Insomnia in patients with advanced lung cancer admitted to palliative care services.

Aim To assess the prevalence of insomnia and possible associated factors in patients with advanced lung cancer admitted to different settings of palliative care. Methods Secondary analysis of a consecutive sample of patients with advanced lung cancer receiving palliative care. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System (ESAS), Athens Insomnia Scale (AIS) and the Hospital Anxiety and depression scale (HADS), as well as concomitant medical treatment were recorded. Results One-hundred-eight-two patients with advanced lung cancer were surveyed. The mean age was 69.9 years (SD 10.8), and 121 patients (66%) were men. The majority of patients showed consistent levels of insomnia. A poor Karnofsky level, pain, nausea, and drowsiness, time from diagnosis (1-3 years), HADS anxiety, and HADS depression, were positively associated with insomnia. Conclusions About 50% of patients with advanced lung cancer admitted to palliative care services had relevant insomnia. Several factors associated with insomnia have been identified and should prompt physicians for a careful examination and subsequent treatment

Distal left circumflex coronary artery flow reserve recorded by transthoracic Doppler echocardiography: a comparison with Doppler-wire

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Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

<p>Abstract</p> <p>Background</p> <p>Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR).</p> <p>Methods</p> <p>In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test ≥2 was considered normal CFR.</p> <p>Results</p> <p>Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 ± 0.5 to 2.6 ± 0.5, p = 0.03) and in LCx (1.7 ± 1 to 2.12 ± 1, p = 0.05). CFR was under normal at baseline in 30% of patients <it>vs </it>8% after six months in LAD (p = 0.027), and in 69% of patients <it>vs </it>30% after six months in LCx (p = 0.066).</p> <p>Conclusion</p> <p>CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation.</p

The circulating SARS-CoV-2 spike variant N439K maintains fitness while evading antibody-mediated immunity

SARS-CoV-2 can mutate to evade immunity, with consequences for the efficacy of emerging vaccines and antibody therapeutics. Herein we demonstrate that the immunodominant SARS-CoV-2 spike (S) receptor binding motif (RBM) is the most divergent region of S, and provide epidemiological, clinical, and molecular characterization of a prevalent RBM variant, N439K. We demonstrate that N439K S protein has enhanced binding affinity to the hACE2 receptor, and that N439K virus has similar clinical outcomes and in vitro replication fitness as compared to wild- type. We observed that the N439K mutation resulted in immune escape from a panel of neutralizing monoclonal antibodies, including one in clinical trials, as well as from polyclonal sera from a sizeable fraction of persons recovered from infection. Immune evasion mutations that maintain virulence and fitness such as N439K can emerge within SARS-CoV-2 S, highlighting the need for ongoing molecular surveillance to guide development and usage of vaccines and therapeutics

Will the Economic Impact of COVID-19 Persist? Prognosis from 21st Century Pandemics

COVID-19 has had a disruptive economic impact in 2020, but how long its impact will persist remains unclear. We offer a prognosis based on an analysis of the effects of five previous major epidemics in this century. We find that these pandemics led to significant and persistent reductions in disposable income, along with increases in unemployment, income inequality and public debt-to-GDP ratios. Energy use and CO2 emissions dropped, but mostly because of the persistent decline in the level of economic activity rather than structural changes in the energy sector. Applying our empirical estimates to project the impact of COVID-19, we foresee significant scarring in economic performance and income distribution through 2025, which be associated with an increase in poverty of about 75 million people. Policy responses more effective than those in the past would be required to forestall these outcomes

ADMISSION TO PALLIATIVE CARE AND INDICATORS OF END-OF-LIFE INTENSITY OF CARE IN CANCER PATIENTS FROM THE LOMBARDY REGION, ITALY

Objectives: Hospital-based and home palliative care have been associated to a reduction of aggressive treatments in the end-of-life, but data in the Italian context are scanty. We aim therefore investigate the role of palliative care on indicators of end-of-life intensity of care among cancer patients in Lombardy, the largest Italian region. Methods: Within a retrospective study using the healthcare utilization databases of Lombardy, we selected all residents who died in 2019 with a diagnosis of cancer. We considered as exposure variables admission to palliative care and time at palliative care admission, and as indicators of aggressive care hospitalizations, diagnostic/therapeutic procedures, in-hospital death, emergency department visits, and chemotherapy over a time-window of 30 days before death; chemotherapy in the last 14 days was also considered. Results: Our cohort included 26,539 individuals; of these, 14,320 (54%) were admitted to palliative care before death. Individuals who were admitted to palliative care had an odds ratio of 0.27 for one hospitalization, 0.14 for ≥2 hospitalizations, 0.25 for hospital stay ≥12 days, 0.38 for minor diagnostic/therapeutic procedures, 0.18 for major diagnostic/therapeutic procedures, 0.02 for in-hospital death, 0.35 for one emergency department visit, 0.29 for ≥2 emergency department visits, and 0.66 for chemotherapy use in the last 30 days; the odds ratio was 0.56 for chemotherapy use in the last 14 days. Conclusions: This large real-world analysis confirms and further support the importance of palliative care assistance for cancer patients in the end-of-life; this is associated to a significant reduction in unnecessary treatments

Laurel but Hardy: unintended poisoning, a case report of oleander misidentification as bay laurel

Introduction: Nerium oleander is a toxic plant containing cardiac glycosides throughout all its parts, thereby posing severe health risks upon ingestion. The clinical manifestations of oleander poisoning closely resemble those of digoxin toxicity, encompassing a spectrum of gastrointestinal symptoms, neuropsychiatric disorders, and cardiac disturbances. This scientific case report describes a case of accidental intoxication resulting from the consumption of an oleander leaves infusion misidentified as bay laurel leaves. Case report: An 84-year-old patient consumed an oleander leaves infusion, and after four hours experienced gastrointestinal symptoms. He contacted the poison control center (PCC) and was advised to go to the emergency department (ED). Upon arrival, the patient presented stable vital signs without cardiac irregularities. The PCC recommended the administration of activated charcoal, vigilant monitoring, including electrocardiography (ECG). Subsequent ECGs assessments revealed the presence of third-degree atrioventricular block; in consultation with the PCC, digoxin-specific antibodies and external pacing were necessary. The patient was discharged on the eighth day in good hemodynamic condition, and outpatient follow-up visits showed clinical stability. Discussion: This study offers insights for the management of similar cases. The limitations of conventional assays in measuring oleander cardiac glycosides were observed, emphasizing reliance on clinical evaluation. The patient's trajectory, remaining asymptomatic despite severe ECG changes post-ingestion, underscores the importance of prolonged clinical monitoring

“Heavy Metal”: Management of lead toxicity following a gunshot injury with retained lead fragments, a case report

: There is limited literature on managing chronic lead exposure from non-removable sources such as lead fragments. In this case report, we present the complexities and clinical considerations involved in treating an elderly patient who sustained a comminuted knee fracture due to a gunshot wound, complicated by retained lead fragments. This case highlights the absence of comprehensive guidelines for managing chronic lead exposure when complete fragment removal is impractical. It also emphasizes the importance of a multidisciplinary approach to decision-making, while considering patient autonomy in such unique clinical scenarios

TECNOLOGIE DELLA FUSIONE NUCLEARE: RICERCA E INNOVAZIONE IN ITALIA

In questa nota si da’ un breve riassunto dello stato dell’arte e delle prospettive delle ricerche sulle tecnologie della fusionenucleare in Italia e delle principali innovazioni “di prodotto” (hardware e/o software) da esse derivanti. Queste ricerchecoprono uno spettro assai ampio e per sua natura interdisciplinare di attivita’, che include le tecnologie dei materiali innovativi(superconduttori, ceramici, compositi, triziogeni, strutturali, a bassa attivazione, etc.), le tecnologie del vuoto, dei componentiad alto flusso termico, della manutenzione remotizzata, la criogenia, l’analisi di sicurezza, il trattamento della potenza elettrica,le tecnologie per il riscaldamento, il controllo e la diagnostica del plasma, ma anche lo sviluppo, la convalida sperimentale e l’applicazione di strumenti di calcolo sofisticati per la modellazione elettromagnetica/termofluidodinamica/meccanica deicomponenti dell’impianto. In particolare, viene qui documentata la posizione rilevante a livello internazionale che l’Italia occupa nel campo delle tecnologie della fusione nucleare: l’ENEA, il CNR e diverse sedi universitarie collaborano infatti da molti anni, all’interno dell’Associazione EURATOM-ENEA per la Fusione, alla ricerca e sviluppo di tecnologie innovative per i principali esperimenti esistenti sia nel nostro Paese (FTU a ENEA/Frascati e RFX a CNR/Padova) sia all’estero (ad es. il grande esperimento europeo JET a Culham (GB)). Questo nell’ottica di progetti internazionali (ITER in primis), che dovrebbero portare alla realizzazione di un reattore dimostrativo entro alcune decine di anni