Role of multidrug-resistant pathogens in health-care-associated pneumonia.

Comment on: Rethinking the concepts of community-acquired and health-care-associated pneumonia. [Lancet Infect Dis. 2010

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p < 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes

Clinical impact of broad-spectrum empirical antibiotic therapy in patients with healthcare-associated pneumonia: a multicenter interventional study

Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia distinct from community-acquired pneumonia (CAP). A multicenter observational study in 2008 finds that patients with HCAP have a mortality rate significantly higher than patients with CAP, and a worse outcome is associated at logistic regression analysis with a low adherence to empirical antibiotic therapy recommended by ATS/IDSA guidelines. We designed a prospective interventional study to establish whether administration of a broad-spectrum antibiotic therapy consistent with the 2005 ATS/IDSA guidelines has an effect on the clinical outcome of hospitalized patients with HCAP. All patients with HCAP prospectively admitted in 25 medical wards of 20 Italian hospitals during a 1-month period were included in the study. All patients were assigned to receive an empirical therapy including a fluoroquinolone plus an anti-MRSA agent plus either piperacillin-tazobactam or a carbapenem. Main measures for improvement were duration of antibiotic therapy, length of hospital stay, and in-hospital mortality rate. Patients were compared with a historical control group of 90 patients, and followed up to discharge or death. HCAP patients receiving a guideline-concordant therapy had a shorter duration of antibiotic therapy (median 15 vs. 12 days, p = 0.0002), a shorter duration of hospitalization (median 18 vs. 14 days, p = 0.02), and a lower mortality rate (17.8 vs. 7.1 %, p = 0.03). Our results suggest that an empirical broad-spectrum therapy is associated with improved outcome in patients with HCAP

Pancreatic tumors imaging: an update

Currently, ultrasound (US), computed tomography (CT) and Magnetic Resonance imaging (MRI) represent the mainstay in the evaluation of pancreatic solid and cystic tumors affecting pancreas in 80-85% and 10-15% of the cases respectively. Integration of US, CT or MR imaging is essential for an accurate assessment of pancreatic parenchyma, ducts and adjacent soft tissues in order to detect and to stage the tumor, to differentiate solid from cystic lesions and to establish an appropriate treatment. The purpose of this review is to provide an overview of pancreatic tumors and the role of imaging in their diagnosis and management. In order to a prompt and accurate diagnosis and appropriate management of pancreatic lesions, it is crucial for radiologists to know the key findings of the most frequent tumors of the pancreas and the current role of imaging modalities. A multimodality approach is often helpful. If multidetector-row CT (MDCT) is the preferred initial imaging modality in patients with clinical suspicion for pancreatic cancer, multiparametric MRI provides essential information for the detection and characterization of a wide variety of pancreatic lesions and can be used as a problem-solving tool at diagnosis and during follow-up

Comparison between the effects of epidural lidocaine, tramadol, and lidocaine-tramadol on postoperative pain in cats undergoing elective orchiectomy

Background: In veterinary clinical practice, orchiectomy is one of the most common surgical procedures for cats and is performed mainly in young animals. The purpose of this study was to compare three different epidural (EP) analgesic protocols used in cats undergoing orchiectomy in order to determine which protocol resulted in superior outcomes in terms of perioperative analgesia. Twenty-one client-owned male cats were premedicated with a combination of dexmedetomidine (10&nbsp;µg/kg) and midazolam (0.2&nbsp;mg/kg) injected intramuscularly. Anesthesia was induced intravenously with propofol. Cats were randomly divided in three treatment groups of seven animals each: Group L received EP lidocaine (2&nbsp;mg/kg), Group T received EP tramadol (1&nbsp;mg/kg), and Group LT received EP lidocaine (2&nbsp;mg/kg) plus tramadol (1&nbsp;mg/kg). The post-operative pain level was assessed using two different scales: the Glasgow Composite Measure Pain Scale-Feline (CMPS-F) and the Feline Grimace Scale (FGS). Rescue analgesia was administered when the CMPS-F total score was ≥5 or the FGS total score was ≥4. Results: No adverse effects related to tramadol or lidocaine were observed. Based on post-operative pain assessments, significant differences between groups were observed according to both pain scoring systems. In particular, in Group LT, the CMPS-F and FGS scores decreased significantly in the first six hours following castration. Conclusions: Based on our results, EP lidocaine plus tramadol provided the best post-operative analgesic effects in cats submitted to orchiectomy lasting 6&nbsp;h and could also be a choice to consider for longer surgical procedures

Association between daily levels of air pollution and school absences in the proximity of a cement plant in Italy

Background: Emission of dust represents the main hazard associated with cement production and may cause adverse respiratory health effects to the population living nearby. Aim: To evaluate the association between daily levels of PM10 and a morbidity indicator (school absenteeism) in children aged 7-14 years attending a school within 2km from a cement plant in Fumane (Northern Italy). Methods: Data on absences of students (average: 461 students/year) and daily concentrations of PM10 from a fixed monitoring station placed in the schoolyard were collected for 3 school years (541 school days from November 2007 to June 2010). The association between pollution in the same day (Lag 0) and in the previous 4 days (Lag 1 to 4) and school absenteeism was studied using generalized additive Poisson regression models, adjusting for short-term trend, day of the week, flu epidemics and daily temperature. Results: During the considered period, the daily average concentration of PM10 was 34.8 µg/m³. An increase of 10 µg/m³ of PM10 was associated with a significant increase of 2.2% in school absences (RR:1.022; 95%CI: 1.007-1.037) two days after (lag2). The association between average level of pollutants from Lag 0 to Lag 4 and school absences confirmed the presence of a statically significant association with PM10 levels (RR:1.016; 95%CI:1.003-1.029 for each + µg/m³ of PM10). Conclusions: Daily PM10 levels are associated with school absences, a proxy indicator of short-term morbidity, in children who attend schools in proximity to a cement plant. Primary prevention interventions aimed at reducing air pollution in the area are recommended

Urban Seismic Networks, Structural Health and Cultural Heritage Monitoring: The National Earthquakes Observatory (INGV, Italy) Experience

A multiscale approach to the monitoring of earthquakes and their effects can represent an effective tool for the reduction of seismic risk. Devoted monitoring networks are essential to cope with the seismic emergency in urban areas, to assess the damage scenarios, which are useful for the preservation of the strategic functions and services and to improve the community resilience to earthquakes. The National Earthquake Observatory, Italian Institute for Geophysics and Volcanology (ONT-INGV, Italy), has been recently involved in several projects devoted to the reduction of seismic risk by means of the implementation of urban-scale and building-scale monitoring networks. Such systems represent a necessary support for the well-established national seismic network. All these approaches (country, urban, and building scale) could be framed within of a unique system in which each part holds different tasks, with the common final objective of the earthquake risk reduction. In this paper different approaches, experiences and potential capabilities on urban seismic networks, structural health and cultural heritage monitoring implemented in Italy by the ONT-INGV will be presented, with the ultimate goal of achieving an effective integrated multi-scale system.PublishedArticle 1271IT. Reti di monitoraggio e sorveglianzaN/A or not JC

InSAR Monitoring of Italian Coastline Revealing Natural and Anthropogenic Ground Deformation Phenomena and Future Perspectives

In this work, we use X and C-band SAR data provided by the COSMO-SkyMed and ENVISAT missions to detect and measure some ground deformation phenomena along six coastal areas of Italy. In particular, we exploit multi-temporal interferometric synthetic aperture radar (InSAR), i.e., small baseline subsets (SBAS) and interferometric point target analysis (IPTA) methods, to retrieve the deformation rate maps and time series for each investigated area. Multi-temporal InSAR analysis revealed local subsidence and uplifting effects in Ravenna Coastal Areas, Fiumicino, Campi Flegrei, Sibari Plain, Augusta Bay, and Taranto Gulf. Our work is meant as a demonstrator to show how InSAR-based analysis can provide a detailed understanding of the coastal hazards. Such analysis also opens up new monitoring scenarios such as the possibility of designing a near real-time surveillance service based on Sentinel-1 SAR data.Publishedid 31522T. Deformazione crostale attivaJCR Journa

Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer: meta-analysis of randomized clinical trials

<p>Abstract</p> <p>Background</p> <p>Although the addition of bevacizumab to 1^stline chemotherapy provides a significant survival benefit for advanced colorectal cancer, the magnitudes of both advantages and toxicities have not been extensively investigated.</p> <p>Methods</p> <p>A literature-based meta-analysis was conducted; Hazard Ratios were extracted from randomized trials for primary end-points (Progression Free Survival, PFS, Overall Survival OS). The log of event-based risk ratio were derived for secondary endpoints (objective/partial response rate, ORR/PR; severe hypertension, bleeding and proteinuria). Absolute differences and the number needed to treat/harm (NNT/NNH) were calculated. A meta-regression analysis with clinical predictors and a sensitivity analysis according to the trial phase-design were conducted as well.</p> <p>Results</p> <p>Five trials (2,728 pts) were selected. The addition of bevacizumab to 1^stline chemotherapy significantly increased both PFS (although with significant heterogeneity) and OS over exclusive chemotherapy by 17.1% and 8.6% (NNT 6 and 12), regardless of the study setting (non significant interaction between phase II and III). The chance to improve PR was significantly increased by 6.5% (NNT 15), with a trend for ORR. The risk of hypertension was significantly increased by 6.2% (NNH 16). According to the meta-regression analysis, female gender and rectal primary site were significant predictors for PFS benefit.</p> <p>Conclusions</p> <p>Notwithstanding all the concerns related to costs and the significant HTN risk, the significant outcome improvement provided by bevacizumab in first-line treatment for unselected advanced colorectal cancer patients, should be considered when choosing the appropriate up-front therapy.</p