COVID-19 after 2 Years from Hospital Discharge: A Pulmonary Function and Chest Computed Tomography Follow-Up Study.

INTRODUCTION: Serial follow-up with pulmonary function testing (PFT) and chest computed tomography (CT) after severe COVID-19 are recommended. As a result, many longitudinal studies have been published on COVID-19 of different grade of severity up to 1-year follow-up. Therefore, we aimed at a long-term observational study throughout 2 years after severe COVID-19. METHODS: Severe COVID-19 patients were consecutively recruited after hospital discharge between March and June 2020 and prospectively followed up for 24 months, with mMRC dyspnea scale and PFT at 6, 12, and 24 months. Chest CT was performed when clinically indicated. RESULTS: One hundred one patients enrolled completed the observational study. At 24 months, those with reduced total lung capacity (TLC) were 16%, associated with fibrotic ground glass opacity (GGO) and mMRC score >1, respectively, in 75% and 69% of them. At 24 months, those with a reduced diffusing capacity of the lung for CO were 41%, associated with fibrotic GGO and mMRC score >1, respectively, in 53% and 22% of them. CONCLUSION: Two years after hospitalization for severe COVID-19, a non-negligible number of patients still suffer from "long COVID" due to respiratory damage.

[Campylobacter: a vintage pathogen to the fore].

Campylobacteriosis is caused by Gram bacteria. Most common species are C. jejuni and C. coli. Campylobacteriosis is a rare cause of sepsis, and in some European countries it is more common than salmonellosis, becoming a public health problem. We have treated a 66-year-old patient, hypertensive, ischemic cardiopathic, scheduled for coronary angiography, hospitalized with AKI, in a state of shock after some days of acute diarrhea. Because of the pathogen's seasonal nature and the patient's clinical features, in addition to common coproculture also Campylobacter has been sought, and found. Treated with volume repletion and antibiotics, within one week normal kidney functions were fully restored. He had a coronary angiography a week after being discharged from the hospital.

COVID-19 6 months after hospital discharge: pulmonary function impairment and its heterogeneity.

After 6 months, about half of #COVID19 discharged subjects present impaired respiratory function with exertional dyspnoea, mainly due a reduced CO diffusion (34%), followed by pulmonary restriction (19%) https://bit.ly/3vcnbdR.

Feasibility of UV-VIS-Fluorescence spectroscopy combined with pattern recognition techniques to authenticate a new category of plant food supplements.

Bud extracts, named also "gemmoderivatives", are a new category of natural products, obtained macerating meristematic fresh tissues of trees and plants. In the European Community these botanical remedies are classified as plant food supplements. Nowadays these products are still poorly studied, even if they are widely used and commercialized. Several analytical tools for the quality control of these very expensive supplements are urgently needed in order to avoid mislabelling and frauds. In fact, besides the usual quality controls common to the other botanical dietary supplements, these extracts should be checked in order to quickly detect if the cheaper adult parts of the plants are deceptively used in place of the corresponding buds whose harvest-period and production are extremely limited. This study aims to provide a screening analytical method based on UV-VIS-Fluorescence spectroscopy coupled to multivariate analysis for a rapid, inexpensive and non-destructive quality control of these products.

Branch bark of holm oak (Quercus ilex L.) for reconstructing the temporal variations of atmospheric deposition of hexavalent chromium.

The bark from the annual segments of the branches of holm oak (Quercus ilex L.) is exposed to trace element deposition for a known period of time and thus it is a possible candidate as a bioindicator for reconstructing historical changes in pollution. A series of samples were analysed for Cr(VI) concentration by electrothermal atomic absorption spectrometry (ET-AAS) after selective extraction in a sodium carbonate solution. In this way the atmospheric deposition of Cr(VI) was reconstructed from 2001 to 2010 in an area where an industrial plant produced Cr(VI) compounds until 2003. The present study shows the potential of this type of sample as a natural archive for persistent pollutants, useful for monitoring changes that occur before a monitoring programme is established, with the advantage of being easy to collect almost everywhere.

The bark of holm oak (Quercus ilex, L.) for airborne Cr(VI) monitoring.

In this work, the bark of holm oak was used as a bioindicator to study the atmospheric distribution of Cr(VI). The chosen method (alkaline extraction and atomic absorption determination) was found in the literature, adapted for use with the matrix involved, and validated. The method had some limits, but provided an excellent estimation of Cr(VI) concentrations with good sensitivity and a reasonable time of analysis and cost. Thirty-four samples of holm oak collected in three areas characterised by different possible sources of pollution (the area near a former chromate production plant, an urban area, and a rural "reference" area) were analysed, obtaining concentrations ranging from 1.54 to 502 µg g(-1) near the industrial plant, ranging from 0.22 to 1.35 µg g(-1) in the urban area, and mostly below the detection limit (0.04 µg g(-1)) in the rural area. The bark of holm oak proved to be a good bioindicator to detect Cr(VI) in the environment. The extraction procedure followed by atomic absorption analysis is simple, provides good sensitivity, and it is suitable for environmental studies.

Therapeutic management of chronic hepatitis B in clinical practice: a region-wide survey.

GOALS: To characterize the clinical and treatment pattern in a large population of hepatitis B virus (HBV) patients managed at tertiary referral centers in clinical practice. BACKGROUND: Successful treatment, either with interferon (IFN) or nucleos(t)ide analogs (NUCs), of chronic HBV infection is associated with improved long-term patient outcome. However, in clinical practice, the actual management of these patients is not well characterized, and data regarding treatment pattern in this setting are lacking. METHODS: In this cross-sectional study, we evaluated 505 patients chronically infected with HBV alone and who had at least 1-year follow-up. We assessed indication to, rate of, and type of treatment as well as the characteristics of treated patients. RESULTS: Overall prevalence of positivity for HBe antigen was 19.3%, and the majority of patients had chronic hepatitis (47.5%). Non-Italian patients represented approximately one third of the population (27.1%). Among patients with indication to antiviral therapy (n=318), treatment was actually carried out in 264 patients (83.0%), prevalently with NUCs (65.9%). IFN-treated patients were younger (P<0.001), more frequently male (P=0.025) and HBeAg positive (P=0.003), and less frequently cirrhotics (P<0.001) as compared with patients treated with NUCs. CONCLUSIONS: In a geographical area with a low positivity for HBe antigen, antiviral therapy is actually carried out in the majority of patients who have indication to treatment, prevalently with NUCs, whereas IFN treatment is more frequently carried out in young, HBe antigen-positive patients who do not have advanced liver disease.

Varied spectrum of clinical presentation and mortality in a prospective registry of visceral leishmaniasis in a low endemicity area of Northern Italy.

BACKGROUND: Visceral Leishmaniasis (VL) is endemic in 88 countries, in areas of relatively low incidence with a relevant proportion of immune suppressed patients clinical presentation, diagnosis and management may present difficulties and pitfalls. METHODS: Demographic data, clinical, laboratory features and therapeutic findings were recorded in patients identified by a regional VL disease registry from January 2007 to December 2010. RESULTS: A total of 55 patients (36 adults mean age 48.7 years, 19 children median age 37.5 months) were observed presenting with 65 episodes. All childen were immunocompetent, whereas adults affected by VL included both immunocompetent (n°17) and immunesuppressed (n°19) patients. The clinical presentation was homogeneous in children with predominance of fever and hepato-splenomegaly. A wider spectrum of clinical presentations was observed in immunocompromised adults. Bone marrow detection of intracellular parasites (Giemsa staining) and serology (IFAT) were the most frequently used diagnostic tools. In addition, detection of urinary antigen was used in adult patients with good specificity (90%). Liposomal amphotericin B was the most frequently prescribed first line drug (98.2% of cases) with 100% clinical cure. VL relapses (n°10) represented a crucial finding: they occurred only in adult patients, mainly in immunocompromised patients (40% of HIV, 22% of non-HIV immunocompromised patients, 5,9% of immunocompetent patients). Furthermore, three deaths with VL were reported, all occurring in relapsing immunocompromised patients accounting for a still high overall mortality in this group (15.8%). CONCLUSIONS: The wide spectrum of clinical presentation in immunesuppresed patients and high recurrence rates still represent a clinical challenge accounting for high mortality. Early clinical identification and satisfactory treatment performance with liposomal amphotericin B are confirmed in areas with low-level endemicity and good clinical standards. VL needs continuing attention in endemic areas where increasing numbers of immunocompromised patients at risk are dwelling.

Hepatitis B Reactivation in a HBsAg-Negative, HBcAb-Positive Patient Receiving Fludarabine for the Treatment of Chronic Lymphocytic Leukaemia.

Hepatitis B virus (HBV) reactivation is an increasingly recognized cause of morbidity and mortality in patients undergoing chemotherapy. In haematology, the risk of reactivation of B hepatitis among HBsAg-positive patients has been documented; therefore, use of lamivudine prophylaxis is recommended before starting chemotherapy. Differently, for HBsAg-negative patients with markers of previous HBV infection (i.e., presence of isolated anti-HBc positivity) (anticore patients) management strategies are not univocal. We describe a rare case of HBV reactivation in an anticore patient after fludarabine therapy for chronic lymphocytic leukaemia. The patient fully recovered after a 6-month course of lamivudine with persistent HBV-DNA clearance and loss of HBsAg. The most important feature of this case is that fludarabine alone infrequently determines HBV reactivation, especially in anticore patients. Therefore, we suggest that patients candidates to receive fludarabine therapy should be considered for lamivudine prophylaxis, not only if HBsAg-positive, but even if anticore-positive only.

Insulin resistance predicts rapid virological response in non-diabetic, non-cirrhotic genotype 1 HCV patients treated with peginterferon alpha-2b plus ribavirin.

BACKGROUND/AIMS: The rapid decline in hepatitis C virus RNA is crucial for determining the outcome of therapy in patients with genotype 1 chronic hepatitis C. However, the variables influencing the early phase of viral decay are still largely unexplored. We aimed to assess which pre-treatment variable may predict rapid virologic response (RVR) and sustained virologic response (SVR). METHODS: We evaluated 90 consecutive non-diabetic patients with genotype 1 chronic hepatitis C without cirrhosis, treated with peginterferon alpha-2b plus ribavirin. Viral load (COBAS Amplicore, Roche) was measured at 1, 4 and 12 weeks after starting treatment, and then 24 weeks after the end of treatment. RESULTS: The overall SVR was 47%. The SVR in patients with RVR was 100%. Age, GGT levels, viral load, steatosis, fibrosis and HOMA-IR were significantly associated with RVR in univariate analysis. After logistic regression, HOMA-IR proved to be the strongest independent predictor of RVR (OR 0.37, 95% CI: 0.16-0.89; p=0.027), whereas fibrosis had a weaker independent association with RVR (OR 0.32, 95% CI: 0.1-1.04; p=0.057). Among the eight pre-treatment variables, both BMI and steatosis were significantly associated with HOMA-IR, either in univariate or in multivariate analyses. CONCLUSIONS: Our data suggest that insulin resistance is strongly associated with RVR, thus reflecting the important role played by metabolic factors in the early phase of viral kinetics. HOMA-IR would appear to be a useful tool in predicting RVR and should be evaluated at baseline in all chronic hepatitis C patients before initiating antiviral treatment.

Avaliaçäo do estado nutricional de indivíduos adultos sadios de classe média: ingestäo energética e protéica, antropometria, exames bioquímicos do sangue e testes de imunocompetência / Evaluation of nutritional status of adult healthy subjects of middle class. Energy and protein intake, antrhopometry, blood biochemical test and immunocompetence testes

Foram estudados parâmetros relacionados ao estado nutricional de 151 adultos sadios, pertencentes à classe média e residindo em Botucatu, SP, Brasil. Valores antropométricos foram maiores nos homens, com exceçäo da prega tricipital e da área adiposa do braço. O aumento da idade associou-se a aumento dos valores da massa muscular (homens e mulheres) e do peso do corpo, da prega tricipital e da área adiposa do braço (mulheres). Os resultados antropométricos aproximaram-se dos valores referenciais internacionais, mas näo foram inteiramente concordantes com eles, sendo inferiores para o peso corpóreo e circunferência e área musculares do braço. Nos indivíduos de menos de 50 anos, os valores da ingestäo energética foram ligeiramente inferiores aos níveis recomendados. A ingestäo protéica foi adequada. Os valores médios das proteínas e lípides do soro foram similares aos valores de referência. Testes de hipersensibilidade cutânea säo apresentados como uma prova funcional para avaliaçäo do estado nutricional

Avaliaçäo nutricional em pacientes portadores de insuficiência renal crônica / Nutritional assessment of chronic uremic patients

No presente trabalho foram avaliados 12 indivíduos (nove homens e três mulheres) que recebiam atendimento na Unidade de Tratamento Dialítico da Clínica Médica do hospital das Clínicas da Faculdade de Medicina de Botucatu. Estes pacientes foram submetidos à avaliaçäo do estado nutricional, mediante história alimentar, métodos antropométricos e bioquímicos, sendo subdivididos em três grupos: pacientes sem tratamento dialítico, pacientes em diálise peritoneal e pacientes em hemodiálise. Desses 12 pacientes, seis näo recebiam tratamento dialítico, sendo que foram avaliados uma única vez, e os que passavam por tratamento dialítico foram avaliados antes e depois mesmo. Através dos resultados, pode-se observar que os indivíduos com insuficiência renal crônica apresentam ingestäo calórica bastante inadequada, além dos dados antropométricos e bioquímicos que também indicaram significativos graus de deficiência do estado nutricional. Através destes dados, este trabalho também pretende demonstrar a importância de maiores cuidados dietéticos, para que esses indivíduos possam ter uma manutençäo substancial de seu estado nutricional. Também foi sugerido um exemplo de dieta para pacientes renais crônicos näo-submetidos a tratamento dialítico

Comportamento da hemoglobina glicosilada (HbA1) e glicemia de jejum em indivíduos normais e portadores de "diabetes mellitus" / Behavior of glycosylated hemoglobin (HbA1) and fasting blood glucose in normal subjects and in patients with diabetes mellitus

Em estudo realizado em indivíduos normais e pacientes diabéticos, observaram-se médias e desvios-padräo de glicemia de jejum de 83 + ou - 11,4mg% em normais, 192 + ou - 117,9mg% em diabéticos tipo I, 181 + ou - 68,7mg% em diabéticos tipo II e 163 + ou - 83,9mg% na amostra total. A hemoglobina A1 apresentou as seguintes médias e desvios-padräo: 5,5 + ou - 0,8% nos normais, 12,7 + ou - 4,0% nos diabéticos tipo I, 9,7 + ou - 3,3% nos tipos II e 9,3 + ou - 3,7% na amostra total. Observou-se correlaçäo linear(r) positiva e significante entre glicemia de jejum e hemoglobina A1 nos diabéticos tipo I(r = 0,598; p <0,01), diabéticos tipo II(r = 0,624; p <0,01) e amostra total (r = 0,686; p <0,01). Näo se detectou correlaçäo significante entre esses dois parâmetros no grupo normal. Com o tratamento do diabetes mellitus, observou-se queda das médias da glicemia de jejum e da hemoglobina A1. Houve correlaçäo linear(r) positiva e significativa entre a diferença da glicemia (glicemia) e a da hemoglobina A1 (HbA1) correspondente, antes e após tratamento (r = 0,569; p <0,025). Os resultados obtidos atestam a relaçäo existente entre glicemia de jejum e hemoglobina A1, assim como a tendência desta hemoglobina de acompanhar as variaçöes da glicemia de jejum, comprovando a utilidade da dosagem da hemoglobina A1 no controle de tratamento do diabetes mellitus

Avaliaçäo do estado nutricional: métodos bioquímicos / Evaluation of nutritional status: biochemical methods

A desnutriçäo protéico-calórica (DPC) é hoje reconhecidamente o principal problema dos pacientes hospitalizados. O tratamento desta síndrome tem como primeira etapa a avaliaçäo do estado nutricional do paciente o qual pode ser efetuada mediante aplicaçäo de métodos antropométricos, clínicos, bioquímicos,. dietéticos e métodos funcionais (imunocompetência celular, hemostasia, trabalho físico, fertilidade, fecúndidade, etc.). Nenhum destes métodos é autosuficiente para o diagnóstico nutricional completo do indivíduo. Estas limitaçöes säo superadas pelo emprego de esquemas englobando o maior número possível de métodos. O presente trabalho revê os principais tipos de métodos bioquímicos classificando-os em medidas diretas ou indiretas dos nutrientes. Do ponto de vista do significado dos resultados bioquímicos há diferenciaçäo entre os índices estáticos e os índices funcionais do estado nutricional. A maior vantagem do segundo sobre o primeiro reside na análise seriada do mesmo indivíduo prescindindo-se, portanto, de padröes populacionais. De modo geral, os métodos bioquímicos säo bastante úteis na detecçäo de deficiências nutricionais marginais e na confirmaçäo do diagnóstico clínico