Climate change and human health: Last call to arms for us.

Climate change, now the foremost global health hazard, poses multifaceted challenges to human health. This editorial elucidates the extensive impact of climate change on health, emphasising the increasing burden of diseases and the exacerbation of health disparities. It highlights the critical role of the healthcare sector, particularly anaesthesia, in both contributing to and mitigating climate change. It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.

Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit.

Intensive care units (ICU) for various reasons, including the increasing age of admitted patients, comorbidities, and increasingly complex surgical procedures (e.g., transplants), have become "the epicenter" of nosocomial infections, these are characterized by the presence of multidrug-resistant organisms (MDROs) as the cause of infection. Therefore, the perfect match of fragile patients and MDROs, as the cause of infection, makes ICU mortality very high. Furthermore, carbapenems were considered for years as last-resort antibiotics for the treatment of infections caused by MDROs; unfortunately, nowadays carbapenem resistance, mainly among Gram-negative pathogens, is a matter of the highest concern for worldwide public health. This comprehensive review aims to outline the problem from the intensivist's perspective, focusing on the new definition and epidemiology of the most common carbapenem-resistant MDROs (Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales) to emphasize the importance of the problem that must be permeating clinicians dealing with these diseases.

Antimicrobial approach of abdominal post-surgical infections.

Abdominal surgical site infections (SSIs) are infections that occur after abdominal surgery. They can be superficial, involving the skin tissue only, or more profound, involving deeper skin tissues including organs and implanted materials. Currently, SSIs are large global health problem with an incidence that varies significantly depending on the United Nations' Human Development Index. The purpose of this review is to provide a practical update on the latest available literature on SSIs, focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.

Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis.

Ceftolozane-tazobactam (C/T) is a combination of an advanced-generation cephalosporin (ceftolozane) with a ß-lactamase inhibitor (tazobactam). It is approved for the treatment of complicated urinary-tract/intra-abdominal infections and hospital-acquired/ventilator-associated pneumonia. This systematic review and meta-analysis (registered prospectively on PROSPERO, no. CRD42019134099, on 20 January 2020) aimed to evaluate the effectiveness of C/T combination therapy compared to C/T monotherapy for the treatment of severe infections and to describe the prevalence of microorganisms in the included studies. We retrieved literature from PubMed, EMBASE, and CENTRAL, until 26 November 2020. Eligible studies were both randomised trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was all-cause mortality; secondary outcomes were (i) clinical improvement and (ii) microbiological cure. Eight nonrandomised studies were included in the qualitative synthesis: Seven retrospective cohort studies and one case-control study. The meta-analysis of the four studies evaluating all-cause mortality (in total 148 patients: 87 patients treated with C/T alone and 61 patients treated with C/T combination therapy) showed a significant reduction of mortality in patients receiving C/T combination therapy, OR: 0.31, 95% CI: 0.10-0.97, p = 0.045. Conversely, the meta-analysis of the studies evaluating clinical improvement and microbiological cure showed no differences in C/T combination therapy compared to C/T monotherapy. The most consistent data come from the analysis of the clinical improvement, n = 391 patients, OR: 0.97, 95% CI: 0.54-1.74, p = 0.909. In 238 of the 391 patients included (60.8%), C/T was used for the treatment of infections caused by Pseudomonas aeruginosa.

Diagnostic accuracy of computerized tomography (CT) angiography in detecting non-variceal gastrointestinal bleeding (NVGIB): a sistematic review.

INTRODUCTION: The American Society for Gastrointestinal Endoscopy (ASGE) has produced numerous algorithms for the management of gastrointestinal bleeding (GIB) in which endoscopy plays a major role. The aim of this Systematic Review was to evaluate the diagnostic accuracy of computerized tomography (CT) angiography in detecting non-variceal gastrointestinal bleeding (NVGIB). METHODS: Studies were identified on PubMed, Web of Science and Scopus databases from 2009 to 2019. The search performed included the following terms: "digestive" and "bleeding" as well as "acute bleeding gastrointestinal" or "acute bleeding digestive". Studies were included if enrolled adult patients and included measures of diagnostic accuracy (sensibility and specificity) of CT angiography in detecting GIB. Studies on variceal bleeding were excluded. First, a bivariate diagnostic randomeffects meta-analysis was fitted through REML (Restricted maximum likelihood approach) method, with the estimation of pooled sensitivity, specificity and SROC curve. Then, an univariate model was fitted for the 11 studies, with the estimation of pooled Diagnostic Odds Ratio and Cochrane's Q for heterogeneity. RESULTS: Eleven studies were eligible for inclusion criteria and so included in the analysis. The pooled sensitivity is 85% [75%, 92%], the pooled specificity 93% [89%, 96%]. The pooled DOR is 94.35 [37.91, 234.82]. Q for heterogeneity is not significant (p=0.377). CONCLUSIONS: CT angiography showed a good sensibility and specificity in detecting NVGIB. Therefore, it would be useful to consider CT angiography use also in the suspicion of NVGIB, especially when endoscopy is not immediately available and there are signs and symptoms of bleeding in progress.

A new simple score for prediction of difficult laryngoscopy: the EL.GA+ score.

BACKGROUND: Preoperative airway assessment plays a key role in the context of difficult airway management. Several scores have been proposed to predict difficult intubation including the el-Ganzouri index (EL.GA). Anatomical parameters such as the opening of the mouth or the circumference of the neck (which currently is not usually evaluated) are used to predict difficult intubation. The nutritional status of super-morbid obesity (body mass index [BMI] > 50 kg m-2) is a recognised risk factor for difficult intubation. METHODS: This is a single-centre, retrospective, observational study whose aim is to validate an additional parameter (anatomical plus nutritional) to the El.GA index, hence the choice of the acronym for the definition of the study: EL.GA+, in predictivity of airway management; multiple logistic regression analysis was performed to determine the predictive role of BMI, neck circumference and opening of the mouth of intubation difficulty measured with the gold standard. RESULTS: In total, 240 patients who had an elective surgical procedure under general anaesthesia, requiring endotracheal intubation, were examined. The predictive value of the EL.GA score was confirmed by the values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) according to the data reported in the literature. Furthermore, based on the values of the PPV and NPV (0.69 and 0.60 respectively), neck circumference of 42.5 cm can be taken as a cut-off value for which EL.GA+ becomes predictive of difficult intubation in patients with mild obesity (BMI of 30 to 35). CONCLUSIONS: The EL.GA+ score greatly increases the prediction of difficult laryngoscopy in mildly obese patients.