MFM Guidance for COVID-19

The World Health Organization (WHO) has declared COVID-19 a global pandemic. Healthcare providers should prepare internal guidelines covering all aspect of the organization in order to have their unit ready as soon as possible. This document addresses the current COVID-19 pandemic for maternal-fetal medicine (MFM) practitioners. The goals the guidelines put forth here are two fold- first to reduce patient risk through healthcare exposure, understanding that asymptomatic health systems/healthcare providers may become the most common vector for transmission, and second to reduce the public health burden of COVID-19 transmission throughout the general population. Box 1 outlines general guidance to prevent spread of COVID-19 and protect our obstetric patients. Section 1 outlines suggested modifications of outpatient obstetrical (prenatal) visits. Section 2 details suggested scheduling of obstetrical ultrasound. Section 3 reviews suggested modification of nonstress tests (NST) and biophysical profiles (BPP). Section 4 reviews suggested visitor policy for obstetric outpatient office. Section 5 discusses the role of trainees and medical education in the setting of a pandemic. These are suggestions, which can be adapted to local needs and capabilities. Guidance is changing rapidly, so please continue to watch for updates

Caratterizzazione della scorrevolezza di polveri con un metodo penetrometrico

Gli argomenti principali trattati sono il texture analyzer con cui si è lavorato per caratterizzare la sabbia di Fontainebleau tramite indentazione, la risoluzione di problematiche afferenti al macchinario, la metodica di preparazione del campione, il metodo di analisi dei dati e la ricerca di un modello per correlare i dati con modelli già esistenti e una proposta di miglioramento.ope

Predictive role of nasal functionality tests in the evaluation of patients before nocturnal polysomnographic recording

Obstructive sleep apnoea syndrome is a disease characterized by a collapse of the pharyngeal airway resulting in repeated episodes of airflow cessation, oxygen desaturation, and sleep disruption. It is a common disorder affecting at least 2-4% of the adult population. The role of nasal resistance in the pathogenesis of sleep disordered breathing and sleep apnoea has not been completely clarified. Aim of the present study was to establish whether nasal resistance and nasal volumes, measured by means of Active Anterior Rhinomanometry and Acoustic Rhinometry together with Muco-Ciliary Transport time play a positive predictive role in the evaluation of Obstructive sleep apnoea syndrome patients before running a nocturnal polysomnographic recording. A retrospective study was performed analysing 223 patients referred for suspected Obstructive sleep apnoea syndrome. All patients were submitted to complete otorhinolaryngological evaluation and underwent nocturnal polysomnography. On the basis of polysomnographic data analysis, the apnoea-hypopnoea index and snoring index, patients were classified into two groups: Group 1 (110/223 patients) with a diagnosis of mild-moderate Obstructive sleep apnoea syndrome (apnoea-hypopnoea index < 30) and Group 2 (113/223 patients) affected by snoring without associated hypoxaemia/hypercapnia. A control group of 76 subjects, not complaining of sleep disorders and free from nasal symptoms was also selected. The results showed, in all the snoring and Obstructive sleep apnoea syndrome patients, total nasal resistance and increased Muco-Ciliary Transport time compared to standard values. Furthermore, the apnoea-hypopnoea index was significantly higher in patients with higher nasal resistence and significantly different between the groups. These results allow us to propose the simultaneous evaluation of nasal functions by Active Anterior Rhinomanometry, Acoustic Rhinometry, and Muco-Ciliary Transport time in the selection of patients undergoing polysomnography

Anisotropic Electrostatic Interactions in Coarse-Grained Water Models to Enhance the Accuracy and Speed-Up Factor of Mesoscopic Simulations

Water models with realistic physical-chemical properties are essential to study a variety of biomedical processes or engineering technologies involving molecules or nanomaterials. Atomistic models of water are constrained by the feasible computational capacity, but calibrated coarse-grained (CG) ones can go beyond these limits. Here, we compare three popular atomistic water models with their corresponding CG model built using finite-size particles such as ellipsoids. Differently from previous approaches, short-range interactions are accounted for with the generalized Gay-Berne potential, while electrostatic and long-range interactions are computed from virtual charges inside the ellipsoids. Such an approach leads to a quantitative agreement between the original atomistic models and their CG counterparts. Results show that a timestep of up to 10 fs can be achieved to integrate the equations of motion without significant degradation of the physical observables extracted from the computed trajectories, thus unlocking a significant acceleration of water-based mesoscopic simulations at a given accuracy

Nasal obstruction and headache. A real correlation?

to evaluate the relationships between headache and nasal obstruction or nasal allergy on a group of Italian school children

Alterations in rhinosinusal homeostasis in a sportive population: our experience with 106 athletes

The aim of the present work was to analyse the alterations of rhino-sinusal physiology in 106 professional athletes (swimmers, skiers, boxers and runners) using objective rhinological methods. Every athlete underwent an accurate anamnesis, a complete objective ORL evaluation, an active anterior rhinomanometry, an acoustic rhinometry and an evaluation of mucociliary transport time (MCTt). Skiers were also submitted to a nasal decongestion test (NDT). In swimmers, the mean MCTt was 27.4+/-4.97 min (normal value: 13+/-3 min; P<0.0001). The average MCTt for the skier group was 19.58+/-1.92 min ( P<0.0001); the mean value of total basal nasal resistance was 0.37+/-0.05 Pa/ml per s (normal value =0.25 Pa/ml per s; P<0.001). After NDT, total nasal resistance was 0.18+/-0.02 Pa/ml per s. In the group of boxers, the total mean nasal resistance was 0.64+/-0.05 Pa/ml per s ( P<0.001); the mean cross-sectional area at the nasal valve level was 0.57+/-0.04 cm(2) (normal value =0.55+/-0.05 cm(2)) and at the inferior turbinate level 0.83+/-0.05 cm(2) (normal value =0.4+/-0.04 cm(2); P<0.001); the TMC average time was 27.35+/-2.21 min ( P<0.0001). Finally, for the runners, the mean MCT time was 20.56+/-2.35 min ( P<0.001). Knowing the alterations of the physiological nasal respiration is of extreme importance to develop a correct and timely therapeutic approach to be able to restore rhino-sinusal homeostasis. Athletes, in fact, need the earliest therapeutic aid in order to avoid the interference of prolonged rhino-sinusal alterations with their performance and also to avoid a more serious clinical situation concerning the inferior airways

Validation of the Intergrowth-21 curves for the diagnosis of fetal growth restriction in a high-risk population

Obiettivi: confrontare l’accuratezza di diversi parametri nella predizione dei nati piccoli per l’epoca gestazionale (SGA). Materiali e metodi: Studio retrospettivo su pazienti a rischio che afferivano agli Ambulatori degli Ospedali di Bologna e Padova tra il 2013 e il 2015. Abbiamo considerato i nati con peso <10’, 5’ e 3’ percentile. Nel primo studio sono state confrontate le curve della circonferenza addominale (CA) secondo Intergrowth-21 (IG-21) e secondo SIEOG. Nel secondo studio sono stati confrontati: CA secondo IG-21, peso fetale stimato (PFS) secondo gli standard neonatali IG-21, PFS secondo gli standard prenatali IG-21 e Hadlock. Gli z-scores della CA secondo IG-21 e secondo SIEOG sono stati confrontati per il primo studio. Per il secondo studio sono stati ricavati: PFS secondo la formula IG-21 ed interpretato secondo gli standard neonatali IG-21 e PFS secondo la formula Hadlock e interpretato secondo gli standard prenatali Hadlock e IG-21. L’accuratezza dei diversi parametri è stata valutata confrontando le ROC-AUC. Risultati: I studio: 428 pazienti. Il 19%, 9.3% e 6.2% dei nati aveva un peso rispettivamente <10’, 5’ e 3’ percentile. Le ROC-AUC della CA IG-21 e SIEOG sono risultate comparabili. II studio: 406 pazienti. Il 22.9% e l’8.9% dei nati era rispettivamente < al 10’e al 3’ percentile. Gli standard prenatali CA e PFS di IG-21 e di Hadlock hanno avuto una performance simile e significativamente migliore degli standard post-natali. Gli standard prenatali del PFS secondo IG-21 si sono dimostrate migliori nell’identificazione di nati <10 e <3’ percentile per l’epoca rispetto alle curve post-natali e alla CA. Conclusioni: Gli standard SIEOG e IG-21 della CA sono comparabili nella predizione degli SGA ed è preferibile il PFS alla sola CA. E’ preferibile utilizzare gli standard prenatali (Hadlock o IG-21) piuttosto che fare riferimento a standard postnatali IG-21.Objectives: to compare the accuracy of various parameters in the prediction of small for gestational age (SGA) newborns. Material and Methods: We included all patients with a singleton pregnancy who were seen in the University Hospital of Bologna and Padua from 2013 to 2015. In the first study we compared the curves of the fetal abdominal circumference (AC) according to Intergrowth-21 (IG-21) and according to SIEOG. The accuracy of IG-21 and SIEOG AC standards in the detection of SGA neonates was analyzed by ROC-AUC. In the second study we compared the IG-21 AC curves, estimated fetal weight (EFW) according to IG-21 neonatal standards, EFW according to Hadlock and IG-21 prenatal standard. We retrieved EFW according to neonatal IG-21 standards EFW according to prenatal Hadlock and IG-21 standards. The accuracy of these parameters was assessed by the comparison of their ROC-AUC. Results: I study: 428 patients. 19%, 9.3% and 6.2% of neonates were <10’, 5’ and 3’ percentile for GA. AC z-scores ROC curves according to IG-21 and SIEOG performed similarly. II study: 406 patients. 22.9% and 8.9% of neonates were <10’ and 3’ percentile for GA. Prenatal IG-21 and Hadlock standard of AC and EFW performed similarly and significantly better than post-natal standards. Prenatal EFW IG-21 curves were more accurate than postnatal curves and AC. Conclusions: SIEOG and IG-21 AC curves are both accurate in the prediction of SGA neonates. EFW performed better then AC measurement and prenatal standards performed better then IG-21 postnatal standard in the identification of SGA neonates