La sicurezza della somministrazione farmacologica in sala operatoria: studio osservazionale

RIASSUNTO La somministrazione farmacologica in un ambito come quello della sala operatoria è estremamente complesso sia per la tipologia di farmaci sia per il contesto. Tutto ciò aumenta a livello esponenziale la complessití  del lavoro e la possibilití  di incorrere in errori. Gli obbiettivi dello studio sono quelli di analizzare come nelle sale operatorie viene organizzata la conservazione dei farmaci, quali caratteristiche ha la prescrizione farmacologica e la modalití  operativa dell'infermiere. E' stato condotto uno studio descrittivo prospettico in otto sale operatorie di una Azienda Ospedaliero Friulana. Sono state analizzate le prescrizioni farmacologiche avvenute in 96 giornate lavorative. Sono stati analizzati 257 processi di somministrazione farmacologica. Il 100% delle sale operatorie conserva i farmaci in ordine alfabetico e per nome commerciale. Nel 50% (104/208) delle preparazioni farmacologiche vengono utilizzate etichette con codice colore e nelle restanti si utilizzano etichette libere. Nel 69,2% (144/208) dei casi vi sono dei doppi controlli della prescrizione che si effettuano tra medico ed infermiere e nel 29,8% (62/208) dei casi vi sono doppi controlli della preparazione del farmaco tra medico ed infermiere. Il 35,6% (74/208) dei farmaci viene preparato da un operatore diverso da quello che lo somministra. I nodi critici del processo di lavoro risiedono in campi che sono degli infermieri ma anche di altri professionisti. Si può concludere affermando che tale indagine, pilota, è stata sicuramente utile per avere alcune informazioni generali sui processi di lavoro rispetto alla somministrazione farmacologica.ABSTRACT Administration of medication in an environment such as operating rooms is extremely complex and considerably increases the possibility of errors . This study was performed to analyze how medication is stored, prescribed and administered in operating rooms. Eight operating rooms in a Northern Italy hospital were taken into consideration, analyszing the medication prescribed in 96 working days. The critical points that emerged from the study regarded tasks performed by nurses , but also other professionals. This pilot study was useful for acquiring basic data on the working processes that surround the administration of medication. Key words: medication safety, medication use process, operating room, perioperative nursin

Nephrogenic diabetes insipidus in a geriatric patient affected by SARS-CoV-2: complexity of a diagnosis, complexity of a virus

BACKGROUND: Coronavirus disease 2019 (COVID-19) has an important impact on the kidney through direct and indirect damage mechanisms. Most previous studies have highlighted lesions caused by this virus in the early segments of the nephron. However, due to the antigenic characteristics of the virus, with almost ubiquitous receptors, and the molecular release it triggers, the distal segments of the nephron could also be affected. METHODS: A 71 year-old-man with respiratory failure while suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia presented with typical symptoms of diabetes insipidus after ~20 days of hospitalization. The water deprivation test led to the diagnosis of nephrogenic diabetes insipidus. The aetiological study was complex, in particular because of the patient’s previous lithium therapy. RESULTS: The sequence of pathognomonic events typical of diabetes insipidus associated with anamnestic, clinical and laboratory evidence strongly supported the diagnosis of nephrogenic diabetes insipidus due to SARS-CoV-2 rather than other aetiologies. CONCLUSIONS: The collecting duct could represent a target for SARS-CoV-2 infection, directly or indirectly, as a result of lesions of upstream portions of the nephron, which would cascade into the distal segment. Other molecules, besides angiotensin 2 converting enzyme, might be involved in facilitating the viral aggression. The complexity of the geriatric patient shows the importance of a comprehensive approach that integrates careful monitoring of clinical signs and symptoms and laboratory and instrumental tests. This is especially important in the context of SARS-CoV-2 infection and in the management of its unexpected complications

Intraoperative β-Detecting probe for radio-guided surgery in tumour resection

The development of the β− based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma and gliomas already estimated the potentiality of this new treatment. To validate the technique, a prototype of the intraoperative probe detecting β− decays and specific phantoms simulating tumour remnant patterns embedded in healthy tissue have been realized. The response of the probe in this simulated environment is tested with dedicated procedures. This document discusses the innovative aspects of the method, the status of the developed intraoperative β− detecting probe and the results of the preclinical tests

An Intraoperative β−\beta^- Detecting Probe For Radio-Guided Surgery in Tumour Resection

The development of the $\beta^-$ based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma, glioma, and neuroendocrine tumors already estimated the potentiality of this new treatment. To validate the technique, prototypes of the intraoperative probe required by the technique to detect $\beta^-$ radiation have been developed. This paper discusses the design details of the device and the tests performed in laboratory. In such tests particular care has to be taken to reproduce the surgical field conditions. The innovative technique to produce specific phantoms and the dedicated testing protocols is described in detail.Comment: 7 pages, 15 figure

Monitoring of hadrontherapy treatments by means of charged particle detection

The interaction of the incoming beam radiation with the patient body in hadrontherapy treatments produces secondary charged and neutral particles, whose detection can be used for monitoring purposes and to perform an on-line check of beam particle range. In the context of ion-therapy with active scanning, charged particles are potentially attractive since they can be easily tracked with a high efficiency, in presence of a relatively low background contamination. In order to verify the possibility of exploiting this approach for in-beam monitoring in ion-therapy, and to guide the design of specific detectors, both simulations and experimental tests are being performed with ion beams impinging on simple homogeneous tissue-like targets (PMMA). From these studies, a resolution of the order of few millimeters on the single track has been proven to be sufficient to exploit charged particle tracking for monitoring purposes, preserving the precision achievable on longitudinal shape. The results obtained so far show that the measurement of charged particles can be successfully implemented in a technology capable of monitoring both the dose profile and the position of the Bragg peak inside the target and finally lead to the design of a novel profile detector. Crucial aspects to be considered are the detector positioning, to be optimized in order to maximize the available statistics, and the capability of accounting for the multiple scattering interactions undergone by the charged fragments along their exit path from the patient body. The experimental results collected up to now are also valuable for the validation of Monte Carlo simulation software tools and their implementation in Treatment Planning Software packages

Ovarian tissue cryopreservation and transplantation: 20 years experience in Bologna University

Objective: To report the 20-year experience in ovarian tissue cryopreservation (OTC) and ovarian tissue transplantation (OTT) of the Bologna clinical center (Bologna, Italy). Design: Retrospective cohort study. Patients: 1026 pediatrics and women aged between 2 and 38 years who underwent OTC and OTT between January 2002 to January 2022. Results: Of the 1026 patients, 238 (22.8%) were pediatrics (≤ 17 years, Group 1) and 788 (77.2%) were adult women (range 18-38 years, Group 2). In Group 1, 184 (77.3%) patients had malignant diseases and 54 (22.7%) had non-malignant diseases. In Group 2, 746 (94.7%) patients had malignant diseases and 42 (5.3%) had non-malignant diseases. No real complications were observed during surgery. In all the samples analyzed most of the follicles were in the resting stage, while only a few follicles were growing. In both fresh and thawed samples, follicular density was higher in Group 1 than in Group 2 (p < 0.01). Regardless of age, good preservation of follicles and stroma was observed in fresh and thawed ovarian tissue by histological and immunohistochemical analyses (estrogen and progesterone receptors; Ki67 and Bcl2 markers; TUNEL). To date, out of 1026 total women, 812 (79.1%) had their tissue stored. Sixty-eight (6.6%) patients died from their primary disease. Twentyfour (2.3%) women performed 33 OTTs between December 2011 and January 2022. Restoration of menstruation was observed in 15 out of 17 menopausal women. Six pregnancies were achieved, two hesitated in abortion and four in the birth of healthy babies. Conclusion: OTC is the only fertility preservation technique applicable in prepubertal/ pediatrics and in adult patients when stimulation for oocytes/embryos cryopreservation is not possible. The reported data can help future patients and physicians in their discussions and decisions about the need and possibilities of preserving ovarian function

Towards a Radio-guided Surgery with β−\beta^{-} Decays: Uptake of a somatostatin analogue (DOTATOC) in Meningioma and High Grade Glioma

A novel radio guided surgery (RGS) technique for cerebral tumors using $\beta^{-}$ radiation is being developed. Checking the availability of a radio-tracer that can deliver a $\beta^{-}$ emitter to the tumor is a fundamental step in the deployment of such technique. This paper reports a study of the uptake of 90Y labeled (DOTATOC) in the meningioma and the high grade glioma (HGG) and a feasibility study of the RGS technique in these cases.Comment: 21 pages, 5 figure

Identifying people at risk for influenza with low vaccine uptake based on deprivation status: a systematic review

Background: Influenza vaccination is an important public health intervention for controlling disease burden, but coverage rates are still low also in risk groups. In order to identify non-vaccinating subgroups, deprivation and socio-economic indices, i.e. measures used to synthetically describe people\u2019s socio-economic status while taking into account several dimensions, may be used. We aimed to synthetize evidence from studies investigating association between deprivation/socio-economic indices and influenza vaccination coverage in population at risk\u2014 persons 65 years of age, individuals with comorbidities, pregnant women and health-care workers. Methods: We searched PubMed, ISI WoS, CINAHL and Scopus to identify observational studies published up to October 10th 2017 in English or Italian. Studies reporting quantitative estimates of the association between deprivation/socioeconomic indices and influenza vaccination coverage in populations at risk were included. Results: A total of 1474 articles were identified and 12 were eventually included in the final review. Studies were mostly cross-sectional, performed in European countries, from 2004 to 2017. Seven studies focussed on deprivation and five on socioeconomic indices. Studies on deprivation indices and vaccination coverage showed that people from the most deprived areas had lower coverage. Regarding socio-economic condition, results were contrasting, even though it may also be concluded that people from lower groups have lower vaccination coverage. Conclusions: Our work supports the possibility to identify people likely to have lower influenza vaccination coverage based on deprivation/socio-economic indices. Efforts should be performed in order to further strengthen robustness, transferability and suitability of these indices in addressing public health problems

Lipid-based systems loaded with PbS nanocrystals: near infrared emitting trackable nanovectors

Hydrophobic PbS nanocrystals (NCs) emitting in the near infrared spectral region were encapsulated in the core of micelles and in the bilayer of liposomes, respectively, to form polyethylene glycol (PEG)-grafted phospholipids. The phospholipid-based functionalization process of PbS NCs required the replacement of the pristine capping ligand at the NC surface with thiol molecules. The procedures carried out for two systems, micelles and liposomes, using PEG-modified phospholipids were carefully monitored by optical, morphological and structural investigations. The hydrodynamic diameter and the colloidal stability of both micelles and liposomes loaded with PbS NCs were evaluated using Dynamic Light Scattering (DLS) and z-potential experiments, and both were satisfactorily stable in physiological media. The cytotoxicity of the resulting PbS NC-loaded nanovectors was assessed by the in vitro investigation on Saos-2 cells, indicating that the toxicity of the PbS NC loaded liposomes was lower than that of the micelles with the same NC cargo, which is reasonable due to the different overall composition of the two prepared nanocarriers. Finally, the cellular uptake in the Saos-2 cells of both the NC containing systems was evaluated by means of confocal microscopy studies by exploiting a visible fluorescent phospholipid and demonstrating the ability of both luminescent nanovectors to be internalized. The obtained results show the great potential of the prepared emitting nanoprobes for imaging applications in the second biological window