Atendimento ao cliente.

bitstream/item/41078/1/Atendimento-ao-cliente-Reciclando-Ideias3.pd

Severe asthma: One disease and multiple definitions

Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem

Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey

Background: During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods: A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results: Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. Conclusions: Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted

Lactobacillus fermentum ME-3 – an antimicrobial and antioxidative probiotic

The paper lays out the short scientific history and characteristics of the new probiotic Lactobacillus fermentum strain ME-3 DSM-14241, elaborated according to the regulations of WHO/FAO (2002). L. fermentum ME-3 is a unique strain of Lactobacillus species, having at the same time the antimicrobial and physiologically effective antioxidative properties and expressing health-promoting characteristics if consumed. Tartu University has patented this strain in Estonia (priority June 2001, patent in 2006), Russia (patent in 2006) and the USA (patent in 2007). The paper describes the process of the identification and molecular typing of this probiotic strain of human origin, its deposition in an international culture collection, and its safety assessment by laboratory tests and testing on experimental animals and volunteers. It has been established that L. fermentum strain ME-3 has double functional properties: antimicrobial activity against intestinal pathogens and high total antioxidative activity (TAA) and total antioxidative status (TAS) of intact cells and lysates, and it is characterized by a complete glutathione system: synthesis, uptake and redox turnover. The functional efficacy of the antimicrobial and antioxidative probiotic has been proven by the eradication of salmonellas and the reduction of liver and spleen granulomas in Salmonella Typhimurium-infected mice treated with the combination of ofloxacin and L. fermentum strain ME-3. Using capsules or foodstuffs enriched with L. fermentum ME-3, different clinical study designs (including double-blind, placebo-controlled, crossover studies) and different subjects (healthy volunteers, allergic patients and those recovering from a stroke), it has been shown that this probiotic increased the antioxidative activity of sera and improved the composition of the low-density lipid particles (LDL) and post-prandial lipids as well as oxidative stress status, thus demonstrating a remarkable anti-atherogenic effect. The elaboration of the probiotic L. fermentum strain ME-3 has drawn on wide international cooperative research and has taken more than 12 years altogether. The new ME-3 probiotic-containing products have been successfully marketed and sold in Baltic countries and Finland

Caratterizzazione strutturale e meccanica di biomateriali altamente porosi in titanioc ommercialmente puro per l'ortopedia artroprotesica: Il trabecular titaniumtm

he use of EBM (Electron Beam Melting) for the production of objects and components with complex shape has strongly increased in the past years in different industrial sectors. For the biomedical sector, in particular, the use of EBM allows to obtain bio compatible metallic cellular solids that may strongly enhance the osseointegration of orthopaedic implants, while keeping good mechanical properties. In this work, two different cellular solids obtained by EBM processes of commercially pure grade 2 titanium have been characterized. The investigated structures, having a complex three dimensional foam shape, cannot be easily obtained using conventional productive technologies. For this work, two different kinds of structure have been produced: (A) with a smaller single cell diameter and (B) with a larger single cell diameter. These structures have been completely characterized and confronted with literature results for commercially pure titanium and Ti-6Al-4V grade 5. The relative density has been evaluated using two different techniques, with scale and caliber and with Archimede's method, the single porosity diameter has been evaluated using Scanning Electron Microscope Images and image post-processing software, the composition has been investigated by X-ray spectroscopy using the EDXS (Energy Dispersive X-ray Diffraction) equipment of the SEM, the microstructure and the grain dimension has been investigated on polished samples using chemical etching performed with Kroll solution (2% HF, 6% HNO3 in demineralized water) and the mechanical properties have been evaluated using a UMTS equipment. Mean porosity resulted to be close to spongy bone (near 77% for sample A and near 89% for sample B). The mean porosity diameter (0.76 mm for sample A and 1.37 mm for sample B) resulted to be sufficient to enhance the osseointegration of the component, in particular in sample A. Vickers microhardness resulted to be around 300 HV for both samples, homogeneous across the entire structure and sensibly higher than literature values for grade 2 titanium (200 HV), while metallographic attack showed a complex microstructure with irregular shaped grains characterized by a high surface over volume ratio and compenetration between the different grains. Mechanical tests showed that sample A, as expected, is more resistant than sample B (Tensile ultimate strength: 15.5 MPa for sample A and 5.3 for sample B, compressive ultimate strength 13 MPa for sample A), while sample B showed a lower elastic modulus, even lower than literature data on spongy bone. This study results suggest that the two different structures in grade 2 titanium may be successfully used for biomedical applications in order to promote osseointegration of prosthetic implants