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

Building therapeutic relationship in schizophrenic and alcohol-related disorder cases

Current literature on the dual diagnosis in cases of schizophrenia and alcohol dependence has reported how pharmacological treatment has positive effects on the reduction of both disorders. Nevertheless, patients have considerable difficulties in following the prescribed medication. This work aims to build an engagement stage and therapeutic relationship in seven patients with schizophrenic and alcohol-related disorder cases. This result was achieved through the use of the vignette technique and narrative psychodynamic approach during group counselling sessions. Positive and Negative Symptoms Scale (PANSS) and Munich Alcoholism Test (MALT) were applied before and after treatment. A follow-up session was organized. The PANSS and MALT scores indicated there was no reduction of the psychiatric symptoms after treatment. The follow-up session showed positive outcomes in terms of increasing the level of socialisation as well as awareness of their own condition; at the same, an adherence to pharmacological treatment and psychotherapy for all the subjects

The Automated External Defibrillator : Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival

The Automated External Defibrillator : Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled "European Study about AED Use by Lay Rescuers " (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12-59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0-7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.Peer reviewe

Contrast-enhanced ultrasound assessment of arterial vascularization of small nodules arising in the cirrhotic liver

Aim of this study was to compare contrast-enhanced ultrasound and multi-detector row computed tomography in detecting arterial hypervascularity in small cirrhotic nodules

The automated external defibrillator: Heterogeneity of legislation, mapping and use across europe. new insights from the ensure study

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey re-quest for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was re-flected in different AED use and survival

Cronache meridionali. A. I, n.1-12 (1954)

N. 1 (gennaio 1954): La direzione: ai lettori, P. 1 ; De Martino, F., La Costituzione e il Mezzogiorno, P. 3 ; Miceli, G., e L. De Luca, Difesa del suolo e Cassa del Mezzogiorno in Calabria, P. 13 ; Chiaromonte, G., Primo bilancio d'elle leggi per la industrializzazione, P. 18 ; Amendola, G.,Tesseramento 1954, P. 33 ; Silipo, L., L'alluvione in Calabria, P. 37 ; Cimino, M., La crisi dell'industria zolfiera siciliana, P. 43 ; Sereni, E., Il Mezzogiorno e la C. E. D., P. 48 ; Amendola, G., Una politica unitaria per il Nord e per il Sud, P. 54 ; Bianco, M., Il Mezzogiorno in Parlamento, P. 57 ; Lapiccirella. R., Il conglobamento dei salari, P. 59 ; Alicata, M., Patti agrari, riforma fondiaria e attività degli Enti, P. 61 ; Sansone, N., Due dibattiti sulla cultura meridionale, P. 64 ; Chiaromonte, G., Dalla stampa, P. 65 ; Alicata, M., Carlo Scarfoglio: Il Mezzogiorno e l'Unità d'Italia, P. 68 ; Bertoli, G., Friedrich Vochting: Die italienische Siidfrage, P. 70 ; Arfè, G., Camillo Di Cavour (Carteggio di). La liberazione del Mezzogiorno e la formazione del Regno d'Italia, P. 75 Nitti, F. S., Acqua e boschi in Calabria e Basilicata, P. 77.N. 2 (febbraio 1954): Lussu, E., e E. Spano: Il brigantaggio in Sardegna, P. 81 ; Maglietta, C., : Contratti di lavoro e leggi sociali nelle industrie meridional, P. 95 ; Assennato, M., La crisi delle libere professioni in Puglia, P. 101 ; Alicata, M., Miseria e nobiltà, P. 113 ; Cimino, M., La scoperta del petrolio siciliano, P. 116 ; Sotgiu, G., Cinque anni di vita della Regione sarda, P. 120 ; Franco, P., La legge stralcio in Lucania, P. 124 ; Amendola, G., L'inverno e la crisi, P. 139 ; Lapiccirella, R., La «sottoretribuzione» delle donne lavoratrici, P. 141 ; Alicata, M., Lotte e successi delle raccoglitrici di olive, P. 144 ; Sansone, N., L'inaugurazione del San Ferdinando, P. 146 ; Chiaromonte, G., Dalla stampa, P. 149 ; Villari, R., Ruggero Moscati: Il Mezzogiorno d'Italia nel Risorgimento ed altri saggi, P. 152 ; Alicata, M., Carlo Montella: I parenti del Sud, P. 155 ; Colajanni, N., I "fasci dei lavoratori" e le Amministrazioni locali, P. 157.N. 3 (marzo 1954): Grieco, R., Nel LX anniversario dei fasci siciliani, P. 161 ; Vitale, G., Crisi agraria e riforma contrattuale, P. 172 ; Ricci, P., Nuovi contenuti nella letteratura e nell' arte del Mezzogiorno, P. 182 ; Alicata, M., Miserie e nobiltà, P.192 ; Speciale, G., La tragedia di Mussomeli, P. 195 ; Levrero, S., Case e lavoro a Napoli, P. 200 ; Spallone, G., Inverno abruzzese, P. 203 ; Sinibaldo, T. , La morte di Pisciotta, P. 209 ; De Martino, F., Un governo debole e pericoloso, P. 220 ; Lamanna, G., La conferenza nazionale degli assegnatari- degli enti di riforma, P. 223 ; Cassese, L., Giuseppe Masi: Le origini della borghesia lucana ; Cassese, L., Rosario Villari: Rapporti economico-sociali nelle campagne meridionali nel secolo XVIII, P. 229 ; Villani, P., Giorgio Wenner: L'industria tessile salernitana dal 1824 al 1918, P. 233 ; Vitale, G., Inea-Svimez: L'economia dell' olio - La struttura dell' industria olearia nel Mezzogiorno, P. 235 ; Fucini, R., I tuguri di Napoli, P. 237.N. 4 (aprile 1954): Cacciapuoti, S., Alcuni aspetti della condizione umana degli operai napoletani, P. 241 ; Bianco, M., La Cassa per il Mezzogiòmo in Lucania, P. 252 ; Ovazza, M., e N. Colajanni, Il monopolio elettrico e l'ente siciliano di elettricità, P. 259 ; Alicata, M., Miserie e nobiltà, P. 268 ; Silipo, L., Gli assegnatari dell'Ente Sila, P. 273 ; Montalbano, G., Riforma dmministrativa e legge elettorale in Sicilia, P., 277 ; Scionti, R., La legge stralcia in Puglia, P. 281 ; Il rapporto dell'e.c.e. BuI Mezzogiorno, P. 291 ; Amendola, G., L'alleanza di Castellammare, P. 296 ; Grifone, P., Un successo dei contadini nella lotta per le assicurazioni sociali, P. 298 ; Il bilancio di un comune meridionale, P. 301 ; Dalla stampa, P. 306 ; Villari, R., Carmelo Caristia: Teoria e prassi politica nella rivoluzione siciliana del 1848, P. 311 ; Amendola, G., Tommaso Pedio: Le lettere di Giustino Fortunato a Ettore Ciccotti, P. 312 ; Chiaromonte, G., Carlo Rodanò: Mezzogiomo e sviluppo economico, P. 314 ; Franchetti, L., I patti agrari in Basilicata e in Calabria 318.N. 5 (maggio 1954): L'umanità ad una svolta, P. 321 ; Labriola, A., Primo Maggio 1890 a Napoli, P. 324 ; Regis, G., Il commercio estero e l'economia meridionale, P. 330 ; Spezzano, F., I comuni rioieraschi e la S. M. E., P. 340 ; Sotgiu, G., La soluzione della crisi regionale sarda, P. 349 ; Lapiccirella, R., L'Ilva di Bagnoli, la Navalmeccanica e la riorganizzasione dell' I. R. I., P. 349 ; De Martino, F., Sotto l'etichetta centrista, P. 363 ; Bianco, M., Il bilancio dei lavori pubblici al. Senato, P. 365 ; Mastroianni G., Francesco Zerrella: L'eclettismo francese e la cultura filosofica meridionale nella prima metà ael secolo XIX, P. 371 ; Piromalli, A., Paolo Apostoliti: Scrittori calabresi del novecento, P. 373 ; Due corrispondenze dal Cilento: I contadini- L'emigrazione, P. 377 ; Il resoconto dei lavori dell'Assemblea del Comitato Nazionale per la Rinascita del Mezzogiorno, P. 384.N. 6 (giugno 1954): Togliatti, P., L'azione democratica e socialista nel Mezzogiorno, P. 401 ; Pirastu, I., Briganti e forze di polizia in provincia di Nuoro, P. 426 ; Giudiceandrea, G., Democrazia e problemi della produzione in Sila, P. 431 ; Lalli, R., La scuola e maestri nel Molise, P. 435 ; De Martino, F., 'La crisi del partito' monarchico, P. 451 ; Bianco, M., Il bilancio dell'agricoltura alla Camera, P. 454 ; Renda, F., Il convegno di Palermo sulla industrializzazione del Mezzogiorno, P. 456 ; Dalla stampa, P. 461 ; Alicata, M., Gabriele Pepe: Pane e terra nei Sud, P. 463 ; Alicata, M., Vittore Fiore: Ero- nato sui mari del tonno, P. 465 ; Villari, R., Danilo Dolci: Fare presto (e bene) perché si muore, P. 466 ; Chiaromonte, G., A. N. I. D. E. L., Relazione del Consiglio all’Assemblea dei soci, P. 468 ; La convenzione democratica per la riforma dei patti agrari, P. 473.N. 7-8 (luglio-agosto 1954): Per una Ia vera Europa, P. 481 ; Napolitano, G., Problema demografico e sviluppo economico, P. 484 ; Tosi, D., L'industria delle conserve vegetali, P. 495 ; Viviani, L., I bambini di Napoli, P. 507 ; Amiconi, N., Il Convegno abruzzese-molisano per la montagna, P. 514 ; De Falco, N., La situazione edilizia di Taranto, P. 522; Formiggini, G., La lotta per la realizzazione della riforma agraria in Sicilia, P. 526 ; Amendola, G., La Democrazia cristiana nel Mezzogiorno, P. 538 ; Bianco, M., La conclusione della sessione parlamentare, P. 542 ; Vitale, G., Lotte nelle campagne per la riforma contrattuale, P. 544 ; Villari, R., Giovanni Cottone: Giùstino Fortunato, P. 550 ; Chiaromonte, G., Ferdinando Rocco: Scritti e discorsi, P. 553 ; Villari, R., Leonida Repaci: Un riccone torna alla terra, P. 556 ; Le «Lettere napoletane» di Antonio Labriola, P. 558.N. 9 (settembre 1954): Alicata, M., Il meridionalismo non si può fermare ad Eboli, P. 585 ; Peggio, E., “Aree depresse” e politica imperialistica, P. 604 ; Alinovi, A., L'avvenire di Resina "mercato degli stracci”, P. 620 ; Silipo, L., La lotta per la riforma dei contratti agrari in Calabria, P. 625 ; Roxas, C., Il processo dei "carusi” di Lercara, P. 629 ; De Martino, F., Un governo che non pùò sopravvivere, P. 640 ; Ricci, P., La seconda rassegna delle arti figurative nel Mezzogiorno, P. 642 ; Chiaromonte, G., Salvatore Tramonte: Sviluppo economico e industrializzazione del Mezzogiorno, P. 650 ; Napolitano, G., Aldo De Jaco: Le domeniche di Napoli, P. 652 ; Tedesco, N., Ignazio Buttitta: Lu pani si chiama pani, P. 653 ; Colajanni, N., Mafia e politica, P. 659.N. 10 (ottobre 1954): Amendola, G., La lezione di Salerno, P. 655 ; Secchia, P., Il significato e il valore delle quattro giornate, P. 669 ; Boeri, E., Le quattro giornate di Napoli e la resistenza, P. 677 ; Romagnoli, L., I salari agricoli nel Mezzogiorno, P. 681 ; Francavilla, C., La Fiera del Levante, P. 690 ; Manzione, G., Tre anni di vita dell'Ente riforma nella Valle del Sele, P. 694 ; Esposito, V., La crisi della pesca in Sicilia, P. 699 ; Napolitano, G., Il congresso internazionale sulle aree arretrate, P. 703 ; Spezzano, Imposte e autonomia nei comuni, P. 712 ; Avolio, G. Enti di riforma e disdette, P. 714 ; Bologna, F. La mostra del ritratto storico napoletano, P. 718 ; Grifone, P. Annuario dell'Agricoltura 1953, P.727 ; Freda, I., Dina Bertoni Jovine: Storia della scuola popolare in Italia, P. 731 ; Resoconto dei lavori dell'assemblea del Comitato nazionale per la Rinascita del Mezzogiorno, P. 736.N. 11-12 (novembre-dicembre 1954): Saluto ai delegati del II Congresso del popolo meridionale, P. 745 ; Lo sviluppo democratico del Mezzogiorno dal 1944 al 1954, P. 747 ; Amendola, P., Le responsabilità del disastro nel Saiemitano, P. 790 ; Montalbano, G., Alluvioni e legislazione idraulica, P. 806 ; Fiore, T., Taranto non vuol morire, P. 811 ; Esposto, E., La legge sul Fùcino, P. 847 ; Valenzi, M., I monopoli all' assalto di Ischia, P. 853 ; Conti, E., Presente e avvenire di Reggio Calabria P. 857 ; Vitale, G., La giornata nazionale del contadino, P. 866 ; Assennato, M., Michele Viterbo: La Puglia e il suo Acquedotto, P. 873 ; Pirastu, L., Franco Cagnetta: Inchiesta su Orgosolo, P. 878 ; I problemi del lavoro nel Mezzogiorno d'Italia, P. 883

A machine-learning parsimonious multivariable predictive model of mortality risk in patients with Covid-19

The COVID-19 pandemic is impressively challenging the healthcare system. Several prognostic models have been validated but few of them are implemented in daily practice. The objective of the study was to validate a machine-learning risk prediction model using easy-to-obtain parameters to help to identify patients with COVID-19 who are at higher risk of death. The training cohort included all patients admitted to Fondazione Policlinico Gemelli with COVID-19 from March 5, 2020, to November 5, 2020. Afterward, the model was tested on all patients admitted to the same hospital with COVID-19 from November 6, 2020, to February 5, 2021. The primary outcome was in-hospital case-fatality risk. The out-of-sample performance of the model was estimated from the training set in terms of Area under the Receiving Operator Curve (AUROC) and classification matrix statistics by averaging the results of fivefold cross validation repeated 3-times and comparing the results with those obtained on the test set. An explanation analysis of the model, based on the SHapley Additive exPlanations (SHAP), is also presented. To assess the subsequent time evolution, the change in paO2/FiO2 (P/F) at 48 h after the baseline measurement was plotted against its baseline value. Among the 921 patients included in the training cohort, 120 died (13%). Variables selected for the model were age, platelet count, SpO2, blood urea nitrogen (BUN), hemoglobin, C-reactive protein, neutrophil count, and sodium. The results of the fivefold cross-validation repeated 3-times gave AUROC of 0.87, and statistics of the classification matrix to the Youden index as follows: sensitivity 0.840, specificity 0.774, negative predictive value 0.971. Then, the model was tested on a new population (n=1463) in which the case-fatality rate was 22.6%. The test model showed AUROC 0.818, sensitivity 0.813, specificity 0.650, negative predictive value 0.922. Considering the first quartile of the predicted risk score (low-risk score group), the case-fatality rate was 1.6%, 17.8% in the second and third quartile (high-risk score group) and 53.5% in the fourth quartile (very high-risk score group). The three risk score groups showed good discrimination for the P/F value at admission, and a positive correlation was found for the low-risk class to P/F at 48 h after admission (adjusted R-squared=0.48). We developed a predictive model of death for people with SARS-CoV-2 infection by including only easy-to-obtain variables (abnormal blood count, BUN, C-reactive protein, sodium and lower SpO2). It demonstrated good accuracy and high power of discrimination. The simplicity of the model makes the risk prediction applicable for patients in the Emergency Department, or during hospitalization. Although it is reasonable to assume that the model is also applicable in not-hospitalized persons, only appropriate studies can assess the accuracy of the model also for persons at home