High Risk of Secondary Infections Following Thrombotic Complications in Patients With COVID-19

Background. This study’s primary aim was to evaluate the impact of thrombotic complications on the development of secondary infections. The secondary aim was to compare the etiology of secondary infections in patients with and without thrombotic complications. Methods. This was a cohort study (NCT04318366) of coronavirus disease 2019 (COVID-19) patients hospitalized at IRCCS San Raffaele Hospital between February 25 and June 30, 2020. Incidence rates (IRs) were calculated by univariable Poisson regression as the number of cases per 1000 person-days of follow-up (PDFU) with 95% confidence intervals. The cumulative incidence functions of secondary infections according to thrombotic complications were compared with Gray’s method accounting for competing risk of death. A multivariable Fine-Gray model was applied to assess factors associated with risk of secondary infections. Results. Overall, 109/904 patients had 176 secondary infections (IR, 10.0; 95% CI, 8.8–11.5; per 1000-PDFU). The IRs of secondary infections among patients with or without thrombotic complications were 15.0 (95% CI, 10.7–21.0) and 9.3 (95% CI, 7.9–11.0) per 1000-PDFU, respectively (P = .017). At multivariable analysis, thrombotic complications were associated with the development of secondary infections (subdistribution hazard ratio, 1.788; 95% CI, 1.018–3.140; P = .043). The etiology of secondary infections was similar in patients with and without thrombotic complications. Conclusions. In patients with COVID-19, thrombotic complications were associated with a high risk of secondary infections

Integration of structural information within a BIM-based environment for seismic structural e-permits

The assessment of the structural safety of buildings, with the related outcomes and other structural information, is typically reported in un-structured sets of documents (tables, drawings, reports, etc.). This happens even if Building Information Modelling (BIM) workflows, platforms, and standards are adopted. Generally, the BIM database provides input data for the structural design, but most of the data produced by structural designers, according to the structural codes, do not fully integrate into the BIM database along with other context-related information. These data are not easily recorded, especially in openBIM standard file formats such as Industry Foundation Classes (IFC). In the context of digital procedures for permit applications pertaining to seismic structural engineering, the authors propose an openBIM approach for the integration of structural information to support the activities of building authorities’ bodies (BABs). The proposed framework has led to the development of an Information Delivery Manual (IDM) and a Model View Definition (MVD), considering the IFC schema, for the integration and exchange of information within a BIM-based environment. Successively, the authors implemented the proposed IDM/MVD solution in a case study that provided an effective workflow for innovative future delivery of necessary information to building authorities to obtain seismic authorization permits

Building Information Modelling in Structural Engineering: A Qualitative Literature Review

Over the past decade, the fields of civil engineering, i.e., structural engineering, have increasingly used the building information modelling (BIM) approach in both professional practice and as the focus of research. However, the field of structural engineering, which can be seen as a sub-discipline of civil engineering, misses, as far as the authors are aware, a real state-of-the-art on the use of BIM in this regard. The aim of this paper, therefore, is to start bridging that gap. In particular, the authors have conducted a traditional literature review on the utilisation of BIM in structural engineering, enabling them to perform a detailed content analysis of publications. The qualitative investigation of the literature that the authors have conducted has highlighted six main BIM uses in structural engineering: (1) structural analyses; (2) production of shop drawings; (3) optimized structural design, early identification of constructability issues, and a comparison of different structural solutions; (4) seismic risk assessments; (5) existing-condition modelling and retrofitting of structures; and (6) structural health monitoring. Each of these is discussed in relation to their reference workflows; use of information models; information exchanges; and main limitations. In the conclusions, the authors identify current gaps in knowledge, as well as likely developments and improvements in the utilization of BIM in structural engineering. The authors also outline the possible significance of this work more broadly

Structural e-permits: an openBIM, model-based procedure for permit applications pertaining to structural engineering

This paper investigates the creation and use of integrated IFC models to modernise traditional processes for applications to building authorities for structural engineering approvals and permits. First, we provide a brief overview of e-permit systems in the AEC sector, with the focus on solutions that implement openBIM standards like IFC, MVD, and IDM. Second, we conduct a study on the information requirements of Italy’s seismic-authorisation processes relating specifically to the field of structural engineering. Third, we describe preliminary research on defining the structural engineering information that needs to be incorporated in the IFC format for e-permitting scopes. Fourth, we present our early work on the development of an MVD that would enable the automatic extraction of integrated IFC models. Fifth, we illustrate the reference workflow of the Str.E.Pe. project and propose a preliminary proof-of-concept that makes use of an IFC model, which has been integrated with structural information to support the activities of the building authority in Avellino. The officers there have developed a SWOT analysis using IFC models to assist them in assessing the compliance of structural projects with seismic requirements. Finally, the paper sets out additional research we intend to undertake and our conclusions

Effectiveness of benralizumab in severe eosinophilic asthma: Distinct sub-phenotypes of response identified by cluster analysis

BACKGROUND: Benralizumab is effective in severe eosinophilic asthma (SEA), but suboptimal responses are observed in some patients. Although several factors have been associated with benralizumab response, no cluster analysis has yet been undertaken to identify different responsiveness sub‐phenotypes. OBJECTIVE: To identify SEA sub‐phenotypes with differential responsiveness to benralizumab. METHODS: One hundred and five patients diagnosed with SEA who had completed 6 months of benralizumab treatment were included in a hierarchical cluster analysis based on a set of clinical variables that can be easily collected in routine practice (age, age at disease onset, disease length, allergen sensitization status, blood eosinophil count, IgE levels, FEV(1)% predicted, nasal polyposis, bronchiectasis). RESULTS: Four clusters were identified: Clusters 2 and 3 included patients with high levels of both IgE and eosinophils (type‐2 biomarkers high), whereas Clusters 1 and 4 included patients with only one type‐2 biomarker at a high level: IgE in Cluster 1 and eosinophils in Cluster 4. Clusters 2 and 3 (both type‐2 biomarkers high) showed the highest response rate to benralizumab in terms of elimination of exacerbations (79% and 80% respectively) compared to Clusters 1 and 4 (52% and 60% respectively). When super‐response (the absence of exacerbation without oral corticosteroid use) was assessed, Cluster 2, including patients with more preserved lung function than the other clusters, but comparable exacerbation rate, oral corticosteroid use and symptom severity, was the most responsive cluster (87.5% of patients). CONCLUSIONS: Our cluster analysis identified benralizumab differential response sub‐phenotypes in SEA, with the potential of improving disease treatment and precision management

Effectiveness and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps and associated comorbidities: a multicentric prospective study in real life

Biologics are currently one of the main treatment options for a number of diseases. The IgG4 monoclonal antibody dupilumab targets the Interleukin-4 receptor alpha chain, thus preventing the biological effects of the cytokines IL-4 and IL-13, that are essential for the Th2 response. Several controlled trials showed that dupilumab is effective and safe in patients with atopic dermatitis (AD), severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), thus resulting in approval by regulatory agencies. Aim of the study was to evaluate the efficacy and safety of dupilumab in adult patients with CRSwNP stratified by common overlapping comorbid conditions

Effectiveness and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps and associated comorbidities: a multicentric prospective study in real life

Background: Biologics are currently one of the main treatment options for a number of diseases. The IgG4 monoclonal antibody dupilumab targets the Interleukin-4 receptor alpha chain, thus preventing the biological effects of the cytokines IL-4 and IL-13, that are essential for the Th2 response. Several controlled trials showed that dupilumab is effective and safe in patients with atopic dermatitis (AD), severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), thus resulting in approval by regulatory agencies. Aim of the study was to evaluate the efficacy and safety of dupilumab in adult patients with CRSwNP stratified by common overlapping comorbid conditions. Methods: We performed a multicenter, observational, prospective study enrolling adult patients with severe CRSwNP who had started dupilumab treatment in the context of standard care from January 2021 to October 2021. Data were collected from twentynine Italian secondary care centers for allergy and clinical immunology, all of which were part of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). A number of efficacy parameters were used. Patient data were compared using the Wilcoxon test for paired data. All statistical analyses were performed with SPSS version 20 (IBM, Armonk, NY, USA). Results: In total, 82 patients with nasal polyposis were identified. A significant improvement was detected for all the applied efficacy parameters, i.e. 22-item Sino-Nasal Outcome Test (SNOT-22) and bilateral endoscopic nasal polyp score (NPS) scores for CRSwNP, Rhinitis Control Scoring System (RCSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores for allergic perennial rhinitis, Forced Expiratory Volume in the 1st second (FEV1) and Asthma Quality of Life Questionnaire (AQLQ) scores for asthma, Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI) scores for AD. A non-significant improvement was also obtained in the Urticaria Activity Score over 7 days (UAS7) for chronic spontaneous urticaria. Treatment with dupilumab was well tolerated. Conclusions: These data suggest that dupilumab treatment in patients suffering from CRSwNP and associated comorbidities may be suitable. Such outcome, although confirmation by trials is warranted, suggests the possibility to treat different disorders with a single therapy, with favorable effects especially under the cost-effectiveness aspect

Effectiveness and safety of dupilumab in patients with chronic rhinosinusitis with nasal polyps and associated comorbidities: a multicentric prospective study in real life

Biologics are currently one of the main treatment options for a number of diseases. The IgG4 monoclonal antibody dupilumab targets the Interleukin-4 receptor alpha chain, thus preventing the biological effects of the cytokines IL-4 and IL-13, that are essential for the Th2 response. Several controlled trials showed that dupilumab is effective and safe in patients with atopic dermatitis (AD), severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), thus resulting in approval by regulatory agencies. Aim of the study was to evaluate the efficacy and safety of dupilumab in adult patients with CRSwNP stratified by common overlapping comorbid conditions