Factors affecting the organization and management of emergency mass casualty events public health institutions: Lazio Region ARES experience

Background: Mass Casualty Events also referred to as Disasters, are those occurrences causing damage, ecological disruption, loss of human life or destruction of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.Methods: The study was carried out in Rome between 2008/2009 while based at Sapienza University Departmento Esperimentale at Policlinico emergency hospital. Data was collected by interviews from key professional informants in the organization and management of disasters in Lazio region referred to as Azienda Regionale di Emergenza Sanitaria (ARES) using interview guides, questionnaires and focused group discussions. Additional data on identified sites and installations was collected by the observational survey method (transect  visits/walks) around Rome installations that the authority considers prone to disasters including tourist parks and public parks, hotels, stadia, train stations and Vaticans. Observations were analyzed qualitatively. This study was approved through the institutional review board of Rome University through the Departimento Medicina Esperimentale and Departmento d’Emergenza Accetazzione (DEA). Results: Disaster Management was found to be prioritized always and effectively represented for ready intervention by prepared pre- organized multi- agency teams at every site visited. These on- scene project squads comprised a representation from the armed forces, police, fire department, medical and ambulance service all under a unified command of leadership with a specified job description. Factors identified were: Political will, human resource planning, appropriate communication utilization, time management and sufficient preparedness for disasters in Region Lazio.Conclusion: Disaster Management is a necessity since liability to disasters is open to all to humanity around the world. Factors affecting disaster management enable an efficient fore casting and prompt response to avoid worsening that chaotic situation upon disaster intervention in any affected community.Keywords: Disasters, Calamity, Catastrophes, Mass emergency Casualty events, Organizatio

Diminished presynaptic GABA(B) receptor function in the neocortex of a genetic model of absence epilepsy

Changes in GABA(B) receptor subunit expression have been recently reported in the neocortexof epileptic WAG/Rij rats that are genetically prone to experience absence seizures.These alterations may lead to hyperexcitability by downregulating the function of presynapticGABA(B) receptors in neocortical networks as suggested by a reduction in paired-pulsedepression. Here, we tested further this hypothesis by analyzing the effects induced by theGABA(B) receptor agonist baclofen (0.1-10 μM) on the inhibitory events recorded in vitro fromneocortical slices obtained from epileptic (>180 day-old) WAG/Rij and age-matched, nonepilepticcontrol (NEC) rats. We found that higher doses of baclofen were required todepress pharmacologically isolated, stimulus-induced IPSPs generated by WAG/Rij neuronsas compared to NEC. We also obtained similar evidence by comparing the effects ofbaclofen on the rate of occurrence of synchronous GABAergic events recorded by WAG/Rijand NEC neocortical slices treated with 4-aminopyridine+glutamatergic receptor antagonists.In conclusion, these data highlight a decreased function of presynaptic GABA(B) receptorsin the WAG/Rij rat neocortex. We propose that this alteration may contribute toneocortical hyperexcitability and thus to absence seizures

Bacterial Faecal Flora in Healthy Women of Different Ages

The composition of the intestinal flora is the result of host physiology, microbial interaction and environmental influences. The possible relationship between faecal flora composition and hormonal modifications in healthy women of different ages was studied. Forty-four normal women were divided into the following groups according to age: group I, 2747 yr; group II, 50-55 yr, 5 yr after menopause. The subjects received no pharmacological treatment. Samples were collected on the 8th and 23rd day of the cycle; two samples were obtained from each postmenopausal woman. Qualitative and quantitative determination of microorganisms was carried out using slightly modified standard methods. In fertile women (group I), the microflora composition was similar for samples collected on the 8th-10th day and during the premenstrual period (23rd day). In postmenopausal women (group III), an increase in fungi, clostridia and aerobic lactobacilli mean concentrations were observed. Escherichia coli mean levels increased and Enterobacteriaceae such as Enterobacter cloacae and Citrobacter freundii were present in 80 per cent of subjects studied. The length of menopause was found to have only a slight influence on flora: the behaviour of the microflora composition in menopausal women in group II may be considered intermediate between groups I and III. This preliminary study demonstrates that there are fluctuations in the composition of the faecal flora in healthy women. The differences observed between premenopausal and postmenopausal women may be a consequence of modifications of the steroid sex hormone pattern.Keywords - Intestinal flora; Age; Premenopausal women; Postmenopausal women; Menopause

Cytoplasmic and nuclear events controlling Tax-mediated activation of the NF-κB pathway: involvement of TAB2, IKKgamma/NEMO and calreticulin

The Tax oncoprotein of HTLV-1 initiates T-cell transformationby dysregulating cell cycle progression andinhibiting DNA damage responses. The subsequentgenomic instability might result in constitutive activationof the NF-B pathway observed in HTLV-1-transformedT lymphocytes. Our previous results indicatedthat differential modifications of Tax by ubiquitinationor sumoylation controlled its retention either in thecytoplasm or in the nucleus, respectively. Here we showthat Tax is targeted to pre-existing punctate cytoplasmicstructures which contain the TNF-receptor associatedprotein 2 (TAB2)

Emergency Department as an epidemiological observatory of Human Mobility: the experience of the Moroccan population

We conducted a retrospective study of the accesses to the Emergency Department registered from January 2000 to December 2014 in 5 major hospitals in the Metropolitan Area of Rome. We extrapolated data relating to patients of Moroccan origin from about 5 million total accesses, so we compared with Italians data which, in the same period, came to ED. The Moroccan population is distinguished by a larger number of diagnoses belonging to the ICD-9 code of Infectious Diseases and, more precisely, to Respiratory Infectious Diseases. There are also no differences in the assignment of such diagnoses to Moroccans with Italian citizenship, and this led to think that this could play an important role in the use of the ED and moreover that enrollment to the National Health Service may reduce its inappropriate use. Regarding to Degenerative Disorders, the result of our analysis is quite emblematic, showing that the accesses to the ED is due to Cardiovascular Diseases: 6.33% of Italians' accesses against 1.81% of Moroccans and 2.36% of Moroccans with Italian citizenship. The main explanation for this difference is, obviously, due to the age of the population: about 60% of Moroccans who accessed to ED was less than 40 years old. It is interesting how, in the field of ​​Cardiovascular Diseases, Moroccans have a lower percentage of diagnosis compared to Italians for acute diseases and a greater percentage of diagnoses for chronic diseases, suggesting once again that accesses to ED for migrants often is due to the inability to use the general services of the National Health Service. In conclusion, from the point of view of the Emergency Department, Migration Medicine still has Infectious Diseases as the main reason for access. Degenerative Disorders remain a prerogative of the Italians, but we could certainly assume that the Moroccan population would develop at some point with the aging

IKKepsilon involvement in Tax-mediated activation of INF pathway

HTLV-1 Tax de-regulates several cellular signaling pathways leading to cell transformation by altering gene expression, intracellular protein distribution and cell proliferation. Tax-1 induces persistent activation of several transcriptional factors and signal transduction pathways, including NF-\u3baB and CREB/ATF. It is known that Tax-1 constitutively activates TAK1 (transforming growth factor-\u3b2-activated kinase 1) and modifies the interferon (INF) regulatory signals by controlling the expression of INF transcription factors 3 (INF3) and INF4. We have recently reported that HTLV-1 and HTLV-2 Tax proteins interact with TAK1-binding protein 2 (TAB2) of the NF-\u3baB pathway and that both Tax proteins transactivate NF-\u3baB promoters [1]. TAB2 functions as an adaptor protein to recruit TAK1 to TRAF2 (TNF-\u3b1 receptor-associated factor) in TNF-\u3b1 signaling pathways. In the present study we have investigated Tax-1 and Tax-2 role in modifying INF and NF-\u3baB activation through the recruitment of IKKepsilon, an I\u3baB kinase homologue involved in NF-\u3baB and INF3 signaling pathways. By co-immunoprecipitation experiments, we have found that both IKKepsilon and Tax-1, but not Tax-2, are present in protein complexes in transfected cells. IKKepsilon and Tax-1 or Tax-2 role in the activation of INF responsive elements or NF-\u3baB containing promoters have been analyzed after transfecting the protein genes in 293T cells and measuring the effect by luciferase assay. Co-expression of Tax-1 and IKKepsilon resulted in an increased IRF activation mediated by IKKepsilon. Interaction of IKKepsilon with Tax-1 and Tax-2 and their possible effects in the de-regulation of the IRF3 pathways will be discussed

Interplay between Nox2 activity and platelet activation in patients with sepsis and septic shock. a prospective study

Background. Although preclinical studies highlighted the potential role of NADPH oxidase (NOX) in sepsis, only few studies evaluated the oxidative stress in patients with sepsis and septic shock. The objective of the study is to appraise the oxidative stress status and platelet function in patients with sepsis and septic shock compared to healthy controls. Methods and Results. Patients with sepsis or septic shock admitted to the hospital Policlinico Umberto I (Sapienza University, Rome) underwent a blood sample collection within 1 hour from admission. Platelet aggregation, serum thromboxane B2 (TxB2), soluble NOX2-derived peptides (sNox2-dp), and hydrogen peroxide breakdown activity (HBA) were measured and compared to those of healthy volunteers. Overall, 33 patients were enrolled; of these, 20 (60.6%) had sepsis and 13 (39.4%) septic shock. Compared to healthy controls (n=10, age 67.8±3.2, male 50%), patients with sepsis and septic shock had higher platelet aggregation (49% (IQR 45-55), 60% (55.75-67.25), and 73% (IQR 69-80), respectively, p<0.001), higher serum TxB2 (77.5 (56.5-86.25), 122.5 (114-131.5), and 210 (195-230) pmol/L, respectively, p<0.001), higher sNox2-dp (10 (7.75-12), 19.5 (17.25-21), and 33 (29.5-39) pg/mL, respectively, p<0.001), and lower HBA (75% (67.25-81.5), 50% (45-54.75), and 27% (21.5-32.5), respectively, p<0.001). Although not statistically significant, a trend in higher levels of serum TxB2 and sNox2-dp in patients who died was observed. Conclusions. Patients with septic shock exhibit higher Nox2 activity and platelet activation than patients with sepsis. These insights joined to better knowledge of these mechanisms could guide the identification of future prognostic biomarkers and new therapeutic strategies in the scenario of septic shock

Bacterial faecal flora in healthy women of different ages.

The composition of the intestinal flora is the result of host physiology, microbial interaction and environmental influences. The possible relationship between faecal flora composition and hormonal modifications in healthy women of different ages was studied. Forty-four normal women were divided into the following groups according to age: group I, 27–41 yr; group II, 50–55 yr, 5 yr after menopause. The subjects received no pharmacological treatment. Samples were collected on the 8th and 23rd day of the cycle; two samples were obtained from each postmenopausal woman. Qualitative and quantitative determination of microorganisms was carried out using slightly modified standard methods. In fertile women (group I), the microflora composition was similar for samples collected on the 8th—10th day and during the premenstrual period (23rd day). In postmenopausal women (group III), an increase in fungi, clostridia and aerobic lactobacilli mean concentrations were observed. Escherichia coli mean levels increased and Enterobacteriaceae such as Enterobacter cloacae and Citrobacter freundii were present in 80 per cent of subjects studied. The length of menopause was found to have only a slight influence on flora: the behaviour of the microflora composition in menopausal women in group II may be considered intermediate between groups I and III. This preliminary study demonstrates that there are fluctuations in the composition of the faecal flora in healthy women. The differences observed between premenopausal and postmenopausal women may be a consequence of modifications of the steroid sex hormone pattern

Platelet activation is associated with myocardial infarction in patients with pneumonia

BACKGROUND: Troponins may be elevated in patients with pneumonia, but associations with myocardial infarction (MI) and with platelet activation are still undefined.OBJECTIVES: The aim of this study was to investigate the relationship between troponin elevation and in vivo markers of platelet activation in the early phase of hospitalization of patients affected by community-acquired pneumonia.METHODS: A total of 278 consecutive patients hospitalized for community-acquired pneumonia, who were followed up until discharge, were included. At admission, platelet activation markers such as plasma soluble P-selectin, soluble CD40 ligand, and serum thromboxane B2 (TxB2) were measured. Serum high-sensitivity cardiac troponin T levels and electrocardiograms were obtained every 12 and 24 h, respectively.RESULTS: Among 144 patients with elevated high-sensitivity cardiac troponin T, 31 had signs of MI and 113 did not. Baseline plasma levels of soluble P-selectin and soluble CD40 ligand and serum TxB2 were significantly higher in patients who developed signs of MI. Logistic regression analysis showed plasma soluble CD40 ligand (p < 0.001) and soluble P-selectin (p < 0.001), serum TxB2 (p = 0.030), mean platelet volume (p = 0.037), Pneumonia Severity Index score (p = 0.030), and ejection fraction (p = 0.001) to be independent predictors of MI. There were no significant differences in MI rate between the 123 patients (45%) taking aspirin (100 mg/day) and those who were not aspirin treated (12% vs. 10%; p = 0.649). Aspirin-treated patients with MIs had higher serum TxB2 compared with those without MIs (p = 0.005).CONCLUSIONS: MI is an early complication of pneumonia and is associated with in vivo platelet activation and serum TxB2 overproduction; aspirin 100 mg/day seems insufficient to inhibit thromboxane biosynthesis. (MACCE in Hospitalized Patients With Community-acquired Pneumonia; NCT01773863)