Carlo Forlanini Hospital

This study explored residents’ awareness, behaviors, and key factors affecting sustainable waste management in Mogadishu, Somalia. Guided by the Theory of Planned Behavior, it examined how awareness of waste management principles influences household waste handling practices and identified factors that facilitate or hinder this process. A descriptive quantitative research design was used, employing structured questionnaires administered to residents. Data were analyzed with descriptive statistics and non-parametric tests in SPSS version 27. The results showed moderate awareness of health and environmental risks associated with improper waste disposal, along with a limited understanding of environmentally safe disposal methods and waste categorization. Significant differences were found across education levels in awareness of safe disposal methods (χ² (4) = 17.295, p = 0.002) and knowledge of recyclable waste (χ² (4) = 16.877, p = 0.002). Additionally, familiarity with local waste management rules (ρ = 0.394, p < 0.01) and regular waste separation routines (ρ = 0.469, p < 0.01) showed strong positive correlations with actual waste management behaviors. Although many residents reported practicing proper waste disposal, consistent implementation remained difficult, revealing a persistent gap between knowledge and action. Access to reliable waste collection services, community support, and educational programs emerged as crucial enablers of sustainable waste management. Overall, the study emphasizes the need for combined educational, institutional, and infrastructural strategies to enhance sustainable waste management and advance Sustainable Development Goals 3, 11, and 12.

Therapeutic prone positioning is widely used to improve oxygenation in patients with acute respiratory distress syndrome but is associated with an increased risk of pressure injuries, particularly affecting facial and anterior body regions. This systematic review was conducted according to PRISMA 2020 and Joanna Briggs Institute guidelines and was prospectively registered in PROSPERO (CRD42023442604). PubMed, CINAHL, Web of Science, Scopus, and the Cochrane Library were searched from inception to June 2025, including grey literature. Primary studies involving adult, mechanically ventilated patients undergoing therapeutic prone positioning and evaluating pressure injury prevention strategies were included. Methodological quality was assessed using JBI critical appraisal tools. Owing to clinical and methodological heterogeneity, findings were synthesized using a Synthesis Without Meta-analysis (SWiM) approach. Eight studies with heterogeneous designs were included. Preventive interventions mainly comprised prophylactic dressings, repositioning and support devices, and comprehensive care bundles. Most strategies were associated with a reduction in pressure injury incidence, particularly in facial and anterior anatomical areas. Greater effectiveness was observed when interventions were implemented within structured protocols supported by staff training and multidisciplinary coordination. Preventive strategies appear effective in reducing pressure injuries associated with prone positioning in critically ill patients. The implementation of standardized, bundled prevention protocols may improve patient safety in intensive care settings.

Abstract Background Historically, isolated tricuspid valve surgery for significative tricuspid regurgitation has been associated with high in-hospital mortality rates. Consequently, the early success of transcatheter repair and replacement techniques has expanded access to relatively low-risk treatment options. However, it remains unclear whether transthoracic echocardiography (TTE) alone is sufficient for screening patients undergoing transcatheter or surgical interventions, or if transesophageal echocardiography (TEE) is always required. Aim The aim of this study is to compare the accuracy of 2D and 3D tricuspid valve assessments using TTE versus TEE in screening patients eligible for surgical or transcatheter interventions for tricuspid regurgitation (TR). Methods Consecutive patients diagnosed with symptomatic and significant TR were prospectively enrolled. Each patient underwent both 2D/3D TTE and 2D/3D TEE on the same day. Right ventricular (RV) size and function were assessed using 2D imaging from the apical RV-focused view (TTE) and the mid-esophageal four-chamber view (TEE) at end-diastole. 3D reconstructions were used to evaluate tricuspid annular dimensions (diameters, area, perimeter), leaflet morphology, valve orifice area, and coaptation parameters. The coaptation gap was measured from the transgastric view (TEE) and 3D reconstructions (TTE). The GLIDE score was calculated for both modalities. All echocardiographic exams were acquired and analyzed by a single expert operator in a blinded fashion. To assess intra- and inter-observer variability, 30 studies (15 TTE and 15 TEE) were randomly selected for double-blind re-analysis by the same operator. These were then independently re-evaluated by a second experienced operator. Results The study population consisted of 42 patients (25 males, 17 females) with a median age of 79 years. Among them, 52.3% had severe TR, 42.8% had massive TR, and 4.7% had torrential TR. No statistically significant differences were observed between TTE and TEE in the evaluation of TR severity, RV size and function, annular dimensions, coaptation gap, or GLIDE score (p > 0.05). However, leaflet number was more accurately assessed by TEE (p < 0.001). Intra- and inter-operator variability for the selected 2D/3D parameters showed excellent agreement. (Table 1 and 2) Conclusions TTE is a reliable tool for the initial screening of patients with significant TR who are candidates for surgical or transcatheter intervention. However, TEE provides superior visualization of leaflet morphology and should be performed in patients with favorable TTE findings. These results are particularly relevant for elderly and frail patients, who may be spared a transesophageal examination if TTE findings are already unfavorable.Table 1 Table 2

Abstract Introduction Anthracyclines and human epidermal growth factor receptor 2 (HER-2) inhibitors are cornerstone therapies for breast cancer but are associated with significant cardiotoxicity. While sodium–glucose cotransporter 2 (SGLT2) inhibitors such as dapagliflozin have demonstrated cardio–renal protective effects during anthracycline treatment, their efficacy in preventing cardiotoxicity from sequential anthracycline and HER-2 blockade remains poorly understood. This study investigates the cardioprotective role of dapagliflozin in a preclinical model of chemotherapy-induced cardiotoxicity. Methods Female C57Bl/6 mice were divided into four groups and treated for 10 days as follows: (1) a normal control group receiving saline (sham); (2) a model control group receiving doxorubicin (2.17 mg/kg/day for 5 days) followed by HER-2-blocking monoclonal antibody (2.25 mg/kg/day for 5 days); (3) a dapagliflozin-only group (10 mg/kg/day via oral gavage); and (4) a treatment group receiving the combination of doxorubicin, HER-2 inhibitor, and dapagliflozin. Cardiac function was assessed using echocardiography (VEVO 2100), analyzing IVS; d-D (mm), LVID; d-D (mm), LVPW; d-D (mm), LV Mass (mg), LVID; s-D (mm), EF (%) (Ejection Fraction), FS (%) (Fractional Shortening), Radial Strain (Pk%) and Longitudinal Strain (Pk%). Biomarkers of myocardial injury and inflammation (NLRP3, MyD88, CXCR4, H-FABP, troponin-T, and cytokines) were quantified via ELISA and immunohistochemistry. Circulating markers such as mitofusin-2, cardiac myosin light chain, malondialdehyde (MDA), and 4-hydroxy-2-nonenal (4-HNE) were also measured. Results Dapagliflozin significantly preserved the ejection fraction and reduced both radial and longitudinal strain impairment in mice treated with the doxorubicin–HER-2 inhibitor combination (p < 0.001). Levels of myocardial NLRP3, MyD88, CXCR4, H-FABP, interleukin-1β, and troponin-T were significantly lower in the dapagliflozin-treated group compared to the chemotherapy-only group. Serum markers of oxidative stress and cardiac injury, including mitofusin-2, MDA, 4-HNE, BNP, and high-sensitivity C-reactive protein (hs-CRP), were also reduced by dapagliflozin treatment. Conclusion Our findings demonstrate that dapagliflozin effectively mitigates early cardiac dysfunction and injury in a preclinical model of sequential doxorubicin and HER-2 inhibitor therapy.

Background: Studies on the organization and structure of dreams before and after acute myocardial infarction (AMI) are lacking. Methods: We retrospectively studied dream patterns before and after AMI in the STEP-IN-AMI trial (Short-TErm Psychotherapy IN Acute Myocardial Infarction). We also performed an analysis to describe how this pattern may change during ontopsychological short-term psychotherapy (STP) performed after AMI. Forty-seven patients (pts) aged 31-70 were studied. Results: At baseline, 21/47 (45%) pts remembered dreams, which increased to 43/47 (91%) with psychotherapy (p < 0.0001). Recurring dreams, described as a state of anguish, despair, perceived inability to complete an action, or grief over one's mother's early death, occurred before AMI in 16/47 pts (24%). After the third psychotherapy session, no pts reported recurring dreams (p < 0.001). In dreams that occurred during the year before AMI, 12 of 25 symbols referred to people known to pts and who had died of a cardiac disease; 9 of 25 symbols referred to an accident, danger, or distressing events. Overall, 21 of 25 symbols were associated with danger to an individual's life (84%). The incidence of "negative" symbols was sharply reduced during psychotherapy, from 84% to 32% during the first three psychotherapy sessions and to 9% in the last phase of psychotherapy (p < 0.0001). Conclusions: Our study is the very first on dreams in pts with AMI, and it also examines how STP may change dream patterns in this cohort of pts. AMI pts frequently do not remember dreams that occurred before AMI or report distressing dreams. STP after AMI significantly increased their ability to remember dreams and sharply reduced the incidence of negative/distressing dreams. The results suggest that (1) dream symbols may be connected to the biological status of the dreamer, warning the dreamer of their cardiac condition; (2) ontopsychological STP may act as a stimulus for inner personal change for AMI pts.

Novel β-lactam/β-lactamase inhibitor combinations (BL/BLICs) such as ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), imipenem/relebactam (IMP/REL) and aztreonam/avibactam (ATM/AVI) have expanded therapeutic choices against KPC-producing K. pneumoniae. However, emerging resistance threatens their long-term efficacy. We investigated the prevalence, genomic mechanisms, and clinical correlates of resistance to these agents among KPC-producing K. pneumoniae bloodstream isolates. Consecutive KPC-producing K. pneumoniae bloodstream isolates collected between 2021 and 2024 at a tertiary university hospital were tested for susceptibility to novel BL/BLICs and comparators. Whole-genome sequencing (WGS) was performed on isolates resistant to any BL/BLIC to characterise genetic backgrounds. Clinical data from corresponding patients were analysed to explore risk factors and outcomes. Among 178K. pneumoniae isolates, ATM/AVI, IMP/REL and MEM/VAB retained excellent in vitro activity (≥ 96% susceptible), while 11% were resistant to CAZ/AVI. One hundred fifty-four (86.5%) were susceptible to all BL/BLICs, whereas 24 (13.5%) displayed resistance to at least one agent, most commonly CAZ/AVI. WGS revealed a genetically diverse population mainly comprising high-risk clones ST512 and ST101. Resistance was driven by KPC variants (KPC-31, KPC-167, KPC-93, KPC-49, KPC-14, KPC-121, KPC-33) and porin disruptions (OmpK36 insertions, OmpK35 loss). Most patients (91%) had prior colonisation and recent β-lactam exposure; median time to resistance emergence was 47days. The 28-day mortality among patients with BL/BLIC-resistant infections was 21.7%. Resistance to novel BL/BLICs among KPC-producing K. pneumoniae is emerging in Italian hospitals, largely mediated by blaKPC variants and porin defects under selective antibiotic pressure. While ATM/AVI, MEM/VAB and IMP/REL remain highly active, resistance to CAZ/AVI is increasingly frequent. Continuous genomic surveillance and optimised antimicrobial stewardship are essential to preserve the efficacy of these last-line agents.

Abstract Background osteoarthritis (OA) is a prevalent chronic joint disorder, primarily affecting older adults, with higher frequency in females. It involves progressive cartilage degeneration, leading to pain and disability. The global prevalence of OA continues to rise, especially in aging populations, with the knee being the most affected site. OA is a multifactorial disease associated with obesity, mechanical stress, and systemic inflammation. No disease-modifying OA drugs are currently approved, and treatment is mostly symptomatic. This study aimed to provide updated epidemiological data and insight into clinical characteristics and treatment patterns of OA in Italy, through the implementation of a national rheumatology registry. Methods the ESORT registry, coordinated by the Italian Society of Rheumatology (SIR), included eight rheumatologic centers across Italy. Patients with clinical and radiographic OA at different joint sites were enrolled between 2016 and 2022. Data collected included demographics, BMI, affected joints, baseline VAS pain scores, and current or initiated treatments. Descriptive statistical analyses were performed on the pooled dataset. Results a total of 322 patients were included. The cohort had a female-to-male ratio of 2:1, with a mean age of 73.3 ± 14.7 years and mean BMI of 26.2 ± 4.5 kg/m². The most affected site was the knee (62%), followed by hip (40%), spine (38.2%), and hand (35%). Mean baseline VAS was 49.3 ± 22.2. Regarding treatment, 39.1% used non-selective NSAIDs, 28.8% paracetamol, 45% received hyaluronic acid injections, and 15.2% corticosteroid injections. Conclusions the ESORT registry offers critical insights into OA epidemiology in Italy, underscoring the need for further phenotype-driven research, and integrated care.

ABSTRACTBackgroundBowel urgency (BU) is reported by over 80% of patients with ulcerative colitis (UC) and 60% of those with Crohn's disease (CD). However, the impact of advanced therapies on BU has not been consistently evaluated.ObjectivesTo assess the effect of advanced therapies on BU improvement in patients with UC and CD.MethodsThis retrospective cohort study included all consecutive patients with confirmed UC or CD who started an advanced therapy with available data regarding BU before and after induction therapy between 2023 and 2024 at two tertiary centers. BU was assessed using the numeric‐rating‐scale urgency score (NRS‐us), with BU defined as NRS‐us ≥ 3. The primary endpoint was BU improvement (NRS‐us ≤ 3 or reduction of at least two points) after the induction phase. Multivariate logistic regression analysis identified factors associated with BU improvement.ResultsA total of 159 patients were included (56% male; 65% UC; median age: 36 years (Interquartile range [IQR] 27–25)). TNFα inhibitors were the most frequently used agents (49.6%). At baseline, the median NRS‐us was 7. After induction, 50.9% of patients achieved BU improvement, with a mean reduction of 2.3 ± 2.9 points. BU improvement was significantly associated with clinical remission (false‐discovery‐rate [FDR] = 0.009 in CD and FDR = 0.010 in UC), normalization of fecal calprotectin (FDR = 0.001), CRP (FDR = 0.008), and bowel wall thickness on intestinal ultrasound (FDR = 0.001). No significant differences were observed between therapeutic classes.ConclusionBU improved in approximately half of IBD patients following induction with advanced therapies. Its improvement correlated with clinical, biochemical, and ultrasound remission, supporting the incorporation of BU assessment into routine clinical monitoring.

Background: Many literature studies have reported the beneficial effects of probiotics on human health, but few articles have evaluated their “real effects” on the modulation of microbiota after their use. Lactobacillus reuteri (L. reuteri) is one of the most studied probiotics with the best effects on gut microbiota. Aims: The primary aim of our study was the evaluation of the intestinal colonization by L. reuteri-LMG P 27481 and its effects on the modification of the gut bacterial flora. The secondary aim was the evaluation of side effects through the validated Gastrointestinal Symptom Rating Scale (GSRS). Patients and Methods: This is an interventional, open-label study conducted on 20 healthy adults (10 men and 10 women M/F; mean age 34 ±15 years) who received a probiotic Reuterin® LMG (L. reuteri LMG P 27481) for 28 consecutive days in drops at a concentration of 1 × 109 (five drops per day). Microbiota analysis was performed at enrollment (T0), at the end of probiotic supplementation (T1) and after a 14-day follow-up period (T2). Results: In our study we observed interesting quantitative and functional variations as regards the Firmicutes/Bacterioidetes ratio, intestinal permeability, and the production of short-chain fatty acids (SCFA). This probiotic was safe and was able to improve patients’ symptoms. Conclusions: The intake of L. reuteri LMG-P 27481 in healthy subjects showed transitory variations in some functional and metabolic gut functions, especially an improvement in the barrier effect and intestinal permeability, y and an increase in SCFA. Future studies should include target populations to have a greater range for modulation of the gut microbiota.

Since the beginning of the percutaneous coronary intervention (PCI) era, periprocedural myocardial infarction (PMI) has been recognized as a potential source of impaired outcomes in patients undergoing revascularization. Subsequently, several different definitions of PMI have been provided, coming from trial research groups or international consensus. Despite these efforts, the debate over the prognostic value or PMI in terms of mortality risk, as well as its role in defining composite ischemic endpoints in clinical investigations, has been extremely active. Currently, three international definitions of PMI are available: the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the definition by the Society for Cardiovascular Angiography and Interventions (SCAI). These definitions differ significantly in terms of sensitivity and prognostic relevance, which has led to heterogeneous findings in clinical studies investigating this topic. Thus, this review aims to provide an overview of the main features of these definitions, their association with the risk of mortality, and how different definitions can influence the results of major investigations in the research setting.