Electrical Impedance Tomography and Prone Position During Ventilation in COVID-19 Pneumonia: Case Reports and a Brief Literature Review

At the end of 2019, a novel coronavirus (COVID-19) was identified as the cause of a cluster of pneumonia cases, with high needs of mechanical ventilation in critically ill patients. It is still unclear whether different types of COVID-19 pneumonia require different ventilator strategies. With electrical impedance tomography (EIT) we evaluated, in real time and bedside, the distribution of ventilation in the different pulmonary regions before, during, and after pronation in COVID-19 respiratory failure. We present a brief literature review of EIT in non-COVID-19 patients and a report of 2 COVID-19 patients: one that did not respond well and another one that improved during and after pronation. EIT might be a useful tool to decide whether prone positioning should or should not be used in COVID-19 pneumonia

Covid-19 pandemic in an italian obstetric department: Sharing our experience

Background and aim of the work: The outbreak of the novel coronavirus (or SARS-CoV 2) has struck the healthcare system worldwide. Within few weeks hospitals had to reorganize their internal logistics and structure covering any level of care, from the Emergency Room to medical Departments. Methods: Due to the state of medical emergency, the Gynecology and Obstetrics Unit of the University Hospital in Udine developed new protocols for the usual standard of care, ensuring a safe environment for both healthcare providers and patients. Results: By a continuous update of scientific evidence, the Department was able to increase capacity as well as maintain flexibility when an unexpected high number of admissions was required. 40 COVID-19 positive patients were admitted to our Department between March and December 2020, none of them had complications and no case of cross infection between patients and medical staff were registered. Conclusion: We aimed to share our experience, which provided a notable lesson about what to expect and how to prepare a high-risk pregnancy referral center in response to a pandemic. (www.actabiomedica.it)

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

Background: The incidence of cerebral fat embolism (CFE) ranges from 0.9\u201311%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the \u2018mechanical theory\u2019, and the \u2018chemical theory\u2019. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods: We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age\ua0 65\ua018 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results: One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (\ub118). The mean age for males (29 \ub1 14) was significantly lower than for females (51 \ub1 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27\u20132.48, p < 0.001; 95%CI 0.48\u20132.34, p < 0.001). Conclusions: FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48\u201372 h

Factors associated with the development of septic shock in patients with candidemia: A post hoc analysis from two prospective cohorts

Background: Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia. Methods: A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3). Results: Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03-6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04-4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12-0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08-4.24, p = 0.02). Conclusions: Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms

Ventilatory associated barotrauma in COVID-19 patients: A multicenter observational case control study (COVI-MIX-study)

Background: The risk of barotrauma associated with different types of ventilatory support is unclear in COVID-19 patients. The primary aim of this study was to evaluate the effect of the different respiratory support strategies on barotrauma occurrence; we also sought to determine the frequency of barotrauma and the clinical characteristics of the patients who experienced this complication. Methods: This multicentre retrospective case-control study from 1 March 2020 to 28 February 2021 included COVID-19 patients who experienced barotrauma during hospital stay. They were matched with controls in a 1:1 ratio for the same admission period in the same ward of treatment. Univariable and multivariable logistic regression (OR) were performed to explore which factors were associated with barotrauma and in-hospital death. Results: We included 200 cases and 200 controls. Invasive mechanical ventilation was used in 39.3% of patients in the barotrauma group, and in 20.1% of controls (p<0.001). Receiving non-invasive ventilation (C-PAP/PSV) instead of conventional oxygen therapy (COT) increased the risk of barotrauma (OR 5.04, 95% CI 2.30 - 11.08, p<0.001), similarly for invasive mechanical ventilation (OR 6.24, 95% CI 2.86-13.60, p<0.001). High Flow Nasal Oxygen (HFNO), compared with COT, did not significantly increase the risk of barotrauma. Barotrauma frequency occurred in 1.00% [95% CI 0.88-1.16] of patients; these were older (p=0.022) and more frequently immunosuppressed (p=0.013). Barotrauma was shown to be an independent risk for death (OR 5.32, 95% CI 2.82-10.03, p<0.001). Conclusions: C-PAP/PSV compared with COT or HFNO increased the risk of barotrauma; otherwise HFNO did not. Barotrauma was recorded in 1.00% of patients, affecting mainly patients with more severe COVID-19 disease. Barotrauma was independently associated with mortality. Trial registration: this case-control study was prospectively registered in clinicaltrial.gov as NCT04897152 (on 21 May 2021)

La magia nell'Europa moderna. Tradizioni e mutamenti, Atti del convegno (Firenze, 2-4 ottobre 2003)

Muovendo dagli esiti più fecondi e stimolanti del vivace dibattito novecentesco intorno alla presenza e al significato della magia nella cultura filosofica della prima età moderna, nei saggi inclusi nel volume vengono approfonditi, con un'impostazione interdisciplinare, le varie posizioni dottrinali e i diversi livelli della pratica magica che, a partire dalla seconda metà del '400 e lungo i due secoli successivi, toccano e coinvolgono ambiti diversi del sapere: dalla filosofia alla religione, dalla medicina alla scienza giuridica

A Rare Cause of Respiratory Insufficiency in a 30-Year-Old Transgender Woman

Case Presentation: A 30-year-old transgender woman who was HIV positive presented to the ED with progressive severe dyspnea and hemoptysis that started 1 day earlier. The patient was undergoing antiretroviral therapy with emtricitabine-rilpivirine-tenofovir with good compliance and feminizing hormone therapy with cyproterone acetate. She was otherwise healthy and was not taking any other medications