"Hemolysis, or not hemolysis, that is the question". Use of hydroxychloroquine in a patient with COVID-19 infection and G6PD deficiency

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Occurrence of fungi in the potable water of hospitals: A public health threat

Since the last decade, attention towards the occurrence of fungi in potable water has increased. Commensal and saprophytic microorganisms widely distributed in nature are also responsible for causing public health problems. Fungi can contaminate hospital environments, surviving and proliferating in moist and unsterile conditions. According to Italian regulations, the absence of fungi is not a mandatory parameter to define potable water, as a threshold value for the fungal occurrence has not been defined. This study evaluated the occurrence of fungi in potable water distribution systems in hospitals. The frequency of samples positive for the presence of fungi was 56.9%; among them, filamentous fungi and yeasts were isolated from 94.2% and 9.2% of the samples, respectively. The intensive care unit (87.1%) had the highest frequency of positive samples. Multivariable model (p < 0.0001), the variables of the period of the year (p < 0.0001) and type of department (p = 0.0002) were found to be statistically significant, suggesting a high distribution of filamentous fungi in the potable water of hospitals. Further studies are necessary to validate these results and identify the threshold values of fungi levels for different types of water used for various purposes to ensure the water is safe for consumption and protect public health

Epoxy Resins for Flooring Applications, an Optimal Host for Recycling Deactivated Cement Asbestos

Cement asbestos slates, commonly known as Eternit((R)) and still abundant in private and public buildings, were deactivated through a thermal process. The resulting deactivated cement asbestos powder (DCAP), a mixture of Ca-Mg-Al silicates and glass, was compounded with Pavatekno Gold 200 (PT) and Pavafloor H200/E (PF), two different epoxy resins (bisphenol A epichlorohydrin) for flooring applications. The addition of the DCAP filler to the PF samples causes a slight but acceptable decrease in the relevant mechanical properties (compressive, tensile, and flexural strengths) upon increasing DCAP content. The addition of the DCAP filler to pure epoxy (PT resin) causes a slight decrease in the tensile and flexural strengths with increasing DCAP content, while the compressive strength is almost unaffected, and the Shore hardness increases. The main mechanical properties of the PT samples are significantly better than those of the filler-bearing sample of normal production. Overall, these results suggest that DCAP can be advantageously used as filler in addition to, or in substitution for, commercial barite. In particular, the sample with 20 wt% of DCAP is the best performing in terms of compressive, tensile, and flexural strengths, whereas the sample with 30 wt% of DCAP shows the highest Shore hardness, which is an important property to be considered in flooring applications

Bioética e direitos fundamentais: a recusa às transfusões de sangue pelas Testemunhas de Jeová

This paper will examine the Institute of Bioethics and fundamental rights in the face of the refusal of blood transfusions by Jehovah's Witnesses. Based on investigating the motives involved in this decision and what legal support they have for their will to be recognized. It is a right provided for in the Federal Constitution that guarantees the patient's autonomy to avail himself of his existential choices, however, that is in conflict with the divergent position of the doctors who seek the judicial route to impose on the patient the use of hemotherapy against his will , provoking state intervention based on the claim that the individual's decision causes the collision of fundamental principles, such as the right to life and the right to religious freedom. For this, we studied bibliographies, laws of the current legal order, articles and jurisprudence, what remained for demonstrating the non-occurrence of a collision of fundamental rights, bearing in mind that Jehovah's Witnesses do not want to have their right to life, for religious reasons, but to guarantee it in its integral form by accepting the use of alternative methods. The existence of legitimacy in refusing blood transfusions based on fundamental principles, especially on the right to life, made possible by the recognition of blood as a risk treatment and the use of alternatives to blood transfusion.Trabalho de Conclusão de Curso (Graduação)Este trabalho analisará o instituto da Bioética e direitos fundamentais diante da recusa das transfusões de sangue pelas Testemunhas de Jeová. Tendo por base investigar os motivos que envolvem essa decisão e qual o respaldo legal possuem para que se reconheça a sua vontade. Trata-se de direito previsto na Constituição Federal que garante a autonomia do paciente de se valer de suas escolhas existenciais, porém que se choca com o divergente posicionamento dos médicos que buscam a via judicial para impor ao paciente o uso da hemoterapia contra sua vontade provocando a intervenção estatal fundamentada na alegação de que a decisão do indivíduo causa a colisão de princípios fundamentais (direito à vida versus direito à liberdade religiosa). Para isso, foram estudadas bibliografias, leis do ordenamento jurídico vigente; artigos e jurisprudências; que restaram por demonstrar a não ocorrência de colisão de direitos fundamentais, tendo em vista que as Testemunhas de Jeová não querem dispor de seu direito à vida, por fundamento religioso, e sim de garanti-lo em sua forma integral por aceitar a utilização de melhores métodos. Portanto, comprovando-se a existência de legitimidade na recusa às transfusões de sangue com base nos princípios fundamentais, principalmente no direito à vida, possibilitada pelo reconhecimento do sangue como um tratamento de risco e a utilização de alternativas a estes

Circulating hematopoietic stem cells and putative intestinal stem cells in coeliac disease

Background: The intestinal stem cells (ISC) modulation and the role of circulating hematopoietic stem cells (HSC) in coeliac disease (CD) are poorly understood. Our aim was to investigate the longitudinal modifications in peripheral blood HSC traffic and putative ISC density induced by gluten-free diet (GFD) in CD. Methods: Thirty-one CD patients and 7 controls were enrolled. Circulating CD133+ and CD34+ HSC were measured by flow cytometry, at enrolment and after 7 days and 1, 3, 6, 12, and 24 months of GFD. Endoscopy was performed at diagnosis and repeated at 6, 12, and 24 months following GFD. We used the Marsh-Oberhuber score to evaluate the histological severity of duodenal damage; immunohistochemistry was employed to measure the intraepithelial lymphoid infiltrate (IEL, CD3+ lymphoid cells) and the putative ISC compartment (CD133+ and Lgr5+ epithelial cells). Results: At enrolment, circulating HSCs were significantly increased in CD patients and they further augmented during the first week of GFD, but progressively decreased afterwards. CD patients presented with villous atrophy, abundant IEL and rare ISC residing at the crypt base. Upon GFD, IEL progressively decreased, while ISC density increased, peaking at 12 months. After 24 months of GFD, all patients were asymptomatic and their duodenal mucosa was macroscopically and histologically normal. Conclusions: In active CD patients, the ISC niche is depleted and there is an increased traffic of circulating HSC versus non-coeliac subjects. GFD induces a precocious mobilization of circulating HSC, which is followed by the expansion of the local ISC compartment, leading to mucosal healing and clinical remission

Global response of Plasmodium falciparum to hyperoxia: a combined transcriptomic and proteomic approach

<p>Abstract</p> <p>Background</p> <p>Over its life cycle, the <it>Plasmodium falciparum </it>parasite is exposed to different environmental conditions, particularly to variations in O₂pressure. For example, the parasite circulates in human venous blood at 5% O₂pressure and in arterial blood, particularly in the lungs, at 13% O₂pressure. Moreover, the parasite is exposed to 21% O₂levels in the salivary glands of mosquitoes.</p> <p>Methods</p> <p>To study the metabolic adaptation of <it>P. falciparum </it>to different oxygen pressures during the intraerythrocytic cycle, a combined approach using transcriptomic and proteomic techniques was undertaken.</p> <p>Results</p> <p>Even though hyperoxia lengthens the parasitic cycle, significant transcriptional changes were detected in hyperoxic conditions in the late-ring stage. Using PS 6.0™ software (Ariadne Genomics) for microarray analysis, this study demonstrate up-expression of genes involved in antioxidant systems and down-expression of genes involved in the digestive vacuole metabolism and the glycolysis in favour of mitochondrial respiration. Proteomic analysis revealed increased levels of heat shock proteins, and decreased levels of glycolytic enzymes. Some of this regulation reflected post-transcriptional modifications during the hyperoxia response.</p> <p>Conclusions</p> <p>These results seem to indicate that hyperoxia activates antioxidant defence systems in parasites to preserve the integrity of its cellular structures. Moreover, environmental constraints seem to induce an energetic metabolism adaptation of <it>P. falciparum</it>. This study provides a better understanding of the adaptive capabilities of <it>P. falciparum </it>to environmental changes and may lead to the development of novel therapeutic targets.</p

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]