Air Pollution,Aeroallergens, and Emergency Room Visits for Acute Respiratory Diseases and Gastroenteric Disorders among Young Children in Six Italian Cities

Background

Past studies reported evidence of associations between air pollution and respiratory symptoms and morbidity for children. Few studies examined associations between air pollution and emergency room (ER) visits for wheezing, and even fewer for gastroenteric illness. We conducted a multicity analysis of the relationship between air pollution and ER visits for wheezing and gastroenteric disorder in children 0–2 years of age.

Methods

We obtained ER visit records for wheezing and gastroenteric disorder from six Italian cities. A city-specific case–crossover analysis was applied to estimate effects of particulate matter (PM), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide, adjusting for immediate and delayed effects of temperature. Lagged effects of air pollutants up to 6 prior days were examined. The city-specific results were combined using a random-effect meta-analysis.

Results

CO and SO₂ were most strongly associated with wheezing, with a 2.7% increase [95% confidence interval (CI), 0.5–4.9] for a 1.04-μg/m³ increase in 7-day average CO and a 3.4% (95% CI, 1.5–5.3) increase for an 8.0-μg/m³ increase in SO₂. Positive associations were also found for PM with aerodynamic diameter ≤ 10 μg and NO₂. We found a significant association between the 3-day moving average CO and gastroenteric disorders [3.8% increase (95% CI, 1.0–6.8)]. When data were stratified by season, the associations were stronger in summer for wheezing and in winter for gastroenteric disorders.

Conclusion

Air pollution is associated with triggering of wheezing and gastroenteric disorders in children 0–2 years of age; more work is needed to understand the mechanisms to help prevent wheezing in children.     

The Impact of a Clinical Information System in an Intensive Care Unit

Purpose Although clinical information systems (CISs) have been available and implemented in many Intensive care Units (ICUs) for more than a decade, there is little objective evidence of their impact on the quality of care and staff perceptions. This study was performed to compare time spent charting with pen and paper patient data versus time spent with the new electronic CIS and to evaluate staff perceptions of a CIS in an ICU. Materials and Methods Time spent every day was calculated for each patient, for 7 days, for recording on the paper vital signs and physician therapeutic orders and time spent for computing fluid balance and scores. This time was then compared with time required to make the same activities by means of CIS, 10 months after its introduction in ICU. Four years after the installation of CIS, a questionnaire was given to all staff attending to the ICU to evaluate their opinions of the CIS. Results The CIS took less staff time to record common ICU data than paper records (3 ± 2 minutes/day versus 37 ± 7 minutes/day respectively, P< 0.001). Perceptions of the CIS were that computers promoted an improving charting quality. Conclusions The implementation of a CIS was associated with a reduced time spent for daily activity and a positive medical and nursing staff perception. Donati A, Gabbanelli V, Pantanetti S, Carletti P, Principi T, Marini B, Nataloni S, Sambo G, Pelaia P. The impact of a clinical information system in an intensive care unit.     

Management and imaging of low rectal carcinoma

Large variations in recurrence rates have been reported with the best results following total mesorectal excision (TME) surgery for low and middle rectal cancers. However, the low rectal cancers still have higher rates of local recurrence (up to 30%) whether operated by low anterior resection or abdominoperineal excision (APE) due to high rates of circumferential margin involvement. The treatment of choice for low rectal cancers that encroach upon the potential circumferential resection margin is surgery combined with preoperative neoadjuvant treatment. Preoperative chemotherapy combined with long-term radiotherapy reduces recurrence rates and preoperative loco-regional staging can help to select the patients more likely to benefit from neo-adjuvant therapy. Surface coil MRI is the most promising modality for patient selection, which can provide good views of the circumferential resection margin especially the presence or absence of tumour encroaching the intersphincteric plane.     

Patient dose in full-field digital mammography: an Italian survey

The aim of this study was to compare performance and patient dose of full-field digital mammography units for clinical use. Measurements of linearity and automatic exposure control stability were performed on four units installed in as many Italian sites. The tube output was also obtained by the same ionization chamber, permitting to evaluate ratios mGy/mAs for each available spectrum. The entrance air-kerma was calculated over a sample of 800 cranio-caudal mammograms and the average glandular dose obtained, assuming two mean glandular compositions of 50 and 30%, respectively. Digital systems showed very good linearity and comparable responses. The stability of the automatic exposure control was better than 5% for all systems. Regarding doses, the two mammography units that work mainly in contrast mode deliver, respectively, 17 and 28% more dose compared with those working in standard mode. For the latter mode, the mean average glandular dose was in the range 1.25–1.37 mGy and 1.37–1.49 mGy for the 50 and 30% glandular composition, respectively. Results of this study were compared with those of other surveys, showing that full-field digital mammography allows a significant clinical dose reduction compared with screen/film mammography.     

Severe pancytopenia and hemophagocytosis after HHV-8 primary infection in a renal transplant patient successfully treated with foscarnet

We report the occurrence of human herpesvirus (HHV)-8 primary infection in an adult male kidney recipient. Four months after transplantation, the patient developed visceral Kaposi sarcoma, and 1 month later he presented with progressive and severe peripheral cytopenia, in the presence of a normocellular or hypercellular bone marrow (BM) with hemophagocytosis. HHV-8 was the sole pathogen detected by polymerase chain reaction either in the serum or in the BM. HHV-8 latent nuclear antigen was detected in immature progenitor cells from the BM. Immunosuppressive therapy was reduced, and the patient was treated with foscarnet for 2 weeks, leading to a dramatic normalization of blood cell counts, concomitantly with the disappearance of HHV-8 viremia. At the end of antiviral therapy, the patient received chemotherapy, and Kaposi sarcoma regressed in 2 months. Severe peripheral cytopenia may be a posttransplant complication after HHV-8 infection, for which treatment with foscarnet seems appropriate.