Chronobiology of transient global amnesia Hoyer, Carolin; Higashida, Kyoko; Fabbian, Fabio ...
Journal of neurology,
01/2022, Letnik:
269, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Introduction
The etiology of transient global amnesia (TGA) is still a matter of debate. Based, among others, on the observation of a close temporal relation between certain events and subsequent TGA ...episodes, recent proposals discuss the relevance of stress-associated processes impacting on hippocampal functioning. Circadian, infra- and ultradian rhythmicity has been found to play a relevant role in the multifactorial pathomechanisms of various disorders but has not been thoroughly studied in TGA.
Methods
Data of patients with a final diagnosis of TGA were collected in Mannheim, Germany (06/1999–01/2018,
n
= 404), and in the Kansai district, Japan (04/2006–03/2018,
n
= 261). Chronological patterns of TGA occurrence were determined.
Results
Significant circadian rhythmicity of TGA occurrence with bimodal peaks (mid-morning, late afternoon) was found for the entire population (
p
= 0.002) and for either sub-cohort (Mannheim:
p
= 0.003, Kansai:
p
= 0.007). This finding was confirmed for either sex (women:
p
= 0.004, men:
p
= 0.004) and different age groups (< 65 years:
p
= 0.0009, ≥ 65 years:
p
= 0.003). There was no variation according to day of the week, month or season, but the proportion of patients with a weekday episode was significantly higher in the Mannheim cohort (
p
= 0.002).
Discussion
We identified a robust circadian rhythm in TGA occurrence which remarkably applied to either of the two study sites located on different continents and which was independent of sex and age. In light of abundant evidence of circadian rhythmicity of both, components of the human stress response system and memory, chronobiological analyses may provide an opportunity to further uncover the mechanisms underlying TGA.
We studied the outcomes of peripheral artery disease (PAD) patients enrolled in a structured in-home walking program right before the lockdown due to the SARS-CoV-2 epidemic emergency, to determine ...whether this intervention ensured the maintenance of mobility even in the case of movement restrictions.
We selectively studied 83 patients (age 72 ± 11, males
n
= 65) enrolled in the program within 9-month before the lockdown. The usual intervention was based on two daily 8-min sessions of slow intermittent in-home walking prescribed in circa-monthly hospital visits. During the lockdown, the program was updated by phone. Six-minute (6MWD) and pain-free walking distance (PFWD) were measured pre- and post-lockdown as well as body weight (BW), blood pressure (BP), and ankle-brachial index (ABI). Sixty-six patients were measured 117 ± 23 days after their previous visit. A safe, pain-free execution of the prescribed sessions was reported (median distance: 74 km). Overall, the 6MWD was stable, while PFWD improved (
p
< 0.001). The improvement was not related to age/gender, comorbidities, type of home but to the time of enrollment before lockdown. The new-entry subjects (≤ 3 months;
n
= 35) obtained significant improvements post-lockdown for 6MWD and PFWD, while those previously enrolled (> 3 months;
n
= 31) were stable. Decreased BW with stable BP and ABI values were also recorded, with better outcomes for new-entry subjects. In PAD patients, a structured walking program performed inside home and purposely guided by phone was adhered to by patients and favored mobility and risk factor control during the COVID-19 pandemic, regardless of walking ability, type of home and external conditions.
Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. This study proposed a new tool, i.e. modified qSOFA, for the early prognostic assessment of septic ...patients. All cases of sepsis/septic shock consecutively observed in 2 years (January 2017–December 2018), at St. Anna University Hospital of Ferrara, Italy, were included. Each patient was evaluated with qSOFA and a modified qSOFA (MqSOFA), i.e. adding a SpO2/FiO2 ratio to qSOFA. Logistic regression and survival analyses were applied to compare the two scores. A total number of 1137 consecutive cases of sepsis and septic shock were considered. Among them 136 were excluded for incomplete report of vital parameters. A total number of 668 patients (66.7%) were discharged, whereas 333 (33.3%) died because of sepsis-related complications. Data analysis showed that MqSOFA (AUC 0.805, 95% C.I. 0.776–0.833) had a greater ability to detect in-hospital mortality than qSOFA (AUC 0.712, 95% C.I. 0.678–0.746) (
p
< 0.001). Eighty-five patients (8.5%) were reclassified as high-risk (qSOFA< 2 and MqSOFA≥ 2) resulting in an improvement of sensitivity with a minor reduction in specificity. A significant difference of in-hospital mortality was observed between low-risk and reclassified high-risk (
p
< 0.001) and low-risk
vs.
high-risk groups (
p
< 0.001). We demonstrated that MqSOFA provided a better predictive score than qSOFA regarding patient’s outcome. Since sepsis is an underhanded and time-dependent disease, physicians may rely upon the herein proposed simple score, i.e. MqSOFA, to establish patients’ severity and outcome.
Background
We conducted a study, based on discharge hospital sheets International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), in order to evaluate the relationship ...between chronic kidney disease (CKD), acute kidney injury (AKI), multi-morbidity, and in-hospital mortality (IHM).
Methods
This study included all hospital admissions for
chronic obstructive pulmonary disease
(COPD) exacerbations between January 1, 2000, and December 31, 2013, recorded in the database of the University Hospital St. Anna of Ferrara. Age, sex, and diagnosis of CKD and AKI were collected, and Charlson comorbidity index (CCI) was calculated by ICD-9-CM codes. IHM was our main outcome.
Results
We analyzed 7073 subjects with COPD exacerbation; they were more frequently male (56.9 vs 43.1 %), and mean age was 76.7 ± 9.8 years. Diagnosis of CKD was present in 771 patients (10.9 %), while AKI was diagnosed in 354 cases (5 %). A total of 554 patients (7.8 %) died during hospitalization, and LOS was 10.3 ± 11.2 days (median 8 days); the CCI corrected for CKD was 2.30 ± 1.65. Univariate analysis showed that IHM group had higher age (81.2 ± 7.9 vs 76.3 ± 9.9 years,
p
< 0.001), CCI (2.61 ± 2.21 vs 2.28 ± 1.62,
p
= 0.001), and LOS (11.1 ± 15.1 vs 10.3 ± 10.8 days,
p
= 0.001) and developed AKI more frequently (16.6 vs 4 %,
p
< 0.001) than survivors. Multivariate logistic regression analysis showed an independent association of IHM with age (OR 1.063; 95 % CI 1.050–1.075,
p
< 0.001), male sex (OR 1.229; 95 % CI 1.016–1.486,
p
= 0.033), logCCI (OR 2.051; 95 % CI 1.419–2.964,
p
< 0.001), and AKI (OR 3.849; 95 % CI 2.874–5.155,
p
< 0.001).
Conclusions
Acute kidney injury (AKI) represents a very important predictive factor of IHM in male older adult with multi-morbidity admitted because of COPD exacerbations.
During the COVID-19 2020 outbreak, a large body of data has been provided on general management and outcomes of hospitalized COVID-19 patients. Yet, relatively little is known on characteristics and ...outcome of patients managed in Internal Medicine Units (IMU). To address this gap, the Italian Society of Internal Medicine has conducted a nationwide cohort multicentre study on death outcome in adult COVID-19 patients admitted and managed in IMU. This study assessed 3044 COVID-19 patients at 41 referral hospitals across Italy from February 3rd to May 8th 2020. Demographics, comorbidities, organ dysfunction, treatment, and outcomes including death were assessed. During the study period, 697 patients (22.9%) were transferred to intensive care units, and 351 died in IMU (death rate 14.9%). At admission, factors independently associated with in-hospital mortality were age (OR 2.46,
p
= 0.000), productive cough (OR 2.04,
p
= 0.000), pre-existing chronic heart failure (OR 1.58,
p
= 0.017) and chronic obstructive pulmonary disease (OR 1.17,
p
= 0.048), the number of comorbidities (OR 1.34,
p
= 0.000) and polypharmacy (OR 1.20,
p
= 0.000). Of note, up to 40% of elderly patients did not report fever at admission. Decreasing PaO
2
/FiO
2
ratio at admission was strongly inversely associated with survival. The use of conventional oxygen supplementation increased with the number of pre-existing comorbidities, but it did not associate with better survival in patients with PaO
2
/FiO
2
ratio < 100. The latter, significantly benefited by the early use of non-invasive mechanical ventilation. Our study identified PaO
2
/FiO
2
ratio at admission and comorbidity as the main alert signs to inform clinical decisions and resource allocation in non-critically ill COVID-19 patients admitted to IMU.
Infectious diseases (ID) are frequently cause of internal medicine wards (IMW) admission. We aimed to evaluate risk factors for in-hospital mortality (IHM) in IMW patients with ID, and to test the ...usefulness of a comorbidity score (CS).This study included ID hospital admissions between January 2013, and December 2016, recorded in the database of the local hospital. ICD-9-CM codes were selected to identify infections, development of sepsis, and to calculate a CS.We analyzed 12,173 records, (age 64.8 ± 25.1 years, females 66.2%, sepsis 9.3%). Deceased subjects (1545, 12.7%) were older, had higher percentage of sepsis, pulmonary infections, and endocarditis. Mean value of CS was also significantly higher. At multivariate analysis, the odds ratio (OR) for sepsis (OR 5.961), endocarditis (OR 4.247), pulmonary infections (OR 1.905), other sites of infection (OR 1.671), and urinary tracts infections (OR 0.548), were independently associated with IHM. The CS (OR 1.070 per unit of increasing score), was independently associated with IHM as well. The calculated weighted risk, obtained by multiplying 1.070 for the mean score value in deceased patients, was 19.367. Receiver operating characteristic (ROC) analysis showed that CS and development of sepsis were significant predictors for IHM (area under the curve, AUC: 0.724 and 0.670, respectively).Careful evaluation of comorbidity in internal medicine patients is nowadays matter of extreme importance in IMW patients hospitalized for ID, being IHM related to severity of disease, type and site of infection, and also to concomitant comorbidities. In these patients, a careful evaluation of CS should represent a fundamental step in the disease management.
This review was performed to investigate the association between treatment with dialysis and Takotsubo syndrome in patients with end-stage renal disease. We systematically explored the PubMed ...database using the search terms “Takotsubo cardiomyopathy” and/or “stress-induced cardiomyopathy” and/or “Takotsubo syndrome” in combination with “dialysis” and “uremia.” Of 3630 articles found, 8 articles reporting 10 cases were selected for analysis. Most patients were women, and their age ranged from 51 to 84 years. Diabetes mellitus and hypertension were diagnosed in 40% of patients, and glomerular disease was diagnosed in 30%. One only patient was treated with peritoneal dialysis; all others were treated with hemodialysis. The outcome was unfavorable in only one patient. An association between Takotsubo syndrome and dialysis is uncommon, but not negligible, and comorbidities play a major role in determining the clinical outcome.
Kawasaki disease (KD) or mucocutaneous lymph node syndrome is a vasculitis that mostly occurs in young children. Adult-onset KD (AKD) is rare and often misdiagnosed. Here we report a rare case of KD ...with cholestasis as principal symptom.
A 43-year-old caucasian man was admitted to our hospital for high fever, lack of appetite related to nausea and vomiting, headache and significant malaise. Physical examination highlighted fever, increasing jaundice, bilateral laterocervical lymph nodes, erythema of the palms, and strikingly red lips and conjunctiva. The clinical course was complicated by arterial hypotension, tachycardia, decreasing haemoglobin, increasing acute phase reactants tests, and multiorgan failure. Due to cardiovascular instability the patient was admitted to the local Intensive Care Unit. Chest X-ray, abdominal ultrasound, chest and abdominal CT and Colangio Magnetic Resonance were normal. Jaundice was investigated and infections, autoimmune diseases or drugs adverse reactions, were excluded. Also coronary artery computed tomography was carried out excluding coronary artery aneurysms. Broad-spectrum antibiotics were not effective. After exclusion other possible conditions, diagnosis of KD was set. He was treated with high doses of corticosteroids and acetylsalicylic acid and clinical conditions as well as laboratory exams improved.
This report dealing with an adult onset of atypical KD may be of benefit to physicians of various specialties, including primary care doctors, hospital internists, intensivists and gastroenterologists due to its peculiarities. It demonstrates that a case of prolonged fever unresponsive to antibiotics and related to cholestatic jaundice, oedema or erythema of the extremity associated with desquamation of feet and hands, and red eyes, may suggest atypical form of KD.
Haemopericardium with cardiac tamponade following minor blunt trauma is a rare, life-threatening condition. The diagnosis of cardiac tamponade as well as therapeutic management may be delayed, since ...the link between trauma and illness is often overlooked. We report the case of an old woman who developed a relatively delayed cardiac tamponade due to an otherwise minor blunt chest trauma following syncope.
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