Increased risk of acquisition of New Delhi metallo-beta-lactamase-producing carbapenem-resistant enterobacterales (Ndm-cre) among a cohort of covid-19 patients in a teaching hospital in Tuscany, Italy

We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days)

Preparedness and response to the covid-19 emergency: Experience from the teaching hospital of Pisa, Italy

In Italy, the coronavirus disease 2019 (COVID-19) emergency took hold in Lombardy and Veneto at the end of February 2020 and spread unevenly among the other regions in the following weeks. In Tuscany, the progressive increase of hospitalized COVID-19 patients required the set-up of a regional task force to prepare for and effectively respond to the emergency. In this case report, we aim to describe the key elements that have been identified and implemented in our center, a 1082-bed hospital located in the Pisa district, to rapidly respond to the COVID-19 outbreak in order to guarantee safety of patients and healthcare workers

Amyloid deposits and fibrosis on left ventricular endomyocardial biopsy correlate with extracellular volume in cardiac amyloidosis

BACKGROUND: The relative contribution of amyloid and fibrosis to extracellular volume expansion in cardiac amyloidosis (CA) has never been defined. METHODS AND RESULTS: We included all patients diagnosed with amyloid light-chain (AL) or transthyretin cardiac amyloidosis at a tertiary referral center between 2014 to 2020 and undergoing a left ventricular endomyocardial biopsy. Patients (n=37) were more often men (92%), with a median age of 72 years (interquartile range, 68–81). Lambda-positive AL was found in 14 of 19 AL cases (38%) and kappa-positive AL in 5 of 19 (14%), while transthyretin was detected in the other 18 cases (48%). Amyloid deposits accounted for 15% of tissue sample area (10%–30%), without significant differences between AL and transthyretin amyloidosis. All patients displayed myocardial fibrosis, with a median extent of 15% of tissue samples (10%–23%; range, 5%–60%), in the absence of spatial overlap with amyloid deposits. Interstitial fibrosis was often associated with mild and focal subendocardial fibrosis. The extent of fibrosis or the combination of amyloidosis and fibrosis did not differ significantly between transthyretin amyloidosis and AL subgroups. In 20 patients with myocardial T1 mapping at cardiac magnetic resonance, the combined amyloid and fibrosis extent displayed a modest correlation with extracellular volume (r=0.661, P=0.001). The combined amyloid and fibrosis extent correlated with high-sensitivity troponin T (P=0.035) and N-terminal pro-B-type natriuretic peptide (P=0.002) serum levels. CONCLUSIONS: Extracellular spaces in cardiac amyloidosis are enlarged to a similar extent by amyloid deposits and fibrotic tissue. Their combination can better explain the increased extracellular volume at cardiac magnetic resonance and circulating biomarkers than amyloid extent alone

Reliability and validity of PedsQL for Portuguese children aged 5–7 and 8–12 years

BACKGROUND: Pediatric Quality of Life Inventory (PedsQL) is a measure to assess health-related quality of life (HRQoL) in children and adolescents. It is formed by 23 items adapted to children age and includes a parent proxy report version. With four multidimensional subscales and three summary scores, it measures health as defined by WHO. The concepts measured by this instrument are ‘physical functioning’ (8 items), ‘emotional functioning’ (5 items), ‘social functioning’ (5 items) and ‘school functioning’ (5 items). It also measures a ‘total scale score’ (23 items), a ‘physical health summary score’ (8 items) and a ‘psychosocial health summary score’ (15 items). The aim of this paper is to present the main results of the cultural adaptation and validation of the PedsQL into European Portuguese. METHODS: The Portuguese version was the result of a forward-backward translation process, with a cognitive debriefing analysis, guaranteeing face validity and semantic equivalence. Children aged 5–7 and 8–12 were randomly selected and were asked to fill a socio-demographic data survey and the Portuguese versions of PedsQL and KINDL, another HRQoL measure for children and adolescents. They were divided into three groups, healthy children, children with type I diabetes and children with spina bifida. The reliability was tested for reproducibility (ICC) and internal consistency (Cronbach’s alpha). The construct validity (known-groups discriminant validity) was supported by differences between self-reports from healthy children and children with chronic conditions, and from children with chronic diseases and their parents. The criterion validity was tested after the correlations of the scores obtained by both children and adolescents HRQoL assessment instruments. RESULTS: A total of 179 children and 97 parents were recruited. PedsQL demonstrated good levels of reproducibility (r > 0.95 in all versions) and acceptable levels of internal consistency with Cronbach’s alpha at 0.70 on most scales. Concordance values between children’s and parents’ perceptions ranged between 0.36 and 0.78 and the correlations with KINDL questionnaire were excellent, supporting concurrent validity. CONCLUSIONS: The Portuguese version of the PedsQL demonstrated acceptable psychometric properties for future research and clinical practice for children aged 5–12

Safety and efficacy of levosimendan in patients with cardiac amyloidosis

none5noNo abstract availablemixedAimo A.; Rapezzi C.; Arzilli C.; Vergaro G.; Emdin M.Aimo, A.; Rapezzi, C.; Arzilli, C.; Vergaro, G.; Emdin, M

Sleep measures expressing 'functional uncertainty' in elderlies' sleep.

BACKGROUND: The notion of 'functional uncertainty' during sleep was first proposed to indicate an inability of the central nervous system to maintain stable states by coordinating physiological processes. While the presence of functional uncertainty phenomena has been shown in infants and hypothesized in the elderly, its actual occurrence in the aged population has never been systematically investigated. OBJECTIVE: The aim of the study is to identify, in the sleep of aged individuals, indexes of sleep instability and fragmentation as markers of functional uncertainty, by comparing a sample of healthy elderly subjects to one of young adults. METHODS: We compared polysomnograhic recordings of 20 healthy elderly subjects (age range 65-85 years) with those of 20 young individuals (age range 22-32 years), with special regard to the variables expressing functional uncertainty in sleep, such as continuity (e.g. arousals, awakenings), stability (e.g. state transitions, periods of marked 'functional uncertainty') and cyclic organization parameters. RESULTS: Significant differences emerged for all variables of interest: the elderly group showed higher indexes of fragmentation and instability than the young, as well as less and shorter cycles, and a lower percentage of time spent in cycles. CONCLUSION: Our results support the hypothesis of a progressive sleep quality disruption with aging, expressed by pronounced sleep instability, fragmentation and disorganization. We propose that functional uncertainty measures could usefully be included in standard sleep assessments on both aged and sleep-disordered populations as accurate sleep quality indexe

Relationship between juxtaglomerular apparatus and plasma renin activity in human reno-vascular hypertension.

Juxtaglomerular cell count (JGCC) and juxtaglomerular activity (JA) on the fragments of the ischemic kidney and plasma renin activity (PRA) in peripheral venous blood were studied in 26 renovascular patients. In 11 cases PRA was also measured in renal venous blood. JGCC and JA values were always above normal range and both were significantly related to the PRA values in peripheral venous blood, while only JA was related to the PRA values in renal venous blood. These data indicate that in human renovascular hypertension the juxtaglomerular apparatus is hyperplastic and hypergranulated: the correlation between its morphological appearance and PRA seems to indicate that the renin-angiotensin system may be in some way involved in the genesis of hypertensio