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Peracetic acid (PAA) is a disinfectant with a wide spectrum of antimicrobial activity, but little is known about the feasibility of using it in the field of drinking water treatment. The aim of this study has been assess disinfectant efficacy of PAA, alone or in combination with hypochlorite, against M. avium in drinking water M. avium is a common opportunistic pathogen in immunocompromised subjects that is able to survive and grow in drinking water distribution systems. In this study PAA did not show appreciable activity against the greater number of tested strains (16/21) up to 5 ppm of PAA, a weak activity was seen on 4 strains, while a significant reduction in viable cells (about 50%) was seen only on 1 strain after 48 h of treatment with 5 ppm of PAA. We also evidenced that M. avium was unaffected by chlorine concentration usually present in drinking water distribution system. Finally, the combination of PAA and sodium hypochlorite did not promote enhanced antimicrobial efficacy respect to the single disinfectants. In conclusion, our result would indicate that PAA is an unlikely candidate for the disinfection of drinking water from M. avium and further strategies are required to eliminate M. avium from drinking water system.

A computer-based system integrated into the hospital information system for the pharmacological management of the chronic heart-failure patients admitted to the heart-failure unit of Montescano is presented. The major aims of the system involved monitoring the patients' treatment history and the related therapeutic decision-making. The treatment history of the first 151 consecutive CHF patients admitted after the system implementation is examined. The prescribed drug doses at admission and at discharge are compared, as well as the differences in etiology and NYHA class between patients discharged with or without each drug. Several considerations can be drawn from this analysis. First of all, in heart failure patients the choice of drugs is limited and optimal treatment is a result of individualized dosages. Secondly, time and trials are necessary to obtain optimal treatment. Consequently, continuity of care and in- and out-hospital networks are advisable. Third, a computer-based system offers advantages not only for the pharmacological management itself, but also for improving the quality of care through continuous analysis of the decision-making process.

Background: In many cardiac conditions, Doppler of transmitral flow has been showed to be related to left ventricular filling pressure, but several factors may limit its practical value in estimating pulmonary wedge pressure in patients with chronic heart failure. Pulmonary venous velocities directly depend on the oscillations of left atrial pressure. Recent studies suggest that transthoracic Doppler of pulmonary venous flow provides a more accurate estimation of pulmonary wedge pressure. However the relative values of transmitral and pulmonary venous flow for assessing pulmonary wedge pressure in patients with chronic heart failure have not been fully classified until now. Accordingly, we performed this study to assess the feasibility of transthoracic Doppler of pulmonary venous flow in patients with chronic heart failure and to evaluate whether it provides additional information regarding pulmonary wedge pressure when compared with Doppler indices of transmitral flow., Methods: Simultaneous Doppler echocardiographic examinations and right heart catheterizations were performed prospectively in 300 consecutive patients with chronic heart failure due to dilated cardiomyopathy. The correlations of mitral and pulmonary venous flow velocity variables, left atrial volumes, mitral regurgitation jet area and left ventricular ejection fraction with pulmonary artery wedge pressure were evaluated., Results: A complete recording of transthoracic pulmonary venous flow including all components was obtained in 66% of patients, while only systolic and diastolic forward flow were recorded in 88% of patients. Several indices, derived from pulmonary venous flow, were correlated with pulmonary wedge pressure; the strongest correlation was between systolic fraction of peak velocities and pulmonary wedge pressure (r = -0.76). This value was similar to that obtained between deceleration rate (r = 0.78) and deceleration time (r = -0.67) of transmitral flow and pulmonary wedge pressure. A systolic fraction > 40% showed a greater positive predictive value than restrictive pattern of transmitral flow for identifying patients with pulmonary wedge pressure > 18 mmHg (95% vs 86% p < 0.05). This accuracy is confirmed also in patients who had a single peak of transmitral flow., Conclusions: Doppler of pulmonary venous flow can be performed in a high percentage of patients with chronic heart failure due to dilated cardiomyopathy. The indices derived from transthoracic pulmonary venous flow are strongly correlated with pulmonary wedge pressure and improve the noninvasive identification of patients with high pulmonary wedge pressure, even when transmitral flow pattern is difficult to be interpreted.