Search

Since December 2019, the world has been facing the life-threatening disease, named Coronavirus disease-19 (COVID-19), recognized as a pandemic by the World Health Organization. The response of the Emergency Medicine network, integrating "out-of-hospital" and "hospital" activation, is crucial whenever the health system has to face a medical emergency, being caused by natural or human-derived disasters as well as by a rapidly spreading epidemic outbreak. We here report the Pavia Emergency Medicine network response to the COVID-19 outbreak. The "out-of-hospital" response was analysed in terms of calls, rescues and missions, whereas the "hospital" response was detailed as number of admitted patients and subsequent hospitalisation or discharge. The data in the first 5 weeks of the Covid-19 outbreak (February 21-March 26, 2020) were compared with a reference time window referring to the previous 5 weeks (January 17-February 20, 2020) and with the corresponding historical average data from the previous 5 years (February 21-March 26). Since February 21, 2020, a sudden and sustained increase in the calls to the AREU 112 system was noted (+ 440%). After 5 weeks, the number of calls and missions was still higher as compared to both the reference pre-Covid-19 period (+ 48% and + 10%, respectively) and the historical control (+ 53% and + 22%, respectively). Owing to the overflow from the neighbouring hospitals, which rapidly became overwhelmed and had to temporarily close patient access, the population served by the Pavia system more than doubled (from 547.251 to 1.135.977 inhabitants, + 108%). To minimize the possibility of intra-hospital spreading of the infection, a separate "Emergency Department-Infective Disease" was created, which evaluated 1241 patients with suspected infection (38% of total ED admissions). Out of these 1241 patients, 58.0% (n = 720) were admitted in general wards (n = 629) or intensive care unit (n = 91). To allow this massive number of admissions, the hospital reshaped many general ward Units, which became Covid-19 Units (up to 270 beds) and increased the intensive care unit beds from 32 to 60. In the setting of a long-standing continuing emergency like the present Covid-19 outbreak, the integration, interaction and team work of the "out-of-hospital" and "in-hospital" systems have a pivotal role. The present study reports how the rapid and coordinated reorganization of both might help in facing such a disaster. AREU-112 and the Emergency Department should be ready to finely tune their usual cooperation to respond to a sudden and overwhelming increase in the healthcare needs brought about by a pandemia like the current one. This lesson should shape and reinforce the future.

The outcome of refractory/relapsed (R/R) acute leukemias is still dismal and their treatment represents an unmet clinical need. However, allogeneic transplantation (allo-HSCT) remains the only potentially curative approach in this setting. A prospective study (GANDALF-01, NCT01814488; EUDRACT:2012-004008-37) on transplantation with alternative donors had been run by GITMO using a homogeneous myeloablative conditioning regimen with busulfan, thiotepa and fludarabine while GVHD prophylaxis was stratified by donor type. The study enrolled 101 patients; 90 found an alternative donor and 87 ultimately underwent allo-HSCT. Two-year overall survival of the entire and of the transplant population (primary endpoint) were 19% and 22%, without significant differences according to disease, donor type and disease history (relapsed vs refractory patients). Two-year progression-free survival was 19% and 17% respectively. The cumulative incidences of relapse and non-relapse mortality were 49% and 33% at two years. Acute grade II-IV and chronic GVHD occurred in 23 and 10 patients. Dose intensification with a myeloablative two-alkylating regimen as sole strategy for transplanting R/R acute leukemia does seem neither to improve the outcome nor to control disease relapse. A pre-planned relapse prevention should be included in the transplant strategy in this patient population.

We describe clinical characteristics, treatments and outcomes of 44 Caucasian patients with coronavirus disease (COVID-19) at a single hospital in Pavia, Italy, from 21–28 February 2020, at the beginning of the outbreak in Europe. Seventeen patients developed severe disease, two died. After a median of 6 days, 14 patients were discharged from hospital. Predictors of lower odds of discharge were age > 65 years, antiviral treatment and for severe disease, lactate dehydrogenase > 300 mg/dL.

This essay examines Irmgard Keun's novel Das kunstseidene Madchen (1932) against the backdrop of Weimar-era discourses on the emancipatory potential of vision. While the narrative's thematization of vision has been productively analyzed from the perspective of feminist and film theory, less attention has been paid to its ties to contemporary discourses concerned with retooling a vision enhanced by new technologies like film into an instrument of emancipatory self-fashioning. As the article shows, Keun's novel reflects critically on these discourses by casting its heroine's sentimental journey in terms of an education in vision that leads to acknowledging the distance between the visual as a mode of inscription and the visible as a domain of perception. In so doing the novel delivers a critical commentary on contemporary discourses that located agency in a conquest of the visible attained by manipulating the visual.

The Chatter of the Visible examines the paradoxical narrative features of the photomontage aesthetics of artists associated with Dada, Constructivism, and the New Objectivity. While montage strategies have commonly been associated with the purposeful interruption of and challenge to narrative consistency and continuity, McBride offers an historicized reappraisal of 1920s and 1930s German photomontage work to show that its peculiar mimicry was less a rejection of narrative and more an extension or permutation of it—a means for thinking in narrative textures exceeding constraints imposed by “flat” print media (especially the novel and other literary genres). McBride’s contribution to the conversation around Weimar-era montage is in her situation of the form of the work as a discursive practice in its own right, which affords humans a new way to negotiate temporality, as a particular mode of thinking that productively relates the particular to the universal, or as a culturally specific form of cognition.

The quality control of herbal drugs and their intermediates is essential, especially when they are used as feedstock for medicine development. This study aimed at applying the methodologies established by Brazilian legislation for the development of parameters concerning the characterization and quality control of leaf powder and tincture of Arrabidaea chica (H & B) Verlot. Known as cipó-pau (vinestick), carajeru, pariri, among others, it presents antifungal activity and is used in several diseases such as mycosis and ringworm. The physico-chemical characteristics of the plant drug. The phytochemical screening of the t inc tur e indi cat ed the pr e s enc e of r educ ing sugar s , anthocyanidins , anthocyanins , anthraquinones, steroids, triterpenoids, phenols, flavanonols, flavanols, flavanones, saponins and tannins catechists. HPLC chromatograms showed peaks at 275 nm and 290 nm, with Rt of 8.91 and 13.57 min, whose corresponding spectra showed absorption maxima which is characteristic of flavones and biflavonols -283 nm and 334 nm. Some metabolites found in the phytochemical screening and detected by HPLC may justify the popular use of A. chica as antimicrobial and antifungal medicine., Colegio de Farmacéuticos de la Provincia de Buenos Aires

Hepatocellular carcinoma often affects blacks at an early age. The purpose of this study was to ascertain if the association between chronic hepatitis B virus infection and hepatocellular carcinoma is the same in young and older black patients. Serum markers of hepatitis B infection were measured by radioimmunoassay in 391 blacks with hepatocellular carcinoma, 173 of whom were less than or equal to 30 yr old and 218 of whom were greater than or equal to 50 yr old. Only 2 of the young patients showed no markers of current or past hepatitis B infection compared with 31 (14.3%) of the older patients (p less than 0.001). Hepatitis B surface antigen was present in 81.5% of the young patients and of these 34.5% were e antigen-positive. The corresponding figures in the older patients were 29.8% and 10.9% (p less than 0.001 in each instance). It is concluded that whereas the association between hepatocellular carcinoma and hepatitis B infection is almost universal in young blacks, a subgroup of older blacks shows no evidence of ever having been infected with this virus.

Background & aims: An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods: Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results: The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of 'agree' responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement ('agree' + 'somewhat agree'); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% 'agree'), 13 priorities had 90% combined agreement. Conclusions: Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community's efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications: An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat.

Silver nanoparticles (AgNPs), embedded into a specific polysaccharide (EPS), were biogenerated by Klebsiella oxytoca DSM 29614 under aerobic (AgNPs-EPSaer) and anaerobic conditions (AgNPs-EPSanaer). Both AgNPs-EPS matrices were tested by MTT assay for cytotoxic activity against human breast (SKBR3 and 8701-BC) and colon (HT-29, HCT 116 and Caco-2) cancer cell lines, revealing AgNPs-EPSaer as the most active, in terms of IC50, with a more pronounced efficacy against breast cancer cell lines. Therefore, colony forming capability, morphological changes, generation of reactive oxygen species (ROS), induction of apoptosis and autophagy, inhibition of migratory and invasive capabilities and proteomic changes were investigated using SKBR3 breast cancer cells with the aim to elucidate AgNPs-EPSaer mode of action. In particular, AgNPs-EPSaer induced a significant decrease of cell motility and MMP-2 and MMP-9 activity and a significant increase of ROS generation, which, in turn, supported cell death mainly through autophagy and in a minor extend through apoptosis. Consistently, TEM micrographs and the determination of total silver in subcellular fractions indicated that the Ag+ accumulated preferentially in mitochondria and in smaller concentrations in nucleus, where interact with DNA. Interestingly, these evidences were confirmed by a differential proteomic analysis that highlighted important pathways involved in AgNPs-EPSaer toxicity, including endoplasmic reticulum stress, oxidative stress and mitochondrial impairment triggering cell death trough apoptosis and/or autophagy activation.