COVID-19 lockdown, personal protective equipment, hyper-hygiene and allergy.

Summary: At the beginning of SARS-CoV 2 pandemic, in the absence of "targeted" therapies, the national health authorities have introduced some measures aimed at reducing the spread of infection in the community (lockdown, social distancing, personal protective equipment (PPE), personal hygiene and disinfection of living environments). All the containment measures have led to both positive and negative effects in patients with allergic diseases. We believe that further studies should be undertaken to investigate the possible correlations between SARS-CoV-2 infection and allergy, from a broader perspective. In particular, the risk factors for the development of undesirable effects should be investigated, especially in healthcare professionals forced to use PPE and sanitizing agents for a long time. However, since the COVID-19 pandemic probably will not be short-lived, the use of such protective aids will necessarily be widespread even in the general population. Therefore, further studies on the materials used for the production of PPE and sanitizing agents would be necessary to reduce their sensitizing and, in some cases, toxic potential.

Lessons from peculiar cases of anaphylaxis: why allergists should be prepared for the unexpected.

Summary: Anaphylaxis is the most severe systemic hypersensitivity reaction, it can be caused by a number of well identified triggers such as foods, drugs, stinging insects and facilitated by predisposing clinical conditions. However, sometimes anaphylaxis shows up with uncommon or peculiar characteristics which could delay diagnosis and therapeutic treatment. In this report we aimed to describe less accounted / difficult-to-approach shapes of anaphylaxis to facilitate clinicians to suspect these severe reactions even in uncommon conditions. We choose to present data on anaphylaxis regarding simulation, mode of exposure to sensitizing agents, pregnancy, exposure to animals, intimate behaviour, psychological stress and other situations.

Influence of age on enzyme activities of pyrimidine metabolism in the chicken heart.

The effect of the aging on the activities of enzymes involved in UMP-CMP metabolism were evaluated in the heart of newborn (1-day-old), young (20-day-old), adult (12-month-old), and aged (30-month-old) chickens. In newborn animals, UMP metabolism proceeds preferentially towards cytidine compounds rather than to breakdown. In addition, two pathways different from those involved in de novo synthesis may contribute to the synthesis of UMP: one, through cytosine deaminase that shows its maximal activity; the other, by uridine kinase, the main "salvage" enzyme of pyrimidine nucleotides. In young chickens, pyrimidine metabolism regards especially UMP. In fact, the lower activities of cytidylate phosphatase and cytosine deaminase, together with the remarkable increase of uridine kinase indicate that the metabolic flux converges on the main salvage pathway. In adult chickens, pyrimidine catabolism is enhanced, as supported by the maximal activity of the enzymes involved in UMP-CMP breakdown. On the contrary, the remarkable reduction of the anabolic enzymes suggests a limited resort to the salvage pathways. Finally, in aged chickens a reduced pyrimidine catabolism and a greater utilization of the salvage pathways appear to take place, thus contributing to the maintenance of pyrimidine nucleotide pool.

The "new VA": delivering health care value through integrated service networks.

In an effort to meet powerful societal and industry-wide forces of change, the Veterans Health Administration has initiated a fundamental reengineering of itself, and is currently undergoing an innovative transformation that is among the most profound of any organization in American history.

Racial variations in cesarean section rates: an analysis of Medicaid data in Louisiana.

The objective of this study was to investigate racial variation in cesarean section rates among Medicaid beneficiaries in Louisiana. Results indicate that over a three-year period, white women had higher rates than women of other races when stratified by age, locality, accompanying diagnoses, and hospital ownership. Comparing Louisiana Medicaid data with birth certificate records, rates among all births were slightly higher than Medicaid births, with the same racial trend. These variations imply significant differences in costs and reimbursement to providers and raising questions about efficiency of current obstetric practices in Louisiana. Implications for a managed care system are discussed.

Enzymes involved in guanine monophosphate metabolism of aging chicken heart.

The activities of enzymes involved in GMP metabolism were studied in the heart of aging chickens. In newborn (1-day-old) animals, GMP breakdown apparently leads to the final products of purine metabolism, as the activity of hypoxanthine-guanine phosphoribosyl-transferase (HGPRT), the salvage enzyme of GMP is not detectable. On the contrary, HGPRT shows maximal activity in young (20-day-old) chickens, when xanthine oxidase activity is very low, indicating that the metabolic flux converges on the salvage pathway. Again, maximal activity of the catabolic enzymes and a limited resort to the salvage pathway characterize GMP metabolism of adult (12-month-old) hearts. Finally, in aged (30-month-old) chickens, a reduced GMP catabolism and a greater utilization of the salvage pathway might contribute to the maintenance of the guanine nucleotide pool. In conclusion, the pattern of the activities of enzymes relating to GMP metabolism in the aging heart, compared to AMP metabolism, indicates a parallel temporal regulation of the purine pathways.

Changes of glycosaminoglycan composition in aging chicken brain. A preliminary investigation.

The qualitative and quantitative pattern of GAGs was examined by electrophoresis in aging chicken brain in four different stages starting from day 1 to 30 months. GAG content referred to defatted dry tissue exhibits constant decrease. Four main GAGs have been identified with a mobility corresponding to hyaluronate, condroitin sulfate, heparan sulfate and dermatan sulfate controls. Hyaluronate appears the main GAG represented while dermatan sulfate the minor one. Our data show that in chicken brain GAG percentage undergoes age-related changes.

Pathways of adenine nucleotide metabolism: degradation and resynthesis of IMP in ageing chicken heart.

The activities of enzymes involved in adenine nucleotide metabolism and the concentration of their metabolic products were studied in the hearts of chickens from birth to advanced age. In particular, in order to investigate the main mechanisms which contribute to ensure availability of adenine nucleotides during ageing of the heart, IMP concentration and the activities of enzymes involved in its turnover were studied. In newborn animals, AMP degradation, though limited in amount, was found to lead to the final products of purine metabolism. In fact, the activity of hypoxanthine phosphoribosyl-transferase (HPRT)-the salvage enzyme of IMP-was not detected. On the contrary, in young chickens, the low concentration of final products of purine metabolism, together with a remarkable activity of HPRT and a high concentration of IMP, indicates that metabolic flux converges on the salvage pathway. In adult chickens, an increase of purine catabolism was observed. This, together with an optimal concentration of endogenous adenine nucleotides, is indicative of a particularly high AMP metabolism. Finally, in chickens of advanced age, a reduced purine catabolism appeared to take place, thus contributing to the maintenance of the adenine nucleotide pool. In ageing heart, a major role of IMP turnover probably consists in the preservation of adenine nucleotides and in the recovery of high-energy phosphates.

Age-related changes of AMP breakdown in chicken heart.

The activity of adenylate deaminase, adenylate phosphatase and adenosine deaminase, as well as the endogenous content of adenine nucleotides, was examined in the heart of ageing chickens. In new-born (1-day-old) and young (20-day-old) chickens, AMP degradation in the heart seems to proceed preferentially through deamination, while in adult (1-year-old) through dephosphorylation. Compared with the adult heart, a 2-year-old one exhibits a decline of AMP catabolism. The total adenine nucleotide content and the concentration of ATP are higher in adult and aged chicken hearts, than in new-born and young ones. Adaptive mechanisms might occur in the heart of ageing chickens to ensure an adequate availability of adenine nucleotides.

An overview of managed care in state Medicaid programs.

The National Governor's Association predicts that Medicaid will account for 28 percent of total state spending in 1995, double the 1991 level. During 1992, total Medicaid enrollment reached 31.6 million beneficiaries, up 4.7 million (17.5 percent) from 1991. The total expenditure of $118.2 billion in 1992 was up 25 percent from the 1991 level of 94.5 billion. A recent General Accounting Office (GAO) report, revealed that, in 1990, 43 percent of 99 million emergency department visits were for minor ailments. From 1985 to 1990, Medicaid emergency department visits increased 34 percent, compared to 19 percent growth in all emergency department visits. A Department of Health and Human Services Inspector General Report on Medicaid recipient emergency department usage recommended that states develop a comprehensive initiative to reduce nonemergency usage of the emergency department, including increased implementation of managed care options. During 1992, 42 states used some type of Medicaid cost containment measure, with managed care being the most frequent choice.

Health care cost containment: an overview of policy options.

While health care has become one of the leading policy concerns of the American public, cost containment has emerged as the most prominent underlying factor. Components of health care cost escalation include societal problems, consumer demand, an aging population, the technology explosion, administrative inefficiencies, the malpractice crisis, fraud and abuse, the lack of health promotion and disease prevention, the rising number of uninsured, and regulatory issues. The three major categories of health reform proposals, with characteristic cost containment features, are discussed. A comprehensive listing of available cost containment interventions is summarized in ten categories.

Proposals for health care reform: how do we evaluate them?

The Society for Academic Emergency Medicine suggests a systematic approach to evaluating proposals for reform of the medical care system. Described are the three components of the problem--access, cost, and quality. Then, goals are proposed for health care reform. With this background, we describe the major questions that reform proposals must address and the potential impact of reform on emergency medicine. Emergency physicians must actively support health reform legislation that is in the over-all best interest or our patients and our specialty, and work with the new federal administration to evaluate proposed changes.

Health care access problems of medically indigent emergency department walk-in patients.

OBJECTIVES: To obtain health care access data on emergency department walk-in patients and to determine factors associated with delayed access to care. DESIGN: Survey of stable ED walk-in patients in the triage area. SETTING: University of California Irvine Medical Center, an urban, 493-bed, noncounty, Level I teaching hospital treating 38,000 emergency patients annually. PARTICIPANTS: A quota of 1,000 consecutive patients derived from a representative selection of service days was included; 94% of eligible patients agreed to participate. Patients with obstetrical problems (more than 20 weeks' gestation) were excluded. INTERVENTIONS: Pretested health access survey, available in both Spanish and English, administered by investigator. RESULTS: Public aid/self-pay insurance status was significantly associated with routine use of the ED for care (P less than .003), income of less than $10,000 (P less than .0002), refusal of care by health provider (P less than .001), refusal of care at an ED (P less than .03), and delay in seeking health care (P less than .0002). Income of less than $10,000 was significantly associated with routine use of the ED for care (P less than .02), and delay in seeking health care (P less than .04). Statistical analysis done using chi 2 with continuity correction and with the binomial test for comparison of two proportions. CONCLUSION: Among stable ED walk-in patients surveyed at our facility, low-income individuals and those with public aid/self-pay insurance status were significantly more likely to use the ED as a routine source of health care, and more likely to delay in seeking needed health care, than higher income and fully insured individuals. These data should be useful to health policymakers in formulating rational, cost-effective strategies that improve access to early treatment and prevention.

Aggression directed toward emergency department staff at a university teaching hospital.

STUDY OBJECTIVE: To determine the scope and magnitude of patient and visitor aggression directed toward emergency department staff. DESIGN: One-year retrospective review of university police log records and ED staff incident reports. SETTING: Medium-sized, urban, noncounty, university Level I teaching hospital treating approximately 40,000 ED patients annually. TYPE OF PARTICIPANTS: All violent incidents involving patients/visitors and ED staff that triggered a police response to the ED area were included in the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All ED violent episodes were recorded and categorized by shift, type of incident, type of police response, perpetrator, and site of incident. It was found that police responded to the ED nearly twice daily; the night shift had 32% of the cases with only 13% of the patient volume; custody and medical psychiatric clearance patients accounted for 40% of the cases; more than 20% of incidents occurred in the waiting room; and 4.2% of the incidents represented a significant threat to ED staff. CONCLUSION: ED violence is a significant and under-reported problem at our medium-sized university teaching hospital. These data are useful in objectively quantifying the scope of violence in our institution, and they underscore the potential risk to emergency patients, visitors, and staff. There is an acute need for additional studies in other settings so that appropriate and cost-effective security recommendations can be formulated.