Impact of a multidisciplinary management team on clinical outcome in ICU patients affected by Gram-negative bloodstream infections: a pre-post quasi-experimental study

Background: Bloodstream infections (BSIs) by Gram-negative pathogens play a major role in intensive care patients, both in terms of prevalence and severity, especially if multi-drug resistant pathogens are involved. Early appropriate antibiotic therapy is therefore a cornerstone in the management of these patients, and growing evidence shows that implementation of a multidisciplinary team may improve patients' outcomes. Our aim was to evaluate the clinical and microbiological impact of the application of a multidisciplinary team on critically ill patients. Methods: Pre-post study enrolling critically ill patients with Gram negative bloodstream infection in intensive care unit. In the pre-intervention phase (from January until December 2018) patients were managed with infectious disease consultation on demand, in the post-intervention phase (from January until December 2022) patients were managed with a daily evaluation by a multidisciplinary team composed of intensivist, infectious disease physician, clinical pharmacologist and microbiologist. Results: Overall, 135 patients were enrolled during the study period, of them 67 (49.6%) in the pre-intervention phase and 68 (50.4%) in the post-intervention phase. Median age was 67 (58-75) years, sex male was 31.9%. Septic shock, the need for continuous renal replacement therapy and mechanical ventilation at BSI onset were similar in both groups, no difference of multidrug-resistant organisms (MDRO) prevalence was observed. In the post-phase, empirical administration of carbapenems decreased significantly (40.3% vs. 62.7%, p = 0.02) with an increase of appropriate empirical therapy (86.9% vs. 55.2%, p < 0.001) and a decrease of overall antibiotic treatment (12 vs. 16 days, p < 0.001). Despite no differences in delta SOFA and all-cause 30-day mortality, a significant decrease in microbiological failure (10.3% vs. 29.9%, p = 0.005) and a new-onset 30-day MDRO colonization (8.3% vs. 36.6%, p < 0.001) in the post-phase was reported. At multivariable analysis adjusted for main covariates, the institution of a multidisciplinary management team (MMT) was found to be protective both for new MDRO colonization [OR 0.17, 95%CI(0.05-0.67)] and microbiological failure [OR 0.37, 95%CI (0.14-0.98)]. Conclusions: The institution of a MMT allowed for an optimization of antimicrobial treatments, reflecting to a significant decrease in new MDRO colonization and microbiological failure among critically ill patients

Clinical evaluation of switching from immediate-release to prolonged-release lithium in bipolar patients, poorly tolerant to lithium immediate-release treatment: A randomized clinical trial

open13Aim: The effect of switching from lithium immediate release (Li-IR) to lithium prolonged release (Li-PR) on lithium-induced tremor after 1 and 12 weeks of treatment was evaluated in a randomized, multicenter, open trial, in bipolar patients from the participating sites with a tremor severity ≥2 (Udvalg for Kliniske Undersøgelser [UKU] rating scale) despite optimal lithium titration. Methods: The primary endpoint was the evaluation of tremor by means of the UKU scale after 1 week of treatment. Secondary endpoints included manic Young Mania Rating Scale (YMRS) and depressive symptoms (Montgomery-Asberg Depression Rating Scale), a global assessment of the patient's status (Clinical Global Impression), polyuria/polydipsia (UKU item 3.8) and patient-reported outcomes. Results: Owing to difficulties in including suitable patients the enrollment phase was closed when 73 patients were randomized. Notwithstanding the lower number of patients, in the modified intention-to-treat population (n = 70) the primary endpoint was statistically significant: tremor improved after 1 week in 62.9% in Li-PR group against 20.0% of patients in Li-IR group (p = .0006; two-tailed Fisher's exact test). The difference remained statistically significant after 4 (p = .0031) and 12 weeks (p = .0128). The same analysis performed in the PP population confirmed these results. Among the secondary endpoints, only the factor convenience of the treatment satisfaction questionnaire showed a statistically significant difference between groups. There were no apparent differences in the safety profile of the two formulations. Conclusions: This study is the first comparative documentation of a potential benefit of the prolonged-release formulation in reducing the symptom tremor, a well-known adverse effect of lithium therapy. Indeed, the study results should be interpreted taking into account the sample size lower than planned.openPelacchi, Federica; Dell'Osso, Liliana; Bondi, Emi; Amore, Mario; Fagiolini, Andrea; Iazzetta, Paolo; Pierucci, Daniela; Gorini, Manuela; Quarchioni, Elisa; Comandini, Alessandro; Salvatori, Enrica; Cattaneo, Agnese; Pompili, MaurizioPelacchi, Federica; Dell'Osso, Liliana; Bondi, Emi; Amore, Mario; Fagiolini, Andrea; Iazzetta, Paolo; Pierucci, Daniela; Gorini, Manuela; Quarchioni, Elisa; Comandini, Alessandro; Salvatori, Enrica; Cattaneo, Agnese; Pompili, Maurizi

The impact of chronic daily nicotine exposure and its overnight withdrawal on the structure of anxiety-related behaviors in rats: Role of the lateral habenula

Tobacco smoking is a serious health problem worldwide and a leading cause of mortality. Nicotine, the addictive component of tobacco, affects a range of emotional responses, including anxiety-related behaviors. Although perceived by smokers to be anxiolytic, evidence suggests that smoking increases anxiety and that mood fluctuates with nicotine intake. Thus, nicotine addiction may depend on easing the psychobiological distress caused by its abuse. The lateral habenula (LHb) has been implicated as a neural substrate for acute nicotine-induced anxiety, but its role in anxiety-like behaviors associated with chronic nicotine exposure has not been explored. Here, we assessed the effect of chronic nicotine exposure and its subsequent overnight withdrawal on anxiety-like behavior using both quantitative and multivariate T-pattern analysis in rats tested using the hole-board apparatus. Additionally, we explored the role of the LHb by comparing the behavioral effects of short-term nicotine withdrawal in chronically treated LHb-lesioned rats. Quantitative analysis revealed increased anxiety-like behavior in chronically treated overnight nicotine-deprived rats, as manifested in reduced general and focused exploratory behaviors, which was eased in animals that received nicotine. Quantitative analysis failed to reveal a role of the LHb in overnight nicotine deprivation-induced anxiety. Conversely, T-pattern analysis of behavioral outcomes revealed that chronic nicotine-treated rats still show anxiety-like behavior following nicotine challenge. Moreover, it demonstrated that the LHb lesion induced a stronger anxiolytic-like response to the acute challenge of nicotine in chronically nicotine-exposed animals, implicating the LHb in the anxiogenic effect of chronic nicotine exposure. These data further highlight the LHb as a promising target for smoking cessation therapies and support the importance of T-pattern analysis for behavioral analysis

Female gender and psychological profile of outpatients attending Post-COVID-19 follow-up: some preliminary results

Background: The Post-COVID syndrome, characterized by persistence of psychological, neurologic, and physical symptoms, affects a large proportion of COVID-19 survivors. Specifically, females seem at increased risk of experiencing more psychological manifestations of Post-COVID Syndrome. Methods: A sample of 60 PCR (Polymerase Chain Reaction) confirmed COVID-19 outpatients (48.3% female; age mean= 56.1; SD= 10.8) attending an outpatient clinic dedicated to Post-COVID-19 follow-up was enrolled for this study. Each participant completed the Psychosocial Index to assess stress, well-being, psychological distress, and illness behavior, the Impact of Event Scale – Revised to evaluate post-traumatic stress symptoms and, the Hospital Anxiety and Depression Scale to assess anxiety and depression; the Connor-Davidson Resilience Scale to assess resilience; and N scale of NEO Five Factor to assess “Neuroticism”. Results: More than half of patients showed clinical or subclinical anxiety and depressive symptoms. Post-traumatic stress symptoms were found in 58.3% of sample. Resilience levels were in a medium range (71.0 ± 15.2). Statistical analysis found a predominance of depressive symptomatology (p = 0.0453), hyperarousal manifestations (p = 0.0049), perception of stress (p = 0.0001) and trait of neuroticism in women (p 0.0001). Our results show psychological distress, post-traumatic symptoms, poor psychological well-being, depression and anxiety symptoms for several weeks after infection in patients who had COVID-19. Moreover, female outpatients had a higher perception of distress, hyperarousal manifestations and depressive symptomatology than the male counterpart.                    Conclusions: As a novelty, this study gives us a deeper understanding of the psychological Post-COVID-19 profile in a clinical sample of pneumological outpatients. Moreover, it focused on gender differences identifying the female gender as a risk factor with respect to psychological illness. Our findings suggest the relevance of planning personalized interventions and assessment aimed at higher psychopathological risk groups, such as females

L’Europa antagonista e riformatrice

The European Union as innovative actor - The book develops the analysis in two parts, which are linked, although deal with different aspects: one concerns the concepts of antagonism and innovation as EuropÈs characteristics, the other concerns strategies and difficulties of integration process in XXI Century. Institutional and administrative reforms, as well as functioning machinery and economic and enlargement strategies are analysed in depth. This helps to understand why Europe must in the futureact on the basis of clear strategies and cope the international challanges by innovation. Parole Chiave: Europa; prospettive; strategie. Keywords: Europe; Perspectives; Strategies.

You Are The One I Want to Communicate With! Relational Motives Driving Audience-Tuning Effects on Memory

We investigated the role of relational motives in the saying-is-believing effect (Higgins & Rholes, 1978). Building on shared reality theory, we expected this effect to be most likely when communicators were motivated to get along with the audience. In the current study, participants were asked to describe an ambiguous target to an audience who either liked or disliked the target. The audience had been previously evaluated as a desirable vs. undesirable communication partner. Only participants who communicated with a desirable audience tuned their messages to suit their audience’s attitude towards the target. In line with predictions, they also displayed an audience-congruent memory bias in later recall.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Molecular characterization of monoamine oxidase in zebrafish (Danio rerio)

Monoamine oxidase (MAO) is responsible for the degradation of a number of neurotransmitters and other biogenic amines. In terrestrial vertebrates, two forms of the enzyme, named MAO A and B, were found in which mammals are coded by two similar but distinct genes. In teleosts, the biochemical data obtained so far indicate that enzyme activity is due to a single form, whose sequence, obtained for trout, displays 70% identity with mammal MAO A and B. In this paper, we carried out an investigation of zebrafish MAO (Z-MAO) to shed further light on the nature of the MAO form present in aquatic vertebrates. Sequencing studies have revealed an open reading frame 522-amino-acids long with MW 58.7 kDa, displaying 84% identity with trout MAO and about 70% identity with mammal MAO A and MAO B. Analysis of the sequence and of the predicted secondary structure shows that also in Z-MAO principal domains characterizing the MAOs are present. The domain linking the FAD is very well conserved, while the transmembrane domain sequence linking the enzyme to the external mitochondrial membrane does not appear to be conserved even with respect to trout MAO. Comparison with the amino acids which, according to the human MAO B and rat MAO A models, line the substrate-binding site shows that in Z-MAO, several residues (V172, N173, F200, L327) differ from MAO B but are similar or identical to the corresponding ones present in rat MAO A, as well as in trout MAO. A three-dimensional model is reported of the substrate-binding site of Z-MAO obtained by comparative modeling. Our observations support the hypothesis that the MAO form present in aquatic vertebrates is a MAO A-like form. Experiments performed to test the effect of selective MAO A (clorgyline) and MAO B (deprenyl) inhibitors on the enzyme's activity in liver and brain confirm the presence of a single form of MAO in zebrafish. (C) 2004 Elsevier Inc. All rights reserved

Motor neuron, peripheral nerve, and neuromuscular junction disorders

In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly