Duration of antimicrobial treatment for uncomplicated streptococcal bacteraemia: Another example of shorter is better.

Duration of treatment for uncomplicated streptococcal bacteraemia is unknown. The study aims to assess clinical outcomes of patients with uncomplicated streptococcal bacteraemia receiving a short course (5-10 days) of antimicrobial treatment compared to those receiving the traditional, longer duration (11-18 days). This retrospective study was conducted at the Lausanne University Hospital, Switzerland and included episodes of uncomplicated streptococcal bacteraemia among adult patients from 2015 to 2023. Clinical failure was defined as mortality, recurrence of bacteraemia by the same streptococcal species and development in bone and joint infection within 120 days. During the study period, 336 episodes of uncomplicated streptococcal bacteraemia were included. The median duration of antimicrobial treatment was 10 days (interquartile range: 7-14); 184 (55%) and 152 (45%) episodes received a short (5-10 days) and long (11-18 days) duration of antimicrobial treatment, respectively. Forty-three (13%) episodes had clinical failure; 120-day mortality was 11% (36 episodes); recurrence of bacteraemia by the same streptococcal species was observed in 8 episodes (2%). No difference in clinical failure was observed between episodes receiving short and long courses of antimicrobial treatment (10% versus 16%; P 0.143). The Cox multivariable regression model found that a Charlson comorbidity index >4 (aHR 4.87, 95% CI 3.08-7.71), and septic shock (1.67, 1.04-2.67) were associated with clinical failure; a short course of antimicrobial treatment was not associated with clinical failure (0.90, 0.57-1.12). This study has shown that a short duration of antimicrobial treatment for cases of streptococcal bacteraemia is effective and safe

Predictors of Mortality of Streptococcal Bacteremia and the Role of Infectious Diseases Consultation: A Retrospective Cohort Study.

Streptococcal bacteremia is associated with high mortality. Thia study aims to identify predictors of mortality among patients with streptococcal bacteremia. This retrospective study was conducted at the Lausanne University Hospital, Switzerland, and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023. During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P .001; hazard ratio [HR], 2.87; confidence interval [CI]: 1.58-5.22), Streptococcus pyogenes (P = .011; HR, 2.54;CI: 1.24-5.21), sepsis (P < .001; HR, 7.48; CI: 3.86-14.47), lower respiratory tract infection (P = .002; HR, 2.62; CI: 1.42-4.81), and absence of source control interventions within 48 hours despite being warranted (P = .002; HR, 2.62; CI: 1.43-4.80) were associated with 14-day mortality. Conversely, interventions performed within 48 hours of bacteremia onset, such as infectious diseases consultation (P < .001; HR, 0.29; CI: .17-.48) and appropriate antimicrobial treatment (P < .001; HR, .28; CI: .14-.57), were associated with improved outcome. Our findings underscore the pivotal role of infectious diseases consultation in guiding antimicrobial treatment and recommending source control interventions for patients with streptococcal bacteremia

A Novel Digitized Method for the Design and Additive Manufacturing of Orthodontic Space Maintainers

Primary dentition is crucial in influencing the emergence of permanent teeth. Premature primary tooth loss can result in undesired tooth motions and space loss in the permanent dentition. Typically, fixed or removable dental appliances are adopted to maintain edentulous space until the eruption of permanent teeth. However, traditional space maintainers have limitations in terms of variability in tooth anatomy, potential allergic reactions in some individuals (i.e., nickel sensitivity), difficulties in maintaining oral hygiene, and patient acceptance. The present study introduces a fully digital framework for the design and manufacturing of customized pediatric unilateral space maintainers using generative algorithms. The proposed approach overcomes the current challenges by using a biocompatible resin material and optimizing the device's size, design, and color. The methodology involves intraoral scanning, surface selection, and trim, generative 3D modeling, finite element analysis (FEA), and additive manufacturing (AM) through vat photopolymerization. FEA results demonstrate the device's mechanical performance and reliability, while additive manufacturing ensures design freedom, high resolution, surface finishing, dimensional accuracy, and proper fit. The mechanical interlocking system facilitates easy and effective positioning of the device. This digital approach offers the potential for wider usage of space maintainers and can be further validated through experimental assessments and clinical studies

Designing for Experiences in Blended Reality Environments for People with Dementia

Blended Reality environments have the potential to provide scalable solutions that are affordable, adaptable and easily deployable to support people with dementia. Use of these technologies is associated with experience of presence which is an experience with technologically mediated perceptions that generates a feeling of being there and the illusion of non-mediation. Our study examines what constitutes an experience of presence for people with dementia when they interact with MRTs. An observational study with ten participants (MoCA = 18 to 23, Age = 63 to 88 years) played a game of Tangram on Osmo. Six of these participants also played Young Conker on HoloLens. The experiences of the participants in the digital space, the physical space, and their attention crossover between the two spaces were coded in Noldus Observer XT 14.1. The study found four main themes that have an impact on the experience of presence in PwD – correspondences, effortless access to physical and digital content, awareness of reality and emergence. Correspondences between physical and digital spaces require PwD to have constant information about the state and nature of physical and digital content. The transitions between physical and digital should be seamless. PwD demonstrated positive experiences with Osmo, an augmented Virtuality technology while their experience with HoloLens, augmented reality technology was negative. The factors impacting experience of presence were prominent in Osmo while they were mostly absent in HoloLens throughout the game play. The outcomes of this study have resulted in a set of recommendations and guidelines for designers to design correspondences for experience of presence. We are currently working on developing prototypes using these guidelines for evaluations with PwD.AGE-WEL

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden. Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18–45 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment. Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR. . Conclusions: These fndings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

SANI definition of Clinical Remission in Severe Asthma: a Delphi consensus

: Severe Asthma affects about 10% of the asthmatic population, and it is characterized by a low lung function and a higher count of blood leucocytes, mainly eosinophils. To date, various definitions are used in clinical practice and in the literature to identify asthma remission: clinical remission, inflammatory remission, and complete remission. The aim of this work is to highlight a consensus for asthma remission using a Delphi method. In the context of SANI (Severe Asthma Network Italy), accounting for 57 Severe Asthma Centers and more then 2200 patients, a Board of six expert drafted a list of candidate statements in a questionnaire, which has been revised to minimize redundancies and ensure clear and consistent wording for the first round (R1) of the analysis. 32 statements have been included in the R1 questionnaire, and then submitted to a panel of 80 experts, which used a 5-points Likert scale to measure their agreement to each statement. Then, an Interim Analysis of R1 data have been performed, items were discussed and considered to produce a consistent questionnaire for the round 2 (R2) of the analysis. After this, the Board set the R2 questionnaire, which included only the important key topics. Panelists have been asked to vote the statements in the R2 questionnaire afterwards. During R2, the criteria of complete clinical remission (the absence of need for OCS, symptoms, exacerbations/attacks, and a pulmonary function stability) and those of partial clinical remission (the absence of need for OCS, and 2 out of 3 criteria: the absence of symptoms, exacerbations/attacks, and a pulmonary stability) were confirmed. This SANI Delphi Analysis defined a valuable, independent and easy to use tool to test the efficacy of different treatments in patients with severe asthma enrolled into the SANI registry

Handy: Novel hand exoskeleton for personalized rehabilitation

Worldwide, stroke is the third cause of disability. The majority of people affected by this disease cannot perform activities of daily living. Bringing the therapy to the patients' home is complex, and in literature, there are still open challenges to face. Starting from therapists' and patients' needs, this paper describes a possible solution: HANDY, a rehabilitative active hand exoskeleton for post-stroke patients. With a desktop application, they perform three different types of exercises: passive, active and based on activities of daily living. They can also control the exoskeleton themselves in a serious-game approach with a leap motion controller. We evaluated our method with patients at the Villa Beretta rehabilitative center. Preliminary results from the session about comfort, usability and willingness to utilize the system are promising

MemHolo: mixed reality experiences for subjects with Alzheimer’s disease

HoloLens is the most recent and advanced forms of wearable Mixed Reality (MR) technology. It enables the user wearing a head-mounted device to experience 3D holographic objects “inside” the visualization of the real environment where he or she is located. Existing HoloLens applications have been developed in domains such as data visualization, entertainment, industrial training, education, and tourism, but the use of this technology in the arena of mental health is largely unexplored. The paper presents a HoloLens-based system called MemHolo that addresses persons with mild Alzheimer’s Disease (AD). AD is associated to a chronic progressive neurodegenerative process that severely affects cognitive functioning (especially memory) and some motor functions. MemHolo is intended to be used as a cognitive training tool to practice short-term and spatial memory in a safe and controlled virtual environment, and to mitigate the effects of mental decline. The paper discusses the design process of MemHolo, and describes three evaluation studies on progressive prototypes. To our knowledge, MemHolo is the first HoloLens application designed natively for persons with AD. Our empirical work sheds a light on how these people experience HoloLens applications, highlights some challenges and potential benefits of using MR technology in the AD arena, and may pave the ground towards new forms of treatment

Handy: Novel hand exoskeleton for personalized rehabilitation

Worldwide, stroke is the third cause of disability. The majority of people affected by this disease cannot perform activities of daily living. Bringing the therapy to the patients' home is complex, and in literature, there are still open challenges to face. Starting from therapists' and patients' needs, this paper describes a possible solution: HANDY, a rehabilitative active hand exoskeleton for post-stroke patients. With a desktop application, they perform three different types of exercises: passive, active and based on activities of daily living. They can also control the exoskeleton themselves in a serious-game approach with a leap motion controller. We evaluated our method with patients at the Villa Beretta rehabilitative center. Preliminary results from the session about comfort, usability and willingness to utilize the system are promising