Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission.

BACKGROUND: Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). MATERIALS/METHODS: Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. RESULTS: Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58-76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). CONCLUSIONS: In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

Psychopharmacological treatment in borderline personality disorder: A pilot observational study in a real-world setting.

Psychotherapy is the cornerstone of treatment for borderline personality disorder (BPD) while pharmacotherapy should be considered only as an adjunctive intervention. In clinical practice, however, most of BPD patients only receive medication. The aim of the study is to first describe pharmacological treatment in BPD patients in Italy and secondly to evaluate if comorbidity or illness severity are associated with the prescription of different class compounds. Data on pharmacological treatment and clinical evaluation of 75 BPD patients were collected in 5 clinical settings. The association between comorbidity and medication was assessed. Moreover, we evaluated the association between pharmacotherapy and severity, defined by a cluster analysis aimed at detecting different groups of patients. Most of the participants (82.7%) were characterized by polypharmacy, with a mean of 2.4 medications per person. Interestingly, the prescription didn't seem to depend on/be based on the severity of the disorder and was only partially determined by the presence of comorbidity. In conclusion, our findings are similar to what described in other clinical studies, supporting the idea that medication management for BPD is only partially coherent with international guidelines. This pilot study confirms the need for more rigorous studies to gain greater understanding of this topic and diminish the gap between guidelines and the real clinical world.

Retrieving cloud geometrical extents from MIPAS/ENVISAT measurements with a 2-D tomographic approach.

Clouds represent a critical factor in regulating the Earth's atmosphere and its energy balance. Satellite instruments can measure the energy balance and global atmospheric properties only through an accurate knowledge of the vertical profile of cloudiness, which is as yet one of the key shortages in atmospheric science. The Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) on-board the ENVISAT satellite, designed to infer the amount of atmospheric trace-gases, demonstrated also sensitivity to the radiation emitted from clouds. In order to model the effect of the geometrical extent of a cloud on MIPAS measurements, we developed a retrieval model capable to simulate cloud effects on broad spectral intervals accounting for the two-dimensional (2-D) variability of the atmosphere in the satellite orbit plane. The 2-D analysis revealed a sensitivity of MIPAS spectra to both the vertical and horizontal extents and the position of clouds along the instrument line of sight. One-dimensional models were found to underestimate Cloud Top Height (CTH) by approximating clouds as an infinite horizontal layer with a finite vertical extents. With the 2-D approach, we showed it is possible, for optically thin Polar Stratospheric Clouds (PSCs), to retrieve both CTH and horizontal dimension by analyzing simultaneously all the limb observations that come across the cloud with their field of view. For a selected case study we found a very good agreement for both PSC CTH and horizontal extents retrieved from MIPAS measurements and those retrieved from coincident CALIOP (Cloud-Aerosol Lidar with Orthogonal Polarisation) measurements.

The crowned dens syndrome. Evaluation with CT imaging.

PURPOSE: The purpose of this study was to verify the value of computed tomography (CT) in the diagnosis of the "crowned dens" syndrome, not only in crystal deposition diseases, but also in other rheumatic or nonrheumatic conditions. MATERIALS AND METHODS: Thirty-eight patients (15 men and 23 women; mean age 55 years; age range 35-79) with neck pain were examined and divided into two groups: (1) patients already identified as rheumatic and referred for further investigation of the atlantoaxial region; (2) patients with symptoms confined to the cervical spine, with inconclusive radiographic findings. Unenhanced CT of the cervical spine (Tomoscan SR 7000 Philips, Eindhoven, Netherlands) was performed in all patients. There were 11 cases of rheumatoid arthritis (ten women and one man), two calcium pyrophosphate dihydrate crystal deposition disease (both women), one of systemic sclerosis (a woman), one of osteoarthritis (a man), one of seronegative arthritis (a man), four of neoplasm (one woman and three men) with suspected cervical involvement, one (a man) of haematological disease (lymphoma), one (a woman) of menopausal osteoporosis, ten (five men and five women) of recent or previous trauma with suspected involvement of the skull base and first cervical vertebrae and six of unknown painful cervical dysfunction (three men and three women). RESULTS: CT demonstrated calcific deposits around the dens in 12 patients (three men and nine women), in the transverse and alar ligaments, and in the anterior atlantooccipital membrane. CT revealed horseshoe- or crown-like calcification surrounding the odontoid process. In our series, other rheumatic diseases, especially rheumatoid arthritis, showed similar irregular calcifications of the atlantoaxial joint. Discussion. In calcium pyrophosphate dihydrate (CPPD) crystal deposition disease, the spine may be the only site of involvement, generally asymptomatic. Crystals located in the transverse ligament of the atlas give rise to the crowned dens syndrome, usually in patients affected by severe degenerative lesions of the atlantoaxial joint and peripheral chondrocalcinosis. Symptoms may be absent, or a neurological compressive syndrome may develop. Symptoms tend to worsen with age. The diagnosis is not always easy, as the symptoms are similar to those of other diseases, such as meningitis, cervicobrachial pain, occipitotemporal headache, calcific tendinitis of the longus colli muscle, spondylodiscitis and retropharyngeal abscess. CONCLUSION: CT is the gold standard in identifying crowned dens syndrome, as it is able to depict the shape and site of calcification and any bone erosions. Radiography of other joints (wrist, knee, pubic symphysis) may help to ascertain whether the disease is due to calcium pyrophosphate dihydrate or hydroxyapatite crystals, and is therefore recommended for routine patient management. Magnetic resonance imaging (MRI) is indicated for the study of neurological complications.

Assessment of the horizontal resolution of retrieval products derived from MIPAS observations.

We report the results of a study aimed at the assessment of the trade-off between precision and horizontal resolution of the retrieval products of MIPAS (Michelson Interferometer for Passive Atmospheric Sounding) operating onboard the ENVIronmental SATellite. By exploiting different observation setups we could perform the study by acting on both the retrieval and the sampling grids. Our results are compared with those previously obtained on simulated observations [Appl. Opt. 43, 1-11 (2004)]. We show that the horizontal sampling of the atmosphere operated by the spectrometer cannot be pushed beyond some limits without inducing unacceptable correlations among the retrieved profiles. These correlations show-up only when using a two-dimensional retrieval algorithm and can be evaluated through the instabilities that they trigger in the horizontal distribution of the retrieval products. In order to reduce these instabilities we compare the strategy of degrading the retrieval grid with the strategy of applying horizontal regularization. We discuss the different trade-off between precision and spatial resolution connected with the two strategies. The method adopted in this study, is applicable to any orbiting limb sounder measuring along the orbit track.

Borderline personality disorder. Suicidality and self-mutilation.

Epidemiological and neurobiological perspectives about suicidality in borderline patients are described, highlighting how self-destructive and seemingly suicidal acts are their "behavioral specialty." Principles for management, including the need for a primary clinician to oversee safety, and the pros and cons of both "contracting for safety" and hospitalization are presented. Clinical material is used to illustrate an approach that involves minimal initiative to rescue by therapists, a readiness to comply with patients' wishes for protection (the principle of false submission), and very active interpretation. This approach is contrasted with those advocated by Linehan and Kernberg.

Discrete representation and resampling in limb-sounding measurements.

The processes of discretization, interpolation, and resampling are frequently used in data analysis. Here the formalism of functional spaces is used as a framework for the description and characterization of both the measurement operation and these subsequent processes. The tools provided by this formalism are applied to the problem of resampling of atmospheric volume mixing ratio vertical profiles obtained with limb-sounding measurements. In particular, a resampling method that uses the conservation of the vertical column as a constraint is presented and compared with other methods. The effects of the resampling process in terms of error propagation and loss of vertical resolution are also evaluated.

Geo-fit Approach to the Analysis of Limb-Scanning Satellite Measurements.

We propose a new approach to the analysis of limb-scanning measurements of the atmosphere that are continually recorded from an orbiting platform. The retrieval is based on the simultaneous analysis of observations taken along the whole orbit. This approach accounts for the horizontal variability of the atmosphere, hence avoiding the errors caused by the assumption of horizontal homogeneity along the line of sight of the observations. A computer program that implements the proposed approach has been designed; its performance is shown with a simulated retrieval analysis based on a satellite experiment planned to fly during 2001. This program has also been used for determining the size and the character of the errors that are associated with the assumption of horizontal homogeneity. A computational strategy that reduces the large number of computer resources apparently demanded by the proposed inversion algorithm is described.

Optimized forward model and retrieval scheme for MIPAS near-real-time data processing.

An optimized code to perform the near-real-time retrieval of profiles of pressure, temperature, and volume mixing ratio (VMR) of five key species (O(3), H(2)O, HNO(3), CH(4), and N(2)O) from infrared limb spectra recorded by the Michelson Interferometer for Passive Atmospheric Sounding (MIPAS) experiment on board the European Space Agency (ESA) Environmental Satellite ENVISAT-1 was developed as part of a ESA-supported study. The implementation uses the global fit approach on selected narrow spectral intervals (microwindows) to retrieve each profile in sequence. The trade-off between run time and accuracy of the retrieval was optimized from both the physical and the mathematical points of view, with optimizations in the program structure, in the radiative transfer model, and in the computation of the retrieval Jacobian. The attained performances of the retrieval code are noise error on temperature <2 K at all the altitudes covered by the typical MIPAS scan (8-53 km with 3-km resolution), noise error on tangent pressure <3%, and noise error on VMR of the target species <5% at most of the altitudes covered by the standard MIPAS scan, with a total run time of less than 1 min on a modern workstation.

Derivation of temperature and pressure from submillimetric limb observations.

We demonstrate the feasibility of retrieval of temperature and pressure profiles from spaceborne limb-sounding spectroscopic measurements in the submillimetric region. Whether these profiles can be retrieved determines whether a submillimetric instrument can be self-sufficient as far as the atmospheric model is concerned or whether complementary sensors in other spectral regions, dedicated to temperature and pressure measurements, are needed. Molecular-oxygen transitions are selected for the purpose of temperature and pressure retrieval on the basis of realistic observational parameters. We use a mathematical model of the retrieval process to evaluate the information content of the spectral features and to study the trade-off between the uncertainty of the retrieved profiles and their vertical resolution. It is shown that, using only one oxygen transition and without any constraint, one can achieve uncertainties of 5% for both temperature and pressure from 10 to approximately 40 km of altitude with a vertical resolution of 3 km; above 40 km the vertical resolution needs to be degraded to limit the uncertainties. The possibility of exploiting a priori information is discussed, as well as the effects of external constraints that can be used to improve the quality of the retrieved profiles. The sources of systematic error that need to be considered for the compilation of the total error budget are also evaluated.

Correction of instrument line-shape distortions in Fourier transform spectroscopy.

A recovery procedure has been developed to correct instrument line-shape distortions observed in Fourier transform spectroscopy. The procedure can be described as a phase-error correction performed in the spectral domain to correct for path-difference-dependent phase errors observed in sharp spectral features. The technique has been applied successfully to high-resolution atmospheric emission spectra. The inherent broadening of the real features has been separated accurately from instrumental distortions. Using models for the path-difference-dependent error sources and data from two narrow window regions at 50 and 118 cm(-1), we show that the distortion has a simple dependence on the spectral frequency.

Piroxicam-induced analgesia: evidence for a central component which is not opioid mediated.

Piroxicam is a nonsteroidal anti-inflammatory drug with a potent analgesic effect. In order to establish whether the analgesic action of Piroxicam has a central component, we studied the effect of the drug on the nociceptive orbicularis oculi reflexes evoked by electrical stimulation of the cornea and supraorbital nerve in healthy subjects. Piroxicam significantly suppressed the corneal reflex and R3 component of the blink reflex by 28% (p < 0.05) and 50% (p < 0.01), respectively. This effect was not reversed by the i.v. injection of naloxone. Beta-endorphin levels did not change. Piroxicam administration induces distinct inhibitory changes in nociceptive reflexes, which suggests that the analgesic action of the drug has a central component. The ineffectiveness of naloxone, and the lack of beta-endorphin changes, indicate that this central action is independent of the opioid system; other pain regulatory systems are probably involved.