Atypical Presentation of Acute Coronary Syndrome-Not ST Elevation: A Case Report

We describe the unexpected case of a 70-year-old man, with medical history of ischemic heart disease and surgery for aneurysm of abdominal aorta, who comes to the emergency department complaining of low-back pain without other symptoms or signs of organic failure. After a few hours we see a deterioration of physical conditions with pulmonary oedema, increase of blood pressure, changing in the ECG pattern, and worsening of left ventricular function with progressive increase of biomarkers for myocardial necrosis. So this pain has revealed the premature symptom of an acute coronary syndrome (ACS). After a short time a subsequent cardiac arrest complicates the clinical situation. After resuscitation, the patient undergoes successfully to coronary angiography and performed a percutaneous transluminal coronary angioplasty (PTCA)

The Augustan Aqueduct of Capua and its Historical Evolution

Augustus built at his own expense an aqueduct, known as Aqua Iulia, for Capua, located in today’s Campania region of Southern Italy, which was in Roman times one of the most important civitas of the empire. The course of this aqueduct and of its likely branches destined to two small towns, Saticula and Calatia, is hypothesized, in part based on the re-use, in the seventeenth century, of about 8 miles of the ancient aqueduct for another water supply to serve Naples, namely the Carmignano aqueduct. Then, it is described the subsequent transformation, in the eighteenth century, of the new water supply along a new route at a higher altitude, in a third water supply to serve the Bourbon royal palace of Caserta, a magnificent construction built in the same years. In short, the historical evolution of the Augustan aqueduct of Capua is discussed in the framework of the served communities and of the organization and history of the territory crossed, so showing the richness of information that may be obtained by an integrated study of the transformation over time of an important water infrastructure

L’acquedotto augusteo del Serino nel contesto del sistema viario e delle centuriazioni del territorio attraversato e delle civitates servite

L’acquedotto augusteo del Serino è qui descritto non tanto nelle sue caratteristiche tecniche ma nel suo inquadramento nel contesto del territorio attraversato. L’articolo evidenzia quali città (civitates) o insediamenti erano serviti e perché altre civitates erano escluse. Sono inoltre accennate le strade principali e le centuriazioni delle zone attraversate. Ciò permette di valutare in modo chiaro e immediato come grandiose opere quali l’acquedotto augusteo non erano monumenti isolati ma integrati in un contesto di governo e organizzazione del territorio assai capillare, esteso e organizzato

Psychological implications of abortion: a longitudinal study on two cohorts of women who recur to elective and therapeutic abortion

Objective. The aim of this work was to identify risk predictors of a negative psychological outcome among personal, situational and systemic characteristics of women who choose to interrupt a pregnancy by elective (e.g., not feeling ready for giving birth) or therapeutic means (e.g., fetal abnormalities). Methods. A prospective study on two cohorts were conducted and focused on a group of women: the first recurred to elective abortion (VTP) (n=20) and the second recurred to therapeutic abortion (TTP) (n=30). The psychological distress was measured before and after abortion through the administration of two psychometric tests: SCL-90-r and CES-D. Dependent samples t-test was used to evaluate the tendency of the two cohorts’ mean scores before and after abortion; repeated measures analysis of variance (ANOVA) was used to analyze the variance of mean scores of subgroups isolated for variables of interest before and after abortion. Results. After the termination of pregnancy, in VTP a significant decrease between t-0 and t-1 mean score (p<0.05) was observed in all SCL90-r’s global scores and subscales: GSI (p=0.036), PST (p=.031), PSDI (p=0.004), SOM (p=0.009), DEP (p=0.032), ANX (p=0.036) and even in CES-D score of DEP (p=0.017) and SOM (p=0.011) subscales. In TTP a relevant decrease was found in SCL-90’s SOM (p=0.023) and ANX, (p=0.016) subscales and in CES-D total score (p=0.020), POS (p=0.014) and SOM (p=0.09)subscales. In VTP group presence of partner support and absence of relational problems resulted as protective factors from a worse outcome. Conclusion. The results of this study suggest that, following an induced abortion, women experienced a significant improvement in the mood state compared to the period before the event; poor partner support and relational problems related with the abortion emerged as risk factors for a significantly worse psychological outcome compared to other causes interruption of pregnancy

Prominent Features of the Augustan Aqueduct in the Naples Bay Area

The great Aqua Augusta aqueduct served the Naples Bay area with fresh water during the time of the Roman Empire. There are very prominent features of the Aqua Augusta, some that are truly unique when considering other great aqueducts in the Roman Empire. Each one of these features was engineered to provide water to the public for various uses. The structures include tunnels (with two major types of construction), hydraulic chutes, arcades (one to an island), baths (located along a well-travelled road), and storage reservoirs. Also, there is the epigraph discovered at the water source. Important villas that may have influenced the alignment of the aqueduct are also discussed

Prominent features of the Augustan aqueduct in the Naples Bay area

The great Aqua Augusta served the Naples Bay area with fresh water during the time of the Roman Empire. There are very prominent features of the Aqua Augusta, some that are extraordinary when considering other great aqueducts in the Roman Empire. For example, the deep tunnels allowed access to a spring water source from a separate watershed, which resulted in transbasin diversion of the water supply. Each one of the prominent features was engineered to provide water to the public for various uses. The prominent structures included other shallower tunnels (with two major types of construction), hydraulic chutes, arcades (one to an island), baths (located along a well-traveled road), and storage reservoirs. Also, there is the epigraph discovered at the water source. Important villas that may have influenced the alignment of the aqueduct are also discussed

Albiglutide efficacy and safety in the Latino/Hispanic subpopulation for the integrated phase III program

<p><b>Objective</b>: to evaluate the efficacy and safety of albiglutide compared with placebo and active comparators from an integrated trial subpopulation of Latino/Hispanic patients whose type 2 diabetes mellitus (T2DM) was inadequately controlled on their current regimen of diet and exercise, with or without oral antidiabetic drugs (OADs) and/or insulin.</p> <p><b>Methods</b>: Latino/Hispanic patient subpopulations (N = 1204) across 7 phase III albiglutide studies (N = 4400) were evaluated post-hoc for efficacy and safety. Comparators were placebo, sulfonylureas, insulin, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors. Glycatedhemoglobin (HbA_1c) change from baseline to the time of the primary endpoint assessment (from 26 to 104 weeks) was evaluated in patients on diet and exercise and/or OADs, with or without insulin. Patients were allowed to continue in the study if hyperglycemic rescue was required, according to a prespecified algorithm and at the discretion of the investigator.</p> <p><b>Results</b>: At baseline in the Latino/Hispanic subpopulation, the mean HbA_1c was 8.3%, mean age was 53 years, mean body mass index was 32 kg/m², and mean duration of T2DM was 8.0 years. The primary endpoint of mean HbA_1c difference (albiglutide – placebo) was −0.94% for the Latino/Hispanic subpopulation and −0.86% (<i>p </i>< 0.001) for the overall phase III population. Changes in fasting plasma glucose mirrored those of HbA_1c. Weight loss with albiglutide was numerically greater than with OADs and insulin in both populations, but it was smaller than with liraglutide. Within the Latino/Hispanic subpopulation, more injection-site reactions were reported with albiglutide vs all comparators, while gastrointestinal and hypoglycemic adverse events were comparable between the two groups, and the latter was uncommon when used without insulin and/or a sulfonylurea.</p> <p><b>Conclusions</b>: In the Latino/Hispanic population, albiglutide resulted in effective lowering of glucose and modest weight loss, and it was generally well tolerated.</p

The analgesic efficacy of continuous elastomeric pump ropivacaine wound instillation after appendectomy

STUDY OBJECTIVE: To evaluate the analgesic efficacy and safety of ropivacaine 0.2% when administered continuously via elastomeric pump after appendectomy. DESIGN: Prospective, randomized, double-blinded study. SETTING: Surgical ward of a university hospital. PATIENTS: 96 ASA physical status I and II patients of at least 14 years of age, undergoing appendectomy through a McBurney incision. INTERVENTIONS: Patients were randomly assigned into two groups: 500 mg of ropivacaine in 48 hours (10 mL of 0.2% ropivacaine 20 mg, starter dose plus 5 mL/h continuous wound infusion via elastomeric pump device; n = 48) in the experimental group and 250 mL of normal saline, as placebo, in the control group. MEASUREMENTS: Postappendectomy pain, measured either with a simple verbal scale or with a visual analog scale, parenteral analgesic consumption, and global satisfaction were all measured. MAIN RESULTS: A reduction in postoperative pain was observed in the ropivacaine group. Degree of pain, with a simple verbal scale measurement of severe and unbearable, was significantly lower in the ropivacaine group than in the normal saline group from time 0 to 24 hours at rest and from time 0 to 36 hours on coughing. A significant lower pain intensity (visual analog scale) was found in the ropivacaine group both at rest and on coughing, beginning at three hours and continuing to 36 hours postoperatively. The mean number of rescue analgesic doses was significantly lower in the ropivacaine group. There were no statistically significant differences in the frequency of adverse events between the two groups. CONCLUSIONS: Wound instillation with ropivacaine 0.2% is a useful, practical, and safe method for management of postoperative pain after appendectomy