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INTRODUCTION:Optimal nutrition during the first 1000 days of a child's life is crucial for healthy growth and development. Caregiver feeding practices can significantly affect what foods are offered, which foods are preferred and how healthy eating patterns are established, highlighting the need for clear guidance and recommendations. Currently, there are no national guidelines focused on the transition from being fed at birth to independent eating by 2 years old. This study aimed to develop concise, evidence-based recommendations to support healthy eating behaviours in children aged 0-2 years. METHODOLOGY:A systematic literature search was conducted on PubMed, Cumulated Index to Nursing and Allied Health Literature and Excerpta Medica Database to identify relevant articles. The GRADE-ADOLOPMENT methodology was employed to adopt, adapt or develop evidence-based recommendations for feeding and eating practices in infants and young children. This includes using the Evidence-to-Decision framework to ensure recommendations considered the balance of benefits and harms, feasibility and cultural appropriateness. A multidisciplinary panel of domain experts reviewed and refined the recommendations, with consensus defined as ≥70% agreement. A total of 64 articles were reviewed, comprising eight observational cohort studies, 25 randomised controlled trials and 31 systematic reviews (including four meta-analyses). The included studies examined key aspects of complementary feeding: 20 focused on timing, 30 on types of food, 13 on self-regulation and one on the feeding environment. RESULTS:Seven consensus statements were developed based on the evidence and organised into four main domains: Variety, Autonomy, Setting and Timing. All statements achieved unanimous agreement among domain experts. CONCLUSION:These guidelines provide clear, evidence-based recommendations for practical nutrition strategies during early childhood.
Purpose: The aim of the retrospective, single-center study was to assess the prognostic value of immune cell-based and albuminbased ratios regarding lethal outcome in critically ill COVID-19 patients. Patients and Methods: We analyzed 612 adult critically ill COVID-19 patients admitted to the intensive care unit (ICU) between April 2020 and November 2022. Blood measurement on admission to the ICU encompassed complete blood count (CBC), IL-6, C-reactive protein (CRP), albumin, lactate, lactate dehydrogenase (LDH), serum bicarbonate, arterial base deficit/excess (BD/E), and D-dimer. All the measured and calculated parameters were compared between survivors and nonsurvivors, with the outcome measure being hospital mortality. - neutrophil count divided by the result of white blood cell (WBC) count - neutrophil count), N/LP - Neutrophil count x 100/ count, Systemic Inflammation Response Index (SIRI) - neutrophil x monocyte/lymphocyte count] were investigated. White blood cell and neutrophil counts were significantly higher, while lymphocyte and platelet counts were significantly lower in nonsurvivors. MPV, Monocyte count and PLR values did not differ significantly between groups. Albumin-based ratios included CRP-to-Albumin Ratio (CAR), Lactate-to-Albumin Ratio (LAR) and LDH-to-Albumin Ratio (LDH/ALB). All values were significantly higher in nonsurvivors. Conclusion: The only independent predictor of lethal outcomes at ICU admission is the albumin-based LDH/ALB ratio. Most of the other parameters were moderate, although highly significant predictors of mortality in critically ill COVID-19 patients.
BACKGROUND:The management of high-surgical-risk patients with moderate to severe acute cholecystitis is challenging in clinical practice. Early laparoscopic cholecystectomy is considered the gold standard for patients who do not respond to conservative treatment. However, for those unfit for surgery due to high risk, alternative treatment options, such as percutaneous cholecystostomy (PC), are available. There are no clear guidelines regarding the management of patients following PC. The primary aim of this study was to propose indications for PC in high-surgical-risk patients with acute cholecystitis and to establish management strategies for gallbladder drainage, either as a bridge to surgery or as a definitive treatment, according to available literature. MATERIALS AND METHODS:After a targeted literature review, International and Italian experts in the field from the Italian Society of Research in Surgery (SIRC) and the Italian Society of Emergency Surgery and Trauma (SICUT) were consulted to provide their evidence-based opinions on the topic. Statements were proposed during subsequent rounds using the Delphi methodology. Ten statements were provided, and the final agreement is presented in this study. RESULTS:Patients with moderate acute cholecystitis, a Charlson Comorbidity Index (CCI) ≥ 6, and American Society of Anesthesiologists-Performance Status (ASA-PS) ≥ 3 who fail conservative treatment should undergo laparoscopic cholecystectomy as the first-line approach. For those with severe acute cholecystitis at high-surgical risk, percutaneous cholecystostomy is recommended to relieve symptoms within 24-48 hours. Once the infection is controlled, we should assess which patients may be candidates for interval laparoscopic cholecystectomy. For patients selected for surgery, laparoscopic cholecystectomy is recommended at least six weeks after PC placement. In patients not suitable for surgery, such as those with CCI ≥ 6 and ASA-PS ≥ 4, percutaneous cholecystostomy should remain in place for at least three weeks, after which, following radiographic confirmation of biliary tree patency, the tube may be removed. CONCLUSIONS:This consensus, developed through a multidisciplinary collaboration of interventional radiologists, gastroenterologists, and surgeons, provides a clear and practical guide for managing high-risk surgical patients with acute cholecystitis.
Background:Cardiac remodeling in response to hemodynamic and neurohormonal factors is the primary driver of heart failure progression. Angiotensin receptor-neprilysin inhibitor (ARNI) has superior beneficial effects on mortality and quality of life compared to angiotensin-converting enzyme inhibitor (ACEI). Speckle-tracking echocardiography can detect early subtle changes in cardiac structure in numerous cardiac diseases. The study was conducted to evaluate the possible impact of ARNI therapy compared to ACEI on cardiac remodeling using echocardiographic parameters, including global longitudinal strain (GLS) in heart failure with reduced left ventricular ejection fraction (HFrEF) patients. Methods:This prospective observational study included eighty recently diagnosed HFrEF patients with left ventricular ejection fraction (LVEF) ≤35%, prescribed the four pillars of guideline-directed medical therapy, and uptitrated to the maximally tolerated doses. The study included two groups: the ARNI group included forty patients prescribed ARNI, and the ACEI group included forty patients prescribed ACEI. All patients underwent two- and three-dimensional (2D and 3D) echocardiography to assess baseline parameters, including indexed left ventricular (LV) volumes and 2D and 3D GLS, at baseline and after a 6-month follow-up period. Results:Both groups had no significant differences regarding demographic data and echocardiographic findings at baseline. After a 6-month follow-up period, there was a significant reduction in LV-indexed volumes in the ARNI group (P < 0.001) and indexed left atrial volumes (P = 0.013) compared to the ACEI group. There was a significant improvement in the ARNI group regarding LVEF (P = 0.011), 2D GLS (P < 0.001), and 3D GLS compared to the ACEI group, but no significant change in the LV mass index. Multivariate regression analysis showed that the use of ARNI, absence of diabetes mellitus, and a higher baseline GLS (above-9.1%) are independent predictors for the occurrence of reverse remodeling (defined as an increase in LVEF ≥5%). Conclusion:The inclusion of ARNI in the pharmacotherapy of HFrEF patients is an independent predictor of LV reverse remodeling, as observed in a significant improvement in both 2D and 3D volumetric echocardiographic parameters, improved LVEF and longitudinal LV systolic function, represented in 2D and 3D GLS. Baseline 3D GLS and not LVEF or 2D GLS can help predict the occurrence of reverse remodeling in HFrEF patients.
