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Rangers safeguard the balance between humans and nature by protecting and managing biodiversity and natural resources. The challenging working conditions that rangers face make them vulnerable to wildlife attacks and exposure to zoonotic and vector-borne diseases. Despite all of these work-related challenges and threats to their health, a vast majority of rangers lack access to adequate medical treatment facilities. This research has used data from the one of the largest and most comprehensive surveys of rangers across multiple countries, collected as part of the Global Ranger Perception Survey, to examine the relationship between the precarious working conditions of rangers and their health outcomes. By comparing data from the 2020 World Malaria Report, our study highlights the severe malaria burden carried by rangers around the world. Malaria prevalence in rangers working in Central Africa, East Africa, and South America was estimated to be four times higher than in the general population. The results of this study are valuable because they show that rangers are a vulnerable, high-risk population of professionals and their working conditions are highly associated with their respective health outcomes. The research also makes it imperative that improving working conditions is essential for maintaining a professional ranger workforce that protects the planet’s natural areas and biodiversity.

Abstract Sore throat represents one of the main causes of antibiotic overprescription in children. Its management is still a matter of debate, with countries considering streptococcal pharyngotonsillitis a benign and self-limiting condition and others advocating for its antibiotic treatment to prevent suppurative complications and acute rheumatic fever. Italian paediatricians frequently prescribe antibiotics on a clinical basis regardless of microbiological results. Moreover, broad-spectrum antibiotics are inappropriately prescribed for this condition. In this regard, an intersociety consensus conference was issued to promote the judicious use of antibiotic therapy in paediatric outpatient settings. A systematic review of the literature was performed, and updated recommendations were developed according to the GRADE methodology. Antibiotic treatment with amoxicillin (50 mg/kg/day) for 10 days is recommended in all children with proven streptococcal pharyngitis. Benzathine-penicillin could be prescribed in children with impaired intestinal absorption or inability to tolerate enteral intake and in those at high risk of suppurative complications with low compliance to oral therapy. In children with suspected amoxicillin allergy, third-generation cefalosporins for five days are recommended in low-risk patients, and macrolides are recommended in high-risk ones. Candidates for tonsillectomy due to recurrent pharyngitis could be treated with amoxicillin-clavulanic acid, clindamycin, or combined therapy with amoxicillin plus rifampicin for four days, in an attempt to avoid surgery.

Abstract Background Paracetamol and ibuprofen are the most commonly used drugs for pain treatment in children and their combination has shown improved analgesic effect compared to treatment with either drug alone. Current literature lacks specific guidelines regarding the settings in which this combination should be adopted. Methods The survey, conducted with Delphi methodology, involved 75 hospital and outpatient pediatricians with clinical experience in the management of pain in children. Pediatricians involved were asked to validate or not the results of the previous NominalGroup Tecnique (NGT) consensus and thus specify the optimal clinical settings in which the paracetamol/ibuprofen fixed-dose combination could be adopted. Results The results confirm the importance of the fixed-dose paracetamol and ibuprofen combination for the control of mild-to-moderate acute pain in children. Particularly, this association seems to be appropriate in case of headache, earache, odontalgia and musculoskeletal pain, and in specific settings such as post-operative and post-procedural pain. The broadening of the panel brought to slight variations in clinical management practices between hospital and outpatient specialists. Nonetheless, overall consensus supports the notion that the fixed dose combination is more efficacious than monotherapies and it is well tolerated. Moreover, experts unanimously agree on the usefulness of the combination for caregivers, leading to improved adherence and effectiveness. Conclusions Both the NGT consensus and the broader Delphi consensus confirm the usefulness of the paracetamol-ibuprofen fixed-dose combination in pediatric pain. This is attributed to its superior effectiveness compared to monotherapies, a good tolerability profile, and improved compliance and ease of use. Some pain settings related to chronic, inflammatory and rheumatological pathologies remain to be investigated to evaluate the use of this combination.

Abstract Indoor air quality is negatively affected by the emission of different combustion sources releasing airborne particles and related particle-bound toxic compounds (e.g., heavy metals and polycyclic aromatic hydrocarbons). To date, very few studies focused on the chemical characterization of the airborne particles emitted by indoor sources were carried out; moreover, no data on their size-resolved chemical compositions are available. In the present study, an experimental analysis aimed at determining the size-segregated content of heavy metals and polycyclic aromatic hydrocarbons in airborne particles (including sub-micrometric ones) emitted by widely-used indoor combustion sources (i.e., incenses, candles, mosquito-coils, and cooking activities) was carried out. To this purpose, airborne particles were collected through an electric low-pressure impactor and were post-analyzed by means of chromatography–mass spectrometry and atomic emission spectrometry techniques. Results of the analyses showed that the chemical composition of the emitted particles is not invariant to the particle size, indeed, an important contribution of sub-micrometric particle range to the total mass of chemical compounds emitted by the sources was noticed. These findings also demonstrated that significant underestimations of particle-bound compounds depositing in the lungs could occur if size-dependent compositions are not adopted.

A multispecialty trauma team must provide care for pelvic gunshot wounds (PGW) due to the high risk of associated morbidity and mortality, the high density of organs that might be wounded within the pelvis, and the potential consequences of these complicated injuries. We present a case of a 59-year-old woman hemodynamically stable with firearm injury to the left buttock. CT examination showed free air in the peritoneal cavity and in the retroperitoneum and a focal contrast extravasation within the uterine fundus. The patient underwent urgent laparotomy that revealed triple bowel perforation (sigmoid colon, medium rectum, ileum) and a laceration of the posterior and anterior uterine wall at level of the cervix with no signs of active bleeding. The bullet was lodged above the peritoneal reflection, in the right pelvis, and it was removed, and handed over to the judicial authority. The perforated bowel segments were resected with Hartmann's procedure and ileal anastomosis. The uterine laceration was repaired. Although all the viscera and the structures along the trajectory can be harmed, pelvic gunshot wounds have the potential to inflict serious injury. Nongravid uterine traumas are a unique occurrence, and proper care requires an understanding of lesion grading. Finding the gynecological lesion in female patients is essential to receiving the best care and protecting the reproductive system.

There is not a welfare protocol for horses reared for meat production in semi-extensive systems. The aims of the study were to develop a specific welfare protocol suitable to be applied at pasture and on stable; and to evaluate whether the welfare items were influenced by the farming system (pasture vs stable). 52 non-animal-based measures (N-ABMs) and 14 animal-based measures (ABMs), classified into 6 thematic areas (training, feeding, facilities, ABMs, biosecurity, health management) were selected by a focus group. The protocol was applied on a total of 429 Catria horses located across 26 pastures during the warm seasons and on 7 stables during the cold seasons. Differences obtained within each horse-unit were calculated by using the diversity index (VARNC) and the distance from the ideal (dfi) index. Chi-square test was used for comparing the relative frequencies (%) of the answers (pasture vs stable). Most the welfare items were classified as adequate in both pasture and stable, yet differences were found within ‘training’ (p = 0.02) and ‘feeding’ (p

Abstract Pediatric asthma management is a compelling challenge for every pediatrician. Different aspects require attention and definition. The present Intersocietal Survey aimed to collect real-world experiences from a sample of Italian pediatricians. A web platform was used to collect anonymous answers to the survey questions. Four hundred four pediatricians participated in this initiative promoted by the Italian Society of Pediatric Allergy and Immunology (SIAIP), the Society of Preventive and Social Pediatrics (SIPPS), and the Federation of Italian Pediatricians (FIMP). The results showed an extensive participation of primary care pediatricians (72%). There was a large consensus about diagnostic criteria and medication choice. However, treatment duration and device choice were various. Adherence to guidelines on general aspects of practical clinical management was high. In conclusion, the present Intersocietal Survey confirmed that pediatric asthma management is rather satisfactory, even if further improvement should concern a more widespread use of ICS for acute asthma/wheezing attacks, a better definition of the duration of ICS and bronchodilator use, and hospital-primary care integration.

Study region: In this study, we compared the spatiotemporal evolution of rainfall trends in E-OBS and ERA5 to those detected using historical rainfall series recorded by ground-based networks in Southern Italy. In particular, the study is applied to the Campania, Basilicata, Apulia, Calabria and Sicily regions (84,000 km2 in total) on seasonal and annual scales. Study focus: Meteorological gridded datasets at large spatial scales are widely used in many hydroclimatic applications as they provide long and spatially homogeneous records. Regional trend analyses based on these data need to be treated with caution due to some potential limitations at relevant hydrological scales, such as the coarse spatial resolution and the spatio-temporal inhomogeneity of the underlying data. Gradual trends and abrupt change points were studied on rainfall data from 1979 to 2019. New hydrological insights for the region: Both gridded datasets capture the major trends in observed rainfall, with a predominance of positive values driven by changes in September-November. Overall, ERA5 returns flatter results compared to E-OBS, with the former comparing well with observations in Sicily and Apulia, while the latter is performing well in Campania and partially in Calabria and Basilicata. Most statistically significant trends are associated with discontinuities in the early 2000s, and this is well captured by both ground and gridded datasets. The general behavior in inter-annual variability trends in Southern Italy is captured by both datasets, with ERA5 also detecting regional patterns.

Abstract The preservation of cultural heritage, including ancient photographic materials, is of paramount importance in the field of conservation science. In this context, the microbial diversity of ‘Skull and Crossbones’, a 1983 photograph by Robert Mapplethorpe printed on silver gelatine, was assessed. We employed both culture-dependent and culture-independent methods to characterize microbial communities inhabiting this artwork. Vibrational Raman micro spectroscopy and FT-IR spectroscopy were utilized to assess the chemical degradation condition and characterize the chemical components of the silver gelatin print. The combination of molecular sequencing methods (Sanger and HTS approach) and non-invasive vibrational spectroscopy yielded valuable insights into the microbial communities thriving on photographic material and the chemical degradation of the print. Isolated fungal strains were added to the Fungal Collection at the University of Naples Federico II, and their deteriorative potential was investigated by adding substrates, commonly used in canvas photographs to the culture media. These results establish a link between microbial communities colonizing ancient photographic materials, paper decomposition, and the enzymatic patterns of the retrieved microorganisms. This information is invaluable for understanding and addressing biodeterioration progression on valuable works of art, such as historical photographs, which remain understudied.

Per- and polyfluoroalkyl substances (PFASs) are carbon–fluorine compounds with widespread industrial and domestic use, posing potential toxicological risks to humans and ecosystems. Several analytical methods have been developed to assess the occurrence of PFASs in the environment, but a standardized method, applicable to all matrices, is still lacking. This paper reviews the extraction and chromatographic detection methods for PFAS assessment in environmental samples, considering parameters such as the LOD, LOQ, and recoveries. Solid phase extraction (SPE) is commonly used, showing high recovery rates for water, soil, and sediment samples using HBL and WAX polymeric sorbents (85–100% and 93–111.5%, respectively). LC-MS has demonstrated low LODs and LOQs in seawater (0.01–0.08 ng L−1; 0.03–0.24 ng L−1), marine sediment (0.002–0.018 ng g−1; 0.004–0.054 ng g−1), and dust (0.08–0.68 pg g−1; 0.26–2.25 pg g−1), indicating its sensitivity when detecting trace PFAS levels. Evaluating PFASs is crucial for the development of future removal strategies and risk assessments. Potential solutions including the use of PFAS substitutes and innovative adsorption techniques for their adsorption could present promise in reducing their environmental presence.

Seorang pasien laki-laki usia 34 tahun yang dirawat dengan dengan diagnosis deep vein thrombosis tungkai kanan dan sindrom nefrotik primer relaps. Trombosis pada sindrom nefrotik dapat timbul dari kebocoran protein dengan berat molekul yang tinggi sehingga menyebabkan hiperkoagulabilitas, peningkatan sintesis faktor yang mendorong trombosis, aktivasi dan agregasi trombosit, aktivasi sistem koagulasi, atau penurunan antikoagulan endogen. Pasien sudah diterapi dengan heparin dan terapi untuk sindrom nefrotik. Pasien dipulangkan dengan perbaikan klinis dan kontrol rutin ke poliklinik.

ABSTRACTThe first hydrogeological mapping of Ischia Island at the 1:10,000 scale is presented and discussed. The ‘Map of the geohydrologic units of Ischia Island’ and the accompanying hydrostratigraphic sequence at a basin scale are based on the most recent geological maps and data from the CAR.G Project, and on new volcanological and hydrogeological surveys and studies. Data sources include the database stored by the INGV, Sezione di Napoli, Osservatorio Vesuviano and field investigations, including a survey of the springs and thermo-mineral springs which has been neglected up to now. In total 130 volcanostratigraphic units and 18 geohydrologic units were recognized; the distribution of fumaroles sites was enhanced, and 60 springs/thermal springs were identified/rediscovered. The proposed hydrogeological map provides an overview of the volcano-tectonic evolution of Ischia Island and upgrades the hydrogeological model, becoming a catalyst for the effort to acquire better data and to manage natural both resources and risks.

Summary: Background: To assess the equivalence of tranexamic acid (TRAN) versus synthetic oxytocin (OXY) in reducing post-partum blood loss, in full-term patients (37–42 weeks), at low risk of post-partum hemorrhage, with vaginal childbirth. Methods: Phase III, randomized (1:1), open-label, longitudinal, multi-center, prospective clinical trial (Prot. n 63209, ClinicalTrials.gov Identifier: NCT02775773). From January 7, 2020, to June 30, 2023, a total of 256 women were enrolled at two general urban community hospitals in Italy, serving a multi-ethnic patient population with National Health Insurance. The primary outcome was to explore a potential equivalence between the two treatments (OXY and TRAN) in preventing total blood loss. Therefore, we randomized 231 women into two groups: Group A (OXY), 127 women who were administered 10UI intramuscularly within 5 min from childbirth; Group B (TRAN), 104 women to whom 1-g slow intravenous infusion was administered within 5 min from childbirth. Findings: At the time of delivery, mean blood loss for OXY group versus TRAN group was 269.12 mL versus 263.88 mL, respectively, with equivalence between the two groups. Similarly, there was equivalence in total blood loss between the OXY and the TRAN group (397.66 mL versus 405.64 mL, respectively. No statistical differences between Hb levels at admission and discharge in the two groups were reported. No difference was found in terms of additional uterotonic and surgical therapies between the two groups of patients. Neither group showed thrombotic complications at check-up performed after 7 days or after a questionnaire regarding adverse effects, subjected after 40 days. Interpretation: The study shows the equivalence of tranexamic acid versus synthetic oxytocin in post-partum blood loss prophylaxis in term patients at low risk of PPH with vaginal childbirth. The safety profiles of OXY and TRAN were similar. Funding: None.