Emanuela Cataudella

Toxic hepatitis in occupational exposure to solvents

The liver is the main organ responsible for the metabolism of drugs and toxic chemicals, and so is the primary target organ for many organic solvents. Work activities with hepatotoxins exposures are numerous and, moreover, organic solvents are used in various industrial processes. Organic solvents used in different industrial processes may be associated with hepatotoxicity. Several factors contribute to liver toxicity; among these are: species differences, nutritional condition, genetic factors, interaction with medications in use, alcohol abuse and interaction, and age. This review addresses the mechanisms of hepatotoxicity. The main pathogenic mechanisms responsible for functional and organic damage caused by solvents are: inflammation, dysfunction of cytochrome P450, mitochondrial dysfunction and oxidative stress. The health impact of exposure to solvents in the workplace remains an interesting and worrying question for professional health work.

Depression in older breast cancer survivors

BackgroundBreast cancer is the most commonly diagnosed cancer among U.S. women .The 5-year survival rate for this tumour is nowadays 85%, and the 61% of these women are still alive at 15 years. When depression symptoms are present as a consequence of breast cancer treatments, they may interfere negatively with patients’ quality of life. The aim of this study was to examine the effects of breast cancer treatment on the quality of life and the impact of depression on the health-related life.MethodsWe enrolled 173 women aged 65-75 years with early stage breast cancer diagnosed over the last 10 years, initially recruited to participate in a study examining heath-related quality of life in the first 5 years after breast cancer diagnosis. Participants were divided into four groups: 1) 46 breast cancer survivors (aged 65-70); 2) 62 women diagnosed with breast cancer (aged 65-69); 3) 32 women with recurrent breast cancer after 10 years (aged 66-75); 4) 30 women in good health status (aged 60-70). The Geriatric Depression Scale was used as a routine part of a comprehensive geriatric assessment. Collection of data for the application of instruments, such as sociodemographic variables (age, educational level, social state) and clinical date (stage and time of the disease and treatment), was carried out by trained researcher assistants.ResultsOur results demonstrated the correlation between depression and previous cancer experiences. In fact, in patients with cancer experience, the grade of depression was significantly higher compared to healthy subjects. Furthermore, we demonstrated that the patients with recurrent breast cancer were severely depressed compared to other groups.ConclusionsA high percentage of participants were identified as having emotional and/or well being problems. Further investigations on the cause of depression problems cancer-related are needed.

Neutrophil-To-Lymphocyte Ratio: An Emerging Marker Predicting Prognosis in Elderly Adults with Community-Acquired Pneumonia

To explore the performance of the neutrophil‐to‐lymphocyte ratio (NLR), an index of systemic inflammation that predicts prognosis of several diseases, in a cohort of elderly adults with community‐acquired pneumonia (CAP).

Testing Clinical Scores to Diagnose Incident Deep Vein Thrombosis in Patients Hospitalized in a Department of Medicine: Can Biomarkers Improve Accuracy?

Shifting the context from the emergency department to the department of medicine, we compared different scores to diagnose deep vein thrombosis (DVT) in patients with several comorbidities, hospitalized in a department of internal medicine. We prospectively recruited 178 consecutive hospitalized patients in whom clinical suspicion of DVT was assessed by Wells modified score for DVT, Hamilton, Kahn, and St Andrè Hospital scores. Deep vein thrombosis was confirmed in 85 (48%) patients by both echocolor Doppler and angiocomputed tomography scan. The use of risk scores based on symptoms and clinical signs was weakly useful (area under the curve [AUC]: 0.69, positive predictive value: 59%, and negative predictive value: 74%). Patients with DVT had significantly (P < .0001) lower serum albumin and protein S levels compared to those without DVT. Moreover, serum protein S (AUC: 0.82) and albumin in percentage (AUC: 0.80) showed a better accuracy than clinical scores (P < .001) in assessing the diagnosis of DVT. Therefore, serum albumin and protein S improved the accuracy of clinical scores for the diagnosis of incident DVT in patients hospitalized in a department of medicine.

Geriatric Evaluation of Oncological Elderly Patients

Cancer has a high prevalence in older age. The management of cancer in the older aged person is an increasingly common problem. Age may be construed as a progressive loss of stress tolerance, due to decline in functional reserve of multiple organ systems, high prevalence of comorbid conditions, limited socioeconomic support, reduced cognition, and higher prevalence of depression. In the elderly, the comorbidities and physiological changes in the pharmacokinetics reduce the prospective for therapy and suggest the importance of a multidimensional assessment of cancer patients as well as the formulation of predictive models of risk, in order to estimate the life expectancy and tolerance to treatment. The pharmacological changes of age include decreased renal excretion of drugs and increased susceptibility to myelosuppression, mucositis, cardio toxicity and neurotoxicity. The chemotherapy in patients older than 75 years is very limited. The geriatric assessment is considered a valid tool in geriatric medical. It is important for two main reasons: first of all, for the need to distinguish the features linked to the geriatric syndromes from those ones which are strictly connected to the cancer pathology; secondly, for its potential prognostic value.

Reply to: Neutrophil to Lymphocyte Ratio As a Risk Stratification Tool for Older Adults with Pneumonia

infections). We would like to comment on the following points. The main value of prognostic scores in pneumonia is to guide decisions regarding site of care (inpatient vs outpatient). Thus, it would be useful to report how many more people could be managed as outpatients based on NLR stratification than with previously validated scores or other clinical criteria (e.g. hypoxia, which is a common independent indication for hospitalization). The authors could also report the mortality in their study of individuals with a CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, Aged 65 and older) score of 2 or less (55% of study participants). Although individuals with a CURB65 score of 2 are usually admitted, closely supervised outpatient management may be possible in selected individuals, and reporting mortality in this subgroup would allow better assessment of the study’s results. Would stratification according to NLR help identify low-risk individuals within this intermediate-risk subgroup? Considering that all participants in this study were admitted to the hospital, the generalizability of the results to individuals managed as outpatients needs to be examined in future studies. It would be useful if the authors could report the indications for admission in their study (e.g., high risk score, hypoxia, other reason); 10.3% of admitted participants were at low risk according to CURB-65 score. Knowing the indications for admission in the subgroup with a NLR less than 11.12 would further clarify whether the NLR could be a useful parameter to identify individuals who could be managed as outpatients. For example, Mean partial pressure of oxygen in the study was 55.3 mmHg, suggesting that many of the participants would have required hospitalization according to this clinical criterion alone. Furthermore, 36.4% of participants had significant functional impairment, which could necessitate hospitalization irrespective of other risk stratification parameters. A table comparing the characteristics of survivors with those of nonsurvivors would also provide useful information. The significant gap in mortality between the low-risk group (0% in those with NLR <11.12) and the intermediate-risk group (30% in those with NLR 11.12–13.4%) suggests the possibility of overfitting to the study’s population suggests the possibility of overfitting to the study’s population, calling into question the generalizability of these cut-offs to other populations. Nevertheless, the cut-off derived from this study is very close to the cut-off derived from a previous study, although validation in larger studies will be required before using these cut-offs in clinical practice. According to the study’s protocol, individuals taking immunosuppressive medications were excluded, but 29.7% of participants were taking oral corticosteroids. This requires clarification. Corticosteroid use can increase the NLR and could bias the results of the study, especially considering that those taking corticosteroids might have had more severe underlying disease (e.g., severe chronic obstructive pulmonary disease with frequent exacerbations) and therefore worse prognosis. Would the results of the study be same if the 58 participants taking oral corticosteroids were excluded? Stamatis Karakonstantis, MD, MRes Internal Medicine Department B, General Hospital of Heraklion “Venizeleio-Pananeio”, Heraklion, Greece

Mean Transaortic Gradient is an Emerging Predictor of Chronic Kidney Disease in Elderly Patients

Arterial hypertension (AH) is a major risk factor for chronic kidney disease (CKD). However, whether AH maintains this role in the development of CKD in elderly patients with aortic stenosis (AS) or whether transaortic gradient influences CKD remains unclear. Consecutive hospitalized patients were prospectively recruited to evaluate the relationship between AS and CKD. In all patients, transthoracic 2-dimensional echocardiography was performed to evaluate AS; renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. A total of 346 patients were included in the study (mean age: 79.5 ± 7.4 years): 104 had diabetes mellitus (DM), 298 had AH, and 59 (moderate: 52; severe: 7) showed AS. After multivariate analysis, age (P <.01), DM (P = .02), and mean transaortic gradient (P = .03), but not AH, were independent predictors of CKD. Both in the presence (n = 59) or absence (n = 287) of AS, the estimated glomerular filtration rate did not differ in patients with (51 ± 24 mL/min/1.73 m2 and 59 ± 25 mL/min/1.73 m2, respectively) and those without AH (50 ± 21 mL/min/1.73 m2 and 65 ± 24 mL/min/1.73 m2, respectively). In the whole population, for each mm Hg of mean transaortic gradient, the risk of CKD increased by 2.5 times.

An Unexpected Cause of Marked Weight Loss Associated with Vomiting in an Adult Man: Gastric Phytobeozar

Objectives We present the case of an edentulous 47-year-old farmer referred to our Department of Internal Medicine because of postprandial vomiting, hyporexia, asthenia and weight loss. He ate a mostly vegetarian diet. Materials and methods An oesophagogastroduodenoscopy revealed the presence of a phytobezoar at the level of the fundus and body of the stomach. Endoscopic fragmentation and removal of the phytobezoar were unsuccessful and the patient had to undergo open surgery. Results Recovery was uneventful and free of complications. Conclusion Phytobezoars should be taken into account in the differential diagnosis of unexplained vomiting and weight loss. LEARNING POINTS Bezoars are concretions of indigestible materials located in the gastrointestinal tract. Gastric phytobezoars may cause unexplained vomiting and weight loss even in young people. The diagnosis of phytobezoars may be complex and endoscopy is helpful in most cases.