The epidemic phase of Coronavirus disease 2019 (COVID-19) made the Worldwide health system struggle against a severe interstitial pneumonia requiring high-intensity care settings for respiratory failure. A rationalisation of resources and a specific treatment path were necessary. The study suggests a predictive model drawing on clinical data gathered by 119 consecutive patients with laboratory-confirmed COVID-19 admitted in Busto Arsizio hospital. We derived a score that identifies the risk of clinical evolution and in-hospital mortality clustering patients into four groups. The study outcomes have been compared across the derivation and validation samples. The prediction rule is based on eight simple patient characteristics that were independently associated with study outcomes. It is able to stratify COVID-19 patients into four severity classes, with in-hospital mortality rates of 0% in group 1, 6–12.5% in group 2, 7–20% in group 3 and 60–86% in group 4 across the derivation and validation sample. The prediction model derived in this study identifies COVID-19 patients with low risk of in-hospital mortality and ICU admission. The prediction model that the study presents identifies COVID-19 patients with low risk of in-hospital mortality and admission to ICU. Moreover, it establishes an intermediate portion of patients that should be treated accurately in order to avoid an unfavourable clinical evolution. A further validation of the model is important before its implementation as a decision-making tool to guide the initial management of patients.
Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia is a complex and lethal condition. We reported the clinical case of a 58-year-old woman who developed MRSA bacteremia after a 3-month hospitalization for trauma and sepsis. Delay in diagnosis of aortic and mitral endocarditis in the setting of new-onset regurgitations, as the application of suboptimal therapy with linezolid and vancomycin, led to widespread disease with embolic dissemination and development of septic infarctions. Clinicians must be aware of the necessity to consider as high risk of endocarditis new onset valvular regurgitations and of the evidence about the need for daptomycin in treating high-risk MRSA bacteremia.
Introduction. The acetylcholinesterase inhibitor (CI) has recently been used for the treatment of senile dementia of Alzheimer type. Therefore, conflicting results exist in the literature on the action of the CI in the cardiovascular neurovegetative regulation. Aim. In this concern we worked on the ability to remotely monitor patients with dementia in their own homes, with the support of high-tech devices. Materials and Methods. We studied 36 patients (17 F and 19 M, 74,5 ± 8,4 years). At the patients we installed a new devices «Pulse» for a week. From the device we can obtain a record for 5-minute each hour in which the ECG, breath frequency, body position and activity level are reported. From the records we can extrapolate by means of KUBIOS-HRV software the HRV analysis, both linear and nonlinear. We divided the patients in two groups: in therapy with CI (19-9 F, 72,6 ± 7,6 years) and without CI (17-8 F, 75,3 ± 10,1 years). The CI administered generally was Donezepil or rivastigmine. Result. In the morning the indexes of sympathetic tone were more significant high in the patients with CI inhibitors respect to the patients without CI therapy and to the normal control, no differences were present between the control group and thee patients without CI therapy. Respect to patients without CI therapy in the patients with CI therapy we found a surprisingly greater and significant increase in sympathetic activity in all period considered specially during the night periods despite no difference in HR. In fact the linear and nonlinear indexes of the HRV of sympathetic activity was significantly higher in all considered daily period. Conclusion. Our data, obtained in telemedicine by means a new device «Pulse», show the sympathetic HRV indexes are significantly high in patients with CI therapy in all period of the day and this fact is more pronounced during the night hours.
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