187,218 research outputs found
The healthcare and pharmaceutical vulnerability emerging from the new Coronavirus outbreak
No full textWith a constantly increasing number of
infected people world-wide,
1 the
COVID-19 (2019-nCoV)
outbreak risks
becoming a pandemic emergency, and for
this reason, on 28 February 2020 the
WHO upgraded the global risk of the
coronavirus outbreak to ‘very high’.2 As
many studies have shown, in the first
phase of the onset of 2019-nCoV
there is
an exponential curve of infection with a
reproduction number (R0) ranging from 2
to 5,3 an indication that the spread of the
virus cannot spontaneously decrease. A
significant reduction in these R0 values can
possibly be achieved by implementing
specific containment actions, according to
the results of a study of the evolution of
the infections detected in China .4 The
spread of the virus is favoured by its ability
to be transmitted by asymptomatic
patients,5 a particularly grave consideration,
given that the currently estimated
incubation period extends from 2 to 12
days.6 Furthermore, the easiest screening
methods based on the execution of a nasopharyngeal
swab displayed false negative
results in both asymptomatic and symptomatic
patients,7 making it more complex
to intercept possible infected subjects,
especially before a clinical manifestation
of the infection.
Since its onset in Europe, the 2019-nCoV
emergency has been addressed
by implementing social containment
measures. This is particularly true in Italy,
the first European country struck by an
important 2019-nCoV
outbreak. On 4
March 2020 the national government
approved a series of important social
limitation measures including the closure
of schools and universities, and the quarantine
of exposed persons; it also urges
residents to avoid crowded events, and
has set in motion contact tracing efforts.
Considering that containment of the
spread of the virus seems very unlikely, the
restriction measures adopted by Italy seem
more focused on dilution of the epidemic
peak over a wider timeframe. As reported
in a scientific paper,8 the first outcomes
of these measures would be to buy time
for preparations in the healthcare system,
to avoid overwhelming the healthcare
system, and to enable better management
of 2019-nCoV
infected patients.
This seems essential for the Italian
health system, as, since 2009, more than
€37 billion have been cut in healthcare
costs and hospital beds have been reduced
to 3.2 per 1000 inhabitants, compared
with a European average of 5 per 1000
inhabitants.9 The number of hospital beds,
in particular, seems to be a crucial issue
in management of the 2019-nCoV
emergency,
which is characterised by the need
for hospitalisation in intensive care units
for >15% of infected patients.10 For this
reason, the Italian government has set up
a 50% increase in the number of beds in
these critical hospital areas and a patient
distribution agreement between healthcare
institutions aimed at avoiding the
collapse of some hospitals affected by a
greater influx of infected patients.11
Delaying the peak of the epidemic could
also be useful for a subsequent introduction
of some pharmacological interventions.
At present, there is no defined
therapeutic protocol to be used on patients
with 2019-nCoV,
and the drugs that
have shown significant efficacy in some
studies,12 13 such as remdesivir, lopinavir/
ritonavir, and hydroxychloroquine, are
currently undergoing phase 3 clinical trials
( ClinicalTrials. gov register). Another aid
that could take place later is the possible
availability of an effective vaccine capable
of blocking the virus spread. Currently
>15 vaccines are in the pipeline12 but
none are foreseen to be available before
the third quarter of 2020.14
Another important aspect of the global
emergency is certainly linked to its social
impact. Our life dynamics are deeply
influenced by the containment measures,
and for the first time in the 21st century
we are facing a health emergency on a
global scale. However, while solutions
such as remote smart working, video calls
and e-commerce
allow us to carry on with
our lifestyle to some degree, other aspects
of our society such as our global and
connected economy and crucial import
supply chains could be deeply affected.
The supply of medicines is a crucial
issue when facing a global health emergency.
We have become used to hearing
news about shortages of hand sanitiser and
facemasks dictated by so-called
‘panic-buying’,
but a much more serious threat
is the potential shortage of drugs. Locally,
shortages can be linked to increased
demand and difficulties in transport in
the areas most affected by the emergency.
Globally, there could be a remarkable
reduction in the production capability of
pharmaceutical manufacturing facilities
where active pharmaceutical ingredients
(API) are produced, as work is interrupted
to update sanitisation procedures for the
infrastructure and production rooms, or
as scientists, managers and line workers
fall ill with the virus. Moreover, it is well
known that drug makers rely heavily on
ingredients made in Chinese factories.
According to the CEO of Sanofi, 60%
of the world’s API is made in China15
and this could cause supply problems
as the virus’ disruption of the Chinese
economy continues. In fact, a drug was
recently added to the US Food and Drug
Administration’s (FDA’s) Drug Shortages
List specifically because of the effects of
the coronavirus. The manufacturer notified
the FDA that the shortage is due to
problems with the production of an active
pharmaceutical ingredient at a site affected
by coronavirus.16 However, this news is
only the tip of the iceberg, as according
to some sources17 the monitoring of the
risk of shortage related to the 2019-nCoV
would concern “About 150 prescription
drugs—including antibiotics, generics and
some branded drugs without alternatives”.
Unfortunately, not only drug supplies
may risk shortfalls: the production of
medical devices may falter as well. Indeed,
as reported by the FDA, “The agency
reached out to 63 companies with a total
of 72 facilities in China that make essential
medical devices”. FDA Commissioner Dr
Stephen Hahn said that “several of these
facilities in China are adversely affected”
by the epidemic and that their workforces
have taken a hit from the outbreak,
including employees being quarantined.16
These worrying developments provide
an opportunity to discuss economic
realities that create vulnerability in our
healthcare sector. It is becoming clear that
production backup sites are needed to
ensure adequate supplies, even in the most
1Clinical Pharmacy, ISMETT, Palermo, Italy
2Experimental medicine and Public health, University of
Camerino, Camerino, Italy
Correspondence to Dr Carlo Polidori, Experimental
medicine and Public health, University of Camerino,
Camerino 62032, Italy; carlo. polidori@ unicam. it
Editorial
Eur J Hosp Pharm: first published as 10.1136/ejhpharm-2020-002278 on 18 March 2020. Downloaded from http://ejhp.bmj.com/ on March 19, 2020 by guest. Protected by copyright.
2 Leonardi D, et al. Eur J Hosp Pharm Month 2020 Vol 0 No 0
Editorial
complex situations. Also, the fact that,
before this crisis, our healthcare system
had not developed a strategy to deal with
potential epidemics, could provide an
opportunity to reflect on where to act to
be prepared in the event of similar or even
more serious health threats.
Contributors DL and PP wrote the paper and CP
revised it.
Funding The authors have not declared a specific
grant for this research from any funding agency in the
public, commercial or not-for-
profit
sectors.
Competing interests None declared.
Provenance and peer review Not commissioned;
internally peer reviewed.
© European Association of Hospital Pharmacists 2020.
No commercial re-use.
See rights and permissions.
Published by BMJ.
To cite Leonardi D,
Polidori C, Polidori P. Eur J Hosp Pharm Epub ahead of
print: [please include Day Month Year]. doi:10.1136/
ejhpharm-2020-002278
Eur J Hosp Pharm 2020;0:1–2.
doi:10.1136/ejhpharm-2020-002278
ORCID iDs
Carlo Polidori http:// orcid. org/ 0000- 0001- 6946- 8638
Piera Polidori http:// orcid. org/ 0000- 0001- 8496- 9908
References
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2 WHO. Novel Coronavirus(2019-nCoV)
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default- source/ coronaviruse/ situation- reports/
20200228- sitrep- 39- covid- 19. pdf? sfvrsn= 5bbf3e7d_2
3 Zhao S, Lin Q, Ran J, et al. Preliminary estimation of
the basic reproduction number of novel coronavirus
(2019-nCoV)
in China, from 2019 to 2020: a data-driven
analysis in the early phase of the outbreak. Int J
Infect Dis 2020;92:214–7.
4 Wang H, Wang Z, Dong Y, et al. Phase-adjusted
estimation of the number of coronavirus disease 2019
cases in Wuhan, China. Cell Discov 2020;6:1–8.
5 Rothe C, Schunk M, Sothmann P, et al. Transmission of
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6 Centers for Disease Control and Prevention.
Coronavirus disease 2019 (COVID-19). Available:
https://www. cdc. gov/ coronavirus/ 2019- ncov/ about/
symptoms. html
7 Xie X, Zhong Z, Zhao W, et al. Chest CT for typical
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8 Fong MW, Gao H, Wong JY, et al. Nonpharmaceutical
measures for pandemic influenza in nonhealthcare
settings—social distancing measures. Emerg Infect Dis
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media Ue. Ecco tutte le criticit. Available: https://www.
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10 Qiu H, Tong Z, Ma P, et al. Intensive care during the
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13 Kruse RL. Therapeutic strategies in an outbreak
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14 The Jerusalem Post. Israeli scientists: ’In a few weeks,
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"Congestion and peak load pricing: a comparison in electricity and transportation"
No full textNota a pie' di pagina: Even if the paper presented is the result of a common effort, E. Marcucci has written paragraphs: 2.1, 3.1, and 4.1 whereas P. Polidori paragraphs: 2.2, 3.2 and 4.2Abstract: Prices signal the scarcity of resources on the market and produce their efficient allocation. Given the level of high fixed costs characterising most public Utilities (electricity and transport are no exemption to this) there is a strong case for a discriminating use of prices. The demand for public utility service varies periodically and its management constitute the core of the peak load pricing problem. A fundamental aspect of peak load theory is the specific object of pricing. We assume that peak load implies pricing far the use of scarce resource capacity in production, whereas peak load far the use of a network, that is congestion charging, is aimed at the internalisation of external costs. In the case of transport we might adopt, far example, peak load pricing far the management of excessive bus demand and use congestion charging to internalise the external costs imposed by private transportation. In the electricity sector peak load pri¬cing might be used to manage the excessive power demand while congestion pricing is just a part of the transmission pricing mechanism that has to be complemented by electricity losses charging. In the case of transport the two problems overlap since production and transmission coincide
The National Recovery and Resilience Plan: Similarities with the Past and an In-depth Look at Justice
No full textAggiornamenti sull'Allevamento dell'Asina da Latte
No full textNella rilettura di questa nuova edizione del libro su L’allevamento dell’asina da latte, sono rimasto affascinato da molteplici fattori, che traspaiono qua e là nel testo coordinato con capacità e professionalità dal Prof. Paolo Polidori.
La figura dominante, qualsiasi pagina venga letta del libro, è quella di questo magnifico animale: l’asino, nella sua declinazione al femminile. Nel linguaggio comune questa specie è figura poco apprezzata e solitamente assimilata alla stupidità. Ma non è così, bastano poche esperienze per riconoscere nell’asino un animale di grande intelligenza e sensibilità. Purtroppo disponibile all’asservimento del “padrone” anche più spregiudicato, malvagio o stupido.
Ma di contro abbiamo molti esempi di una convivenza, complicità e collaborazione fra l’uno e l’altro, che testimoniano quanto l’uomo e l’asino, sappiano cogliere le reciproche peculiarità per ottenerne vantaggi comuni. Questo cappello alla prefazione del testo era dovuto, come riconoscimento mio e della Fondazione, a chi valorizza una specie che meriterebbe più considerazione dall’uomo e che ci ha accompagnati nella nostra evoluzione.
Il testo, se dovessi usare un unico termine, lo definirei: formidabile. Gli articoli nel loro insieme vanno a costituire non un semplice libro, ma un vero e proprio trattato sull’asina da latte. Dalla gestione dell’allevamento, alle avversità, dal ruolo sociale, alla fisiologia, dall’uso alimentare del latte a quello cosmetico. Ogni argomento viene approfondito per precisarne i particolari, ma sempre mantenendo un livello comunicativo e comprensivo, agibile al medico veterinario, ma pure all’allevatore neofita.
Per altri versi le informazioni che si ricevono alla lettura dei diversi testi, consentono anche al semplice curioso, di apprendere nel rigore scientifico: curiosità, aneddoti e nozioni, affascinanti e sufficienti a formare una preparazione di base per ulteriori approfondimenti.
Insomma un testo che la Fondazione non solo condivide, ma di cui ne va orgogliosa sostenendone la stampa. Non resta che ringraziare il coordinatore dell’opera, il prof. P. Polidori e gli Autori che hanno riempito di contenuti una eccellente idea e che hanno messo a disposizione il loro ”sapere” a vantaggio degli interessati e non da meno, dell’asino. Ai lettori una buona lettura
Post mortem proteolysis and tenderization of beef muscle through infusion of calcium chloride
No full textA study involving 48 beef carcasses was conducted in order to evaluate the effects
of 0.3 M calcium chloride (CaCl2) injection on final tenderness in muscle Longissimus thoracis et lumborum.
Injection of beef carcasses with CaCl2 accelerated post mortem tenderization process.
Ca2+-dependent proteases (m-calpain and m-calpain) and their inhibitor (calpastatin) activities were
all significantly (P < 0.01) decreased in CaCl2 injected animals (n = 24) compared with control animals
(n = 24). Tenderness, assessed by measuring shear force, was significantly improved (P < 0.05)
by CaCl2 injection both at two and eight days post mortem
POLIDORI P., MORETTI V.M., VALFRE' F., CRISPINO A., BERETTA G. (1995). Qualità della carne equina fresca e di un prodotto trasformato. INDUSTRIE ALIMENTARI, vol. 7/8, p. 723-727, ISSN: 0019-901X
No full text“I problemi di coordinamento nell’organizzazione economico istituzionale del settore idrico”
No full textLa riforma dei servizi pubblici locali a rilevanza industriale: aspetti di regolazione ex ante ed ex post
No full textLa tariffazione del traffico: teoria ed applicazioni pratiche
No full textThe present work analyses and classifies the most relevant external costs produced by urban transportation and relates these to the various forms of internalisation through the payment of a tariff. The objective is to confront the theoretical suggestions and the philosophy adopted in the practical implementations in various countries. We conclude that the present technological level available allows both a strong correlation between instruments and objectives as well as a substantial flexibility of the tariff charged so to overcome some of the informational gap concerning the estimation of external costs. The limited application of these systems may probably be due to their distributional effects
Bioactive Peptides in Donkey's Milk
No full textDonkey’s milk (DM) is considered as a good alternative for children affected by cow’s milk protein intolerance (CMPA), when it is not possible breast feeding. DM This milk is very similar to human one, especially considering as regards to the similar lactose content, the low casein content and the similar mineral composition. As regards to the casein protein fraction, in DM are present mainly two types of caseins: beta and alpha s1- caseins whereas the alpha s2- and k-casein content resulted to be very low. The whey protein fraction of DM is characterized by the presence of proteins/peptides with potential nutraceutical function such as lysozyme, lactoferrin, lactoperoxidase, alpha-lactalbumin and beta-lactoglobulin. Lysozyme (14.4 kDa), is a well know enzyme with antimicrobial properties since it is able to hydrolyze the glyosidic bonds of mucopolysaccarides of the bacterial cell walls. DM lysozyme content (1.0 g/l) is much higher if compared to that one found in bovine (traces), human (0.12 g/l) and goat's milk (traces). Lysozyme may have therapeutic, antiviral and anti-inflammatory properties, therefore may help to reduce the incidence of gastrointestinal infections in the infants. Lactoferrin and lactoperoxidase (0.084 g/l and 0.11 mg/l in DM, respectively) are other two proteins that exhibit several activities. In particular, lactoferrin is an iron binding protein involved in regulation of iron homeostasis, cellular growth, anti-microbial and anti-viral functions and protection against cancer development and metastasis. Furthermore lactoferrin may have a prebiotic activity, stimulating the growth of beneficial bacteria in the intestinal tract. alpha-lactalbumin (about 12.0 kDa), is a whey protein with good nutritional value since it provides all essential and branched-chain amino acids to the growing infant, it is able to bind divalent cations facilitating the absorption of essential mineral. In conclusion, DM donkey’s milk possesses a set of nutritional properties especially thanks to the presence of bioactive peptides which have a high nutritional value
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