Antimicrobial resistance (AMR) is a worldwide issue, but with significant epidemiological diversi... more Antimicrobial resistance (AMR) is a worldwide issue, but with significant epidemiological diversity in different countries. A recently observed phenomenon is represented by the diffusion of AMR, initially confined to intensive-care units, to medical wards. This was predictable, since patients hospitalized in medical units are made up of more than 70% of elderly people (over 75 years of age in 1 case out of 2). They are fragile patients, with significant comorbidity (over a half with at least 3 diseases), weakened immune systems, and consequently a higher risk of infection. Given such a scenario, it becomes therefore both necessary and urgent to adopt a multifaceted approach of antimicrobial stewardship programs in order to prevent, detect and control the emergence of antimicrobial resistant organisms. The ideal antimicrobial program is led by an infectious diseases (ID) physician and clinical pharmacist with ID training, together with a list of other important staff: clinical microb...
We report a case of a patient with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE)... more We report a case of a patient with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) associated to portal vein thrombosis (PVT), complicated by hospital-acquired pneumonia (HAP). The pathogenesis of DVT is multifactorial; among risk factors we can list: transitory situations (surgical interventions, infectious diseases with fever, traumas), acquired conditions (neoplasms, antiphospholipid syndrome) or genetically determined situations (thrombophilia). PVT of the sovrahepatic veins is responsible for 5-10% of portal hypertension cases in adults and can be associated to local or systemic infections. PVT is present in 10% of patients with cirrhosis and often associated to cancers. It can also complicate a surgery abdominal intervention. HAP is defined as pneumonia that appears for the first time within 48 h of hospital admission. In Internal Medicine Departments the incidence is 7-10 cases/1.000 of hospital admissions, with an important impact in terms of both mortality an...
excluded if tbey were < 65 years Diagnosis codes were used to exclude procedures being perthrmed ... more excluded if tbey were < 65 years Diagnosis codes were used to exclude procedures being perthrmed tor signs or symptoms or for surveillance (histo D' of polyp, IBD, or cancer). Results: FS-SCR increased in all subgroups, ranging from 16% (65-69 years African American male [AAM]) to 82% (85+ years White female [WF]), with the most dramatic increases in the->80 years age group. Changes in FOBT-SCR ranged from-9% (80-84 years AAM) to 36% (85 + WF), the largest incremem in older ages. The use of BE-SCR declined in almost all snbgroups, ranging from-31% (80-84 years AAM) to 12% (85 + ~VF). CY-SCR increased in virtually all subgroups with most of the increase occurring in the 65-69 years age group (from 7% in AAM to 27% in WF). Conch6tons: in general, increased CRC screening was seen in all age, race, and gender groups wath most of the COL-SCR increases occurring in younger patients. However, in the older age groups, particularly 85 +, dramatic increases in both FS-SCR and FOBT-SCR were noted. Thus, changes in reimbursement were most often associated w'ith large increases in the oldest age groups, which are least likely to benefit from these procedures in terms of prolonging life expeztancy.
Background & Aims: Therapy with interferon alfa (IFNor death. Small follow-up studies 10,11 have ... more Background & Aims: Therapy with interferon alfa (IFNor death. Small follow-up studies 10,11 have reported that a) leads to remission of disease in one third of patients remissions in chronic hepatitis B induced by IFN-a are with chronic hepatitis B. The aim of this study was to of long duration, but the survival of treated patients has better define the long-term prognosis of this outcome. not been well defined. A recent study reported that the Methods: One hundred three patients with chronic hepfrequency of death, liver transplantation, and severe comatitis B who underwent IFN-a therapy in three clinical plications due to cirrhosis was significantly lower among trials between 1984 and 1991 were followed up for patients who responded to IFN-a treatment than those serological status, biochemical evidence of liver diswho did not. 12 ease, and liver complications or mortality through The aim of the current study was to further evaluate 1994. Results: Among 103 patients, 31 (30%) rethe long-term survival and clinical outcome of a cohort sponded to therapy with loss of hepatitis B e antigen of patients with chronic hepatitis B who were treated and viral DNA from serum. Responders were more likely with IFN-a. than nonresponders to be women, black, and to have more severe liver disease including cirrhosis (P õ Materials and Methods 0.05
Antimicrobial resistance (AMR) is a worldwide issue, but with significant epidemiological diversi... more Antimicrobial resistance (AMR) is a worldwide issue, but with significant epidemiological diversity in different countries. A recently observed phenomenon is represented by the diffusion of AMR, initially confined to intensive-care units, to medical wards. This was predictable, since patients hospitalized in medical units are made up of more than 70% of elderly people (over 75 years of age in 1 case out of 2). They are fragile patients, with significant comorbidity (over a half with at least 3 diseases), weakened immune systems, and consequently a higher risk of infection. Given such a scenario, it becomes therefore both necessary and urgent to adopt a multifaceted approach of antimicrobial stewardship programs in order to prevent, detect and control the emergence of antimicrobial resistant organisms. The ideal antimicrobial program is led by an infectious diseases (ID) physician and clinical pharmacist with ID training, together with a list of other important staff: clinical microb...
We report a case of a patient with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE)... more We report a case of a patient with deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) associated to portal vein thrombosis (PVT), complicated by hospital-acquired pneumonia (HAP). The pathogenesis of DVT is multifactorial; among risk factors we can list: transitory situations (surgical interventions, infectious diseases with fever, traumas), acquired conditions (neoplasms, antiphospholipid syndrome) or genetically determined situations (thrombophilia). PVT of the sovrahepatic veins is responsible for 5-10% of portal hypertension cases in adults and can be associated to local or systemic infections. PVT is present in 10% of patients with cirrhosis and often associated to cancers. It can also complicate a surgery abdominal intervention. HAP is defined as pneumonia that appears for the first time within 48 h of hospital admission. In Internal Medicine Departments the incidence is 7-10 cases/1.000 of hospital admissions, with an important impact in terms of both mortality an...
excluded if tbey were < 65 years Diagnosis codes were used to exclude procedures being perthrmed ... more excluded if tbey were < 65 years Diagnosis codes were used to exclude procedures being perthrmed tor signs or symptoms or for surveillance (histo D' of polyp, IBD, or cancer). Results: FS-SCR increased in all subgroups, ranging from 16% (65-69 years African American male [AAM]) to 82% (85+ years White female [WF]), with the most dramatic increases in the->80 years age group. Changes in FOBT-SCR ranged from-9% (80-84 years AAM) to 36% (85 + WF), the largest incremem in older ages. The use of BE-SCR declined in almost all snbgroups, ranging from-31% (80-84 years AAM) to 12% (85 + ~VF). CY-SCR increased in virtually all subgroups with most of the increase occurring in the 65-69 years age group (from 7% in AAM to 27% in WF). Conch6tons: in general, increased CRC screening was seen in all age, race, and gender groups wath most of the COL-SCR increases occurring in younger patients. However, in the older age groups, particularly 85 +, dramatic increases in both FS-SCR and FOBT-SCR were noted. Thus, changes in reimbursement were most often associated w'ith large increases in the oldest age groups, which are least likely to benefit from these procedures in terms of prolonging life expeztancy.
Background & Aims: Therapy with interferon alfa (IFNor death. Small follow-up studies 10,11 have ... more Background & Aims: Therapy with interferon alfa (IFNor death. Small follow-up studies 10,11 have reported that a) leads to remission of disease in one third of patients remissions in chronic hepatitis B induced by IFN-a are with chronic hepatitis B. The aim of this study was to of long duration, but the survival of treated patients has better define the long-term prognosis of this outcome. not been well defined. A recent study reported that the Methods: One hundred three patients with chronic hepfrequency of death, liver transplantation, and severe comatitis B who underwent IFN-a therapy in three clinical plications due to cirrhosis was significantly lower among trials between 1984 and 1991 were followed up for patients who responded to IFN-a treatment than those serological status, biochemical evidence of liver diswho did not. 12 ease, and liver complications or mortality through The aim of the current study was to further evaluate 1994. Results: Among 103 patients, 31 (30%) rethe long-term survival and clinical outcome of a cohort sponded to therapy with loss of hepatitis B e antigen of patients with chronic hepatitis B who were treated and viral DNA from serum. Responders were more likely with IFN-a. than nonresponders to be women, black, and to have more severe liver disease including cirrhosis (P õ Materials and Methods 0.05
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