Home Working and Physical Activity during SARS-CoV-2 Pandemic: A Longitudinal Cohort Study

BACKGROUND

Due to the SARS-CoV-2 pandemic, human lifestyles and occupational settings have changed in the workplace. This survey explores associations of home working employment and related physical activity (PA-MET min/week).

METHODS

A longitudinal cohort study was conducted between March 2020 and March 2021. A standardized method for assessing PA and sedentary time, the Italian version of the International Physical Activity Questionnaire-Short Form (IPAQ-SF), was used through the Microsoft Forms® platform for self-administering the questionnaire. Baseline data were collected, and four follow-ups were performed; a full calendar year was observed.

RESULTS

In total, 310 home workers were recruited in this investigation. The average body mass index (BMI- kg/m2) was 21.4 ± 4.2 at baseline. The value increased at the first follow-up and fluctuated in the other recalls. The t-test of MET values of the four activities (Total PA, Vigorous-intensity activity, Moderate-intensity activity, Walking) show similar results; the total PA, at baseline 275.7 ± 138.6, decreased statistically significantly at the first (198.5 ± 84.6), third (174.9 ± 98.4), and fourth (188.7 ± 78.5) follow-ups, while it increased statistically significantly at the second follow-up (307.1 ± 106.1) compared to the baseline. Sedentary time was constant until the second follow-up, while it increased statistically significantly at the 3rd and 4th follow-up.

CONCLUSION

workers involved reduced and reorganized their PA during this pandemic year. Each business company should intervene to improve the PA levels of workers and reduce sedentary behavior in the workplace.

Post-haemorrhagic hydrocephalus management: Delayed neonatal transport negatively affects outcome

BACKGROUND

Post-haemorrhagic ventricular dilatation (PHVD) still represents an important cause of brain injury in premature infants. Intervention for PHVD is recommended once Ventricular Index (VI) crosses the 97th percentile + 4 mm line according to Levene.

OBJECTIVES

We aimed to compare PHVD severity, timing of intervention, and outcome between outborn infants transferred to a level IV NICU in order to be treated for PHVD and a control population of inborn infants.

METHODS

Preterm infants with PHVD requiring treatment were divided into: outborn infants (transferred to our NICU in order to be treated for PHVD) and inborn infants (PHVD diagnosed at our NICU). Age at intervention, difference between VI and the 97th percentile according to postmenstrual age (VI-p97), permanent shunt rate, and developmental delay rate were compared between the two groups. Neurodevelopmental outcome was assessed using the Vineland Adaptive Behavior Scales II (VABS-II), a parental questionnaire investigating four domains of adaptive behaviour and overall adaptive functioning. Developmental delay was defined as a score <70 (-2 SD or less).

RESULTS

Twelve outborn and 15 inborn infants were included. Age at intervention (31.6 vs 17.4 days) and VI-p97 (left 10.0 vs 5.1 mm, right 7.7 vs 5.1 mm) were significantly higher among outborn infants. A permanent shunt was inserted in 66.7% of outborn and in 40.0% of inborn infants (p = 0.18). After excluding subjects with parenchymal lesions, a significantly higher rate of developmental delay was observed at 5 years in outborn patients compared to inborn patients (66.7% of outborn vs 18.2% of inborn patients with VABS-II composite score <70, p = 0.04).

CONCLUSIONS

Outborn infants reached a significantly more severe ventricular dilatation than inborn infants, largely exceeding the recommended cutoff for intervention. Our follow-up data showed a trend towards a higher rate of permanent shunt and developmental delay in outborn than in inborn patients. Infants requiring treatment should be timely transported to centres with adequate expertise in PHVD management.

Randomised study comparing heart rate measurement in newly born infants using a monitor incorporating electrocardiogram and pulse oximeter versus pulse oximeter alone

AIM

To determine whether IntelliVue (ECG plus Masimo pulse oximeter (PO)) measures heart rate (HR) in low-risk newborns more quickly than Nellcor PO (PO alone).

METHODS

Unmasked parallel group randomised (1:1) study.

RESULTS

We studied 100 infants, 47 randomised to IntelliVue, 53 to Nellcor. Time to first HR was shorter with IntelliVue ECG than Nellcor (median (IQR) 24 (19, 39) vs 48 (36, 69) s, p<0.001). There was no difference in time to display both HR and SpO₂ (52 (47, 76) vs 48 (36, 69) s, p=0.507). IntelliVue PO displayed initial bradycardia more often than the Nellcor (55% vs 6%). Infants monitored with IntelliVue were handled more frequently and for longer.

CONCLUSIONS

IntelliVue ECG displayed HR more quickly than Nellcor PO. IntelliVue PO often displayed initial bradycardia. Infants monitored with IntelliVue were handled more often. Study of ECG in high-risk infants is warranted.

Abatement of 2,4-D by H2O2 solar photolysis and solar photo-Fenton-like process with minute Fe(III) concentrations

The Photo-Fenton-like (PF-like) process with minute Fe(III) concentrations and the Hydrogen Peroxide Photolysis (HPP), using Xe-lamp or solar light as sources of irradiation, were efficiently applied to eliminate the herbicide 2,4-D from water. PF-like experiments concerning ferric and H₂O₂ concentrations of 0.6 mg L^-1 and 20 mg L^-1 respectively, using Xenon lamps (Xe-lamps) as a source of irradiation and 2,4-D concentrations of 10 mg L^-1 at pH 3.6, exhibited complete 2,4-D degradation and 77% dissolved organic carbon (DOC) removal after 30 min and 6 h of irradiation respectively whereas HPP (in absence of ferric ions) experiments showed a 2,4-D reduction and DOC removal of 90% and 7% respectively after 6 h of irradiation. At pH 7.0, HPP process achieved a 2,4-D abatement of approximately 75% and a DOC removal of 4% after 6 h. PF-like exhibited slightly improved 2,4-D and DOC removals (80% and 12% respectively) after the same irradiation time probably due to the low pH reduction (from 7.0 to 5.6). Several chlorinated-aromatic intermediates were identified by HPLC-MS. These by-products were efficiently removed by PF at pH 3.6, whereas at neutral PF-like and acid or neutral HPP, they were not efficiently degraded. With natural solar light irradiation, 10 and 1 mg L^-1 of 2,4-D were abated using minor H₂O₂ concentrations (3, 6, 10 and 20 mg L^-1) and iron at 0.6 mg L^-1 in Milli-Q water. Similar results to Xe-lamp experiments were obtained, where solar UV-B + A light H₂O₂ photolysis (HPSP) and solar photo-Fenton-like (SPF-like) played an important role and even at low H₂O₂ and ferric concentrations of 3 and 0.6 mg L^-1 respectively, 2,4-D was efficiently removed at pH 3.6. Simulated surface water at pH 3.6 containing 1 mg L^-1 2,4-D, 20 mg L^-1 H₂O₂ and 0.6 mg L^-1 Fe(III) under natural sunlight irradiation efficiently removed the herbicide and its main metabolite 2,4-DCP after 30 min of treatment while at neutral pH, 40% of herbicide degradation was achieved. In the case of very low iron concentrations (0.05 mg L^-1) at acid pH, 150 min of solar treatment was required to remove 2,4-D.

Comparison of infant heart rate assessment by auscultation, ECG and oximetry in the delivery room

Clinical assessment of an infant's heart rate (HR) in the delivery room (DR) has been reported to be inaccurate. We compared auscultation of the HR using a stethoscope with electrocardiography (ECG) and pulse oximetry (PO) for determining the HR in 92 low-risk newborn infants in the DR. Caregivers auscultated the HR while masked to the HR on the monitor. Auscultation underestimated ECG HR (mean difference (95% CI) by -9 (-15 to -2) beats per minute (bpm)) and PO HR (mean difference (95% CI) by -5 (-12 to 2) bpm). The median (IQR) time to HR by auscultation was 14 (10-18) s. As HR was determined quickly and with reasonable accuracy by auscultation in low-risk newborns, study in high-risk infants is warranted.

Oxidative Stress as a Primary Risk Factor for Brain Damage in Preterm Newborns

The risk of oxidative stress is high in preterm newborns. Room air exposure of an organism primed to develop in a hypoxic environment, lacking antioxidant defenses, and subjected to hyperoxia, hypoxia, and ischemia challenges the newborn with oxidative stress production. Free radicals can be generated by a multitude of other mechanisms, such as glutamate excitotoxicity, excess free iron, inflammation, and immune reactions. Free radical-induced damage caused by oxidative stress appears to be the major candidate for the pathogenesis of most of the complications of prematurity, brain being especially at risk, with short to long-term consequences. We review the role of free radical oxidative damage to the newborn brain and propose a mechanism of oxidative injury, taking into consideration the particular maturation-dependent vulnerability of the oligodendrocyte precursors. Prompted by our observation of an increase in plasma Adenosine concentrations significantly associated with brain white matter lesions in some premature infants, we discuss a possible bioenergetics hypothesis, correlated to the oxidative challenge of the premature infant. We aim at explaining both the oxidative stress generation and the mechanism promoting the myelination disturbances. Being white matter abnormalities among the most common lesions of prematurity, the use of Adenosine as a biomarker of brain damage appears promising in order to design neuroprotective strategies.

Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: an 18-month observational study

AIMS

This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections.

METHODS

We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months.

RESULTS

At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14 ± 0.41% at 6 months vs. 7.35 ± 0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95 ± 0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018).

CONCLUSIONS

CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.

Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era

Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.

A new variant of Tako-tsubo cardiomyopathy: transient mid-ventricular ballooning

Stress cardiomyopathy is a reversible left ventricular dysfunction precipitated by emotional stress. Affected patients are generally women, whose symptoms are similar to myocardial infarction with reversible apical dyskinesis associated with hypercontractile basal segments and no evidence for hemodynamically significant coronary arterial stenoses by angiography. We report the case of an 82-year-old woman who presented with acute onset of chest pain after emotional stress and with reversible left ventricular dysfunction consisting of akinesis of the midventricular segments and hyperkinesis of the basal and apical segments.