Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Effect of 8-week n-3 fatty-acid supplementation on oxidative stress and inflammation in middle- and long-distance running athletes: a pilot study

Background: Long-chain n-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), may alter oxidative status and immune function after exercise. The aim of this pilot study was to determine the probable association between n-3 supplementation and physical exercise, observing the variations in markers of oxidative stress and inflammation. Methods: Thirty-nine subjects of both sexes aged 17–30 years were divided into two groups: 1) (n = 21) trained Athletes; 2) (n = 18) Sedentary subjects. All subjects were given about 4 g/day of n-3 supplementation, rich in EPA and DHA, for 8 weeks. Blood, saliva and urine samples were collected pre- (T0) and post- (T1) supplementation. Hematological parameters (tryglicerides, total cholesterol, HDL, CPK, LDH, HGH, IGF-1), oxidative markers (MDA, 8-OHdG, PCc), antioxidant parameters (GPx, SOD, CAT, DPPH scavenger), exercise-induced stress markers (testosterone and cortisol) and an inflammatory marker (TNF-α) were measured. All tests were two-sided and a p-value of less than 0.05 was considered as statistically significant. Results: The results showed that MDA and TNF-αmean values significantly decreased after supplementation in both Athletes and Sedentary subjects: variation was greater in Athletes than in Sedentary control subjects. Generally, our results suggested that supplementation with n-3 PUFAs created a synergic variation in the parameters from a baseline state (T0) to a treated state after supplementation (T1), in terms of size and modality, which was significantly different in Athletes compared to Sedentary subjects. Conclusion: In conclusion, supplementation with about 4 g/day of n-3 PUFAs, rich in EPA and DHA, for 8 weeks, seemed to be effective in counteracting some parameters involved in oxidative stress and inflammation, induced by acute strenuous physical exercise

In vitrotemperature dependent activation of T-lymphocytes in Common wall lizards (Podarcis muralis) in response to PHA stimulation

Ecological immunology attempts to explain the variability of immune response among individuals by invoking costs and trade-offs, which may optimize the immune defence against pathogens. In ectotherms body temperature is correlated to that of the surrounding environment, so that their entire physiology, including immune functions, is influenced by the environmental temperature. We used in vitro phytohaemoagglutinin (PHA) stimulation in order to assess the effects of temperature on cell mediated adaptive response in male and female Common wall lizards (Podarcis muralis). Cell cultures were prepared from blood samples, inoculated with PHA and incubated at 22°C, 25°C, 32°C, and 38°C for three days. PHA stimulation caused proliferation of T-lymphocytes, but the effect depended on the incubation temperature. Lymphocyte proliferation was significantly impaired at both 22°C and 38°C compared to 32°C, which represented the highest levels of activation. Furthermore, lymphocyte activation was more variable in males while females were less immune suppressed than males at low temperatures. Differences between sexes suggest a possible influence of steroid hormone

Studio di Fattibilità Operativa del Distretto Culturale dell'Oltrepo Mantovano

Lo studio di Fattibilità, finanziato da Fondazione Cariplo attraverso il bando "Distretti Culturali", riguarda la realizzazione di un Distretto Culturale nell'area dell'Oltrepo Mantovano. Situato nella zona più occidentale della Lombardia, il territorio dell’Oltrepò Mantovano si connota quale “luogo di confine”, spazio della contaminazione tra usi e tradizioni della cultura lombarda ed emiliano-veneta. L’attraversamento del fiume Po ha conformato i caratteri ambientali, paesaggistici e insediativi di questi luoghi, segnando un’identità culturale che ancora permea un’area vasta. Una identità ricca e articolata che si mostra nel permanere di numerose testimonianze fisiche - dalle grandi emergenze monumentali (il “Polirone” e i manufatti degli itinerari gonzaghesco e matildico...), al patrimonio diffuso degli insediamenti rurali (corti, mulini, canali, fossati, rogge, aree golenali, opere idrauliche e di bonifica...) - , ma anche nella realtà degli usi, dei modi del vivere e della memoria collettiva. Il profilo orizzontale “d’acqua” della Bassa Padana, luoghi memori di una difficile transizione dal mondo rurale e artigianale all’economia della produzione industriale: il paesaggio del “Grande Fiume” come “paesaggio del 900”, straordinariamente impresso nella figurazione di autori quali Bacchelli, Celati, Antonioni, Bertolucci, Zavattini, Ligabue, Ghirri... In un territorio così ricco, ma anche gravato oggi dalle criticità indotte da una fase di profonda trasformazione socioeconomica, la definizione di una realtà distrettuale perimetrata su una precisa identità culturale non poteva che fondarsi sull’individuazione di obiettivi e strategie d’azione fortemente condivisi e partecipati dalla comunità locale. Il processo progettuale, articolato per fasi, ha infatti coinvolto una pluralità di soggetti attivi sul territorio (pubbliche amministrazioni, imprese, associazioni di categoria e di volontariato, scuole, ecc.), che hanno cooperato al fine di: 1. individuare ed esprimere una vision in grado di veicolare i valori simbolici e culturali che costruiscono l’identità del Distretto; 2. delineare una strategia di azione, precisando le priorità di intervento in funzione dei valori, delle idee e delle aspettative del territorio; 3. tradurre la strategia in obiettivi e azioni, verificandone la fattibilità; 4. programmare operativamente gli interventi con riferimento alla conservazione per la valorizzazione del patrimonio culturale - tangibile e intangibile - del Distretto, al fine di attivare processi di integrazione socio-economica tra diversi settori produttivi. L’azione progettuale ha accompagnato la comunità locale nella messa a fuoco di una idea guida per la costruzione dell’identità del Distretto: tale vision legge il territorio attraverso l’immagine di “Riserva del ‘900”, selezionando luoghi, paesaggi, inquadrature, manufatti e insediamenti in grado di restituire una fisionomia del territorio fortemente connotata – in alcuni contesti ancora pressoché immutata – dai caratteri della “novecentitudine” dell’Italia agricola e proto-industriale. Priorità strategica del piano d’azione è quindi la “messa in scena del ‘900” in funzione di due obiettivi: • tutelare l’immagine del territorio conservando il patrimonio culturale identitario - materiale e simbolico -, e potenziandone i livelli di accessibilità e fruibilità; • attivare processi integrati di valorizzazione finalizzati a supportare una rivitalizzazione del tessuto socio-economico, anche quale garanzia della sostenibilità dei processi di conservazione