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Tooth extraction is a common procedure that is performed routinely and is associated with very few risks. The formation of a pseudoaneurysm as a direct result of tooth extraction has not been widely reported in published studies; it is more frequent as a complication of orthognathic surgery (1). The purpose of this paper is to describe the literature of maxillary artery pseudoaneurysm and its diagnosis and treatment in the Emer-gency Department. The search engine we used is Pubmed. 39 studies were analyzed; mainly, they were case reports. In this study, we will analyze the cases of pseudoaneurysm formation following dental extraction and orthognotia surgery which are reported in literature.

The aim of this conference was to explain the role of integrative and complementary medicine in breast cancer patients. The topics covered are numerous and their peculiarities are the multidisciplinary characteristics of the researchers involved. The Integrative Medicine Research Group (IMRG) believes in the complementary and integrative approach in cancer patients to improve the quality of life in this particular setting.

The management of Inflammatory Bowel Disease (IBD) has changed significantly in recent years, mainly due to the introduction of biologic medications, however, other factors may also have a role. The aim of this study was to evaluate the evolution of IBD admissions, including trends, modality of admission and rates of surgical intervention, in a tertiary care center.Hospitalization of patients with a diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) were identified between 2000 and 2013, using ICD-9-CM codes for IBD, from our hospital database. The following parameters were evaluated for each admission: type of admission (ordinary vs. day care service), mode of admission (elective vs. emergency care, for ordinary admissions only), admission code, surgical procedures and complication rates. Comparison between pre- and post-biologic therapy introduction years was also performed.Between 2000 and 2013 a total of 8834 IBD-related admissions were recorded. Hospitalizations increased linearly reaching a peak in 2006, with a downward trend in the following years. The downward trend was especially marked for patients younger than 40 years. No significant differences in hospitalization trends between CD and UC were recorded. Disease flare represented the cause of hospitalization in approximately 50% of cases. Overall, 10.8% of patients underwent surgery with no difference between the two conditions. Complications occurred in 28.7% of admissions.Hospitalizations for IBD patients have decreased in recent years, especially in younger patients. However, a significant proportion of patients are still admitted to complete diagnostic workup, indicating the need to better implement outpatient services. A clear reduction in surgery occurrence over time could not be observed in our study.

Since December 2019, new pneumonia of unknown aetiology broke out in Wuhan, Hubei province, China. Subsequently, a virus, later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the causative agent of the disease. Currently, the epidemic has spread all over the world. The most common manifestations of COVID-19 are fever, fatigue and dry cough. At the moment, the nuclide acid test is the gold standard method for the diagnosis of this infection.In the present paper, we report our experience with all patients who came to the Emergency Department from March 1 to April 1, 2020, with suggestive symptoms of COVID-19 infection. Patients: they all underwent a first oropharyngeal and nasopharyngeal swab in the emergency department and, if negative, a second one after at least 24 hours.Our study shows how the results obtained at time zero are usually identical to the ones obtained after 24 hours. We thus suggest, in patients with high suspicion of COVID19 and a negative result at the first swab, to repeat the test after at least 48 hours, during which patients with symptoms of COVID-19 pneumonia disease should be kept in isolation to avoid the risk of contagion.these measures and in particular the early identifica-tion of cases with consequent isolation will allow the containment of the spread of the virus, representing one of the fundamental measures to guarantee and strengthen the control of the infection to reduce hospital admissions, the overload of national health service and health costs.

SARS Cov 2 pandemic outbreak caused countless changes in the daily habits among people in the entire World. National Health Systems were highly stressed and at severe risk of collapse. In the first months of 2020, it was expected a worsening of the typical overcrowding working flow. Quite the opposite, we found out an unexpected decrease throughout the daily ED visits. We evaluated the ER visits of a University Metropolitan Hospital in Rome in March 2020, comparing them with the same month in 2019. We highlight the sharp decline in ED visits for deferrable urgencies, considered among the leading causes of ED overcrowding. On the contrary, the rate of visits for "time-dependent" pathologies is superimposable for those pathologies mainly centralized through the Out-of-Hospital Emergency System. In a historical period where significant outpatient activity restrictions took place, we expected an increase in ED visits for deferred emergencies. On the contrary, it was undergoing a considerable decrease. The critical decrease in accesses recorded in March 2020 can be considered an indicator of ED's improper use. Probably, the fear of a possible coronavirus-related infection might have to lead the population to refer to the ED just in case of real emergency condition or severe medical issues, as it should "normally" be. The critical decrease in accesses recorded in March 2020 can be considered an indicator of ED's improper use. We would highlight the need to sensitize people to proper use of Emergency Medical Services, avoiding overcrowding and overuse. This unexpected event, lead by a global pandemic, could help reorganize the whole Health System.

Mild Traumatic Brain Injury (MTBI) in anticoagulated patients is a common challenge for Emergency Department (ED) Physicians. Anticoagulation is considered a risk factor for developing delayed intracranial hemorrhage (ICH) after MTBI. The occurrence of this event in patients on Vitamin K Antagonists (VKA) or Direct Oral Anticoagulants (DOACs) remains unclear. Primary endpoint: to analyze the role of anticoagulants as risk factors for developing delayed ICH after MTBI and evaluate the indications to repeat a cranial computed tomography (CT) after a period of observation. Secondary endpoint: to assess the difference in the prevalence rate of delayed ICH in patients on VKA versus those on DOACs.We evaluated all consecutive patients admitted to our ED for MTBI, which had a control CT for late ICH after a negative CT at admission. We used a propensity score match (PSM) on factors affecting the need for oral anticoagulation to adjust the comparison between anticoagulated vs. non-anticoagulated patients for the baseline clinical characteristics.Among 685 patients enrolled, 15 (2.2%) developed ICH at control CT. After PSM, the incidence of ICH, although slightly higher, was not statistically different in anticoagulated patients vs. non-anticoagulated (2.3% vs. 0.6%, p=0.371). Among the 111 patients on VKA, 5 (4.5%) had a late ICH, compared to 4 out of 99 (4.0%) on DOACs; the difference was not statistically significant (p=0.868).The risk of developing delayed ICH after MTBI in patients on anticoagulation therapy is low. After correction for baseline covariates, the risk does not appear higher compared to non-anticoagulated patients. Thus, a routine control CT scan seems advisable only for patients presenting a clinical deterioration. Larger, prospective trials are required to clarify the safety profile of DOACs vs. VKA in MTBI.

To develop a deep learning-based decision tree for the primary care setting, to stratify adult patients with confirmed and unconfirmed coronavirus disease 2019 (COVID-19), and to predict the need for hospitalization or home monitoring.We performed a retrospective cohort study on data from patients admitted to a COVID hospital in Rome, Italy, between 5 March 2020 and 5 June 2020. A confirmed case was defined as a patient with a positive nasopharyngeal RT-PCR test result, while an unconfirmed case had negative results on repeated swabs. Patients' medical history and clinical, laboratory and radiological findings were collected, and the dataset was used to train a predictive model for COVID-19 severity.Data of 198 patients were included in the study. Twenty-eight (14.14%) had mild disease, 62 (31.31%) had moderate disease, 64 (32.32%) had severe disease, and 44 (22.22%) had critical disease. The G2 value assessed the contribution of each collected value to decision tree building. On this basis, SpO2 (%) with a cut point at 92 was chosen for the optimal first split. Therefore, the decision tree was built using values maximizing G2 and LogWorth. After the tree was built, the correspondence between inputs and outcomes was validated.We developed a machine learning-based tool that is easy to understand and apply. It provides good discrimination in stratifying confirmed and unconfirmed COVID-19 patients with different prognoses in every context. Our tool might allow general practitioners visiting patients at home to decide whether the patient needs to be hospitalized.

Occurrence of chest pain during an allergic reaction is a typical manifestation of the Kounis syndrome, defined in 1991 by Nicholas Kounis and George Zavras as an "allergic angina", whose clinical course can range from a simple coronary spasm without troponin elevation to an acute myocardial infarction with all the possible complications, including sudden cardiac death. The full pathogenetic mechanisms are still not fully understood, and this is one of the reasons why it is underestimated in the emergency practice; on the other hand, an immediate identification and an appropriate treatment could prevent the occurrence of the most serious consequences. In this article we report the case study of a patient with Kounis syndrome and we review the literature on this uncommon disease; it is fundamental to consider Kounis syndrome as a possible cause of chest pain in patients admitted in the emergency department with an ongoing allergic reaction.

The aim of the study was to develop a cost-of-illness model that would investigate the costs associated with the management of patients suffering from asthma and severe asthma in the context of acute episodes managed in the emergency room.A total of 795 records were collected between adults and paediatric patients. The data collection form reported an identification code for each patient included, gender, age, main discharge diagnosis, medical examinations carried out in the emergency room, the hospitalizations, and, if required by the patient condition, an outpatient visit performed by a pneumologist after the acute event that led the patient to the emergency room. In addition, the data collection form included information related to the pharmacological therapy taken by the patient.Among adult patients who had an admission with an asthma diagnosis, the average cost for the management of an adult patient in a green code in the emergency room is €330.39. As for the yellow code and the red code, the cost rises respectively to €444.04 and €808.25. The paediatric population has a slightly higher cost. As for the green code, the average cost stands at €355.87, for the yellow code €562.34 and €1,041.96 for the red code.Asthma and severe asthma impose a high burden on patients and society due to its chronicity, losses of productivity, and an increase in use of healthcare resources. We carried out the present observational retrospective analysis on asthma and severe asthma patients with the aim of assessing the economic impact from the Italian NHS perspective focusing also on the prescribed pharmacological therapies in the target conditions.

Microbiota is the set of microorganisms that compose our microbial community. The human microbiota comprises a vast collection of bacteria, viruses, fungi and protozoa that co-exist with us and establish physio-metabolic interactions with our cellular pathways. Qualitative and/or quantitative alterations of the microbiota, termed dysbiosis, has already been associated with a wide range of diseases and conditions, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), diverticular disease (DD), colorectal cancer (CRC), asthma, obesity, diabetes mellitus, hypertension, and cardiovascular disease. Microbiota changes in the intestinal lumen stimulate chronic inflammation possibly triggering disease in genetically predisposed individuals. In this review we examined all studies published in the last year in order to provide the newest correlation between specific microbiota alterations and colonic disease, with a focus on future perspectives and strategies based on microbiota modulations.

Objective: Recent randomized control trials (RCTs), have demonstrated the beneficial therapeutic effects of rifaximin for the treatment of the irritable bowel syndrome (IBS). However, in these studies different drug doses have been used and still the optimal therapeutic dose is missing. We aimed to determine rifaximin therapeutic benefit and optimal dose for IBS as evidenced by the results of a network meta-analysis (NWM) of published randomized controlled trials (RCTs). Materials and Methods: PubMed/MEDLINE, EMBASE, and Cochrane Library databases were searched for RCTs investigating the therapeutic effects of rifaximin on IBS through December 2019. Data from each selected RCT were evaluated individually based on an intention-to-treat analysis. A Bayesian NWM was performed to investigate the efficacy rank order of rifaximin therapeutic interventions in IBS. Results: Four eligible studies, including 5 sets of data, were included in this NWM. They included 1,803 IBS patients, randomized to placebo (908 patients), and rifaximin (895 patients). In patients who received rifaximin, four regimens were examined, i.e., (A) = 400 mg tds for 10 days, (B) = 400 mg bid for 10 days, (C) = 550 mg bid for 2 weeks and (D) = 550 mg tds for 2 weeks. The results showed that in IBS rifaximin 400 mg tid for 10 days showed the highest efficacy [SUCRA (surface under cumulative ranking) value 89.5%], in comparison to other rifaximin regimens used and placebo. Conclusions: This NWM showed that the therapeutic efficacy of rifaximin 400 mg tid in IBS patients was greater than that of placebo and the other rifaximin doses studied.

The effort of the Humane Microbiome Project has led to the awareness that many districts of the human organism, like the skin, gastrointestinal tract, and genitals harbor their normal resident microbes. For this reason, the scientific community overcame the dogma that urines are sterile. Instead, the urinary tract hosts many bacteria, the so-called urobiome, that contribute to its homeostasis and pathology. Urobiome seems to be involved in the pathogenesis of the urinary tract infections (UTIs) and its relationship with the gut microbiome is still far from being understood. We describe a case of an emergent urinary condition, the “purple urine bag syndrome” (PUBS) that displayed with a peculiar combination of pathogens: Corynebacterium urealitycum and Enterococcus faecium. Both bacteria have been described as components of the urobiome and the latter is a well-known member of the gut microbiome but also a possible uropathogen. This case report is the starting point to analyze what we know about urobiome, its role in UTIs, and its interactions with the gut microbiome in the socalled “gut-UTIs axis”.

In recent years we have seen an exponential growth in scientific research aimed at characterising the structure and composition of the microbiota, which colonises various organs and systems. These investigations were supported by the development of very recent microbiological analysis techniques, most of which include molecular methods. In more recent times, however, scientific research has focused more on the study and characterization of relationships between the microbiota and systemic diseases. The purpose of this review is to present the scientific evidence, published from April 2019 to March 2020, on the relationships between oral microbiota and systemic pathologies.

An outbreak of a novel coronavirus disease-19 (nCoV-19) infection began in December 2019 in Wuhan, China, and now involved the whole word. Several health workers have been infected in different countries. We report the case of a young man with documented nCoV-19 infection evaluated with lung ultrasound and discuss potential applications of lung ultrasound in this setting. Lung ultrasound allowed the identification of nCoV-19 infection at bed-side. Moreover, lung ultrasound can have several other advantages, such as reduced health worker exposition to infected patients, repeatability during follow-up, low-costs and easier application in low-resource settings.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in Wuhan, China, and has subsequently spread worldwide. An association between increased venous thromboembolism in patients with pneumonia-related to COVID-19 has not yet been well described.We aimed to illustrate cases of pulmonary thromboembolism in patients with acute respiratory distress syndrome related to COVID-19 treated in our intensive care unit. The medical records of patients affected by COVID-19 with acute respiratory distress syndrome in our institute from 1/3/2020 to 31/3/2020 were retrospectively reviewed.Our center registered a high prevalence of thromboembolic events among 62 patients affected by acute respiratory distress syndrome related to COVID-19 despite a regular antithrombotic prophylaxis. Out of these, 32 patients were transferred to other hospitals, and 30 were treated in our center. Venous thromboembolism was registered in 12 (19.3%) cases. In particular, 11 diagnoses of pulmonary embolism and 1 diagnosis of deep vein thrombosis were formulated. We described a case series of venous thromboembolism in nine patients treated in our Intensive Care Unit (ICU). Main pulmonary arteries were always involved in these patients. None of them died.In conclusion, critically ill patients with ARDS related to COVID-19 may have an increased risk of VTE that could be a leading cause of mortality. These patients require a high index of clinical suspicion and an accurate diagnostic approach, in order to immediately start an appropriate anticoagulant treatment.

While it is increasingly outlined the link between gut microbiota and several systemic and gastrointestinal diseases, to date the role of the oral microbiota is not well clarified. Different factors like diet, smoke, alcohol, and use of probiotics have an active role in the development and modification of the oral microbiota. The relation between oral microbiota and oral diseases was better studied in the past, but during the last years, a deeper link between systemic disease and oral microbiota was discovered. This review aims to summarize the results of the most relevant studies published on this topic between April 2018 and March 2019.

Neoplasms are one of the main causes of mortality worldwide. Hepatocellular carcinoma (HCC), oesophageal, gastric, and colorectal cancer represent malignancies with major incidence and impact of the gastrointestinal tract. Unfortunately, patients are often diagnosed with advanced stage disease and this is why our aim should be to implement screening and prevention strategies in order to reduce global cancer-related mortality. Human microbiota is defined as a mix of bacteria, eukaryotes, viruses, and archaea that live in our body; these microorganisms interact with immunological, metabolic, endocrinological, and neurological networks contributing to their modulation, through the production of active metabolites. Several studies have shown a correlation between human gastrointestinal (GI) cancers and dysbiosis defined by the qualitative/quantitative alterations of microbiota, but the exact mechanism through which microbiota is able to interfere with our networks and promotes carcinogenesis has not yet been well defined. Nevertheless, we know that H. pylori acts as a risk factor for gastric cancer, while hepatitis viruses C and B represent a trigger for HCC. Following these examples, many researchers hypothesized that gut microbiota may promote GI cancers, through different mechanisms, such as chronic inflammation, promotion of oxidative stress, alterations of immune response and disruption of body homeostasis then pushing cells towards a path of degeneration. In this review, we analysed studies published in 2019 exploring the role that the human microbiota plays in the genesis and progression of GI tract neoplasms. We also explore if and how microbiota interacts with anti-cancer drugs pharmacodynamic and pharmacokinetics during the drug resistance process.

Acute pancreatitis (AP) may present an aspecific clinical picture without abdominal symptoms (atypical AP). We compared clinical outcomes between typical and atypical AP.Thirty out of 1163 patients (2.6%) presented an atypical AP. Demographic, clinical data, laboratory and radiological findings, management type, length of hospital stay (LOS) and mortality rate were retrospectively reviewed. A case match analysis 2:1 was performed. The final groups comprised 50 typical APs (TAP group) and 25 atypical APs (AAP group).The AAP patients presented fever (36%), syncope (32%) and dyspnea (16%) as the most frequent symptoms. Laboratory values showed similarity between the two groups. We noted a comparable edematous AP rate in both groups (p=0.36). Ten (20%) TAP and 3 (12%) AAP patients needed ERCP, respectively (p=0.38). Cholecystectomy was similarly performed in both cohorts (p=0.81). One TAP patient underwent a percutaneous drainage and subsequent surgical necrosectomy compared to none in the AAP cohort (p=0.47). LOS and mortality rate were comparable (p=0.76 and 0.3, respectively).Similar outcomes have been reached in the two groups. Routine evaluation of the serum amylase values fundamentally contributed to early diagnosis and appropriate treatment.

Additional file 2. SPIRIT 2013 Checklist.

Additional file 1. Details related to main pharmacological interactions and adverse events definition and reporting are provided in the additional file, enclosed in the manuscript.

Acute SARS-CoV-2 respiratory disease is an infectious respiratory disease caused by the virus SARS-CoV-2 belonging to the coronaviridae family. A pandemic is still present as of May 2020. In addition to causing pneumonia, SARS-CoV-2 may induce a direct damage to the heart, causing myocarditis, with significant impairment of cardiac contractility, and/or pericarditis. Elderly patients and those with cardiovascular risk factors, such as hypertension and diabetes mellitus, are at increased risk of heart complications from COVID-19. In this review, we focused on the correlation between COVID-19 infection and the high sensitivity troponin T and I, and their significance in the development of myocarditis. Data emerging from the studies so far conducted indicate that a high value of high-sensitivity troponin represents a negative prognostic indicator when associated with heart damage on an infectious-inflammatory basis (i.e. myopericarditis). We should identify a safe and clear diagnostic algorithm, possibly combining patient clinical history, troponin levels and cardiac ultrasound findings that could help us in the prediction of myopericarditis.

Socioeconomic status (SES) is a well-known determinant of outcomes in cancer. The purpose of this study was to analyze the impact of the SES on the outcomes of Hodgkin lymphoma (HL) patients from the Brazilian Prospective HL Registry. SES stratification was done using an individual asset/education-based household index. A total of 624 classical HL patients with diagnosis from January/2009 to December/2014, and treated with ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine), were analyzed. The median follow-up was 35.6 months, and 33% were classified as lower SES. The 3-year progression- free survival (PFS) in higher and lower SES were 78 and 64% (p

Data about Hodgkin lymphoma (HL) in developing countries are scarce and suggest the existence of substantial disparities in healthcare and outcomes in large areas of the world. In 2009, a prospective registry of HL was implemented in Brazil. Web-based data were contributed by 20 institutions across the country participating in the Brazilian Prospective Hodgkin's Lymphoma Registry. The aim of this study was to present the clinical features and outcomes of newly diagnosed patients with HL aged 13 to 90 years. Multivariate Cox regression models were used to estimate progression-free (PFS) and overall survival (OS) by clinical factors. A total of 674 patients with classical HL were analysed, with a median follow-up of 37 months. Median age was 30 years (13-90). The median time from the onset of symptoms to diagnosis was 6 months (0-60). Only 6% of patients had early favourable disease, while 65% had advanced disease. Stage IVB was present in 26% and a high-risk International Prognostic Score in 38%. Doxorubicin, bleomycin, vinblastine, and dacarbazine was used in 93%. The median dose of radiotherapy was 36 Gy for localized disease and 32 Gy for advanced disease. The 3 year PFS in early favourable, early unfavourable, and advanced disease were 95%, 88%, and 66%, respectively. High-risk International Prognostic Score, advanced disease, and age greater than or equal to 60 were independently associated with poorer PFS and OS; performance status greater than or equal to 2 was also associated with a poorer OS. Poor-risk patients predominated. Radiation doses for localized disease appear higher than current recommendations. Outcomes appear inferior in developing countries than in developed countries. Delayed diagnosis is probably a major factor underlying these findings. Scattered reports from developing nations suggest that many aspects of standard care in developed countries remain unmet needs for populations living in developing countries. The present report contributes to this body of data, with a proper description of what is currently achieved in urban areas in Brazil.

Capnocytophaga canimorsus is a Gram-negative rods frequently isolated as commensal in the saliva of pets that can be transmitted to humans. We report a case of septic shock caused by this pathogen. A 78-year-old man affected by diabetes and hypertension was admitted for fever in our Emergency Department. He reported fever (37.7°C) with normal values of blood pressure, heart rate and saturation of oxygen. Laboratory studies showed increased values of procalcitonin and normal white-cell level. Blood cultures were collected and an empirical antibiotic therapy was started. He reported six days earlier a bite of a dog at the right hand. During the following days the patient presented a deterioration of clinical conditions with fever, asthenia and comparison of petechial lesions. C. canimorsus was isolated from blood cultures. He was treated with fluids and appropriate antibiotic therapy with a full recovery. Dog wounds are frequent minor injuries with an underestimated worldwide incidence because only few patients develop complications. C. canimorsus could be an emerging cause of sepsis, also in immunocompetent patients. The current understanding of risk factors for C. canimorsus associated sepsis and a prompt approach to anamnesis and treatment of early stage injuries, could have a considerable medical outcome.

Carbon monoxide is produced by the incomplete combustion of organic fuel. In the United States, it is responsible for about 500 deaths annually. Increased carboxyhemoglobin concentration and hypoxia disrupt cardiac myocyte integrity and cause dysrhythmias, acute cardiac failure and coronary artery disease. We described a case of a patient with CO-poisoning and ST elevation at ECG precordial leads who developed severe transient heart failure.A 57-year-old man was admitted to the emergency department for acute carbon monoxide poisoning that led to respiratory and cardiac failure. The electrocardiogram showed ST elevation in precordial leads, but the coronary angiography was normal. The patient was successfully treated and discharged. Three days later he was readmitted for similar symptoms and subsequently died. We hypothesize that the ECG findings were related to transient coronary vasospasm due to CO poisoning and that acute respiratory and cardiac failure related to carbon monoxide toxicity caused death.The management of patients poisoned by carbon monoxide requires early identification and intensive treatment and a careful evaluation of the home environment prior to discharge. ST elevation in such patients may be related to coronary vasospasm.

The role of the long head of the biceps (LHB) tendon in producing anterior shoulder pain, first described by Hitchcock and Bechtol in 1948 [1], is now widely accepted. Pathology of the proximal portion of the biceps is commonly encountered by the physician treating shoulder diseases. Lesions of the long head of the biceps can vary in degree from tendinitis, delamination, and subluxation to frank dislocation and can be present in the tendon itself or in the pulley system of the tendon.

Critical illnesses are a significant public health issue because of their high rate of mortality, the increasing use of the Intensive Care Units and the resulting healthcare cost that is about 80 billion of dollars per year. Their mortality is about 12% whereas sepsis mortality reaches 30-40%. The only instruments currently used against sepsis are early diagnosis and antibiotic therapies, but the mortality rate can also be decreased through an improvement of the patient's nutrition. The aim of this paper is to summarize the effects of vitamins A, B, C and E on the balance between pro-oxidants and anti-oxidants in the critical care setting to confirm "a beneficial care enhancing".The peer-reviewed articles analyzed were selected from PubMed databases using the keywords "critical care", "intensive care", "critical illness", "sepsis", "nutritional deficiency", "vitamins", "oxidative stress", "infection", and "surgery". Among the 654 papers identified, 160 articles were selected after title and abstract examination, removal of duplicates and of the studies on pediatric population. Finally, only the 92 articles relating to vitamins A, C, E and the B complex were analyzed.The use of vitamins decreased morbidity and mortality in perioperative period and critically ill patients, especially in ICU. Among the most encouraging results, we found that the use of vitamins, both as monotherapy and in vitamins combinations, play a crucial role in the redox balance. Vitamins, especially vitamins A, C, E and the B complex, could help prevent oxidative damage through the breakdown of the oxidizing chemical chain reaction.Even if the results of the studies are sometimes discordant or inconclusive, the current opinion is that the supplementation of one or more of these vitamins in critically ill patients may improve their clinical outcome, positively affecting the morbidity and the mortality. Further, randomized studies are required to deeply understand the potentiality of a vitamin supplementation therapy and develop homogeneous and standardized protocols to be adopted in every critical care scenario.

Resume Le syndrome d’apnees obstructives du sommeil est associe a une surmorbidite cardiovasculaire, liee notamment aux troubles du rythme et de la conduction cardiaque. La relation entre apnees et la survenue de ces anomalies rythmiques est neanmoins complexe. Nous rapportons le cas d’un patient porteur d’une cardiopathie severe chez lequel des troubles de la conduction ont ete depistes lors d’une polysomnographie. Il s’agissait de troubles de la conduction avec QRS larges survenant lors des apnees surtout en deuxieme partie de nuit. Le traitement par pression positive continue n’a pas permis de corriger ces anomalies qui se sont meme accentuees. La discussion pluridisciplinaire nous a permis d’expliquer ce resultat a priori paradoxal.

We report 2 children with Respiratory Syncytial Virus (RSV) infection complicated with spontaneous pneumopericardium (PP) and pneumomediastinum (PM), one also associated with pneumorrhachis (PR).Two previously healthy children presented with fever, violent dry cough, dyspnea, and tachypnea. Chest X-ray and CT scans showed sizeable PP and PM in both patients. One of them also presented PR. Children were initially treated with intravenous antibiotics, antipyretics, and a cough sedative. Because of worsening of respiratory distress syndrome, children underwent helmet-delivered CPAP with oxygen supplementation. The patients' clinical conditions quickly improved and they were discharged in good conditions.Pathogenetic mechanism of spontaneous PP and PM complicating RSV infection could be related to the cough, causing intrathoracic pressure increase and rupture of alveoli near the mediastinal pleura. Nevertheless, RSV seems to play a role in facilitating such complications, attenuating the cough threshold in infected children.RSV bronchiolitis can lead respiratory and systemic consequences, so their prompt recognition is essential to establish a fast and adequate therapy, especially control of cough and respiratory distress syndrome treatment.

Background Irreparable rotator cuff tears associated with shoulder functional impairment represent a challenge, especially in young and active patients. Latissimus dorsi muscle-tendon transfer is performed to replace the irreversibly lost contractile elements in patients with irreparable tears of the posterosuperior aspect of the rotator cuff.

Standard pharmacological treatment of musculoskeletal conditions is often associated with relevant side effects. Botanical preparations endowed with a good tolerability profile, therefore, could have a role in the management of these disorders. Among different natural products, Boswellia serrata extracts have long been used for the treatment of musculoskeletal disorders, given their marked anti-inflammatory activity and their ability to promote tissue regeneration. However, standard preparations of Boswellia serrata show overall modest pharmacokinetic properties, a limitation which may ultimately lead to reduced efficacy. In an effort to improve the pharmacokinetic properties, Casperome®, a lecithin-based formulation of Boswellia serrata extract representing the whole natural bouquet, has been developed. This formulation was effective in the treatment of Achilles tendonitis, epicondylitis, radiculopathies, ankle sprains and sport injuries as shown in several clinical studies, the majority of which with a randomized design and all evaluating a number of well-recognized parameters of efficacy for the therapy of musculoskeletal disorder. All studies were consistent in showing a prompt decrease of pain and improvement of functionality of the affected area after supplementation with Casperome®, without any relevant adverse effect. Remarkably, these symptomatic improvements were paralleled by reduced plasmatic levels of inflammatory markers and by a diminished need for rescue analgesics. On these bases, Casperome® may have a role in the treatment of musculoskeletal disorders. Clinical studies in other similar conditions (e.g., osteoarthritis) appear warranted to further investigate the efficacy of this botanical product in more specific settings.

Diclofenac is the most widely prescribed non-steroidal anti-inflammatory drug worldwide. Data collected during the last 10 years reported a dose-duration dependent increasing of cardiovascular risk associated with the use of diclofenac, supporting the evidence of a close association with the degree of COX-2 inhibition achieved in vivo. Nevertheless, the amplitude of cardiovascular risk associated with the administration of diclofenac at low doses and for the short-term duration is still poorly defined. Indeed, data did not show a clear and strong increasing of the risk for daily doses of 75 and of 50 mg. Concerning duration, while the identification of a safe temporal window is less defined, some studies reported an absence or a very low risk when the exposure is shorter than 30 days. Today, new low-dosage diclofenac formulations are available, allowing to reduce the systemic exposure, the degree of COX-2 inhibition and possibly the risk of occurrence of cardiovascular events. This is the reason why those new formulations may represent the ideal drug for the management of pain in the emergency setting.

This article introduces a framework for creating rich augmented environments based on a social web of intelligent things and people. We target outdoor environments, aiming to transform a region into a smart environment that can share its cultural heritage with people, promoting itself and its special qualities. Using the applications developed in the framework, people can interact with things, listen to the stories that these things tell them, and make their own contributions. The things are intelligent in the sense that they aggregate information provided by users and behave in a socially active way. They can autonomously establish social relationships on the basis of their properties and their interaction with users. Hence when a user gets in touch with a thing, she is also introduced to its social network consisting of other things and of users; she can navigate this network to discover and explore the world around the thing itself. Thus the system supports serendipitous navigation in a network of things and people that evolves according to the behavior of users. An innovative interaction model was defined that allows users to interact with objects in a natural, playful way using smartphones without the need for a specially created infrastructure. The framework was instantiated into a suite of applications called WantEat, in which objects from the domain of tourism and gastronomy (such as cheese wheels or bottles of wine) are taken as testimonials of the cultural roots of a region. WantEat includes an application that allows the definition and registration of things, a mobile application that allows users to interact with things, and an application that supports stakeholders in getting feedback about the things that they have registered in the system. WantEat was developed and tested in a real-world context which involved a region and gastronomy-related items from it (such as products, shops, restaurants, and recipes), through an early evaluation with stakeholders and a final evaluation with hundreds of users.

Thanks to their chemical composition, extracts from the bilberry are commonly used to manufacture food, health products, supplements and cosmetics. However, in this field, as in others, "the process is the product" and a careful characterization of the entire supply and production chain, from purity and quality of raw material to extraction procedures needs to be implemented by using validated, sensitive and specific techniques of analysis. This position paper discusses the importance of the characterization of bilberry extracts, in order to fight adulteration.

More than 18 types of human papillomavirus (HPV) are associated with cervical cancer, the relative importance of the HPV types may vary in different populations. Objective: To investigate the types of HPV, age distribution, and risk factors for HPV infection in women from Santiago, Chile. Methods: We interviewed and obtained two cervical specimens from a population-based random sample of 1,038 sexually active women (age range, 15-69 years). Specimens were tested for the presence of HPV DNA using a GP5+/6+ primer-mediated PCR and for cervical cytologic abnormalities by Papanicolaou smears. Results: 122 women tested positive for HPV DNA, 87 with high risk types (HR), and 35 with low risks (LR) only. Standardized prevalence of HPV DNA was 14.0% [95% confidence interval (95% CI), 11.5-16.4]. HR HPV by age showed a J reverse curve, whereas LR HPV showed a U curve, both statistically significant in comparison with no effect or with a linear effect. We found 34 HPV types (13 HR and 21 LR); HPV 16, 56, 31, 58, 59, 18, and 52 accounted for 75.4% of HR infections. Thirty-four (3.6%) women had cytologic lesions. Main risk factor for HPV and for cytologic abnormalities was number of lifetime sexual partners, odds ratios for ≥3 versus 1 were 2.8 (95% CI, 1.6-5.0) and 3.8 (95% CI, 1.3-11.4), respectively. Conclusions: LR HPV presented a clear bimodal age pattern; HR HPV presented a J reverse curve. HPV prevalence was similar to that described in most Latin American countries.

The black grouse Tetrao tetrix is declining in most of the Alps where it historically occurred. A better knowledge of the genetics of the wild populations and of captivereared birds is necessary for future reintroduction into areas where they historically occurred or where they are endangered. DNA-markers are the choice of method to study genetics of wild populations, but it is difficult to get blood samples from wild birds to extract DNA. A technique based on feathers as the DNA source was developed. DNA extracted from blood and feathers from seven birds was tested by PCR, 80 10-base primers. Only seven primers showed a repeatable amplification profile between DNA sources and polymorphic variation within the population. The selected primers were used to amplify the DNA extracted from wild black grouse feathers in different areas (Trentino, Cuneo, Maritime Alps). The Trentino population presented a reduced genetic variability with an average band sharing (ABS) of 0.76 ± 0.145 in the captive-reared birds vs 0.70 ± 0.17 in all birds. The birds from Cuneo and the Maritime Alps had an ABS of 0.48 ± 0.07 and 0.35 ± 0.10, respectively, and were quite different from the average genotype.

The Cardioversion of Atrial Fibrillation in Emergency (CAFE) study was an observational, retrospective, multicenter study focusing on patients with recent onset atrial fibrillation (AF) seen in six different Emergency Departments (ED) of Rome, Italy.The aim of this study was to present the baseline characteristics and risk factors of the patients enrolled to the CAFE study.We retrospectively reviewed 3085 eligible patients diagnosed with recent onset AF in any of the EDs between January 2008 and December 2009. Inclusion criteria required documented ICD-9 primary discharge/admission diagnosis of AF in the ED and stable hemodynamic conditions at presentation (systolic blood pressure90 mmHg). Exclusion criteria were permanent AF or an ongoing acute coronary syndrome.Median age was 71 years (interquartile ranges, 62-78 years) and 50.8% were men. Palpitations was the most common symptom at ED presentation and was present in 73.5% of the study subjects. Hypertension was the most prevalent comorbidity, affecting 59.3% of the patients evaluated, and the presence of previous episode(s) of AF was also common (52.3%). Regarding home treatment, the drugs most prescribed were antiplatelets (31.2%) and diuretics (25.2%). A CHADS2 score of 0 was found in 814 patients (26.4%), while a CHADS2 score of 1 was reported in 1114 patients (36.1%). Finally, a CHADS2 score ≥ 2 was reported in 1157 patients (37.5%).The present study represents an important snapshot of demographics, comorbidities, risk factors and anticoagulation management about patients with recent onset AF. Disparities were noted in anticoagulation management, suggesting that this is still a main problem among patients with AF.

In this paper we introduce the idea of interaction with networks of socially intelligent objects as a way of supporting tourists and introducing them to the culture of a territory and as a way of maintaing the cultural heritage of a territory alive. We illustrate this idea with an application we designed in the field of gastronomy. Socially intelligent objects are able to maintain and aggregate knowledge about themselves and their world and are able to establish social relations with other objects and people. In this way they become hubs which allow tourists to get in touch with the world of the objects which is made of a territory, its culture and traditions, people and other objects. We support natural forms of interaction without requiring any electronic infrastructring of the objects. In particular, we designed an interaction paradigm supporting a playful enhancing experience when interacting with objects. We also support a continuum of experience in the real and virtual world.

Wanteat is a framework and a suite of applications which allow users to interact with and explore mixed social networks of smart objects and people in the gastronomy domain, thus promoting the cultural heritage of a territory. Wanteat interaction model is based on the concept of a "wheel" [1].