Italian SARS-CoV-2 patients in intensive care: towards an identikit for subjects at risk?

OBJECTIVE: To investigate patient characteristics and factors that increase the risk of being admitted to intensive care and that influence survival in cases of SARS-CoV-2 pneumonia. PATIENTS AND METHODS: One-hundred and ninety-one SARS-CoV-2 patients were admitted to the "Fondazione Poliambulanza di Brescia" Hospital (Brescia, Lombardy, Italy) in the period 1st March 2020 to 11th April 2020. Data on demographics, clinical presentation at admission, co-morbidities, pharmacological treatment, admission to intensive care and death was recorded. Logistic regression and survival analysis were carried out to investigate the risk of being admitted to intensive care and the risk of death. RESULTS: The mean age of the study cohort was 64.6±9.9 years (range 20-88). Median BMI was 28.5±5 kg/m2. Fever (81%) and dyspnea (65%) were the most common symptoms on admission. Most of patients (63%) had at least one co-existing disease. The 157 (82%) patients admitted to intensive care were more likely to be of intermediate age (60-69 years; OR 3.23, 95% CI 1.32-8.38), overweight (OR 2.66, 95% CI 1.02-7.07) or obese (OR 5.63, 95% CI 1.73-21.09) and with lymphocytopenia (OR 2.75, 95% CI 1.17-6.89) than the 34 patients admitted to the ordinary ward. During intensive care, 50% of patients died and their death was associated with older age (HR 2.06, 95% CI 1.07-3.97), obesity (HR 2.23, 95% CI 1.15-4.35) and male gender (HR 1.9, 95% CI 1.02-3.57). CONCLUSIONS: We found that admission to intensive care and poor survival were associated with advanced age and higher body mass index, albeit with differences in statistical significance. Pre-existing diseases and symptoms on admission were not associated with different clinical outcomes. Interestingly, male gender was more prevalent among SARS-CoV-2 patients and was related negatively to survival, but it was not associated with more frequent admission to intensive care.

Osmotic pressure estimation using the Pitzer equation for forward osmosis modelling.

Forward osmosis (FO) has received widespread recognition in the past decade due to its potential low energy production of water. This study presents a new model analysis for predicting the water flux in FO systems when inorganic-based draw solutions are used under variable experimental conditions for using a laboratory scale cross-flow single cell unit. The new model accounts for the adverse impact of concentration polarization (both ICP and ECP) incorporating the water activity by Pitzer to calculate the bulk osmotic pressures. Using the water activity provides a better correlation of experimental data than the classical van't Hoff equation. The nonlinear model also gave a better estimate for the structural parameter factor (S) of the membrane in its solution. Furthermore, the temperature and concentration of both the draw and feed solutions played a significant role in increasing the water flux, which could be interpreted in terms of the mass transfer coefficient representing ECP; a factor sensitive to the hydraulics of the system. The model provides greatly improved correlations for the experimental water fluxes.

Optimized Long-Range Corrected Density Functionals for Electronic and Optical Properties of Bare and Ligated CdSe Quantum Dots.

The reliable prediction of optical and fundamental gaps of finite size systems using density functional theory requires to account for the potential self-interaction error, which is notorious for degrading the description of charge transfer transitions. One solution is provided by parametrized long-range corrected functionals such as LC-BLYP, which can be tuned such as to describe certain properties of the particular system at hand. Here, bare and 3-mercaptoprotionic acid covered Cd33Se33 quantum dots are investigated using the optimally tuned LC-BLYP functional. The range separation parameter, which determines the switching on of the exact exchange contribution, is found to be 0.12 bohr-1 and 0.09 bohr-1 for the bare and covered quantum dot, respectively. It is shown that density functional optimization indeed yields optical and fundamental gaps and thus exciton binding energies, considerably different compared with standard functionals such as the popular PBE and B3LYP ones. This holds true, despite the well established fact that the leading transitions are localized on the quantum dot and do not show pronounced long-range charge transfer character.

CO2 sorption kinetics of scaled-up polyethylenimine-functionalized mesoporous silica sorbent.

Two CO2 solid sorbents based on polyethylenimine, PEI (M(n) ∼ 423 and 10K), impregnated into mesoporous silica (MPS) foam prepared in kilogram quantities via a scale-up process were synthesized and systematically characterized by a range of analytical and surface techniques. The mesoporous silica sorbent impregnated with lower molecular weight PEI, PEI-423/MPS, showed higher capacity toward CO2 sorption than the sorbent functionalized with the higher molecular weight PEI (PEI-10K/MPS). On the other hand, PEI-10K/MPS exhibited higher thermal stability than PEI-423/MPS. The kinetics of CO2 adsorption on both PEI/MPS fitted well with a double-exponential model. According to this model CO2 adsorption can be divided into two steps: the first is fast and is attributed to CO2 adsorption on the sorbent surface; the second is slower and can be related to the diffusion of CO2 within and between the mesoporous particles. In contrast, the desorption process obeyed first-order kinetics with activation energies of 64.3 and 140.7 kJ mol(-1) for PEI-423/MPS and PEI-10K/MPS, respectively. These studies suggest that the selection of amine is critical as it affects not only sorbent capacity and stability but also the energy penalty associated with sorbent regeneration.

Rhabdomyolysis associated with varicella infection.

Varicella infection is a common childhood disease that usually resolves without complications. However, children under 2 months of age, adolescents, some adults and immunocompromised individuals are at high risk of certain rare life-threatening complications. We report a case of primary varicella infection in an immunocompetent adult complicated by rhabdomyolysis. Recognition of this complication and aggressive fluid therapy with an antiviral agent helped to improve the outcome.

Childhood tuberculosis in the State of Qatar: the effect of a limited expatriate screening programme on the incidence of tuberculosis.

OBJECTIVE: To determine incidence rates and the effectiveness of the expatriate screening programme on paediatric tuberculosis (TB) in the State of Qatar. METHOD: A state-wide, population-based, retrospective analysis of all cases of tuberculosis among children 0-14 years of age reported to the TB Unit of the Division of Public Health during 1983-1996. RESULTS: One hundred and forty-four children with tuberculous disease were identified, with a steadily declining incidence rate (rate of notification) from 11/100000 children (0-14 years) population in 1983 to 7/100000 in 1996. This decrease in the childhood TB case notification rate correlated with foreign-born children, older children and the implementation of expatriate screening in 1986. Diagnosis in 56% of children was made abroad or within 3 months of arrival from vacation and 30% within one year of arrival. Comparison of the three age groups (<5, 5-9 and 10-14 years) showed no significant difference with regard to nationality, sex, type of TB, radiological findings and screening. However older children were more likely to be symptomatic (P < 0.0001) and to have positive tuberculin skin test (TST) reactivity (P = 0.012), culture (P < 0.0001), and gastric aspirates (P = 0.018). CONCLUSION: Although there was a 36% decrease in paediatric TB incidence after the implementation of expatriate screening in 1986, Qatar has a high rate of paediatric tuberculosis. The policy of BCG vaccination at birth should be continued, and screening children at school entry and on return from vacation would be useful for further case identification.

Pattern of mycobacterial resistance to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the state of Qatar after the implementation of DOTS and a limited expatriate screening programme.

OBJECTIVE: To determine the resistance pattern of Mycobacterium tuberculosis to four anti-tuberculosis drugs in pulmonary tuberculosis patients in the State of Qatar after the implementation of DOTS and an expatriate screening programme on arrival. METHOD: A state-wide, population-based, retrospective analysis of all cases of pulmonary tuberculosis with positive M. tuberculosis culture reported to the Division of Public Health TB Unit from January 1996 to December 1998. M. tuberculosis sensitivity testing was done by the Bactec method for isoniazid (INH), rifampicin (RMP), streptomycin (SM) and ethambutol (EMB). The results were interpreted as a daily change of the growth index of test vials (with drug) compared with controls. RESULTS: There were 406 isolates with positive M. tuberculosis culture. Sixty-one (15%) were resistant to one or more of the four anti-tuberculosis drugs, of which 58 (95%) were from newly diagnosed cases (primary) and three (5%) were from previously treated cases (acquired). Primary resistance was as follows: any resistance 15%, INH 12.4%, RMP 2%, SM 5.2%, EMB 0.8% and multidrug resistance (MDR, resistance to INH and RMP at least) was found in 0.8%. Acquired resistance was as follows: any resistance 15%, INH 15%, RMP 5%, SM 5% and MDR 5%. CONCLUSION: The prevalence of resistance to four anti-tuberculosis drugs is strikingly low due to the limited expatriate screening programme (chest radiography) and implementation of DOTS. The four-drug regimen is recommended for the initial phase of therapy until the results of sensitivity testing are known.

Primary tuberculosis of the breast in Qatar: ten year experience and review of the literature.

OBJECTIVE: To present our experience of isolated tuberculosis of the breast, 1988-98. DESIGN: Retrospective study of case notes and radiographs. SETTING: Hamad General Hospital, Qatar. SUBJECTS: 13 multiparous women with tuberculosis of the breast. MAIN OUTCOME MEASURES: Objective confirmation of diagnosis and adequacy of treatment. RESULTS: We found an overall incidence of histologically confirmed tuberculosis to be 0.4%/year. All patients presented with a lump, 2 had nipple discharge and one had a palpable axillary node on the same side. 7 were treated by excision biopsy, 3 by incision and drainage, and 3 had fine needle aspiration (FNA) as their only procedure. All diagnoses were confirmed histologically. 2 patients developed recurrences during treatment but these were successfully treated. CONCLUSION: Although the incidence of the disease is low, the diagnosis should be suspected in young multiparous women with a breast lump in whom malignancy has been excluded. The minimum of surgical intervention (incision or excision biopsy) together with antituberculous drugs seems to be the most successful treatment.

Erythrocyte sedimentation rate in childhood tuberculosis: is it still worthwhile?

OBJECTIVE: To evaluate the utility of the erythrocyte sedimentation rate (ESR) in the diagnosis of childhood tuberculosis. DESIGN: Data were collected retrospectively from the Qatar National Tuberculosis (TB) Registry for children (birth to 14 years of age) from 1983 to 1996. The diagnosis of active tuberculosis was based on positive sputum cultures (or histology) or an abnormal chest radiograph that responded to anti-tuberculosis chemotherapy. RESULTS: Of 144 childhood TB patients, 68 (47%) had an ESR documented at the time of diagnosis. Twenty-two children (33%) had a normal ESR (<10 mm/hour) and 46 children (67%) had an elevated ESR (> or =10 mm/hour) at the time of diagnosis. Culture positive and symptomatic children had significantly higher ESR values than culture negative and asymptomatic children, respectively, at the time of diagnosis. There was no significant difference in ESR values for children with extrapulmonary versus pulmonary disease, and likewise no significant correlation between either age or size of tuberculin skin test reactivity and ESR values. CONCLUSION: Although an elevated ESR may be expected in children with tuberculosis, this study found that one-third of children with TB had a normal ESR at the time of diagnosis, and consequently there would seem to be little value in using ESR as a diagnostic test for childhood tuberculosis.

[Digoxin-like immunoreactive factors. Review of the literature]. / Digoxin-like immunoreactive factor. Revisione della letteratura.

It is confirmed by several studies that in normal subjects a substance recognized by antibodies anti digoxin exists. Such a substance can be found at increased concentration in pregnant women, neonates, in liver or kidney diseases. A limited increase in concentration has been also registered in patients with essential hypertension and in normotensive patients with a family history of hypertension. Serum or urines rich in such a substance show an increased capacity of inhibiting in vitro the sodium-potassium pump and therefore in reducing also in vivo the capacity of reabsorption of sodium and with it, of water. The investigators interest for this substance has two main reasons: 1) the interference that such a substance has in dosages of digitalis in therapeutic monitorizing; 2) the possibility that such a substance has an important physiological role in hydroelectrolytic metabolism.

[Localization of the apical foramen using the newest electronic instruments: stereomicroscopy and SEM (scanning electron microscopy)]. / La localizzazione del forame apicale con strumenti elettronici di ultima generazione: analisi allo stereomicroscopio e al MES.

Introduction of double impedence as new parameter in root canal length electronic measurement allowed first and second generation electronic apical localizers main problems overcoming: precision failure in presence of conducting fluids. Our study's purpose was an in vitro evaluation of two third generation instruments (Apit-Osada and Root ZX-Morita Corp.) ability in apical foramen localization using sodium hypoclorite as irrigating solution. 40 human monorooted teeth with immature apex were studied. 20 samples were measured by Apit and 20 by Root ZX; measurements were recorded when apical foramen was reached. Samples were fixed for stereomicroscope observation before and after apical 3 mm worn and prepared for SEM observation. Evaluations about each system's precision were made by calculating difference between foramen position determined by electronic localizer and its real anatomical position determined by a computed image analizing system linked to SEM. All measurements were included between a minimum value of -0.45 mm and a maximum value of 0.26 mm. Mann Whithney U test was performed to compare average values of the two sample groups but his was not meaningful (p = 0.18) showing that there is no valuable difference in accuracy between Apit and Root ZX. According to most researchers, who consider a +/- 0.5 mm error range clinically acceptable, and considering that in vitro measurements never exceded this limit value we conclude confirming both instruments' safety.

[A case of autotransfusion with particular clinical aspects, paradigmatic of a protocol adopted for children]. / Un caso di autotrasfusione con aspetti clinici particolari, paradigmatico di un protocollo adottato per pazienti in età pediatrica.

The authors report a case of autologous blood transfusion in an 11-year old boy with Spinal Amiotrophy undergoing surgical correction of a kyfo-scoliosis by vertebral arthrodesis with Harrington-Luque. They analyze age related problems as far as the organization of an autologous blood transfusion program is concerned, with intraoperative washed blood salvage and preoperative deposit. A several year experience along with the application of specially designed protocols for children in this field may make it possible to achieve the so-called "zero blood transfusion risk".

[Use of neuroleptoanesthesia for carrying out a Harrington intervention in a patient probably susceptible to malignant hyperthermia]. / Impiego della neuroleptoanestesia per l'esecuzione di un intervento di Harrington in un paziente sicuramente suscettibile di ipertermia maligna.

The Authors, after a brief review of malignant hyperthermia (MH), describe the use of NLA a Harrington's surgical procedure in a malignant hyperthermia susceptible (MHS) patient. Such an anaesthesiological procedure, using benzodiazepines, droperidol, fentanyl, pancuronium and N2O/O2, didn't lead to any form of MH crisis on to complications.

[Application of the Ivory separator in dental restoration]. / La aplicación del separador de Ivory en las reconstrucciones dentales.

The Ivory widener is practical, quick and without deleterious effects on dental and gingival tissues. It allows a gradual and reproducible effect, good visibility of the operatory field and a better access to the dental cavity with saving of healthy tissue.