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The conceivable R0 (the basic reproduction number) is higher than the one present in the literature (7.7 vs 3.8), this is probably due to the conditions in which the dinner took place (not ventilated environment, absence of safety distances, absence of personal protective equipment).The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.
The MonCOVID study aimed to assess the feasibility of early home management and monitoring of patients with suspected or confirmed CoViD-19, and to evaluate if this would ensure a rapid and adequate transfer to hospital care.

This pilot, open-label, single-arm study included adult symptomatic patients with suspected or confirmed CoViD-19 for whom the general practitioner or other carer had decided not to proceed to hospitalization. Participants were monitored daily at home, by measuring the pulse oximetry (SpO2) at rest and after a rapid walking test. The study assessed feasibility outcomes (at least 80% of patients recommended to be sent to the competent emergency room actually transferred within 24 hours from reporting) and efficacy (SpO2 at emergency room admission). Patients with SpO2 values below 90% (86% if affected by chronic pulmonary diseases) at rest or with a decrease in SpO2 of five percentage points after a rapid walking test were recommended for hospital care.

Thirty-seven participants rephe cases collected were not sufficient to demonstrate or refute the hypothesis of the monitoring test effectiveness. However, the study showed the feasibility of such a program, and raised some elements of interest regarding hospital territory integration, the need to develop tools to support home care and the variability of the clinical manifestations of the CoViD-19 disease.The situation of uncertainty several people faced in Italy due to the SARS-CoV-2 epidemic suggested this contribution concerning the potential outcomes in some safety areas of the primary needs of the individual safety and security needs, love and belonging needs, esteem, and self-actualization. When uncertainty features one or more of them, the risk of health outcomes increases, specifically with respect to mental health. This contribution compares the experience of the severe earthquake that hit Emilia-Romagna region (North Italy) in May 2012 and the epidemic of CoViD-19 officially started in Italy in February 2020. Both experiences were lived by the authors, as citizens and mental health professionals. The considerations presented stemmed out from the clinical experience and are articulated around some key words surprise, length, places, society, work, welfare, feelings, economics. Similarities and differences are presented, suggesting that new therapeutic devices are necessary, to hold and treat patients during this specific epidemic, as well as during future ones. Up to the moment we have just been able to chase the shadow, by integrating medieval systems (quarantine) and hyper-technological systems (i.e., the most advanced resuscitation techniques).The target populations for new drugs, in particular when these are labelled for the treatment of chronic diseases, are a central point of health planning as regulatory agencies make their decisions on pharmacoeconomic analyses performed on real-world data, health institutions have the need to plan care pathways starting from the identification of subjects requiring a specific care process and research has recognized real world evidence (RWE) studies as a complementary approach to clinical trials. On the topic of target populations for new drugs for chronic diseases, the first working group of the MaCroScopio project (observatory on chronic diseases) was launched, in which various stakeholders participated, whose reflections have been collected in this consensus document. Starting from the entry of RWE into national and international regulatory procedures, as a strategy for identifying target populations, the document describes the advantages and limitations of administrative health databases as a data source to achieve this goal. In the document is highlighted the need to adapt the identifying algorithms according to the aim to be achieved exploratory aim, economic/organizational scope, planning/evaluation purpose in order to set up the health policy in relation to the positioning of a new drug in a given care path. Finally, the article points out the main methodological challenges that all those interested in this topic are called to face the complementarity between RWE and randomized controlled clinical trials, the need to measure and evaluate the complexity and variability of clinical reality, as well as the opportunity to carry out validation studies of the identification algorithms of the target populations. The resulting consensus document, therefore, intends to lay the foundations for the application of the epidemiological methodology and the use of its results in the area of planning/evaluation of care interventions, in order to identify their effectiveness, quality and sustainability.The classic anamnesis, oriented to the disease, tends to consider the patient as the object of the privileged attention of medical science. Especially in the context of general medicine, characterized by a patient-oriented approach, illness histories are used instead, which are more pertinent to a context characterized by subjectivity and objectivity, both biological and biographical paths. Digital technologies, which have so radically changed the doctor-patient relationship, can help to describe in a more exhaustive way the not strictly clinical needs of patients and doctors and provide the possibility of building a new way of interaction and sharing of the objectives of care.The CoViD-19 pandemic has pointed out the the need for an efficient, timely, ethically correct clinical research, in order to find rapid and reliable responses to health challenges. The guidelines published by the Agenzia Italiana del Farmaco during the pandemic have shown that some useful changes for simplifying and speeding-up clinical research in Italy are feasible, while maintaining high levels of quality. In this perspective, a reflection is a must perhaps we are ready to detach ourselves from that image of a slow and bureaucratic country now widespread in Europe. Perhaps the pandemic has left us something good. Maybe we are really able of working much better, even in non-emergency conditions.Extracorporeal membrane oxygenation (ECMO) has been developed to provide hemodynamic support in patients with severe cardiac or respiratory failure. In the last few years, its use has become increasingly common in interventional cardiology rooms for high-risk coronary interventions and for transcatheter therapies for valvular disease, which are increasingly complex in subsets of fragile patients at high surgical risk and with multiple comorbidities.Here, we describe the treatment of an extremely critical patient for severe dual valvulopathy, severe impairment of post-infarct systolic function, advanced heart failure with prohibitive operative risk. In a single session, the double valvular volume defect was treated percutaneously, using ECMO with an additional drainage of the left ventricle, performing a transcatheter implantation of two aortic valve prostheses with the valve-in-valve technique and the implantation of two MitraClips with excellent final result.
Neurological events after cardiac surgery or transcatheter aortic valve implantation (TAVI) have a dramatic effect on patients' prognosis. Recent development of transcatheter cerebral protection systems aims to reduce their incidence, even if their use is currently limited to TAVI. Here we report our initial experience with transcatheter cerebral protection devices used in patients at high brain embolic risk undergoing cardiac surgery.

Between December 2018 and March 2020, at the Cardiac Surgery Unit of Lancisi Cardiovascular Center in Ancona, Italy, 9 patients (mean age 77 years; median EuroSCORE II 2.2%) underwent cardiac surgery using a transcatheter cerebral protection system (Sentinel, Claret Medical, Santa Rosa, CA, USA). In all cases, a preoperative computed tomography scan highlighted the presence of severely calcified ascending aorta.

The brain protection system was successfully implanted in all patients. Total time for device implantation and removal was less than 10 min in all cases. Four patports the concept of hybrid surgery as a therapeutic approach capable of extending traditional surgical indications with improved patients' outcomes.The prevalence of valvular infective endocarditis (IE) is increasing and is burdened by high mortality and morbidity. Despite the higher risk, the surgical approach is superior to medical therapy alone, and over the years there has been a more aggressive attitude, with earlier indications for surgery. This article aims to review the available literature and the American and European guidelines in order to summarize the most appropriate surgical timing for valvular IE. Although there are discrepancies between the guidelines, an emergent indication (10 mm should be operated early (within a few days). If any micro-organisms are isolated, including fungi or multi-resistant organisms in native IE or staphylococci or gram-negative pathogens in prosthesis IE, a more watchful approach (within 2 weeks) should be evaluated. In the presence of large cerebral embolic strokes or cerebral hemorrhage, re-evaluation at 2 and 4 weeks, respectively, is more appropriate. A multidisciplinary approach, especially in the most complex cases, seems to improve the outcome.Key words. Heart valve dysfunction; Heart valve repair; Heart valve replacement; Heart valve surgery; Infective endocarditis; Timing of surgery.Infective endocarditis is an increasingly common disease in the hospital setting. Although the 2015 guidelines of the European Society of Cardiology deal extensively with many aspects of infective endocarditis, there are still unsolved problems related to diagnosis, in particular to the appropriate use of cardiac imaging methods, that require further study. The aim of this review is to analyze the advantages and limitations of the echocardiographic, radiological and nuclear imaging methods in order to identify diagnostic pathways applicable in clinical practice.Although the indications for surgical management of severe functional tricuspid regurgitation (TR) are now generally accepted, controversy persists concerning the role of intervention for moderate TR. However, there is a trend for intervention in this setting, particularly in patients with annular dilation. Echocardiographic imaging is the gold standard to identify functional TR and distinguish it from a primitive or degenerative form. Currently, surgery remains the best approach for the interventional treatment of TR. selleck chemicals llc Ring annuloplasty seems to provide better results than suture annuloplasty (De Vega technique) and rigid rings appear to be more reliable in the long term, in comparison with flexible bands. Tricuspid valve repair is more beneficial compared with replacement, except in highly selected cases of long-standing TR with multifactorial mechanism.
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