61 research outputs found
MP3. Sulle ruote me la rido
No full textAutobiografia di Matteo Premi, protagonista e co-autore del romanzo, scritto sotto forma di racconto in prima persona e a target giovanile. La narrazione si concentra sulla vita fuori dagli schemi di Matteo, un ragazzo di vent'anni con la tetraparesi spastica, che nonostante gli handicap fisici riesce ad affrontare le sfide quotidiane con allegria e ottimismo, grazie al sostegno della sua famiglia e delle sue passioni: lo studio, la musica e l'hockey su sedia a rotelle.Autobiography by Matteo Premi, main character and co-author of the novel, written as a first-person narrative for juvenile readers. The narration focuses on the unconventional life of Matteo, a twenty-year-old boy with spastic tetraparesis, who, even with all his own physical problems, manages to face his daily challenges with joy and optimism, thanks to his family and passions: studying, music and wheelchair hockey
"Conan - Il ragazzo del futuro". Gli esordi televisivi di Miyazaki Hayao tra autorialità e animazione mainstream
No full textExamining the audiovisual output of the Japanese Oscar-winning director Miyazaki Hayao, the animated series Future Boy Conan (1978) can be regarded as the first broad-based work of his career. Commissioned by TV station NHK to Nippon Animation Studios, this successful series is a free adaptation from a US novel for kids and features the conventional devices of the anime boom’s most exploited genre: science-fiction. Nevertheless, in Conan are also recognizable many of Miyazaki’s future topoi, such as the criticism on the excessive power of technology, the hope for a harmonious relationship between men and nature, the confidence in the skills of the young protagonists. After having positionated the series within the general framework of Japanese animation, the paper analyzes Conan on the whole, reasoning on the devices employed by the author – at the dramatic level and at the visual one – in the working out of structure, themes, setting and characters. The analysis enlightens the seminal value of Conan in Miyazaki’s work, as it let the author fully express a strikingly original style, combining the will to face his personal issues with the attention towards commercial needs. From this perspective, the case of Conan also assumes a paradigmatic importance in defying the position which the director holds in the Japanese animation scene. Anticipating Studio Ghibli’s biggest hits, Miyazaki succeeds in building a multilevel work, suitable for children – the audience determined by the producers – but virtually enjoyable at any age: a mainstream product which unites quality animation with deep stories, commercial attractiveness, convincing characters and imaginative sceneries
Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
Get PDFDespite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSCT). Data on incidence and type of b-IFI are limited, although they are mainly caused by non-fumigatus Aspergillus and non-Aspergillus molds and seem to depend on specific antifungal prophylaxis and patients’ characteristics. Herein, we described the clinical presentation and management of two cases of rare b-IFI which recently occurred at our institution in patients undergoing HSCT and receiving MAP. The management of b-IFI is challenging due to the lack of data from prospective trials and high mortality rates. A thorough analysis of risk factors, ongoing antifungal prophylaxis, predisposing conditions and local epidemiology should drive the choice of antifungal treatments. Early broad-spectrum preemptive therapy with a lipid formulation of amphotericin-B, in combination with a different mold-active azole plus/minus terbinafine, is advisable. The therapy would cover against rare azole-susceptible and -resistant fungal strains, as well as atypical sites of infections. An aggressive diagnostic work-up is recommended for species identification and subsequent targeted therapy
Antibiotic appropriateness for Gram-negative bloodstream infections: impact of infectious disease consultation
No full textBackground: We investigated the role of infectious disease consultation (IDC) on therapeutic appropriateness in Gram-negative bloodstream infections (GNBSIs) in a setting with a high proportion of antibiotic resistance. Secondary outcomes were in-hospital mortality and the impact of rapid diagnostic tests (RDTs). Methods: Retrospective study on hospitalised patients with GNBSIs. Therapy was deemed appropriate if it had the narrowest spectrum considering infection and patients’ characteristics. Interventional-IDC (I-IDC) group included patients with IDC-advised first appropriate or last non-appropriate therapy. Time to first appropriate therapy and survival were evaluated by Kaplan-Meier curves. Factors associated with therapy appropriateness were assessed by multivariate Cox proportional-hazard models. Results: 471 patients were included. High antibiotic resistance rates were detected: quinolones 45.5%, third-generation cephalosporins 37.4%, carbapenems 7.9%. I-IDC was performed in 31.6% of patients (149/471), RDTs in 70.7% (333/471). The 7-day probability of appropriate treatment was 91.9% (95% confidence interval [95%CI]: 86.4–95.8%) vs. 75.8% (95%CI: 70.9–80.4%) with and without I-IDC, respectively (p-value = 0.0495); 85.5% (95%CI: 81.3–89.1%) vs. 69.4% (95%CI: 61.3–77.2%) with and without RDTs, respectively (p-value = 0.0023). Compared to RDTs alone, the combination with I-IDC was associated with a higher proportion of appropriate therapies at day 7: 81.9% (95%CI: 76.4–86.7%) vs. 92.6% (95%CI: 86.3–96.7%). At multivariate analysis, I-IDC and RDTs were associated with time to first appropriate therapy [adjusted hazard-ratio 1.292 (95%CI: 1.014–1.647) and 1.383 (95%CI: 1.080–1.771), respectively], with no impact on mortality. Conclusions: In a setting with a high proportion of antibiotic resistance, IDC and RDTs were associated with earlier prescription of appropriate therapy in GNBSIs, without impact on mortality
The place of ceftazidime/avibactam and ceftolozane/tazobactam for therapy of haematological patients with febrile neutropenia
No full textObjectives: To evaluate ceftazidime/avibactam (C/A) and ceftolozane/tazobactam (C/T) use in haematological patients with febrile neutropenia receiving high-dose chemotherapy and haematopoietic stem cell transplantation (HSCT). Methods: A retrospective study was conducted to assess C/A and C/T efficacy through infection-related mortality (IRM) and bacteraemia clearance for carbapenem-resistant Gram-negative bacteria (CR-GNB) pre-engraftment blood-stream infections (PE-BSIs) between January–December 2018. Results: Seventy patients underwent allogeneic HSCT: C/A and C/T were dispensed in 13% and 3%, respectively. C/A was administered as definite therapy for carbapenem-resistant Klebsiella pneumoniae (CR-Kp) PE-BSI in four carriers (bacteraemia clearance in 5 days), empirical therapy for a clinically documented infection in two patients (one carrier with pneumonia and one non-carrier with shock) and empirical therapy for fever of unknown origin in three CR-Kp carriers. C/T was administered as definite therapy for carbapenem-resistant Pseudomonas aeruginosa (CR-Pa) intra-abdominal infection in one carrier and empirical therapy for a clinically documented infection (pneumonia) in one non-carrier. Among patients without PE-BSIs and with Gram-positive bacteria PE-BSIs, IRM was 0% at +30 days; conversely, it was 30% in GNB PE-BSIs (two CR-Kp and one CR-Pa C/T-resistant). Thirty-nine patients underwent autologous HSCT: C/A and C/T were administered, respectively, as definite therapy for CR-Kp PE-BSI in one carrier (bacteraemia clearance in 3 days) and for Pa PE-BSI (three strains, one CR-Pa) in one non-carrier (bacteraemia clearance in 2 days). Overall, IRM at +30 days was 0%. Conclusions: Monitoring multidrug-resistant GNB colonisation enabled selection of carriers who benefit from prompt administration of new antibiotics, improving HSCT outcomes in a high-risk population. C/A and C/T were effective in bacteraemia clearance; unfortunately, multidrug-resistant GNB PE-BSIs were still a burden to IRM
Impact of surgical timing on survival in patients with infective endocarditis: a time-dependent analysis
No full textThe purpose of this study was to evaluate the impact of surgical timing on survival in patients with left-sided infective endocarditis (IE). This was a retrospective study including 313 patients with left-sided IE between 2009 and 2017. Surgery was defined as urgent (US) or early (ES) if performed within 7 or 28 days, respectively. A multivariable Cox regression analysis including US and ES as time-dependent variables was performed to assess the impact on 1-year mortality. ES was associated with a better survival (aHR 0.349, 95% CI 0.135–0.902), as US (aHR 0.262, 95% CI 0.075–0.915). ES and US were associated with a better prognosis in patients with left-sided IE
Impact of Levofloxacin for Prophylaxis of Pre-engraftment Bloodstream Infections after Allogeneic HSCT: A single-center Matched Analysis in an Endemic Country for Carbapenem-resistant Gram-negative Bacteria
No full textCoronavirus Disease 2019 in Recipient of Allogeneic Hematopoietic Stem Cell Transplantation : Life-threating Features Within the Early Post-engraftment Phase
Get PDFHigh-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies
Get PDFInvasive fungal diseases (IFDs) still represent a relevant cause of mortality in patients affected by hematological malignancies, especially acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) undergoing remission induction chemotherapy, and in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Mold-active antifungal prophylaxis (MAP) has been established as a standard of care. However, breakthrough IFDs (b-IFDs) have emerged as a significant issue, particularly invasive aspergillosis and non-Aspergillus invasive mold diseases. Here, we perform a narrative review, discussing the major advances of the last decade on prophylaxis, the diagnosis of and the treatment of IFDs in patients with high-risk neutropenic fever undergoing remission induction chemotherapy for AML/MDS and allo-HSCT. Then, we present our single-center retrospective experience on b-IFDs in 184 AML/MDS patients undergoing high-dose chemotherapy while receiving posaconazole (n = 153 induction treatments, n = 126 consolidation treatments, n = 60 salvage treatments). Six cases of probable/proven b-IFDs were recorded in six patients, with an overall incidence rate of 1.7% (6/339), which is in line with the literature focused on MAP with azoles. The incidence rates (IRs) of b-IFDs (95% confidence interval (95% CI), per 100 person years follow-up (PYFU)) were 5.04 (0.47, 14.45) in induction (n = 2), 3.25 (0.0013, 12.76) in consolidation (n = 1) and 18.38 (3.46, 45.06) in salvage chemotherapy (n = 3). Finally, we highlight the current challenges in the field of b-IFDs; these include the improvement of diagnoses, the expanding treatment landscape of AML with molecular targeted drugs (and related drug–drug interactions with azoles), evolving transplantation techniques (and their related impacts on IFDs’ risk stratification), and new antifungals and their features (rezafungin and olorofim)
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