Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants

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Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis

Importance: Meropenem is a widely prescribed β-lactam antibiotic. Meropenem exhibits maximum pharmacodynamic efficacy when given by continuous infusion to deliver constant drug levels above the minimal inhibitory concentration. Compared with intermittent administration, continuous administration of meropenem may improve clinical outcomes. Objective: To determine whether continuous administration of meropenem reduces a composite of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria compared with intermittent administration in critically ill patients with sepsis. Design, setting, and participants: A double-blind, randomized clinical trial enrolling critically ill patients with sepsis or septic shock who had been prescribed meropenem by their treating clinicians at 31 intensive care units of 26 hospitals in 4 countries (Croatia, Italy, Kazakhstan, and Russia). Patients were enrolled between June 5, 2018, and August 9, 2022, and the final 90-day follow-up was completed in November 2022. Interventions: Patients were randomized to receive an equal dose of the antibiotic meropenem by either continuous administration (n = 303) or intermittent administration (n = 304). Main outcomes and measures: The primary outcome was a composite of all-cause mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. There were 4 secondary outcomes, including days alive and free from antibiotics at day 28, days alive and free from the intensive care unit at day 28, and all-cause mortality at day 90. Seizures, allergic reactions, and mortality were recorded as adverse events. Results: All 607 patients (mean age, 64 [SD, 15] years; 203 were women [33%]) were included in the measurement of the 28-day primary outcome and completed the 90-day mortality follow-up. The majority (369 patients, 61%) had septic shock. The median time from hospital admission to randomization was 9 days (IQR, 3-17 days) and the median duration of meropenem therapy was 11 days (IQR, 6-17 days). Only 1 crossover event was recorded. The primary outcome occurred in 142 patients (47%) in the continuous administration group and in 149 patients (49%) in the intermittent administration group (relative risk, 0.96 [95% CI, 0.81-1.13], P = .60). Of the 4 secondary outcomes, none was statistically significant. No adverse events of seizures or allergic reactions related to the study drug were reported. At 90 days, mortality was 42% both in the continuous administration group (127 of 303 patients) and in the intermittent administration group (127 of 304 patients). Conclusions and relevance: In critically ill patients with sepsis, compared with intermittent administration, the continuous administration of meropenem did not improve the composite outcome of mortality and emergence of pandrug-resistant or extensively drug-resistant bacteria at day 28. Trial registration: ClinicalTrials.gov Identifier: NCT03452839

Formación y desarrollo profesional docente. El enseñante y su desarrollo profesional según los medios de comunicación en prospectiva 2030

Fil: Bazzanella, María Cecilia. Universidad Católica de Córdoba. Facultad de Educación; ArgentinaFil: Boccardo, Silvia del Carmén. Universidad Católica de Córdoba. Facultad de Educación; Argentina.Fil: Cangelosi, Daniel Horacio. Universidad Católica de Córdoba. Facultad de Educación; ArgentinaFil: Capdevila, Miriam Inés. Universidad Católica de Córdoba. Facultad de Educación; Argentina

Focal nodular hyperplasia and hepatic regenerating nodules in pediatric oncology patients: how much invasive approach is necessary?

Introduction. Hepatic regenerating nodules (HRN) and focal nodular hyperplasia (FNH) are benign regenerating lesions of the liver that rarely occur in children. An increased incidence of these lesions is reported in children treated for cancer.Material and methods. Eight children who developed FNH and HRN after treatment for malignancies in the Oncology unit at the “Bambino Gesu” Pediatric Hospital in Rome, were retrospectively analyzed.Results. The lesions, considered in the differential diagnosis with metastatic relapse of the primitive disease, have been monitored with US or other available imaging techniques. Evolution of the lesions was observed in only 1 patient three years after the initial diagnosis of FNH.Conclusion. In conclusion serial monitoring with imaging techniques is sufficient to rule out liver metastasis and to monitor the evolution of the lesions. Surgery is suggested only in the case of complications

Roman hospital management of a potential CBRNE event

Background: Rome hosts 6 advanced Emergency Departments (EDs) and 7 basic ones are the first line of defense of the city, and should provide healthcare assistance in case of maxi-emergencies. Rome hosts 5 warehouses of National Stockpile Antidotes (SNA), in case of a CBRN event, stockpiles are activated with a long-time call to be charged and delivered through specific trucks. Methods: The present study analyzes the PEIMAFs (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in case of a CBRNe attack. We hypothesized a chemical attack at Saint Peter’s Square during the General Assembly, on Wednesday (at 12.00).Subsequently, with a table-top simulation we evaluated the efficacy and the effectiveness of the SNA, and the travel times between the SNA warehouse and EDs. Findings: Being EDs chronically undermanned during the ordinary working conditions there will be serious issues in suddenly hosting a very large number of critical patients. In addition not all the hospitals inform their workers about PEIMAF or consider CBRNe emergencies in their PEIMAF, and simulations are not always performed. Moreover, the communication between the different institution involved is not optimal, presenting a major risk of contamination in case of CBRNe attacks. Conclusions: Our data highlight that despite an overall good organization there is room of improvement in shorting the times of travelling. In addition we believe is mandatory to develop in all the major roman hospitals the PEIMAF, which should be followed strictly by an organized training plan involving both theorical teaching, indoor and outdoor simulation, in order to train the hospital personnel and to evaluate weaknesses and vulnerabilities of the single PEIMAFs. Concluding, a smart call system can reduce the activation time of SNA, as well as well a better organization between the major hospitals in Rome, which can help reducing delivering time

Cobalamin c defect presenting with isolated pulmonary hypertension

Cobalamin C (cblC) defect is the most common inborn error of vitamin B-12 metabolism. Clinical features vary as does the severity of the disease. In most cases, the clinical symptoms of cblC defect tend to appear during infancy or early childhood as a multisystem disease with severe neurologic, ocular, hematologic, renal, and gastrointestinal signs. The neurologic findings are common and include hypotonia, developmental delay, microcephaly, seizures hydrocephalus, and brain MRI abnormalities. We report a case of a young boy with cblC defect, who did not undergo newborn screening, presenting at the age of 2 years with isolated pulmonary hypertension as the leading symptom. This novel way of presentation of cblC defect enlarges the spectrum of inherited diseases that must be considered in the differential diagnosis of pulmonary hypertension

lomeprol versus iopamidol in tomography of thoracic contrast-enhanced computed and abdominal organs

The aim of this double-blind, parallel-group study was to compare the safety, tolerance, and elficacy ol iomeprol-350 (350 mgl/ml), iomeprol-400 (400 mgl/ml) and iopamidol-37O (370 mgl/ml) for use in contrast-enhanced body computed tomography (CT). Following written informed consent, 120 adult inpatients of either sex requiring CT of thoracic or abdominal organs were randomly assigned to receive iomeprol-350, iomeprol-400 or iopamidol-370. Pre- and post-contrast, all patients underwent clinical, instrumental and laboratory investigation to assess the salety olthe test agents. Tolerance was assessed in terms of discomfort associated with contrast injection. Two experienced radiologists independently and blindly graded the quality ol contrast enhancement obtained with the different contrast solutions by means ola five-point ordinal scale as follows: 1, insufficient;2, sufficient; 3, good; 4, excellent; or E, excessive. Patients in the iomeprol groups needed lewer injections and a smaller volume of contrast medium to obtain examinations of adequate diagnostic quality. Contrast enhancement was judged as excellent or good in about 90% ofthe study examinations, without significant differences between the three study groups. During contrast injection, heat and pain sensations were minimal or absent in most cases. No serious adverse events occurred throughout the study. No significant changes in clinical, instrumental or laboratory safety parameters were observed. In conclusion, iomeprol-4O0 and iomeprol-350 appear to be contrast solutions at least as sale, well tolerated and effective as iopamidol-370 when used as contrast agents lor body CT

Extrahepatic portal vein thrombosis in children and adolescents: Influence of genetic thrombophilic disorders

AIM: To explore the prevalence of local and genetic thrombophilic disorders as risk factors for portal vein thrombosis (PVT) in our series, the largest ever published in pediatric literature