Experiences, Emotions, and Health Consequences among COVID-19 Survivors after Intensive Care Unit Hospitalization

Literature suggested that COVID-19 patients experienced hospitalization as a physically and psychologically stressful event, with the risk to develop post-traumatic stress symptoms. The study aimed to understand psychological experiences of COVID-19 survivors with severe complications during and after ICU hospitalization, and any relevant health consequences. From October 2020 to January 2021, a qualitative study was conducted in Italy via semi-structured interviews by phone or video call addressed to COVID-19 survivors, randomly enrolled among people who released their stories publicly on newspapers, television, or social media. Fifteen individuals (three women and twelve men with average age of 56.4 years) were interviewed. Four main themes emerged: (i) emotion of fear; (ii) isolation and loneliness; (iii) unawareness about the gravity of the situation as a protective factor; (iv) "Long COVID" as consequences of the disease on physical and psychological health. During hospitalization, 66.7% of participants had mild or moderate values of anxiety and depression. After discharge, 86.7% moved to normal values. The results suggest that long-COVID is an important problem to manage to improve patients' quality of life. It is essential to guarantee a holistic take in charge starting before the discharge and continuing care after discharge in the community where they live

Surgical management of abnormal uterine bleeding in fertile age women

Abnormal uterine bleeding is a common gynecological disease and represents one of the most frequent reasons for hospital admission to a specialist unit, often requiring further surgical treatment. Following the so-called PALM-COEIN system we will attempt to further clarify the surgical treatments available today. The first group (PALM) is characterized by structural lesions, which may be more appropriately treated by means of surgical management. Although hysterectomy remains the definitive and decisive choice, there are many alternative techniques available. These minimally invasive procedures offer the opportunity for a more conservative approach. Precise and accurate counseling facilitates better patient selection, based on the patient's desires, age and disease type, allowing treatment to be individually tailored to each woman

The Great pretender: the first case of septic shock due to Capnocytophaga canimorsus in Sardinia. A Case report and review of the literature

Capnocytophaga canimorsus (C. canimorsus) is an emerging pathogen in critical care. C. canimorsus is a Gram-negative bacillus, commonly isolated as a commensal microorganism of the oral flora of healthy dogs and cats. A 63-year-old woman came to the emergency department with fever, chills, and malaise 2 days after a minor dog bite. After admission to the medicine ward, she developed respiratory failure and livedo reticularis. In the intensive care unit (ICU), she presented full-blown septic shock with thrombocytopenia, coagulopathy, severe acute kidney injury, and liver injury. We describe the first case of septic shock with Multiple Organ Dysfunction Syndrome related to Capnocytophaga canimorsus infection in Sardinia and its treatment in a tertiary hospital ICU. We also review recent literature on the relevance of C. canimorsus in human disease and critical illness

Fluconazole therapy for treatment of invasive candidiasis in Intensive Care patients. Is it still valid from a pharmacological point of view?

Fluconazole \u2013 antimycotic belonging to the first generation azoles \u2013 is widely used as treatment for invasive candidiasis and candidemia in numerous clinical settings as Neonatal Intensive Care Unit (NICU) and adult Intensive Care Unit (ICU), as well as oncology, onco-hematology and solid organ transplantation. More recently use of antimycotics has spread to medical divisions, where fungal infections represent an emerging problem due to population\u2019s ageing, malnourishment and important comorbidities. Fluconazole is effective against numerous Candida species, particularly against albicans, tropicalis and parapsilosis strains. On the other hand, C. krusei is intrinsically resistant to fluconazole and C. glabrata can be sensitive or resistant in a dose dependent fashion. Epidemiological variability is noteworthy and depends on the geographical location of the institution, the clinical setting, and the frequency and intensity of fluconazole employment for invasive candidiasis. In many ICUs fluconazole sensitive C. albicans is cultured in 50% of positive samples, while the remaining 50% show growth of variably sensitive fungal species, often resistant to fluconazole. Due to increasingly frequent emergence of resistant strains of Candida spp., American guidelines (IDSA) in 2009, and European ones (ESCMID) in 2012, recommended substitution of fluconazole with echinocandines as first line therapy in patients with severe disease, as defined by an APACHE II score greater than 15. Thus fluconazole must be limited to low risk cases, treatment of sensitive strains and de-escalation from echinocandin therapy, after microbiological diagnosis and drug resistance profile characterizatio

Giant photoinduced reflectivity modulation of nonlocal resonances in silicon metasurfaces

Metasurfaces offer a unique playground to tailor the electromagnetic field at subwavelength scale to control polarization, wavefront, and nonlinear processes. Tunability of the optical response of these structures is challenging due to the nanoscale size of their constitutive elements. A long-sought solution to achieve tunability at the nanoscale is all-optical modulation by exploiting the ultrafast nonlinear response of materials. However, the nonlinear response of materials is inherently very weak, and, therefore, requires optical excitations with large values of fluence. We show that by properly tuning the equilibrium optical response of a nonlocal metasurface, it is possible to achieve sizable variation of the photoinduced out-of-equilibrium optical response on the picosecond timescale employing fluences smaller than 250 μJ / cm2, which is 1 order of magnitude lower than previous studies with comparable reflectivity variations in silicon platforms. Our results pave the way to fast devices with large modulation amplitude.<br/

Recombinant outer membrane vesicles carrying Chlamydia muridarum HtrA induce antibodies that neutralize chlamydial infection in vitro

Background: Outer membrane vesicles (OMVs) are spheroid particles released by all Gram-negative bacteria as a result of the budding out of the outer membrane. Since they carry many of the bacterial surface-associated proteins and feature a potent built-in adjuvanticity, OMVs are being utilized as vaccines, some of which commercially available. Recently, methods for manipulating the protein content of OMVs have been proposed, thus making OMVs a promising platform for recombinant, multivalent vaccines development. Methods: Chlamydia muridarum DO serine protease HtrA, an antigen which stimulates strong humoral and cellular responses in mice and humans, was expressed in Escherichia coli fused to the OmpA leader sequence to deliver it to the OMV compartment. Purified OMVs carrying HtrA (CM rHtrA-OMV) were analyzed for their capacity to induce antibodies capable of neutralizing Chlamydia infection of LLC-MK2 cells in vitro. Results: CM rHtrA-OMV immunization in mice induced antibodies that neutralize Chlamydial invasion as judged by an in vitro infectivity assay. This was remarkably different from what observed with an enzymatically functional recombinant HtrA expressed in, and purified from the E. coli cytoplasm (CM rHtrA). The difference in functionality between anti-CM rHtrA and anti-CM rHtrA-OMV antibodies was associated to a different pattern of protein epitopes recognition. The epitope recognition profile of anti-CM HtrA-OMV antibodies was similar to that induced in mice during Chlamydial infection. Conclusions: When expressed in OMVs HtrA appears to assume a conformation similar to the native one and this results in the elicitation of functional immune responses. These data further support the potentiality of OMVs as vaccine platform

Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with tonsil colonisation by Streptococcus pyogenes

The involvement of pathogenic bacteria in obstructive sleep apnoea syndrome (OSAS) has yet to be elucidated. We investigated the possible role of group A streptococcus (GAS) in OSAS pathogenesis. In 40 tonsillectomized patients affected by OSAS and 80 healthy controls, significant (p < 0.0001) association of GAS with paediatric OSAS was found. Supernatant from streptolysin O (SLO)-producing GAS induced production of cysteinyl leukotrienes (CysLTs) in tonsil mononuclear cells (TMCs). CysLTs-treated TMCs showed significant (p < 0.05) proliferation of CD4+ T, CD19+ and CD19+CD27+CD38+ B lymphocytes. We discovered a SLO-dependent activation of CysLTs production through a pathway involving TOLL-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon-β (TRIF), Myeloid differentiation primary response gene 88 (MyD88), and p38 MAP Kinase. In conclusion, we hypothesise that GAS may contribute to paediatric tonsillar hyperplasia through CysLTs production induced by SLO, and this might explain its association with OSA