Sustained low influenza vaccination in health care workers after H1N1 pandemic: A cross sectional study in an Italian health care setting for at-risk patients

Background: Despite consistent recommendations by all Public Health Authorities in support of annual influenza vaccination for at-risk categories, there is still a low uptake of influenza vaccine in these groups including health care workers (HCWs). Aim of this observational two-phase study was to estimate the immunization rates for influenza in four subsequent seasons and for pandemic H1N1 influenza in HCWs of a University Hospital, and to investigate its distribution pattern and the main determinants of immunization. Phase 1 data collection was performed in 2009-2010, during the peak of H1N1 pandemic. Phase 2 data collection, aimed to investigate seasonal influenza vaccination coverage in the three seasons after pandemic, was performed in 2012-2013. Methods: The overall H1N1 vaccination rate was derived by the Hospital immunization registry. In 2010, the personnel of three Departments (Infectious Diseases, Pediatrics and Gynecology/Obstetrics) completed a survey on influenza. A second-phase analysis was performed in 2012 to investigate influenza vaccination coverage in three consecutive seasons. Results: The first-phase survey showed a low coverage for influenza in all categories (17 %), with the lowest rate in nurses (8.1 %). A total of 37 % of health care workers received H1N1 vaccine, with the highest rate among physicians and the lowest in nurses. H1N1 vaccination was closely related to the Department, being higher in the Department of Infectious Diseases (53.7 %) and Pediatrics (42.4 %) than in Gynecology/Obstetrics (8.3 %). The second-phase survey showed the lowest rate of influenza vaccination in 2012/13 season. The main reasons for not being vaccinated were "Unsure of the efficacy of vaccine" and "Feel not at-risk of getting influenza or its complications". Despite recommendations, influenza vaccine uptake remains poor. Conclusion: Immunization is largely perceived as a personal protection rather than a measure needed to prevent disease spreading to at-risk patients. Compulsory vaccination against influenza should be considered as a possible strategy, at least in health institutions where at-risk patients are admitted

Use of QT intervals for a more accurate diagnose of syncope and evaluation of syncope severity.

Abstract BACKGROUND: This study aimed to evaluate the use of QT intervals, their diagnostic predictive value in patients with syncope and their relationship with syncope severity. METHODS: One hundred and forty nine patients with a diagnosis of syncope were admitted to Internal Medicine departments at the University of Palermo, Italy, between 2006 and 2012, and 140 control subjects hospitalised for other causes were enrolled. QT maximum, QT minimum, QTpeak, QT corrected, QT dispersion and Tpeak-to-Tend interval were compared between two groups. The paper medical records were used for scoring with San Francisco Syncope Rule (SFSR), Evaluation of Guidelines in SYncope Study (EGSYS) score and Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score. RESULTS: Mean QTc (p 424.8 ms (sensibility: 81.88 - specificity: 57.86) showed the greatest predictive value for diagnosis of syncope. On the EGSYS score and on the OESIL score, QTc was significantly prolonged in high-risk patients compared with low-risk patients. On the San Francisco Syncope Rule, QTc and QTdisp were significantly prolonged in high-risk patients compared with low-risk patients. CONCLUSION: Mean QTc, mean QTdisp, mean TpTe, mean QTmax and mean QTpeak were significantly longer in patients with syncope compared with control subjects. Furthermore, prolonged QTc and QTdisp were associated with major severe syncope according to San Francisco Syncope Rule, EGSYS and OESIL risk scores

Identificación y caracterización litológica mediante el uso del sensor ETM+ (Landsat 7). Caso de estudio: entorno del glaciar Upsala, Argentina

Revista oficial de la Asociación Española de Teledetección[EN] The object of this study aims to evaluate and analyze digital image processing techniques applied to the Enhanced Thematic Mapper Plus (ETM+), in order to demark and characterize the outcropping lithologies on the Upsala Glacier basin, Santa Cruz, Argentine Republic. The prolific technological and spatial development experienced in the last decades has given place to the generation, without precedents, of multiple remote sensors capable of capturing information of the terrestrial surface and also the improvement of digital image processing techniques and software; amongst them, the amazing possibilities in the detection and differentiation of diverse covers present on the terrestrial surface can be highlighted, such as glaciers, volcanoes, vegetation, soils, water, types of rock outcrops, etc. This situation improves mapping and monitoring of natural phenomenon in the Earth Sciences field. The proposed methodology includes radiometric corrections, elimination of unwanted covers, statistical evaluation in the combination of the most appropriate bands, application of the Z index, discretization of the statistical series, entailing tasks of spectral classification with field samples and a later validation. Valuable results were obtained by means of digital processing of images, that were validated yielding a 82% of accuracy in the proposed classification, which are good results taking into account the diversity of covers present and the lithological heterogeneity that makes up each pixel (30m). These results were also validated with existing geological maps, obtaining a good agreement.[ES] El objetivo del presente estudio se enfoca en evaluar y analizar técnicas de procesado digital de imágenes aplicadas al sensor Enhanced Thematic Mapper Plus (ETM+), a fin de demarcar y caracterizar las litologías que afloran en la cuenca del glaciar Upsala, Santa Cruz, República Argentina. El prolífico desarrollo tecnológico-espacial experi-mentado en las últimas décadas ha dado lugar a la generación, sin precedentes, de sensores remotos capaces de capturar información de la superficie terrestre y a la mejora de las técnicas de procesado digital de imágenes, entre las que destacan las posibilidades en la detección y diferenciación de diversas cubiertas presentes en la superficie terrestre como glaciares, volcanes, vegetación, suelos, agua, tipos de rocas que afloran, etc. Esta situación ha coad-yuvado y posibilitado obtener promisorios avances en el mapeo y monitoreo de fenómenos naturales en el campo de las ciencias de La Tierra. La metodología propuesta, incluye correcciones radiométricas; eliminación de coberturas no deseadas; evaluación estadística de la combinación de bandas óptima; aplicación del índice Z; discretización de la serie estadística mediante una clasificación no supervisada; tareas de vinculación de la clasificación espectral con muestras litológicas y un posterior muestreo de validación. A través del procesado digital de imágenes, se obtuvieron resultados que fueron validados y arrojaron un 82% de fiabilidad en la clasificación propuesta, lo cual resulta adecua-do teniendo en cuenta la diversidad de cubiertas presentes y la heterogeneidad litológica que compone a cada píxel (30 m). Además, los resultados fueron validados con mapas geológicos pre-existentes obteniendo buena concordan-cia.El estudio fue financiado mediante los proyectos de AGENCIA PICT2921-2012 y PICT1995-2013.Lo Vecchio, A.; Lenzano, MG.; Richiano, S.; Lenzano, LE. (2016). Lithologic identification and characterization using ETM+ (Landsat 7). Study case of the Upsala glacier basin, Argentine. Revista de Teledetección. (46):57-72. https://doi.org/10.4995/raet.2016.4482SWORD57724

Long term planning of flood risks and processes of urbanistic development: the case of the Basilicata region (southern Italy)

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Lithologic identification and characterization using ETM+ (Landsat 7). Study case of the Upsala glacier basin, Argentine

The object of this study aims to evaluate and analyze digital image processing techniques applied to the Enhanced Thematic Mapper Plus (ETM+), in order to demark and characterize the outcropping lithologies on the Upsala Glacier basin, Santa Cruz, Argentine Republic. The prolific technological and spatial development experienced in the last decades has given place to the generation, without precedents, of multiple remote sensors capable of capturing information of the terrestrial surface and also the improvement of digital image processing techniques and software; amongst them, the amazing possibilities in the detection and differentiation of diverse covers present on the terrestrial surface can be highlighted, such as glaciers, volcanoes, vegetation, soils, water, types of rock outcrops, etc. This situation improves mapping and monitoring of natural phenomenon in the Earth Sciences field. The proposed methodology includes radiometric corrections, elimination of unwanted covers, statistical evaluation in the combination of the most appropriate bands, application of the Z index, discretization of the statistical series, entailing tasks of spectral classification with field samples and a later validation. Valuable results were obtained by means of digital processing of images, that were validated yielding a 82% of accuracy in the proposed classification, which are good results taking into account the diversity of covers present and the lithological heterogeneity that makes up each pixel (30m). These results were also validated with existing geological maps, obtaining a good agreement.El objetivo del presente estudio se enfoca en evaluar y analizar técnicas de procesado digital de imágenes aplicadas al sensor Enhanced Thematic Mapper Plus (ETM+), a fin de demarcar y caracterizar las litologías que afloran en la cuenca del glaciar Upsala, Santa Cruz, República Argentina. El prolífico desarrollo tecnológico-espacial experimentado en las últimas décadas ha dado lugar a la generación, sin precedentes, de sensores remotos capaces de capturar información de la superficie terrestre y a la mejora de las técnicas de procesado digital de imágenes, entre las que destacan las posibilidades en la detección y diferenciación de diversas cubiertas presentes en la superficie terrestre como glaciares, volcanes, vegetación, suelos, agua, tipos de rocas que afloran, etc. Esta situación ha coadyuvado y posibilitado obtener promisorios avances en el mapeo y monitoreo de fenómenos naturales en el campo de las ciencias de La Tierra. La metodología propuesta, incluye correcciones radiométricas; eliminación de coberturas no deseadas; evaluación estadística de la combinación de bandas óptima; aplicación del índice Z; discretización de la serie estadística mediante una clasificación no supervisada; tareas de vinculación de la clasificación espectral con muestras litológicas y un posterior muestreo de validación. A través del procesado digital de imágenes, se obtuvieron resultados que fueron validados y arrojaron un 82% de fiabilidad en la clasificación propuesta, lo cual resulta adecuado teniendo en cuenta la diversidad de cubiertas presentes y la heterogeneidad litológica que compone a cada píxel (30 m). Además, los resultados fueron validados con mapas geológicos pre-existentes obteniendo buena concordancia.Centro de Investigaciones Geológica

Health-care organization for the management and surveillance of SARS-CoV-2 infection in children during pandemic in Campania region, Italy

Background: In comparison with adults, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection in children has a milder course. The management of children with suspected or confirmed coronavirus disease (COVID-19) needs to be appropriately targeted. Methods: We designed a hub-and-spoke system to provide healthcare indications based on the use of telemedicine and stringent admission criteria, coordinate local stakeholders and disseminate information. Result: Between March 24th and September 24th 2020, the Hub Centre managed a total of 208 children (52% males, median age, 5.2, IQR 2–9.6 years) with suspected or confirmed COVID-19. Among them, 174 were managed in cooperation with family pediatricians and 34 with hospital-based physicians. One hundred-four (50%) received a final diagnosis of SARS-CoV-2 infection. Application of stringent criteria for hospital admission based on clinical conditions, risk factors and respect of biocontainment measures, allowed to manage the majority of cases (74, 71.1%) through telemedicine. Thirty children (28%) were hospitalized (median length 10 days, IQR 5–19 days), mainly due to the presence of persistent fever, mild respiratory distress or co-infection occurring in infant or children with underlying conditions. However, the reasons for admission slightly changed over time. Conclusion: An hub-and-spoke system is effective in coordinate territorial health-care structures involved in management paediatric COVID-19 cases through telemedicine and the definition of stringent hospital admission criteria. The management of children with COVID-19 should be based on clinical conditions, assessed on a case-by-case critical evaluation, as well as on isolation measures, but may vary according to local epidemiological changes

Association between Coagulation Profile and Clinical Outcome in Children with SARS-CoV-2 Infection or MIS-C: A Multicenter Cross-Sectional Study

Limited data on the coagulation profile in children affected by the SARS-CoV-2 infection are available. We aimed to evaluate the role of d-dimers as predictors of poor outcomes in a pediatric population affected by the SARS-CoV-2 infection or multisystem inflammatory syndrome (MIS-C). We performed a retrospective cross-sectional multicenter study. Data from four different centers were collected. Laboratory tests, when performed, were collected at the time of diagnosis, and 24, 48, 72, 96, 120 and beyond 120 h from diagnosis; blood counts with formula, an international normalized ratio (INR), activated partial thromboplastin time (aPTT), D-dimers and fibrinogen values were collected. Data regarding clinical history, management and outcome of the patients were also collected. Three hundred sixteen patients with a median age of 3.93 years (IQR 0.62–10.7) diagnosed with COVID-19 or MIS-C were enrolled. Fifty-eight patients (18.3%) showed a severe clinical outcome, 13 (4.1%) developed sequelae and 3 (0.9%) died. The univariate analysis showed that age, high D-dimer values, hyperfibrinogenemia, INR and aPTT elongation, and low platelet count were associated with an increased risk of pediatric intensive care unit (PICU) admission (p < 0.01). Three multivariate logistic regressions showed that a d-dimer level increase was associated with a higher risk of PICU admission. This study shows that D-dimer values play an important role in predicting the more severe spectrum of the SARS-CoV-2 infection, and was higher also in those that developed sequelae, including long COVID-19

Reduction in broad-spectrum antimicrobial prescriptions by primary care pediatricians following a multifaceted antimicrobial stewardship program

BackgroundSince 2016, following the Italian “National Plan to Contrast Antimicrobial Resistance”, Campania Region has implemented an antimicrobial stewardship program, including the obligation to associate an appropriate International Classification of Diseases-9 code to each antibiotic prescription, the publication of schemes for empirical antibiotic therapy and educational interventions.MethodsTo evaluate the impact of these interventions on the prescribing habits of family pediatricians, we conducted a retrospective cohort study (January 2016–December 2020), including all patients registered in an associate practice of Primary Care Pediatricians. We collected data on antibiotic prescriptions through a specific study management software; our primary outcomes were the annual prescription rates, calculated for both the number of patients in follow-up and the number of medical consultations, and the annual prescription rates for selected antibiotic classes and molecules. To investigate the hypothesis that chronic conditions would be associated with an increased rate of prescription, we also tested the association between underlying conditions and the number of antibiotics received.ResultsDuring the study period, 2,599 children received 11,364 antibiotic prescriptions (mean 4.37, SD 4.28). From 2016 to 2020 we observed a substantial reduction in both the annual prescription rate per 100 patients (9.33 to 3.39; R2 = 0.927, p = 0.009), and the annual prescription rate per 100 medical consultations (25.49 to 15.98; R2 = 0.996, p &lt; 0.01). The prescription rates of Amoxicillin-Clavulanate (50.25 to 14.21; R2 = 0.983, p = 0.001) and third generation Cephalosporins (28.43 to 5.43; R2 = 0.995, p &lt; 0.01) significantly decreased; we didn't find significant modifications in the prescription rates of Amoxicillin and Quinolones; finally, we observed a trend toward reduction in the prescription of Macrolides. No statistical association was found between antibiotics prescribing frequency and history of chronic diseases.DiscussionFollowing the implementation of the regional interventions on antimicrobial stewardship, we observed a substantial reduction in the overall antibiotic prescription per patients and per medical consultations, with a statistically significant reduction in the use of broad-spectrum molecules. Considering the results of our analysis, new guidance and training interventions addressed to specialists in the primary care sector should be implemented to further limit antibiotic resistance

Retrospective Chart Review of Dabrafenib Plus Trametinib in Patients with Metastatic BRAF V600-Mutant Melanoma Treated in the Individual Patient Program (DESCRIBE Italy)

Background: Real-world data on extended follow-up of patients with BRAF V600-mutant metastatic melanoma are limited. We investigated dabrafenib plus trametinib (dab + tram) outside of a clinical trial setting (Individual Patient Program; DESCRIBE Italy). Objective: To describe the baseline features, treatment patterns, efficacy, and safety outcomes in patients with BRAF V600-mutant unresectable or metastatic melanoma who had received dab + tram as part of the Managed Access Program (MAP) in Italy. Patients and methods: An observational, retrospective chart review was conducted in Italian patients with BRAF V600-mutant unresectable stage III/IV melanoma receiving dab + tram as part of the MAP. Baseline features, treatment patterns, efficacy, and safety outcomes were evaluated. Results: Overall, 499 patients were included in this analysis. BRAF V600E mutation was seen in 81.4% of patients. Overall response rate achieved in 243 of the 390 evaluable patients was 62.3% (95% CI 57.5-67.1). Median progression-free survival (PFS) was 9.3 months (95% CI 8.6-10.6). Subgroup analyses revealed that patients with normal lactate dehydrogenase (LDH) and ≤ three metastatic sites without brain metastases at baseline had better outcomes. With normal LDH at baseline, median PFS for patients with one or two metastatic sites other than cerebral was 18 months. No new safety signals were observed. Treatment was permanently discontinued because of treatment-emergent adverse events (TEAEs) in 9.2% of patients, and pyrexia (27.3%) was the most common TEAE, with a lower incidence than that in the phase 3 studies of dab + tram. Conclusion: Treatment of BRAF V600E-mutant metastatic melanoma with dab + tram in the real-world setting was effective and safe, including the unselected population with several patients having a high tumor burden - concordant with the results of the pivotal phase 3 studies of dab + tram