Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality.

Background: Home births have a mortality risk 2.6 times higher in domiciliary delivery compared to hospital births, but they allow for the adoption of alternative delivery methods like Lotus Birth (LB). This practice entails preserving the connection between the newborn and placenta by leaving the umbilical cord intact, minimizing the trauma and promoting a gentler separation process for both the mother and the infant. Although research has not established neonatal benefits of LB, documented cases have identified associated risks such us sepsis and physiological jundice, precluding its adoption in hospital settings. The potential link between LB and pathological jaundice remains unclear. Known risk factors for severe hyperbilirubinemia and bilirubin encephalopathy include sepsis, blood-group incompatibility, and dehydration; conditions typically preventable through standard hospital protocols. Case report: A male infant born at 40 + 0 weeks of gestational age through a eutocic birth at home by LB was brought to the emergency department on the fourth day of life due to exacerbating jaundice, hyporeactivity, and feeding difficulties persisting for about two days. Laboratory analysis revealed a serum bilirubin level of 51 mg/dL. After admission to NICU infant received intensive phototherapy, IV fluids, exchange transfusion, albumin infusion, IVIG and antibiotic prophylaxis.. The newborn also showed neurological symptoms including muscle stiffness and apparently erratic eye movements, requiring neurological assessment and, during hospitalization, tested positive for COVID-19. Magnetic resonance imaging (MRI) revealed hippocampal changes, and hearing tests yielded pathological results. At one month, the infant was discharged in stable condition but with ongoing neurological and developmental concerns. Conclusion: This case highlights the dangers associated with non-evidence-based birth practices (home birth, lotus birth) and the need for vigilant postnatal monitoring. In conclusion, this clinical case delineates a rare yet extremely serious complication of neonatal AB0 incompatibility jaundice, exacerbated by concurrent sepsis and dehydration compounded by inadequate nutrition following lotus birth at home. Upon admission, the neurological examination suggested a diagnosis of severe hyperbilirubinemic encephalopathy. However, confirmation of neurological damage and the subsequent diagnosis of kernicterus were only possible following the performance of MRI.

Infective endocarditis (IE) due to methicillin-susceptible Staphylococcus aureus (MSSA) still represents a clinical and therapeutic issue. Discrepancies between guidelines, clinical studies and clinical practice have already been highlighted, especially regarding daptomycin use in MSSA cases. The aim of this study was to evaluate daptomycin’s impact on outcomes in this setting. This was a retrospective observational study. We enrolled all patients with MSSA IE admitted from 2015 to 2023. Patients were divided into two groups according to daptomycin administration. We enrolled 76 patients, with 49 in group A (standard treatment) and 27 in group B (treated with daptomycin). The in-hospital crude mortality was 14.3% and 29.6% in group A and B, respectively (p = 0.191). Only heart failure was significantly associated with negative outcome in the univariate and multivariate analyses (OR 6.424, 95% CI, 1.680–24.559; p = 0.007). In this study population, daptomycin treatment for IE due to MSSA was not associated with a reduced mortality rate. Heart failure was the only independent risk factor associated with in-hospital mortality.

Background and Aims: the main purpose of this paper is analyzing the hourly activities performed by Data Managers (DMs) and Clinical Research Coordinators (CRCs) in a Clinical Trial Center (CTC) of an Italian Public Hospital in order to define and monitor the relevant job descriptions of these professionals Materials and Methods: the CTC of the Research and Innovation Departments (DAIRI) has created a tool to collect the hourly activity of DMs and CRCs. In the period between January 1 and December 31, 2022; the activities were collected and grouped in 24 macro areas. Results: the main activities conducted by staff are found in the macro areas "Study Management" (15.78%); "Briefing/Planning" (12.86%) and “Data Management/Data Entry” (12.42%). A difference was found between the activities carried out by CRCs and those conducted by DMs. Conclusions: the results of this monitoring, compared with data obtained at the national level, confirm the heterogeneity of the tasks performed by these professional figures. These differences increasingly underscore the need to obtain recognition of the figure by the National Health System (NHS) with the definition of a precise “job description”.

Severe Acute Respiratory Disease Syndrome Coronavirus 2 has caused a global pandemic. Monoclonal antibodies, antiviral therapy (Remdesivir) and immunomodulatory agents represent one of the most promising therapies to prevent disease progression and reduce the relative risk of severe COVID-19. The aim of this study was to evaluate the impact on the disease progression of the main pharmacological options approved for the patients admitted in hospital with acute COVID-19 infection, according to their vaccination status.. We conducted a study including adult patients with confirmed COVID-19 admitted to the Infectious Diseases Unit of Alessandria’s Hospital in Italy, from October 2021 to March 2022. 102 patients were included in the analysis. The mean age was 69.2 ±15.4 years, 66.7% were males. According to the internal hospital’s guidelines, 47.06% patients with mild to moderate disease were treated with mAbs, 45.10% were treated with Remdesivir, of which 10.78% received combination therapy with mAbs. The most frequently complications were pneumonia (18.63%), respiratory failure (15.68%) and acute respiratory distress syndrome (13.72%). The mean length of hospitalization was 13.42 (±10.90) days and the mortality rate was 11.76%. The treatment with mAbs and immunomodulatory therapy for mild to moderate COVID-19 infection seem to be effective to improve the outcome reducing disease progression and mortality. C-reactive protein (CRP) and ferritin could be considered a good inflammatory marker of disease progression.

Background: Metabolic alkalosis is characterized by increased pH (> 7.45) and serum bicarbonate levels. In the early postnatal period, metabolic alkalosis is an uncommon problem, and its etiology is often due to maternal disorders. In the prenatal period, the mother’s hydroelectrolytic disorders can be transplacentally transmitted to the fetus; these alterations can seriously compromise the newborn’s health. Case report: We report a case of a male infant born at home from an unknown pregnancy, with a gestational age estimated at 34 weeks. The mother was unaware of her pregnancy and had not received prenatal care, giving birth in a non-medical setting. The infant was clinically stable upon arrival at the hospital; however, a blood gas analysis revealed hypochloremic metabolic alkalosis (pH 7.56; pCO2 43,7 mmHg; Cl⁻ 69 mmol/L; Na⁺ 117 mmol/L; K⁺ 3.8 mmol/L; HCO3⁻ 39 mmol/L; SBE + 17.7 mmol/L), which was also confirmed in subsequent tests and was similar to the mother’s electrolyte profile. The mother, who was severely underweight with a BMI of 16.5%, reported a history of vomiting, substance abuse (cannabis and cocaine), and hepatitis C. Due to the infant’s very low birth weight (1440 g) and small-for-gestational-age status, the baby was admitted to the NICU. Initial treatment included respiratory support with high-flow nasal cannula and prophylactic caffeine therapy. No significant apnea episodes were noted, and the infant’s electrolyte disturbances were corrected with isotonic saline infusion, resulting in normalization of the acid–base and electrolyte balance within 72 h. Following the resolution of metabolic alkalosis, the infant showed normal neurodevelopment and growth during the 2-year follow-up. The metabolic alkalosis observed in the infant was attributed to maternal hydroelectrolytic disturbances, likely exacerbated by malnutrition and substance abuse. Conclusion: The case highlights the importance of a thorough maternal history, as transplacental electrolyte imbalances can lead to neonatal complications. Timely intervention in the neonatal period can prevent long-term developmental issues, as evidenced by the infant’s normal growth and neurodevelopment. In conclusion, neonatal metabolic alkalosis should be considered in the context of maternal health factors, and early intervention can mitigate potential short- and long-term risks. Further studies are needed to assess the long-term outcomes of such conditions and the optimal duration for follow-up.