The Care Coordinator's Tasks During the Implementation of an Integrated Care Pathway for Older Patients: A Qualitative Study Based on the French National "Health Pathway of Seniors for Preserved Autonomy" Pilot Program.

Background: Although integrated care and care coordination are known to be beneficial for older adults' population, the specific tasks of a Care Coordinator (CC) for integrated care pathways for this population have not been studied in detail. Setting & Subjects: The French national pilot program PAERPA provided an integrated care pathway for older adults. In North France, a CC was recruited to support patients and professionals. Objectives: (i) To analyse the CC's tasks in an integrated care pathway for older patients, and (ii) to record perceptions on the CC's tasks among the participating general practitioners (GP) and community pharmacists. Design & Methods: Qualitative, two-phase study: (i) Task analysis of the CC's tasks, to compare the planned and actual tasks; (ii) semi-structured interviews among GPs and community pharmacists involved in the pathway. Results: (i) The task analysis showed that the CC's actual tasks differed from planned tasks. The CC was only meant to be involved in the early stages of the process; actually, the CC undertook more or even unforeseen tasks in coordination, communication, and administrative support throughout the care pathways. (ii) The 28 interviewed healthcare professionals considered the CC's tasks to be essential to the success of pathways. They appreciated the CC's administrative support. However, CC's tasks related to interprofessional communication, and patient and family information, were controversially perceived among GPs and pharmacists. Conclusions: The CC's tasks in an integrated care pathway for older adults showed that the CC's overall workload was greater than expected and appreciated by healthcare professionals.

Adaptaciones de la dispensación hospitalaria a pacientes con hemofilia durante la pandemia COVID-19 en España y su influencia en la adherencia / Adaptations of hospital dispensing to haemophilia patients during the COVID-19 pandemic in Spain and its influence on adherence

Introducción: El estado de alarma decretado por la pandemia del virus SARS COV-2 del 14 de marzo hasta el 21 de junio, ha supuesto un desafío para el área de pacientes externos de los Servicios de Farmacia. Nos centramos en los pacientes con hemofilia que se administran factores de la coagulación de forma crónica para prevenir hemorragias.Objetivos: Analizar durante este periodo el porcentaje de pacientes que han recogido su medicación, han mantenido la adherencia al tratamiento y las barreras encontradas para ello. Cuantificar el número y gravedad de episodios hemorrágicos (EH) sufridos y su relación con la pandemia. Analizar la prevalencia y gravedad de COVID en hemofílicos.Métodos: Uno objetivo, utilizando los registros del hospital y otro subjetivo, mediante encuesta oral durante la consulta de atención farmacéutica presencial o telemática.Resultados: El 80% de los pacientes retiraron medicación durante el periodo de estudio, un 30% en domicilio. El último mes las dispensaciones a domicilio se acompañaron de consulta telemática.Un 24% de pacientes disminuyó su adherencia respecto al 2019. Las principales causas fueron dificultad para acudir al hospital, y percepción de no necesitar tratamiento ante la inactividad.No se registraron más EH o ingresos por causas imputables a la pandemia.No hubo ningún enfermo COVID-19 grave y la incidencia de pacientes con síntomas leves fue similar a la población general.Conclusión: La mayoría de los pacientes con hemofilia pudieron acceder a su medicación. La adherencia se redujo. Los EH no aumentaron por causas atribuibles a la pandemia. La incidencia de COVID-19 fue similar a la población. (AU)

Introduction: The state of alarm decreed by the SARS COV-2 virus pandemic from March 14th to June 21st, has meant a challenge for the outpatient area of the pharmacy services. We focus on hemophilia patients who are chronically administered clotting factors to prevent bleeding.Objectives: To analyse during this period the percentage of patients who have collected their medication, maintained adherence to treatment and the barriers encountered in doing so. To quantify the number and severity of haemorrhagic episodes (HD) suffered and their relationship with the pandemic. Analyse the prevalence and severity of COVID in haemophiliacs.Methods: One objective, using hospital records, and one subjective, using an oral survey during the face-to-face or telematic pharmaceutical care consultation.Results: 80% of patients withdrew medication during the study period, 30% at home. In the last month, home deliveries were accompanied by telematic consultation.24% of patients decreased their adherence with respect to 2019. The main causes were difficulty in going to hospital, and perception of not needing treatment in the face of inactivity.There were no more HD or admissions for reasons attributable to the pandemic.There were no serious COVID-19 patients and the incidence of patients with mild symptoms was similar to the general population.Conclusion: Most haemophilia patients were able to access their medication. Adherence was reduced. HD did not increase due to causes attributable to the pandemic. The incidence of COVID-19 was similar to the population. (AU)

Terms used by physicians when deciding to withhold treatment for older patients not having received palliative care in an acute geriatric care unit.

PURPOSE: There are no guidelines or consensus statements on the terms to be used when discussing withholding of treatment for patients in acute geriatric care units and who have not received palliative care. The objective of the present study was to analyze the terms used in medical records to refer to the withholding of treatment for patients who died in an acute geriatric care unit and did not receive palliative care. METHODS: We conducted an ambispective multicentre cohort study based on the DAMAGE study. Data on 53 patients who died in the acute geriatric care unit and who had not received palliative care were extracted from medical records. The verbatims referring to the withholding of treatment were analyzed in terms of keywords and then key concepts, as defined by several reviewers in a consensus-based approach. RESULTS: The mean age of the patients was 86.4 years, 34.1% were male. Terms referring to the withholding of treatment were found for 25 of the 53 patients (47.2%). Most of the decisions on the withholding of treatment were recorded in the week following admission to the acute geriatric care unit. Our analysis of the terms identified 11 key concepts: treatment limitation, no resuscitation, withholding diagnostic procedures, justification of care, ethical considerations, disease progression, uncertainty, the patient's wishes, the family's wishes, patient's comfort, and collegiality. The terms used to describe key concepts varied markedly from one physician to another. CONCLUSION: Decisions about the withholding of treatment are frequently noted in the medical records of patients who die in the acute geriatric care unit without having received palliative care. The broad variety of key concepts and differences in the choice of words highlight the need for standardized terms.

Effects of dietary microbial feed supplement on production efficacy in lactating dairy cows.

This study evaluated the effects of a microbial feed supplement (MFS; Galaxis, Ascus Biosciences Inc.) comprising 2 native rumen microbes on performance parameters in mid-lactation dairy cows. Forty-six lactating primiparous and multiparous Holstein cows [629 ± 62 kg of body weight, mean ± standard deviation (SD); parity 1.64 ± 0.49; 119 ± 38 days in milk; 45.11 ± 3.81 and 52.73 ± 4.77 kg/d of milk yield for primiparous and multiparous, respectively] were enrolled in a study containing 3 experimental periods (P). During all periods, enrolled cows were fed the same base total mixed ration (TMR) ad libitum once daily. During P1 (7 d), baseline data were obtained for covariate analysis. At the beginning of P2 (60 d), cows were assigned to 1 of 2 dietary treatment groups in a randomized complete block design to balance for milk yield (MY), parity, and days in milk: (1) a control diet (CON; base TMR; n = 23), or (2) a control diet supplemented with 5 g/d of MFS (MFS; n = 23). Sample size was determined based on previous, unpublished results involving this MFS; a 3-kg difference between groups with a SD of 3.5 kg could be detected with sufficient power (0.81) using a total sample size of 46 cows. Treatment was top-dressed and hand-mixed into the top one-third of the TMR. During P3 (7 d), no treatment was administered, and all cows were fed the base TMR. When analyzing all cows in the data set, MFS had little to no effect on performance. However, modeling revealed that the fixed effect of covariate milk production level had a significant effect on the response of MY and ECM, and further investigation of the data revealed that treatment effectiveness in P2 correlated with milk production during P1. Cows were retrospectively categorized into 2 milk production groups (MPG) balanced for parity: MPG1 (i.e., <53 kg/d of ECM during P1; n = 34) or MPG2 (i.e., ≥53 kg/d of ECM during P1; n = 12). Energy-corrected milk was increased by 4.4% in MFS-administered MPG1 cows compared with CON cows during P2. Although there were no significant effects of MFS on production variables for MPG2 cows, MY tended to be decreased by 3.9% in MFS-administered cows compared with CON cows. Further investigation is needed to understand production level response differences and the effect of supplemented native rumen microbes on animal health and productivity.

Metagenomic and volatile profiles of ripened cheese obtained from dairy ewes fed a dietary hemp seed supplementation.

Chemical and organoleptic properties of dairy products largely depend on the action of microorganisms that tend to be selected in cheese during ripening in response to the availability of specific substrates. The aim of this work was to evaluate the effects of a diet enriched with hemp seeds on the microbiota composition of fresh and ripened cheese produced from milk of lactating ewes. Thirty-two half-bred ewes were involved in the study, in which half (control group) received a standard diet, and the other half (experimental group) took a diet enriched with 5% hemp seeds (on a DM basis) for 35 d. The dietary supplementation significantly increased the lactose in milk, but no variations in total fat, proteins, caseins, and urea were observed. Likewise, no changes in total fat, proteins, or ash were detected in the derived cheeses. The metagenomic approach was used to characterize the microbiota of raw milk and cheese. The phyla Proteobacteria and Firmicutes were in equally high abundance in both control and experimental raw milk samples, whereas Bacteroidetes was less abundant. The scenario changed when considering the dairy products. In all cheese samples, Firmicutes was clearly predominant, with Streptococcaceae being the most abundant family in the experimental group. The reduction of taxa observed during ripening was in accordance with the increment (relative abundance) of the starter culture Lactococcus lactis and Streptococcus thermophilus, which together dominate the microbial community. The analysis of the volatile profile in ripened cheeses led to the identification of 3 major classes of compounds: free fatty acids, ketones, and aldehydes, which indicate a prevalence of lipolysis compared with the other biochemical mechanisms that characterize the cheese ripening.

Is pizza sutable to type 1 diabetes? A real life identification of best compromise between taste and low glycemic index in patients on insulin pump.

Opposed to whole wheat (WWP), traditional pizza (TP) is loved by patients with type 1 diabetes mellitus (T1DM) despite causing hyperglycemia. 50 well-trained T1DM patients had higher glucose levels after TP than after WWP or mixed flour pizza, which however was tasty, digestible and metabolically appropriate to break diet monotony.

Cryptochrome mediated magnetic sensitivity in Arabidopsis occurs independently of light-induced electron transfer to the flavin.

Cryptochromes are highly conserved blue light-absorbing flavoproteins which function as photoreceptors during plant development and in the entrainment of the circadian clock in animals. They have been linked to perception of electromagnetic fields in many organisms including plants, flies, and humans. The mechanism of magnetic field perception by cryptochromes is suggested to occur by the so-called radical pair mechanism, whereby the electron spins of radical pairs formed in the course of cryptochrome activation can be manipulated by external magnetic fields. However, the identity of the magnetosensitive step and of the magnetically sensitive radical pairs remains a matter of debate. Here we investigate the effect of a static magnetic field of 500 µT (10× earth's magnetic field) which was applied in the course of a series of iterated 5 min blue light/10 min dark pulses. Under the identical pulsed light conditions, cryptochrome responses were enhanced by a magnetic field even when exposure was provided exclusively in the 10 min dark intervals. However, when the magnetic stimulus was given exclusively during the 5 min light interval, no magnetic sensitivity could be detected. This result eliminates the possibility that magnetic field sensitivity could occur during forward electron transfer to the flavin in the course of the cryptochrome photocycle. By contrast, radical pair formation during cryptochrome flavin reoxidation would occur independently of light, and continue for minutes after the cessation of illumination. Our results therefore provide evidence that a magnetically sensitive reaction is entwined with dark-state processes following the cryptochrome photoreduction step.

Understanding the role of threading dislocations on 4H-SiC MOSFET breakdown under high temperature reverse bias stress.

The origin of dielectric breakdown was studied on 4H-SiC MOSFETs that failed after three months of high temperature reverse bias stress. A local inspection of the failed devices demonstrated the presence of a threading dislocation (TD) at the breakdown location. The nanoscale origin of the dielectric breakdown was highlighted with advanced high-spatial-resolution scanning probe microscopy (SPM) techniques. In particular, SPM revealed the conductive nature of the TD and a local increase of the minority carrier concentration close to the defect. Numerical simulations estimated a hole concentration 13 orders of magnitude larger than in the ideal 4H-SiC crystal. The hole injection in specific regions of the device explained the failure of the gate oxide under stress. In this way, the key role of the TD in the dielectric breakdown of 4H-SiC MOSFET was unambiguously demonstrated.

Whole-transcriptome profiling of sheep fed with a high iodine-supplemented diet.

Iodine (I) is a micronutrient that mammals need for proper functionality of thyroid gland since it is the main component of thyroid hormones. Besides studies that have investigated the role of I in livestock nutrition, it is also important to know the transcriptomics changes in small ruminants following I supplementation. Therefore, the aim of this study was to investigate the effects of I on the whole blood transcriptome in sheep. Fifteen lactating cross-bred ewes (3 to 4-year-old, 55 to 65 kg BW) at their late lactation period were enrolled in this study. At the beginning, all the animals had a 2-week acclimation period where they were fed with a basal diet which includes an adequate level of I (2 mg I/animal per day) in the form of calcium iodate (CaI2O6). Then, the ewes were randomly divided into two groups and fed in individual troughs: the control group (n = 5) was maintained on basal diet and the experimental group (I, n = 10) was fed for 40 days with a diet containing a high I supplementation (equivalent to 30 mg I/animal per day), in the form of potassium iodide. Whole blood and milk were collected individually at the beginning (T0) and after the 40 days of supplementation (T40). Iodine quantification was assessed in serum and milk sample. Microarray gene expression analysis was performed on whole blood and, filtering data using a fold change >2 with an adjusted P < 0.05, we identified 250 differentially expressed genes (DEGs) in the I group (T40 v. T0). Looking for biological processes associated with our DEGs, we found significant association with cell growth regulation. Thus, our study unveils the role of I supplementation on gene expression in sheep improving the knowledge about micronutrients in animal nutrition.

Short communication: Compositional characteristics and aromatic profile of caciotta cheese obtained from Friesian cows fed with a dietary supplementation of dried grape pomace.

The aim of the present work was to explore the chemical-sensorial characteristics and aromatic profile of caciotta cheese obtained from Friesian cows fed a diet enriched with grape pomace obtained from red grape (Vitis vinifera L.). Dietary enrichment with grape pomace influenced the production of caciotta cheeses in interesting ways from a compositional point of view, as cheese samples were rich in polyphenols, giving a high antioxidant potential. From a biochemical standpoint, we noted a slight decrease of proteolysis during ripening, whereas, according to the analysis of volatile compounds, lipolysis was the most relevant phenomenon in samples. The presence of bioactive compounds also modified the fatty acid profile of milk and cheese, leading to an increase in concentration of linoleic, vaccenic, and rumenic acids. No significant variations were found in the sensory profile. These results showed the potential of dietary grape pomace intake to influence the chemical-nutritional and nutraceutical properties of cow milk and cheeses, whose introduction to the market could be attractive to consumers, providing interesting implications for the dairy industry. Finally, our results identified of a valid use of an agro-industrial by-product, grape pomace, whose disposal generally presents economic and environmental problems.

Satisfaction of patients' next of kin in a 'Hub & Spoke' ICU network.

This study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist 'Hub' intensive care unit, to 'Spoke' intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21-month period, who were repatriated to Spoke intensive care units for ongoing intensive care. One year after admission to the Hub intensive care unit, two thirds of patients' next of kin said they would have preferred patients to have been treated only in the Hub intensive care unit, and not repatriated. They perceived Hub intensive care unit care to be important, and would have preferred that their relatives be hospitalised there until intensive treatment was completed. The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.

Influencia de un programa de conciliación terapéutica en la tasa de reingreso de pacientes ancianos / Influence of a medication reconciliation program in elderly patients on readmission rate

Objetivo: Principal: medir el impacto en la tasa de reingreso a los 30 días de un programa de conciliación terapéutica al ingreso y al alta en pacientes mayores de 65 años. Secundarios: detectar, clasificar y analizar las discrepancias, errores de conciliación (EC) y prescripción de medicamentos potencialmente inadecuados (MPI). Material y Método: Estudio observacional prospectivo, no controlado, no aleatorizado, unicéntrico, con pacientes mayores de 65 años, ingresados en Medicina Interna y Geriatría. Se realizó conciliación terapéutica al ingreso y al alta, registrando medicación habitual, discrepancias justificadas, no justificadas, EC, MPI y medicamentos de alto riesgo (MAR). Se calculó la tasa de reingreso y se comparó con la tasa del año 2013 para cada servicio médico. Resultados: 91 pacientes con una media de 86 (71-99) años, el 47% con MAR y 8,9 medicamentos crónicos por paciente. Se conciliaron 1113 medicamentos, con 836 discrepancias justificadas, 56 EC y 36 MPI. Los EC se produjeron por omisión (n=34), diferente dosis o vía (n=16), prescripción incompleta (n=1), medicamento equivocado (n=1) y comisión (n=19). Por gravedad se detectaron en las categorías B (n=16), C (n=30), D (n=9) y E (n=1). El 31,9% de los pacientes tuvo un EC. Las tasas de reingreso para Medicina Interna y Geriatría fueron respectivamente de 12,2% y 14,3% frente a las globales de 2013 de 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) y 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusiones: Las tasas de reingreso a los 30 días en los pacientes conciliados fueron inferiores a las globales de 2013, aunque no estadísticamente significativas

Objective: To measure the impact of a pharmacist-based medication reconciliation program on readmission rates 30 days after its implementation, at admission and discharge, in patients aged 65 years and older. Secondary objectives were to detect and classify medication discrepancies, reconciliation errors (RE) and the prescription of potentially inappropriate medications in elderly patients (PIM). Methods: Prospective observational, uncontrolled, nonrandomized, single-center study performed in patients aged 65 years and older, hospitalized in the Internal Medicine and Geriatrics units. Medication reconciliation was performed by a pharmacist at admission and discharge. The pharmacist recorded chronic medication, justified and unjustified discrepancies, RE, PIM and high-risk medications (HRM). 30-day readmission rate was calculated and then compared with the 2013 rate for each medical unit. Results: A total of 91 patients were included, with an average age of 86 (71-99) years, 47% with HRM and 8.9 chronic medications per patient. 1113 medications were reconciled, of which 836 had justified discrepancies, 56 RE and 36 PIM. The RE were caused by omission (n=34), discrepancies in via or dose (n=16), incomplete prescription (n=1), wrong drug (n=1) and commission (n=19). Regarding its seriousness, RE were classified as B (n=16), C (n=30), D (n=9) and E (n=1). 31.9% of the patients had a RE. 30-day readmission rates for Internal Medicine and Geriatrics units were respectively 12,2% and 14,3%, compared with 2013 overall rate of 17,9% (RR=0,652; IC95% 0,279-1,521; p=0,322) and 16,3% (RR=0,895; IC95% 0,443-1,812; p=0,758). Conclusions: 30-day readmission rates were lower than 2013 overall rate with the medication reconciliation program. However, this is not statistically significant

Leptin and paraoxonase activity in cord blood from obese mothers.

OBJECTIVE: Obesity and/or psychopathological disorders of parents represent risk factors for childhood obesity. The aim of the study was to investigate the link between obesity in pregnancy and oxidative stress. METHODS: Venous blood was collected from 37 women at the eighth month of gestation (19 obese and 28 normal weight). Cord blood was obtained at birth from newborns of obese mothers and controls. Cord blood and maternal blood was used to separate plasma to be used for the evaluation of leptin, oxidized LDL and paraoxonase (PON1) activity. RESULTS: Higher levels of leptin were observed both in maternal blood and cord blood of children of obese women compared to normal-weight women. The data also showed lower levels of PON1 activity in plasma of obese women and in the cord blood of their children. Furthermore, a positive correlation was established between levels of PON1 activity in maternal blood and cord blood, suggesting a relationship between PON1 in maternal plasma and fetal cord blood. CONCLUSIONS: Essential obesity in pregnancy is associated with hyperleptinemia. PON1 exerts an antioxidant role; therefore, our results demonstrated that obesity exposes to an increased susceptibility to oxidative damage in both mothers and newborns.

Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome.

OBJECTIVE: To investigate the predictive value of serum C3 and C4 complement component levels in relation to pregnancy outcome in patients with antiphospholipid syndrome (APS). MATERIALS AND METHODS: A prospective study of 47 pregnancies associated with APS was performed. Pregnancy outcome was analyzed in terms of: fetal loss, preterm delivery (≤34 gestational weeks), fetal intrauterine growth restriction (IUGR), birth weight <2500 g and preeclampsia. Week at delivery, neonatal birth weight and neonatal birth weight percentile were also investigated. Hypocomplementemia, positivity for anti-dsDNA and triple positivity for antiphospholipid antibodies (aPL) were related to pregnancy outcome. RESULTS: Forty-three pregnancies ended in live births with a fetal loss rate of 8.5%. Fetal death, preterm delivery and birth weight <2500 g were associated with hypocomplementemia (p = 0.019, p = 0.0002, p < 0.0001 respectively). Lower neonatal birth weight, lower neonatal birth weight percentile and lower week at delivery were associated with hypocomplementemia (p < 0.0001, p = 0.0003, p < 0.0001 respectively) and with triple aPL positivity (p = 0.008, p = 0.014, p = 0.03 respectively). A poor pregnancy outcome was confirmed among primary APS (PAPS) pregnancies with hypocomplementemia. Multivariate analysis confirmed that hypocomplementemia was an independent predictor of lower neonatal birth weight (p = 0.0001) and lower week at delivery (p = 0.002). CONCLUSION: Hypocomplementemia could be considered a novel prognostic factor for pregnancy outcome in APS patients.

PP158. Hypertensive disorders in pregnant women affected by type I diabetes.

INTRODUCTION: Type I diabetes in pregnancy is associated with an increased incidence of hypertensive disorders. OBJECTIVES: The aim of the present study was to evaluate the incidence of hypertensive disorders in pregnant women affected by type I diabetes and pregnancy outcome in women with and without hypertension. METHODS: One hundred seventy two pregnancies in 150 women affected by type I diabetes were assessed. Twelve pregnancies were excluded (8 because of spontaneous abortions, 1 for voluntary abortion and 3 twin pregnancies), and 160 pregnancies were considered for the study. RESULTS: Twenty-five pregnancies (15.6%) were complicated by hypertensive disorders: 4.4% by chronic hypertension (CH), 5% by gestational hypertension (GH), 4.4% by preeclampsia (PE) and 1.8% by preeclampsia superimposed on chronic hypertension (PE+CH); 32% of the women presented a vascular disease (renal or retinal disease). The diabetic women with hypertensive complications were compared with diabetic women without hypertension. The main results are shown in Table 1. Significant differences in mean birth weight and mean gestational age were found. The group affected by preeclampsia showed 14.7% of small for gestational age (SGA) neonates (birth weight percentile less than 10th pc), and 57.1% of large for gestational age (LGA) neonates (birth weight percentile greater than 90th pc), two of them were over 4000 g. Only one case of very preterm delivery (<32 weeks) was observed in the sample. CONCLUSION: As expected, the incidence of hypertensive disorders in population affected by type 1 diabetes is higher than in general population and a poor pregnancy outcome was observed in this group of women. However, the neonatal outcome of women affected by preeclampsia is not different from that observed in women without hypertensive complications (diabetic controls) in terms of mean birth weight despite a significantly lower mean week gestation at delivery.

Kidney transplantation from hepatitis B virus core antibody-positive donors: prophylaxis with hepatitis B immunoglobulin.

OBJECTIVE: Hepatitis B virus core antibody (HBcAb)-positive organ donors have the potential to transmit infection to transplant recipients. PATIENTS AND METHODS: We investigated the use of a single dose of 2000 IU of hepatitis B immunoglobulin in 18 patients among a population of 54 kidney transplant recipients from HBcAb-positive deceased donors. RESULTS: Twelve recipients were HBcAb-positive before transplantation. Among the other 42 patients, 5 (11.9%) seroconverted from HBcAb-negative to HBcAb-positive, whereas one HBcAb-positive recipient became hepatitis B virus surface antigen-positive with clinical signs of active hepatitis 6 years after transplantation. In the 18 patients who underwent prophylaxis, we did not find any seroconversion or hepatitis B virus (HBV) transmission. Graft and patient survival of HBcAb-positive kidney transplants did not differ significantly with a matched population of HBcAb-negative transplantation. CONCLUSION: These results suggest that kidney transplantation from HBcAb-positive donors is safe with a low rate of HBV transmission. A prophylaxis with a single shot of hepatitis B immunoglobulin may be effective in reducing the risk of HBV seroconversion or reactivation and may be suggested in all naïve or HBcAb-positive transplant recipients.

Intestinal obstruction by giant Meckel's diverticulum. Case report.

Most cases of Meckel's diverticulum (MD) are asymptomatic and discovered by chance. Management of MD is controversial. The authors describe an exceptional case of intestinal obstruction caused by a giant MD in a patient who had previously undergone appendectomy. A review of the contradictory literature on this subject leads to the conclusion that careful consideration of clinical and morphological data (patient's age, ASA score, the surgical procedure to be performed, morphology and position of the MD, any fibrotic bands) is required before deciding whether or not to resect an asymptomatic MD.

Classification of a traumatic brain injury: the Glasgow Coma scale is not enough.

BACKGROUND: Classifying the severity of a traumatic brain injury (TBI) solely by means of the Glasgow Coma scale (GCS) is under scrutiny, because it overlooks other important clinical signs. Clinicians treating patients with acute TBI are well placed to suggest which variables, in addition to the GCS, should concur in a new classification of TBI. METHODS: In Italy, acute TBI patients are treated by anaesthetists, and so we asked them, in a questionnaire survey, to rate the weight they give to the GCS and to other clinical variables in their approach to TBI. Because sedation may underestimate GCS scores, we also inquired whether anaesthetists select sedatives that allow drug-free GCS scores. The questionnaire was distributed to 1334 anaesthetists attending courses on neurotrauma; the response rate was 63%. RESULTS: Two thirds of the respondents believe that the definition of severe TBI should include, in addition to GCS scores, pupil reactivity to light and computer tomogram (CT) findings, the variables that guide Italian anaesthetists in TBI management. Most respondents (68.2%) administer sedation which allows prompt neurological evaluation and reliable GCS scoring. A minority of respondents (9.3%) withhold or antagonize sedation, delay tracheal intubation or allow patient-ventilator asynchrony. CONCLUSIONS: Italian anaesthetists would welcome a definition of TBI severity that includes CT findings and pupil reactivity in addition to the GCS.

False-positive IgM for CMV in pregnant women with autoimmune disease: a novel prognostic factor for poor pregnancy outcome.

Our aims were to assess the frequency of false-positive IgM antibodies for cytomegalovirus in pregnant women with autoimmune diseases and in healthy women (controls) and to determine their relationship with pregnancy outcome. Data from 133 pregnancies in 118 patients with autoimmune diseases and from 222 pregnancies in 198 controls were assessed. When positive IgM for cytomegalovirus was detected, IgG avidity, cytomegalovirus isolation and polymerase chain reaction for CMV-DNA in maternal urine and amniotic fluid samples were performed in order to identify primary infection or false positivity. A statistically significantly higher rate of false-positive IgM was found in pregnancies with autoimmune diseases (16.5%) in comparison with controls (0.9%). A worse pregnancy outcome was observed among patients with autoimmune disease and false cytomegalovirus IgM in comparison with those without false positivity: earlier week of delivery (p = 0.017), lower neonatal birth weight (p = 0.0004) and neonatal birth weight percentile (p = 0.002), higher rate of intrauterine growth restriction (p = 0.02) and babies weighing less than 2000 g (p = 0.025) were encountered. The presence of false cytomegalovirus IgM in patients with autoimmune diseases could be used as a novel prognostic index of poor pregnancy outcome: it may reflect a non-specific activation of the immune system that could negatively affect pregnancy outcome. Lupus (2010) 19, 844-849.