Mechanical ventilation and volutrauma: study in vivo of a healthy pig model

Mechanical ventilation is essential in intensive care units. However, it may itself induce lung injury. Current studies are based on rodents, using exceptionally large tidal volumes for very short periods, often after a "priming" pulmonary insult. Our study deepens a clinically relevant large animal model, closely resembling human physiology and the ventilator setting used in clinic settings. Our aim was to evaluate the pathophysiological mechanisms involved in alveolo/capillary barrier damage due to mechanical stress in healthy subjects. We randomly divided 18 pigs (sedated with medetomidine/tiletamine-zolazepam and anesthetised with thiopental sodium) into three groups (n=6): two were mechanically ventilated (tidal volume of 8 or 20 ml/kg), the third breathed spontaneously for 4 hours, then animals were sacrifi ced (thiopental overdose). We analyzed every 30' hemogasanalysis and the main circulatory and respiratory parameters. Matrix gelatinase expression was evaluated on bronchoalveolar lavage fl uid after surgery and before euthanasia. On autoptic samples we performed zymographic analysis of lung, kidney and liver tissues and histological examination of lung. Results evidenced that high V T evoked profound alterations of lung mechanics and structure, although low V T strategy was not devoid of side effects, too. Unexpectedly, also animals that were spontaneously breathing showed a worsening of the respiratory functions

Clinical relevancy and risks of potential drug–drug interactions in intensive therapy

AbstractPurposeEvaluate the potential Drug–Drug Interactions (pDDI) found in prescription orders of adult Intensive Care Unit (ICU) of a Brazilian public health system hospital; quantify and qualify the pDDI regarding their severity and risks to the critical patient, using the database from Micromedex®.MethodsProspective study (January–December of 2011) collecting and evaluating 369 prescription orders (convenient sampling), one per patient.ResultsDuring the study 1844 pDDIs were identified and distributed in 405 pairs (medication A×medication B combination). There was an average of 5.00±5.06 pDDIs per prescription order, the most prevalent being moderate and important interactions, present in 74% and 67% of prescription orders, respectively. In total, there were 9 contraindicated, 129 important and 204 moderate pDDIs. Among them 52 had as management recommendation to “avoid concomitant use” or “suspension of medication”, while 306 had as recommendation “continuous and adequate monitoring”.ConclusionThe high number of pDDIs found in the study combined with the evaluation of the clinical relevancy of the most frequent pDDIs in the ICU shows that moderate and important interactions are highly incident. As the majority of them demand monitoring and adequate management, being aware of these interactions is major information for the safe and individualized risk management

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for >; 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results

Investigating on Besnoitia besnoiti (Apicomplexa, Sarcocystidae) in naturally infected dairy cattle by an integrated approach.

Bovine besnoitiosis, caused by Besnoitia besnoiti, is a (re)emerging disease in Europe (Cortes et al., 2014), including Italy (Gazzonis et al., 2014; 2017). However, its economic impact is scarcely considered and generally underestimated and there are still little studied aspects concerning both the parasite and the disease. Following a natural outbreak of besnoitiosis in a dairy herd, a study was planned to characterize B. besnoiti infection in cattle through a multidisciplinary approach.Suspicious abortions and clinical cases of besnoitiosis were reported in a dairy farm (September 2017, Northern Italy) housing 216 Holstein cattle. Blood samples were collected; haematological and serological analyses (ELISA and confirmatory WB) were performed (Fernandez-Garcia et al., 2009). Histology and molecular (endpoint ITS-1 PCR (Cortes et al., 2007) and sequencing) analyses of tissues from a slaughtered cow with chronic besnoitiosis were carried out. Out of 59 ELISA-positive animals, 50 (23%) were confirmed by WB. B. besnoiti prevalence was higher in cows (41%) than in calves (12%); any heifer did not result positive. Considering haematological parameters, a significant shift in the differential leucocyte formula from lymphocyte to granulocyte was recorded in infected cows (Mean±S.D.:L=46.1±18.4,G=53.9±18.4) if compared to negative animals (Student’s T-test,p=0.012). This finding could be helpful in diagnosis, treatment and control of besnoitiosis. Histology revealed a high load of B. besnoiti tissue cysts in skin, vulva, muzzle, sclera, eyelid, respiratory tract, emphasizing the possibility of parasite transmission through direct contact among animals. B. besnoiti was confirmed by PCR in other organs (heart, liver, aorta wall, tonsil) and especially in ovary, uterus and vulva, suggesting that the infection could affect cows’ fertility. Parasite DNA was also found in masseters posing an important question for food security, even if B. besnoiti is not considered zoonotic. The study suggests that to investigate the dynamics of bovine besnoitiosis is mandatory associate clinical and laboratory tests, including the genetic characterization of the parasite and its eventual correlation with the disease outcome

Individual Particle Characteristics, Optical Properties and Evolution of an Extreme Long‐Range Transported Biomass Burning Event in the European Arctic (Ny‐Ålesund, Svalbard Islands)

This paper reports an exceptional biomass burning (BB) advection event from Alaska registered at Ny‐Ålesund from 10 to 17 July 2015 with particular interest on the influence of the airborne particle characteristics on the optical properties of the aerosol during the event. To this purpose we considered two DEKATI 12‐stage aerosol samples spanning the entire advection and analyzed them by scanning electron microscopy techniques. Aerosol chemical data and microphysical properties were also evaluated in order to correlate any change of individual particle characteristics with the bulk properties of the aerosol. The results of individual particle analysis depict a complex event characterized by a first phase (P1) of massive input of BB carbonaceous particles (i.e., tar balls, popcorn refractory particles, and organic particles), and by a second phase (P2) dominated by inorganic salts. The peculiar feature of this BB event is the exceptionally large grain size of the subspherical organic particles at the beginning of the event with respect to the background. At these conditions a significant increase of the scattering efficiency may occur even for a small increase of the size parameter. Results of the simulation of the complex refractive indices (n‐ik) confirm this evaluation. Aerosol evolution during the event resulted from the combination of three distinct occurrences: (a) progressive rotation of air mass circulation toward non‐BB source areas, (b) development of a thick fog layer in the planetary boundary layer, and (c) sea salt spray direct advection of local/regional provenance

Pharmacovigilance in oncology: pattern of spontaneous notifications, incidence of adverse drug reactions and under-reporting

Estudos de farmacovigilância são imprescindíveis em oncologia, pois os antineoplásicos possuem alta toxicidade e estreita janela terapêutica. Os objetivos deste estudo foram analisar o perfil das notificações espontâneas de reações adversas a medicamentos (RAM) em pacientes oncológicos e a incidência de RAM ao tratamento antineoplásico em um hospital terciário e universitário. Para compor o perfil de RAM, revisaram-se os formulários de notificação de reações em pacientes oncológicos do ano de 2010 e classificaram-se as reações conforme o medicamento envolvido, mecanismo, causalidade e gravidade. Para avaliar a incidência de reações, aplicou-se um questionário no momento da quimioterapia e a gravidade foi classificada pelos Critérios Comuns de Toxicidade. Apenas 10 reações foram notificadas ao Setor de Farmacovigilância, cujo perfil encontrado foi tipo B, grave, possível, e foram principalmente relacionadas aos compostos de platina e taxanos. Na análise da incidência das reações, observou-se que náusea, alopecia, fadiga, diarreia e distúrbio do paladar foram as reações mais frequentes relatadas por pacientes oncológicos, e as reações grau 3 e 4 não foram notificadas. De acordo com essas análises, propõe-se que os profissionais da saúde sejam treinados quanto às notificações e que farmacêuticos clínicos sejam cada vez mais inseridos neste contexto para redução da subnotificação de RAM.The high toxicity and narrow therapeutic window of antineoplastic agents makes pharmacovigilance studies essential in oncology. The objectives of the current study were to analyze the pattern of spontaneous notifications of adverse drug reactions (ADRs) in oncology patients and to analyze the incidence of ADRs reported by outpatients on antineoplastic treatment in a tertiary care teaching hospital. To compose the pattern of ADR, the notification forms of reactions in oncology patients in 2010 were reviewed, and the reactions were classified based on the drug involved, mechanism, causality, and severity. To evaluate the incidence of reactions, a questionnaire at the time of chemotherapy was included, and the severity was classified based on the Common Terminology Criteria. The profiles of the 10 responses reported to the Pharmacovigilance Sector were type B, severe, possible, and they were primarily related to platinum compounds and taxanes. When the incidence of reactions was analyzed, it was observed that nausea, alopecia, fatigue, diarrhea, and taste disturbance were the most frequently reported reactions by oncology patients, and the grade 3 and 4 reactions were not reported. Based on this analysis, it is proposed that health professionals should be trained regarding notifications and clinical pharmacists should increasingly be brought on board to reduce under-reporting of ADRs

ASTROCHRONOLOGICAL CALIBRATION OF THE UPPER SERRAVALLIAN/LOWER TORTONIAN SEDIMENTARY SEQUENCE AT TREMITI ISLANDS(ADRIATIC SEA, SOUTHERN ITALY)

A high resolution cyclostratigraphic study was carried out on a cyclicaly bedded succession of late Middle Miocene deep marine deposits from the Tremiti Islands, Adriatic sea (Italy). Astronomical calibration of the sedimentary cycles provides absolute ages for different calcareous plankton bioevents, widely used for intra Mediterranean correlation, in the interval between 11.12 and 12.60 Ma. The sedimentary record of the S. nicola composite section consists of an alternation of indurated, withish coloured, CaCo3 rich and grey less indurated, CaCo3 poor marly beds, at times replaced by red coloured CaCo3 poor marls. Results of direct correlation between the La 90 (1,1) solution of the insolation curve and the cyclic lithologic patterns occurring in the studied sections, combined with results of spectral methodologies applied on the climate sensitive data (CaCo3 and Globigerinoides) showed that the classic Milankovitch periodicity can be represented through the modulation forcing of the studied sedimentary records.&nbsp

Comparative Personality Traits Assessment of Three Species of Communally Housed Captive Penguins.

Understanding animal personalities has notable implications in the ecology and evolution of animal behavior, but personality studies can also be useful in optimizing animal management, with the aim of improving health and well-being, and optimizing reproductive success, a fundamental factor in the species threatened with extinction. Modern zoos are increasingly being structured with enclosures that host different species, which permanently share spaces. This condition has undeniable positive aspects, but, in some species, it could determine the appearance of collective or synchronized behaviors. The aim of this study was to verify, in a colony of three species of communally housed penguins (Pygoscelis papua, Aptenodytes patagonicus and Eudyptes moseleyi), through a trait-rating assessment, if interspecific group life impacts on the expression of personality traits, and if it is possible to highlight specie-specific expression of personality traits, despite the influence of forced cohabitation. For many of the personality traits we analyzed, we have observed that it was possible to detect an expression that differed, according to the species. From a practical point of view, these data could ameliorate the management of the animals, allowing to design animal life routines, according to the different behavioral characteristics of the cohabiting species