH may be associated with several morphogenetic abnormalities, which include osmic defects that, with ICH, constitute the cardinal manifestations of Kallmann syndrome (KS). KS accounts for approximately 40% of the total ICH cases and has been generally considered to be a distinct subgroup. However, the description of several pedigrees, which include relatives who are affected either with isolated osmic defects, KS, or normo-osmic ICH (nICH), justifies the emerging idea that ICH is a complex genetic disease that is characterized by variable expressivity and penetrance. In this context, either multiple gene variants or environmental factors and epigenetic modifications may contribute to the variable disease manifestations. We review the genetic mechanisms that are presently known to be involved in ICH pathogenesis and provide a clinical overview of the 227 cases that have been collected by the collaborating centres of the Italian ICH Network

The outcome of post-surgical hip prosthesis rehabilitation: results from a monocentric cohort study

Background: With the increase in life expectancy, more patients are undergoing total hip arthroplasty, primarily due to the rising incidence of osteoarthritis. The outcomes of rehabilitation following these surgical interventions are influenced by various factors. This study aims to explore the impact of age, gender, and body mass index (BMI) on pain and functional and rehabilitative outcomes after surgical hip prosthesis rehabilitation. Methods: We enrolled all patients admitted to a private clinic from January 2021 to December 2023 for rehabilitation after unilateral hip arthroplasty. For each patient, we collected data of Barthel Index, Tinetti Scale, Numeric Rating Scale (NRS), and range of motion (ROM) at the beginning and end of the hospitalization. We assessed whether the evaluated outcomes differed based on gender, age, and BMI using the Mann-Whitney and Kruskal-Wallis tests. Results: A total of 2.167 patients were studied (56% female and 36.5% over 75 years old). Male patients, adults (18-64 years), and those with a BMI < 30 showed higher values of Barthel Index, Tinetti Scale, and ROM at both admission and discharge (p < 0.05), along with significantly lower NRS scores. Each subgroup based on age, gender, and BMI showed an improvement in NRS (difference between admission and discharge) of at least 40%, it was about 50% for men and adults. The improvement in ROM (difference between admission and discharge) was more than 10% in both active and passive flexion, around 20% for passive abduction, and 50% for active abduction, with no significant differences based on age, gender, or BMI. Conclusions: Despite the absence of specific contraindications for arthroplasty procedures, a high BMI, age over 75 years, and female gender are associated with slightly worse functional and rehabilitation outcomes compared to other patients undergoing the same procedures. A preoperative screening for the evaluation of osteopenia, osteoporosis, and BMI could be a valuable tool for studying and improving outcomes in these patients

Is raw better? A multiple DNA barcoding approach (full and mini) based on mitochondrial and nuclear markers reveals low rates of misdescription in sushi products sold on the Italian market

New dietary habits have favored an ever growing popularity of Eastern country cooking style and in particular of sushi. Even though the Reg. (EU) 1379/2013 does not apply to restaurants and caterers, the Reg. (EU) 1169/2011 establishes that all the information they provided to the final consumer have to meet the transparency requirements as regards the description of the ingredients used for the preparation of food. The present study aimed at performing a molecular based survey to identify the seafood species used in the sushi preparations at the retail level. A total of 185 samples were collected from sushi venues and supermarkets and DNA barcoding, followed by a pairwise divergence and Neighbor Joining clustering analysis, was applied in order to verify the information declared at purchase. Rather than to a proper training of Food Business Operators working at the catering level, the low mislabeling rate found in this study (3.4%) could be ascribed to the standardization of the products sold in ethnic restaurants. In fact, the common practice of proposing standardized menus always relying on the same species of fish could limit the risk of mislabeling occurrence

New understandings of the genetic basis of isolated idiopathic central hypogonadism

Idiopathic hypogonadotropic hypogonadism is a rare disease that is characterized by delayed/absent puberty and/or infertility due to an insufficient stimulation of an otherwise normal pituitary-gonadal axis by gonadotrophin-releasing hormone (GnRH) action. Because reduced or normal luteinizing hormone (LH)/follicle-stimulating hormone (FSH) levels may be observed in the affected patients, the term idiopathic central hypogonadism (ICH) appears to be more appropriate. This disease should be distinguished from central hypogonadism that is combined with other pituitary deficiencies. Isolated ICH has a complex pathogenesis and is fivefold more prevalent in males. ICH frequently appears in a sporadic form, but several familial cases have also been reported. This finding, in conjunction with the description of numerous pathogenetic gene variants and the generation of several knockout models, supports the existence of a strong genetic component. ICH may be associated with several morphogenetic abnormalities, which include osmic defects that, with ICH, constitute the cardinal manifestations of Kallmann syndrome (KS). KS accounts for approximately 40% of the total ICH cases and has been generally considered to be a distinct subgroup. However, the description of several pedigrees, which include relatives who are affected either with isolated osmic defects, KS, or normo-osmic ICH (nICH), justifies the emerging idea that ICH is a complex genetic disease that is characterized by variable expressivity and penetrance. In this context, either multiple gene variants or environmental factors and epigenetic modifications may contribute to the variable disease manifestations. We review the genetic mechanisms that are presently known to be involved in ICH pathogenesis and provide a clinical overview of the 227 cases that have been collected by the collaborating centres of the Italian ICH Network