Acute coronary occlusion secondary to radiofrequency catheter ablation of a left lateral accessory pathway

A case of asymptomatic acute coronary occlusion secondary to radiofrequency catheter ablation of a left lateral accessory pathway is reported. Due to post-procedural ST modifications of the surface ECG, a coronary angiography was performed which disclosed total occlusion of the first marginal branch of the left circumflex coronary artery. A cute myocardial infarction was confirmed by moderate cardiac enzyme release, abnormal myocardial perfusion scan and mild lateral hypokinesia at echocardiographv. This rare but potentially harmful complication of interventional electrophysiology should be kept in mind and coronary angiography performed immediately when coronary occlusion related to radiofrequency application is suspecte

A New Kind of Quinonic-Antibiotic Useful Against Multidrug-Resistant S. aureus and E. faecium Infections

Indexación: Scopus.A rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics and reducing the therapeutic arsenal available for treatment of infectious diseases. In the present study, we developed a new class of compounds with antibacterial activity obtained by a simple, two step synthesis and screened the products for in vitro antibacterial activity against ATCC® strains using the broth microdilution method. The compounds exhibited minimum inhibitory concentrations (MIC) of 1⁻32 μg/mL against Gram-positive ATCC® strains. The structure⁻activity relationship indicated that the thiophenol ring is essential for antibacterial activity and the substituents on the thiophenol ring module, for antibacterial activity. The most promising compounds detected by screening were tested against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREF) clinical isolates. We found remarkable activity against VREF for compounds 7 and 16, were the MIC50/90 were 2/4 µg/mL and 4/4 µg/mL, respectively, while for vancomycin the MIC50/90 was 256/512 µg/mL. Neither compound affected cell viability in any of the mammalian cell lines at any of the concentrations tested. These in vitro data show that compounds 7 and 16 have an interesting potential to be developed as new antibacterial drugs against infections caused by VREF.https://www.mdpi.com/1420-3049/23/7/177

Modelling Hospital Medical Wards to Address Patient Complexity: A Case-Based Simulation-Optimization Approach

In this paper we focus on patient flows inside Internal Medicine Departments, with the aim of supporting new organizational models taking into account the patient relevant characteristics such as complexity and frailty. The main contribution of this paper is to develop a Discrete Event Simulation model to describe in detail the pathways of complex patients through medical hospital wards. The model has been applied to reproduce a case study of an Italian middle size hospital. The objective is quantifying the impact on resource use and outcome of introducing a new organizational model for medical departments. The re-organization is mainly focused on changing the available beds assignment among the wards to better address the complexity of care of patients with comorbidities. Following a patient-centered approach, patients are segmented considering the clinical characteristics (i.e. the pathology, proxy of Diagnoses Related Groups classification) and sub-grouped considering other characteristics, such as comorbidities and ward of admission. Then, an optimization component embedded into the model chooses the best pooling strategy to reorganize medical wards, determining the corresponding number of beds able to improve process indicators, such as length of stay. The simulation model is presented, and preliminary results are analyzed and discussed

Main and interactive effects of shiftwork, age and work stress on health in an Italian sample of healthcare workers

Among healthcare workers, shiftwork (mostly if nightwork is also included), ageing and work-related stress may be factors leading to impaired health. Such risk factors may also operate in interaction, resulting in an even increased harm for health. The present study aims at evaluating these relationships in a sample of 1842 hospital workers in Northern Italy. Subjects were mainly women, 33.1% were aged X45 yr, and they were almost evenly distributed between dayworkers and rotating shiftworkers (nights included). Shiftwork was associated with poor sleep, while it was protective against gastrointestinal disorders, poor work ability and job dissatisfaction. Work stress was the risk factor with the highest relevance for poor health. Ageing was associated with lower physical health. Few significant interactions were observed. Shiftwork with nights and high work stress significantly interacted in increasing the risk for poor sleep. The\u2018\u2018healthy worker effect\u2019\u2019 may have played a strong role in study findings

II ruolo degli omega-3 nel paziente pluripatologico complesso: dalle evidenze alla pratica clinica in Medicina Interna

II ruolo degli omega-3 nel paziente pluripatologico complesso      M. Campanini, R. Nardi II ruolo degli omega-3 nella prevenzione dell’ipertrigliceridemia pura e iperlipemia combinata, ma non solo: dalle evidenze alla pratica clinica P. Gnerre, O. Para, G. Balbi Gli omega-3 nell’obesità e nell’insulino-resistenza M. Poggiano Gli omega-3 nel diabete mellito di tipo 2 M. Poggiano Gli effetti degli omega-3 sulle aritmie C. Cenci Gli effetti degli omega-3 nella prevenzione dell’infarto miocardico R. Gerloni Omega-3 e scompenso cardiaco R. Gerloni I prodotti naturali: una possibile alternativa alle statine per la riduzione del colesterolo M.C. Pasquini Nutrizione, omega-3 e cancro A. Mazza, G. Rubello, G. Mazza Gli omega-3: trigliceridi naturali o esteri etilici? P. Zuccheri, C. Iacono, G. Benini II ruolo degli omega-3 nel paziente pluripatologico complesso: dalle evidenze alla pratica clinica in Medicina Interna A. Fontanell

La ventilazione non invasiva in Medicina Interna

Legenda delle più comuni abbreviazioni e acronimi Prefazione P. Navalesi Presentazione M. Campanini La NIV in Medicina Interna F. Lari Il ventilatore e i suoi componenti F. Lari Maschere ed interfacce F. Lari Sistemi CPAP (pressione positiva continua applicata alle vie aeree) F. Lari Principi e tecniche di ventilazione meccanica F. Giostra, E. Di Flaviano Insufficienza respiratoria acuta cardiogena - ruolo della ventilazione non invasiva F. Ventrella Riacutizzazione di broncopneumopatia cronica ostruttiva M. La Regina, F. Orlandini Altre indicazioni alla ventilazione meccanica non invasiva F. Pieralli, O. Para, C. Nozzoli Le apnee del sonno: competenza multidisciplinare e ruolo dell’internista F. Lari La ventilazione meccanica non invasiva nella palliazione del paziente oncologico terminale S. Orlando, M. Giorgi-Pierfranceschi La NIV nel paziente con insufficienza respiratoria cronica, la gestione domiciliare - Competenza specialistica nelle patologie pneumologiche pure A. Marchioni, E.M. Clini, B. Beghé Approccio al paziente internistico, candidato alla ventilazione meccanica non invasiva: key messages M. Giorgi Pierfranceschi La ventilazione meccanica non invasiva: conclusioni M. Errico, A. Greco NIV in Medicina Interna: sono necessari sistemi di monitoraggio emodinamico? N. Di Battista, F. Savell

Reliability of capturing foot parameters using digital scanning and the neutral suspension casting technique

<p>Abstract</p> <p>Background</p> <p>A clinical study was conducted to determine the intra and inter-rater reliability of digital scanning and the neutral suspension casting technique to measure six foot parameters. The neutral suspension casting technique is a commonly utilised method for obtaining a negative impression of the foot prior to orthotic fabrication. Digital scanning offers an alternative to the traditional plaster of Paris techniques.</p> <p>Methods</p> <p>Twenty one healthy participants volunteered to take part in the study. Six casts and six digital scans were obtained from each participant by two raters of differing clinical experience. The foot parameters chosen for investigation were cast length (mm), forefoot width (mm), rearfoot width (mm), medial arch height (mm), lateral arch height (mm) and forefoot to rearfoot alignment (degrees). Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were calculated to determine the intra and inter-rater reliability. Measurement error was assessed through the calculation of the standard error of the measurement (SEM) and smallest real difference (SRD).</p> <p>Results</p> <p>ICC values for all foot parameters using digital scanning ranged between 0.81-0.99 for both intra and inter-rater reliability. For neutral suspension casting technique inter-rater reliability values ranged from 0.57-0.99 and intra-rater reliability values ranging from 0.36-0.99 for rater 1 and 0.49-0.99 for rater 2.</p> <p>Conclusions</p> <p>The findings of this study indicate that digital scanning is a reliable technique, irrespective of clinical experience, with reduced measurement variability in all foot parameters investigated when compared to neutral suspension casting.</p

Hydrophobic and ionic-interactions in bulk and confined water with implications for collapse and folding of proteins

Water and water-mediated interactions determine thermodynamic and kinetics of protein folding, protein aggregation and self-assembly in confined spaces. To obtain insights into the role of water in the context of folding problems, we describe computer simulations of a few related model systems. The dynamics of collapse of eicosane shows that upon expulsion of water the linear hydrocarbon chain adopts an ordered helical hairpin structure with 1.5 turns. The structure of dimer of eicosane molecules has two well ordered helical hairpins that are stacked perpendicular to each other. As a prelude to studying folding in confined spaces we used simulations to understand changes in hydrophobic and ionic interactions in nano droplets. Solvation of hydrophobic and charged species change drastically in nano water droplets. Hydrophobic species are localized at the boundary. The tendency of ions to be at the boundary where water density is low increases as the charge density decreases. Interaction between hydrophobic, polar, and charged residue are also profoundly altered in confined spaces. Using the results of computer simulations and accounting for loss of chain entropy upon confinement we argue and then demonstrate, using simulations in explicit water, that ordered states of generic amphiphilic peptide sequences should be stabilized in cylindrical nanopores