Rhabdomyolysis Following Bariatric Surgery: a Retrospective Analysis

Background: Rhabdomyolysis (RML) indicates a skeletal muscle necrosis which results in an emission of intracellular contents from myocytes into the circulatory system. It has been recognized to be a complication of bariatric surgery. A high BMI and a prolonged operative time are the main risk factors associated to the development of RML. The aim of this study is to define the incidence and the main features of RML in a cohort of obese patients undergoing bariatric surgery. Materials and Methods: a retrospective observational analysis was carried out on 100 patients undergone bariatric surgery. The bariatric operations were open or laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG); they were performed at the university hospital Nuovo S. Chiara in 2011. Results: 6 of 100 patients enrolled developed RML. Three of these also showed acute kidney injury due to RML (50%). A significant correlation between post-operative increased creatine phosphokinase (CPK) levels and BMI was found (r=0.369; r2=0,137; p=0.005) as well as a significant correlation between the increased levels of creatine phosphokinase, myoglobin and operative time (increased operative time - highest CPK: r=0.550; r2=0.302; p<0.0001; increased operative time - highest myoglobin: r=0.553; r2=0.305; p<0.0001). Moreover, hypertension and prolonged operative time were found to be variables associated with RML in bivariate analysis. Conclusions: The incidence of RML following bariatric surgery was 6%. Since rhabdomyolysis is the most important complication of bariatric surgery, appropriate precautions should be taken during surgery. Post-operative monitoring of CPK and myoglobin levels is essential for an early diagnosis of RML

Early identification of acute kidney injury after bariatric surgery: Role of NGAL and cystatin C

Background: The aim of our study was to evaluate plasmatic and urinary NGAL and serum cystatin C as early diagnostic markers of acute kidney injury in obese patients undergoing bariatric surgery. Methods: For this this prospective observational study, we recruited 23 patients undergoing gastric by-pass or sleeve gastrectomy, and admitted to the Low Dependence Unit after the surgery. Plasma NGAL (pNGAL), urinary NGAL (uNGAL), serum cystatin C, serum creatinine, and serum urea were measured before surgery as well as 10 h and 24 h after surgery. Mean values of pNGAL, uNGAL, cystatin C, creatinine, and urea concentrations of pre- and post-surgery periods were compared using Student’s t test for paired data. We also evaluated the presence of correlation between modifications of NGAL and cystatin C after surgery and fluid balance, hydration (ml/kg) and diuresis using Pearson’s coefficient of correlation. Results: No patient developed AKI according to the AKIN criteria. pNGAL was significantly higher at T10th than T0(p=0.004). There was no significant difference between uNGAL at T0 and T10th (p=0.53) and between uNGAL at T0 and T24th (p=0.31). uNGAL at T24th was significantly higher in comparison to T10th (p=0.024). uNGAL concentrations were normal in all patients at every time step. Cystatin C concentration did not increase after surgery. Serum creatinine level was significantly higher at T48th, despite being still within the normal range, when compared to T0 (p=0.038). Conclusion: Our study shows that pNGAL can reflect mild tubular damage as its levels increase within a few hours from surgery and return to normal limits afterwards. Concerning uNGAL, there is a minimal increase at T24th, when NGAL concentration in plasma has already decreased. Serum cystatin C does not show any relevant kidney changes, or at least, no more than those ones shown by pNGAL

Evaluation of the AIDS risk perception among healthcare workers in the hospital University Unit of Messina (Italy)

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Clinical features of respiratory syncytial virus bronchiolitis in an infant: rapid and fatal brain involvement

BACKGROUND: Respiratory Syncytial Virus (RSV) infection is a significant cause of bronchiolitis and pneumonia, mostly responsible for hospitalization and infant death worldwide. However, in recent years the importance of extrapulmonary RSV manifestations, especially at neurological level, have become evident. Seizures, lethargy, ataxia and status epilepticus are suggestive of brain involvement, but also in their absence a direct neurological damage RSV-related need to be evaluated. CASE PRESENTATION: A 40-day old male infant was admitted to the Emergency Department with severe bronchiolitis and dyspnea. The patient was reported to be coughing for a week with a vomiting episode in the previous two days. The nasopharyngeal swab confirmed the diagnosis of RSV infection and blood gas test showed hypoxemia and respiratory acidosis. For these reasons, the patient was provided with oxygen therapy. A few hours later, after an initial improvement in clinical parameters, a worsening of respiratory dynamics occurred and the patient was prepared for endotracheal intubation, but in the meantime death occurred. During all the observation period in the Emergency Room, no signs of neuropathological damage were evident. Post mortem examination showed lungs congestion with alveolar atelectasis and white matter degradation with severe edema at brain level. Microbiological analysis performed on autoptic samples confirmed the presence of RSV genome in tracheobronchial aspirate, meningeal swabs, pericardic and abdominal fluids, lung and brain biopsies. CONCLUSIONS: RSV is usually associated with respiratory diseases, however, as reported by an increasingly number of studies, the systemic dissemination of virus during severe disease can lead to a sudden infant death. The clinical picture herein reported showed a severe bronchiolitis resulting in a fatal and underestimated cerebral involvement due to RSV neurotropic behaviour and underline the need for clinicians to pay more attention to neurological involvement of RSV infection, even in absence of cerebral damage evidence

Ultrasound- versus landmark-guided subclavian vein catheterization: a prospective observational study from a tertiary referral hospital

This was a single-center, observational, prospective study designed to compare the effectiveness of a real-time, ultrasound- with landmark-guided technique for subclavian vein cannulation. Two groups of 74 consecutive patients each underwent subclavian vein catheterization. One group included patients from intensive care unit, studied by using an ultrasound-guided technique. The other group included patients from surgery or emergency units, studied by using a landmark technique. The primary outcome for comparison between techniques was the success rate of catheterization. Secondary outcomes were the number of attempts, cannulation failure, and mechanical complications. Although there was no difference in total success rate between ultrasound-guided and landmark groups (71 vs. 68, p\u2009=\u20090.464), the ultrasound-guided technique was more frequently successful at first attempt (64 vs. 30, p\u2009<\u20090.001) and required less attempts (1 to 2 vs. 1 to 6, p\u2009<\u20090.001) than landmark technique. Moreover, the ultrasound-guided technique was associated with less complications (2 vs. 13, p\u2009<\u20090.001), interruptions of mechanical ventilation (1 vs. 57, p\u2009<\u20090.001), and post-procedure chest X-ray (43 vs. 62, p\u2009=\u20090.001). In comparison with landmark-guided technique, the use of an ultrasound-guided technique for subclavian catheterization offers advantages in terms of reduced number of attempts and complications

BIOCHAR SURFACE PROPERTIES THROUGH APPLICATION OF AN INNOVATIVE NMR TECHNIQUE: FAST FIELD CYCLING RELAXOMETRY

Biochar is a carbonaceous material obtained by pyrolysis of biomass feedstocks. It is applied to soils in order to improve fertility and mitigate greenhouse-gases emissions. In fact, from the one hand, biochar changes physical-chemical soil properties, thereby affecting soil fertility. From the other hand, biochar is resistant to chemical and biochemical degradation. For this reason, its use allows carbon sequestration in soils and consequent reduction of carbon dioxide to the atmosphere. Here, dynamics of water at the liquid-solid interface of water saturated biochars is discussed. Results revealed that water dynamics is affected by the nature of biochar parent biomasses. Moreover, biochar chemical physical properties are affected by conditions for their production. It was understood that water undergoes to an inner-sphere interaction mechanism with biochar surface through formation of weak unconventional hydrogen bonds. Recognition of the interaction mechanisms between water and biochar is of paramount importance in order to understand why biochar soil amendments improve soil fertility and crop production

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements