Aspetti positivi e limiti della telemedicina: esperienze di lavoro in Neuropsichiatria infantile in tempo di Covid-19

2021 ◽  
Vol 40 (9) ◽  
pp. 583-586
Author(s):  
Alessandro Albizzati ◽  
Cristina Riva Crugnola ◽  
Margherita Moioli ◽  
Elena Ierardi
Keyword(s):  
Airway Management ◽  
General Anaesthesia ◽  
Case Series ◽  
Patient Characteristics ◽  
Pulmonary Aspiration ◽  
Procedural Sedation ◽  
Main Concern ◽  
Large Case Series ◽  
Fasting Duration ◽  
Large Case

Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.

Il digiuno del bambino prima di una sedazione procedurale

2021 ◽  
Vol 40 (9) ◽  
pp. 576-582
Author(s):  
Arturo Penco ◽  
Francesca Peri ◽  
Federico Poropat ◽  
Ester Conversano ◽  
Egidio Barbi ◽  
...  
Keyword(s):  
Airway Management ◽  
General Anaesthesia ◽  
Case Series ◽  
Patient Characteristics ◽  
Pulmonary Aspiration ◽  
Procedural Sedation ◽  
Main Concern ◽  
Large Case Series ◽  
Fasting Duration ◽  
Large Case

Fasting before procedural sedation is a hot topic in everyday medical life with the main concern regarding pulmonary aspiration. Fasting guidelines before procedural sedation have always been the same as those used for general anaesthesia. However, procedural sedation and general anaesthesia differ in terms of invasiveness, drugs, duration and patient characteristics. This results in lower risk of pulmonary aspiration during procedural sedation, when compared to general anaesthesia. Moreover, a large case series of sedations performed in the emergency department with no respect for the proper fasting times showed no association between fasting duration and any type of adverse event with the latter occurring also in patients that properly fasted. The type of procedure (with the need of airway management) and characteristics of the patient seem to matter more. Furthermore, prolonged fasting is uncomfortable and has been associated with hypoglycaemia and dehydration. For this reason, fasting guidelines before procedural sedation should be adapted on the presence of risk factors, such as ASA score, need for airway management, comorbidities, type of procedure and drug used.

scholarly journals Repository corticotropin injection in patients with advanced symptomatic sarcoidosis: retrospective analysis of medical records

2019 ◽  
Vol 13 ◽  
pp. 175346661988812 ◽  
Author(s):  
Ishveen Chopra ◽  
Yimin Qin ◽  
John Kranyak ◽  
Jack R. Gallagher ◽  
Kylee Heap ◽  
...  
Keyword(s):  
Case Series ◽  
Patient Characteristics ◽  
Starting Dose ◽  
Daily Dose ◽  
Individualized Approach ◽  
Utilization Patterns ◽  
Large Case Series ◽  
The Mean ◽  
Large Case ◽  
Viable Treatment

Background: Repository corticotropin injection (RCI) has regulatory approval for many indications, including symptomatic sarcoidosis. This large case series of patients with advanced symptomatic sarcoidosis treated with RCI describes patient characteristics, RCI utilization patterns, concomitant therapies, and physicians’ assessments of treatment response. Methods: Patients ⩾18 years with symptomatic sarcoidosis, treated with RCI in the previous 36 months, who had completed a course of RCI or received RCI for ⩾6 months at the time of data collection were included. Results: The study included 302 patients (mean age, 51 years; 52%, women) with a mean 4.8 years since initial diagnosis of sarcoidosis. Most patients (76%) had extrapulmonary involvement, primarily in the skin (28%), joints (25%), heart (22%), and eyes (22%); 34% had multiple (⩾2) organ involvement. The mean duration of RCI treatment was 32.5 weeks, with 61.6% of patients continuing RCI therapy for ⩾6 months. The RCI utilization pattern indicated an individualized approach to therapy, with a higher starting dose associated with a shorter duration of therapy compared with a lower starting dose. The percentage of patients who used corticosteroids decreased from 61.3% during the 3 months before initiation of RCI to 12.9% 3 months after RCI therapy; the mean daily dose of corticosteroid decreased from 18.2 mg to 9.9 mg. The proportion of patients given <10 mg/day of prednisone increased from 21% before RCI use to 47% 3 months after RCI use. According to physicians’ assessments of change in patients’ health status after RCI therapy, overall status improved in 95% of patients, overall symptoms in 73%, lung function in 38%, and inflammation in 33%. Conclusions: The findings suggest that RCI is a viable treatment option for patients with advanced symptomatic sarcoidosis and provide insights on patient characteristics and practice patterns to help clinicians determine appropriate use. The reviews of this paper are available via the supplemental material section.

Myelopathy Due to CAR-T Related Neurotoxicity Treated with Siltuximab

2021 ◽  
pp. 10.1212/CPJ.0000000000001078
Author(s):  
Yasmin Aghajan ◽  
Alison Yu ◽  
Caron A. Jacobson ◽  
Austin I. Kim ◽  
Leslie Kean ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cell Therapy ◽  
Chimeric Antigen Receptor ◽  
Hematologic Malignancy ◽  
Case Series ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Car T ◽  
Large Case Series ◽  
Large Case

Chimeric antigen receptor T (CART) cell therapy is highly effective for relapsed/refractory hematologic malignancy [1,2]; however, cytokine release syndrome (CRS) and neurotoxicity are observed in up to 77% of patients [3]. In large case series, the most common presentations of neurotoxicity were encephalopathy (57%), headache (42%), tremor (38%) and aphasia (35%). CART mediated spinal cord toxicity is not well characterized. Structural neurologic damage (stroke and intracranial hemorrhage) was only observed in 1-2% and seizures were seen in 1%-8% of cases [3, 4]. Neuroimaging findings in patients with neurotoxicity are rare and not specific.

scholarly journals Donor Screening for Fecal Microbiota Transplantation

2020 ◽  
Vol 95 (3) ◽  
pp. 181-187
Author(s):  
Han Hee Lee ◽  
Young-Seok Cho
Keyword(s):  
Randomized Clinical Trials ◽  
Fecal Microbiota Transplantation ◽  
Case Series ◽  
Fecal Microbiota ◽  
Resistant Bacteria ◽  
Screening Process ◽  
Antibiotic Resistant ◽  
Donor Screening ◽  
Large Case Series ◽  
Large Case

Fecal microbiota transplantation (FMT), which has been established as the standard treatment for recurrent <i>Clostroides</i> difficile infection, may also play a role in the management of other diseases associated with dysbiosis of the gut microbiota. To ensure efficacy and safety of FMT, an appropriate donor screening process is required. The main purpose of donor screening is to check for infectious diseases that could be transmitted to the recipient. The screening process involves a medical history questionnaire, and blood and stool testing. Several randomized clinical trials and large case series on FMT reported no, or few, adverse events related to infection by following this donor screening process. However, there is still concern over the transmission of antibiotic-resistant bacteria. In addition, a low donor acceptance rate due to rigorous screening makes donor recruitment difficult, and also imposes a significant cost burden. A consensus on the most crucial elements of donor screening is needed for wide application of FMT.

Comparison of auricular and rectal temperature measurement in normothermic, hypothermic, and hyperthermic dogs

2014 ◽  
Vol 42 (01) ◽  
pp. 13-19 ◽  
Author(s):  
B. D. Kruse ◽  
R. Müller ◽  
C. Stockhaus ◽  
K. Hartmann ◽  
A. Wehner ◽  
...  
Keyword(s):  
Body Temperature ◽  
Relative Humidity ◽  
Temperature Measurement ◽  
Rectal Temperature ◽  
Environmental Temperature ◽  
Case Series ◽  
Limits Of Agreement ◽  
Large Case Series ◽  
Healthy Dogs ◽  
Large Case

Summary Objective: Measurement of rectal temperature is the most common method and considered gold standard for obtaining body temperature in dogs. So far, no study has been performed comparing agreement between rectal and auricular measurements in a large case series. The purpose of the study was to assess agreement between rectal and auricular temperature measurement in normothermic, hypothermic, and hyperthermic dogs with consideration of different environmental conditions and ear conformations. Materials and methods: Reference values for both methods were established using 62 healthy dogs. Three hundred dogs with various diseases (220 normothermic, 32 hypothermic, 48 hyperthermic) were enrolled in this prospective study. Rectal temperature was compared to auricular temperature and differences in agreement with regard to environmental temperature, relative humidity, and different ear conformations (pendulous versus prick ears) were evaluated using Pearson’s correlation coefficient and Bland-Altman analysis. Results: Correlation between rectal and auricular temperature was significant (r: 0.892; p < 0.01). However, Bland-Altman plots showed an inacceptable variation of values (bias: 0.300 °C; limits of agreement: –0.606 to 1.206 °C). This variation was above a maximal clinical tolerance of 0.3 °C, which was established by experts’ opinion (n = 16). Relative humidity had a significant influence (p = 0.001), whereas environmental temperature did not. Conclusion: Variation between the two methods of measuring body temperature was clinically unacceptable. Clinical relevance: Although measurement of auricular temperature is fast, simple, and well tolerated, this method provides a clinically unacceptable difference to the rectal measurement.

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