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During the recent years, immigration in Italy has increased. There are few data on the health status of immigrants and there is a need to improve their healthcare. Cardiovascular disorders account for 7.6% of immigrants' diseases and cause 3.6% of the total deaths. Lack of healthcare services to general medicine support and prescriptions leads immigrants to contact the Emergency Department (ED) to receive medical assistance. Primary endpoints of this study were to assess the use of national healthcare system by immigrants and to determine the incidence of cardiovascular diseases, and the frequency and type of risk factors for cardiovascular diseases in these patients. A no-profit, observational, multicentre study was conducted from April to September 2012. We studied 642 foreign patients referring to the ED for various symptoms/signs. One hundred and fourteen patients referred for suspected cardiovascular disease and 105 had a confirmed final diagnosis of cardiovascular disease. The more represented ethnic origin was Caucasian (59%), whereas the most represented country was Romania (24%). The main symptom recorded at ED arrival was chest pain (37.1%). Final cardiovascular diagnoses were represented by: hypertensive crisis (28.5%), acute coronary syndrome (20%), acute heart failure (12.3%), atrial fibrillation (10.4%) and chest pain (10.4%). Past medical history of cardiovascular disease, hypertension, obesity and male sex showed independent significant predictive value for cardiovascular disease diagnosis.Our study provides support for the development of specific primary prevention of cardiovascular risk factors in immigrants with the important role of culturally competent education of individuals and families. Better outpatient management seems to be needed in order to limit the need for emergency room referral.

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RIASSUNTO -Le cisti colloidi sono lesioni del Ill ventricolo, che possono essere trattate chirurgicamente in tre modi: resezione microchirurgica, aspirazione stereotattica e trattamento endoscopico. L'endoscopia offre la possibilita di un'ampia apertura della cisti con aspirazione di tutto il suo contenuto seguita dalla coagulazione della membrana interna secernente la colloide. L'aspirazione stereotattica e l'approccio meno invasivo nel trattamento delle cisti colloidi, ma il successo di questa metodica dipende dalla densita della cisti. La tecnica microchirurgica permette la resezione della lesione ma con una maggiore invasivita e con maggiori rischi di morbidita chirurgica.Dall'agosto 1995 all'ottobre 1997 abbiamo eseguito 10 procedure endoscopiche per trattare nove pazienti con cisti colloidi del Ill ventricolo (6 maschi e 3 femmine). Gli interventi sono stati eseguiti usando un fibro-endoscopio Codman in 9 casi ed un endoscopio rigido Aesculap in 1. 11 trattamento e stato eseguito sotto guida stereotattica in 1 caso con un controllo in neuro-navigazione in 2 e a mano libera in 7 casi.Non sono state osservate recidive sia dal punto di vista clinico che radiologico. 11 confronto fra l'aspirazione stereotattica e l'endoscopia risulta a favore di quest'ultimo tipo di tecnica. La rimozione della sostanza colloide e infatti completa e controllabile con l'endoscopia mentre e parziale e non controllabile visivamente con la stereotassi. I nostri risultati relativi al trattamento endoscopico delle cisti colloidi sono senz'altro incoraggianti. L'intervento presenta una percentuale accettabile di complicanze e, nella nostra esperienza, non sono stati osservati deficit neurologici dovuti alla procedura. AI contrario, la resezione microchirurgica puo spesso dare esito a complicanze postoperatorie, in particolare all'insorgenza di epilessia o disturbi mnestici causati da lesione dei fornici.SUMMARY -Colloid cysts are third ventricle lesions which can be treated surgically in three ways: microsurgical resection, stereotactic aspiration and endoscopic treatment. Endoscopy offers the possibility of opening the cyst widly with aspiration of all its content follow ed by coagulation of the internal colloid-secreting wall. Stereotactic aspiration is the least invasive approach in the treatment of colloid cysts, but the success of this method depends on cyst density. The microsurgical technique allows resection of the lesion at the cost of being more invasive and carrying a much greater risk of morbidity.From August 1995 to October 1997 we undertook ten endoscopic procedures to treat nine patients with colloid cysts of the third ventricle (six males, three females). The procedures were carried out using a Codman fibroendoscope in nine cases and a rigid Aesculap endoscope in one. Treatment was guided by stereotaxis in one case, neuronavigation in two and without a guide in seven. We had not recurrences in clinical symptoms or radiological views.

Background The process of reconciling medicines not available in the hospital has been demonstrated to be a powerful strategy to prevent adverse drug events. Purpose To evaluate drug prescription and administration errors after medicines reconciliation (MR) involving medicines not available in the hospital (MNAH) prescribed prior to admission. Materials and methods We conducted a cross-sectional, observational study in an academic medical centre using computerised physician-order entry (CPOE). After MR at admission, when clinicians decided that these medicines needed to be continued during hospitalisation, since they were not included in the CPOE database, they were prescribed as a generic product, ‘MNAH’ with the drug name and dosage. The main outcome measured was medicines errors involving MNAH detected in the prescription and administration phases. Results We analysed 338 MNAH prescribed to 207 inpatients, mainly for chronic cardiovascular diseases. We detected 211 prescription errors (62.4%, 95% CI: 57–67.6) most of them related to route of administration and dose and 47 drug administration errors (13.9%, 95% CI: 10.4–18). Omission was the principal type of error in both cases. The main causes of these errors were CPOE program deficiencies (62.1%, 95% CI: 55.1–68.6) and lack of information about medicines history in medical records (31.3%, 95% CI: 25.1–38). Most errors did not reach the patient or reached the patient without causing any harm. Errors that caused harm to patients were due to drug duplication. Clinicians considered that 65.9% (95% CI: 59–72.2) of errors could have been avoided with an improved CPOE system. Conclusions Errors associated with prescription and administration of MNAH after MR are common among adult inpatients. Our results suggest that there are two main weak points: i) lack of coordination and available information for clinicians about patients’ medicines history, ii) CPOE deficiencies related to MNAH prescription. No conflict of interest.

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