Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients

PURPOSE

Severe cases of coronavirus disease 2019 develop ARDS requiring admission to the ICU. This study aimed to investigate the ultrasound characteristics of respiratory and peripheral muscles of patients affected by COVID19 who require mechanical ventilation.

MATERIALS AND METHODS

This is a prospective observational study. We performed muscle ultrasound at the admission of ICU in 32 intubated patients with ARDS COVID19. The ultrasound was comprehensive of thickness and echogenicity of both parasternal intercostal and diaphragm muscles, and cross-sectional area and echogenicity of the rectus femoris.

RESULTS

Patients who survived showed a significantly lower echogenicity score as compared with those who did not survive for both parasternal intercostal muscles. Similarly, the diaphragmatic echogenicity was significantly different between alive or dead patients. There was a significant correlation between right parasternal intercostal or diaphragm echogenicity and the cumulative fluid balance and urine protein output. Similar results were detected for rectus femoris echogenicity.

CONCLUSIONS

The early changes detected by echogenicity ultrasound suggest a potential benefit of proactive early therapies designed to preserve respiratory and peripheral muscle architecture to reduce days on MV, although what constitutes a clinically significant change in muscle echogenicity remains unknown.

A validation study of a continuous automatic measurement of the mechanical power in ARDS patients

The mechanical power (MP) is the energy delivered into the respiratory system over time. It can be computed as a direct measurement of the inspiratory area of the airway pressure and volume loop during the respiratory cycle or calculated by "power equations". The absence of a bedside computation limited its widespread use. Recently, it has been developed an automatic monitoring system inside of a mechanical ventilator.

PURPOSE

Our aim was to investigate the repeatability and the accuracy of the measured MP at different PEEP values and tidal volume compared with the calculated MP.

MATERIAL AND METHODS

MP was measured and calculated in sedated and paralyzed ARDS patients at low and high tidal volume, at 5-10-15 cmH₂O of PEEP both in volume and pressure-controlled ventilation. The same measurements were performed twice.

RESULTS

Fifty ARDS patients were enrolled. MP was measured and calculated for a total of 300 measurements. The bias and limits of agreement were 0.38 from -1.31 to 2.0 J/min. The measured and calculated MP were similar in each ventilatory condition.

CONCLUSIONS

The mechanical power measured by a new automatic real time system implemented in a mechanical ventilator was repeatable and accurate compared with the computed one.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Underweight and overweight among children and adolescents in Tuscany (Italy). Prevalence and short-term trends

INTRODUCTION

The recent increase in both childhood obesity and adolescent anorexia nervosa in developed countries has underlined the important consequences that these trends may have on public health, as there is an increased risk that these conditions may become chronic diseases in adulthood. Therefore, it is necessary to monitor prevalence rates and trends in thinness and overweight (including obesity) among children and adolescents at different levels: international, national and sub-national. Since 2001/2002, a nutritional surveillance system has been implemented in the Tuscany Region to estimate the nutritional status and lifestyles of children and adolescents. The main objectives were to assess the prevalence of thinness, overweight and obesity among Tuscan children and adolescents and to provide baseline information on the prevalence of thinness, for the first time calculated according to the new international definitions, for geographical comparisons and descriptions of time trends.

METHODS

Independent cross-sectional sample surveys were conducted in 2002, 2004 and 2006 in Tuscany, North-Central Italy. Data were collected from stratified two-stage cluster samples of children aged 9 years (n = 3,048 in 2002 and n = 1,430 in 2006) and of adolescents aged 11-13-15 years (n = 1,066, n = 1185 and n = 1,160 in 2004 and n = 1,189, n = 1,211 and n = 1,178 in 2006, respectively). Weights and heights of primary school children were measured by means of standardized methods, while those of adolescents were self-reported. Decimal age was calculated from the date of birth to the date of measurement. Body Mass Index classes were calculated according to the International Obesity Task Force standards. Instead of the term underweight in children, we used the term thinness, which the World Health Organization uses to mean low Body Mass Index for age in adults and adolescents. According to Cole's recently published cut-offs for thinness, we divided our Body Mass Index values below 18.5 into three grades.

RESULTS

This study presents data on the prevalence of different grades of nutritional status (thinness, normal weight, overweight and obesity) among Tuscan school-aged children from primary to high school (9-11-13-15-y-old), assessed by means of Body Mass Index, according to international definitions. From 2002 to 2006 the prevalence of thinness among children aged 9 years decreased from 4.6% to 4.2%, and the prevalence of normal weight from 63.7% to 62.4%; the prevalence of overweight (including obesity) rose from 31.7% to 33.4%. From 2004 to 2006, among pre-adolescents aged 11 years, the prevalence of thinness declined from 11.0% to 10.1%; the prevalence of normal weight rose from 68.4% to 70.2%, and the prevalence of overweight declined from 20.7% to 19.6%. Among adolescents aged 13 years, the prevalence of thinness declined from 9.8% to 8.0%; the prevalence of normal weight rose from 73.5% to 74.0%, and the prevalence of overweight from 16.8% to 17.9%. Among adolescents aged 15 years, the prevalence of thinness declined from 9.8% to 8.7%, and the prevalence of normal weight from 77.0% to 71.6%, while the prevalence of overweight rose from 13.3% to 19.7%. The 2006 data showed that the trend in the prevalence of overweight (including obesity) tended to decrease with age for both sexes, though more markedly in girls (from 34.0% at 9-y of age to 12.2% at 15-y of age) than in boys (from 32.8% at 9-y of age to 22.8% at 13-y of age to 27.5% at 15-y of age). By contrast, the prevalence of thinness increased with age in girls (from 4.9% at 9-y of age to 14,1% at 15-y of age), while boys presented a similar low prevalence at 9 and 15-y of age (3.3% and 3.1%), doubling the values at 11 and 13-y of age (7.5% and 6.5%). The trend in the prevalence of normal weight increased with age from 62.4% at 9-y of age to 74.0% at 13-y of age and to 71.6% at 15-y of age. Boys displayed a higher prevalence than girls only at 9-y of age (63.9% vs. 61.0%).

DISCUSSION

The results of this study allow us to analyze data from the nutritional surveillance system in Tuscany using recent definitions of Body Mass Index cut-off points among children, pre-adolescents and adolescents. As a rule, the trend in the prevalence of overweight (including obesity) among girls from 9-y to 15-y-old strongly decreased, while the prevalence of thinness increased. In boys, this decrease was less marked and the prevalence of thinness displayed an irregular trend, with an increment from 9-y to 11-y-old and a decrease from 13-y to 15-y old. The trend in the prevalence of normal weight increased with age, with a higher prevalence among boys than girls.

Nutritional surveillance in Tuscany: eating habits at breakfast, mid-morning and afternoon snacks among 8-9 y-old children

INTRODUCTION

The prevalence of overweight and obesity in children is rapidly increasing in many countries. For that it has been interesting to investigate the eating habits of 8-9 y-old Tuscany children by paying attention to their meals frequency per day and their food choices in total and in relation to children's Body Mass Index (BMI) classes. In addition we considered some environment factors that could affect the children eating behaviours, such as mother's BMI and their education level.

METHODS

A statistical sample of 3076 (1583 males, 1493 females), 8-9 year-old school-children was collected; weight and height were measured using standardized personnel and instruments. BMI classes were calculated using Cole et al.'s cutoff for children and adolescents. In order to evaluate the consumption frequency of individual meals and various foods, a Food Frequency Questionnaire (FFQ) was used, which was completed by the children themselves at school. A self-administered questionnaire revealed the weight and height of parents and their educational levels. Three educational levels were established: high, medium and low.

RESULTS

The results showed that 92.3% of children ate breakfast from 4-7 times a week, the vast majority at home, while only 3% declared consuming breakfast never or almost never The most preferred breakfast consisted of milk and biscuits for all children's BMI classes. 95.9% of children reported having midmorning snack at school; fruit juice and tea are the most frequently consumed liquid foods, and pizza, salami sandwiches and pre-packaged snacks are the most frequently consumed solid foods in all BMI classes. 93.6% ate afternoon snack for the most part at home, even if 12% of children reported consuming it elsewhere; fruit juice and tea with pizza, sandwiches and pre-packaged snacks are still the most highly consumed foods by all children's BMI classes. The consumption frequency of breakfast (P < 0.001), mid-morning (P < 0.05) and afternoon snack (P < 0.05) of 8-9 y-old Tuscany children decrease with increase the children's BMI classes. The same tendency may be noted for the consumption frequency of breakfast in relation to mother's BMI (P < 0.05) and their education level (P < 0.05). This data strengthens the thesis that some home environments can affect the children's eating behaviours.

CONCLUSION

No substantial differences in food choices at the meals analyzed were determined among normal weight, overweight and obese children. Children of normal weight had a greater tendency to consume meals more regularly. Mother's BMI and their education level can have influence on children's eating behaviours.

Increased immunogenicity of the MF59-adjuvanted influenza vaccine compared to a conventional subunit vaccine in elderly subjects

Three-hundred and eight outpatient elderly subjects (> or = 65 years) were randomly assigned to receive the MF59-adjuvanted influenza vaccine (FLU-AD; n = 204) or a conventional subunit influenza vaccine (AGRIPPAL S1; n = 104) in order to compare the safety and immunogenicity of the two vaccines. Although mild pain at the injection site was reported more frequently by subjects immunised with the adjuvanted vaccine, both vaccines were shown to be safe and well tolerated. The adjuvanted vaccine was more immunogenic as indicated by higher post-immunisation geometric mean titres (GMTs) and by higher proportions of subjects with post-immunisation > or = four fold increases of antibody titres or subjects with > or = 1/160 post-immunisation HI titres. These differences, statistically significant for all three strains after immunisation, indicated that, by addition of the MF59 adjuvant emulsion, conventional subunit influenza antigens acquire an enhanced immunogenicity without any clinically significant increase of their reactogenicity.

Prevalence of diphtheria toxin antibodies in human sera from a cross-section of the Italian population

A polycentric study was carried out between 1993 and 1995 in order to evaluate diphtheria immunity on a representative sample of population from different areas of Italy. To determine diphtheria antitoxin, sera from 5187 apparently healthy subjects, divided according to sex and age groups, were titrated using an ELISA indirect method. A basic protective titre of diphtheria antitoxin (> 0.01 IU ml-1) was found in 4080 (78.6%) subjects. No statistically significant differences between males and females were observed. Our findings show that the proportion of susceptibles increases with age and a high proportion of adults no longer has diphtheria antitoxin at protective levels since toxigenic C. diphtheriae circulation is presently lacking in Italy.

Immunity to diphtheria in Siena

The aim of this study, carried out in 1993, was to evaluate diphtheria immunity in Siena. Diphtheria antitoxin levels were measured by means of the immunoenzymatic test (ELISA) in serum samples of 602 apparently healthy subjects (239 males and 363 females) of all ages residing in Siena. According to widely used criteria, 6% of the total population were susceptible to diphtheria (antibody levels < 0.01 IU/ml), 71% had basic protection (0.01-0.09 IU/ml) and 23% were fully protected (> or = 0.1 IU/ml). The results suggested that a high proportion of young population had a protective level of immunity against diphtheria, that susceptibility increased with age and a smaller proportion of males (2.9%) than females (8.3%) were unprotected; this difference was statistically significant. Our results suggest that it may be useful to revaccinate adults with low levels of diphtheria toxoid so that the percentage that remains unprotected does not put the community at risk of an outbreak of diphtheria.

Evaluation of in vitro efficacy of the disinfectant Virkon

A study was conducted on a new acid peroxygen system based disinfectant (Virkon), in order to assess its in vitro efficacy. The chemical was tested on different bacteria (Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli), spores (Bacillus subtilis) and on the Hepatitis B surface antigen (HBsAg), and compared in its activity with phenol and glutaraldehyde (calculation of the 'phenol coefficient' and the 'glutaraldehyde coefficient'). The constancy of speed of disinfection, the coefficient of concentration, the minimal inhibitory concentration (MIC) were also determined, and the destruction of the HBsAg antigenic activity was studied using an ELISA kit. The sporicidal efficacy of Virkon was assessed by cultivating spores in agar nutrient after contact with different dilutions of the disinfectant. The results of the tests showed that Virkon has a high concentration coefficient (mean value of k: 0.374/min) and a wide range of action. The low MIC demonstrates how little concentrations of Virkon can inactivate all studied bacteria. The disinfectant was also able to destroy the hepatitis B surface antigen, and it demonstrated good activity against spores, especially if used in physiologic solution. These characteristics, coupled with the absence of initiation or toxic effects on animals showed by other studies, make wide fields of application for the new disinfectant foreseeable.

Attitudes and behavior of health care personnel regarding influenza vaccination

This paper reports the results of a study conducted by the Italian Association for Immune-Prophylaxis Promotion (AIP.I) with the aim of surveying the attitudes and perceptions of Italian health care workers regarding the use and efficacy of influenza vaccine. The results clearly show that a high proportion of the questioned health care workers showed a general lack of concern about the severity of the disease. Doubts about vaccine efficacy and fear of post-vaccination side effects were also observed to have an important influence on the vaccination acceptance rates. These data underline the need for a systematic education program to provide influenza vaccination within the public and private health-care sectors in Italy.

Prevalence of Streptococcus mutans and dental decay in school children from Siena (Italy)

Epidemiological indexes of dental decay and prevalence of Streptococcus mutans in dental plaque were studied in a group of 255 schoolchildren aged 6-11 from a suburban area near Siena (Italy). Mutans streptococci were isolated from 17.4% of subjects: a significant correlation with dental decay indexes and with the presence of active caries was observed.