Pupillary activity in areas of interest from visual stimuli for neonatal pain assessment

This paper compares the pupillary activity index to traditional eye-tracking metrics like the fixation count and duration in assessing neonatal pain. It explores the benefits of incorporating pupillary activity measures to improve methods that lead to an understanding of cognitive processing and performance evaluation. The estimation of cognitive load using pupil diameter typically involves measures relative to a baseline. Instead, we conducted an eye-tracking study using the Low/High Index of Pupillary Activity to evaluate healthcare experts and non-experts analyzing the faces with and without pain from a dataset of newborn faces. This data was recorded by the Tobii TX300 eye-tracking system in a closed room with controlled lighting. Our contribution is to introduce the LHIPA calculation considering the areas of interest segments of the pupil diameter signal. The results suggest that the visual attention reflected by the traditional metrics may not correspond directly to the respective cognitive load for both sample groups of participants

Natural Products can Efficiently Control the Greater Wax Moth (Lepidoptera: Pyralidae), but are Harmless to Honey Bees

Honey bees (Apis mellifera L.) have great global socioeconomic and environmental importance. However, the greater wax moth (Galleria mellonella L.) is a pest that causes serious worldwide damage to honey bee colonies. Good beekeeping practices and physical, chemical, or natural methods can be used to control wax moths. The use of natural products is a more sustainable option because of their lower toxicity to the environment and the colony. Therefore, we evaluated the efficiency of four natural products for greater wax moth control: neem oil (Azadirachta indica), eucalyptus oil (Eucalyptus spp.), tobacco extract (Nicotiana tabacum), and malagueta pepper extract (Capsicum frutescens). We also evaluated their effects on adult bees and on the population growth of colonies. The 4th instar wax moths and adult bees were subjected to in vitro bioassays of different concentrations of the products. The results allowed usto establish a concentration for each product that was safe for the bees and effectively controlled the moth. Then, we sprayed them on bee colonies to evaluate their effects on population growth. The neem and eucalyptus oils caused wax moth mortality at low concentrations, but did not affect colony population growth. However, they did have a toxic effect on adult bees. The tobacco and pepper extracts efficiently controlled the moth, but did not cause adult bee mortality or interfered with the population growth of the colonies. Therefore, the tobacco and pepper extracts could efficiently control the greater wax moth, without damaging honey bees

Estabelecimento de predador não nativo (Pisces, Erythrinidae) em tributário da bacia do Alto rio Paraná, sul do Brasil

Erythrinus erythrinus is an erythrinid native from the basins of the Amazon, Orinoco, coastal rivers of the Guyana and Lower Paraná, but allochthonous of Tibagi River region, Paranapanema basin. In the present work, we report the occurrence of E. erythrinus in Água dos Tigres and Taquari rivers, in the Paranapanema basin, and aim to verify the occurrence of constancy and the condition of health of its specimens in sub-tributaries of the Lower Paranapanema River. The catch-per-unit-effort of the Água dos Tigres River mouth was about three times higher than the site upstream of the same river, and the Taquari River presented the lowest value. The species presented constancy of catches in tributaries of the basin, where isometric growth and good health condition of the specimens were observed. Its introduction into the Tibagi River basin may have occurred due to an intentional release as remaining live bait discarded in commercial fishery operations or may have dispersed after the flood of the Sete Quedas Falls. The presence of juveniles along with adults indicates that the species is undergoing an establishment stage of the invasion process in the region.Keywords: Tibagi River, biological invasion, fishes, diversity loss.Erythrinus erythrinus é um erythrinídeo nativo das bacias do Amazonas, Orinoco, rios costeiros da Guiana e Baixo Paraná, mas alóctone da região do rio Tibagi, bacia do Paranapanema. No presente trabalho, registra-se a ocorrência da espécie nos rios Água dos Tigres e Taquari, na bacia do Paranapanema, e objetiva-se verificar a constância de captura e condições de saúde dos espécimes em subafluentes do baixo rio Paranapanema. A captura por unidade de esforço da foz do rio Água dos Tigres foi cerca de três vezes maior do que a montante do mesmo rio, e o rio Taquari apresentou o menor valor. A espécie apresentou constância de captura nos tributários da bacia, onde constatou-se crescimento isométrico e boa condição de saúde dos espécimes. Sua introdução na bacia do rio Tibagi pode ter ocorrido devido a solturas intencionais de remanescentes de iscas vivas em pescarias comerciais, ou pode ter se dispersado após a inundação dos Saltos de Sete Quedas. A presença de juvenis junto aos adultos indica que a espécie encontra-se em estabelecimento na região.Palavras-chave: Rio Tibagi, invasão biológica, peixes, perda de diversidade

No evidence of SARS-CoV-2 in hospitalized patients with severe acute respiratory syndrome in five Italian hospitals from 1st November 2019 to 29th February 2020

Background On 9th January 2020, China CDC reported a novel coronavirus (later named SARS-CoV-2) as the causative agent of the coronavirus disease 2019 (COVID-19). Identifying the first appearance of virus is of epidemiological importance to tracking and mapping the spread of SARS-CoV-2 in a country. We therefore conducted a retrospective observational study to detect SARS-CoV-2 in oropharyngeal samples collected from hospitalized patients with a Severe Acute Respiratory Infection (SARI) enrolled in the DRIVE (Development of Robust and Innovative Vaccine Effectiveness) study in five Italian hospitals (CIRI-IT BIVE hospitals network) (1st November 2019 – 29th February 2020). Objectives To acquire new information on the real trend in SARS-CoV-2 infection during pandemic phase I and to determine the possible early appearance of the virus in Italy. Materials and methods Samples were tested for influenza [RT-PCR assay (A/H1N1, A/H3N2, B/Yam, B/Vic)] in accordance with the DRIVE study protocol. Subsequently, swabs underwent molecular testing for SARS-COV-2. [one-step real-time multiplex retro-transcription (RT) PCR]. Results In the 1683 samples collected, no evidence of SARS-CoV-2 was found. Moreover, 28.3% (477/1683) of swabs were positive for influenza viruses, the majority being type A (358 vs 119 type B). A/H3N2 was predominant among influenza A viruses (55%); among influenza B viruses, B/Victoria was prevalent. The highest influenza incidence rate was reported in patients aged 0–17 years (40.3%) followed by those aged 18–64 years (24.4%) and ≥65 years (14.8%). Conclusions In Italy, some studies have shown the early circulation of SARS-CoV-2 in northern regions, those most severely affected during phase I of the pandemic. In central and southern regions, by contrast no early circulation of the virus was registered. These results are in line with ours. These findings highlight the need to continue to carry out retrospective studies, in order to understand the epidemiology of the novel coronavirus, to better identify the clinical characteristics of COVID-19 in comparison with other acute respiratory illnesses (ARI), and to evaluate the real burden of COVID-19 on the healthcare system

The Exponential Phase of the Covid-19 Pandemic in Central Italy: An Integrated Care Pathway

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant’Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes

Epidemiology, management, and outcome of carbapenem-resistant Klebsiella pneumoniae bloodstream infections in hospitals within the same endemic metropolitan area

In the last decade, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become endemic in several countries, including Italy. In the present study, we assessed the differences in epidemiology, management, and mortality of CR-Kp bloodstream infection (BSI) in the three main adult acute-care hospitals of the metropolitan area of Genoa, Italy.From January 2013 to December 2014, all patients with CR-Kp BSI were identified through the computerized microbiology laboratory databases of the three hospitals. The primary endpoints of the study were incidence and characteristics of CR-Kp BSI in hospitals within the same endemic metropolitan area. Secondary endpoints were characteristics of CR-Kp BSI in hospitals with and without internal infectious diseases consultants (IDCs) and 15-day mortality.During the study period, the incidence of healthcare-associated CR-Kp BSI in the entire study population was 1.35 episodes per 10,000 patient-days, with substantial differences between the three hospitals. Patients admitted to the two hospital with internal IDCs were more likely to receive post-susceptibility test combined therapy including carbapenems (77% vs. 26%, p <. 0.001), adequate post-susceptibility test therapies (86% vs. 52%, p <. 0.001), and post-susceptibility therapies prescribed by an infectious diseases specialist (84% vs. 14%, p <. 0.001). Overall, the crude 15-days mortality was 26%. In the final multivariable model, only septic shock at BSI presentation was unfavorably and independently associated with 15-days mortality (odds ratio [OR] 6.7, 95% confidence intervals [CI] 2.6-17.6, p <. 0.001), while a protective effect was observed for post-susceptibility test combined therapies including a carbapenem (OR 0.11, 95% CI 0.03-0.43, p = 0.002).Mortality of CR-Kp remains high. Differences in the incidence of CR-Kp BSI were detected between acute-care centers within the same endemic metropolitan area. Efforts should be made to improve the collaboration and coordination between centers, to prevent further diffusion of CR-Kp

Predicting Outcomes in Pediatric Crohn’s Disease for Management Optimization: Systematic Review and Consensus Statements from PIBD-Ahead Program

A better understanding of prognostic factors within the heterogeneous spectrum of pediatric Crohn's disease (CD) should improve patient management and reduce complications. We aimed to identify evidence-based predictors of outcomes with the goal of optimizing individual patient management. A survey of 202 experts in pediatric CD identified and prioritized adverse outcomes to be avoided. A systematic review of the literature with meta-analysis, when possible, was performed to identify clinical studies that investigated predictors of these outcomes. Multiple national and international face-to-face meetings were held to draft consensus statements based on the published evidence. Consensus was reached on 27 statements regarding prognostic factors for surgery, complications, chronically active pediatric CD, and hospitalization. Prognostic factors for surgery included CD diagnosis during adolescence, growth impairment, NOD2/CARD15 polymorphisms, disease behavior, and positive anti-Saccharomyces cerevisiae antibody status. Isolated colonic disease was associated with fewer surgeries. Older age at presentation, small bowel disease, serology (anti-Saccharomyces cerevisiae antibody, antiflagellin, and OmpC), NOD2/CARD15 polymorphisms, perianal disease, and ethnicity were risk factors for penetrating (B3) and/or stenotic disease (B2). Male sex, young age at onset, small bowel disease, more active disease, and diagnostic delay may be associated with growth impairment. Malnutrition and higher disease activity were associated with reduced bone density. These evidence-based consensus statements offer insight into predictors of poor outcomes in pediatric CD and are valuable when developing treatment algorithms and planning future studies. Targeted longitudinal studies are needed to further characterize prognostic factors in pediatric CD and to evaluate the impact of treatment algorithms tailored to individual patient risk

Clinical-Genetic Features Influencing Disability in Spastic Paraplegia Type 4: A Cross-sectional Study by the Italian DAISY Network

Background and objectives: Hereditary spastic paraplegias (HSPs) are a group of inherited rare neurologic disorders characterized by length-dependent degeneration of the corticospinal tracts and dorsal columns, whose prominent clinical feature is represented by spastic gait. Spastic paraplegia type 4 (SPG4, SPAST-HSP) is the most common form. We present both clinical and molecular findings of a large cohort of patients, with the aim of (1) defining the clinical spectrum of SPAST-HSP in Italy; (2) describing their molecular features; and (3) assessing genotype-phenotype correlations to identify features associated with worse disability. Methods: A cross-sectional retrospective study with molecular and clinical data collected in an anonymized database was performed. Results: A total of 723 Italian patients with SPAST-HSP (58% men) from 316 families, with a median age at onset of 35 years, were included. Penetrance was 97.8%, with men showing higher Spastic Paraplegia Rating Scale (SPRS) scores (19.67 ± 12.58 vs 16.15 ± 12.61, p = 0.009). In 26.6% of patients with SPAST-HSP, we observed a complicated phenotype, mainly including intellectual disability (8%), polyneuropathy (6.7%), and cognitive decline (6.5%). Late-onset cases seemed to progress more rapidly, and patients with a longer disease course displayed a more severe neurologic disability, with higher SPATAX (3.61 ± 1.46 vs 2.71 ± 1.20, p < 0.001) and SPRS scores (22.63 ± 11.81 vs 12.40 ± 8.83, p < 0.001). Overall, 186 different variants in the SPAST gene were recorded, of which 48 were novel. Patients with SPAST-HSP harboring missense variants displayed intellectual disability (14.5% vs 4.4%, p < 0.001) more frequently, whereas patients with truncating variants presented more commonly cognitive decline (9.7% vs 2.6%, p = 0.001), cerebral atrophy (11.2% vs 3.4%, p = 0.003), lower limb spasticity (61.5% vs 44.5%), urinary symptoms (50.0% vs 31.3%, p < 0.001), and sensorimotor polyneuropathy (11.1% vs 1.1%, p < 0.001). Increasing disease duration (DD) and abnormal motor evoked potentials (MEPs) were also associated with increased likelihood of worse disability (SPATAX score>3). Discussion: The SPAST-HSP phenotypic spectrum in Italian patients confirms a predominantly pure form of HSP with mild-to-moderate disability in 75% of cases, and slight prevalence of men, who appeared more severely affected. Early-onset cases with intellectual disability were more frequent among patients carrying missense SPAST variants, whereas patients with truncating variants showed a more complicated disease. Both longer DD and altered MEPs are associated with worse disability