Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy

Background: Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy. Methods: A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother-child separation at birth; rooming-in; breastfeeding. Logistic regression models including women' socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases. Results: During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births. Conclusions: Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies

CloudTUI: a multi cloud platform text user interface

Most of the online services that we use everyday are provided by Cloud Computing infrastructures. This widespread is due to the substantial effort spent to make all these services as much user-friendly as possible. Unfortunately, the usage of the most popular Cloud Computing infrastructures is not easy at all and it requires high computer science skills. In this paper, we propose CloudTUI: a multi Cloud Computing platform text-based interface able to make the interaction with Cloud systems easy and intuitive even for users without any prior experience concerning the Cloud Computing paradigm

Emergency endovascular treatment of complicated type B acute aortic dissections: proximal repair without distal covering.

Background: Endovascular treatment is now the first choice for complicated type B dissections requiring surgery, but some authors claim that merely sealing the entry tear with Thoracic Endovascular Aortic Repair is not enough, advocating use of distal aortic stenting and ballooning. Objectives: This study aims to analyze 12 consecutive complicated type B acute aortic dissections to prove the safety and effectiveness of staged endovascular repair without distal ballooning or stenting. Methods: From January 2016 to September 2018, 15 cases of complicated type B dissections in need of emergency treatment (in less than 24 hours) were referred to our Unit. Endovascular repair was performed to cover the entry tear and the proximal tract of the false lumen, leaving its distal segment untouched. All patients were followed up with serial computed tomography angiography to assess the evolution of the false lumen. Results: Technical success was achieved in all cases. No peri-operative or post-operative deaths from any cause were reported over a mean follow-up of 28 months (range 12-45). False lumen thrombosis and regression > 5mm were observed in 11 cases. One patient underwent endovascular reintervention after 10 months because of expansion of the false lumen. No procedure-related complication was recorded. Conclusions: Staged endovascular repair is, in most cases, a feasible and safe technique for treatment of acute aortic dissections in emergency settings, with low morbidity/mortality rates and low risk of reintervention. Randomized clinical trials will be needed to establish an outcome-based comparison with new techniques such as PETTICOAT and STABILISE

Partial Endograft Removal Preserves the Aortic Walls During Delayed Open Conversions of Endovascular Aortic Repair

Background: Open conversion of endovascular aortic repair (EVAR) is the first-choice treatment in case of endograft failure or high-flow endoleak. However, the traditional technique based on the total removal of the endograft can produce injuries of the aortic walls, with severe consequences on the anastomoses quality. Our aim is to show the advantages of the partial endograft removal on the aortic integrity by reporting a case series including 25 delayed open conversion performed with this technique. Methods: A retrospective study was conducted over the cases of delayed open conversions performed in the last 30 months. Demographics, past medical history, endograft type, causes for conversions, and early and mid-term outcomes were recorded and analyzed in relation with the technique employed (partial vs total endograft removal). Results: Between September 2016 and March 2019, 25 consecutive cases of EVAR failure were converted to open treatment. In all cases, the endografts were resected leaving in place part of the iliac branches, and, whenever possible, also the proximal stent of the main body. Primary technical success was achieved in 100% of cases. Disease-free survival over 18-month median follow-up was 100%. All patients underwent abdominal aortic duplex scan controls as scheduled, with no early or late postoperative complication. No anastomotic aneurysms or any surgery-related complications were observed. Conclusions: Partial endograft removal is a safe and effective technique that could be used to protect the aortic integrity in delayed open conversions of EVAR