LE INFEZIONI DELLE VIE URINARIE NEL PAZIENTE CON TRAPIANTO DI RENE

Il trapianto di rene rappresenta il gold standard terapeutico per i pazienti affetti da insufficienza renale cronica in stadio finale. Le infezioni delle vie urinarie (IVU) sono la patologia infettiva più frequentemente osservata nei pazienti sottoposti a trapianto renale e, nonostante il miglioramento delle tecniche chirurgiche e della profilassi antibiotica, costituiscono ancora oggi un problema clinico di grande rilevanza. Nel presente studio sono stati esaminate le cartelle cliniche di 800 pazienti sottoposti a trapianto renale e seguiti in follow-up presso il D.H. di Nefrologia e Trapianti di Rene dell’AOU “Federico II” di Napoli. Degli 800 pazienti esaminati i Maschi erano n. 508 (63,5%) e le Femmine n. 292 (36,5%). Sugli 800 pazienti sono state effettuate un totale di 35.440 osservazioni e sono state riscontrate n.1.863 (5,25%) osservazioni con IVU. Queste osservazioni corrispondevano a 403 pazienti (50%). Dei 403 pazienti n.132 (32,7%) hanno sviluppato 1 episodio di IVU; n.66 (16,4%) hanno presentato 2 episodi di IVU; n.205 pazienti (51%) hanno manifestato infezioni recidivanti (definite come 3 o più IVU), e tali episodi hanno interessato n.90 maschi (43,9%) e n.115 femmine (56,1%). I pazienti diabetici erano 184 (23,1%) sul numero totale di 800 pazienti in follow-up. Nel gruppo con IVU recidivanti vi erano 60 pazienti (29,3%). Durante il primo anno dal trapianto di rene sono state fatte 9.200 osservazioni in tutti i pazienti e in 634 osservazioni (6,9%) era presente una IVU. Queste osservazioni con IVU corrispondevano a 209 pazienti pari al 51,9% del totale di tutti i 403 pazienti con IVU. In tutte le osservazioni con IVU i patogeni coinvolti sono stati Escherichia Coli (53.8%), Enterobacteriacee (12.5%), Klebsiella spp. (11.6%), Pseudomonas spp. (4.6%), Candida spp. (4%), Proteus spp. (2.9%). A 5 anni dal trapianto la funzione renale tra i pazienti con IVU recidivanti (gruppo A) e quella dei pazienti senza IVU o con IVU non recidivanti (gruppo B) era identica (Gruppo A: creatininemia 1,44+0,56; Gruppo B 1,44+0,69 mg/dl). La prevalenza delle IVU nel campione esaminato si attesta su valori compatibili con quanto descritto in letteratura, confermando che tali infezioni continuano a rappresentare una complicanza molto frequente del trapianto di rene. La loro frequenza è particolarmente rilevante nel primo anno post-trapianto a causa di fattori come la maggiore intensità della terapia immunosoppressiva ed il posizionamento dello stent vescico-ureterale al momento del trapianto con sua rimozione a 2/3 mesi dallo stesso. Escherichia coli rimane il germe maggiormente isolato nelle urinocolture. Riguardo l’influenza delle IVU precoci o tardive sulla sopravvivenza del graft, nella nostra analisi non si è evidenziata una differenza significativa tra la funzione renale tra il gruppo di pazienti IVU e il gruppo non-IVU

A Mixed Methods Study Exploring Brazilian and United Kingdom University Students’ Pre-Drinking Behaviour and Alcohol Use During Nights out

This thesis explores students’ drinking behaviour in nightlife settings. In many parts of the world, much of the burden of alcohol is related to risky alcohol consumption amongst students, which often occurs during a night out, including during pre-drinking (drinking at home or other private settings before going out). In several countries, creating a safer nightlife environment has become synonymous with reducing levels of violence, injury and other health problems associated with high levels of alcohol use. This research was conducted in England, where policies and interventions to prevent nightlife-related harms have been implemented, and in Brazil, where there is no well-established prevention activity in place. A high prevalence of pre-drinking and related harms can be found across many countries, including Brazil and the UK. Hence, it is important to understand this phenomenon in more detail considering the different policy and cultural factors that might affect such behaviour, in order to inform effective policies and practices aimed at preventing and reducing pre-drinking and its associated harms across countries with diverse nightlife environments and drinking cultures. Thus, a mixed-method research study was undertaken, comprising a survey, completed by 1,151 Brazilian university students and 424 UK university students, and focus group interviews with 25 Brazilian students currently living in the UK, aimed at exploring cross-cultural differences in drinking behaviours within nightlife settings from a socio-ecological perspective. Differences in the prevalence of pre-drinking and alcohol consumption were found between Brazilian and UK respondents. The findings suggested that more UK students pre-drink, yet Brazilian students drink more than UK students when they do pre-drink. Students’ attitudes and perceptions towards existing alcohol policies (e.g. drink-drive incidents; restrictions on alcohol sales and drunk and disorderly behaviour) differed between the two countries, which might have an influence on their drinking behaviour in a nightlife context. Brazilian students’ views suggested that the UK’s heavy drinking culture is influenced by the interaction of many factors, including the perceived British students’ cultural drinking norms focused on drinking large amounts of alcohol when compared with Brazilian students and the fact that according to Brazilian participants’ views British students have more positive outcome expectations towards drunkenness. Brazilian participants’ views also iii suggested that the acceptance of drunkenness amongst students is higher in the UK, with an emphasis on British students intentionally getting extremely drunk for entertainment. For Brazilian participants getting drunk was suggested not to be a priority for having a good night out, rather it was perceived to be a consequence for losing control of drinking. Moreover, Brazilian students’ perceived effectiveness of alcohol policy also differed between the two countries, with emphasis on lax law enforcement in Brazil. Effective policies targeted towards reducing drunkenness and its risks within nightlife settings need to be put in place particularly in Brazil, where law implementation and strict enforcement are not the rules, resulting in a culture of drinking that can be harmful to university students

Nietzsche después de Schopenhauer

El artículo trata de dar una respuesta al problema de la relación Nietzsche- Schopenhauer. Nietzsche, que fue ante todo un ‘moralista’, opone su escepticismo y su idea de individuo a la metafísica de Schopenhauer. Aunque hay simetría en la elección y en el planteamiento de los temas, hay importantes diferencias. Nietzsche hace de los dos mundos –fenómeno y noúmeno– un solo mundo, pero en el sentido del escepticismo y de la negación. En Schopenhauer, al contrario, la unificación se da en el sentido de la afirmació

El pensamiento como dinamita

This article addresses Nietzsche as a global problem in all its diverse and often contrasting profiles; it finds unity under variety, explains Nietzsche and his avènement, more with history than with philosophy, and clarifies its deep roots in the vast Western sunset catastrophe. Transfiguring the crisis of civilization into tragic poetry, Nietzsche builds a spiritual body for it and legitimizes it. It is acknowledged that Nietzsche has removed the foundation from above and abroad, but has not completed the necessary further stepfor preventing man from becoming a crazy cell of the universe: exposing the foundation from the bottom, the gravity of the species, which gives full meaning to knowledge and morality, or consents to overcome nihilism in the intrahuman sphere.En este artículo se afronta a Nietzsche como problema global en todos sus diversos y a menudo contrastantes perfiles; encuentra la unidad bajo la variedad, explica a Nietzsche y su avènement, más con la historia que con la filosofía y hace comprender en sus raíces profundas la inmensa catástrofe del ocaso de Occidente. Transfigurando la crisis de la civilización en poesía trágica, Nietzsche le confiere cuerpo espiritual y legitimación. Se reconoce que Nietzsche ha suprimido el fundamento de lo alto y del exterior, pero no ha llevado a cabo el paso ulterior necesario para evitar que el hombre se convierta en una célula loca del universo: sacar a la luz el fundamento desde abajo, la gravedad de la especie, que da pleno sentido al conocimiento y a la moral, o sea, consiente superar el nihilismo en la esfera intrahumana

Effect of Compatibilisers on Mechanical, Barrier and Antimicrobial Properties of iPP/ZnO Nano/Microcomposites for Food Packaging Application

It is investigated the effects of the addition of three PPgMA, with different molecular weight and maleic anhydride content, on the structure, morphology, mechanical, thermal and antimicrobial properties and oxygen permeability of iPP/ZnO 98/2 wt% composite. The composition of iPP/PPgMA/ZnO composites is fixed at 88/10/2 wt%, that is, about 10 wt% of iPP is substituted with PPgMA. The composites are prepared via melt mixing by using a twin-screw extruder. The ZnO is obtained in a preindustrial scale spray pyrolysis platform. The Fourier Transform Infrared spectroscopy indicates that the ZnO particles, in all the ternary composites, react with maleic anhydride groups of PPgMA. From the analyses of the mechanical properties, permeability to oxygen and antibacterial activity agaist E.Coli, it is concluded that the best compatibiliser among the three is PPgMA with 1.4% of MA and Mw 65,000, but the antibacterial activity is much lower than that of the binary iPP/ZnO 98/2 wt%. Moreover, it is found that the antibacterial activity is more efficient for the film that presents clusters of the ZnO particles on the surface than the film with ZnO particles smaller and better distributed on the film surface, and embedded in it