Ottimizzazione del processo di gestione delle modifiche della distinta base prodotto il caso IMA S.p.A.

A seguito di un’esigenza esplicitata della Divisione IMA Ilapak Lugano, il team del PaLM Entreprise ha creato il Modulo Segnalazione Modifiche (MSM) con lo scopo di standardizzare e strutturare il flusso informativo relativo alle modifiche della distinta base dagli uffici tecnici a quelli della logistica e produzione. La prima analisi effettuata è stata incentrata sulla situazione AS-IS e sul primo applicativo che utilizzava Ilapak Lugano, il Segnalazione Modifiche (SM). Dopo aver appreso il funzionamento del vecchio SM, sono emerse diverse criticità come la scarsa integrazione con la piattaforma PaLM e con gli altri sistemi che conducevano a problemi di trasmissione di informazione tra gli uffici e ad errori nel recupero delle modifiche corrette. Dopo differenti riunioni tra i due team sono state concordate le prime specifiche. Successivamente l’elaborato procede con un’analisi della situazione TO-BE, descrivendo le caratteristiche ed i vantaggi del MSM. Uno dei principali benefici è che il Modulo è perfettamente integrato all’interno del PaLM e con tutti i sistemi PDM e CAD. Tutto ciò permette di migliorare la comunicazione e la collaborazione tra i vari dipartimenti, in special modo tra gli uffici tecnici e la logistica e con i fornitori. La terza ed ultima analisi è, invece, una valutazione economica: vengono calcolati i costi della situazione AS-IS, quelli della TO-BE e, in seguito, viene fatta un’analisi costi/benefici, confrontando i due scenari. Attraverso l’implementazione del MSM, si ottengono i seguenti risultati: non solo si ottiene una riduzione dei costi, ma anche un risparmio importante di tempo per gli operatori. Ilapak Lugano è risultata essere la portavoce di un progetto che, in realtà, molte altre Divisioni IMA desiderano. Senza dubbio, il fine ultimo del progetto del MSM è quello di introdurlo in quante più Divisioni possibili, rendendolo un modulo indispensabile all’interno dell’azienda

Acinetobacter baumannii Resistance to Sulbactam/Durlobactam: A Systematic Review

Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have limited therapeutic options. Sulbactam-durlobactam is a combination of two beta lactamase inhibitors with activity against CRAB under phase 3 clinical investigation. We performed a systematic review on in vitro studies reporting A. baumannii resistances against sulbactam/durlobactam. We considered "resistant" species to be those with MIC >= 8 mg/L. Ten studies were included in the review (9754 tested isolates). Overall, 2.3% of A. baumannii were resistant to sulbactam/durlobactam, and this percentage rose to 3.4% among CRAB subgroups and to 3.7% among colistin-resistant strains. Resistance was 100% among metallo beta-lactamase-producing strains. Overall, in 12.5% of cases, sulbactam/durlobactam resistance was associated with the production of NDM-1, in 31.7% of cases with the substitutions in the PBP3 determinants, and in the remaining cases the resistance mechanism was unknown. In conclusion, A. baumannii resistance towards sulbactam/durlobactam is limited, except for MBL-producing strains

Exploiting bacteria for improving hypoxemia of COVID-19 patients

Background: Although useful in the time-race against COVID-19, CPAP cannot provide oxygen over the physiological limits imposed by severe pulmonary impairments. In previous studies, we reported that the administration of the SLAB51 probiotics reduced risk of developing respiratory failure in severe COVID-19 patients through the activation of oxygen sparing mechanisms providing additional oxygen to organs critical for survival. Methods: This "real life" study is a retrospective analysis of SARS-CoV-2 infected patients with hypoxaemic acute respiratory failure secondary to COVID-19 pneumonia undergoing CPAP treatment. A group of patients managed with ad interim routinely used therapy (RUT) were compared to a second group treated with RUT associated with SLAB51 oral bacteriotherapy (OB). Results: At baseline, patients receiving SLAB51 showed significantly lower blood oxygenation than controls. An opposite condition was observed after 3 days of treatment, despite the significantly reduced amount of oxygen received by patients taking SLAB51. At 7 days, a lower prevalence of COVID-19 patients needing CPAP in the group taking probiotics was observed. The administration of SLAB51 is a complementary approach for ameliorating oxygenation conditions at the systemic level. Conclusion: This study proves that probiotic administration results in an additional boost in alleviating hypoxic conditions, permitting to limit on the use of CPAP and its contraindications

I.S.Mu.L.T - Rotator cuff tears guidelines

Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

Thyroid papillary carcinoma arising in ectopic thyroid tissue within a neck branchial cyst

BACKGROUND: Thyroid gland derives from one median anlage at the base of the tongue, and from the two fourth branchial pouches. A number of anomalies may occur during their migration. These can be in form of ectopic tissues, which are frequently found along the course of thyroglossal duct and rarely in other sites, many of these may develop same diseases as the thyroid gland. CASE PRESENTATION: A 36-years-old female presented with a 3 month history of left side neck mass. The mass disappeared following aspiration of brown colored fluid, which on cytological examination showed cells with nuclear irregularities that warranted the resection of the lesion. The histology demonstrated a thyroid papillary carcinoma arising within the branchial cyst. Thereafter, the patient underwent a total thyroidectomy with central lymph nodes dissection. Histology showed a multifocal papillary carcinoma with central lymph nodes metastases. Only four cases of primary thyroid carcinomas in neck branchial cyst have been described so far. CONCLUSION: In a lateral cystic neck mass, although rare, occurrence of ectopic thyroid tissue and presence of a papillary thyroid carcinoma should be kept in mind

Whole-Genome Sequencing (WGS) of Carbapenem-Resistant K. pneumoniae Isolated in Long-Term Care Facilities in the Northern Italian Region

K. pneumoniae (KPN) is one of the widest spread bacteria in which combined resistance to several antimicrobial groups is frequent. The most common β-lactamases found in K. pneumoniae are class A carbapenemases, both chromosomal-encoded (i.e., NMCA, IMI-1) and plasmid-encoded (i.e., GES-enzymes, IMI-2), VIM, IMP, NDM, OXA-48, and extended-spectrum β-lactamases (ESBLs) such as CTX-M enzymes. In the present study, a total of 68 carbapenem-resistant KPN were collected from twelve long-term care facilities (LTCFs) in the Northern Italian region. The whole-genome sequencing (WGS) of each KPN strain was determined using a MiSeq Illumina sequencing platform and analysed by a bacterial analysis pipeline (BAP) tool. The WGS analysis showed the prevalence of ST307, ST512, and ST37 as major lineages diffused among the twelve LTCFs. The other lineages found were: ST11, ST16, ST35, ST253, ST273, ST321, ST416, ST1519, ST2623, and ST3227. The blaKPC-2, blaKPC-3, blaKPC-9, blaSHV-11, blaSHV-28, blaCTX-M-15, blaOXA-1, blaOXA-9, blaOXA-23, qnrS1, qnrB19, qnrB66, aac(6′)-Ib-cr, and fosA were the resistance genes widespread in most LTCFs. In this study, we demonstrated the spreading of thirteen KPN lineages among the LTCFs. Additionally, KPC carbapenemases are the most widespread β-lactamase

Neural network-based analog fault diagnosis using testability analysis

A fault diagnosis procedure for analog linear circuits is presented. It uses an off-line trained neural network as a classifier. The innovative aspect of the proposed approach is the way the information provided by testability and ambiguity group determination is exploited when choosing the neural network architecture. The effectiveness of the proposed approach is shown by comparing with similar work that has already appeared in the literature