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Antonella Potalivo,1,* Jonathan Montomoli,1,* Francesca Facondini,1 Gianfranco Sanson,2 Luigi Arcangelo Lazzari Agli,3,4 Tiziana Perin,5 Francesco Cristini,6 Enrico Cavagna,7 Raffaella De Giovanni,8 Carlo Biagetti,6 Ilaria Panzini,9 Cinzia Ravaioli,10 Maria Maddalena Bitondo,1 Daniela Guerra,1 Giovanni Giuliani,1 Elena Mosconi,1 Sonia Guarino,1 Elisa Marchionni,6 Gianfilippo Gangitano,5 Ilaria Valentini,3,4 Luca Giampaolo,8 Francesco Muratore,7 Giuseppe Nardi1 1Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy; 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; 3Department of Pneumology, Infermi Hospital, Rimini, Italy; 4Ceccarini Hospital, AUSL della Romagna, Riccione, Italy; 5Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy; 6Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini,Italy; 7Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy; 8Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy; 9Department of Clinical Research, AUSL della Romagna, Ravenna, Italy; 10Ausl della Romagna Health Care Service Direction, Ravenna, Italy*These authors contributed equally to this workCorrespondence: Giuseppe NardiDepartment of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Viale Settembrini 2, Rimini 47921, ItalyTel +39 0541-705254Fax +39 0541 705886Email 4doctornardi@gmail.comPurpose: Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources.Patients and Methods: All COVID-19 patients (26/02/2020– 18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab.Results: We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001).Conclusion: This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.Keywords: COVID-19, mechanical ventilation, mortality, noninvasive ventilation, multidisciplinary team approach, ARDS

In order to find the optimal value of the hot water temperature to be reached so that there is no Legionella spp. at the dispensing points, 920 samples of water at temperature between 54 and 60 Celsius degree were analyzed at the Lugo and Faenza hospitals (Ravenna). Thought the analysis of the linear trendline results indicate that the temperature required is close to 60 degrees but as it's difficult to maintain in old plants, a careful patient's risk assessment needs to be carried out and therefore install antibacterial membrane filters at the dispensers.

This aim of the study was to identify effective levels of ClO2 for control of Legionella spp. contamination in the hot water (45-55 °C.) distribution system of a 579-bed hospital in Ravenna (Italy). Overall, 663 hot water samples were collected from the hospital's sinks and shower taps and were analyzed. Trend line analysis, which describes the trend in the number of positive samples collected according to disinfectant concentration, shows that the lowest number of positive samples was achieved with concentrations of ClO2 between 0.22 and 0, 32 mg /l.

Salmonella is a ubiquitous pathogen that can infect host species, like wild birds, rodents, and/or arthropods, which may transmit infection to domestic animals and human population.In order to assess the related risk, a cross-sectional study was performed on 1114 carcasses of wild animals from a north-eastern area of the Emilia-Romagna Region, Italy.During post mortem examination, intestine samples were cultured. A statistical analysis demonstrated that there is no correlation between the presence of sub-clinically infected animals and greater human population density. In contrast, a significant correlation between the number of carcasses positive for Salmonella spp. and greater spatial density of pig, poultry, and cattle farms was observed (p0.01).The results of the present study show that wild animals with omnivorous feeding habits are particularly exposed to Salmonella colonization and, consequently, to spreading the organism. Regarding drug resistance, this study confirms the resistance to antimicrobials is increasing in commensal and environmental isolates.

Introduction Taking part in drinking games and creating videos on social media sites, together with excess alcohol consumption and its adverse consequences, are becoming imperative new ways of improving young people's ‘personal branding’. The context and creation of videos on the web show various qualitative/quantitative assessments of drinking games (rate and frequency), in order to increase ‘likes’ in personal branding in “online' …

Little is known about human papilloma virus (HPV) seroprevalence in the healthy Italian population. The aim of the study was to assess seroprevalence of antibodies against HPV 6, 11, 16 and 18 among girls and young women in Italy.Sera were tested with a commercially available ELISA assay detecting specific IgG.Seroprevalence was 54.1% in girls between 11 to 18 years old and 8.2% in over 18s. Overall seropositivity in birth cohorts invited for free immunization reached 72.8% and was significantly higher than in other age subgroups. The highest levels of antibodies were detected in girls of 12 years old that should have just completed the vaccination schedule.A standardized seroepidemiological survey on HPV represents a useful tool for identifying groups at risk in which immunization is recommended, monitoring of vaccinated women, assessing whether booster vaccination is required.

Background The spread of different games through the internet and via social networks is becoming a serious health problem that physicians and medical professionals have to deal with, and it is necessary for them to be aware of the risks those behaviours are connected to. Unintentional injuries are the leading cause of morbidity and mortality among child and teens and some Authors reports recommendation regarding safe practices to reduce injuries [1][2]. The “deadly new craze” involving bikers taking turns to cross a busy road without checking for cars is an unsafe practice visible in web videos. Methods In this study we considered a particular case of bicycle accident related with a game proposed via web: the bike roulette challenge. We developed an appropriate, educational public health training program to understand the current characteristics of unintentional road traffic injury related with web challenges. Results This case is about a 16 year-old male patient arrived alive to the hospital with thoracic and abdominal trauma. The length of stay was 18 days associated with serious surgical complications. Conclusion In recent years is commonly possible to find strange, crazy, popular videos, via web with the intention to obtain in young population a good number of “likes”. Bike roulette is a particular game described via web and is one of the new cause of trauma. Identifying biker roulette related injury in administrative data collections can be very problematic; the results of this apparently isolated case report can be used to research appropriate procedures and timely referrals of severe adolescent injury related to web games. School appropriate interventions have got the potential to reduce unintentional trauma related to these behaviours.