Disease status, reasons for discontinuation and adverse events in 1038 Italian children with juvenile idiopathic arthritis treated with etanercept

Background: Data from routine clinical practice are needed to further define the efficacy and safety of biologic medications in children with juvenile idiopathic arthritis (JIA). The aim of this analysis was to investigate the disease status, reasons for discontinuation and adverse events in Italian JIA patients treated with etanercept (ETN). Methods: In 2013, all centers of the Italian Pediatric Rheumatology Study Group were asked to make a census of patients given ETN after January 2000. Patients were classified in three groups: group 1 = patients still taking ETN; group 2 = patients discontinued from ETN for any reasons; group 3 = patients lost to follow-up while receiving ETN. All three groups received a retrospective assessment; patients in group 1 also underwent a cross-sectional assessment. Results: 1038 patients were enrolled by 23 centers: 422 (40.7%) were in group 1, 462 (44.5%) in group 2, and 154 (14.8%) in group 3. Median duration of ETN therapy was 2.5 years. At cross-sectional assessment, 41.8% to 48.6% of patients in group 1 met formal criteria for inactive disease, whereas 52.4% of patients in group 2 and 55.8% of patients in group 3 were judged in clinical remission by their caring physician at last visit. A relatively greater proportion of patients with systemic arthritis were discontinued or lost to follow-up. Parent evaluations at cross-sectional visit in group 1 showed that 52.4% of patients had normal physical function, very few had impairment in quality of life, 51.2% had no pain, 76% had no morning stiffness, and 82.7% of parents were satisfied with their child's illness outcome. Clinically significant adverse events were reported for 27.8% of patients and ETN was discontinued for side effects in 9.5%. The most common adverse events were new onset or recurrent uveitis (10.2%), infections (6.6%), injection site reactions (4.4%), and neuropsychiatric (3.1%), gastrointestinal (2.4%), and hematological disorders (2.1%). Ten patients developed an inflammatory bowel disease and 2 had a malignancy. One patient died of a fulminant streptococcal sepsis. Conclusions: Around half of the patients achieved complete disease quiescence under treatment with ETN. The medication was overall well tolerated, as only one quarter of patients experienced clinically significant adverse events and less than 10% had treatment discontinued for toxicity

Last mile delivery mode proposal for Domino’s Pizza in Lima

Se propone una nueva modalidad de entrega que comparamos con la actual. Ésta consiste en compartir recursos, los repartidores, entre tiendas con el fin de reducir la variabilidad de la demanda y optimizar su utilización. Se hace la hipótesis que esta nueva modalidad puede reducir los costos de contratación, reduciendo la cantidad de repartidores para lograr el mismo nivel de servicio que se tiene, utilizándolos más eficientemente. El costo total de la operación se resume en tres componentes: el de contratar, el cual es variable según la cantidad de repartidores; el costo esperado por la pérdida de las órdenes que se entregan fuera del tiempo establecido con el cliente, el cual disminuye con la cantidad de repartidores y el costo adicional por el traslado de los repartidores entre tiendas para cubrir la demanda necesitada, el cual incrementa según se compartan más los recursos. Se propone un modelo (algoritmo) de de optimización para minimizar el costo total, cambiando la cantidad de repartidores que se contrata y la configuración de redes entre tiendas

A ROS-Based GNC Architecture for Autonomous Surface Vehicle Based on a New Multimission Management Paradigm

This paper presents the design and implementation of BAICal (Intelligent Autonomous Buoy by the University of Calabria), an autonomous surface vehicle (ASV) developed at the Autonomous Systems Lab (LASA) of the Department of Computer Science, Modeling, Electronics, and Systems Engineering (DIMES), University of Calabria. The basic project was born as a research program in marine robotics with multiple applications, either in the sea or in lake/river environments, for data monitoring, search and rescue operations and diver support tasks. Mechanical and hardware designs are discussed by considering a three-degree-of-freedom (3DoF) dynamical model of the vehicle. An extension to the typical guidance, navigation, and control (GNC) software architecture is presented. The software design and the implementation of a manager module (M-GNC architecture) that allows the vehicle to autonomously coordinate missions are described. Indeed, autonomous guidance and movement are only one of several more complex tasks that mobile robots have to perform in a real scenario and that allow a long-term life cycle. Module-based software architecture is developed by using the Robot Operating System (ROS) framework that is suitable for different kinds of autonomous vehicles, such as aerial, ground, surface or underwater drones

POSTOPERATIVE PAIN CONTROL IN THE SURGERY OF CROHN’S DISEASE

Background. Crohn’s disease (CD) is a chronic, granulomatous, inflammatory disease of the gastrointestinal tract and of yet unidentified etiology. The majority of CD patients require surgery during their clinical history, to manage both the disease complications and medical treatment failures1. Patients may experience visceral pain during the chronic phase of the disease and may perceive an amplified acute postoperative pain due to abnormal pain reactions developed secondary to the chronic pain2,3. Aims. The aim of our study was to critically evaluate the efficacy of the methods used in our practice for postoperative pain control in patients undergoing surgery for complications of CD. Methods. This observational and retrospective study included 197 consecutive patients with CD who underwent surgery between September 2011 and September 2012 and that were followed for postoperative pain control by the Acute Pain Service (APS) of Sant’Orsola-Malpighi teaching Hospital of Bologna. Pain ratings were made by instructed anesthesia residents using a 0-10 numerical rating scale (NRS) both under static (NRSs) and dynamic (NRSd) conditions. Our in-house postoperative pain management protocols are: Protocol A, intravenous administration of NSAIDs or paracetamol at fixed hours (not considered for this analysis), Protocol B, continuous intravenous administration of morphine chlorhydrate or tramadol, Protocol C, Patient Controlled Analgesia (PCA) with morphine chlorhydrate and Protocol D, Results.Among all protocols the median of NRSs was higher in patients treated with Protocol D; from the 48^ postoperative also the latter got comparable with the other two protocols considered. Similar trend was found also for the NRSd. dynamic conditions, at 8^ postoperative hour significant differences were found between Protocol C and D, showing a better effectiveness of the PCA (8^h: p=0,004). At 16^, 24^, 32^, 40^ and 48^ hours epidural analgesia was found to be less effective than both PCA and continuous intravenous analgesia. Conclusions. Our data support the assumption that the PCA represent the best analgesic choice for the treatment of postoperative pain in CD patients. The median trend of NRSs and NRSd with PCA was lower in most of evaluations, suggesting a major patient’s satisfaction with pain management. This has been explained by the ‘theory of locus of control’2,4. Satisfactory results were also obtained using intravenous opioid analgesia; they were comparable to the PCA at all evaluations. We also demonstrated that in CD patients epidural infusion was less effective for postoperative pain control. This limited efficacy of epidural analgesia may be explained by the limited size of the anesthetic block as compared to the size of the surgical incision. Bibliography. 1. Poggioli G, Pierangeli F, Laureti S et al. Review article: indication and type of surgery in Crohn's disease. Aliment.Pharmacol.Ther. 2002;16 Suppl 4:59-64 2. Cameron CA, Sawatzky JA. Postoperative pain management: the challenges of the patient with Crohn's disease. Medsurg.Nurs. 2008;17:85-91. 3. McCance K.L., Huether S.E. Pathophysiology: The biological basis for disease in adults and children. 5 ed. St. Louis: Elsevier Mosby, 2006. 4. Lackner JM, Quigley BM, Blanchard EB. Depression and abdominal pain in IBS patients: the mediating role of catastrophizing. Psychosom.Med. 2004;66:435-41

Contamination of a water bottle warmer in neonatal Intensive care unit and Klebsiella Pneumoniae ESBL + outbreak: cases series

Infections caused by extended-spectrum β-lactamases (ESBLs)-producing bacteria in particular Klebsiella Pneumoniae (KPE+), are on a constant rise and are a noted cause of outbreaks in neonatal intensive care units (NICUs). In the NICU of Policlinico di Foggia, an outbreak of infections in 2018 brought to the start of a serial check of presence and favorable conditions associated with KPE+ diffusion. The outbreak was controlled by improving basic hygiene measures such as hand washing, the use of disposable gloves and gowns, and removing a potential environmental contamination source such as the water bottle warmer

Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries

OBJECTIVES: Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally—UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild—to quantify the occurrence of selected comorbidities in patients with JIA. METHODS: Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. RESULTS: 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1–1.8%) and uveitis (15–19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). CONCLUSION: This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies