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Agostoni C.,University of Milan | Baselli L.,University of Milan | Mazzoni M.B.,Emergency Unit
European Journal of Internal Medicine | Year: 2013

In the last decades several studies tested the hypothesis that at early development stages certain foods or nutrients, in specific amounts, fed during limited sensitive periods, may determine an endocrine metabolic asset leading to clinical alterations that take place decades later (early nutritional programming of long term health). Evidence is mounting for programming effects of infant feeding. Observational studies indicate that breast feeding, relative to formula feeding, reduces the risk for obesity at school age by about 20% even after adjustment for biological and sociodemographic confounders. Moreover, breastfeeding is constantly associated with increased neurodevelopmental scores up to early adulthood, while its outcome in terms of delayed decay of brain function is still unknown. Besides the environment surrounding breastfeeding, specific nutrients within human milk may play a direct role. With the introduction of solids the major changes in diet are represented by the sudden decrease of fat intake from 50 to 30% of total energy. A protein excess, commonly found throughout all European Countries, has been associated to a higher risk of adiposity in early childhood, as confirmed by first reports from a large European trial. The amount of fat does not seem to be associated with later adiposity, while its quality may affect blood lipoproteins, blood pressure and neurodevelopmental performance. Early intake of dietary fibers might also have beneficial effects. Epidemiologic data show that episodes of rapid growth (growth acceleration hypothesis), whichever the dietary habits, are associated with later unfavorable health conditions and should be prevented. © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Source

Komindr A.,Emergency Unit | Baugh C.W.,Brigham and Womens Hospital | Grossman S.A.,Beth Israel Deaconess Medical Center | Bohan J.S.,Brigham and Womens Hospital
International Journal of Emergency Medicine | Year: 2014

Background: To improve efficiency, emergency departments (EDs) use dedicated observation units (OUs) to manage patients who are unable to be discharged home, yet do not clearly require inpatient hospitalization. However, operational metrics and their ideal targets have not been created for this setting and patient population. Variation in these metrics across different countries has not previously been reported. This study aims to define and compare key operational characteristics between three ED OUs in the United States (US) and three ED OUs in Asia. Methods: This is a descriptive study of six tertiary-care hospitals, all of which are level 1 trauma centers and have OUs managed by ED staff. We collected data via various methods, including a standardized survey, direct observation, and interviews with unit leadership, and compared these data across continents. Results: We define multiple key operational characteristics to compare between sites, including OU length of stay (LOS), OU discharge rate, and bed turnover rate. OU LOS in the US and Asian sites averaged 12.9 hours (95% CI, 8.3 to 17.5) and 20.5 hours (95% CI, -49.4 to 90.4), respectively (P = 0.39). OU discharge rates in the US and Asia averaged 84.3% (95% CI, 81.5 to 87.2) and 88.7% (95% CI, 81.5 to 95.8), respectively (P = 0.11), and the bed turnover rates in the US and Asian sites averaged 1.6 patients/bed/day (95% CI, -0.1 to 3.3) and 0.9 patient/bed/day (95% CI, -0.6 to 2.4), respectively (P = 0.27). Conclusions: Prior research has shown that the OU is a resource that can mitigate many of problems in the ED and hospital, while simultaneously improving patient care and satisfaction. We describe key operational characteristics that are relevant to all OUs, regardless of geography or healthcare system to monitor and maximize efficiency. Although measures of LOS and bed turnover varied widely between US and Asian sites, we did not find a statistically significant difference. Use of these metrics may enable hospitals to establish or revise an ED OU and reduce OU LOS, increase bed turnover, and discharge rates while simultaneously improving patient satisfaction and quality of care. © 2014 Komindr et al.; licensee Springer. Source

Rombola F.,Emergency Unit | Rombola F.,Internal and Emergency Medicine Unit
Acta Gastro-Enterologica Belgica | Year: 2011

Mediterranean spotted fever (MSF) is an infectious disease, caused by Rickettsia conorii. It can have a serious course, even deadly, with many types of complications. Described is a case of a 70-year-old man, hospitalized for fever, abdominal pain, amylase and lipase elevation, and ultrasound hypoechoic pancreas. The working diagnosis at admission was acute pancreatitis. 2 days after admission, the patient developed signs of MSF: fever, maculopapular rash, and "tache noire". Treatment with oral doxycycline was started. After 5 days of therapy, there was complete remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with Mediterranean spotted fever. Much more rare is pancreatic involvement. Source

Marchetti P.,Emergency Unit | D'Avanzo C.,University of Padua | Orsato R.,Research Unit | Montagnese S.,University of Padua | And 8 more authors.
Gastroenterology | Year: 2011

Background & Aims: Electroencephalography has not been completely quantified in patients with cirrhosis. We investigated the electroencephalogram (EEG) dynamics in patients with cirrhosis. Methods: We performed closed-eye EEGs on 175 patients with cirrhosis (age, 55 ± 11 years; 24% Child-Pugh class A, 48% class B, and 285 class C), conducted clinical and psychometric assessments for hepatic encephalopathy (HE), and followed the patients for 1 year. EEG characteristics were assessed in the frequency domain, in the frontal (F3-F4) and parietal (P3-P4) derivations. Intrahemispheric (frontoparietal, right, and left) and interhemispheric (F3-F4 and P3-P4) coherence were computed. The EEGs of 50 healthy volunteers (age, 56 ± 17 years) served as controls. Results: Compared with controls, the EEGs of patients with cirrhosis had a reduced frequency in the posterior derivations (P3/P4 mean dominant frequency, 9.1 ± 1.8 and 8.9 ± 1.7 Hz vs 10.4 ± 1.3 and 10.2 ± 1.3 Hz, respectively; P < .01) and an increase in interhemispheric parietal relative coherence within the theta band (22.3% ± 5.5% vs 18.9% ± 3.5%; P < .01). These features were more prominent in patients with Child class C and in patients with a history of overt HE; they correlated with hyperammonemia and hyponatremia. The decrease in EEG frequency, along with the increase in interhemispheric theta coherence in the posterior derivations, was inversely associated with survival and the occurrence of overt HE during the follow-up period. Conclusions: In patients with cirrhosis, alterations in the EEG were significantly associated with the severity of liver disease and HE; the EEG might be used in determining prognosis. © 2011 AGA Institute. Source

Agostoni C.,Pediatric Clinic 2 | Laicini E.,Emergency Unit
International Journal of Food Sciences and Nutrition | Year: 2014

Recent findings suggest that an early exposure to dietary antigens may be more protective towards allergy than a later introduction even in high-risk infants. The consequent earlier introduction of food items such as egg yolk and oily fish, together with breastfeeding continuation through the first year, could contribute to reducing protein and increasing fat supply, respectively. These changes might have a role in the overall prevention of non-communicable disorders of adulthood. © 2014 Informa UK Ltd. Source

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