Enterocutaneous fistula management and clinical nutrition in sepsis of abdominal wall incisional hernia. Tips, tricks and literature revision

Background: The Enterocutaneous Fistula (ECF) treatment requires a multidisciplinary approach and high costs, and shows critical morbidity and mortality rates. For these reasons, it is one of the most challenging problems in colorectal and incisional hernia surgery. Methods: This article synopsizes the current classification systems’ successful management and provides an in-depth review of septic source surgical control, Clinical Nutrition, Hyper Baric Oxygen Therapy (HBOT) and negative pressure (VAC), output quantity management, wound care, operative timeline, and considerations such as Inflammatory Bowel Disease (IBD), and Enteroatmospheric Fistula (EAF). Result: We report a 71-year-old septic fistulated male with an incisional hernia, and chronic medullary dysplasia. This study compares our results with the literature. This case concerns a very complex and long-lasting clinical scenario because of erythropoietic and immunity systems default that led the patient to death. The use of negative pressure therapy to manage abdominal fistula is still controversial. Patients suffering from enterocutaneous fistula require adequate nutritional support to fight hypercatabolism due to the fistula’s inflammation, fluids, proteins, and salts loss. Conclusions: An aggressive multidisciplinary approach, including prosthesis explantation are needed. Clinical nutrition starts with TPN (Total Parenteral Nutrition) followed by EN (Enteral Nutrition) as soon as possible. Moreover, VAC and HBOT therapies are useful to treat this life-threatening condition

The effects of COVID-19 pandemic on elective post-bariatric surgery waiting list. A single plastic surgery center investigation

Objective: After massive weight loss, patients that meet specific criteria can be inserted in an ad-hoc post-bariatric surgery list in order to be subjected to body contouring procedures. During COVID-19 pandemic, the Italian National Health System has been overwhelmed by the continue load of life-threatening patients that needed medical assistance. Plastic surgery practice enormously scaled back during this period and this fact greatly affected elective procedures waiting lists. The aim of our study is to analyze how the lockdown and its related sanitary policies affected post-bariatric patients' behaviors towards the delay of their procedure. Patients and methods: A 7-item questionnaire was administered to all patients. Change in the desire to be subjected to body contouring procedures was recorded. Smoking status, level of training during quarantine and psychological co-morbidities were also evaluated. Results: 124 patients completed the questionnaire. Data analysis showed that none of them encountered a decrease of the desire to be subjected to post-bariatric plastic surgery procedures. Conclusions: The present study showed that all the patients in the waiting list did not modify their interest in being subjected to post-bariatric surgery procedures, even though the waiting time increased

Flow synthesis and biological studies of an analgesic adamantane derivative that inhibits P2X7-evoked glutamate release

We report the biological evaluation of a class of adamantane derivatives, which were achieved via modified telescoped machine-assisted flow procedure. Among the series of compounds tested in this work, 5 demonstrated outstanding analgesic properties. This compound showed that its action was not mediated through direct interaction with opioid and/or cannabinoid receptors. Moreover, it did not display any significant anti-inflammatory properties. Experiments carried out on rat cerebrocortical purified synaptosomes indicated that 5 inhibits the P2X7-evoked glutamate release, which may contribute to its antinociceptive properties. Nevertheless, further experiments are ongoing to characterize the pharmacological properties and mechanism of action of this molecule

Evaluated Community Fire Safety Interventions in the United States: A Review of Current Literature

The purpose of the study was to assess the state of fire prevention research, provide an updated synthesis of evaluated fire prevention programs, and discuss the role of fire fighters and data systems in prevention efforts. The review included all evaluations of U.S. based fire prevention interventions published between January 1998 and September 2004 and any earlier articles about U.S. fire prevention interventions not included in two prior review articles. We retrieved information from each identified study including evaluation findings, involvement of fire service personnel and use of existing data systems. We identified twelve articles: seven reported on smoke alarm interventions, three on multi-faceted programs, and two other programs. Five programs involved fire service personnel in the design, implementation, and/or evaluation, and three used existing data systems. Studies reviewed suggest that canvassing and smoke alarm installations are the most effective means of distributing alarms and increasing the functional status of distributed alarms. The functionality of smoke alarms, an issue noted in earlier reviews, remains a problem. Programs involving partnerships with fire departments have indicated success in preventing fires and deaths, improving smoke alarm ownership and functional status, and improving children’s fire safety knowledge. Using existing data systems to target and to evaluate interventions was effective. In the years since prior reviews, some improvements in the rigor of evaluation designs have been made, but there is still a need for high quality evaluations that will inform fire injury prevention efforts

Caring for Caregivers (C4C): study protocol for a pilot feasibility randomised control trial of Positive Written Disclosure for older adult caregivers of people with psychosis

Background: The caregivers of people who experience psychosis are themselves at risk of developing physical and mental health problems. This risk is increased for older adult caregivers who also have to manage the lifestyle and health changes associated with ageing. As a consequence, older adult caregivers are in particular need of support; we propose a Written Emotional Disclosure (WED) intervention, called Positive Written Disclosure (PWD). Methods/design: This is a pilot randomised controlled trial of PWD compared to a neutral writing control and a no writing condition. We aim to recruit 60 participants, 20 in each arm. This study will utilise a mixed-methods approach and collect quantitative (questionnaires) and qualitative (interviews) data. Quantitative data will be collected at baseline and 1, 3, and 6 months post baseline. Participants who complete a writing task (PWD or neutral writing control) will be invited to complete an exit interview to discuss their experiences of the intervention and study. The study is supported by a patient and public involvement group. Discussion: The results of this trial will determine whether a definitive trial is justified. If so, the quantitative and qualitative findings will be used to refine the intervention and study protocols

Evaluation of expressive writing for postpartum health: A randomized controlled trial

Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect the health of women. There is some evidence that expressive writing can have positive effects on psychological and physical health, particularly during stressful periods. The current study aimed to evaluate whether expressive writing would improve women’s postpartum health. A randomized controlled trial was conducted with three conditions: expressive writing (n=188), a control writing task (n=213), or normal care (n=163). Measures of psychological health, physical health and quality of life were measured at baseline (6-12 weeks postpartum), 1 month and 6 months later. Ratings of stress were taken before and after the expressive writing task. Intent-to-treat analyses showed no significant differences between women in the expressive writing, control writing and normal care groups on measures of physical health, anxiety, depression, mood or quality of life at 1 and 6 months. Uptake and adherence to the writing tasks was low. However, women in the expressive writing group rated their stress as significantly reduced after completing the task. Cost analysis suggest women who did expressive writing had the lowest costs in terms of healthcare service use and lowest cost per unit of improvement in quality of life. Results suggest expressive writing is not effective as a universal intervention for all women 6-12 weeks postpartum. Future research should examine expressive writing as a targeted intervention for women in high-risk groups, such as those with mild or moderate depression, and further examine cost-effectiveness

Coordinated strategy for a model-based decision support tool for coronavirus disease, Utah, USA

The coronavirus disease pandemic has highlighted the key role epidemiologic models play in supporting public health decision-making. In particular, these models provide estimates of outbreak potential when data are scarce and decision-making is critical and urgent. We document the integrated modeling response used in the US state of Utah early in the coronavirus disease pandemic, which brought together a diverse set of technical experts and public health and healthcare officials and led to an evidence-based response to the pandemic. We describe how we adapted a standard epidemiologic model; harmonized the outputs across modeling groups; and maintained a constant dialogue with policymakers at multiple levels of government to produce timely, evidence-based, and coordinated public health recommendations and interventions during the first wave of the pandemic. This framework continues to support the state's response to ongoing outbreaks and can be applied in other settings to address unique public health challenges

First overview on the 4th Annex I Habitats Report in Italy: methods, criticality, results and future prospects

Like all the other EU/28 countries, in 2019 Italy developed the 4th Italian Report ex-Art. 17 on the conservation status of the Habitats of Annex I to the 92/43/EEC Directive. Institutional referent of the process, on behalf of the Ministry for Environment, Land and Sea Protection (MATTM), was the Italian Institute for Environmental Protection and Research (ISPRA) with the scientific support of the Italian Botanical Society (SBI). A huge working group composed of thematic and territorial experts was formed with the task to collect, analyse, validate the data resulting from Annex I Habitat monitoring in Italy for the period 2013-2018, whose collection is in charge to the regional administrations. Data on 124 types of terrestrial and inland water Habitats present in Italy have been processed in order to assess their overall conservation status in the Biogeographic Regions of occurrence. The carried out activity led to the compilation of 278 assessment sheets. The work included a critical analysis of the data and a broad scientific confrontation aimed at finding methodologically robust solutions to fill the gaps. The work was structured so as to guarantee the traceability of the information and to allow the collection of "gray" literature and scientific articles, phytosociological surveys and unpublished material of the specialists, composing a substantial pool of data useful for starting a long-term process to support the next reporting cycles. Cartographic outcomes, associated databases and additional data used for the assessments will be available online on the ISPRA Portal as soon as the validation process by the European Commission will be completed. A freely accessible online archive of phytosociological surveys representative of the various Annex I Habitats in Italy is being set up within the national "VegItaly" database, managed by the Italian Society of Vegetation Science, by way of a dedicated archive named "HAB_IT". Such a long-term vision, oriented to the storage and enhancement of knowledge, represents an important innovative aspect and a significant progress towards the construction of an effective monitoring system for the conservation of Annex I Habitats in Italy