Case report. emergency CABG following failure of PTCA in a COVID-19 patient

The coronavirus disease 2019 (COVID-19) pandemic outbreak, caused by severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) is affecting people worldwide representing a public health emergency. The effect of concomitant COVID-19 on patients who underwent cardiac surgery using cardiopulmonary bypass (CPB) is still undefined. Both SARS-Cov-2 infection and CPB can develop a cytokines storm and haemostatic disarrangements leading to acute respiratory distress syndrome (ARDS) and post-perfusion lung syndrome, respectively. SARS-Cov-2 infection may trigger and exacerbate post-inflammatory state after CPB resulting in higher risk of post-surgical adverse outcomes. International guidelines lack to provide standard management protocols for pre-operative COVID-19 patients requiring non-deferrable cardiac surgery intervention. We present a report of a successful coronary artery bypass grafting (CABG) emergency operation in a COVID-19 patient, who presented unstable angina and coronary artery dissection during cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)

CTX-M-15 Type Extended-Spectrum Beta-Lactamase-Producing Enterobacter cloacae In Bioaerosol of a Municipal Solid Waste Recycling Plant: A New Possible Reservoir of Infection?

Background: Although there are many reports of antibiotic resistant microorganisms released from the treated municipal wastewater, less attention has been given to other waste treatment activities. We report the occurrence of antibiotic resistant strains isolated from the working setting of a solid waste recycling plant in Italy which serves 195 municipalities. Methods: To assess microbial contamination levels, several sampling points were chosen for their relevance in evaluating exposure of the workers to biological risk, especially during indoor operations. Active sampling was carried out using the Surface Air System and Rodac plate method was applied to surface sampling. Species identification and antimicrobial susceptibilities were obtained by Vitek2 System (bioMérieux, France) and by the agar-diffusion method. The presence of resistance genes was investigated by multiplex PCR assay. Results: In all sampling points a significant contamination of aerosol was detected, although the total microbial counts resulted within the limit proposed by the National authority (10000 CFU/sqm). The counts of Enterobacteriaceae were always above the limit of 100 CFU/sqm and strains of Enterobacter cloacae resistant to third generation cephalosporins were detected, carrying the blaCTX-M15 gene. Conclusions: The contamination of workplace with multidrug-resistant strains is a crucial area for public health actions to avoid the conjunction of factors that promote evolution and spread of antibiotic resistance

Erectile dysfunction in hyperuricemia: A prevalence meta‐analysis and meta‐regression study

AbstractBackgroundWhether and to what extent an association exists between hyperuricemia and erectile dysfunction (ED) has not yet been fully determined.ObjectiveTo define pooled prevalence estimates and correlates of erectile dysfunction in men with hyperuricemic disorders.Materials and methodsA thorough search of Medline, Scopus, and Cochrane Library databases was performed. Data were combined using random‐effects models and the between‐study heterogeneity was assessed by Cochrane's Q and I2 tests. A funnel plot was used to assess publication bias.ResultsOverall, 8 studies included gave information about 85,406 hyperuricemic men, of whom 5023 complained of erectile dysfunction, resulting in a pooled erectile dysfunction prevalence estimate of 33% (95% Confidence Interval: 13–52%; I² = 99.9%). The funnel plot suggested the presence of a publication bias. At the meta‐regression analyses, among the available covariates that could affect estimates, only type 2 diabetes mellitus was significantly associated with a higher prevalence of erectile dysfunction (β = 0.08; 95% Confidence Interval: 0.01, 0.15, p = 0.025). At the sub‐group analysis, the pooled erectile dysfunction prevalence decreased to 4% (95% Confidence Interval: 0%–8%) when only the largest studies with the lowest prevalence of type 2 diabetes mellitus were included and increased up to 50% (95% Confidence Interval: 17%–84%) when the analysis was restricted to studies enrolling smaller series with higher prevalence of type 2 diabetes mellitus.ConclusionsA not negligible proportion of men with hyperuricemia can complain of erectile dysfunction. While a pathogenetic contribution of circulating uric acid in endothelial dysfunction cannot be ruled out, the evidence of a stronger association between hyperuricemia and erectile dysfunction in type 2 diabetes mellitus points to hyperuricemia as a marker of systemic dysmetabolic disorders adversely affecting erectile function

How do gender and education interact in physical inactivity patterns in different domains among adults?

O objetivo do estudo foi identificar interação entre gênero e escolaridade na ocorrência de inatividade física em diferentes domínios (deslocamento, domicílio, lazer e trabalho) em adultos de Florianópolis, Santa Catarina. Os dados foram coletados de setembro/2009 a janeiro/2010 com indivíduos de 20 a 59 anos. Empregou-se um delineamento transversal de base populacional e a inatividade física em cada domínio foi definida como a não participação em atividades físicas específicas, avaliadas por questionário validado aplicado por entrevistas face a face. Foram entrevistados 1720 adultos. Nos homens, a prevalência de inatividade física foi mais elevada do que entre as mulheres no deslocamento (56,9% versus 44,5%; p < 0,001, respectivamente) e no domicílio (79,0% versus 40,4%; p < 0,001 respectivamente). No lazer, a inatividade física foi mais frequente entre as mulheres (58,1% versus 45,5%; p < 0,001). Interações entre gênero e escolaridade foram estatisticamente significativas no deslocamento (p = 0,004), domicílio (p < 0,001) e lazer (p = 0,04). No deslocamento, os homens foram mais inativos do que as mulheres dos cinco aos oito anos completos de estudo. A inatividade física no domicilio foi maior entre os homens em todos os níveis de escolaridade, com redução na magnitude das diferenças percentuais entre os gêneros, conforme o aumento da escolaridade. No lazer, as mulheres foram mais inativas do que os homens a partir dos nove anos de estudo. Constataram-se diferentes interações entre gênero e escolaridade conforme os padrões de inatividade física em seus diferentes domínios.The aim of the study was to identify interactions between gender and education on the prevalence of physical inactivity in different domains (commuting, household, leisure and work) among adults of Florianopolis, Brazil. Data were collected from September/2009 to January/2010 with individuals 20-59 years old. This was a cross-sectional population-based study, and physical inactivity in each domain was defined as non-participation in specific physical activities, using a validated Brazilian questionnaire administered by face to face interviews. We interviewed 1720 adults. In men, the prevalence of physical inactivity was higher than among women in commuting (56.9% versus 44.5%; p < 0.001, respectively) and at home (79.0% versus 40.4%; p < 0.001, respectively). In leisure, physical inactivity was higher among women (58.1% versus 45.5%; p < 0.001). Interactions between gender and education were statistically significant in commuting (p = 0.004), household (p < 0.001) and leisure (p = 0.04). Men were more inactive than women from five to eight years of schooling. Household physical inactivity was higher among men at all levels of education, with a reduction in the magnitude of the percentage differences between the genders, with increasing of education. In leisure, women were more inactive than men since nine years of study. Different interactions between gender and schooling were observed according to the patterns of physical inactivity in different domains

Around the tangent cone theorem

A cornerstone of the theory of cohomology jump loci is the Tangent Cone theorem, which relates the behavior around the origin of the characteristic and resonance varieties of a space. We revisit this theorem, in both the algebraic setting provided by cdga models, and in the topological setting provided by fundamental groups and cohomology rings. The general theory is illustrated with several classes of examples from geometry and topology: smooth quasi-projective varieties, complex hyperplane arrangements and their Milnor fibers, configuration spaces, and elliptic arrangements.Comment: 39 pages; to appear in the proceedings of the Configurations Spaces Conference (Cortona 2014), Springer INdAM serie

Gut, oral, and nasopharyngeal microbiota dynamics in the clinical course of hospitalized infants with respiratory syncytial virus bronchiolitis

IntroductionRespiratory syncytial virus (RSV) is the most common cause of bronchiolitis and hospitalization in infants worldwide. The nasopharyngeal microbiota has been suggested to play a role in influencing the clinical course of RSV bronchiolitis, and some evidence has been provided regarding oral and gut microbiota. However, most studies have focused on a single timepoint, and none has investigated all three ecosystems at once.MethodsHere, we simultaneously reconstructed the gut, oral and nasopharyngeal microbiota dynamics of 19 infants with RSV bronchiolitis in relation to the duration of hospitalization (more or less than 5 days). Fecal samples, oral swabs, and nasopharyngeal aspirates were collected at three timepoints (emergency room admission, discharge and six-month follow-up) and profiled by 16S rRNA amplicon sequencing.ResultsInterestingly, all ecosystems underwent rearrangements over time but with distinct configurations depending on the clinical course of bronchiolitis. In particular, infants hospitalized for longer showed early and persistent signatures of unhealthy microbiota in all ecosystems, i.e., an increased representation of pathobionts and a depletion of typical age-predicted commensals.DiscussionMonitoring infant microbiota during RSV bronchiolitis and promptly reversing any dysbiotic features could be important for prognosis and long-term health

Long-term disability trajectories in relapsing multiple sclerosis patients treated with early intensive or escalation treatment strategies

Background and aims: No consensus exists on how aggressively to treat relapsing-remitting multiple sclerosis (RRMS) nor on the timing of the treatment. The objective of this study was to evaluate disability trajectories in RRMS patients treated with an early intensive treatment (EIT) or with a moderate-efficacy treatment followed by escalation to higher-efficacy disease modifying therapy (ESC). Methods: RRMS patients with ⩾5-year follow-up and ⩾3 visits after disease modifying therapy (DMT) start were selected from the Italian MS Registry. EIT group included patients who received as first DMT fingolimod, natalizumab, mitoxantrone, alemtuzumab, ocrelizumab, cladribine. ESC group patients received the high efficacy DMT after ⩾1 year of glatiramer acetate, interferons, azathioprine, teriflunomide or dimethylfumarate treatment. Patients were 1:1 propensity score (PS) matched for characteristics at the first DMT. The disability trajectories were evaluated by applying a longitudinal model for repeated measures. The effect of early versus late start of high-efficacy DMT was assessed by the mean annual Expanded Disability Status Scale (EDSS) changes compared with baseline values (delta-EDSS) in EIT and ESC groups. Results: The study cohort included 2702 RRMS patients. The PS matching procedure produced 363 pairs, followed for a median (interquartile range) of 8.5 (6.5-11.7) years. Mean annual delta-EDSS values were all significantly (p &lt; 0.02) higher in the ESC group compared with the EIT group. In particular, the mean delta-EDSS differences between the two groups tended to increase from 0.1 (0.01-0.19, p = 0.03) at 1 year to 0.30 (0.07-0.53, p = 0.009) at 5 years and to 0.67 (0.31-1.03, p = 0.0003) at 10 years. Conclusion: Our results indicate that EIT strategy is more effective than ESC strategy in controlling disability progression over time

Long-term mortality prediction after operations for type A ascending aortic dissection

<p>Abstract</p> <p>Background</p> <p>There are few long-term mortality prediction studies after acute aortic dissection (AAD) Type A and none were performed using new models such as neural networks (NN) or support vector machines (SVM) which may show a higher discriminatory potency than standard multivariable models.</p> <p>Methods</p> <p>We used 32 risk factors identified by Literature search and previously assessed in short-term outcome investigations. Models were trained (50%) and validated (50%) on 2 random samples from a consecutive 235-patient cohort. NN were run only on patients with complete data for all included variables (N = 211); SVM on the overall group. Discrimination was assessed by receiver operating characteristic area under the curve (AUC) and Gini's coefficients along with classification performance.</p> <p>Results</p> <p>There were 84 deaths (36%) occurring at 564 ± 48 days (95%CI from 470 to 658 days). Patients with complete variables had a slightly lower death rate (60 of 211, 28%). NN classified 44 of 60 (73%) dead patients and 147 of 151 (97%) long-term survivors using 5 covariates: immediate post-operative chronic renal failure, circulatory arrest time, the type of surgery on ascending aorta plus hemi-arch, extracorporeal circulation time and the presence of Marfan habitus. Global accuracies of training and validation NN were excellent with AUC respectively 0.871 and 0.870 but classification errors were high among patients who died. Training SVM, using a larger number of covariates, showed no false negative or false positive cases among 118 randomly selected patients (error = 0%, AUC 1.0) whereas validation SVM, among 117 patients, provided 5 false negative and 11 false positive cases (error = 22%, AUC 0.821, p < 0.01 versus NN results). An html file was produced to adopt and manipulate the selected parameters for practical predictive purposes.</p> <p>Conclusions</p> <p>Both NN and SVM accurately selected a few operative and immediate post-operative factors and the Marfan habitus as long-term mortality predictors in AAD Type A. Although these factors were not new per se, their combination may be used in practice to index death risk post-operatively with good accuracy.</p

Risk of Getting COVID-19 in People With Multiple Sclerosis

Background and Objectives Several studies have assessed risk factors associated with the severity of COVID-19 outcomes in people with multiple sclerosis (PwMS). The potential role of disease-modifying therapies (DMTs) and demographic and clinical factors on the risk of acquiring SARS-CoV-2 infection has not been evaluated so far. The objective of this study was to assess risk factors of contracting SARS-CoV-2 infection in PwMS by using data collected in the Italian MS Register (IMSR). Methods Acase-control (1:2) studywas set up. Cases included PwMSwith a confirmed diagnosis ofCOVID-19, and controls included PwMS without a confirmed diagnosis of COVID-19. Both groups were propensity score–matched by the date of COVID-19 diagnosis, the date of last visit, and the region of residence. No healthy controls were included in this study. COVID-19 risk was estimated by multivariable logistic regression models including demographic and clinical covariates. The impact of DMTs was assessed in 3 independent logistic regression models including one of the following covariates: last administeredDMT, previousDMTsequences, or the place where the last treatment was administered. Results A total of 779 PwMS with confirmed COVID-19 (cases) were matched to 1,558 PwMS without COVID-19 (controls). In all 3 models, comorbidities, female sex, and a younger age were significantly associated (p &lt; 0.02)with a higher risk of contractingCOVID-19. Patients receiving natalizumab as last DMT(OR[95%CI]: 2.38 [1.66–3.42], p &lt; 0.0001) and those who underwent an escalation treatment strategy (1.57 [1.16–2.13], p = 0.003) were at significantly higher COVID-19 risk. Moreover, PwMS receiving their last DMT requiring hospital access (1.65 [1.34–2.04], p &lt; 0.0001) showed a significant higher risk than those taking self-administered DMTs at home. Discussion This case-control study embedded in the IMSR showed that PwMS at higher COVID-19 risk are younger, more frequently female individuals, and with comorbidities. Long-lasting escalation approach and last therapies that expose patients to the hospital environment seem to significantly increase the risk of SARS-CoV2 infection in PwMS. Classification of Evidence This study provides Class III evidence that among patients with MS, younger age, being female individuals, having more comorbidities, receiving natalizumab, undergoing an escalating treatment strategy, or receiving treatment at a hospital were associated with being infected with COVID-19. Among patients with MS who were infected with COVID-19, a severe course was associated with increasing age and having a progressive form of MS, whereas not being on treatment or receiving an interferon beta agent was protective