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Due to the presence of artefacts in stool samples, the copromicroscopic diagnosis of Ascaris lumbricoides is not always straightforward, particularly in the case of fertilized decorticated eggs. A total of 286 stool samples from 115 schoolchildren in India and 171 adult immigrants in Italy were screened for the presence of A. lumbricoides eggs by both Kato-Katz thick smear and Mini-FLOTAC. If the outer layer of A. lumbricoides eggs was absent, two aliquots of each stool sample were preserved: one for coproculture to identify larvae after development and one to compose a pool of stool for molecular analysis. A total of 64 stool samples (22.4%) were positive for A. lumbricoides using the Kato-Katz thick smear; 36 (56.3%) of these showed mammillated A. lumbricoides eggs, 25 (39.1%) showed elements resembling fertilized decorticated eggs, while three samples (4.7%) showed both mammillated and decorticated eggs. By Mini-FLOTAC, 39 stool samples (13.6%) were positive, while decorticated A. lumbricoides-like eggs were identified as artefacts. These results were confirmed by negative coprocultures and quantitative polymerase chain reaction. Mini-FLOTAC can be used for a reliable diagnosis of A. lumbricoides, thanks to the flotation and translation features which allow a clearer view, resulting in the correct identification of A. lumbricoides eggs.
To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications.
Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on or price change in SSB were included.
Studies conducted in countries of different income classifications.
The search yielded 8349 articles of which 21 met inclusion criteria.
Among the sixteen studies selected, only two did not show that consumption, sales and purchase decreased as the price of SSB increased. In eight of the thirteen studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20 % taxation on SSB would result in a greater decrease in the prevalence of overweight and obesity compared to a 10 % rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle- and middle-income countries.
A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSB and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.
Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media.
A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted.
From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application.
Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.
There is an association between unemployment, poor mental health and suicidal behaviour. There is a modulating effect of the strength of national social security programmes: countries with the weakest welfare states showed a greater impact of unemployment on rates of suicide.
While employment may be beneficial to health, exposure to a range of psychosocial hazards can also put workers at risk of poor mental health. People with mental health conditions now represent the largest group receiving out-of-work sickness benefits. In the UK, rates of employment of people with schizophrenia may have fallen. Supported employment is significantly more effective than pre‐vocational training. The initial business case for IAPT (Independent Access to Psychological Treatment) assumed that the receipt of cognitive behavioural therapy (CBT) would result in people returning to work, but few did. More recently, we have seen a shift from ‘work’ as therapy to ‘work’ as a human right. Annual surveys conducted in England between 2004 and 2008 repeatedly showed that, of those who use mental health services and were unemployed, more than half would have liked help in gaining employment but mental health services had not offered such help.
Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings were included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an eight-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. OR and 95 % CI were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4·5 v. <3·25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR = 0·54, 95 % CI 0·35, 0·91) and specifically in postmenopausal women (OR = 0·55, 95 % CI 0·34, 0·95), in cases with oestrogen positive and progesterone positive breast cancer subtypes (OR = 0·54, 95 % CI 0·39, 0·89 and OR = 0·68, 95 % CI 0·43, 0·89, respectively) and in obese women (OR = 0·52, 95 % CI 0·35, 0·81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form a part of cost-effective breast cancer prevention guidelines.
To explore whether people from Black, Asian and minority ethnic (BAME) communities experience equality of access and outcome in individual placement and support (IPS) employment services. Cross-sectional data were analysed of all people with severe mental health problems who accessed two mature high-fidelity IPS services in London in 2019 (n = 779 people).
There were no significant differences between the proportions of people who gained employment. The data strongly suggest that people from BAME communities are not differentially disadvantaged in relation to either access to or outcomes of IPS employment services.
The challenge for mental health professionals is not to decide who can and who cannot work but, how to support people on their case-loads to access IPS and move forward with life beyond their illness.
To analyse trends of social inequality in breastfeeding and infant formula (IF) use in Latin America between 1990 and 2010 decades.
Time-series cross-sectional study with data from Demographic and Health Surveys. We described the prevalence of exclusive breastfeeding (EBF), breastfeeding between 6 and 12 months (BF6-12) and IF for infants under 6 months (IF < 6) and between 6 and 12 months (IF6-12). Social inequalities were assessed using the slope index of inequality (SII) and concentration index (CIX). Trends in the prevalence of breastfeeding, IF and index of social inequality were analysed by a linear regression model with weighted least squares variance.
Bolivia, Colombia, Dominican Republic, Guatemala, Haiti and Peru.
51·358 alive infants younger than 12 months.
Five countries showed an increasing trend for EBF and BF6-12, four increased for IF < 6 and six for IF6-12. Simultaneous decrease in IF < 6 (Colombia: −0·3/year; Haiti: −0·02/year) and increase in EBF (Colombia: +2·0/year; Haiti: +1·9/year) were observed only in two countries. EBF prevalence was high in the lowest income quintiles in five countries, and IF prevalence was high in the highest income quintiles in all countries and over the decades. For BF6-12, a decrease in inequality (prevalence increased in the highest quintile) was observed in Guatemala (SII1995 = −0·42; SII2015 = −0·28) and the Dominican Republic (SII1996 = −0·54; SII2013 = −0·26). Guatemala was the only country showing a decrease in inequality for BF (SII = −0·005; CIX = −0·0035) and an increase for IF (SII = 0·022; CIX = 0·01).
The inequality in BF and IF remained over time. However, inequality in IF < 6 has decreased because low-income infants have increased use and high-income infants have decreased.
To describe the duration of breast-feeding between 1990 and 2013 and to estimate the association between breast-feeding duration and sociodemographic, health and pro-breast-feeding policies and programmes in Latin American countries.
This is a cross-sectional study with data from Demographic and Health Surveys programme conducted in Bolivia, Brazil, Colombia, Peru and the Dominican Republic between 1990 and 2013. The median duration of breast-feeding was estimated by survival analysis. Information on pro-breast-feeding policies and programmes was extracted from the World on Breastfeeding Trends Initiative (WBTi) tool. The association between the duration of breast-feeding and WBTi tool score was analysed by multilevel survival regression.
Nationally representative cross-sectional survey from Bolivia, Brazil, Colombia, Peru and Dominican Republic.
We included children under 24 months of age, totalling 17 318 children.
Breast-feeding duration showed a significant increase in all countries, except the Dominican Republic. Mothers with higher schooling level (HR = 1·66; 95 % CI 1·35, 2·04), higher income (HR = 1·58; 95 % CI 1·40, 1·77) and overweight (HR = 1·14; 95 % CI 1·05, 1·23) breastfed for a shorter time. Breast-feeding in the first hour of life (HR = 0·79; 95 % CI 0·74, 0·83) was associated with increase in the duration of breast-feeding. Regarding WBTi, Peru presented the lowest score and the Dominican Republic presented the highest score. WBTi score was inversely related to the duration of breast-feeding for this set of countries (HR = 1·07; 95 % CI 1·02, 1·12).
Mothers with better socio-economic conditions and overweight breastfed for a shorter time. Breast-feeding in the first hour was associated with longer duration of breast-feeding. In this set of countries, higher scores from WBTi tool did not result in longer duration of breast-feeding.
The Kubic FLOTAC microscope (KFM) is a compact, low-cost, versatile and portable digital microscope designed to analyse fecal specimens prepared with Mini-FLOTAC or FLOTAC, in both field and laboratory settings. In this paper, we present the characteristics of the KFM along with its first validation for fecal egg count (FEC) of gastrointestinal nematodes (GINs) in cattle. For this latter purpose, a study was performed on 30 fecal samples from cattle experimentally infected by GINs to compare the performance of Mini-FLOTAC either using a traditional optical microscope (OM) or the KFM. The results of the comparison showed a substantial agreement (concordance correlation coefficient = 0.999), with a very low discrepancy (−0.425 ± 7.370) between the two microscopes. Moreover, the KFM captured images comparable with the view provided by the traditional OM. Therefore, the combination of sensitive, accurate, precise and standardized FEC techniques, as the Mini-FLOTAC, with a reliable automated system, will permit the real-time observation and quantification of parasitic structures, thanks also to artificial intelligence software, that is under development. For these reasons, the KFM is a promising tool for an accurate and efficient FEC to improve parasite diagnosis and to assist new generations of operators in veterinary and public health.
Our study aimed to describe body phenotypes (BP) estimated by multivariate analysis and their association with body mass.
Body phenotypes were defined based on demographic variables, anthropometric data (body mass, height, skinfolds and circumferences), body composition (phase angle measured by bioelectrical impedance analysis), biochemical parameters (triglycerides, glucose, total cholesterol ratio/Low Density Lipoproteins (LDL), haemoglobin and sexual maturation (pubic hair and breasts or gonads). Analysis of variance (ANOVA) was performed to verify the differences between skin colour and the stages of pubertal development, body phenotypes, body composition, anthropometric, and biochemical variables.
Cities of São Paulo-SP, Piracicaba-SP and Florianópolis-SC from Brazil and the United States.
9269 adolescents aged between 10 to 15 years old.
The composition of BP was similar in all surveys, which are: BP1 was composed by skinfolds, body mass and circumferences variables; BP2 by pubic hair, breast in girls or gonad in boys, height and age; BP3 by cholesterol, triglycerides and glucose; and BP4 by phase angle, haemoglobin and glucose (negative loading). There was a strong correlation (r = 0.9, p <0.001) between BP1 and body mass index.
We highlighted independence observed between biochemical parameters, anthropometry, body composition and sexual maturation. BP may support the calculation of scores for diagnosis of obesity based on anthropometric variables and overcome ambiguity in the isolated use of body mass index.
Earlier reports revealed oxysterol metabolites of Opisthorchis spp. liver fluke origin conjugated with DNA bases, suggesting that the generation of these DNA-adducts may underlie the mutagenicity and carcinogenicity of the infection with these food-borne pathogens. Here, we employed liquid chromatography-mass spectrometry to investigate, compare and contrast spectrograms of soluble extracts from Fasciola hepatica adult worms from bile ducts of cattle with those from O. viverrini and O.felineus from experimentally infected hamsters. F. hepatica and Opisthorchis spp. shared common compounds including oxysterol-like metabolites, bile acids and DNA-adducts, but the spectrometric profiles of F. hepatica included far fewer compounds than Opisthorchis species. These findings support the postulate that parasitic oxysterol-like metabolites could be related to carcinogenesis associated to infection and they point to a molecular basis for the differences among major groups of liver flukes concerning infection-induced malignancy.
The authors investigated the historical and clinical variables of 159 inpatients affected by mood disorders in order to identify variables which might differentiate psychotic from non-psychotic forms. The results showed that 32% of the patients had psychotic symptoms. Although no significant difference was detected with regard to the severity of depression, psychotic depressives were younger and had a lower age at onset, as well as a shorter episode length. These features suggest that depression may express itself with or without psychotic symptoms, according to the different individual and, perhaps, biological substrate. Taken together, our findings seem to indicate that psychotic depression should not be considered a separate clinical entity, but a subtype of mood disorders.
Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide. Prolonged fasting and excessive caloric intake are possible nutritional causes of NAFLD incurred by patients with eating disorders (ED).
Aims of this study are: identifying if eating disorders are associated with NAFLD; evaluating possible improvements of the risk of NAFLD and of psychopathology determined by integrated multidisciplinary treatment (behavioral therapy, dietary assessment and treatment, clinical care overall).
78 patients with ED received the integrated multidisciplinary treatment. Psychopathology and eating symptoms were assessed before and after treatment through Eating Disorder Inventory and Questionnaire of Eating Behaviours (QEB). The risk of NAFLD was evaluated by Fatty liver index (FLI) based on values of γGT, BMI, triglycerides and waist circumference.
54% of patients with binge eating disorder in our sample has a 60-FLI, indicating a risk of NAFLD higher than 85%.
FLI (p: 0.003) and yGT (p: 0.006) were significantly lower after treatment, thus indicating an improvement in the risk of NAFLD. Four of the eight EDI's subscales improved: Drive for thinness (p: 0.008), Interoceptive awareness (p < 0.001), Bulimia (p: 0.001), Ineffectiveness (p: 0.014). Two of the three SCA's subscales improved: Binge Eating (p: 0.001) and Food Restriction (p: 0.016).
the association between NAFLD and eating disorders was shown together with the efficacy of the multidisciplinary treatment. The risk index FLI and γGT were reduced by the therapy but should be monitorized over time.
To demonstrate the complex correlation existing in patients with eating disorders between hormonal alterations and psychopathological symptomatology, that has been little studied until now.
60 women aged between 16 and 35 years and diagnosed with Anorexia Nervosa and Bulimia Nervosa according to the DSM-IV were assessed using the SCL-90-R, EDI, BAT and DES II. A blood sample was taken from each patient in the morning, on the seventh day of the menstrual cycle or on the corresponding day from the women with amenorrhea; the following hormone levels were measured: TSH, FT3, FT4, LH, FSH, 17-beta-estradiol, cortisol, DHEAS. Pearson's Correlation Coefficient has been used to test the correlation between hormonal level and test scores.
Positive correlations exist between BMI and FT3 and LH, which decrease when BMI decreases. We can observe positively significant correlations between LH and FSH levels and the BAT scale scores.No one significant correlation was found between hormonal levels and dissociative symptoms as measured by DES. With regard to EDI, the following psychopathological features correlate with hormonal assessment: the wish to be thin, body dissatisfaction and perfectionism.
Our findings suggest a significant correlation between psychopathological features we considered and hormonal readings, especially LH, FSH, TSH, FT3. When these hormonal readings decrease, the patients’ self-ratings and their body dissatisfaction decrease. That attributes a protective meaning to the dietary symptom akin to an effective measure that relieves the person's feelings of inadequacy.
Even if obesity isn’t a psychiatric disorder included in the DSM IV-TR, it is associated with a high prevalence of psychopatological features. Mainly obese patients on a waiting list for bariatric surgery are affected by psychiatric disorders more often than non-obese individuals.
To estimate the prevalence of psychopatology in obese patients on a waiting list for weight loss surgery.
To demonstrate the importance of a multidisciplinary approach to bariatric surgery that includes a psychodiagnostic evaluation.
Forty-seven patients on a waiting list for bariatric surgery were assessed using the SCL-90-R.
In a high rate of patients (83%) was identified a significantly altered value at least in one of the SCL-90-R subscales. Mainly the 80.85% has expressed a psychological distress through physical symptoms (SOM), the 63.82% had a deflection of mood (DEP), the 61.7% had a higher ability to perceive both internal and external stimuli (IS); suspiciousness (PAR) occurred in 59.57% of patients (PAR).
Our results suggest a high rate of psychopatological alterations in patients on a waiting list for weight loss. These individuals try to manage their emotions through the relationship with food, and the body become a way to express themselves. Therefore the early detection and the treatment of the psychopatological features associated with obesity could have a role to improve the therapeutic outcome, and a multidisciplinary approach could represent an essential element to reach a global resolution of both clinical and mental features of patients.
The original cognitive-behavioural model of bulimia nervosa (CBT-BN) proposes that specific dysfunctional cognitions and behavioural factors maintain BN, and has provided the basis for the widely used cognitive-behavioural therapy (CBT) of BN. However, Fairburn et al. (2003) noted that among treatment completers with BN, only 40% achieved full remission of the bulimic symptomatology. The enhanced CBT-BN model (CBT-E) proposed by the authors describes how four additional factors (i.e., clinical perfectionism, low self esteem, mood intolerance and interpersonal difficulties) interact with the core psychopathology of BN (i.e., over-evaluation of eating, weight, and shape and their control) to maintain the disorder.
The goal of this study was to examine (a) the validity of the CBT-E model and (b) whether each of the four hypothesized maintenance factors intensifies the core psychopathology-bulimic symptomatology relationship in a clinical sample.
Data were analysed from 362 adults seeking treatment for BN (n = 167) or atypical BN (n =195) at four Italian specialized care centres, using latent variable structural equation modeling approach.
Both the measurement and the structural model were good fits for the data. All four hypothesized factors exacerbated the core psychopathology-bulimic symptomatology relationship. Core psychopathology explained approximately 47.7% of the variance of bulimic symptomatology. The inclusion of the direct effects and interaction terms increased the explained variance of bulimic symptomatology to 64%.
Overall, results supported the validity of the CBT-E model and highlighted the importance of assessment and treatment of the four maintenance processes included in the CBT-E model.
Psoriasis is a multifactorial chronic infiammatory skin disease that often occurs in patients with overweight or obesity; obesity makes psoriasis less susceptible to therapy and a moderate weight loss improves drug response. Many studies shows connections between obesity and eating disorders, but few studies investigated the link between eating disorders and psoriasis.
To evaluate the presence of eating disorders and psychopathological traits in patients affected by psoriasis compared with a control population, and correlate this data with different features of cutaneous disease and BMI.
To suggest the importance of a psychological support that could reduce the occurrence of loss of control over food.
We enrolled 100 consecutive psoriatic outpatients and a control group of 100 selected non psoriatic outpatients, matched by BMI to the study group. The assessment battery was composed by the Psoriasis Area and Severity Index (PASI) score, the EDI and SCL-90R.
Most of EDI and SCL-90R subscales resulted more altered in psoriatic population compared to the controls (p < .001 for IA and ID, and p < .05 for GSI). Moreover, we noticed an association between the progressive weight gain and the impairment of most of EDI subscales, indicating the presence of an ED in only psoriasis group (p < .01).
Psoriasis is associated with psychopathological traits and symptoms commonly associated with eating disorders. A multidisciplinary approach could have an important role to reduce the loss of control over food, to loss weight and to improve the drug response.
Given the poor compliance of schizofrenic patients to antipsychotic therapies, are been developed drugs in long-acting formulation that for their pharmacokinetic ensures prolonged therapeutic activities. Currently, we consider that their efficacy depends on hereditary tracts, influencing both pharmacodynamic and pharmacokinetic parameters.
Investigate relationships between clinical efficacy and genetic polymorphims of long-acting drugs’ pharmacodynamic targets.
Seventy-eight psychotic patients, treated with atypical long-acting antipsychotics (olanzapine pamoate, paliperidone palmitate, risperidon and aripiprazole), were examined. We carried out a blood sampling to evaluate dopaminergic DRD2 and glutamatergic GRM3 genetic receptors polymorphisms. PANSS and BPRS scales were used to assess clinical condition.
Regarding the GRM3 genes, the study of rs2228595 and rs6465084 polymorphisms showed a prevalence of wild type genotypic frequency of 81.2% and 56.2%, respectively. The prevalence of the patients with mutated heterozygote genotype (rs6465084 polymorphisms) resulted high (40.6%). Considering rs1989796 e rs274622 polymorphisms, the sample showed a prevalence of mutated heterozygote genotype in the 53.1% e 45.3%, respectively, with a percentage of 43.7% of patients with a mutation in homozygosis. Considering the rs146812 polymorphism, the 53.1% of patients resulted with a wild type genotype. Finally, findings showed a prevalence of 56.2% for the mutated heterozygote genotype in the DRD2 rs6277 polymorphism. The genotypic categorization analysis demonstrated a significative association between the GRM3 rs274622 polymorphism and higher BPRS scores.
The relationship between rs274622 polymorphism and worse clinical conditions could indicate a major resistance to long-acting antipsychotics in patients with genotypic frequency CT (mutated heterozygosis) for this polymorphism.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Bipolar disorders (BD) are chronic and recurrent psychopathological conditions characterized by therapeutic failures (TFs), regardless of the initial choice of psychiatric medication with a high prevalence of adverse drug reactions (ADRs). Cytochrome P450(CYP)2D6 genetics has been recently suggested to have a role in the response to treatment and extra-pyramidal symptoms (EPS) across several psychiatric conditions.
To evaluate interindividual differences in CYP2D6 enzyme activities, TFs and ADRs rates in BDs patients.
To tailor psychiatric medication choice and dose based on pharmacogenetic test.
We analyzed 16 clinical relevant polymorphisms CYP2D6 genotype in Psychiatric Unit of Foggia using the InfinitiTM Analyzer; the Simpson Angus Scale (SAS) was used to measure drug-induced EPS and Brief Psychiatric Rating Scale-24 (BPRS-24) response to treatment.
Ten drug-resistant patients were consecutively enrolled, and six of these experience major ADR during therapy with worsening of symptoms before screening for CYP polymorphism: BM (*2A/*5 genotype, BPRS-24 T0: 63, T14: 51), SR (*2A/*4, BPRS-24 T0: 66, T14: 59), LT (*4/*17 BPRS-24 T0: 72, T14: 64), DC (*2A/*4A BPRS-24 T0: 69, T14: 54), AL (*2A/*2A, BPRS-24 T0: 72, T14: 64), PA (*2A/*2A BPRS-24 T0: 52, T14: 46).
According to the specific CYP2D6 polymorphism, we personalized patients’ treatment considering that poor and extensive metabolizers have different rates of ADR and responses to treatment. CYP2D6 genotype's knowledge is useful for the reduction of therapeutic attempt during patient clinical history, thus reducing admission time and costs, and to guide clinicians toward a better patient management.
Disclosure of interest
The authors have not supplied their declaration of competing interest.