Nasal pressure swings as the measure of inspiratory effort in spontaneously breathing patients with de novo acute respiratory failure.

Background- Excessive inspiratory effort could translate into self-inflicted lung injury, thus worsening clinical outcomes of spontaneously breathing patients with acute respiratory failure (ARF). Although esophageal manometry is a reliable method to estimate the magnitude of inspiratory effort, procedural issues significantly limit its use in daily clinical practice. The aim of this study is to describe the correlation between esophageal pressure swings (\u394P es ) and nasal (\u394P nos ) as a potential measure of inspiratory effort in spontaneously breathing patients with de novo ARF. Methods- From January 1 st , 2021 to September 1 st , 2021, 61 consecutive patients with ARF (83.6% related to COVID-19) admitted to the Respiratory Intensive Care Unit (RICU) of the University Hospital of Modena (Italy) and candidate to escalation of noninvasive respiratory support (NRS) were enrolled. Clinical features and tidal changes in esophageal and nasal pressure were recorded on admission and 24 hours after starting NRS. Correlation between \u394P es and \u394P nos served as primary outcome. The effect of \u394P nos measurements on respiratory rate and \u394P es was also assessed. Results- \u394P es and \u394P nos were strongly correlated at admission (R 2 =0.88, p<0.001) and 24 hours apart (R 2 =0.94, p<0.001). The nasal plug insertion and the mouth closure required for \u394P nos measurement did not result in significant change of respiratory rate and \u394P es . The correlation between measures at 24 hours remained significant even after splitting the study population according to the type of NRS (high-flow nasal cannulas [R 2 =0.79, p<0.001] or non-invasive ventilation [R 2 =0.95, p<0.001]). Conclusions- In a cohort of patients with ARF, nasal pressure swings did not alter respiratory mechanics in the short term and were highly correlated with esophageal pressure swings during spontaneous tidal breathing. \u394P nos might warrant further investigation as a measure of inspiratory effort in patients with ARF

Rapid identification of Burkholderia cepacia complex species recovered from cystic fibrosis patients using matrix-assisted laser desorption ionization time-of-flight mass spectrometry

The aim of this study was to establish the identification ability of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for bacteria of Burkholderia cepacia complex (Bcc) and to compare these results with those obtained by a molecular method (PCR-RFLP). A total of 57 isolates was used in the study. Isolates were collected from 31 patients attending the Regional Cystic Fibrosis Unit from January 2001 to December 2005. For phenotypic identification, both automated and manual systems were used. Using mass spectrometry, we identified all 57 isolates, previously identified by molecular method. Of these, 28 isolates were identified as B. cenocepacia, although not differentiated further into lineages. Moreover, other isolates were identified as B. cepacia (12 isolates), B. stabilis (12 isolates), and B. vietnamiensis (5 isolates). Our data indicate a good correlation between the two approaches

Smoking Habit in Severe Obese after bariatric procedures

Background Bariatric procedures provide an effective means of short term weight loss and sustained weight control for the morbidly obese. The effect of bariatric procedures on smoking habit in obese subjects is not well known. Therefore, we examined the short term effect of bariatric surgery on smoking habit of severe obese patients up to 12 months from the intervention. Methods Smoking habit was assessed in a cohort of 78 morbid smoking obese patients followed at our clinic for bariatric procedures. They underwent non surgical intra-gastric balloon (IB) or surgical procedures such as lap–band laparoscopic surgery (LAGB) or sleeve gastrectomy/gastric by-pass (SPG). Subjects were administered a written questionnaire about their smoking habit before and 3, 6 and 12 months after the procedures. Results No differences were found among the three groups at 6 and 12 months after the procedures (IB 21 %, LAGB 6 %, SPG 5 %; and IB 14 %, LAGB 3 %, SPG 5 %). Only after 3 months, the rate of quitting of the IB group was higher than LAGB and SPG groups (36 %, 6 % and 5 %, respectively; p = 0.02). Conclusions Bariatric procedures have no effects on smoking habit of moderate-to-heavy smoker severe obese patients. The use of other traditional smoking cessation methods in patients undergone to bariatric procedures should be implemented

Effect of bariatric surgery on the six-minute walk test in severe uncomplicated obesity

The six-minute walk test (6mWT) is a simple index of functional capacity in healthy people, and it has been used to estimate exercise capacity in obese subjects. The aim of this study was to determine whether weight reduction induced by laparoscopic adjustable gastric banding (LAGB) improves the functional capacity in the severely obese on the 6mWT

In vitro biofilm formation by methicillin susceptible and resistant Staphylococcus aureus strains isolated from cystic fibrosis patients

Staphylococcus aureus is one of the most common pathogens isolated from respiratory tracts of Cystic Fibrosis patients (CF). The infection by this pathogen starts in early infancy, often preceding chronic infections by Pseudomonas aeruginosa. The infection and colonization by methicillin-resistant Staphylococcus aureus (MRSA) are, by then, events very frequent among CF patients and this bacterial isolation leads to complications in therapeutic management because of the limited treatment options. Strains of Staphylococcus aureus are able to produce biofilms on natural or synthetic surfaces. Biofilms are sophisticated communities of matrix-encased bacteria and infections by biofilm-producing bacteria are particularly problematic because sessile bacteria can often withstand host immune responses and are generally much more tolerant to antibiotics. The first aim of this work is to evaluate the ability of MRSA strains isolated from respiratory secretions of CF patients to develop biofilms in comparison with methicillin-sensitive Staphylococcus aureus (MSSA) strains obtained from respiratory secretions of CF patients.Therefore, our second aim is to evaluate the environmental influence on this ability. To evaluate the development of biofilm on solid matrix and the possible environmental influence,we applied the method described by Christensen et al. We found that a significantly higher number of MRSA strains were biofilm positive compared with MSSA strains (p<0.05).The presence of glucose did not influence the ability to form biofilm in our MRSA strains (p=0.165). MSSA strains are not strong biofilm-producers, but, when grown in TSB added with 0.25% glucose, the number of biofilm-forming strains increases, as expected. These data suggest a possible association between methicillin-resistance and biofilm formation

Serum In Vivo and In Vitro Activity of Single Dose of Ertapenem in Surgical Obese Patients for Prevention of SSIs.

Despite progress made in the control of post-operative infections, the incidence of surgical site infections (SSIs) is still high. An improper perioperative antibiotic use can expose patients to the risk of resistant microorganisms, and, in surgical obese patients, the drug dosage and infusion time are critical points. The aim of our study was to evaluate the effectiveness of ertapenem in the prophylaxis of SSIs in obese patients undergoing general or bariatric surgery. METHODS: A total of 63 obese patients, candidates for several surgical interventions, were enrolled and divided into two groups. Patients received antibiotic prophylaxis before surgery: the case group received venous infusion of ertapenem; the control group received standard prophylaxis. Serum samples were tested for antimicrobial activity against Gram-positive and Gram-negative bacteria. RESULTS: After single-dose ertapenem in obese patients, we registered in vitro activity of sera against the growth of non-extended beta lactamase (ESBL)-producing Escherichia coli, Proteus mirabilis, Citrobacter freundii, Enterobacter cloacae, and non-ESBL-producing Klebsiella pneumoniae. Moreover, methicillin-sensitive Staphylococcus aureus and Streptococcus viridans were also inhibited. We found in vivo efficacy according to clinical monitoring: at the weekly and monthly follow-ups, one patient in the case group and six patients in the control group presented superficial incisional SSIs. CONCLUSIONS: These preliminary results are suggestive of the efficacy of ertapenem in perioperative prophylaxis of SSIs in obese patients; however, they need to be confirmed by further investigations and more defined trials

Serum In Vivo and In Vitro Activity of Single Dose of Ertapenem in Surgical Obese Patients for Prevention of SSIs

Background Despite progress made in the control of postoperative infections, the incidence of surgical site infections (SSIs) is still high. An improper perioperative antibiotic use can expose patients to the risk of resistant microorganisms, and, in surgical obese patients, the drug dosage and infusion time are critical points. The aim of our study was to evaluate the effectiveness of ertapenem in the prophylaxis of SSIs in obese patients undergoing general or bariatric surgery. Methods A total of 63 obese patients, candidates for several surgical interventions, were enrolled and divided into two groups. Patients received antibiotic prophylaxis before surgery: the case group received venous infusion of ertapenem; the control group received standard prophylaxis. Serum samples were tested for antimicrobial activity against Gram-positive and Gram-negative bacteria. Results After single-dose ertapenem in obese patients, we registered in vitro activity of sera against the growth of nonextended beta lactamase (ESBL)-producing Escherichia coli, Proteus mirabilis, Citrobacter freundii, Enterobacter cloacae, and non-ESBL-producing Klebsiella pneumoniae. Moreover, methicillin-sensitive Staphylococcus aureus and Streptococcus viridans were also inhibited. We found in vivo efficacy according to clinical monitoring: at the weekly and monthly follow-ups, one patient in the case group and six patients in the control group presented superficial incisional SSIs. Conclusions These preliminary results are suggestive of the efficacy of ertapenem in perioperative prophylaxis of SSIs in obese patients; however, they need to be confirmed by further investigations and more defined trials