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Marcello Picchio,Annalisa Romina Di Filippo,Martina Spaziani,Simone Orelli,Riccardo Bellagamba,Giuliano Guttoriello,Alessandro De Cesare,Erasmo Spaziani 대한갑상선-내분비외과학회 2021 The Koreran journal of Endocrine Surgery Vol.21 No.3
Purpose: The study aims to determine whether postoperative infusion of betamethasone reduces the risk of symptomatic hypocalcaemia (SHC) and other complications after total thyroidectomy. Methods: We compared a group of patients receiving betamethasone (beta group) postoperatively to a group without any perioperative glucocorticoid infusion (no beta group). Plasma levels of parathyroid hormone, total calcium, and C-reactive protein (CRP) were measured pre- and postoperatively. Complications were recorded within a 30-day follow-up. Postoperative SHC was the primary outcome. Results: In the beta group and the no beta group, 54 patients and 47 patients were included, respectively. In the beta group, the incidence of SHC (4 pts vs. 14 pts in the no beta group; P=0.003) was reduced. In the beta group, serum calcium levels were higher on postoperative day 1 (8.6 mg/dL vs. 8.2 mg/dL in the no beta group; P=0.001) and day 2 (8.7 mg/dL vs. 8.1 mg/dL in the no beta group; P<0.000). In the beta group, serum C-reactive protein levels were lower postoperatively. In a univariate analysis, American Society of Anaesthesiology score > I (odds ratio [OR], 0.19; P=0.002), no betamethasone treatment (OR, 0.19; P=0.006), and parathyroid glands remaining in situ (PGRIS) score <3 (OR, 6.00; P=0.005) were related to postoperative SHC; in a multivariate analysis, betamethasone treatment (OR, 0.09; P=0.007) and PGRIS score <3 (OR, 8.41; P=0.045) were related to postoperative SHC. No difference was observed in postoperative complications. Conclusion: Postoperative use of betamethasone reduces the incidence of SHC after thyroid surgery without affecting other complications.
Francesca Fiore,Stefano Cacciatore,Salvatore Tupputi,Clara Agostino,Rossella Montenero,Giovanni Spaziani,Daniele Elmi,Martina Medei,Manuela Antocicco,Federica Mammarella,Eleonora Taddei,Ester Manes-Gr 대한노인병학회 2022 Annals of geriatric medicine and research Vol.26 No.4
Frailty is a clinically measurable state of vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Chronic diseases, aggressive treatments, antibiotic overuse, microbiota changes, immune senescence, and increased use of medical devices and implants (i.e., central lines and catheters) expose modern patients to healthcare-associated infections (HAIs), multidrug-resistant bacteria, and new and unusual opportunistic pathogens. Older adults are among the main victims of HAIs and are associated with high costs, disability, morbidity, and mortality. Ralstonia pickettii is an emerging opportunistic pathogen that causes rare nosocomial infections in frail individuals. Herein, we present a case of bloodstream infection caused by R. pickettii in an 88-year-old woman with a relatively mild course. In addition to describing this unusual finding, this report discusses the problem of HAIs in older adults. Older age, comorbidities, and hospital admissions were among the main risk factors for HAIs. Adherence to guidelines, training, auditing, and surveillance is crucial for reducing the burden of HAIs in acute settings. Furthermore, avoiding incongruous hospitalizations would have positive implications both for preventing HAIs and improving patient quality of life.