Hypertension and emergency medicine: an update

The objective of this paper is to evaluate the correct management of hypertension in emergency departments. Studies were identified searching PubMed up to April 30, 2012, combining the terms 'HYPERTENSIVE EMERGENCY' and 'HYPERTENSIVE URGENCY'. The search strategy was limited to English and Italian language papers on adult and pediatric patients. Hypertensive crises are commonly found in emergency departments. A range of pharmacological options are available in this setting, but each physician should tailor theoretical principles to the individual patient according to his or her clinical parameters

Evaluation of renal function in clinical practice: the basics

The evaluation of renal function in Internal Medicine plays an important role in the staging and prognosis of chronic kidney disease, but also for the daily clinical activity (for example, dosage of drugs). This review describes the options for estimating renal function that are currently in use, underlining limits and indications

The RNA-binding protein PTBP1 is necessary for B cell selection in germinal centers.

Antibody affinity maturation occurs in germinal centers (GCs), where B cells cycle between the light zone (LZ) and the dark zone. In the LZ, GC B cells bearing immunoglobulins with the highest affinity for antigen receive positive selection signals from helper T cells, which promotes their rapid proliferation. Here we found that the RNA-binding protein PTBP1 was needed for the progression of GC B cells through late S phase of the cell cycle and for affinity maturation. PTBP1 was required for proper expression of the c-MYC-dependent gene program induced in GC B cells receiving T cell help and directly regulated the alternative splicing and abundance of transcripts that are increased during positive selection to promote proliferation

Subplinian monogenetic basaltic eruption of Sunset Crater, Arizona, USA

Sunset Crater volcano, located ~25 km northeast of downtown Flagstaff (Arizona, USA) in the San Francisco volcanic field, represents an interesting case of highly explosive monogenetic volcanism. Sunset Crater is a young (ca. 1085 CE) scoria cone, ~290 m high, that produced 0.52 km3 dense rock equivalent (DRE) of basaltic magma (0.16, 0.12, and 0.24 km3 DRE for the scoria cone, lava flows, and tephra deposit, respectively). The activity developed in three distinct phases: an initial fissure phase, followed by a highly explosive phase, and a final low-explosivity waning phase. The first phase was characterized by the opening of a 10-kmlong fissure, which produced the Gyp Crater spatter mounds and the Vent 512 lava flow ~10 km SE of the main scoria cone, followed by lava fountaining activity that produced the first tephra layer (unit 1, 0.01 km3 DRE). During the second highly explosive phase, the activity migrated to the northwest to evolve into a single-vent eruption, which formed the main scoria cone. The central vent activity was initially characterized by variable eruptive styles, which started the process of cone building, including deposition of a second tephra layer (unit 2, 0.01 km3 DRE), and the effusion of the two main lava flows (Bonito and Kana'a). Following the initiation of effusive activity, the eruption increased in explosivity to produce three subplinian tephra layers from the central vent (units 3, 4, and 5), which emitted more than 0.22 km3 DRE of basalt, with associated eruption columns >20 km high. By the end of this phase, the Kana'a lava flow was almost completely emplaced, but the Bonito flow continued to grow, forming a 3-km-diameter flow field. A final waning phase produced several tephra units, commonly discontinuous and reworked, with <0.01 km3 DRE cumulative volume. The comparatively large volume of tephra, the high eruptive columns, and high mass eruption rates make Sunset Crater the most explosive monogenetic eruption studied to date (volcano explosivity index [VEI] 3–4). Sunset Crater volcano represents an interesting case of monogenetic volcanism in that its activity was characterized by highly explosive eruptive phases up to subplinian in scale and intermittent episodes of lava effusion that heavily affected prehistoric communities in the area. Explosive basaltic volcanism should be considered when assessing volcanic hazards in continental settings, such as in the western United States

The acceptability of the NICE recommendations for schizophrenia in the Italian Departments of Mental Health. The SIEP-DIRECT'S Project on the discrepancy between routine practice and evidence.

AIMS: This paper aims at presenting the most significant results emerging from the work carried out by the focus groups of the multi-centre Project SIEP-DIRECT'S. The Project is aimed at assessing the existing discrepancies between the evidence-based NICE guidelines for schizophrenia and the usual practices of care given by Italian mental health services. Each focus group was requested to give an evaluation on: (a) appropriateness of the English NICE guidelines in the context of the Italian mental health services; (b) clarity and usefulness of the 103 indicators developed on the basis of the NICE recommendations to measure their level of application within the services. METHODS: In each of the 19 mental health departments or psychiatric services participating in the Project there were organized "multidisciplinary" focus groups and "specialistic" focus groups. The former included, amongst others, professional operators of the mental health services, patients, their relatives, representatives of patient organizations and general practitioners. They examined the recommendations and indicators upon which the participants could express their opinion or judgment based on their knowledge, experience or information in their possession. The latter group, composed only of psychiatrists, examined the recommendations and indicators relative to pharmacological treatments that regarded the specific competences of their professional category. RESULTS: Most NICE recommendations seemed appropriate to the working context of the Italian services. However, some perplexity emerged as regards specific organizational models of the services, such as the specific services for psychotic onsets or the assertive outreach teams, which were believed not to be strictly pertinent to the traditional organization of mental health care in our Country. There were also some criticisms regarding the cognitive-behavioural treatments which the NICE Guidelines recommend as the principle psychotherapeutic option for patients with schizophrenia, since in many Italian services, when the use of psychological interventions are needed, the tendency is to prefer interventions based on psychodynamic theories. The SIEP indicators were generally held to be clear and acceptable. CONCLUSIONS: In the view of the focus groups, the NICE guidelines are on the whole useful and suitable for orientating the services in the choice of more efficacious practices in the treatment of patients with schizophrenia. Moreover, the results obtained legitimate the use of the set of SIEP indicators for the evaluation of good practices and the quality of care offered by Italian services. Finally, the use of focus groups delines to a different context as well as the verification of the comprehensibility and applicability of SIEP indicators

Microbiome dysbiosis is associated with disease duration and increased inflammatory gene expression in systemic sclerosis skin

Abstract Background Infectious agents have long been postulated to be disease triggers for systemic sclerosis (SSc), but a definitive link has not been found. Metagenomic analyses of high-throughput data allows for the unbiased identification of potential microbiome pathogens in skin biopsies of SSc patients and allows insight into the relationship with host gene expression. Methods We examined skin biopsies from a diverse cohort of 23 SSc patients (including lesional forearm and non-lesional back samples) by RNA-seq. Metagenomic filtering and annotation was performed using the Integrated Metagenomic Sequencing Analysis (IMSA). Associations between microbiome composition and gene expression were analyzed using single-sample gene set enrichment analysis (ssGSEA). Results We find the skin of SSc patients exhibits substantial changes in microbial composition relative to controls, characterized by sharp decreases in lipophilic taxa, such as Propionibacterium, combined with increases in a wide range of gram-negative taxa, including Burkholderia, Citrobacter, and Vibrio. Conclusions Microbiome dysbiosis is associated with disease duration and increased inflammatory gene expression. These data provide a comprehensive portrait of the SSc skin microbiome and its association with local gene expression, which mirrors the molecular changes in lesional skin

Reorganization of haemodialysis during COVID-19 emergency: a report from Dialysis Centers of Parma province

The epidemic wave that hit Italy from February 21st, 2020, when the Italian National Institute of Health confirmed the first case of SARS‑CoV‑2 infection, led to a rapid and efficient reorganization of Dialysis Centers' activities, in order to contain large-scale spread of disease in this clinical setting. We herein report the experience of the Hemodialysis Unit of Parma University Hospital (Azienda Ospedaliero-Universitaria, Parma, Italy) and the Dialysis Centers of Parma territory, in the period from March 1st, 2020 to June 15, 2020. Among patients undergoing chronic haemodialysis, 37/283 (13%) had positive swabs for SARS‑CoV‑2, 9/37 (24%) died because of COVID-19. Twenty-three patients required hospitalization, while the remaining were managed at home. The primary measures applied to contain the infection were: the strengthening of personal protective equipment use by doctors and nurses, early identification of infected subjects by performing oro-pharyngeal swabs in every patient and in the healthcare personnel, the institution of a triage protocol when entering Dialysis Room, and finally the institution of two separate sections, managed by different doctors and dialysis nurses, to physically separate affected from unaffected patients and to manage "grey" patients. Our experience highlights the importance and effectiveness of afore-mentioned measures in order to contain the spread of the virus; moreover, we observed a higher lethality rate of COVID-19 in dialysis patients as compared to the general population

Correction: Interaction of healthcare staff's attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment.

[This corrects the article DOI: 10.1371/journal.pone.0196313.]

Interaction of healthcare staff’s attitude with barriers to physical activity in hemodialysis patients: A quantitative assessment

<div><p>Background and aim of the study</p><p>In hemodialysis patients, sedentarism is a potentially modifiable mortality risk factor. We explored whether healthcare staff’s attitude towards exercise interacts with patient-perceived barriers in modifying the level of physical activity in this population.</p><p>Methods</p><p>In this prospective, cross-sectional, multicenter study we recruited 608 adult patients and 330 members of the healthcare staff in 16 hemodialysis units in Italy. We assessed patient-perceived barriers to, and healthcare staff’s attitude towards, exercise by specific questionnaires. We fitted multilevel linear models to analyze the relationships of either barriers or staff’s attitude, and their interaction, with a measure of patient self-reported physical activity (the Human Activity Profile–Adjusted Activity Score [HAP-AAS]), adjusting for multiple confounders. We also employed latent class analysis to dichotomize patients into those endorsing or not endorsing barriers.</p><p>Results</p><p>Most barriers were negatively associated with the HAP-AAS (adjusted change attributable to a given barrier ranging between -5.1 [“Feeling too old”, 95% Confidence Interval: -9.4 to -0.8] and -15.6 [“Ulcers on legs and feet”, 95%CI: -24.8 to -6.5]. We found a significant interaction between staff’s attitude and barriers (adjusted P values ranging between 0.03 [“I do not believe that it is physician’s or nurse’s role providing advice on exercise to patients on dialysis”] and 0.001 [“I do not often ask patients about exercise”]). A beneficial effect of a proactive staff’s attitude was evident only in patients not endorsing barriers.</p><p>Conclusions</p><p>Barriers and non-proactive staff’s attitude reduce physical activity in hemodialysis patients. Patients not endorsing barriers benefit the most from a proactive staff’s attitude.</p></div