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Ambient insecticides are receiving increasing attention in many developed countries because of their value in reducing mosquito nuisance. As required by the European Union Biocidal Products Regulation 528/2012, these devices require appropriate testing of their efficacy, which is based on estimating the knockdown and mortality rates of free-flying (free) mosquitoes in a test room. However, evaluations using free mosquitoes present many complexities. The performances of 6 alternative methods with mosquitoes held in 2 different cage designs (steel wire and gauze/plastic) with and without an operating fan for air circulation were monitored in a test room through a closed-circuit television system and were compared with the currently recommended method using free mosquitoes. Results for caged mosquitoes without a fan showed a clearly delayed knockdown effect, whereas outcomes for caged mosquitoes with a fan recorded higher mortality at 24 h, compared to free mosquitoes. Among the 6 methods, cages made of gauze and plastic operating with fan wind speed at 2.5-2.8 m/sec was the only method without a significant difference in results for free mosquitoes, and therefore appears as the best alternative to assess knockdown by ambient insecticides accurately.
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Aedes/efectos de los fármacos , Productos Domésticos/análisis , Insecticidas/farmacología , Control de Mosquitos/métodos , Animales , Femenino , Italia , Control de Mosquitos/normasRESUMEN
BACKGROUND: Since 2010 Veneto region (North-Eastern Italy) planned a special integrated surveillance of summer fevers to promptly identify cases of West Nile Fever (WNF), dengue (DENV) and chikungunya (CHIKV). The objectives of this study were (i) To increase the detection rate of imported CHIKV and DENV cases in travellers from endemic areas and promptly identify potential autochthonous cases.(ii) To detect autochthonous cases of WNF, besides those of West Nile Neuroinvasive Disease (WNND) that were already included in a national surveillance. METHODS: Human surveillance: a traveler who had returned within the previous 15 days from endemic countries, with fever >38°C, absence of leucocytosis (leukocyte count <10,000 µL), and absence of other obvious causes of fever, after ruling out malaria, was considered a possible case of CHIKV or DENV. A possible autochthonous case of WNF was defined as a patient with fever >38°C for <7 days, no recent travel history and absence of other obvious causes of fever. Entomologic surveillance: for West Nile (WNV) it was carried out from May through November placing CDC-CO2 traps in five provinces of Veneto Region, while for DENV and CHIKV it was also performed around residences of viremic cases. RESULTS: Human surveillance: between 2010 and 2012, 234 patients with fever after travelling were screened, of which 27 (11,5%) were found infected (24 with DENV and 3 with CHIKV). No autochthonous case of DENV or CHIKV was detected. Autochthonous patients screened for WNF were 408, and 24 (5,9%) were confirmed cases. Entomologic surveillance: the WNV was found in 10, 2 and 11 pools of Culex pipiens from 2010 to 2012 respectively, in sites of Rovigo, Verona, Venezia and Treviso provinces). No infected Aedes albopictus with DENV or CHIKV was found. CONCLUSIONS: Veneto is the only Italian region reporting WNV human cases every year since 2008. WNV is likely to cause sporadic cases and unforeseeable outbreaks for decades. Including WNF in surveillance provides additional information and possibly an early alert system. Timely detection of DENV and CHIKV should prompt vector control measures to prevent local outbreaks.
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Infecciones por Alphavirus/epidemiología , Culicidae/clasificación , Dengue/epidemiología , Monitoreo Epidemiológico , Insectos Vectores/virología , Fiebre del Nilo Occidental/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Alphavirus/virología , Animales , Fiebre Chikungunya , Virus Chikungunya/genética , Virus Chikungunya/aislamiento & purificación , Culicidae/virología , Dengue/virología , Virus del Dengue/genética , Virus del Dengue/aislamiento & purificación , Femenino , Enfermedades de los Caballos/epidemiología , Caballos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Viaje , Fiebre del Nilo Occidental/veterinaria , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/genética , Virus del Nilo Occidental/aislamiento & purificación , Adulto JovenAsunto(s)
Carcinoma de Células Renales/diagnóstico por imagen , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Endosonografía , Etanol/administración & dosificación , Hemorragia Gastrointestinal/tratamiento farmacológico , Neoplasias Gástricas/diagnóstico por imagen , Anciano de 80 o más Años , Carcinoma de Células Renales/secundario , Femenino , Hemorragia Gastrointestinal/diagnóstico por imagen , Humanos , Neoplasias Gástricas/secundarioRESUMEN
Gastroparesis is a chronic disease of the stomach that causes a delayed gastric emptying, without the presence of a stenosis. For 30 years the authors identified pylorospasm as one of the most important pathophysiological mechanisms determining gastroparesis. Studies with EndoFLIP, a device that assesses pyloric distensibility, increased the knowledge about pylorospasm. Based on this data, several pyloric-targeted therapies were developed to treat refractory gastroparesis: Surgical pyloroplasty and endoscopic approach, such as pyloric injection of botulinum and pyloric stenting. Notwithstanding, the success of most of these techniques is still not complete. In 2013, the first human gastric per-oral endoscopic myotomy (GPOEM) was performed. It was inspired by the POEM technique, with a similar dissection method, that allows pyloromyotomy. Therapeutical results of GPOEM are similar to surgical approach in term of clinical success, adverse events and post-surgical pain. In the last 8 years GPOEM has gained the attention of the scientific community, as a minimally invasive technique with high rate of clinical success, quickly prevailing as a promising therapy for gastroparesis. Not surprisingly, in referral centers, its technical success rate is 100%. One of the main goals of recent studies is to identify those patients that will respond better to the therapies targeted on pylorus and to choose the better approach for each patient.
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BACKGROUND: Guidelines recommend to cease inflammatory bowel disease (IBD) biologic therapy during coronavirus disease 2019 (COVID-19). AIM: To investigate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody positivity in an IBD cohort, COVID-19 disease severity and to evaluate the correlation with clinical/therapeutic variables. METHODS: Prospective observational cohort study. IBD patients were tested for SARS-CoV-2 IgG. Data on COVID-19 disease, demographics/therapeutics and clinical features of the IBD population were collected. IgG ≥ 7 was set for SARS-CoV-2 antibody positivity. Throat swab was performed in cases of IgG positivity. Correlations between antibody positivity or COVID-19 symptoms and therapeutic/clinical data were assessed. RESULTS: In total, 103 IBD patients were enrolled. Among them, 18.4% had IgG ≥ 7. Multivariate analysis of antibody positivity correlated only with IBD treatment. For IgG ≥ 7, the odds ratio was 1.44 and 0.16 for azathioprine and mesalazine, respectively, vs biologic drugs (P = 0.0157 between them). COVID-19 related symptoms were reported in 63% of patients with IgG positivity. All but one patient with COVID-19 symptoms did not require ceasing IBD treatment or hospitalization. IBD treatment and body mass index correlated with COVID-19 disease development with symptoms. CONCLUSION: The IBD population does not have a higher risk of severe COVID-19. The relative risk of having SARS-CoV-2 antibodies and symptoms was higher for patients taking azathioprine, then biologic therapy and lastly mesalazine. None of the patients under biologic therapy developed severe COVID-19.
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Gastrointestinal tract is an uncommon site of breast cancer metastasis. Rectal linitis plastica (RLP) is a rare presentation of rectal neoplasia, both primary and secondary, and refers to a diffuse infiltration of the wall by an infiltrating carcinoma. Diagnostic assessment of RLP may be challenging since cross-sectional imaging and endoscopic findings may be nonspecific, and endoscopic biopsies are frequently non-diagnostic due to the submucosal disease localization. Endoscopic ultrasound (EUS) with fine needle biopsy (FNB) is widely used for the diagnostic assessment of sub-epithelial lesions of upper and lower gastrointestinal tract. However, data about the use of EUS in case of rectal linitis plastica are very poor. We present a case of rectal metastasis as the first presentation of lobular breast cancer, presenting as rectal linitis plastica and diagnosed with EUS-FNB.
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Neoplasias de la Mama , Carcinoma Lobular , Linitis Plástica , Neoplasias del Recto , Neoplasias Gástricas , Humanos , Femenino , Linitis Plástica/diagnóstico por imagen , Linitis Plástica/patología , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/secundario , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Biopsia con Aguja Fina , Neoplasias Gástricas/patologíaRESUMEN
BACKGROUND: About 10%-30% of acute pancreatitis remain idiopathic (IAP) even after clinical and imaging tests, including abdominal ultrasound (US), contrast-enhanced computed tomography (CECT) and magnetic resonance cholangiopancreatography (MRCP). This is a relevant issue, as up to 20% of patients with IAP have recurrent episodes and 26% of them develop chronic pancreatitis. Few data are available on the role of EUS in clarifying the etiology of IAP after failure of one or more cross-sectional techniques. AIM: To evaluate the diagnostic gain after failure of one or more previous cross-sectional exams. METHODS: We retrospectively collected data about consecutive patients with AP and at least one negative test between US, CECT and MRCP, who underwent linear EUS between January 2017 and December 2020. We investigated the EUS diagnostic yield and the EUS diagnostic gain over different combinations of these cross-sectional imaging techniques for the etiologic diagnosis of AP. Types and frequency of EUS diagnosis were also analyzed, and EUS diagnosis was compared with the clinical parameters. After EUS, patients were followed-up for a median of 31.5 mo to detect cases of pancreatitis recurrence. RESULTS: We enrolled 81 patients (63% males, mean age 61 ± 18, 23% with previous cholecystectomy, 17% with recurrent pancreatitis). Overall EUS diagnostic yield for AP etiological diagnosis was 79% (20% lithiasis, 31% acute on chronic pancreatitis, 14% pancreatic solid or cystic lesions, 5% pancreas divisum, 5% autoimmune pancreatitis, 5% ductal abnormalities), while 21% remained idiopathic. US, CECT and MRCP, taken alone or in combination, led to AP etiological diagnosis in 16 (20%) patients; among the remaining 65 patients, 49 (75%) obtained a diagnosis at EUS, with an overall EUS diagnostic gain of 61%. Sixty-eight patients had negative US; among them, EUS allowed etiological diagnosis in 59 (87%). Sixty-three patients had a negative CECT; among them, 47 (74%) obtained diagnosis with EUS. Twenty-four had a negative MRCP; among them, 20 (83%) had EUS diagnosis. Twenty-one had negative CT + MRCP, of which 17 (81%) had EUS diagnosis, with a EUS diagnostic gain of 63%. Patients with biliary etiology and without previous cholecystectomy had higher median values of alanine aminotransferase (154 vs 25, P = 0.010), aspartate aminotransferase (95 vs 29, P = 0.018), direct bilirubin (1.2 vs 0.6, P = 0.015), gamma-glutamyl transpeptidase (180 vs 48, P = 0.006) and alkaline phosphatase (150 vs 72, P = 0.015) Chronic pancreatitis diagnosis was more frequent in patients with recurrent pancreatitis at baseline (82% vs 21%, P < 0.001). During the follow-up, AP recurred in 3 patients, one of which remained idiopathic. CONCLUSION: EUS is a good test to define AP etiology. It showed a 63% diagnostic gain over CECT + MRCP. In suitable patients, EUS should always be performed in cases of IAP. Further prospective studies are needed.
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Among the few mosquito larvicides available in the market, Bacillus thuringiensis subsp. israelensis (Bti) and B. sphaericus (Bs) represent the most environmentally safe alternatives. The combination of the 2 products is known to overcome their specific limitations by producing a synergistic effect. The aim of the study was to assess the effect and persistence of a single treatment with a granular Bti + Bs formulation on highly vegetated ditches in northeastern Italy that represents the primary rural larval sites for Culex pipiens, the primary vector of the West Nile virus in Europe. The analysis takes into account the nonlinear temporal effects on the population dynamics of larvae and pupae. The results showed a dramatic reduction in mosquito larval abundance 24 h posttreatment (93%) and was effective against larvae up to 22 days (100%). The residual effect after 28 days was 99.5%, and a limited residual effect was observed after 39 days (31.2%). A reduction in pupal density was observed after 4 days (70%) and was >98% from days 14 to 28 posttreatment, persisting for up to 39 days (84% after 39 days). The results demonstrate the effective use of the Bti + Bs formulation against Cx. pipiens in vegetated ditches in rural areas. Our modeling framework provides a flexible statistical approach to predict the residual effect of the product over time, in order to plan a seasonal intervention scheme.
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Bacillus thuringiensis , Bacillus , Culex , Culicidae , Animales , Bacillaceae , Larva , Control de Mosquitos/métodos , Mosquitos Vectores , Control Biológico de Vectores/métodos , PupaRESUMEN
BACKGROUND: Japanese encephalitis virus (JEV) is the principal cause of mosquito-borne encephalitis in human populations within Asia. If introduced into new geographic areas, it could have further implications for public and animal health. However, potential mosquito vectors for virus transmission have not been fully investigated. The Asian tiger mosquito, Aedes albopictus, has emerged in Europe and is now expanding its geographical range into more northerly latitudes. Culex quinquefasciatus, although absent from Europe, has been detected in Turkey, a country with territory in Europe, and could act as a vector for JEV in other regions. To assess the risk of these invasive species acting as vectors for JEV and therefore potentially contributing to its geographical expansion, we have investigated the vector competence of Ae. albopictus and Cx. quinquefasciatus. METHODS: Two colonised lines of Ae. albopictus (Italy and Spain) and a line of Cx. quinquefasciatus (Tanzania) were compared for susceptibility to infection by oral feeding with JEV strain SA-14, genotype III at 106 PFU/ml and maintained at 25 °C. Specimens were processed at 7 and 14 days post-inoculation (dpi). Rates of infection, dissemination and transmission were assessed through detection of viral RNA by real-time polymerase chain reaction (RT-PCR) in mosquito body, legs and saliva, respectively, at each time point. Where possible, infection and dissemination were confirmed by immunohistochemical (IHC) detection of the JEV envelope protein. RESULTS: Aedes albopictus from Italy showed no susceptibility to infection with JEV strain SA-14. Conversely, Ae. albopictus colonised in Spain was susceptible and 100% of infected mosquitoes that were subjected to saliva screening expressed viral RNA at 14 dpi. Culex quinquefasciatus was highly susceptible to infection as early as 7 dpi and 50% of infected mosquitoes that were subjected to saliva screening expressed viral RNA at 14 dpi. Infection and dissemination were confirmed in Cx. quinquefasciatus by IHC detection of JEV envelope protein in both the mid-gut and salivary glands. CONCLUSIONS: Aedes albopictus from two different locations in Europe range from being susceptible to JEV and capable of transmission through to being resistant. Culex quinquefasciatus also appears highly susceptible; therefore, both species could potentially act as vectors for JEV and facilitate the emergence of JEV into new regions.
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Aedes , Culex , Virus de la Encefalitis Japonesa (Especie) , Animales , Susceptibilidad a Enfermedades , Virus de la Encefalitis Japonesa (Especie)/genética , Mosquitos Vectores , ARN Viral/genéticaRESUMEN
Vector-borne diseases are a worldwide threat to human health. Often, no vaccines or treatments exist. Thus, personal protection products play an essential role in limiting transmission. The World Health Organization (WHO) arm-in-cage (AIC) test is the most common method for evaluating the efficacy of topical repellents, but it remains unclear whether AIC testing conditions recreate the mosquito landing rates in the field. This study aimed to estimate the landing rate outdoors, in an area of Europe highly infested with the Asian tiger mosquito (Aedes albopictus (Skuse, 1894, Diptera: Culididae)), and to determine how to replicate this rate in the laboratory. To assess the landing rate in the field, 16 individuals were exposed to mosquitoes in a highly infested region of Italy. These field results were then compared to results obtained in the laboratory: 1) in a 30 m3 room where nine volunteers were exposed to different mosquito abundances (ranges: 15-20, 25-30, and 45-50) and 2) in a 0.064 m3 AIC test cage where 10 individuals exposed their arms to 200 mosquitoes (as per WHO requirements). The highest mosquito landing rate in the field was 26.8 landings/min. In the room test, a similar landing rate was achieved using 15-20 mosquitoes (density: 0.50-0.66 mosquitoes/m3) and an exposure time of 3 min. In the AIC test using 200 mosquitoes (density: 3,125 mosquitoes/m3), the landing rate was 229 ± 48 landings/min. This study provides useful reference values that can be employed to design new evaluation standards for topical repellents that better simulate field conditions.
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Aedes/efectos de los fármacos , Vuelo Animal , Repelentes de Insectos/farmacología , Control de Mosquitos , Mosquitos Vectores/efectos de los fármacos , Aedes/fisiología , Animales , Conducta Alimentaria/efectos de los fármacos , Femenino , Italia , Mosquitos Vectores/fisiologíaRESUMEN
Hepatobiliary disorders are among the most common extraintestinal manifestations in inflammatory bowel diseases (IBD), both in Crohn's disease and ulcerative colitis (UC), and therefore represent a diagnostic challenge. Immune-mediated conditions include primary sclerosing cholangitis (PSC) as the main form, variant forms of PSC (namely small-duct PSC, PSC-autoimmune hepatitis overlap syndrome and IgG4-related sclerosing cholangitis) and granulomatous hepatitis. PSC is by far the most common, presenting in up to 8% of IBD patients, more frequently in UC. Several genetic foci have been identified, but environmental factors are preponderant on disease pathogenesis. The course of the two diseases is typically independent. PSC diagnosis is based mostly on typical radiological findings and exclusion of secondary cholangiopathies. Risk of cholangiocarcinoma is significantly increased in PSC, as well as the risk of colorectal cancer in patients with PSC and IBD-related colitis. No disease-modifying drugs are approved to date. Thus, PSC management is directed against symptoms and complications and includes medical therapies for pruritus, endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease. Other non-immune-mediated hepatobiliary disorders are gallstone disease, whose incidence is higher in IBD and reported in up to one third of IBD patients, non-alcoholic fatty liver disease, pyogenic liver abscess and portal vein thrombosis. Drug-induced liver injury (DILI) is an important issue in IBD, since most IBD therapies may cause liver toxicity; however, the incidence of serious adverse events is low. Thiopurines and methotrexate are the most associated with DILI, while the risk related to anti-tumor necrosis factor-α and anti-integrins is low. Data on hepatotoxicity of newer drugs approved for IBD, like anti-interleukin 12/23 and tofacitinib, are still scarce, but the evidence from other rheumatic diseases is reassuring. Hepatitis B reactivation during immunosuppressive therapy is a major concern in IBD, and adequate screening and vaccination is warranted. On the other hand, hepatitis C reactivation does not seem to be a real risk, and hepatitis C antiviral treatment does not influence IBD natural history. The approach to an IBD patient with abnormal liver function tests is complex due to the wide range of differential diagnosis, but it is of paramount importance to make a quick and accurate diagnosis, as it may influence the therapeutic management.
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Polymerase chain reaction (PCR)-based genotyping of mutations in the voltage-sensitive sodium channel (vssc) associated with resistance to pyrethroid insecticides is widely used and represents a potential early warning and monitoring system for insecticide resistance arising in mosquito populations, which are vectors of different human pathogens. In the secondary vector Aedes albopictus-an Asian species that has invaded and colonized the whole world, including temperate regions-sequencing of domain II of the vssc gene is still needed to detect the V1016G mutation associated with pyrethroid resistance. In this study we developed and tested a novel allele-specific PCR (AS-PCR) assay to genotype the V1016G mutation in this species and applied it to the analysis of wild populations from Italy. The results confirm the high accuracy of the novel AS-PCR and highlight frequencies of the V1016G allele as >5% in most sampling sites, with peaks of 20-45% in coastal touristic sites where pyrethroid treatments are extensively implemented, mostly for mosquito nuisance reduction. The high frequency of this mutation observed in Italian Ae. albopictus populations should serve as a warning bell, advocating for increased monitoring and management of a phenomenon which risks neutralizing the only weapon today available to counteract (risks of) arbovirus outbreaks.
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Autoimmune pancreatitis is a chronic fibroinflammatory autoimmune mediated disease of the pancreas. Clinically, obstructive painless jaundice and upper abdominal pain are the main symptoms. Focal AIP is characterized by segmental involvement of pancreatic parenchyma and it is often radiologically represented by a pancreatic mass. In these cases, the diagnosis can be very challenging, since it may be easily confused with pancreatic cancer. Therefore, we suggest a combined approach of imaging tests as the diagnostic workup. EUS study combined with CEUS and elastography, if available, increases the accuracy of the method to rule out cancer. Moreover, the lesion should always be sampled under EUS guidance to obtain a cyto/histological diagnosis. The diagnostic workup should also include the use of diagnostic clinical criteria (extrapancreatic lesions, steroid response) and laboratory findings (CA 19.9 and IgG4 evaluations).
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Gastrointestinal leaks and fistulae are serious, potentially life threatening conditions that may occur with a wide variety of clinical presentations. Leaks are mostly related to post-operative anastomotic defects and are responsible for an important share of surgical morbidity and mortality. Chronic leaks and long standing post-operative collections may evolve in a fistula between two epithelialized structures. Endoscopy has earned a pivotal role in the management of gastrointestinal defects both as first line and as rescue treatment. Endotherapy is a minimally invasive, effective approach with lower morbidity and mortality compared to revisional surgery. Clips and luminal stents are the pioneer of gastrointestinal (GI) defect endotherapy, whereas innovative endoscopic closure devices and techniques, such as endoscopic internal drainage, suturing system and vacuum therapy, has broadened the indications of endoscopy for the management of GI wall defect. Although several endoscopic options are currently used, a standardized evidence-based algorithm for management of GI defect is not available. Successful management of gastrointestinal leaks and fistulae requires a tailored and multidisciplinary approach based on clinical presentation, defect features (size, location and onset time), local expertise and the availability of devices. In this review, we analyze different endoscopic approaches, which we selected on the basis of the available literature and our own experience. Then, we evaluate the overall efficacy and procedural-specific strengths and weaknesses of each approach.
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Fuga Anastomótica , Fístula , Fuga Anastomótica/etiología , Fuga Anastomótica/cirugía , Endoscopios , Endoscopía , Endoscopía Gastrointestinal , Humanos , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
Aquatain® is an alternative larvicide formulation to the currently used larvicides. Its efficacy can be assessed monitoring emerging adults with a floating device that was recently developed for use in catch basins. In this study, the efficacy of Aquatain in controlling Aedes albopictus and Culex pipiens complex was investigated by comparing the adults emerging from 25 treated catch basins with that of 25 control basins in northeastern Italy. Basins were monitored weekly for 9 times and the efficacy was evaluated using the Mann-Whitney U-test and calculating the inhibition of emergence at each sampling. Aquatain was effective in reducing the number of emerging mosquitoes for both species, but its duration was affected by rainfall. Intensive showers (>10 mm daily) seem to reduce the efficacy of the product, allowing an increase in emerging adults after about 2 wk. This finding suggests that climatic factors should be taken into account to decide the right time for reapplication of Aquatain during routine larval treatments.
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Aedes , Culex , Insecticidas , Control de Mosquitos , Silicio , Aedes/crecimiento & desarrollo , Animales , Culex/crecimiento & desarrollo , Italia , LarvaRESUMEN
AIMS: To assess the association between mitral regurgitation (MR) and left atrial (LA) structural and functional remodelling and their effect on pulmonary haemodynamics. METHODS AND RESULTS: Consecutive unselected patients undergoing comprehensive echocardiography were enrolled. Parameters of cardiac structure and function were obtained as well as mitral effective regurgitant orifice area (ERO) and estimation of pulmonary artery systolic pressure (PASP). Measures of LA structure [LA volume (LAV)] and function [peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit strain (CS)] were also calculated. The study population included 102 patients (mean age 70 ± 14 years, 42% women), with a mean ejection fraction of 52 ± 13%. MR was classified as organic due to mitral valve prolapse in 14 patients (14%) and functional in 88 patients (86%). Mean ERO was 0.12 ± 0.12 cm2 and 86 patients (84%) had an ERO ≤0.2 cm2 . ERO was significantly associated with worse measures of LA structure and function. Despite the low burden of MR, the association remained significant after adjusting for clinical and echocardiographic confounders (ß: 3.7, P = 0.022 for LAV; ß: -3.0, P = 0.003 for PALS; ß: -1.8, P = 0.027 for PACS) and was significantly related with functional MR (P for interaction <0.001). ERO was also significantly associated with PASP, and measures of LA function (PALS and PACS) significantly modified this relationship (P for interaction <0.001). CONCLUSIONS: Even a mild degree of MR contributes to LA remodelling and this relationship plays an active role in pulmonary circulation, suggesting a potential mechanism by which these parameters contribute to the development of heart failure.
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Insuficiencia Cardíaca , Insuficiencia de la Válvula Mitral , Anciano , Anciano de 80 o más Años , Función del Atrio Izquierdo , Femenino , Atrios Cardíacos/diagnóstico por imagen , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagenRESUMEN
BACKGROUND: To date, there is no agreement on the timing to perform a physical session in patients on veno-venous extracorporeal membrane oxygenation (VV-ECMO). We aimed to assess whether early physiotherapy (within the first week from ECMO start) could affect in-ICU mortality. METHODS: Our retrospective observational study included 101 adults supported on VV ECMO from 2009 to 2016, consecutively admitted at our ECMO referral Center in Florence (Italy). Clinical data right before ECMO start were collected for all patients. The level of mobilization using the ICU mobility scale was recorded on the first session and at discharge. RESULTS: Early physiotherapy (within the first week) was more frequently initiated in patients with lower BMI (P=0.013) and it was associated with lower duration of ECMO support (P=0.03), mechanical ventilation (P=0.001) and length of stay (P=0.001). In-ICU mortality was not different between the two subgroups. CONCLUSIONS: In patients on VV-ECMO support, physiotherapy is feasible and safe and that early physiotherapy, initiated within the first week from ECMO start, is associated with shorter duration of ECMO support and ICU length of stay.
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Oxigenación por Membrana Extracorpórea/métodos , Modalidades de Fisioterapia , Síndrome de Dificultad Respiratoria/terapia , Adulto , Anciano , Índice de Masa Corporal , Cuidados Críticos , Femenino , Vena Femoral , Humanos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/complicaciones , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Rango del Movimiento Articular , Respiración Artificial , Síndrome de Dificultad Respiratoria/etiología , Síndrome de Dificultad Respiratoria/rehabilitación , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
The increasing number of exotic arbovirus cases imported in Europe and the 2017 chikungunya outbreak in central/southern Italy highlight the urgency of evidence-based outbreak management plans to predict, prevent or interrupt spreading of these arboviruses to non-endemic countries in temperate regions. We here present the results of three mark-release-recapture experiments conducted in a peri-urban area of North-East Italy to estimate the spatio-temporal dynamics of the dispersal of Aedes albopictus females looking for oviposition sites. The Flight Range of 90% of the mosquito population (FR90) was found to exceed 200 m, consistently with data obtained from a previous study conducted in a highly urbanised area in Rome (Central Italy). Modelling results showed that dispersal can be so rapid that insecticide spraying within a 200m-radius around a potential infected case leaves >10% probability that a potentially infected mosquito escapes the treatment, even if this is carried out after only 2-3 days since the importation of a viremic case. These data provide evidence in favour of an update of guidelines for the control of exotic autochthonous arbovirus transmission in temperate areas and highlight the need of effective surveillance approaches and rapid response to contain the risks associated to imported viremic cases.