Removal of iron ore slimes from a highly turbid water by DAF.

This paper addresses Dissolved Air Flotation (DAF) process variables, such as the flocculation parameters and the recycle water addition, as well as the pretreatment chemical variables (coagulation conditions), to determine the optimal values for the flotation of iron ore slimes found in a highly turbid water sample from the Gualaxo do Norte River, a tributary of the Doce River Basin in Minas Gerais, Brazil. This work was conducted using a flotatest batch laboratory-scale device to evaluate the effectiveness of DAF for cleaning the water polluted by the Samarco tailings dam leakage and determine the ability of DAF to reduce the water turbidity from 358 NTU to values below 100 NTU, aiming to comply with current legislation. The results showed that the four types of tested coagulants (PAC, ferric chloride, Tanfloc SG and Tanfloc SL) provided adequate conditions for coagulation, flocculation and flotation (in the range of 90-99.6% turbidity reduction). Although the process variables were optimized and low residual turbidity vales were achieved, results revealed that a portion of the flocs settled at the bottom of the flotatest columns, which indicated that the turbidity results represented removal caused by a combination of flotation and sedimentation processes simultaneously.

The influence of floc size and hydraulic detention time on the performance of a dissolved air flotation (DAF) pilot unit in the light of a mathematical model.

The influence of floc size and hydraulic detention time on the performance of a dissolved air flotation (DAF) pilot unit was investigated in the light of a known mathematical model. The following design and operational parameters were considered: the hydraulic detention time (tdcz) and hydraulic loading rate in the contact zone, the down-flow loading rate in the clarification zone, the particle size distribution (d F), and the recirculation rate (p). As a reference for DAF performance analysis, the proposed ß.td parameter from the above mentioned mathematical model was employed. The results indicated that tdcz is an important factor in DAF performance and that d F and floc size are also determinants of DAF efficiency. Further, ß.td was sensitive to both design and operational parameters, which were varied in the DAF pilot plant. The performance of the DAF unit decreases with increasing ß.td values because a higher td (considering a fixed ß) or a higher ß (e.g., higher hydrophobicity of the flocs for a fixed td) would be necessary in the reaction zone to reach desired flotation efficiency.

Characterization of micro-bubble size distribution and flow configuration in DAF contact zone by a non-intrusive image analysis system and tracer tests.

This paper aims to investigate the influence of some dissolved air flotation (DAF) process variables (specifically: the hydraulic detention time in the contact zone and the supplied dissolved air concentration) and the pH values, as pretreatment chemical variables, on the micro-bubble size distribution (BSD) in a DAF contact zone. This work was carried out in a pilot plant where bubbles were measured by an appropriate non-intrusive image acquisition system. The results show that the obtained diameter ranges were in agreement with values reported in the literature (10-100 microm), quite independently of the investigated conditions. The linear average diameter varied from 20 to 30 microm, or equivalently, the Sauter (d(3,2)) diameter varied from 40 to 50 microm. In all investigated conditions, D(50) was between 75% and 95%. The BSD might present different profile (with a bimodal curve trend), however, when analyzing the volumetric frequency distribution (in some cases with the appearance of peaks in diameters ranging from 90-100 microm). Regarding volumetric frequency analysis, all the investigated parameters can modify the BSD in DAF contact zone after the release point, thus potentially causing changes in DAF kinetics. This finding prompts further research in order to verify the effect of these BSD changes on solid particle removal efficiency by DAF.

Liver disease as risk factor for cystic fibrosis-related diabetes development.

AIM: To evaluate clinical and genetic factors, besides pancreatic insufficiency, associated with increased risk of cystic fibrosis-related diabetes. METHODS: Case-control (1:1) study on 138 cystic fibrosis patients. Data were collected on gender, age at diagnosis, reason for cystic fibrosis diagnosis, family history of type 1 or 2 diabetes mellitus, pre-existing severe liver disease, and class of cystic fibrosis transmembrane regulation mutation. Moreover, information was obtained on lung involvement and degree of exocrine pancreatic insufficiency evaluated 1 year before the diagnosis of cystic fibrosis-related diabetes in patients and age-matched controls. RESULTS: Compared to controls, patients with cystic fibrosis-related diabetes had a higher probability of having already been diagnosed with liver disease (16.7% versus 1.7%, OR = 11.6, 95% CI 1.43-93.0). Moreover, in the year before diabetes onset, cases had slightly worse pulmonary function compared to controls (FEV1 = 58.4 +/- 27% predicted versus 67.4 +/- 21% predicted; p = 0.05). No significant effects related to the other factors considered were found. CONCLUSION: Severe liver disease was found to significantly increase the risk of developing cystic fibrosis-related diabetes. Patients with liver disease should be scheduled for earlier diabetes screening in order to identify and possibly treat glucose intolerance.

[Incidence of nosocomial rotavirus infections in a pediatric hospital over a 3-year period]. / Incidenza di infezioni nosocomiali da Rotavirus in un Ospedale pediatrico in un periodo di 3 anni.

AIM: To estimate the incidence rate of hospital-acquired rotavirus infections (HRI) in a paediatric hospital in a 3-year period; the risk of HRI associated to age, sex, ward, season; the cost determined by HRI for the healthcare system. METHODS: Retrospective epidemiological study, carried out using hospital datasets, with the analysis of some clinical records. RESULTS: In the 2003-2005 period the HRI incidence rate was 1.9% (mean age 15.2 months, SD 11.8, range 1.5-49), with a decreasing trend over years. Children aged less than 8 months were at higher risk of HRI than others (RR 1.83, CI 95% 1.18-2.85) as well as were children admitted to a 0-18 months pediatric medicine ward (RR=2.84, CI 95% 1.78-4.5) and to an infectious diseases ward (RR=4.9, CI 95% 3.4-7). The incidence of HRI was higher in the winter than in the rest of the year (RR 1.59, CI 95% 1.07-2.36). The hospital stay of children with HRI was prolonged by a mean of 5.2 days compared to age, sex and comorbidity-matched controls. (P=0.02). CONCLUSIONS: The method used in this study is easily reproducible. Data obtained can be used as internal quality indicators and to evaluate the performance of different hospital wards in infection control. Infection prevention activities should involve mothers and families of hospitalized children, as they perform on them a great deal of basic care and hygiene activities which are at risk for hospital cross-infections.

Angiosarcoma of the heart: structural and ultrastructural study.

BACKGROUND: Primary cardiac tumours are rare. Nearly 70% of primary cardiac tumours are benign, the majority of which are represented by myxomas. The most frequent primary cardiac neoplasm is the angiosarcoma that represents 31% of primary cardiac malignant. We report a particular clinical case of cardiac angiosarcoma, its light and transmission electron microscopic aspects and a review of the recent literature. METHODS: A 52 years old man died for a severe right ventricle filling deficit caused by an intracavitary tumour originated from the right atrial anterolateral wall. The fragments obtained from autoptic tumoral cardiac tissue were processed for light and electron microscopy. The section were stained with haematoxilineosin, Masson trichromic and Gomori method. An immunohistochemical study for vimentin, Factor VIII related antigen and peroxidase-conjugated lectin from Ulex Europaeus was also performed using the unlabed peroxidase-antiperoxidase method. RESULTS: The hematoxylin-eosin staining showed that the tumoral mass was composed by a well-differentiated histotype characterized by numerous vascular areas in which neoplastic cells were loosely and irregularly arranged to form incomplete vessels or anastomized blood-filled vascular channels. On the other hand, some less-differentiated solid areas were present and irregularly surrounded the differentiated vascular areas. Results of Ulex Europeaeus Agglutinin I labelling were positive in both solid and vascular areas of the tumour although the positive reaction was less evident in the solid zones Factor VIII related antigen positive cells were less numerous and mainly found in vascular areas. The observation by electron microscopy showed the lack of evident pinocytotic vesicles, the presence of thin and delicate cytoplasmatic processes, Weibel-Palade bodies, and also the disarrangement of the extracellular fibrous matrix. CONCLUSION: The light microscopy observation and immunohistochemical study underscore that is not easy to obtain information about the level of differentiation of this tumour. The presence of blood-filled lumina and the identification of typical markers of endothelial cells seems to indicate a well-differentiated nature. However, the ultrastructural findings seem to indicate a less differentiated nature.

Influence of flocculation conditions in the performance of an experimental domestic sewage treatment plant consisting of an anaerobic expanded bed reactor followed by dissolved air flotation.

This paper presents the results of a study performed with an experimental domestic sewage treatment plant (240 m3 x d(-1) flow) consisting of expanded bed anaerobic reactor (EBAR) followed by dissolved air flotation (DAF) unit. For the flotation step, the anaerobic reactor effluent was previously coagulated with 50 mgFeCl3 x l(-1) and flocculated under different conditions (mean velocity gradient, Gf, and flocculation time, Tf). The Gf values were from 60 to 100 s(-1) associated with 13 and 20 min Tf values. During the tests, the following operational conditions of the flotation unit were maintained: chemical addition (50 mgFeCl3 x l(-1)), 18% recirculation rate associated with a pressure of 450 +/- 10 kPa in the saturation chamber and overflow rate of 180 m3 x m(-2) x d(-1). Temperature ranged from 23.8 degrees C to 30.0 degrees C. Best results were achieved for Gf = 80 s(-1) and Tf = 20 min. For these conditions, the DAF unit removal efficiencies were: 94.4% for chemical oxygen demand (with 53 mg x l(-1) COD residual), 87% for phosphorus (with 0.80 mgP x l(-1) residual), 96.7% for total suspended solids (with 9 mg x l(-1) TSS residual) and 96.4% for turbidity (with 12.9 NTU residual), when the anaerobic reactor effluents have worst quality during the whole day.

A preoperative index of mortality for patients undergoing surgery of type A aortic dissection.

BACKGROUND: The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. METHODS: From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. RESULTS: The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas non-emergent operations had an in-hospital mortality rate of 13.7% (p<0.01). Univariate analysis revealed among 39 preoperative and operative variables, age (years), age >70 years, remote myocardial infarction, cerebrovascular dysfunction, diabetes, preoperative renal failure, shock, cardiopulmonary bypass time (minutes), emergency operation as factors associated to in-hospital death (p<0.05). Stepwise logistic regression analysis selected as independent predicting variables (p<0.05), remote myocardial infarction (p=0.006), preoperative renal failure (p=0.032), shock (p=0.001), age >70 years (p=0.007). Finally, a probability table of death risk was obtained with the logistic regression coefficients. The lower death probability (10.6%) was calculated in absence of risk variables; the higher one in presence of all of them (79.7%). Between these extremes, a total of 64 combinations of death risk were obtained. CONCLUSIONS: Increasing age, shock, coronary artery disease and renal failure are variously associated to a high risk of in-hospital death after surgical correction of type A aortic dissection. This predictive model of death probability allows to collocate preoperatively patients with type A aortic dissection at different levels of risk for in-hospital death.

Sewage treatment by anaerobic biological process associated with dissolved air flotation.

This paper presents the results of a study performed with a lab-scale batch DAF unit fed with previously coagulated (with FeCl3 or cationic polymer) effluent from a pilot scale up-flow anaerobic sludge blanket (UASB) reactor treating domestic sewage. The adequate coagulation/flocculation conditions--chemical dosage, time (Tf) and mean velocity gradient (Gf) in the flocculation step--and air requirements for flotation process were investigated. Best results were achieved for 65 mg.l-1 of FeCl3 at Tf around 15 min and Gf of 80 s-1. In the assays where only polymer was applied, 7 mg.l-1 of cationic polymer dosage gave optimum removals with Tf around 15 min and Gf of 30 s-1. Air requirements ranged from 9.5 to 19.0 g of air.m-3 wastewater. Best TSS (95% and residual of 2 mg.l-1), COD (85% and residual of 20 mg.l-1) and total phosphate (95% and residual of 0.6 mg.l-1) removals were obtained when applying FeCl3, although the use of cationic polymer also produced good level of TSS (74% and residual of 14 mg.l-1) and COD (75% and residual of 45 mg.l-1) removals. For the UASB-DAF (batch) system and FeCl3, global efficiencies would be 97.2% for COD, 97.9% for phosphate and 98.9% for TSS.

Ozonation followed by coagulation/flocculation and flotation as post-treatment of the effluent from an anaerobic baffled reactor treating domestic sewage.

This paper reports on the use of ozonation and dissolved air flotation as a post-treatment of the effluent from an anaerobic baffled reactor treating domestic sewage. After preliminary essays, the present experiment was performed fixing coagulant doses and, to all of them, some ozone doses were investigated. Later, the pH value and the ozone dose which provided the best removal efficiencies of all the parameters involved were tested, changing the coagulant dose and varying, for each of them, two ozone doses: the zero one and the optimum. Considering the best conditions of coagulation/flotation (ferric chloride dose of 65 mg.L-1 and pH around 5.5), the ozone dose application of 6 mg.L-1 led to a significant level in the removal efficiency of COD (80.4%), BOD (79.0%), total phosphate (93.4%), apparent color (91.9%) and turbidity (97.0%), demonstrating that the system seems to be efficient and capable of promoting a high degree of sewage post-treatment, reducing the coagulant dose until 30%, with a consequent reduction in the sludge generation.

Liquid ventilation in an infant with persistent interstitial pulmonary emphysema.

We present the case of a full term infant affected by diffuse persistent interstitial pulmonary emphysema (PIPE), who was treated with partial liquid ventilation (PLV) after the failure of conventional management. PIPE is a lethal chronic lung disease of unclear pathogenesis. Clinical history, radiological and histological findings confirmed the diagnosis in our patient. PLV applied for 48 hours resulted in a significant improvement in the infant's respiratory function and was not associated with adverse effects. We concluded that PLV could be effective in prolonging the survival of infants with PIPE; its application represents an effective form of respiratory support in infants with chronic lung disease.

Fiberoptic and conventional phototherapy effects on the skin of premature infants.

To evaluate the effects of conventional phototherapy and fiberoptic phototherapy on trans-epidermal water loss in preterm infants with and without skin ointment application, 20 infants were randomly assigned to receive conventional or fiberoptic phototherapy for non-hemolytic hyperbilirubinemia. After conventional phototherapy, there were no significant differences in trans-epidermal water loss between ointment-treated and untreated areas. After fiberoptic phototherapy, trans-epidermal water loss significantly increased from ointment-treated and untreated areas, but the increase was less in treated areas.

The role of blood transfusions and iron intake on retinopathy of prematurity.

BACKGROUND: The role of blood transfusions and iron intake in the pathogenesis or retinopathy of prematurity (ROP) is controversial. AIM: To evaluate the influence of packed red cell (PRC) transfusions and iron intake on ROP incidence. STUDY DESIGN: Prospective observational study. SUBJECTS: Forty-five preterm infants with birthweight <1250 g were studied. After ophthalmological study, they were divided into group A (n=24) that included newborns without ROP, and group B (n=21) that included newborns with ROP. RESULTS: Logistic regression analysis demonstrated that gestational age (OR 0.61; 95% C.I. 0.41-0.90), transfusion volume during the first week (OR 1.16; 95% C.I. 1.03-1.3) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62), and iron intake during the first week of life (OR 1.15; C.I. 1.01-1.32) and during the first 2 months of life (OR 2.93; 95% C.I. 1.52-5.62) were associated with the development of ROP. CONCLUSION: Our study showed that gestational age, blood transfusion volume and iron load by transfusions are associated with the risk of occurrence of ROP in infants with a birthweight of less than 1250 g.

[Reconstruction of mental health services in Bosnia and Herzegovina]. / Rekonstrukcija sluzbe za zastitu mentalnog zdravlja u Federaciji Bosne i Hercegovine.

Psychiatric services in Bosnia-Herzegovina before the war disaster was fairly developed and one of the best organized services amongst the republics of the former Yugoslavia. The psychiatric care system was based on psychiatric hospitals and small neuropsychiatric wards within general hospitals, accompanied by psychiatric services in health centers. The onset of war in B&H brought devastation and destruction in all domains of life, including the demolition and closing of numerous traditional psychiatric institutions, together with massive psychological suffering of the whole civilian population. Already during the war, and even more so after the war, the reconstruction and reorganization of the mental health services was undertaken. The basis of mental health care for the future is designed as a system where majority of services is located in the community, as close as possible to the habitat of the patients. The key aspect of the system of the comprehensive health care is primary health care and the main role is assigned to family practitioners and mental health professionals working in the community. Large psychiatric institutions were either closed or devastated, or have their capacities extensively reduced. There will be no reconstructions or reopening of the old psychiatric facilities, nor the new ones will be built. The most integrated part of the psychiatric system are the Community based mental health centers. Each of these centers will serve a particular geographic area. The centers will be responsible for prevention and treatment of psychiatric disorders, as well as for the mental health well being. Chronic mental health patients without families and are not able to independently live in the community will be accommodated in designated homes and other forms of protected accommodation within their communities. The principal change in mental health policy in B&H was a decision to transfer psychiatric services from traditional facilities into community, much closer to the patients. Basic elements of the mental health policy in B&H are: Decentralization and sectorization of mental health services; Intersectorial activity; Comprehensiveness of services; Equality in access and utilization of psychiatric service resources; Nationwide accessibility of mental health services; Continuity of services and care, together with the active participation of the community. This overview discusses the primary health care as the basic component of the comprehensive mental health care in greater detail, including tasks for family medicine teams and each individual member. 1. Comprehensive psychiatric care is implemented by primary health care physicians, specialized Centers for community-based mental health care, psychiatric wards of general hospitals and clinical centers in charge of brief, "acute" inpatient care; 2. Primary mental health care is implemented by family practitioners (primary care physicians) and their teams; 3. Specialized psychiatric care in community is performed professional teams specialized mental health issues' within Mental health centers in corresponding sectors; 4. A great deal of relevance is given to development of confidence and utilization of links between primary health care teams and specialized teams in Mental health centers and psychiatric in patient institutions; 5. Psychiatric wards within general cantonal hospitals, departments of psychiatric clinics in Sarajevo, Tuzla, and Mostar, and Cantonal Psychiatric hospital in Sarajevo (Jagomir) shall admit acute patients as well as chronic (with each new relapse). Treatment in these facilities is brief an patients are discharged to return to their homes, with further treatment referral to their family practitioner or designated Mental health center; 6. Chronic mental patients with severe residual impairment in social, psychological, and somatic functioning, shall live in the community with their families or independently. Those chronic patients without families and economic and other resources to live independently shall be placed in supervised Homes in the communities where they live. The above delineated strategy of mental health care program in B&H has several fundamental and specific objectives, among which the most important are: Reduction of incidence and prevalence of some mental disorders, particularly war stress-related disorders and suicide; Reduction of level of functional disability caused by mental disorders through improvement of treatment and care of individuals with mental health problems; Improvement of psychosocial well being of people with mental health problems, through implementation of comprehensive and accessible service for community mental health care; and Respect of basic human rights of individuals with mental health disabilities. The program has been updated since 1996, after the two-year pilot program. The main goals for current two- and five-year period are: Implement the mental health care reform program by launching all 38 Mental health centers in the Federation of BiH by 2002; Complete the 10-day education and re-education of at least 50% of all professionals employed in mental health services in FB&H by 2002; and Achieve that 80 percent of all mental health problems are treated by family medicine teams (primary care practitioners) and specialized mental health services (Community mental health care centers) by 2005.

Determinants of early and late outcome after surgery for type A aortic dissection.

The aim of this study was to identify the most important variables associated with early and late mortality in patients operated on for type A aortic dissection over a 15-year period. From January 1984 to March 1999, 110 patients underwent surgery for type A aortic dissection. The 88.1% of patients had an acute type A dissection (AD) and 11.8% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 21.8% and 14.5% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 70.9% of cases, in the arch in 17.2%, and in the descending aorta in 7.2%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. Kaplan-Meier and Cox regression analyses and hazard function for death risk were used to analyze factors influencing overall and surgical survival. The overall in-hospital mortality rate was 20.9% (23/110 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas nonemergent operations had an in-hospital mortality rate of 13.7% (p < 0.01). Univariate analysis revealed 41 preoperative and operative variables, including age (years), age >70 years, remote myocardial infarction, cerebrovascular dysfunction, diabetes, preoperative renal failure, shock, cardiopulmonary bypass time (minutes), emergency operation, as factors associated to in-hospital death (p < 0.05). Stepwise logistic regression analysis for in-hospital death selected as independent predicting variables (p < 0.05) remote myocardial infarction [p = 0.006, odds ratio (OR) = 1.9], preoperative renal failure (p = 0.031; OR = 0.8), shock (p = 0.001; OR = 3.1), and age >70 years (p = 0.007; OR = 1.7). Follow-up ranged from 9 to 172 months (median 78 months), with Kaplan-Meier survivals for all the patients and hospital survivors of 42% and 54% at 10 years, respectively. Cox regression analysis has identified postoperative stroke [relative risk (RR) = 3.7; p = 0.012), intimal tear in the aortic arch (RR = 2.3; p = 0.036), and postoperative renal failure (RR = 4.5; p = 0.007) as independent predictors of reduced survival at follow-up. When this kind of analysis was performed on hospital survivors only, preoperative renal dysfunction (RR = 1; p = 0.013), reoperation (RR = 1.7;p = 0.004) and intimal tear in the aortic arch (RR = 1.2; p = 0.002) emerged as risk factors. The actuarial freedom from reoperation was 85.4% at 5 years. Multiple factors still influence early and late survival after surgery for type A aortic dissection. Preoperative renal impairment both affects early and late outcome. Early postoperative course affects late outcome in hospital survivors. The presence of the intimal tear in the aortic arch has a negative impact on late survival.

Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants.

UNLABELLED: The aim of our study was to evaluate whether the prophylactic use of ibuprofen would reduce the incidence of significant patent ductus arteriosus (PDA) and to confirm the effectiveness of ibuprofen as rescue treatment in closing PDA. Eighty preterm infants with gestational age less than 34 wk with infant respiratory distress syndrome (iRDS) were randomized to receive intravenous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) either within 24 h of life (group A) or after echocardiographic diagnosis of PDA (group B). To evaluate the severity of RDS in each patient, we calculated the initial and highest values of Oxygenation Index (O.I. = mean airway pressure x FiO2 x 100/PaO2) and Ventilatory Index (V.I. = O.I. x mechanical respiratory rate). Other studied variables were ventilatory support, renal function, biochemical and haematological profiles, frequency of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of group B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arteriosus after ibuprofen treatment. Initial and highest values of O.I. and V.I. were similar in both groups A and B. No significant differences between the groups were observed in regard to respiratory support, renal function and frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adverse effects. CONCLUSION: Prophylactic treatment with ibuprofen reduces PDA occurrence in preterm infants with iRDS at 3 d of life in comparison with rescue treatment, but both modes are effective in closing the ductus without significant adverse effects.

Brain hemodynamic changes in preterm infants after maintenance dose caffeine and aminophylline treatment.

OBJECTIVE: To investigate the acute effects of low-dose caffeine and aminophylline on cerebral blood flow in preterm infants, using both near-infrared spectroscopy (NIRS) and cerebral Doppler ultrasonography. METHODS: Preterm infants with a gestational age of <32 weeks and birth weight of <1,500 g were randomized to receive either caffeine or aminophylline treatment for apnea of prematurity. The study period went from 30 min before to 60 min after the administration of the maintenance dose of pure caffeine (2.5 mg/kg once a day) or aminophylline (1.25 mg/kg twice a day). NIRS was used to measure changes in oxygenated hemoglobin (O(2)Hb), deoxygenated hemoglobin (HHb), oxidized-reduced cytochrome aa3 (CtOx), and mean cerebral oxygen saturation (SmO(2) = O(2)Hb/total Hb). Changes in cerebral blood volume (DeltaCBV) after caffeine or aminophylline administration were calculated. Cerebral blood flow velocity (CBV) in the pericallosal artery was evaluated by cerebral Doppler ultrasounds. RESULTS: Data collected by NIRS and cerebral Doppler ultrasounds did not show significant differences before and after caffeine treatment. We observed a significant increase in O(2)Hb and HHb concentration and in CBV at 30 min after the infusion of aminophylline, which tended to return to baseline at the end of the study period. CONCLUSION: Caffeine does not significantly affect brain hemodynamics, while aminophylline induces a significant transient increase in O(2)Hb and HHb concentration and CBV.

Risk factors for the development of respiratory distress syndrome and transient tachypnoea in newborn infants. Italian Group of Neonatal Pneumology.

Respiratory distress syndrome (RDS) and transient tachypnoea (TT) are the most frequent acute respiratory diseases in the newborn. This study investigated the risk factors for RDS and TT in newborn infants. A population of 63,537 newborns was enrolled in a 12-month survey in Italy, 734 (1.15%) affected by RDS and 594 (0.93%) affected by TT. Multivariate regression analysis of maternal and perinatal data and the calculation of odds ratios (with 95% confidence intervals) were performed. It was demonstrated that gestational age, birthweight, maternal age, elective and emergency caesarean section (CS), and male sex were risk factors for RDS, while gestational age, maternal diseases, twinning, birthweight, operative vaginal delivery, elective and emergency CS, and male sex were risk factors for TT. The data confirm previous reports and demonstrate that advanced maternal age is a risk factor for RDS, while ruling out maternal diseases as independent risk factors for RDS.