Awake prone position is an emerging rescue therapy applied in patients undergoing noninvasive ventilation (NIV) for acute hypoxemic respiratory failure (ARF) related to novel coronavirus disease ...(COVID-19). Although applied to stabilize respiratory status, in awake patients, the application of prone position may reduce comfort with a consequent increase in the workload imposed on respiratory muscles. Thus, we primarily ascertained the effect of awake prone position on diaphragmatic thickening fraction, assessed through ultrasound, in COVID-19 patients undergoing NIV.
We enrolled all COVID-19 adult critically ill patients, admitted to intensive care unit (ICU) for hypoxemic ARF and undergoing NIV, deserving of awake prone positioning as a rescue therapy. Exclusion criteria were pregnancy and any contraindication to awake prone position and NIV. On ICU admission, after NIV onset, in supine position, and at 1 h following awake prone position application, diaphragmatic thickening fraction was obtained on the right side. Across all the study phases, NIV was maintained with the same setting present at study entry. Vital signs were monitored throughout the entire study period. Comfort was assessed through numerical rating scale (0 the worst comfort and 10 the highest comfort level). Data were presented in median and 25th-75th percentile range.
From February to May 2021, 20 patients were enrolled and finally analyzed. Despite peripheral oxygen saturation improvement 96 (94-97)% supine vs 98 (96-99)% prone, p = 0.008, turning to prone position induced a worsening in comfort score from 7.0 (6.0-8.0) to 6.0 (5.0-7.0) (p = 0.012) and an increase in diaphragmatic thickening fraction from 33.3 (25.7-40.5)% to 41.5 (29.8-50.0)% (p = 0.025).
In our COVID-19 patients assisted by NIV in ICU, the application of awake prone position improved the oxygenation at the expense of a greater diaphragmatic thickening fraction compared to supine position. Trial registration ClinicalTrials.gov, number NCT04904731. Registered on 05/25/2021, retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT04904731 .
Cystic fibrosis (CF) is a genetic disease affecting today nearly 70,000 patients worldwide and characterized by a hypersecretion of thick mucus difficult to clear arising from the defective CFTR ...protein. The over-production of the mucus secreted in the lungs, along with its altered composition and consistency, results in airway obstruction that makes the lungs susceptible to recurrent and persistent bacterial infections and endobronchial chronic inflammation, which are considered the primary cause of bronchiectasis, respiratory failure, and consequent death of patients. Despite the difficulty of treating the continuous infections caused by pathogens in CF patients, various strategies focused on the symptomatic therapy have been developed during the last few decades, showing significant positive impact on prognosis. Moreover, nowadays, the discovery of CFTR modulators as well as the development of gene therapy have provided new opportunity to treat CF. However, the lack of effective methods for delivery and especially targeted delivery of therapeutics specifically to lung tissues and cells limits the efficiency of the treatments. Nanomedicine represents an extraordinary opportunity for the improvement of current therapies and for the development of innovative treatment options for CF previously considered hard or impossible to treat. Due to the peculiar environment in which the therapies have to operate characterized by several biological barriers (pulmonary tract, mucus, epithelia, bacterial biofilm) the use of nanotechnologies to improve and enhance drug delivery or gene therapies is an extremely promising way to be pursued. The aim of this review is to revise the currently used treatments and to outline the most recent progresses about the use of nanotechnology for the management of CF.
In 2008 the Italian government classified the Bussi sul Tirino area (Central Italy) as Site of National Interest destined to remediation which, unfortunately, has not yet begun. The decision followed ...>20 years of illegal dumping of industrial wastes, lasting from 1984 to 2005, that generated the biggest illegal toxic waste disposal site in Europe. The contamination profile of the site was mainly characterized by PCDD/Fs, PCBs, PAHs, chlorinated solvents, Hg, and Pb. Due to the health concern of the population and local authorities, an extensive monitoring and biomonitoring campaign was carried out in 2017–2018, checking the site-specific pollutants in local food (free-range hens' eggs, milk from grazing sheep and goats, wild edible mushrooms, and drinking water), environmental (air and freshwaters) and biological (human urine) matrices. A total of 314 samples were processed, obtaining 3217 analytical data that were compared with regulatory limits, when available, and values reported by international literature.
The sum PCDD/Fs and DL-PCBs ranged from 0.24 to 3.6 pg TEQ g−1 fat, and from 0.46 to 8.3 pg TEQ g−1 fat, respectively in milk in eggs, in line with the maximum levels established by CE Regulations except for an egg sample. As regards PAHs, all our results were lower than the literature data, as well as for Hg and Pb. Outdoor air showed levels of chlorinated solvents ranging from <LOD to 36 μg m−3, and freshwaters from 0.21 to 2.8 μg L−1. All drinking water samples resulted compliant with the maximum levels established by the current EU directive.
Despite the severe pollution of the illegal dumping site and the remediation not yet carried out, the local environment and the population living in Bussi and surroundings seem not to be affected by significant exposure to the toxics characterizing the landfill.
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•Occurrence data from highly polluted site in central Italy are presented.•Local food, fresh and drinking waters, air and human urine were sampled.•PCDD/Fs, PCBs, PAHs, chlorinated VOCs, Mercury and Lead were determined.•In most samples, contaminants resulted in line with limits and literature data.•Local environment and population seem not to be significantly exposed.
Antibiotic resistance is a serious health and social problem that will have a substantial impact in the coming years on the world health and economy. Thus, the increasing demand for innovative ...antibiotics, has prompted many researchers in the medical, microbiological, and biochemical fields to exploit the properties of antimicrobial peptides (AMPs). When properly used, designed, and conveyed, AMPs can really represent a valid alternative to conventional drugs especially in situations that are particularly difficult to treat such as chronic infections found in Cystic Fibrosis (CF) patients. In this review we focused on the applications of AMPs in the specific field of CF, illustrating different types of peptides from natural, naturally modified, synthetic as well as the different strategies used to overcome the barriers, and the physiological conditions in which AMPs must operate.
There are no parameters predicting the individual probability of “full response” to cardiac resynchronization therapy (CRT). The aim of this work was to find prognostic factors of full clinical and ...echocardiographic responses (i.e., ≥50% left ventricular ejection fraction LVEF and New York Heart Association class I) after 1 year of CRT. This was a prospective follow-up study that involved 2 hospitals. Patients (n = 75) with advanced heart failure (64 ± 9 years of age, 87% men, LVEF 24 ± 7%) who received CRT were followed for 17 ± 9 months. Univariate and multivariate regression analyses were used to identify predictors of full CRT response. A nomogram predicting the individual probability of full CRT response during follow-up was calculated. There were 13 patients with restoration of normal LVEF versus 62 without (mean LVEF 56% ± 5% vs 31% ± 8%, respectively, p <0.001). Predictors of full response included cause of heart disease, baseline QRS width, and degree of QRS shortening in response to CRT. Patients with nonischemic heart disease, baseline QRS width ≤150 ms, and QRS shortening ≥40 ms in response to CRT had a >75% probability of restoration of normal LVEF. In conclusion, our nomogram using a combination of cause, baseline QRS width, and degree of QRS shortening in response to CRT allows assessment of individual probability of full response. This observation awaits further confirmation from larger series.
Objective
In transposition of great arteries (TGA), aortopulmonary mismatch (APM) can determine postoperative neo‐aortic insufficiency after arterial switch operation (ASO). The distortion of ...sinu‐tubular junction may be the geometric mechanism responsible. We developed a strategy able to reduce the mismatch at the timing of ASO, and in this study, we aimed to describe our indications and results.
Methods
Preoperative root circumferences at the level of the mid‐portion of sinus of Valsalva and ascending aorta circumference were used to define APM. Indication to surgery was a neo‐aortic root (NAR) to ascending aorta ratio ≥ 1.4. Along with standard ASO, posterior neo‐aortic sinus inverted conal resection and punch technique for coronary reimplantation was used in all patients to re‐establish the more geometric ratio possible between the two components. Hypoplastic aortic arch (HAA) and aortic coarctation (CA) were managed by aortic arch enlargement with an autologous pericardial patch.
Results
Twenty patients (20 male), 19 with diagnoses TGA (17 with ventricular septal defect, 85%) and 1 with Taussig–Bing anomaly underwent ASO. HAA was present in three (15%) and CA in two (10%). The mean preoperative neo‐aortic to ascending aorta ratio was 1.8 versus 1.1 postoperatively (p < .01). No moderate or severe neo‐aortic insufficiency was observed before discharge and at a mean follow‐up of 4.3 years (interquartile range = 0.5–12 years).
Conclusion
Neo‐aortic reduction plasty with coronary reimplantation by punch technique is an effective strategy to approach preoperative APM in TGA. This technique confers a more harmonious geometry to NAR that can improve neo‐aortic valve function.
The emergency caused by the COVID-19 pandemic reactivated numerous debates on the social protections required for distinct labor groups and the need to guarantee work and income for the population. ...This article focuses on the experiences of people who work without ties to an employer and who self-identify as part of the popular, social, and solidarity economy (EPSS) in Argentina. It aims to contribute to the academic debate by identifying the conditions that favored the sustainability and organization of their work beyond the context of the emergency. In particular, we seek to examine whether the situation opened up by the pandemic led to new processes of recognition, institutionalization, and protection for these labor groups or not. A qualitative research process was developed based on interviews with representatives of 14 organizations of EPSS of Greater Rosario (primary sources) and the review of emergency measures and programs implemented by the three levels of government – national, provincial, and local – beginning with the declaration of the health emergency until December 2021 (secondary sources). In the final reflections, the main results are highlighted, positing that the state’s responses did not give rise to new institutions, rights, and protections, but rather “organized” and “administered” the institutionality that already existed.
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