Archivio istituzionale della ricerca - Alma Mater Studiorum Università di Bologna
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Overnight Stay in the Emergency Department and In-Hospital Mortality Among Elderly Patients: A 6-Year Follow-Up Italian Study
Get PDFBackground/Objectives: Due to challenges in securing hospital beds, elderly patients may face prolonged emergency department (ED) stays. Recent studies have highlighted an association between ED overnight stays (EDOSs) before admission and increased mortality. This study aimed to evaluate the potential impact of EDOSs on mortality among elderly patients awaiting a regular bed in a standard hospital ward. Methods: This monocentric, retrospective study included subjects ≥ 75 years who required urgent hospitalization between 2017 and 2022. Two groups were compared: patients hospitalized between 00:00 and 08:00 following an ED overnight stay (EDOS group), and those admitted directly to conventional medical units between 08:00 and 00:00 (Ward group). The primary outcome was in-hospital mortality 30 days after ED visit. Results: Among the 20,009 patients included (median age: 85 years [IQR: 80–89]), 3064 (15.3%) belonged to the EDOS group, while 16,945 (84.7%) were in the Ward group. In-hospital mortality occurred in 3020 cases (15.1%), with no significant differences observed between the groups. The variables identified by the logistic model as predictors of mortality included age > 85 years, Charlson Comorbidity Index (CCI) ≥ 5, National Early Warning Score (NEWS) > 6 at arrival, infectious diseases, respiratory diseases, and circulatory system diseases, yielding an accuracy of 0.700 ± 0.007. EDOS while awaiting inpatient beds was not a predictor of mortality. Conclusions: The results of our study did not show an association between mortality and EDOS, even when considering the large sample size collected over 6 years and the varying percentages of patients awaiting hospital beds
Clinical Relevance of IFT140 Loss-of-Function Variants in Development of Renal Cysts
Get PDFBackground: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease, affecting approximately 1 in 1000 individuals. This genetically heterogeneous condition is primarily caused by monoallelic pathogenic or likely pathogenic variants in the PKD1 and PKD2 genes, accounting for 78% and 15% of typical cases, respectively. Recently, the application of NGS methods has led to the identification of additional genes associated with ADPKD, which have been incorporated into routine diagnostic testing for detecting phenocopies of the disease. Methods: In this study, targeted NGS (tNGS) analysis of the main cystogenes associated with classic and atypical ADPKD was performed in a cohort of 218 patients clinically diagnosed with cystic nephropathies. Results: Genetic testing identified variants in 175 out of 218 cases (80.3%). Among these, 133 probands (76%) harbored likely pathogenic or pathogenic variants in one or more genes of the panel, while 42 individuals (24%) had a variant of unknown significance (VUS). Specifically, one or more class 4/5 variants in PKD1, PKD2, or both were identified in 111 (83.5%) probands. Remarkably, a pathogenic variant in the IFT140 gene was identified in 14 index cases (8% of positive individuals, 6.4% of the global cohort): 10 distinct loss-of-function (LoF) variants were identified (including four frameshift variants, four nonsense variants, and two splice site defects); one individual carried a second IFT140 missense variant classified as VUS. Furthermore, five affected family members were found to carry a P/LP LoF variant in IFT140. Conclusions: Our data support that IFT140 heterozygous IFT140 LoF variants result in an atypical, mild form of ADPKD, consisting of bilateral kidney cysts and renal functional decline at older ages. Furthermore, we describe the second pediatric patient with a mild form of ADPKD due to an IFT140 variant and discuss hyperuricemia as a previously unappreciated feature of this condition
Blockchain: a promising tool in tackling food waste
No full textA significant proportion of the world’s food supply is lost or wasted, with profound economic, environmental, and social consequences. This waste not only represents a significant financial burden but also wastes vital resources. Among these challenges, blockchain technology is proving to be a transformative solution. It offers decentralized systems that can revolutionize food waste management by improving transparency, traceability, and accountability throughout the supply chain. This chapter first addresses the problem of food waste management and then discusses how the unique capabilities of blockchain can address these challenges. By utilizing blockchain’s capabilities, we have the potential to decrease food waste and promote sustainability. However, for blockchain to be fully effective, the issues of scalability, standardization, and environmental protection must be overcome through continued research, innovation, and collaboration between industries and policymakers
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No full textPossiamo distinguere due dimensioni principali nelle quali il cancro è entrato a far parte della vita di Susan Sontag: c’è il piano del corpo dell’autrice che tre volte si trova a fronteggiare un tumore; e poi c’è quello della riflessione intellettuale che ha portato Sontag a scrivere, a ridosso della guarigione dal primo cancro al seno, Malattia come metafora (1978)
Investigating Bacterial Bloodstream Infections in Dogs and Cats: A 4-Year Surveillance in an Italian Veterinary University Hospital
Get PDFIn small animal practice, blood cultures (BCs) are essential for diagnosing bacterial bloodstream infections (BSIs) and guiding targeted antimicrobial therapy, particularly in relation to the rise of multidrug-resistant (MDR) pathogens. This study analyzed 96 positive BCs from dogs and cats at the Veterinary University Hospital (VUH) of Bologna (2020-2024), assessing bacterial prevalence, antimicrobial resistance, and associated risk factors. Escherichia coli was the most common isolate (29/96), followed by Streptococcus canis (11/96). MDR percentage was 29.2% (28/96), with Gram-negatives associated with higher rates (p = 0.040). Nearly half of the cases (46.9%, 45/96) were suspected healthcare-associated infections (HAIs) significantly associated with the number of invasive devices used (p = 0.008) and with the absence of co-positive samples (p = 0.012). Empirical antibiotic therapy was administered in 94.8% (91/96) of cases, with ampicillin-sulbactam and marbofloxacin as the most used drugs. In vitro empirical therapy appropriateness was 76.9% (70/91). MDR was associated with inappropriate empirical therapy (p < 0.001). Mortality within 30 days was 36.5% (35/96), significantly linked to antibiotic escalation (p = 0.006). The findings highlight the need for systematic BC surveillance in veterinary settings to optimize treatment strategies (especially in countries with restrictions on antibiotic use in animals) to mitigate MDR spread and to protect public health
Situare le relazioni socio-naturali ai tempi della crisi climatica tramite la letteratura ottocentesca
Get PDFSi sono assai modificate le dinamiche urbano-rurali in seguito alla rivoluzione industriale con l’avvento di svariate forme di infrastruttura e lavoro. Diversamente dall’idea di un ritorno alle campagne in termini di un idillio postmoderno, è possibile identificare certi modi di abitare lo spazio al di fuori della città che fondono la tradizione con l’innovazione. Sotto l’ispirazione dei processi di integrazione come la Strategia Nazionale per le Aree Interne in Italia, affrontiamo le complessità di questo tipo di territorio per mezzo di due poemi contrastanti: «La plaine» di Émile Verhaeren («Les villes tentaculaires», 1895) descrive l’influsso di una città divorante; «The Village Garden» di Amy Levy («A London Plane-Tree», 1889) evoca il fascino effimero di un giardino tranquillo
On Some Stochastic Hyperbolic Equations with Symplectic Characteristics
Get PDFWe study the effect of Gaussian perturbations on a class of model hyperbolic partial differential equations with double symplectic characteristics in low spatial dimensions. The coefficients of our partial differential operators contain harmonic oscillators in the space variables, while the noise is additive, white in time and colored in space. We provide sufficient conditions on the spectral measure of the covariance functional describing the noise that allows for the existence of a random field solution for the resulting stochastic partial differential equation. Furthermore, we show how the symplectic structure of the set of multiple points affects the regularity of the noise needed to build a measurable process solution. Our approach is based on some explicit computations for the fundamental solutions of several model partial differential operators together with their explicit Fourier transforms
Is COVID-19 Coagulopathy a Thrombotic Microangiopathy? A Prospective, Observational Study
Get PDFSevere COVID-19 is often associated with coagulopathy and thrombotic complications. The underlying mechanisms are complex and multifactorial, involving platelet activation, dysregulation of the complement cascade, fibrinolytic imbalance, release of pro-inflammatory cytokines, immunothrombosis, antiphospholipid antibodies, and alterations in the von Willebrand factor (vWF)/ADAMTS13 axis. These pathways are also implicated in thrombotic microangiopathies (TMAs), characterized by endothelial injury and widespread microvascular thrombosis. In this prospective monocentric observational study, we investigated whether COVID-19-associated coagulopathy meets the criteria for TMA and evaluated the roles of complement activation and vWF/ADAMTS13 imbalance in disease severity. Forty-three hospitalized COVID-19 patients were enrolled and stratified by disease severity. Blood samples collected at admission were analyzed for hematologic, coagulation, inflammatory, and complement parameters. A 30-day follow-up recorded survival and thrombotic events. All patients showed elevated vWF and factor VIII levels; however, only vWF collagen-binding activity (vWF-CBA) significantly correlated with disease severity. ADAMTS13 activity remained above 60% in all cases, and no schistocytes were detected, arguing against a diagnosis of classical TMA. Nevertheless, the vWF-CBA/ADAMTS13 ratio was significantly higher in severe cases, particularly in unvaccinated individuals, suggesting endothelial dysregulation. Complement analysis revealed increased C5a levels and decreased C3b/iC3b ratios in severe disease, consistent with complement activation and consumption. C2 levels were also lower in these patients. Although complement activation and vWF/ADAMTS13 imbalance did not directly correlate, both pathways showed a similar trend according to disease severity. Overall, our findings indicate that COVID-19-related coagulopathy does not fulfill the criteria for classical TMA but shows features of complement-mediated endothelial injury and vWF dysregulation. The vWF-CBA may serve as a rapid, standardized tool for assessing endothelial dysfunction. Activation of the complement system, particularly via the lectin and alternative pathways, appears central to the prothrombotic state in severe COVID-19
Epidemiology of hospitalization for hip replacement: Which implications for orthopaedics and rehabilitation? A 15-year longitudinal study
Get PDFPurpose: The increasing incidence of hip replacement (HR) is related to the ageing of the population and the increasing longevity of new implants. The primary purpose of this study is to assess the number of HR hospitalizations in Italy, referring to official national hospitalization reports. The secondary aim is to evaluate the characteristics of patients who underwent HR, comparing the future predictions of the prevalence of HR between Italy and other countries. Methods: The present study considered adult patients (aged 20 years or older) who underwent HP. The data regarding hospitalizations for HR performed between 2001 and 2015 were collected by the National Hospital Discharge reports carried out by the Italian Ministry of Health. These reports provided data concerning all hospital admission occurring in Italy, both from public and private institutions. Results: Overall, 64.5% of HR were performed on female patients, whereas only 35.5% were male. The median length of hospital stay was 12.3 ± 8.1 days. During the 15-year study period, the main primary diagnoses were osteoarthrosis, localized, primary (46.1%). In 2001, 66,171 hospitalizations for HR were performed, equivalent to 5.4% of all those included in the National Hospital Discharge report (1,228,025); in 2015, this figure reached 95,200 units 7.8% of the total. There has been an annual increase of HR of 2.63%. From 2001 to 2015, the incidence of operations increased from 144.1 to 192.3 per 100,000 residents with at least 20 years of age. Conclusions: This longitudinal study confirms the progressive incidence in HR hospitalizations and the burden for the healthcare system in orthopaedics and rehabilitation fields. Level of Evidence: Level II