Acute chest syndrome in children with sickle cell disease: Data from a national AIEOP cohort identify priority areas of intervention in a hub-and-spoke system

: Acute chest syndrome (ACS) is a frequent cause of hospitalization in sickle cell disease (SCD). Despite advances in acute care, many settings still lack knowledge about ACS best practices. After the AIEOP Guidelines were published in 2012, suggesting standardized management in Italy, a retrospective study was performed to assess the diagnostic and therapeutic pathways of ACS in children. From 2013 to 2018, 208 ACS episodes were presented by 122/583 kids in 11 centres. 73 were male, mean age 10.9 years, 85% African, 92% HbSS or Sβ°. In our hub-and-spoke system, a good adherence to Guidelines was documented, but discrepancies between reference centres and general hospitals were noted. Improvement is needed for timely transfer to reference centres, use of incentive spirometry, oxygen therapy and pain management

Determination of surfactants and some of their metabolites in untreated and anaerobically digested sewage sludge by subcritical water extraction followed by liquid chromatography-mass spectrometry

Enormous amounts of sewage sludge are worldwide generated and released into the environment. Analysis of the most common and/or toxic chemicals in sludge should be mandatory before deciding its destination. Surfactants and some of their breakdown products are invariably the most common organic contaminants in domestic sewage sludge. For determining these compounds, we have developed a method based on extraction with subcritical water followed by liquid chromatography-mass spectrometry. On extracting surfactants and their metabolites from 50 mg of sludge, the efficiency of the water extraction device was evaluated in terms of pH of the extractant, temperature, and time of the static extraction. The best extraction conditions were obtained by using carbonate buffer (pH 9.4) at 200 degrees C as extractant, 10 min of static extraction at the pressure of 100 bar followed by 17 min of dynamic extraction. Analyte collection was performed by inserting a solid-phase extraction cartridge downstream the extraction cell. Compared to 16-h Soxhlet extraction with methanol, this procedure was remarkably more efficient in extracting anionic surfactants and acidic metabolites of nonylphenol ethoxylates (NPECs). A short survey was conducted to estimate concentration changes of target compounds after 14-d sludge anaerobic digestion. Results showed that 54-74% of both neutral and weakly acidic ethoxylate species were removed after residence of the sludge in the digester. On the contrary, little, if any, removal of anionic surfactants was observed after the digestion treatment. As expected, the level of nonylphenol increased under anaerobic conditions

ESTRIOL AND ITS CONJUGATES IN LATE PREGNANCY DETERMINED BY EXTRACTION WITH CARBOPACK-B AND LIQUID-CHROMATOGRAPHY WITH FLUOROMETRIC DETECTION

Abstract We report a method for measuring estriol and its intact conjugates in urine, serum, and amniotic fluid. A single assay can be done within about 50 min, eight samples assayed in less than 5 h. A 70-microL urine sample is diluted and the estriol conjugates are adsorbed from it onto graphitized carbon black (Carbopack B, Supelco). After two washings, the analytes are desorbed with chloroform/methanol (60/40, by vol) containing tetrapropylammonium bromide. After solvent evaporation, the residue is redissolved in 100 microL of water/acetonitrile and 20 microL is injected into the chromatograph. Or 1 mL of serum or 0.5 mL of amniotic fluid is deproteinized with cold methanol, then passed through the Carbopack column. After three washings, the estriol and its conjugates are desorbed and treated as for urine. Mean analytical recoveries of the analytes in any of these body fluids were within about 92-98%, except for estriol-3-sulfate-16 alpha-glucuronide in serum (mean recovery 88.3%). The limit of sensitivity is well below the concentrations of clinical interest, and the method is not susceptible to substantial interferences

New Insights and methods in the approach to Thalassemia Major. The lesson From the case of adrenal insufficiency

Background: Thalassemia Major (TM) is a complex pathology that needs a highly skilled approach. Endocrine comorbidities are nowadays the most important complications, including hypogonadism, hypothyroidism, diabetes mellitus, and bone diseases. Recent works stated that there could be a relevant prevalence of adrenal insufficiency (AI) present in TM, and this fact may become crucial, especially in case of major stressful events. Aim: Test the reliability of the standard test to diagnose AI in a group of TM and correlate it with clinical, hematological, and radiological data. Methods: We evaluated endocrine damages and the efficacy of iron chelation therapy in 102 patients affected by TM. AI was assessed by tetracosactide (Synacthen) 1 mcg iv (low-dose test, LDT) stimulation test. Patients with a subnormal response (peak cortisol < 500 nmol/L) were followed up to 5 years to check the symptoms and signs of AI. Results: We found AI in 13.7% of the population studied. We did not find any correlation between AI and all data evaluated. Only female gender seems to be a protective factor. A follow up of the patients affected by AI showed no signs of adrenal crisis, in spite of no replacement therapy. Conclusions: Our study shows a relevant prevalence of AI in TM, especially in males. The absence of an adrenal crisis, in spite of no replacement therapy, during the long-term follow up, seems to underline that current methods to evaluate AI, in TM, should consider a different and specific diagnostic test or different cut off for diagnosis

Aggregates Of A Cationic Porphyrin As Supramolecular Probes For Biopolymers

The copper(II) derivative of the dicationic trans-bis(N-methylpyridinium-4-yl)diphenylporphyrin (t-CuPagg) forms large fractal aggregates in aqueous solution under moderate ionic strength conditions. A kinetic investigation of the aggregation process allows for a choice of experimental conditions to quickly obtain stable assemblies in solution. These positively charged aggregates are able to interact efficiently with negatively charged chiral species, (including bacterial spores) leading to induced circular dichroism signals in the Soret region of the porphyrin, now acting as a sensitive chiroptical probe. (C) 2015 Elsevier Inc. All rights reserved

Zenker diverticulum in the right side of the neck resembling a thyroid mass at ultrasound

Zenker's diverticulum represents the most common form of pharyngo-oesophageal diverticula usually occurring on the left side of the neck. Due to its anatomical proximity to the thyroid, it can mimic a thyroid mass. Here we describe the case of an asymptomatic 49-year-old man referred to the Thyroid Clinic of the Policlinico Umberto I Hospital-"Sapienza" University of Rome for thyroid sonography due to a family history of autoimmune thyroid disease. The patient's thyroid blood tests did not reveal any abnormalities. The sonographic examination showed a dishomogeneus and hypoechoic thyroid gland. In addition, in the third middle of the right lobe, a mass (with a diameter greater than 26 mm), with heterogeneous internal echogenicity, hypoechoic margins and internal hyperechoic spots was recorded, with no appreciable flow at the Doppler evaluation. The TI-RADS score was 4c. Hence, the patient underwent ultrasound-guided fine-needle aspiration cytology that revealed the presence of squamous cells without cytological atypia, erythrocytes, muscular and vegetable fibres, colonies of bacteria in the absence of inflammatory infiltrate. This was consistent with the diagnostic hypothesis of oesophagus diverticulum, which was confirmed by means of a barium-swallow oesophagography. This case report underlines the possibility that a suspicious thyroid mass may result from a Zenker's diverticulum, even if located on the right side, especially if the lesion has a heterogeneous echo-texture, a hypoechoic rim and internal hyperechoic spots

Advances on the use of Galileo signals in time metrology: calibrated time transfer and estimation of UTC and GGTO using a combined commercial GPS-Galileo receiver

This study presents some first timing results obtained using the Galileo signals and the satellite orbits and clocks provided in the navigation messages. It is firstly shown how it is possible to determine the hardware delays of Galileo signals in a GNSS station already calibrated for GPS signals. Calibrated time transfer solutions between ORB and IT obtained from Galileo signals are then presented. Finally the Galileo dissemination of UTC and GPS to Galileo Time Offset (GGTO) are compared with respect to the same quantities estimated using a calibrated GNSS receiver