Defining Kawasaki disease and pediatric inflammatory multisystem syndrome-temporally associated to SARS-CoV-2 infection during SARS-CoV-2 epidemic in Italy: results from a national, multicenter survey

Background: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. Conclusion: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths

New map of the physical world on Mercator's projection, showing the new discoveries made at the Pole by Captain Parry, from the engraver Stucchi, 1830.

Map shows indigenous peoples, major cities, physical features, continental boundaries and a boundary line for the islands comprising Oceania. Inset: "Elevazione delle principali montagne della Terra disegnata dietro le opere di Humboldt" [Elevation of the main mountains of the earth based on the works of Humboldt]. Relief shown pictorially and by profile in inset. Scale not given

Fatality rates implied by the Italian building code

AbstractThe project Rischio Implicito – Norme Tecniche per le Costruzioni (RINTC) assessed the seismic structural reliability, in terms of the annual rate of earthquakes causing failure, of a large set of code‐conforming buildings, designed to be located in three different sites, representative of low, mid, and high seismic hazard in Italy. It was found that seismic reliability tends to decrease significantly as the site's hazard increases, despite the design actions having the same return period at all sites. Because this is a consequence of the code's approach, the simple study presented in this paper aims to contribute to the discussion on whether the code‐implied safety is yet acceptable. To this end, the annual fatality rates due to the seismic failure of the buildings from the mentioned project are computed, in a simplified manner, and compared with the annual risk from other common causes of death in Italy; the latter obtained based on data from the Italian Statistical Institute. The results, although subjected to the conventionality of the working assumptions, seem to indicate that seismic fatality risk is generally lower than that of other causes of death, by one or more orders of magnitude at the lower hazard sites. This can contribute to the discussion on seismic structural safety due to the characteristics of the Italian code that are common to state‐of‐the‐art codes internationally

Survival analysis of obese patients undergoing liver transplantation

Introduction. The influence of preoperative obesity in liver transplanted patients remains undetermined. Objective. To analyze the survival of obese patients undergoing liver transplantation. Methods. We calculated the body mass index (BMI; kg/m(2)) of 244 liver transplantation patients. All transplantations were performed from September 1991 to December 2006. The patients were divided according to the BMI values: nonobese (NO) patients (BMI 30). Pre- and postoperative data were used. The following statistical tests were employed: Student's t test, Kaplan-Meier survival, and Cox-Mantel tests. Results. Group O was composed of 38 individuals (15.3%) with BMI of 33.1, and the BMI of NO was 24. Group O showed an average age of 50.1 years and group NO, 45.5 years (P .05). A Cox proportional hazard analysis showed that the survival time in this study was related to red blood cell transfusions, recipient sodium, MELD score, donor sodium, and age. Recipient age was a main factor in multiple regression analysis for obese patients in this study. Conclusion. There was no significant difference between O and NO for the 1-year and long-term survivals, but older patients displayed lower survival times.39103225322

What seismic risk do we design for when we design buildings?

This paper discusses two issues related to the seismic performance of code-conforming structures from the probabilistic standpoint: (i) the risk structures are implicitly exposed to when designed via state-of-the-art codes; (ii) which earthquake scenarios are expected to erode the portion of safety margins determined by elastic seismic actions for these structures. Both issues are addressed using recent research results referring to Italy. Regarding (i), during the last few years, the Italian earthquake engineering community is putting effort to assess the seismic risk of structures designed according to the code currently enforced in the country, which has extended similarities with Eurocode 8. For the scope of the project, five structural typologies were designed according to standard practice at five sites, spanning a wide range of seismic hazard levels. The seismic risk assessment follows the principles of performance-based earthquake engineering, integrating probabilistic hazard and vulnerability, to get the annual failure rates. Results, although not fully consolidated yet, show risk increasing with hazard and uneven seismic reliability across typologies. With regard to (ii) it is discussed that, in the case of elastic design actions based on probabilistic hazard analysis (i.e., uniform hazard spectra), exceedance of spectral ordinates can be likely-to-very-likely to happen in the epicentral area of earthquakes, which occur relatively frequently over a country such as Italy. Although this can be intuitive, it means that design spectra, by definition, do not necessarily determine (elastic) design actions that are conservative for earthquakes occurring close to the construction site. In other words, for these scenarios protection is essentially warranted by the rarity with which it is expected they occur close to the structure and further safety margins implicit to earthquake-resistant design (i.e., those discussed in the first part)