Valutazione del turn over dei farmaci antiretrovirali in particolare da IP a NNRTI

Objective: To determine the turnover for each antiretroviral drugs present in TP’s of patients under care for HIV infection, with a special focus on PI’s and NNRTI’s. Design/Methods: We have carried out a retrospective analysis with the aim of evaluating the turnover of each drug in the 3-year period 1998-2000. Using a specifically designed software, it was possible to determine the changes in TP for each single patient. We then calculated a different weighted percentage for each drug on the basis of the time interval from the drug entry to its exclusion from the TP: the shorter the interval, the greater the assigned weight. Finally we carried out a cluster analysis in order to obtain homogeneous groups of molecules showing the same degree of therapy switches. We established that a higher average score corresponds to a higher therapy switch rate. Results: Zidovudine/Lamivudine combination, Indinavir, Lamivudine, Nerivapine and Nelfinavir are the drugs with the lowest turnover. On the other hand, Saquinavir, Didanosine, Zidavudine, and Stavudine show the highest turnover. Conclusion: The introduction of NNRTI’s with the associated switch from PI’s (Saquinavir, Nelfinavir) and the Zidavudine/Lamivudine combination enables a simplification of the treatment. This practice appeared to be a good choice in the 3-year period under consideration. The adoption of these therapeutic solutions reduce the turnover, consequently giving more stability to TP’s

Towards the sustainable hydrogen production by catalytic conversion of C-laden biorefinery aqueous streams

An extensive screening of representative molecules of a post-hydrothermal process side stream has been performed with the aim of producing a gas mixture rich in hydrogen by catalytic aqueous phase reforming. The survey enlightens possible routes of valorisation of these by-products, scarcely investigated with other processes so far. The influence of reaction temperature was studied in the 230–270 °C range, looking at both the composition of the gas phase and the characterization of the liquid products. Indeed, the information coming from the condensed phase may provide relevant insights on the components that are not easily reformed, and that should be studied to improve the performance of the process. Binary and ternary mixtures of four selected compounds were tested to investigate synergistic and inhibiting effects, going towards the direction of a real biorefinery stream. The spent alumina-supported catalyst was characterized, outlining possible deactivation mechanisms of the catalytic system, and reused in two successive tests

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Toward crustacean without chemicals: a descriptive analysis of consumer response using price comparisons

Background: To date, there seems to be limited-to-zero emphasis about how consumers perceive crustacean products subject to either chemical and or non-chemical preservative treatments. In addition, studies that investigated price comparisons of crustacean products subject to either chemical or chemical-free preservative methods seem unreported. Objective: This study focused on providing some foundational knowledge about how consumers perceive traditionally harvested crustaceans that are either chemical-treated and or free of chemicals, incorporating price comparisons using a descriptive approach. Design: The study design employed a questionnaire approach via interview using a computer-assisted telephone system and sampled 1,540 participants across five key locations in Italy. To actualize consumer sensitivity, ‘price’ was the focus given its crucial role as a consumption barrier. Prior to this, variables such as demographic characteristics of participants, frequency of purchasing, quality attributes/factors that limit the consumption of crustaceans were equally considered. Results: By price comparisons, consumers are likely to favor chemical-free (modified atmosphere packaging) crustacean products amid a price increase of up to 15%. But, a further price increase such as by 25% could markedly damage consumers’ feelings, which might lead to a considerable number opting out in favor of either chemical-treated or other seafood products. Comparing locations, the studied variables showed no statistical differences (p>0.05). On the contrary, the response weightings fluctuated across the studied categories. Both response weightings and coefficient of variation helped reveal more about how responses deviated per variable categories. Conclusions: This study has revealed some foundational knowledge about how consumers perceive traditionally harvested crustaceans that were either chemical-treated or subject to chemical-free preservative up to price sensitivity using Italy as a reference case, which is applicable to other parts of the globe

LOW EF: THE BEST MARKER OF POOR PROGNOSIS IN PATIENTS AFFECTED BY NON COMPACTION.

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A coronary right fistula canalized in a small accessory right atrial chamber.

The coronary artery fistulas are rare congenital anomalies with a very low incidence. These can be symptomatic or asymptomatic because the hemodynamic consequences of the fistula vary and depend on the shunt dimensions. Discordant opinions instead are present in the literature for the defect closing in asymptomatic patients. Here, we describe a patient affected by a coronary right fistula canalized in a small accessory right atrial chamber. During follow-up, we observed a progressive dilatation of the right coronary artery (maximum diameter 10.3 mm) with hemodynamic overload of the right sections