Open Conversion after EVAR: Indications and Technical Details

Endovascular aortic aneurysm repair (EVAR) is widely used for the treatment of abdominal aortic aneurysms. Complications secondary to EVAR are also treated with endovascular techniques. When this is not applicable, open surgical repair is mandatory. Surgical re-intervention following EVAR is considered to be more demanding compared with primary open repair and it is related to the type of endograft implanted (infra renal vs. suprarenal fixation), to the indications for surgical conversion (infection vs. non infection), to the setting of presentation (elective vs. emergency) and type of conversion (total vs. partial). While technically challenging, delayed open conversion of EVAR can be accomplished with low morbidity and mortality in both the elective and emergent settings. These results reinforce the justification for long-term surveillance of endografts following EVAR

Induction of labor at full-term in pregnant women with uncomplicated singleton pregnancy: A systematic review and meta-analysis of randomized trials

INTRODUCTION: The lowest incidence of perinatal morbidity and mortality occurs around 39-40 weeks. Therefore, some have advocated induction of uncomplicated singleton gestations once they reach full-term. The aim of the study was to evaluate the risk of cesarean delivery, and any maternal and perinatal effects of a policy of induction of labor in women with full-term uncomplicated singleton gestations. MATERIAL AND METHODS: We performed an electronic search from inception of each database to August 2018. All results were then limited to randomized trial. No restrictions for language or geographic location were applied. Inclusion criteria were randomized clinical trials of asymptomatic women with uncomplicated, singleton gestations at full-term (ie, between 39+0 and 40+6 weeks) who were randomized to either planned induction of labor or control (ie, expectant management). Only trials on asymptomatic singleton gestations without premature rupture of membranes or any other indications for induction evaluating the effectiveness of planned induction of labor in full-term singleton gestations were included. The primary outcome was the incidence of cesarean delivery. RESULTS: Seven randomized clinical trials, including 7598 participants were analyzed. Three studies enrolled only women with favorable cervix, defined as a Bishop score of ≥5 in nulliparous women or ≥4 in multiparous women. One trial included only women aged 35 years or older. Women randomized to the planned induction of labor, received scheduled induction usually at 39+0 to 39+6 weeks of gestation, whereas women in the control group received expectant management usually until 41-42 weeks of gestation, or earlier if medically indicated. Methods of induction usually included cervical ripening, with either misoprostol or Foley catheter, in conjunction with or followed by oxytocin for women with unfavorable cervix, and oxytocin and artificial rupture of membranes for those with favorable cervix. Five trials also used artificial rupture of membranes as a method for induction. Uncomplicated full-term singleton gestations that were randomized to receive induction of labor had similar incidence of cesarean delivery compared with controls (18.6% vs 21.4%; relative risk 0.96, 95% CI 0.78-1.19). Regarding neonatal outcomes, induction of labor at full-term was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; relative risk 0.32, 95% CI 0.18-0.57), and lower mean birthweight (mean difference -98.96 g, 95% CI -126.29 to -71.63) compared with the control group. There were no between-group differences in other adverse neonatal outcomes. CONCLUSIONS: Induction of labor at about 39 weeks is not associated with increased risk of cesarean delivery

Malaria, HIV and Malnutrition among Internally Displaced People in Mozambique During COVID-19 Pandemic: Results from a Community-Based Intervention

Background: The spread of COVID-19 poses an unprecedented challenge to care delivery in post-disaster and conflict situations. In Mozambique, the 2019 cyclone Idai and the violence by Non-State-Armed-Groups devastated the province of Sofala and Cabo Delgado respectively and led to the displacement of thousands of people living in poor and overcrowded conditions. The pandemic has further aggravated the situation. Doctors with Africa CUAMM (University college for aspiring missionary doctors) implemented surveillance activities in these regions between October 2020 and September 2021. The aim of this study is to give an overview of the prevalence of malaria, malnutrition, COVID-19 related symptoms and access to HIV testing. Methods: Data were collected in targeted internally displaced people (IDP) sites in Sofala and Cabo Delgado province between 31st January and 25th September 2021. The tool used enabled to assess COVID-19 symptoms, risk of HIV infection, malaria cases and malnutrition in children under five. Results: The project reached 93 503 people. During the study period, 13.6% people reported at least one symptom suggestive of COVID-19 infection. Malaria Rapid Diagnostic Tests (RDT) were administered to 86% of the recruited people (n = ?), with a positive diagnosis in the 4.5% of them (n = ?). Among the recruited Internally Displaced Persons (IDP), 23.1% were considered eligible for HIV screening, but only 1.4% were referred for testing. Acute malnutrition was found in 6.3% of children screened and, among these, a higher prevalence of concurrent COVID-19 symptoms was reported. Discussion: Our study highlights the importance of mass clinical screening for COVID-19 infection in this target population to enact prevention behavior, although this may not be enough, due to the pivotal role played by asymptomatic transmissions. Considering the overlap of the symptoms of COVID-19 and malaria, a combined diagnostic algorithm is urgently needed to avoid underdiagnosing malaria. Moreover, the high prevalence of respiratory symptoms in malnourished children confirmed the known correlation between malnutrition and respiratory infection. Finally, access to HIV screening needs to be implemented, given the high prevalence of people with HIV risk factors to avoid diagnostic delay. Conclusions: Population-specific needs make necessary to develop new screening methods that respond to the specific characteristics of the target population

How the First Year of the COVID-19 Pandemic Impacted Patients’ Hospital Admission and Care in the Vascular Surgery Divisions of the Southern Regions of the Italian Peninsula

Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study. Each received a 13-point questionnaire investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs. 2019 (9161 patients): post-EVAR surveillance, hospitalization for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased (1484 (16.2%) vs. 1014 (14.3%), p = 0.0009; 1401 (15.29%) vs. 959 (13.52%), p = 0.0006; and 1558 (17.01%) vs. 934 (13.17%), p < 0.0001, respectively), while admissions for revascularization or major amputations for chronic limb-threatening ischemia and urgent revascularization for symptomatic carotid stenosis significantly increased (1204 (16.98%) vs. 1245 (13.59%), p < 0.0001; 355 (5.01%) vs. 358 (3.91%), p = 0.0007; and 153 (2.16%) vs. 140 (1.53%), p = 0.0009, respectively). Conclusions: The suspension of elective procedures during the COVID-19 pandemic caused a significant reduction in post-EVAR surveillance, and in the hospitalization of asymptomatic carotid stenosis revascularization and Rutherford 3 peripheral arterial disease. Consequentially, we observed a significant increase in admissions for urgent revascularization for symptomatic carotid stenosis, as well as for revascularization or major amputations for chronic limb-threatening ischemia

Economia aeroportuale e tutela della concorrenza nel trasporto aereo

Attualmente è in corso un profondo cambiamento della gestione aeroportuale poiché, per effetto dell’entrata in vigore di un nuovo specifico regolamento comunitario, i vecchi gestori aeroportuali hanno ampliato la sfera delle loro competenze. Il concetto stesso di aeroporto è soggetto ad un profondo mutamento in quanto si passa da una logica di servizio pubblico che doveva essere offerto gratuitamente, ad un nuovo concetto di aeroporto, considerato come un vera e propria “fonte di reddito”; di conseguenza cambierà anche il modo attraverso il quale vengono gestiti gli aeroporti. Nel lavoro vengono analizzati e descritti il funzionamento di un aeroporto, l’economia aeroportuale, il coinvolgimento della comunità della comunità economica europea nel trasporto aereo e la tutela della concorrenza nei servizi aeroportuali

L’evoluzione normative dei lavori pubblici dopo la “legge obiettivo”

Con l’obbiettivo di “realizzare opera pubbliche di qualità e nel minor tempo possibile”, il legislatore si è posto il problema di come accelerare gli iter normativi delle opere pubbliche modificando, se il caso, il preesistente impianto normativo e legislativo prevedendo – nel settore delle cosiddette “grandi opere strategiche di preminente interesse nazionale” – l’istituzione di nuove figure come il General Contractor, con il fine di assicurare l’esecuzione e la consegna dell’opera “chiavi in mano” nei tempi stabiliti

Arriva il transrapid: si viaggia in treno ad oltre 400 chilometri orari su un cuscino magnetico

Tecnologie innovative applicate al settore dei trasporti consentono di migliorare la mobilità senza danneggiare l’ambiente. Nell’ambito della mobilità sostenibile il nuovo sistema ferroviario Transrapid 08, treno a levitazione magnetica di tipo “Maglev” (Magnetic levitation train), costituisce una valida soluzione per assicurare, in maniera rapida e sicura, i collegamenti sia su media e lunga distanza che tra una città ed il suo aeroporto. In Italia, allo stato attuale, non sono previsti specifici programmi di sviluppo; tuttavia la flessibilità del sistema Maglev lo rende particolarmente idoneo per realizzare efficaci interconnessioni con la costituenda linea ferroviaria ad alta capacità (su talune tratte già in avanzata fase di realizzazione) soprattutto in taluni punti critici quali, ad esempio, i nodi urbani

Economia aeroportuale

Il managment aeroportuale sta cambiando in quanto le vecchie compagnie aeroportuali, in conseguenza della nuova specifica Regolamentazione europea, hanno esteso le loro competenze. A seguito del cambiamento della vecchia logica di servizio pubblico, anche il concetto di aeroporto è cambiato. Come conseguenza di tutto ciò, il modo in cui si gestivano gli aeroporti è destinato a cambiare

Infrastrutture e internazionalizzazione: i presupposti per lo sviluppo

I motivi di fondo che hanno portato ad avviare una Politica Comune dei Trasporti, sono oggi ancor più forti che nel passato. Il passaggio alla moneta unica ha, infatti, rafforzato l’importanza delle tematiche connesse all’interoperabilità delle reti ed all’interconnessione dei sistemi e dei modi di trasporto. Il rafforzamento e l’adeguamento di questa politica, anche sulla scorta dell’esperienza maturata in questi anni, sono divenuti problemi che sollecitano una soluzione immediata