Naloxone Administration Route in Opioid Overdose: A Review of Vermont EMS Data

Objective: Emergency Medical System (EMS) personnel administer the direct opioid antagonist naloxone in cases of opioid overdose via intramuscular (IM), intravenous (IV), subcutaneous (SQ), intraosseous (IO), or intranasal (IN) routes. Some early studies suggest that the intranasal route of administration is of similar effectiveness to injectable routes. The main objective of our study was to compare the efficacy of intravenous and intraosseous (IV/IO) routes of naloxone administration to the intranasal (IN) route in suspected opioid overdoses in Vermont. Methods: We reviewed retrospective data from Vermont EMS Statewide Incident Reporting Network (SIREN) between April 2014 and August 2016. We included all patients that were entered into SIREN and administered naloxone during the study period. Predictor variables were route of administration, medication dosage, crew member level, and cardiac arrest (yes or no). We conducted a binary logistic regression in SPSS to predict improvement in patient condition. Results: Our sample consisted of 1139 cases of first-dose naloxone administration. 1076 cases contained sufficient data to be analyzed. Patients who experienced a cardiac arrest were less likely to respond to naloxone (OR 10.8, 95% CI (5.908-19.694)). Route of administration, crew member level, and dosage (in the normal therapeutic range of 0.1-2mg) did not have a statistically significant effect on patient response to naloxone. Conclusions: Our findings, in conjunction with other recent research, suggest that intranasal administration is a safe and effective route when compared with intravenous and intraosseous routes. Intranasal administration has several distinct advantages over injectable routes, including the potential to reduce the risk of needle-stick injuries and blood-borne pathogen transmissions and to be handled by individuals with less medical training. In cases of cardiac arrest, we recommend that providers focus on treatments with proven benefit, including CPR and proper ventilation and oxygenation

Hyperspectral Chemical Imaging of Single Bacterial Cell Structure by Raman Spectroscopy and Machine Learning

6openopenBarzan, Giulia; Sacco, Alessio; Mandrile, Luisa; Giovannozzi, Andrea Mario; Portesi, Chiara; Rossi, Andrea MarioBarzan, Giulia; Sacco, Alessio; Mandrile, Luisa; Giovannozzi, Andrea Mario; Portesi, Chiara; Rossi, Andrea Mari

Post vaccinal temporary sensorineural hearing loss

In our systematic research we identified four studies concerning the onset of neurological adverse events following vaccination and two excluding this association. A 33-year-old Italian man, belonging to the Italian Army was hospitalized because he suffered from vertigo, nausea and sudden right hearing loss not classified (NDD), that set in 24 h after the administration of tetanus-diphtheria and meningococcal vaccines. Some neurological events arising after vaccination are very difficult to treat. In our case, the functional recovery on low and medium frequencies was possible about 6 months after the morbid event

Development of innovative antioxidant food packaging systems based on natural extracts from food industry waste and Moringa oleifera leaves

Active packaging that prolongs food shelf life, maintaining its quality and safety, is an increasing industrial demand, especially if integrated in a circular economy model. In this study, the fabrication and characterization of sustainable cellulose-based active packaging using food-industry waste and natural extracts as antioxidant agents was assessed. Grape marc, olive pomace and moringa leaf extracts obtained by supercritical fluid, antisolvent and maceration extraction in different solvents were compared for their antioxidant power and phenolic content. Grape and moringa macerates in acetone and methanol, as the most efficient and cost-effective extracts, were incorporated in the packaging as coatings or in-between layers. Both systems showed significant free-radical protection in vitro (antioxidant power 50%) and more than 50% prevention of ground beef lipid peroxidation over 16 days by indirect TBARS and direct in situ Raman microspectroscopy measurements. Therefore, these systems are promising for industrial applications and more sustainable farm-to-fork food production systems

An effective numerical modelling strategy for FRCM strengthened curved masonry structures

Fabric Reinforced Cementitious Matrix (FRCM) composites are currently considered a very effective solution for strengthening masonry constructions. However, the mechanical interactions governing the response and the strength of FRCM reinforced masonry structures are very complex, especially in the case of curved structures. Moreover, these interactions involve several interfaces between different materials. Thus, the development of accurate numerical models for curved FRCM reinforced masonry structures comes up against several difficulties, and models too complex for practical applications can be obtained. In addition, several mechanical parameters needed for the calculations are generally inaccessible by conventional experimental tests. Here, a suitable numerical modelling strategy for FRCM strengthened curved masonry structures is proposed to combine the accuracy in simulating the actual behaviour in terms of stiffness, strength and collapse mechanisms with a reasonable simplicity, making the proposed approach usable also by practitioners, by adopting commercial codes and at a moderate computational effort. The relatively small number of mechanical parameters characterizing the model can be determined by ordinary experimental tests on materials or by literature formulations. The proposed modelling strategy is validated with respect to experimental data found in literature concerning a FRCM reinforced masonry barrel vault, and then is employed for studying the seismic capacity of the vault through a pushover analysis. A broad sensitivity analysis sheds light on the effect of variations of the mechanical parameters on the predicted overall behaviour, showing the robustness of the results obtainable through the proposed approach concerning inaccuracies in the determination of the parameters often very difficult to determine by ordinary experimental tests on masonry structures.Funding: Financial support from ReLUIS (Italian Department of Civil Protection) and from the Italian Ministry of University and Research (MUR) in the framework of Project PRIN2020 #20209F3A37 is gratefully acknowledged

Severe intestinal bleeding due to left-sided portal hypertension after pancreatoduodenectomy with portal resection and splenic vein ligation

Pancreatoduodenectomy (PD) with portal vein (PV)/superior mesenteric vein (SMV) resection is well accepted for pancreatic head cancer because of the improvement in margin-negative resection and survival rates, without increasing postoperative morbidity and mortality in high volume centers. There is controversy in the surgical literature regarding the safety of splenic vein (SV) ligation during a PD with PV-SMV resection. Simple SV ligation has been associated with the development of left-sided portal hypertension, gastrointestinal bleeding and hypersplenism over the long term. We report a rare case of severe intestinal bleeding due to left-sided portal hypertension in patient who underwent a PD with PV-SMV confluence segmental resection and splenic ligation, preserving left gastric vein and inferior mesenteric vein, for cephalic pancreatic adenocarcinomas, seven months previously

The ascorbic acid content of tomato fruits is associated with the expression of genes involved in pectin degradation

<p>Abstract</p> <p>Background</p> <p>High levels of ascorbic acid (AsA) in tomato fruits provide health benefits for humans and also play an important role in several aspects of plant life. Although AsA metabolism has been characterized in detail, the genetic mechanisms controlling AsA accumulation in tomatoes are poorly understood. The transcriptional control of AsA levels in fruits can be investigated by combining the advanced genetic and genomic resources currently available for tomato. A comparative transcriptomic analysis of fruit tissues was carried out on an introgression line containing a QTL promoting AsA accumulation in the fruit, using a parental cultivar with lower AsA levels as a reference.</p> <p>Results</p> <p>Introgression line IL 12-4 (<it>S. pennellii </it>in a <it>S. lycopersicum </it>background) was selected for transcriptomic analysis because it maintained differences in AsA levels compared to the parental genotypes M82 and <it>S. pennellii </it>over three consecutive trials. Comparative microarray analysis of IL 12-4 and M82 fruits over a 2-year period allowed 253 differentially-expressed genes to be identified, suggesting that AsA accumulation in IL 12-4 may be caused by a combination of increased metabolic flux and reduced utilization of AsA. In particular, the upregulation of a pectinesterase and two polygalacturonases suggests that AsA accumulation in IL12-4 fruit is mainly achieved by increasing flux through the L-galactonic acid pathway, which is driven by pectin degradation and may be triggered by ethylene.</p> <p>Conclusions</p> <p>Based on functional annotation, gene ontology classification and hierarchical clustering, a subset of the 253 differentially-expressed transcripts was used to develop a model to explain the higher AsA content in IL 12-4 fruits in terms of metabolic flux, precursor availability, demand for antioxidants, abundance of reactive oxygen species and ethylene signaling.</p