BackgroundWernicke’s encephalopathy is an acute neurological disorder resulting from thiamine deficiency mainly related to alcohol abuse. Severe thiamine deficiency is an emerging problem in non-alcoholic patients and it may develop in postoperative surgical patients with risk factors.Case presentationWe reported a case of a 46 years old woman who underwent, one year before, to cephalic duodenopancreatectomy complicated with prolonged recurrent vomiting. She underwent to a second surgical operation for intestinal sub-occlusion and postoperatively she developed septic shock and hemorrhagic Wernicke’s disease. After ICU admission, because of neurological deterioration, she underwent CT scan and MRI that highlighted a strong suspicion for Wernicke’s disease. We treated her with an initially wrong low dose of thiamine, then after MRI we increased the dosage with a neurological status improvement. Despite therapeutic efforts used to control septic shock and thrombocytopenia, she died on the 21st day after surgery because of massive cerebral bleeding and unresponsive cerebral edema.ConclusionEarly detection of subclinical thiamine deficiency is a difficult task, as symptoms may be nonspecific. Wernicke’s disease remains a clinical diagnosis because there are no specific diagnostic abnormalities revealed in cerebrospinal fluid, electroencephalogram or evoked potentials. About this, the best aid for a correct diagnosis is the clinical suspicion and clinicians should consider the disorder in any patients with unbalanced nutrition, increased metabolism or impaired food absorption. A hallmark of our case was the brain hemorrhage in the typical areas of the Wernicke’s disease, maybe triggered by the thrombocytopenia secondary to sepsis. It might be a good clinical practice administer thiamine to all patients presenting with coma or stupor and risk factors related with thiamine deficiency. Any therapeutic delay may result in permanent neurological damage or death.

Delirium remains a challenging clinical problem in hospitalized older adults, especially for postoperative patients. This complication, with a high risk of postoperative mortality and an increased length of stay, frequently occurs in older adult patients. This brief narrative paper aims to review the recent literature regarding delirium and its most recent update. We also offer physicians a brief and essential clinical practice guide to managing this acute and common disease.

Following the outbreak of the COVID-19 pandemic, Italy has implemented an extensive vaccination campaign involving individuals above the age of 12, both sexes. The public opinion and the medical community alike questioned the usefulness and efficacy of the vaccines against SARS-CoV-2. The widespread opinion was that the vaccines protected individuals especially against serious conditions which could require intensive care and may lead to the death of the patient rather than against the possibility of infection. In order to quantify the effect of the vaccination campaign, we calculated the relative risks of non-vaccinated and vaccinated individuals for all possible outcomes of the disease: infection, hospitalization, admission to intensive care and death. Relative risk was assessed by means of likelihood ratios, the ratios of the probability of an outcome in non-vaccinated individuals to the probability of the same outcome in vaccinated individuals. Results support the hypothesis that vaccination has an extensive protective effect against both critical conditions and death. Nonetheless, the relative magnitude of the protection in vaccinated individuals compared to those non-vaccinated appears to be higher against the former outcome than the latter, for reasons which need to be investigated further.

ObjectivesThe aim of this study was to evaluate and quantify the relative risk of hospital admission and death because of Sars-Cov2 infection between non-vaccinated and vaccinated individuals in Italy.MethodsData about vaccinated and non-vaccinated people, infections, hospital admissions, intensive care units and fatalities were extracted from the bulletin published by the Italian National Health Institute (Istituto Superiore di Sanità) on the 24th of December 2021. Likelihood ratios of hospital admission, intensive care and death were calculated between non-vaccinated and vaccinated people for each of the observed patient outcomes, in order to quantify the relative risk in the two sub-populations.ResultsNon-vaccinated people had a 3.1 time higher risk of becoming infected compared to vaccinated individuals. Non-vaccinated individuals had a 5.1 times higher risk of being admitted to hospital and a 10.4 times higher risk of becoming critical compared to vaccinated individuals. Further, non-vaccinated people had a 4.3 times higher risk to die compared to vaccinated individuals.ConclusionsThe relative risk of infection, hospital and intensive care admission is progressively higher in non-vaccinated compared to vaccinated individuals in case of infection by Sars-Cov2, as the condition worsens. Still, the relative risk does not increase further when the outcome is death, possibly because non-vaccinated individuals are younger and healthier of those who decided to take the vaccine. Individual conditions may play a more relevant role than the vaccine when the illness becomes critical.

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