Anna Hospital Research Articles

Predictive value of geriatric-quickSOFA in hospitalized older people with sepsis

BackgroundQuickSOFA, a prognostic score proposed for patients with infection, has shown a poor predictive value in the geriatric population, probably because of the inappropriateness of the Glasgow Coma Scale (GCS) in assessing acute alteration of mental status in older patients. Indeed, the GCS might result chronically low in older patient with pre-existing cognitive disorders. The aim of this study was to develop an alternative quickSOFA (geriatric-quickSOFA), using the presence of delirium, assessed according to DSM-5 criteria, instead of GCS assessment, to predict mortality in hospitalized older patients with sepsis.MethodsRetrospective observational study in Acute Geriatrics Unit of St. Anna Hospital of Ferrara (Italy). The study enrolled 165 patients hospitalized between 2017 and 2018 with diagnosis of sepsis or septic shock. Demographic, clinical data and 30-day survival were collected for each patient. Based on arterial blood pressure, respiratory rate, and the presence of delirium, geriatric-quickSOFA was calculated at admission. Primary outcome was 30-day mortality.ResultsOne hundred sixty-five patients were enrolled with a median age of 88 years; 60.6% were men. High quickSOFA score was not significantly correlated neither with in-hospital nor 30-day mortality. High geriatric-qSOFA score was significantly related to both in-hospital (13.3%vs 51.5%, p = 0.0003) and 30-day mortality (30.0%vs 84.3%, p < 0.00001).ConclusionGeriatric-quickSOFA is significantly associate with short-term mortality risk in older patients with sepsis. Geriatric quickSOFA seems to represent a more suitable and useful predictive tool than the traditional quickSOFA in the geriatric population.

Chronic nonbacterial osteomyelitis: description of three pediatric cases.

Chronic recurrent multifocal osteomyelitis (CRMO) or also called chronic non-bacterial osteomyelitis (CNO) is the most common autoinflammatory bone disease. It is characterized by the presence of symptomatic and non-symptomatic bone lesions, mono or multifocal. The main sites involved are the metaphyses of the long bones, the bones of the pelvis, the vertebrae, the clavicle, the mandible. Local symptoms include pain, swelling, and warmth in the absence or presence of fever. The inflammatory process can involve the skin (palmoplantar pustulosis or acne) and the intestine. Diagnosis is complex and uses imaging techniques (X-ray, total-body MRI, scintigraphy) as well as common laboratory tests aimed at identifying an inflammatory state. In doubtful cases, especially in the monofocal forms, it is mandatory to perform a biopsy examination to rule out malignancy. The differential diagnosis includes neoplastic diseases, chronic infections, metabolic diseases, traumatic outcomes. Treatment is not standardized and involves the use of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, sulfasalazine, methotrexate, TNF inhibitors and bisphosphonates based on the experience of the individual centers. We report the experience of our Center (Operative Unit of Pediatrics S. Anna Hospital in Ferrara) with the description of 3 clinical cases, diagnosed from 2016 to 2018, treated with bisphosphonates with good clinical response and remission in two of them, while one patient had an adverse reaction to pamidronate and was subsequently successfully treated with methotrexate.

EVALUASI MUTU PELAYANAN KEFARMASIAN PADA MASA PANDEMI COVID-19 DI RUMAH SAKIT SANTA ANNA KOTA KENDARI

Quality is compliance with predefined standards or following the requirements. Minimum Service Standards health in hospitals is very important to measure the hospital's performance of health services. This study aims to describe the quality of service at the Pharmacy Installation at Santa Anna Hospital, Kendari City during the Covid-19 pandemic based on five indicators of minimum pharmaceutical service standards are waiting time for drug services, the absence of errors in drug administration, writing prescriptions according to the formulary, patient satisfaction and availability of SOP (Standard Operating Procedures). This study is observational research which is descriptive used cross sectional design. The sample was outpatients for 90 samples at Santa Anna Hospital, Kendari City, who fulfill the inclusion criteria. Instruments used questionnaire sheets and observation sheets. The results showed that the indicator of waiting time for concocted drugs and non-concocted drugs was 8 minutes and 4 minutes, respectively. There was no error in administering medications (100%). The suitability of prescription writing to the National Formulary was 99.73%, patient satisfaction to tangible dimensions and reliability dimensions were 82.23% and 84.84%, respectively. The responsiveness dimension was 79.65%, the assurance dimension was 83.54%, and the empathy dimension was 85.48%, and the availability of the standard operating procedure was 63.64%. This study's pharmacy installation at Santa Anna Hospital in Kendari City has not fulfilled the predetermined Minimum Service Standards.

Coronavirus disease 2019 and first-trimester spontaneous abortion: a case-control study of 225 pregnant patients

BackgroundThe disease caused by the severe acute respiratory syndrome coronavirus 2 was named coronavirus disease 2019 and classified as a global public health emergency. The evidence related to the impact of coronavirus disease 2019 on pregnancy is limited to the second and third trimester of pregnancy, whereas data on the first trimester are scant. Many viral infections can be harmful to the fetus during the first trimester of pregnancy, and whether severe acute respiratory syndrome coronavirus 2 is one of them is still unknown.ObjectiveWith this study, we evaluated severe acute respiratory syndrome coronavirus 2 infection as a risk factor for early pregnancy loss in the first trimester of pregnancy. Furthermore, coronavirus disease 2019 course in the first trimester was assessed.Study DesignBetween February 22 and May 21, 2020, we conducted a case-control study at S. Anna Hospital, Turin, among pregnant women in their first trimester, paired for last menstruation. The cumulative incidence of coronavirus disease 2019 was compared between women with spontaneous abortion (case group, n=100) and those with ongoing pregnancy (control group, n=125). Current or past infection was determined by the detection of severe acute respiratory syndrome coronavirus 2 from nasopharyngeal swab and severe acute respiratory syndrome coronavirus 2 immunoglobulin G and immunoglobulin M antibodies in a blood sample. Patient demographics, coronavirus disease 2019–related symptoms, and the main risk factors for abortion were collected.ResultsOf 225 women, 23 (10.2%) had a positive test result for coronavirus disease 2019. There was no difference in the cumulative incidence of coronavirus disease 2019 between the cases (11/100, 11%) and the controls (12/125, 9.6%) (P=.73). Logistic regression analysis confirmed that coronavirus disease 2019 was not an independent predictor of early pregnancy loss (odds ratio, 1.28; confidence interval, 0.53–3.08). Coronavirus disease 2019–related symptoms in the first trimester were fever, anosmia, ageusia, cough, arthralgia, and diarrhea; no cases of pneumonia or hospital admission owing to coronavirus disease 2019–related symptoms were recorded. No difference in the incidence of symptoms was noted between the 2 groups.ConclusionSevere acute respiratory syndrome coronavirus 2 infection during the first trimester of pregnancy does not seem to predispose to early pregnancy loss; its cumulative incidence did not differ between women with spontaneous abortion and women with ongoing pregnancy. Coronavirus disease 2019 appears to have a favorable maternal course at the beginning of pregnancy, consistent with what has been observed during the second and third trimesters.

Prognostic factors in older patients admitted in ICU with diagnosis of abdominal sepsis (sepsis-3 criteria)

Background & aims. In septic older patients, hospitalization in Intensive Care Unit (ICU) is often associated with unfavourable outcomes. The aim of this study was to estimate the prevalence of geriatric age in patients admitted to ICU for abdominal sepsis and to investigate predictors of mortality, including quickSOFA, a recent prognostic index proposed for septic patients. Methods. Prospective observational study on patients admitted to ICU of St. Anna Hospital (Ferrara) between January and July 2016 with the following inclusion criteria: 1) adults (18 years); 2) abdominal infection treated with surgically techniques; 3) admission to ICU. Demographic, clinical data and survival at 30 and 90-day were collected for each patient. Results. Thirty patients were enrolled, and the majority of geriatric patients (80% ≥ 65 years and 53% ≥ 75 years). The 30 and 90-day mortality was 17 and 37%, respectively. Almost all deaths occurred in older age (mortality rate of 42%). SOFA (Sepsis Related Organ Failure Assessment) score was the prognostic index most frequently associated with exitus at 30 (AUC = 0.702) and 90 days (AUC = 0.730). quickSOFA was only related to early mortality (AUC = 0.640). Conclusions. Our data confirm the high geriatric prevalence among patients admitted to ICU for abdominal sepsis, underlining the advanced age as a negative prognostic factor. SOFA score appears a reliable prognostic indicator of mortality, also in older population, while quickSOFA proved effective only for short-term mortality.

Could Anti-Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID-19 Infection? Data From Centers of Southern Italy.

BACKGROUNDCoronavirus disease 2019 (COVID‐19) is the cause of a pandemic disease, with severe acute respiratory syndrome by binding target epithelial lung cells through angiotensin‐converting enzyme 2 in humans. Thus, patients with hypertension with COVID‐19 could have worse prognosis. Indeed, angiotensin‐converting enzyme inhibitors and/or angiotensin receptor blockers may interfere with angiotensin‐converting enzyme 2 expression/activity. Thus, patients with hypertension undergoing angiotensin‐converting enzyme inhibitor and/or angiotensin receptor blockers drug therapy may be at a higher risk of contracting a serious COVID‐19 infection and should be monitored. Moreover, in the present study we investigated the effects of angiotensin‐converting enzyme inhibitor versus angiotensin receptor blockers versus calcium channel blockers on clinical outcomes as mechanical ventilation, intensive care unit admissions, heart injury, and death in 62 patients with hypertension hospitalized for COVID‐19 infection.METHODS AND RESULTSThe multicenter study was prospectively conducted at Department of Infectious Diseases of Sant'Anna Hospital of Caserta, and of University of Campania "Luigi Vanvitelli" of Naples, at Department of Advanced Surgical and Medical Sciences of University of Campania "Luigi Vanvitelli," Naples, and at General Medical Assistance Unit "FIMG," Naples, Italy. Lowest values of left ventricle ejection fraction predicted deaths (1.142, 1.008–1.294, P<0.05), while highest values of interleukin‐6 predicted the admission to intensive care unit (1.617, 1.094–2.389), mechanical ventilation (1.149, 1.082–1.219), heart injuries (1.367, 1.054–1.772), and deaths (4.742, 1.788–8.524).CONCLUSIONSAnti‐hypertensive drugs didn't affect the prognosis in patients with COVID‐19. Consequently, tailored anti‐inflammatory and immune therapies in addition to chronic antihypertensive therapy, could prevent a worse prognosis, as well as improve the clinical outcomes in patients with hypertension with COVID‐19 infection.

The "scar" of a pandemic: Cumulative incidence of COVID-19 during the first trimester of pregnancy.

Congenitally‐ or perinatally‐acquired viral infections can be harmful to the fetus but data are limited about prevalence and outcomes of coronavirus disease 2019 (COVID‐19) disease during the first trimester of pregnancy. We report epidemiologic data from a study investigating a cohort of women who became pregnant just before or during the COVID‐19 pandemic. We recruited 138 consecutive pregnant women attending for first trimester screening (11‐13 weeks of gestation) at Sant'Anna Hospital, Turin, Piedmont, Italy, during the plateau and the falling phase of the COVID‐19 epidemic curve. Patients were tested for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) immunoglobulin M/immunoglobulin G antibody levels and SARS‐CoV‐2 detection in sera and nasopharyngeal swab samples. COVID‐19 cumulative incidence during the first trimester was of 10.1% with high prevalence of asymptomatic patients (42.8%). Similar to the course of the disease in non pregnant adults, 80% to 90% of infections were not severe.The prevalence of reported symptoms was four‐fold higher in SARS‐CoV‐2 positive patients (57%) than in those negative (13%) (P < .001), suggesting that direct self‐testing should open doors to confirmatory testing for COVID‐19. Our findings support the need for COVID‐19 screening in early pregnancy in epidemic areas to plan materno‐fetal health surveillance programs.

Vacuum intraoperative specimen mammography: A novel technique

ObjectiveIntraoperative specimen mammography (ISM) is a diffuse technique that allows surgeons to check specimens immediately after lumpectomy. Although the specimen is slightly compressed, the radiological image can be distorted by tissue overlap, and this may affect the evaluation of tumour borders, resulting in extension of the lumpectomy. As ISM may be less precise due to inadequate compression, a vacuum effect was applied to the specimen to increase the precision of margin detection. Study designThis study was conducted at St. Anna Hospital Breast Unit, Turin, Italy. Women who underwent lumpectomy for cancer were eligible for inclusion. Both standard ISM (sISM) and vacuum ISM (vISM) were performed. Eighteen specimens obtained after lumpectomy from 1 April 2018 to 31 April 2018 were scanned. sISM (two orthogonal projections) was performed. Next, the specimen was placed in a vacuum, and vISM was performed. The examination was completed with a second orthogonal projection after removal of the vacuum, replacement of the specimen and repositioning of the vacuum. Additional tissue was removed if the surgeon considered that excision was inadequate. Finally, the specimen was sent for definitive histopathological analysis, which is the gold standard for the assessment of surgical margins. Intraoperative histological margin assessment was not performed. The sISM and vISM images and final histopathology reports were compared. ResultsFor sISM, specificity was 47 % [95 % confidence interval (CI) 25–70], sensitivity was 67 % (95 % CI 21–94), positive predictive value (PPV) was 20 % (95 % CI 6–51) and negative predictive value (NPV) was 88 % (95 % CI 53–98). For vISM, specificity was 100 % (95 % CI 80–100), sensitivity was 67 % (95 % CI 21–94), PPV was 100 % (95 % CI 34–100) and NPV was 94 % (95 % CI 72–99). ConclusionThese data suggest that the vacuum technique is feasible, cost-saving and yields results that are similar to those from frozen sections but without the limitations, such as prolonged operating time, high variability in sensitivity due to pathologists’ abilities, risk of compromising the histological report, and unreliability for small lumps and ductal carcinoma in situ.

Treatment of fistula-in-ano: Outcome comparison between traditional surgery and novel approaches. A retrospective cohort study in a single center

Aim: Fistula-in-ano is a well described disease but no definitive surgical technique has been developed. We conducted a retrospective cohort study in a single center to evaluate patients who underwent surgical treatment of a perianal fistula from 2012 to 2018 in our hospital. The aim of the study was to compare the outcome of different surgical techniques (Fistulotomy/fistulectomy and seton, Video-Assisted Anal Fistula Treatment (VAAFT), Micro-fragmented adipose tissue injection, Lipogems®).Methods: A cohort of 103 patients with anal fistula who qualified for elective surgery between 2012 and 2018 were recruited at Sant’Anna Hospital in Ferrara. All patients underwent a digital rectal examination and preoperative magnetic resonance imaging (MRI) to identify the fistula tract and internal opening. Patients were divided into 4 groups, one for each type of surgery they underwent: Fistulotomy/fistulectomy and seton, Video-Assisted Anal Fistula Treatment (VAAFT), Micro-fragmented adipose tissue injection, Lipogems®). Numerical rating scale (NRS) was used to assess subjective pain one week after surgery and documented. The scale ranged from 0 to 10, where 0 stands for no pain and 10 stands for worst pain ever faced. Primary end point was fistula recurrence at 1 year of follow-up. Secondary end point was evaluation of post-operative pain. Results: There were 71 males and 32 females, with a median age of 50 years (range 21-89 years). Among them, 79 patients were newly diagnosed, the other 24 patients had undergone previous surgery and had recurrence. In total, 118 surgical operation were performed for anal fistula. During the follow-up period, anal fistula recurrence was observed in 13 patients after VAAFT, 3 patients after Micro-fragmented adipose tissue injection, 4 after fistulotomy, 12 after fistulectomy, 10 after seton placement and 8 after Lipogems® technique. One week after surgery, pain was evaluated by all patients on a scale from 0 to 10. The mean scores of patients who underwent VAAFT, micro-fragmented adipose tissue injection, fistulotomy, fistulectomy, seton placement and Lipogems® technique were 1 (0-5), 1.5 (0-8), 5 (3-8), 6.8 (5-9), 4.2 (2-6) and 0 (0-2), respectively. Conclusion: This study presents the difficulties in managing anal fistulas and the variety of surgical options. VAAFT and Micro-fragmented adipose tissue injection appear to be safe and feasible options in the management of anal fistula, and short-term healing rates are acceptable with no sustained effect on continence. There is, however, a paucity of robust data with long-term outcomes. These techniques are thus welcome additions. Lipogems ® technique is a safe and reproducible procedure, unfortunately according to our experience, it does not promote fistula healing in patients with recurrent inter-sphincteric anal fistula. We do not suggest the use of this technique as a first-line treatment.

Ultrasound and clinical characteristics of uterine smooth muscle tumors of uncertain malignant potential (STUMPs)

Objective(s)Smooth muscle tumors of uncertain malignant potential are rare uterine neoplasms. Their identification through imaging is still limited due to the few available descriptions in the scientific literature. The objective of this paper is to provide clinical and ultrasound features that could support an early identification of these neoplasms. Study designWe retrospectively evaluated preoperative sonographic data of patients receiving a histopathological diagnosis of smooth muscle tumors of uncertain malignant potential between 2014 and 2019 at the S. Anna Hospital (Turin, Italy), a tertiary gynecological center. Tumors were characterized on the basis of ultrasound images using terms and definitions according to the morphological uterus sonographic assessment group. ResultsA total of fourteen patients with smooth muscle tumors of uncertain malignant potential (20 lesions, including 18 pure and 2 with associated leiomyosarcoma) were identified. The median age was 47 years (range 28–77) and nine (64%) patients were of reproductive age. Six patients (43%) were asymptomatic, two (14%) presented with abdominal pain, two (14 %) with menorrhagia and four (29%) with both symptoms. Two (14%) patients developed local recurrences as uterine smooth muscle tumor of uncertain malignant potential and leiomyosarcoma, respectively.At ultrasound imaging, nine (69%) smooth muscle tumors of uncertain malignant potential were poorly or moderately vascularized and nine (82%) showed both circumferential and intra-lesional flows. Only three (15%) showed shadowing. The outlines were well-defined in seventeen cases (85%) and most (90%) showed isoechoic or mixed echogenicity with microcystic anechoic areas in fourteen (70%) of cases. Conclusion(s)Sonographic features of smooth muscle tumors of uncertain malignant potential may vary and a pathognomonic description has not been recognized. However, the identification of single or multiple lesions with specific ultrasound features should raise the suspicion of tumors of uncertain malignant potential. These features include isoechogenicity or mixed echogenicity, regular borders, presence of internal microcystic and anechoic areas, circumferential and intralesional vascularization ranging from minimal to high and absence of shadowing.

Risk of Symptomatic Infection after Non-Primary Congenital Cytomegalovirus Infection.

Cytomegalovirus (CMV) is the leading cause of congenital infection. Its occurrence is phenotypically heterogeneous. The type of maternal infection, primary or non-primary, is an important factor related to the symptomatic disease, the primary infection was long considered the only cause of severe neonatal disease. We aimed to analyze the association of primary and non-primary infection with pathological outcomes in infants and with long-term sequelae at follow-up. This was a monocentric retrospective observational study on a population of 91 infants diagnosed with a CMV infection at the Neonatal Care Unit of Neonatology at the Sant’Anna Hospital of Turin during the period of June 2005 to December 2018. Infants underwent clinical, laboratory, and neuroradiological evaluations at birth. Subsequently, the patients were monitored in an auxological, neurodevelopment, and audiological follow-up. Regarding primary vs. non-primary infection, we found a higher percentage of incidence of symptomatic and neurological localized infection, as well as long-term sequelae in the latter. However, no significant difference between the two populations was found. We underline the possibility of re-infection in previously immunized mothers (non-primary infection) with unfavorable neonatal and long-term outcomes.

Splenic Infarction: An Unusual Condition with Numerous Difficult Options: A Case-Report, Literature Review and Surgical Observations

Splenic infarction is a rare cause of acute abdomen whose aetiology is stratified according to age group. In patients under the age of 40 most causes are attributable to hematological or genetic pathologies, while in patients over 40 years old, the thromboembolic manifestations play a major role. The diagnosis of splenic infarction can be almost an enigma for the doctor who is evaluating a patient with non-specific abdominal pain, possible hyperpyrexia or rise in phlogosis and LDH indexes. The scientific literature on splenic infarction is rather scarce and consists mostly of articles with few cases. In this article, with the help of a rather emblematic clinical case that has come to the attention of the Emergency Department of the S. Anna Hospital in Ferrara, and subsequently to the Surgery Unit, we want to reflect not so much on the diagnosis of this pathology but rather on the therapeutic strategies following the diagnosis. Is splenic infarction a pathology of surgical interest? On what terms and times should surgical treatment be proposed to the patient? Is there an alternative to surgery? How should follow-up be conducted in these patients? These are questions to which the literature currently available has not yet been able to answer and, in the future, we hope we will start researches on the treatment of a condition which does not seem to be so rare.

The ADNEX model to triage adnexal masses: An external validation study and comparison with the IOTA two-step strategy and subjective assessment by an experienced ultrasound operator

ObjectivesThe ADNEX (Assessment of Different NEoplasias in the adneXa) model was developed using parameters collected by experienced (level III) ultrasound examiners. Our primary aim was to externally validate the ADNEX model. Then, the discriminatory performance of ADNEX was compared with the two-step strategy and subjective assessment by an experienced ultrasound operator. MethodsBetween February 2013 and January 2017, all patients who were scheduled for surgery for an adnexal mass at the Sant’Anna Hospital in Turin were enrolled in this study. Preoperative transvaginal sonography was performed, and the two-step strategy was applied for triage of the adnexal mass. Two ultrasound examiners, IOTA certified, applied the ADNEX model to all the collected masses based on the ultrasound reports. Finally, an experienced operator assigned the subjective assessment based on recorded ultrasound images. The discrimination and calibration performance of ADNEX were evaluated. The AUC was calculated for the basic discrimination between benign and malignant tumours. In addition, AUCs were computed for each pair of tumour types using the conditional risk method. ResultsA total of 577 patients were included in the analysis: the overall prevalence of malignancy was 25 %. With ADNEX, the AUC to differentiate between benign and malignant masses was 0.9111 (95 % CI 0. 8788-0.9389). At risk cut-offs of 1%, 10 % and 30 %, sensitivities were 100 %, 89.6 % and 79.2 %, respectively, and specificities were 2.8 %, 76.2 % and 89.6 %, respectively. Discrimination between benign and stage II–IV tumours was good (AUC 0.935). The model had the most difficulties discriminating between borderline and stage I tumours (AUC 0.666), and between stages II–IV invasive and secondary metastatic tumours (AUC 0.736). The polytomous discrimination index (PDI) was 0.61 for ADNEX, whereas PDI for random performance would be 0.25. ADNEX proved to be equally or more accurate than the subjective assessment or the two-step strategy in the discrimination between benign and malignant adnexal masses. Conclusionsthe ADNEX model could probably be successfully applied when an expert examiner is not available and, therefore both a subjective assessment and the two-step strategy cannot be performed.

Waiting times for diagnosis and surgery in a large obstetric-gynecological hospital in Italy

Abstract Issue Diagnostic testing and surgical waiting times are related to quality of healthcare services. An extension of waiting times, indeed, could lead to a diagnostic or therapeutic delay, with potential consequences on patient health outcomes. Several policies have been implemented in different European countries in order to improve these indicators. Our study aims to analyse the waiting times of the largest obstetric and gynaecological hospital of Northern Italy, in order to identify potential issues in women’s health services. Description of the problem Data of “Sant’Anna Hospital” (Turin, Italy) about the waiting times in the period 2016-2017 for outpatient and surgical services addressed to women were collected. Specifically, number of health care procedures and mean waiting times (MWT) for “Obstetric-Gynaecological Echography” (OGE), “First Endocrinological Visit” (FEV), “First Gynaecological Visit” (FGV), “Surgical Intervention for Breast Cancer” (SIBC) and “Surgical Intervention for Uterus Cancer” (SIUC) were retrieved. Results were compared with the benchmark identified by the regional law. Results A total of 21,735 OGEs were performed, with a MWT of 3 days in 2016 and 5 days in 2017, below the benchmark (11 days). The total number of FEVs was 1,234, with a MWT of 19 and 23 days in 2016 and 2017 respectively, again below the benchmark (30 days). The FGVs were 21,096 with a MWT of 9 (2016) and 24 (2017) days (benchmark 30 days). The number of SIBCs (N = 89) performed within 30 days (benchmark) were 87 (98% of SIBCs), while SIUCs (N = 90) were 84 (93%). Lessons The waiting times of the “Sant’Anna hospital” were, for all the performances considered, shorter than the regional benchmarks. This is an indicator of the quickness of diagnosis and treatment and, indirectly, of the quality of care. An international comparison among the main European hospitals should be encouraged in a perspective of continuous improvement of health care provided to European citizens. Key messages Diagnostic testing and surgical waiting times are useful to assess the quickness and quality of health care provided in European hospitals. “Sant’Anna hospital”, leader for women’s health care, provides care with waiting times shorter than benchmarks. It would be interesting to compare its results with other large European hospitals.

A Simply Quick Look and Immediately the Bulb Lights Up!

Marco Manfredi*1, Marialaura Pesenti2 and Giancarlo Gargano1 Author Affiliations 1Department of Maternal and Child, Italy 2Endocrinology Outpatients, Italy Received: October 24, 2019 | Published: October 31, 2019 Corresponding author: Marco Manfredi, Pediatric Unit, Azienda USL-IRCCS di Reggio Emilia, Sant’Anna Hospital, Castelnovo ne’ Monti, Reggio Emilia, Italy DOI: 10.26717/BJSTR.2019.22.003744

Risk of Preeclampsia and Adverse Pregnancy Outcomes after Heterologous Egg Donation: Hypothesizing a Role for Kidney Function and Comorbidity.

Background and objectives: Preeclampsia (PE) is a risk factor for kidney diseases; egg-donation (ED) increasingly used for overcoming fertility reduction, is a risk factor for PE. CKD is also a risk factor for PE. However, kidney function is not routinely assessed in ED pregnancies. Objective of the study is seeking to assess the importance of kidney function and maternal comorbidity in ED pregnancies. Design, setting, participants and measurements. Design: retrospective observational study from clinical charts. Setting: Sant’Anna Hospital, Turin, Italy (over 7000 deliveries per year). Selection: cases: 296 singleton pregnancies from ED (gestation > 24 weeks), who delivered January 2008–February 2019. Controls were selected from the TOrino Cagliari Observational Study (1407 low-risk singleton pregnancies 2009–2016). Measurements: Standard descriptive analysis. Logistic multiple regression analysis tested: PE; pregnancy-induced hypertension; preterm delivery; small for gestational age; explicatory variables: age; BMI; parity; comorbidity (kidney diseases; immunologic diseases; thyroid diseases; other). Delivery over time was analyzed according to Kaplan Meier; ROC (Relative Operating Characteristic) curves were tested for PE and pre-term delivery, employing serum creatinine and e-GFR as continuous variables. The analysis was performed with SPSS v.14.0 and MedCalc v.18. Results: In keeping with ED indications, maternal age was high (44 years). Comorbidity was common: at least one potential comorbid factor was found in about 40% of the cases (kidney disease: 3.7%, immunologic 6.4%, thyroid disease 18.9%, other-including hypertension, previous neoplasia and all other relevant diseases—10.8%). No difference in age, parity and BMI is observed in ED women with and without comorbidity. Patients with baseline renal disease or “other” comorbidity had a higher risk of developing PE or preterm delivery after ED. PE was recorded in 23% vs. 9%, OR: 2.513 (CI 1.066–5.923; p = 0.039); preterm delivery: 30.2% vs. 14%, OR 2.565 (CI: 1.198–5.488; p = 0.044). Limiting the analysis to 124 cases (41.9%) with available serum creatinine measurement, higher serum creatinine (dichotomised at the median: 0.67 mg/dL) was correlated with risk of PE (multivariate OR 17.277 (CI: 5.125–58.238)) and preterm delivery (multivariate OR 2.545 (CI: 1.100–5.892). Conclusions: Within the limits of a retrospective analysis, this study suggests that the risk of PE after ED is modulated by comorbidity. While the cause effect relationship is difficult to ascertain, the relationship between serum creatinine and outcomes suggests that more attention is needed to baseline kidney function and comorbidity.

Anthropometric and acoustic pharyngometric parameters in sleep-disordered breathing due to structural pharyngeal alterations

INTRODUCTION : Sleep-disordered breathing is a medico-social problem of rising importance worldwide. There are various clinical forms of sleep apnea such as obstructive sleep apnea (OSA) and central sleep apnea as well as snoring. Recently, there have been considerable advances in the diagnosis of OSA and snoring. А IМ : This study aimed at applying the method of acoustic pharyngometry for the diagnosis of pharyngeal alterations in subjects with sleep-disordered breathing within a preventive otorhinolaryngological programme in the city of Varna for the first time in Bulgaria. MATERIALS AND METHODS : Between January 1, 2016 and August 31, 2019, screening for sleep-disordered breathing was performed among 100 subjects, 62 males at a mean age of 48.82±11.45 years and 38 females at a mean age of 52.42±16.54 years in the Division of Otorhinolaryngology, St. Anna Hospital of Varna. Clinical inspections, anterior rhinoscopy, pharyngoscopy, indirect laryngoscopy, acoustic rhinometry, as well as acoustic pharyngometry by means of Eccovision ® acoustic pharyngometer were used. The t -test for independent variables and the correlation analysis were applied for statistical data processing. RESULTS : The acoustic pharyngometry identified several pharyngeal alterations. There were statistically significant changes of the anthropometric parameters (body mass index, neck circumference and adjusted neck circumference) and pharyngometric ones (pharyngeal cavity and vocal tract lengths and volumes) between males and females. There were statistically significant positive and negative correlations between the values of these parameters. CONCLUSION : Within the complex otorhinolaryngological examination of the pharyngeal structure and function in the subjects suspected for sleep-disordered breathing, acoustic pharyngometry could play an irreplaceable role as a cost-effective tool.

Pharmaceutico-Analytical Study of Tulasi (Ocimum sanctum Linn.) Arka (Hydro-distillate)

Journal of Ayurveda Medical Sciences,2018,3,3,424-426.DOI:10.5530/jams.2018.3.23Published:April 2019Type:Short CommunicationAuthors:Kavyashree Maliyappa Rajanna, Harini Ashwathanarayana, Prakash Lakshminarayana Hegde, and Sunil Kumar Koppala Narayana Author(s) affiliations:Kavyashree Maliyappa Rajanna*, Harini Ashwathanarayana, Prakash Lakshminarayana Hegde, Sunil Kumar Koppala Narayana1 Department of Dravyaguna, SDM College of Ayurveda and Hospital Hassan, Karnataka 573201, 1Siddha Central Research Institute, CCRS, Ministry of AYUSH, Anna Hospital Campus, Arumbakkam, Chennai 600106, India. Abstract:Introduction: Tulasi (Ocimum sanctum Linn.) of Lamiaceae known as Holy BasilIt is commonly available and cultivated across the India and it is having many therapeutic usages and Arkaisan important dosage form because it has good patient compliance, long shelf life and increased potency. TulasiArka is one such Arka used for Shwasa (Asthma), Kasa (Cough) and Hikka (Hicough). Methods: Tulasiarka was prepared using leaves of O.sanctum as per the standard procedure. The prepared Arka was subjected to organoleptic, physiochemical and GCMS study. Results: Analysis of prepared Arka was carried out as per the protocols laid down by Ministry of AYUSH, Govt of India for Arka. 14 chemical compounds were detected in TulasiArka by GCMS Analysis. Conclusion: Organoleptic characters, physiochemical analysis, and GC-MS values can be used as supplement tool for standardization of the TulasiArka. Keywords:Ayurvedic hydro-distillates, GCMS, TulasiArkaView:PDF (1.84 MB)

Risk of adverse pregnancy outcomes by pre-pregnancy Body Mass Index among Italian population: a retrospective population-based cohort study on 27,807 deliveries.

To estimate the impact of increasing pre-pregnancy Body Mass Index (BMI) on the risk of adverse maternal and perinatal outcomes, in patients who delivered in an Italian tertiary care Obstetric department. Data, related to women who delivered at Sant'Anna Hospital, Turin, between 2011 and 2015, were collected retrospectively from the hospital database. According to BMI, women were considered as normal weight, overweight, and class 1, 2 and 3 obese (WHO criteria). Logistic regression analysis studied the impact of BMI on maternal and neonatal outcomes, adjusting results for maternal age and parity. Adjusted absolute risks of each outcome were reported according to incremental values in pre-pregnancy BMI. A total of 27,807 women were included. 75.8% of pregnancies occurred among normal-weight women, whereas 16.7% were overweight, and 7.5% obese women (5.4% class 1, 1.7% class 2 and 0.4% class 3). A 10% decrease in pre-pregnancy BMI was associated with a reduction of at least 15% of Gestational diabetes mellitus (GDM), preeclampsia, maternal admission to intensive care unit (ICU), macrosomia, APGAR 5' < 6 and neonatal admission to ICU. GDM and preeclampsia resulted in the highest reduction being almost 30%. Larger differences in BMI (20-25%) corresponded to at least a 10% in reduction of risk of preterm and very preterm delivery and emergency cesarean section. Differences in maternal pre-pregnancy BMI had no impact on the frequency of shoulder dystocia and stillbirth. This study offers a quantitative estimation of negative impact of pre-pregnancy obesity on the most common pregnancy and perinatal complications.

Impact of cancer in the management of delivery: 10 years of variations

Importance: The active-during-pregnancy-cancer (ADPC) is a condition that complicates the 0.1% of pregnancies. Abortion, preterm delivery and cesarean section (CS) are common attitudes for these patients, because of scarcity of evidence-based studies. Not-active-during-pregnancy-cancer (NADPC) is an increasing medical problem. The fertility of young girls survived to neoplasia is significantly lower compared to general population and there are increased rates of low birth weight and preterm birth.Objective: To analyze the impact that the pregnancy-related neoplastic disease has on management of deliveries in the decade 2006–2015.Material and methods: In this observational study, we collected obstetric and oncological data about 205 patients bearing a history of cancer related to pregnancy between January 2006 and September 2016 from Sant’Anna Hospital database archive in Turin. The entire population was divided in 59 patients with ADPC and 146 patients with NADPC because it was cured before starting the gestation. Three ADPC and three NADPC patients who completed their pregnancy in the year 2016 were excluded from the 10 years 2006–2015 trends realization. All in situ and invasive cancers were considered.Results: In ADPC patients, we registered 3.4% miscarriage and 15.3% iatrogenic abortion. The type of delivery was vaginal (22%) and CS (59.3%). Induction of labor was 14.6%, elective CS was 68.8%: the indication for these procedures was 78.6% oncological. The average gestational age was 35.5 weeks. In NADPC patients, we registered 9.6% miscarriage and 8.2% iatrogenic abortion. The type of delivery was vaginal (43.2%) and CS (39%). Induction of labor was 11.7%, elective CS was 36.7%: the indication for these procedures was 77.5% obstetrical. The average gestational age was 38.3 weeks.Conclusions: Ten-year trends in ADPC and NADPC patients showed an increase of induced deliveries and a decrease in elective CS. We observed not significant reduction of gestational age and birth weight. A contemporary decrease of oncological indications for CS in the two populations was reported.