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Hip fractures most frequently occur in the elderly population. They are mainly caused by falls from standing position. The presence of several comorbidities, in particular neuropsychiatric disorders, are related to high percentages of falls, disability and mortality rates. Delirium and depression are the two most common mental disorders in this population. Delirium is strongly related to an increase of functional limitation in activities of daily living, a decline in walking autonomy, and a higher rate of nursing home placement or death. A multi-factorial intervention program, consisting of oxygen supplementation, intravenous fluid supplementation and extra-nutrition, accurate monitoring of vital signs, adequate pain treatment, daily delirium screening, reduction in drug use, and modification in peri-operative management, should always be performed in good clinical practice. Patients who undergo surgery frequently experience depression that can worsening functional outcome. An early detection and an adequate intervention based on psychological support and pharmacological treatment can give good results. We propose a simple flow chart for the management of elderly hip fracture patients that should be used in both Orthopaedics and Rehabilitative settings.

Hip fractures in elderly patients are a major health problem in the industrialised world. Italy records more than 85,000 hip fractures/year; 77% of these occur in women, 79% of whom are aged over 75 years (data from Italian Health Ministry discharge records for 2005).Hip fractures generate 30% of overall hospitalisation costs. It is calculated that, in the over-65s alone, the annual cost of fractures exceeds 1 billion euros.The incidence of this disease is increasing constantly, and it is predicted that by 2030 there will be around 750,000 new cases in Europe each year (data from Italian Health Ministry discharge records for 2006).This is an extremely interesting phenomenon, not only from the economic and organisational perspectives, but also as regards the profile of healthcare required, given that hip fractures are often associated with a worsening of quality of life and increased mortality.Elderly fracture patients generally have comorbidities that need to be assessed before and after surgery. Recommendations for the care of these patients include: early surgical intervention, use of prophylactic antibiotics and thromboembolic prophylaxis, good control of perioperative pain to improve ambulation, prevention of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery; it is also necessary to detect and manage delirium and other cognitive disorders in order to reduce the risk of complications and of institutionalisation.Neuropsychiatric disorders such as dementia and delirium increase the mortality of these patients in the six months following hip fracture, while depression can have a negative effect on functional outcome and survival in the longer term. Delirium in hip fracture patients seems to be different from that observed in other types of patient, showing a different clinical course.Delirium is a frequent post-operative complication in elderly patients treated for hip fracture. Several fundamental factors have been identified in the genesis of this comorbidity. The use of psychotropic drugs in the preoperative period seems to significantly increase the risk of developing postoperative delirium.Hyperactive delirium, characterised by increased pyschomotor activity, agitation and behavioural disturbances, is the delirium subtype most often encountered in patients with proximal femur fractures.In short, cognitive and mood disorders in elderly hip fracture patients are associated with an increased risk of poor functional outcome and of reduced survival. Therefore, identification and treatment of these conditions is central to a correct therapeutic approach to the fragile elderly patient with hip fracture

Sesame seed allergy, a potentially very severe food allergy, seems on the rise worldwide but is still uncommon in Italy. The aim of the present study was to investigate the allergenic profile of Italian sesame seed-allergic patients.Patients with genuine sesame seed allergy diagnosed over one year in a large number of allergy centers scattered through Italy were considered for the study. Their IgE reactivity to sesame seed allergens was characterized by immunoblot analysis.Eleven sesame seed allergic patients were detected and studied. 10/10 patients showed IgE reactivity against a sesame allergen at about 20 kDa, and 7/10 showed an extremely strong reactivity at about 32 kDa. The same 7 sera reacted also against a 28 kDa allergen, although such reactivity was significantly weaker in 6/7 cases. Eight patients showed IgE reactivity at about 48 kDa, and 5 sera reacted against higher m.w. proteins at about 67 kDa. Two sera showed IgE reactivity at about 43 kDa as well. Only one serum appeared to react to 2S-albumin.Italian sesame seed-allergic patients react mostly against allergens other than those described so far as major ones. A large number of recombinant sesame allergens will be needed for a comprehensive component- resolved diagnosis of allergy to this food.

Anisakis simplex (As), a parasite in fish, is able to sensitize humans via the alimentary tract. The prevalence of hypersensitivity and allergy to As outside the Iberian peninsula has not been investigated so far. We investigated Anisakis hypersensitivity in different areas of Italy.Consecutive subjects seen at 34 Italian allergy centers from October to December 2010 were investigated both by specific interview and by skin prick test (SPT) with As extract.A total of 10 570 subjects were screened, of which 474 (4.5%) scored positive on Anisakis SPT and 66 of these (14% of those sensitized; 0.6% of the studied population) had a history of As allergy. Marinated anchovies were the most frequent cause of allergic reactions. Thirty-four (52%) patients were mono-sensitized to Anisakis. Sensitization rate showed marked geographic differences (range: 0.4-12.7%), being highest along the Adriatic and Tyrrhenian coasts, where homemade marinated anchovies are an age-old tradition. In inland centers in northern Italy, the prevalence was directly related to the number of inhabitants. The analysis of the impact of immigration on the prevalence of Anisakis hypersensitivity showed that about 60% of sensitized subjects in Milano and Torino came from southern Italy or from non-European countries.Anisakis hypersensitivity and allergy are mainly a matter of dietary habits. Areas where marinated anchovies are popular can be considered as 'endemic' for this type of food allergy, whereas immigration and, possibly, new or imported trendy food styles, such as eating raw fish carpaccios or sushi, are a major causative factor in big cities of inland zones.