Financial Relationships Between Public Administration and Public Enterprises: Theoretical Foundations and Practical Implications

The objective of this study is to analyze the institutional and organizational structure of public service companies in Italy. After analyzing the various reforms of the Public Administration, research has focused on the crisis and the insolvency of publicly owned companies, as, for the first time and recently the legislator has organically regulated the consequences of the insolvency of the same, affirming their general submission to bankruptcy and insolvency proceedings. Still the norm also outlined the procedure for the adoption of preventive plans should aim to avoid insolvency in financial hardship cases, and to remedy the crisis of the investee companies. After having dealt with the issue of historical evolution and territorial distribution of the phenomenon of public enterprises in Italy, aspects of the legal framework of the object of study will be addressed. The next section analyzes the contents of the reform of public companies, recalling the reference standards and the important news concerning the coverage of losses of companies. The new discipline produces important repercussions on public budgets and therefore on the community: for this reason, the conclusions of the study will deal with this aspect

Comments on: Methylene blue? therapeutic alternative in the management of septic shock refractory to norepinephrine

It is a comment on an interesting case report focusing on the use of methylene blue in septic shock refractory to noreprinephrine. In septic shock, the response to pathogen-associated molecular patterns (PAMPS) and damage-associated molecu- lar patterns (DAMPS) generates a combination of vasodilation and increased capillary permeability. Capillary leak, coupled with greater vessel capacitance mediated by vasoplegia, may result in absolute or more commonly relative hypovolemia. The L-arginine nitric oxide (NO) pathway plays a pivotal role in regulating cardiovascular hemodynamics and vascular permeability. Methylene blue inhibits inducible NO synthase (NOS) and guanylate cyclase, thereby reversing NO induced vasodilation. In septic shock, it was firstly used at the beginning of the 1990s. This drug has resulted beneficial and safe in randomized clinical trials and case reports. Recently, its clinical use has been deeply reviewed, and we are strongly convinced that it would deserve further attention and prospective, randomized, clinical trials

The Routes of Administration for Acute Postoperative Pain Medication

Effective treatment of postoperative acute pain, together with early mobilization and nutrition, is one of the perioperative strategies advocated to improve surgical outcome and reduce the costs of hospitalization. Moreover, adequate pain control reduces perioperative morbidity related to surgical stress and can also prevent the incidence of chronic postoperative pain syndromes, whose treatment is still a challenge. The choice of the most appropriate analgesics depends not only on the drug class, but also on the most suitable route of administration, the best dosage for that route, and unique limitations and contraindications for every patient. In the present review, a comprehensive analysis was performed on the different routes of administration of acute postoperative pain medications and their indications and limitations, focusing on recent evidence and international recommendations

Craniofacial Growth Series Volume 56

https://deepblue.lib.umich.edu/bitstream/2027.42/153991/1/56th volume CF growth series FINAL 02262020.pdfDescription of 56th volume CF growth series FINAL 02262020.pdf : Proceedings of the 46th Annual Moyers Symposium and 44th Moyers Presymposiu

Acute Kidney Injury in Coronavirus Disease 2019 Infected Patients: A Meta-Analytic Study

Introduction: In clinical reports on coronavirus disease 2019 (COVID-19), the incidence of acute kidney injury (AKI) is extremely variable, although AKI is described as an independent risk factor for mortality. A meta-analysis was performed to clarify the incidence and the impact of COVID-19-related AKI on mortality. Methods: All trials reporting the incidence of AKI in COVID-19 patients were searched using MEDLINE, the Cochrane Library, and EMBASE databases (last update April 26, 2020). Results: Ten trials with a sample of 5,166 patients were included. AKI occurred in 947 out of 5,166 (18.3%) patients. AKI incidence was higher in severe cases: 62/305 severe patients developed AKI (20%) versus 27/1,268 nonsevere patients (2%) (p = 0.00001). AKI occurred in 475 out of 915 (52%) deceased patients versus 183 out of 2,678 (7%) survivors (p = 0.00001). Continuous renal replacement therapy was significantly more frequent in severe cases and in dead patients. Conclusion: A significant increase in mortality rate was observed in COVID patients who developed AKI, and AKI incidence was also higher in severe cases. Any supportive strategies to protect kidney could represent valuable intervention to reduce mortality in severe COVID-19 patients

A Bilateral Lumbar Multidermatomal Herpes Zoster in an Elderly Woman with Chronic Kidney Disease

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Derecho de petición y el procedimiento administrativo en la Municipalidad Distrital de Huaura-período 2020

OBJETIVO: El estudio postulado tiene como objetivo básico, demostrar cómo se relaciona el derecho de petición con el procedimiento administrativo, para que a través de un estudio descriptivo se pueda identificar la problemática que se ha presentado en la Municipalidad Distrital de Huaura-Período 2020. METODOLOGÍA: En relación a este tema, es importante señalar que la investigación es de tipo descriptiva, la cual se realiza con la ayuda de un grupo de 52 trabajadores, así como, el uso de la observación, cuestionarios y contenido documental. RESULTADOS: En relación con la idea anterior y de acuerdo con la verificación y procesamiento de datos, se descubrió una RELACIÓN SIGNIFICATIVA ENTRE LAS VARIABLES IDENTIFICADAS; esto sobre la base de cálculo de un Chi cuadrado Ji 2 = 18.112, gl=4 (al cual se le asigna un valor de probabilidad adjunto) y un valor de significación de 0,004. CONCLUSIONES: Finalmente, se ha demostrado que existe una relación significativa entre el derecho de petición y el procedimiento administrativo, el cual presenta un regular nivel medio-baj

P076. Improving patient communication and management by the use of the "Headache Digest", a pilot study

The Headache Digest (HD) is a self-administered questionnaire consisting of 13 items with multiple choice responses constructed according to the ICHD-III beta diagnostic criteria. Seven questions concern headache features. The remaining items collect details regarding onset, clinical course, attack frequency, symptomatic drugs assumption and efficacy. A section is reserved for the doctor dealing with patient’s medical history. The ID-Migraine, a self-administered questionnaire, consisting of only 3 items, is a valid and reliable screening instrument for migraine and was validated in Italy, but it does not provide information concerning headache course HD and ID-Migraine were given to 68 consecutive new patients referring to the Bari Headache Center. Sixty-two patients received the diagnosis of migraine by the headache specialist. HD showed a sensitivity of 0.98 (95% CI 0.91-0.99) and a specificity of 0.66 (95% CI 0.3- 0.90). ID-Migraine showed a sensitivity of 0.75 (95% CI 0.63-0.84) and a specificity of 0.66 (95% CI 0.3-0.90). According to this pilot study, Headache Digest is more sensitive than ID-Migraine whereas both tools showed the same specificity

Evaluación de decibeles ambientales y su propuesta de un plan de mitigación del paradero de buses del distrito de Sayan -2022

La investigación se desarrolló en el distrito de Sayán departamento de Lima-Provincias. Objetivo: Evaluar el grado de decibeles ambientales para proponer un plan de mitigación en el paradero de buses del distrito de Sayán - 2022: Metodología: El tipo de investigación es aplicativo, el diseño de investigación no experimental, El análisis estadístico se realizó con el programa SPSS, de T Student. Resultados: En la Estación de Monitoreo 1. De zona comercial, Puesto de control de la comisaría Sayán (EM1), el resultado promedio fue 77.05(dB), a partir de calcular con la ECA 70 (dB) que se logró determinar como 100% en esta estación de monitoreo sobrepasando 10.07 % de ruido del estándar de calidad ambiental; en la Estación de Monitoreo 2. Donde existe mayor contaminación el Paradero de buses informal de Sayán (EM2), el resultado promedio fue 79.35 (dB), donde calculando con la ECA 70 (dB) que se logró determinar como 100% en esta estación de monitoreo sobrepasando 13.35 % ruido del estándar de calidad ambiental; en la Estación de Monitoreo 3. Carretera salida 100 m. de Sayán (EM3), el resultado promedio fue 77.95 (dB), donde realizando el cálculo con la ECA 70 (dB) se logró determinar como 100% en esta estación de monitoreo sobrepasando 11.35 % ruido del estándar de calidad ambiental; en la Estación de Monitoreo 4. De zona comercial, Paradero de buses en el distrito de Sayán. (EM4), el resultado promedio fue 74.7 (dB), donde calculando con la ECA 70 (dB) se determinó como 100% en esta estación de monitoreo sobrepasando 6.71 % ruido del estándar de calidad ambiental, Conclusiones: En la prueba de análisis, la hipótesis alterna cumple en forma significativa en las 4 estaciones de monitoreo, declinando la hipótesis nula; debido a lo expuesto existe una interrelación directa entre los decibeles y la propuesta del plan de mitigació

Vasopressor-Sparing Action of Methylene Blue in Severe Sepsis and Shock: A Narrative Review

Shock is a serious acute circulatory failure leading to inadequate oxygen delivery to the cells. Its treatment is mainly based on circulating fluid optimization, and vasopressors to provide an adequate mean arterial pressure and microcirculatory flow. Norepinephrine is the drug of choice, but high dosages may be responsible for several side effects, including increased myocardial oxygen consumption, dysrhythmias, and peripheral and organ ischemia. Moreover, some patients are “non-responders” to first-line norepinephrine treatment. Hence, other drugs have been proposed to reach and maintain the hemodynamic target. In general, they are described as catecholamine-sparing agents. Among others, the most used are vasopressin, corticosteroids, and angiotensin II. Methylene blue (MB) represents a further option, even though its use is still a topic of controversy. This review article tries to summarize what is known and unknown about the actions of MB in patients in shock. It reduces excessive production of nitric oxide via blockade of guanylate cyclase in shock states. At present, it appears the MB provides positive results in septic shock, if administered early. Further randomized controlled trials are warranted regarding its use to provide more precise indications to physicians involved in the treatment of such patients