The role of 3D printing during COVID-19 pandemic: a review

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has spread through more than 180 countries, leading to diverse health systems overload around the world. Because of the high number of patients and the supply chain disruption, it generated a shortage of medical devices and personal protective equipment. In this context, initiatives from the additive manufacturing community emerged to fight the lack of devices. Diverse designs were produced and are currently being used in hospitals by patients and health workers. However, as some devices must follow strict standards, these products may not fulfill these standards. Therefore, to ensure the user's health, there is a need for understanding each device, their usage, and standards. This study reviews the use of additive manufacturing during COVID-19 pandemic. It gathers the source of several 3D printed devices such as face shields, face masks, valves, nasopharyngeal swabs, and others, discussing their use and regulatory issues. In this regard, the major drawbacks of the technology, addressed for the next pandemic scenario, are highlighted. Finally, some insights of the future of additive manufacturing during emergency are given and discussed.

3D-printed valves to assist noninvasive ventilation procedures during the COVID-19 pandemic: a case study

Aim: To produce valves to be used with full-face snorkeling masks for noninvasive ventilation (NIV) procedure during the coronavirus disease 2019 (COVID-19) pandemic. Materials & methods: ISINNOVA’s Charlotte valves for full-face snorkeling masks used for NIV procedures were redesigned, produced by selective laser sintering additive manufacturing, and submitted to air leakage tests. Results: The final model assembly did not present air leakage during the NIV procedure on human models, minimizing risks of air contamination. Conclusion: This study shows the feasibility of using additive manufactured valves with snorkel facial masks to support health systems during COVID-19 and possible future pandemics.

Increased incidence of esophageal atresia in northwest Tuscany: years 1994-2007

AIM

Esophageal atresia (EA) and imperforate anus are congenital disorders with an incidence that ranges between 1/4000 and 1/5000 births. The aim of this work was to assess the incidence of these malformations in northwest Tuscany and the associated anomalies in comparison with the data published by the Tuscan Congenital Diseases Registry.

METHODS

A retrospective study was made analyzing the cases of these malformations in the years 1994-2007 on a total of 25051 births at the Division of Neonatology of S. Chiara Hospital, Pisa.

RESULTS

The authors found 14 cases of EA and 5 cases of imperforate anus. In these case histories of EA and imperforate anus the incidence was 1/1800 and 1/5000 respectively in comparison with the data issued by the Tuscan Congenital Diseases Registry with an incidence of 1/6644 and 1/1403 in all Tuscany. Five cases of EA (35%) and 2 cases of imperforate anus (40%) were associated with other congenital malformations.

CONCLUSION

Our retrospective study shows a higher incidence of EA in northwest Tuscany than in all the rest of Tuscany unlike the incidence of imperforate anus that it is the same of the rest of Tuscany. In both cases isolated form is most frequent than syndromic one.

Postural Health in Women: The Role of Physiotherapy

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Normothermic perfusion and lung function after cardiopulmonary bypass: effects in pulmonary risk patients

Fifty patients at risk for postoperative lung dysfunction and undergoing elective coronary revascularization have been randomly assigned to receive normothermic (36 degrees C) perfusion with warm heart protection (NP group) or hypothermic (28 degrees C) perfusion with cold heart protection (HP group). Lung function before and after cardiopulmonary bypass (CPB) was studied through the determination of the intrapulmonary shunt (Qs/Qt), the alveoloarterial oxygen gradient (A-a delta O2), and the artero-alveolar carbon dioxide gradient (a-A delta CO2). The Qs/Qt after CPB was significantly lower in the NP group (27.1 +/- 2.6 vs 35.7 +/- 2.3) as well as the A-a delta O2 (50.2 +/- 1.5 vs 57.6 +/- 2.4), both data returned to comparable between the groups after 3 h in the intensive care unit. The a-A delta CO2 was significantly lower after CPB in the NP group (5.2 +/- 0.74 vs 8.2 +/- 0.8). Hospital stay and mortality were comparable in the two groups; intubation time and rate of early extubation showed a trend in favour of the NP group; the rate of patients suffering hypoxia and/or hypercapnia after extubation was significantly lower in the NP group (12%) versus the HP group (44%). Normothermia seems to exert a protective effect against lung dysfunction after CPB. The absence of a rewarming injury associated with reperfusion, a limitation of the hypothermic-induced vasoconstriction due to local cooling of the lung and a better compliance of the normothermic lung are hypothesized as beneficial effects of the 'all-warm' strategy.

Circulating diphtheria antitoxin levels in children aged 11-14 years in relation to the vaccinal history

Diphtheria antitoxin level in serum samples obtained from 204 healthy children aged 11-14 years was determined by means of an indirect haemagglutination technique and related to the vaccinal history of the subjects. Irrespective of the time since the last toxoid inoculation, the mean antitoxin titre per ml of serum in the individuals who had received incomplete/irregular anti-diphtheria vaccination in childhood was significantly higher when the number of toxoid doses was higher (from two to more than four doses); the same was not observed for individuals given primary vaccination (three toxoid doses) according to the schedule for childhood vaccination in Italy (regular vaccinees) and one or more booster doses. Between 8 and 13 years after the last of three toxoid doses, a significantly negative association between mean antitoxin titre and time was observed only in irregularly vaccinated children (r = -0.82; p less than 0.05); nevertheless, up to thirteen years after the last vaccine dose, more than 95% of the children exhibited protective levels of antitoxin (greater than 0.125 turkey red blood cells passive haemagglutination units per ml). No significant decrease in mean antitoxin titre was observed between 4 and 10 years after the last of four either regularly or irregularly administered toxoid doses.