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COVID-19 is a complex and heterogeneous disease. The pathogenesis and the complications of the disease are not fully elucidated, and increasing evidence shows that SARS-CoV-2 causes a systemic inflammatory disease rather than a pulmonary disease. The management of hospitalized patients in COVID-19 dedicated units is advisable for segregation purpose as well as for infection control. In this article we present the standard operating procedures of our COVID-19 high dependency unit of the Policlinico Hospital, in Milan. Our high dependency unit is based on a multidisciplinary approach. We think that the multidisciplinary involvement of several figures can better identify treatable traits of COVID-19 disease, early identify patients who can quickly deteriorate, particularly patients with multiple comorbidities, and better manage complications related to off-label treatments. Although no generalizable to other hospitals and different healthcare settings, we think that our experience and our point of view can be helpful for countries and hospitals that are now starting to face the COVID-19 outbreak.

Background:The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy.Methods:It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels.Results:A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated proliferative diabetic retinopathy, and 53 (7.5%) had laser-treated retinopathy. In the entire sample of 3657 subjects, a normal macula was present in 90.9% of cases, diabetic macular edema of any kind in 5.4%, and other maculopathies in 3.4%.Conclusion:In this large cohort study on patients undergoing cataract surgery, more than one-fourth were diabetics and more than one-fourth of these had diabetic macular edema. These high prevalences suggest the opportunity to plan an adequate preoperative assessment in all patients in order to reduce the risk of postoperative development or worsening of a sight-threatening complication such as chronic diabetic macular edema.

A partire dall'intervento di riordino condotto sugli archivi dell'Associazione parenti delle vittime della strage di Ustica e di Daria Bonfietti, il breve saggio analizza gli eventi storico-istituzionali che hanno portato alla formazione dei due archivi, ne analizza la struttura, sottolinea le relazioni che intercorrono fra i due complessi e si concentra, infine, sulla funzione di archivio supplente svolto in particolare dalla documentazione in copia conservata nell'archivio dell'Associazione.

L’archivio, conservato a Bologna presso l’Istituto Parri, rappresenta una testimonianza tangibile dell’attività svolta dall’associazione negli ultimi 25 anni per l’individuazione dei responsabili del disastro di Ustica e per la trasmissione della memoria della strage. L’archivio, riordinato e inventariato nell’ambito del progetto “Una città per gli archivi”, si compone tra l’altro di manifesti, fotografie, registrazioni sonore e audiovisive integralmente digitalizzati e consultabili online.

To investigate the possibility of artificially decreasing intra-abdominal pressure (IAP) by applying continuous negative pressure around the abdomen. We investigated the effects of negative extra-abdominal pressure (NEXAP) on IAP and central venous pressure (CVP) in 30 patients admitted to our intensive care unit (age 57±17 years, BMI 26.1±4.0 kg/m2, SAPS II 41.8±17.0). Patients with severe hemodynamic instability and/or those admitted following a laparotomy were not studied. Measurements included bladder pressure as an estimate of IAP, CVP, invasive mean arterial pressure (MAP) and heart rate (HR). In five patients extensive hemodynamic measurements were also taken using a Swan-Ganz catheter. Following measurements at baseline (Basal), NEXAP (Life Care – Nev 100, Respironics) was applied on the abdomen, in random order, at a pressure equal to IAP (NEXAP0), 5 cmH2O (NEXAP-5) or 10 cmH2O (NEXAP-10) more negative than NEXAP0. Basal IAP ranged from 4 to 22 mmHg. NEXAP decreased IAP from 8.7±4.3 mmHg to 6±4.2 (Basal vs NEXAP0 p

Abnormalities in tear film structure depend on alterations in efficacy of tear production, drainage and evaporation systems that may disrupt the three-layer pattern of tears. Any change occurring to tear organization leads to disequilibrium, resulting in a hyperosmolar state. This can occur in both aqueous-deficient and -adequate dry eye syndromes of different pathogenic origins.

Keratoconjunctivitis sicca, regardless of origin, is associated with variable levels of inflammation of the ocular surface. Chronic inflammation induces and maintains the metaplastic changes that typically develop in the conjunctival epithelium of patients with this disease. Although inflammatory phenomena associated with KCS can be immunomediated and/or induced by local prostaglandin secretion, it is unknown which of the two mechanisms has the prevailing role in the genesis of injury. Nevertheless, it is reasonable to assume that inflammatory prostaglandins are liberated as a result of epithelial damage. In support of this hypothesis, a recent study demonstrated the efficacy of a therapy consisting of cycles of topically administered steroids in the treatment of KCS(4). However, the study also reported notable risks to other aspects of ocular structural health from the well known side effects of corticosteroids, e.g., intraocular hypertension and cataracts. A therapy with non-steroidal and non-preserved anti-inflammatory agents in association with tear substitutes could be an effective therapy for the reduction of inflammation of the ocular surface and its associated symptoms.

The detection of tear film-related pathology of the ocular surface during routine clinical eye examination, especially in early cases, is not always straightforward. Therefore a number of specific tests such as Schirmer test, fluorescein and rose bengal staining, etc. are usually added to the examination.1–4 The addition of these specific tests is time consuming, and they are often neglected by the general ophthalmologist. In consequence, the diagnosis of tear film disorders by the general ophthalmologist is not as frequent as it could be.

Dr Mohr suggests that the increased mortality observed in the arly-therapeutic hypothermia (TH) group could be attributable to biased patient allocation into the two study cohorts, involving reater clinical severity (as measured with the SAPS II score) in the arly-TH group and more patients with pulseless electrical activity PEA)-/asystole-cardiac arrests. Our study was conceived with a prospective observational (non andomised) design. The patients were allocated to each study roup exclusively according to the time elapsed from cardiac arrest o the start of therapeutic hypothermia (as determined by the actual linical course), and were not arbitrarily assigned to them. The two groups were indeed similar, with respect to rescue ime, time to return of spontaneous circulation (ROSC), oriin (out-of-hospital versus in-hospital) and presenting cardiac hythm, although there is a non-significant trend towards more EA/asystole in the early-TH group. Clinical severity on intensive are unit admission was greater in the early-TH group (SAPS II score 4 versus 56, p = 0.03) but the difference narrows when comparing atients categorised according to the median time between cardiac rrest and the start of therapeutic hypothermia (post hoc analyis, 90 min: SAPS II 63.5 versus 59; p = 0.12; data not published). oreover, neurological outcome was not different between the two roups, suggesting that hypothermia had beneficial effects in both roups. We had insufficient data to formulate any hypothesis as to why utcome was worse in the early-hypothermia group of our poplation. However, other studies question the benefits of an early tart of TH. In a recent study by Haugk et al., the rapid reducion of temperature in patients undergoing TH was a predictor for

Purpose: To quantify the quality of vision achieved with multifocal and bifocal contact lenses. Methods: We analyzed differential light sensitivity by computerized automatic perimetry in 21 patients wearing monofocal soft contact lenses (group 1, controls) and multifocal and bifocal contact lenses (groups 2 and 3, respectively). Seven patients each were fitted with multifocal or bifocal contact lenses; seven patients were without contact lenses (without correction for testing the visual periphery and with near-vision correction using monofocal contact lens for testing the central 30 degrees of vision). The type of correction was randomly changed in a crossover fashion so that each eye was examined at different times with different corrections. Humphrey 640 VFA computerized automated perimetry was used to test visual fields at baseline, 45 days, and 3, 4.5, and 6 months. Results: A statistically significant difference was found between the global sensitivities (GS) of the central visual field in patients with near-vision monofocal contact lenses and with bifocal contact lenses (P=0.0273) and between the GS of the central visual fields with multifocal contact lenses and with bifocal contact lenses (P=0.0261). In both cases, the GS were significantly reduced with bifocal contact lenses (total GS: group 1, 11256 dB (Decibels); group 2, 11154 dB; group 3, 10679 dB). Conclusions: The results indicate that there is reduced differential light sensitivity in the central 30 deg of the visual field with bifocal contact lenses compared with multifocal contact lenses and monofocal contact lenses (controls).