Tailored treatment of intestinal angiodysplasia in elderly

Background: Angiodysplasia of the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and severe anemia in elderly. Different treatments exist for this kind of pathology. Methods: The aim of this work was to study 40 patients treated for intestinal angiodysplasia with two different kind of endoscopic treatments: argon plasma coagulation (APC) and bipolar electrocoagulation (BEC). Results: Age of patients was similar in both groups (76,2 ± 10.8 years vs 74,8 ± 8,7 years, P = 0,005). Angiodysplasia treated were located in small bowel, right colon, left colon, transverse colon and cecum. We analysed number of treatment, recurrence, hospital discharge, needs of blood transfusions before and after endoscopic treatment. Number of treatment was the same in both groups (1,2 ± 0,2 vs 1,1 ± 0,1, P < 0,001). We had more recurrence in patients treated with BEC (4/20 vs 2/20, P < 0,001). Hospital discharge was comparable in both groups (5,3 ± 3,1 days vs 5,4 ± 2,8 years, P < 0.001) Conclusions: Treatment of angiodysplasia in elderly is not easy. Different kinds of treatment could be adopted. APC and BEC are both safe and effective. The choice of a treatment should consider several factors: age, comorbidity, source of bleeding. In conclusion we think that treatment of bleeding for angiodysplasia in elder population should be a tailored treatment. © 2015 Rita Compagna et al., published by De Gruyter Open

Micro-electro discharge machining drilling of stainless steel with copper electrode: The influence of process parameters and electrode size

This article is about the implementation of an acquisition system for the measurement of micro-electro discharge machining process parameters and the statistical analysis of their influence on the process performance. The micro-electro discharge machining drilling of 316L stainless steel with copper tubular electrodes was studied and the exchanged power was taken into account as a comprehensive variable able to represent the effect of the peak current and voltage on the final result. The direct proportionality between the exchanged power and the nominal process parameters was verified. A linear and non-linear regression approach was used in order to obtain predictive equations for the most important aspects of micro-electro discharge machining process, such as the machining time and the electrode wear

Risk factors for HBV/HIV/HCV in drug addicts: a survey of attendees of a Department of Pathological Dependence

Introduction. This study aims to determine risk factors for the acquisition of HIV, HBV and HCV infections among Injection Drug Users (IDUs) who attended the out-patient clinic of the Department of Pathological Dependence at Bari Hospital in Bari Province (Italy). Methods. The study was conducted in the year 2008 using the information available in the out-patient files of 291 drug addicts who were undergoing treatment. Results. Their average age was 29.3 and 133 (45.7%) of them were affected by HIV/ HBV/ HCV. The use of injected heroin, being separated or divorced, and having committed a crime were found to be risk factors for infection by HIV/ HBV/ HCV, while having a school diploma or a university degree and the use of cannabinoids were negatively associated with the infective diseases. Discussion and conclusions. While the data from the Italian Departments of Pathological Dependence concerning HIV diffusion in treated patients have been showing a reduction in the number of cases of seropositivity, drug addiction in industrialized countries is still the second most important risk factor, after promiscuous sexual behaviour, for infection by parenteral transmission. Correct risk assessment is essential for the planning of effective strategies for primary and secondary prevention

Risk factors for HBV/HIV/HCV in drug addicts: a survey of attendees of a Department of Pathological Dependence

Introduction. This study aims to determine risk factors for the acquisition of HIV, HBV and HCV infections among Injection Drug Users (IDUs) who attended the out-patient clinic of the Department of Pathological Dependence at Bari Hospital in Bari Province (Italy). Methods. The study was conducted in the year 2008 using the information available in the out-patient files of 291 drug addicts who were undergoing treatment. Results. Their average age was 29.3 and 133 (45.7%) of them were affected by HIV/ HBV/ HCV. The use of injected heroin, being separated or divorced, and having committed a crime were found to be risk factors for infection by HIV/ HBV/ HCV, while having a school diploma or a university degree and the use of cannabinoids were negatively associated with the infective diseases. Discussion and conclusions. While the data from the Italian Departments of Pathological Dependence concerning HIV diffusion in treated patients have been showing a reduction in the number of cases of seropositivity, drug addiction in industrialized countries is still the second most important risk factor, after promiscuous sexual behaviour, for infection by parenteral transmission. Correct risk assessment is essential for the planning of effective strategies for primary and secondary prevention

Immunization coverage among splenectomized patients: Results of an ad hoc survey in Puglia Region (South of Italy)

Patients with anatomic or functional asplenia have a 10-50&nbsp;times higher risk than general population to develop Overwhelming Post-Splenectomy Infection. Evidences are unanimous in recommending splenectomised patients to receive meningococcal, antipneumococcal and Haemophilus influenzae type B vaccinations according to a specific timing. In Italy there are no current data on the immunisation coverage in these patients. This study aims to investigate immunisation coverage in patients undergoing elective or urgent splenectomy for 2012-2013 in the 3 Apulian hospitals. The patients discharged with the code ICD-9-CM 41.5 - "Total splenectomy" were enrolled. The administration of vaccines was verified through consultation of medical records, archives of general practitioners and vaccination offices. In the study period, 166 subjects underwent splenectomy and none of them received vaccinations during hospitalization. 25 splenectomised patients (15.1%) received at least one of the recommended vaccinations. 21 patients (12.6%) received vaccine against Streptococcus pneumonia, 13 (7.8%) meningococcal vaccine, 10 patients (6%) Haemophilus influenzae type B vaccine. The low vaccination coverage could be due both to poor perception of the risk of infection and to a lack of knowledge on vaccinations by surgeons. For this reason it is necessary to draw up and share operational protocols that establish the administration of vaccines

Educational level, marital status and sex as social gender discharge determinants in chronic obstructive pulmonary disease exacerbations: a time-to-event analysis

The aim of this study is to evaluate, in patients hospitalized for COPD exacerbation, how educational level, marital status and sex (social gender indicators) affect the home discharge probability (main effects) and how interact with each other in affecting this probability (effect modification). Data for all patients discharged with a principal diagnosis of COPD with exacerbation (ICD-9 491.21) by Apulian hospitals between 2013 and 2017 were retrieved from the National Hospital Discharge Register Database. A multivariable multi-stratified frailty cox proportional-hazard regression with interaction terms was fitted in order to assess the effect of sex, educational level and marital status on the time-to-event for home discharge through the estimation of hazard ratios. Adjusting for several patient and hospitalization characteristics and for healthcare facilities, low educational level (<8 years of schooling) is associated with a lower probability of being discharged to home in both sexes and in all marital status categories (HR 0.92, 95%CI 0.87-0.97, p=0.0020). Female sex is associated with a lower probability of being discharged to home only in married patients (HR 0.83, 95%CI 0.78-0.88, p<0.0001). Marital status different from married is associated with a lower probability of being discharged to home only in male patients, in particular single patients (HR 0.82, 95%CI 0.74-0.92, p=0.0009), separated or divorced patients (HR 0.71, 95%CI 0.58-0.86, p=0.0005) and widowed patients (HR 0.87, 95%CI 0.80-0.95, p=0.0018). Differently from findings about protective effect of education, the evidence of different effects of sex on home discharge probability among civil statuses and of different effect of civil status among sexes is supposed to be a proxy for social gender health and healthcare inequalities

Genetic characterization of measles virus strains isolated during an epidemic cluster in Puglia, Italy 2006–2007

The genetic characterization of wild-type measles strains isolated during an epidemic cluster of measles occurred in Puglia (South Italy), between November 2006 and January 2007, was performed. Measles virus (MV) detection was carried out by a nested RT-PCR on 8 of 18 total cases. The viruses were analyzed using the standard genotyping protocols. The N gene sequences of the strains from outbreak were identical to each other, and sequence analysis revealed that the viruses belonged to genotype B3, subgroup B3.1, never identified before in Italy. An importation of measles B3.1 strains from Africa was hypothesized. Molecular surveillance will help to monitor the progress in measles elimination

Influenza vaccination coverage among medical residents: An Italian multicenter survey

Although influenza vaccination is recognized to be safe and effective, recent studies have confirmed that immunization coverage among health care workers remain generally low, especially among medical residents (MRs). Aim of the present multicenter study was to investigate attitudes and determinants associated with acceptance of influenza vaccination among Italian MRs. A survey was performed in 2012 on MRs attending post-graduate schools of 18 Italian Universities. Each participant was interviewed via an anonymous, self-administered, web-based questionnaire including questions on attitudes regarding influenza vaccination. A total of 2506 MRs were recruited in the survey and 299 (11.9%) of these stated they had accepted influenza vaccination in 2011-2012 season. Vaccinated MRs were older (P = 0.006), working in clinical settings (P = 0.048), and vaccinated in the 2 previous seasons (P < 0.001 in both seasons). Moreover, MRs who had recommended influenza vaccination to their patients were significantly more compliant with influenza vaccination uptake in 2011-2012 season (P < 0.001). "To avoid spreading influenza among patients" was recognized as the main reason for accepting vaccination by less than 15% of vaccinated MRs. Italian MRs seem to have a very low compliance with influenza vaccination and they seem to accept influenza vaccination as a habit that is unrelated to professional and ethical responsibility. Otherwise, residents who refuse vaccination in the previous seasons usually maintain their behaviors. Promoting correct attitudes and good practice in order to improve the influenza immunization rates of MRs could represent a decisive goal for increasing immunization coverage among health care workers of the future. © 2014 Landes Bioscience