Publications by authors named "Matteo Paganini"

39 Publications

Knowledge Gaps and Research Priorities on the Health Effects of Heatwaves: A Systematic Review of Reviews.

Int J Environ Res Public Health 2022 05 12;19(10). Epub 2022 May 12.

CRIMEDIM-Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy.

Although extreme weather events have played a constant role in human history, heatwaves (HWs) have become more frequent and intense in the past decades, causing concern especially in light of the increasing evidence on climate change. Despite the increasing number of reviews suggesting a relationship between heat and health, these reviews focus primarily on mortality, neglecting other important aspects. This systematic review of reviews gathered the available evidence from research syntheses conducted on HWs and health. Following the PRISMA guidelines, 2232 records were retrieved, and 283 reviews were ultimately included. Information was extracted from the papers and categorized by topics. Quantitative data were extracted from meta-analyses and, when not available, evidence was collected from systematic reviews. Overall, 187 reviews were non-systematic, while 96 were systematic, of which 27 performed a meta-analysis. The majority evaluated mortality, morbidity, or vulnerability, while the other topics were scarcely addressed. The following main knowledge gaps were identified: lack of a universally accepted definition of HW; scarce evidence on the HW-mental health relationship; no meta-analyses assessing the risk perception of HWs; scarcity of studies evaluating the efficacy of adaptation strategies and interventions. Future efforts should meet these priorities to provide high-quality evidence to stakeholders.
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http://dx.doi.org/10.3390/ijerph19105887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9140727PMC
May 2022

Delayed Neurological Sequelae Successfully Treated with Adjuvant, Prolonged Hyperbaric Oxygen Therapy: Review and Case Report.

Int J Environ Res Public Health 2022 04 27;19(9). Epub 2022 Apr 27.

Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy.

Carbon Monoxide (CO) intoxication is still a leading cause of mortality and morbidity in many countries. Due to the problematic detection in the environment and subtle symptoms, CO intoxication usually goes unrecognized, and both normobaric and hyperbaric oxygen (HBO) treatments are frequently administered with delay. Current knowledge is mainly focused on acute intoxication, while Delayed Neurological Sequelae (DNS) are neglected, especially their treatment. This work details the cases of two patients presenting a few weeks after CO intoxication with severe neurological impairment and a characteristic diffused demyelination at the brain magnetic resonance imaging, posing the diagnosis of DNS. After prolonged treatment with hyperbaric oxygen, combined with intravenous corticosteroids and rehabilitation, the clinical and radiological features of DNS disappeared, and the patients' neurological status returned to normal. Such rare cases should reinforce a thorough clinical follow-up for CO intoxication victims and promote high-quality studies.
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http://dx.doi.org/10.3390/ijerph19095300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9104642PMC
April 2022

Implementation of a nurse-led alternate care site for the management of the surge of patients with COVID-19 in an Italian emergency department.

Emerg Med J 2022 Jul 23;39(7):554-558. Epub 2022 Mar 23.

Emergency Department, San Bassiano Hospital, ULSS7 Pedemontana, Bassano del Grappa, Italy.

Background: To accommodate and separate the large numbers of patients going to hospital with COVID-19, many EDs had to create new pathways for patients. We describe the outcomes of patients treated in a nurse-led alternate care site (ACS) at our hospital.

Methods: This was a retrospective study of outcomes of patients managed at the ACS of 'San Bassiano' Hospital ED, Bassano del Grappa, Italy between 9 March and 16 April 2020. Self-presenting patients aged 5 years and older, suspected of having COVID-19, were initially diverted to the ACS. Patients with a National Early Warning Score ≥5 or with a desaturation ≥4% after the walking test were sent back to the main ED COVID-19 path for further evaluation and medical attention and were not further followed up. In the ACS, patients received a CXR, blood samples and a nasopharyngeal swab to test for SARS-CoV-2, and were sent home. An emergency physician reviewed the results later and called the patient back 5-6 hours later with instructions to return for medical evaluation of abnormal findings, or to seek their general practitioner's attention. Patients received a follow-up phone call 15 days later to learn of their course.

Results: A total of 487 patients were fully managed in the ACS and discharged home. Of the 392 (80.5%) patients with no abnormalities after the workup and instructed to stay at home, 29 reattended the ED in the next 15 days, and 13 were admitted. Among the 95 patients asked to return and receive medical attention, 20 were admitted and of those discharged, 3 reattended the ED within 15 days. At 15 days, no patient was deceased or received invasive ventilation; one admitted patient received non-invasive ventilation.

Conclusions: A nurse-led ACS diverted a substantial proportion of patients from main ED resources without associated negative clinical outcomes.
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http://dx.doi.org/10.1136/emermed-2021-212056DOI Listing
July 2022

Health and healthcare variables associated with Italy's excess mortality during the first wave of the COVID-19 pandemic: An ecological study.

Health Policy 2022 04 8;126(4):294-301. Epub 2022 Mar 8.

Department of Statistical Science, University of Padova, Via C. Battisti, 241, Padova 35121, Italy.

Background: Healthcare factors have strongly influenced the propagation of COVID-19. This study aims to examine whether excess mortality during the first phase of the COVID-19 outbreak in Italy was associated with health, healthcare, demographic, and socioeconomic, provincial-level indicators.

Methods: This ecological study concerns the raw number of deaths reported from February 1 to April 30, 2020 and the mean number of deaths occurred during the same months from 2015 to 2019, per province. Information on socioeconomic factors and healthcare settings was extracted from updated databases on the Italian National Institute of Statistics (ISTAT) website. A multivariate model and four multilevel models were constructed to test the association between excess mortality and the analysed indicators across 107 Italian provinces.

Results: The hospitalization rate in long-term care wards and the cardiovascular disease mortality rate correlate positively with excess mortality (p <0.05), while higher densities of licensed physicians and of general practitioners are associated with lower excess mortality (p <0.05). After controlling for the COVID-19 cumulative incidence in each province, only the density of licensed physicians remains negatively associated with excess mortality (p <0.01).

Conclusion: Some health and healthcare variables (in particular, the density of physicians) are strongly associated with excess mortality during the first wave of the COVID-19 pandemic in Italy and should be targeted to increase the resilience of health systems.
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http://dx.doi.org/10.1016/j.healthpol.2022.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8902063PMC
April 2022

Oxidative stress and motion sickness in one crew during competitive offshore sailing.

Sci Rep 2022 01 21;12(1):1142. Epub 2022 Jan 21.

Institute of Clinical Physiology, National Research Council (CNR), Milan, Italy.

Competitive Offshore Ocean Sailing is a highly demanding activity in which subjects are exposed to psychophysical stressors for a long time. To better define the physiological adaptations, we investigated the stress response of subjects exposed to 3-days long ocean navigation with disruption of circadian rhythms. 6 male subjects were involved in the study and provided urine and saliva samples before setting sail, during a single day of inshore sailing, during 3-days long ocean navigation, and at the arrival, to measure oxidative stress, cortisol, nitric oxide metabolites (NOx) and metabolic response. Motion Sickness questionnaires were also administered during the navigation. The crew suffered a mean weight loss of 1.58 kg. After the long navigation, a significant increase in ROS production and decrease in total antioxidant capacity and uric acid levels were observed. Lipid peroxidation, NO metabolites, ketones, creatinine, and neopterin levels were also increased. Furthermore, a significant increase in cortisol levels was measured. Finally, we found a correlation between motion sickness questionnaires with the increase of NOx, and no correlation with cortisol levels. Physical and psychological stress response derived from offshore sailing resulted in increased oxidative stress, nitric oxide metabolites, and cortisol levels, unbalanced redox status, transient renal function impairment, and ketosis. A direct correlation between motion sickness symptoms evaluated through questionnaires and NOx levels was also found.
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http://dx.doi.org/10.1038/s41598-022-05219-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782845PMC
January 2022

Blood gas analyses in hyperbaric and underwater environments: a systematic review.

J Appl Physiol (1985) 2022 02 23;132(2):283-293. Epub 2021 Dec 23.

Environmental Physiology and Medicine Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy.

Pulmonary gas exchange during diving or in a dry hyperbaric environment is affected by increased breathing gas density and possibly water immersion. During free diving, there is also the effect of apnea. Few studies have published blood gas data in underwater or hyperbaric environments: this review summarizes the available literature and was used to test the hypothesis that arterial Po under hyperbaric conditions can be predicted from blood gas measurement at 1 atmosphere assuming a constant arterial/alveolar Po ratio (a:A). A systematic search was performed on traditional sources including arterial blood gases obtained on humans in hyperbaric or underwater environments. The a:A was calculated at 1 atmosphere absolute (ATA). For each condition, predicted arterial partial pressure of oxygen ([Formula: see text]) at pressure was calculated using the 1 ATA a:A, and the measured [Formula: see text] was plotted against the predicted value with Spearman correlation coefficients. Of 3,640 records reviewed, 30 studies were included: 25 were reports describing values obtained in hyperbaric chambers, and the remaining were collected while underwater. Increased inspired O at pressure resulted in increased [Formula: see text], although underlying lung disease in patients treated with hyperbaric oxygen attenuated the rise. [Formula: see text] generally increased only slightly. In breath-hold divers, hyperoxemia generally occurred at maximum depth, with hypoxemia after surfacing. The a:A adequately predicted the [Formula: see text] under various conditions: dry ( = 0.993, < 0.0001), rest versus exercise ( = 0.999, < 0.0001), and breathing mixtures ( = 0.995, < 0.0001). In conclusion, pulmonary oxygenation under hyperbaric conditions can be reliably and accurately predicted from 1 ATA a:A measurements.
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http://dx.doi.org/10.1152/japplphysiol.00569.2021DOI Listing
February 2022

Elderly People's Access to Emergency Departments during the COVID-19 Pandemic: Results from a Large Population-Based Study in Italy.

J Clin Med 2021 Nov 26;10(23). Epub 2021 Nov 26.

Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, 35128 Padova, Italy.

Across the world, people have avoided seeking medical attention during the coronavirus pandemic, resulting in a marked reduction in emergency department (ED) visits. This retrospective cohort study examines in detail how the present pandemic affects ED use by the elderly. The regional database on ED visits in Veneto (northeastern Italy) was consulted to extract anonymous data on all ED visits during 2019 and 2020, along with details concerning patients' characteristics (access mode, triage code, chief complaint, and outcome). A year-on-year comparison was drawn between 2019 and 2020. There was a 25.3% decrease in ED visits in 2020 compared to the previous year. The decrease ranged from -52.4% in March to -18.4% in September when comparing the same months in the two years. This decrease started in late February 2020, with the lowest numbers of visits recorded in March and April 2020 (during the "first wave" of the COVID-19 pandemic in Italy), and in the autumn (during the "second wave"). The proportion of visits to the ED by ambulance has increased sharply since March 2020, and patients arrived more frequently with severe conditions (red or yellow triage tags) that often required a hospitalization. The greatest decrease was in fact observed for non-urgent complaints. This decreased concerned a wide range of conditions, including chest pain and abdominal pain. The sharp reduction observed in the present study is unlikely to be attributed entirely to the effect of lockdown measures. Individual psychological and media-induced fear of contagion most likely played a relevant role in leading people to avoid seeking medical attention.
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http://dx.doi.org/10.3390/jcm10235563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658732PMC
November 2021

Pediatric emergency department visits during the COVID-19 pandemic: a large retrospective population-based study.

Ital J Pediatr 2021 Nov 4;47(1):218. Epub 2021 Nov 4.

Department of Cardiologic, Vascular and Thoracic Sciences and Public Health, University of Padova, Via Loredan, 18, 35131, Padova, Italy.

Background: COVID-19 pandemic has stretched healthcare system capacities worldwide and deterred people from seeking medical support at Emergency Departments (ED). Nevertheless, population-based studies examining the consequences on children are lacking.

Methods: All ED visits from 2019 to 2020 in Veneto, Italy (4.9 million residents) were collected. Anonymized records of pediatric (≤14 years) ED visits included patient characteristics, arrival mode, triage code, clinical presentation, and discharge mode. Year-on-year variation of the main ED visit characteristics, and descriptive trends throughout the study period have been examined.

Results: Overall, 425,875 ED presentations were collected, 279,481 in 2019, and 146,394 in 2020 (- 48%), with a peak (- 79%) in March-April (first pandemic wave), and a second peak (below - 60%) in November-December (second pandemic wave). Burn or trauma, and fever were the two most common clinical presentations. Visits for nonurgent conditions underwent the strongest reduction during both pandemic waves, while urgent conditions reduced less sharply. ED arrival by ambulance was more common in 2020 (4.5%) than 2019 (3.5%), with a higher proportion of red triage codes (0.5%, and 0.4% respectively), and hospitalizations following ED discharge (9.1%, and 5.9% respectively).

Conclusion: Since the beginning of the COVID-19 pandemic, pediatric ED presentations underwent a steeper reduction than that observed for adults. Lockdown and fear of contagion in hospital-based services likely deterred parents from seeking medical support for their children. Given COVID-19 could become endemic, it is imperative that public health experts guarantee unhindered access to medical support for urgent, and less urgent health conditions, while minimizing infectious disease risks, to prevent children from suffering direct and indirect consequences of the pandemic.
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http://dx.doi.org/10.1186/s13052-021-01168-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567132PMC
November 2021

Oxidative Stress and Inflammation, MicroRNA, and Hemoglobin Variations after Administration of Oxygen at Different Pressures and Concentrations: A Randomized Trial.

Int J Environ Res Public Health 2021 09 16;18(18). Epub 2021 Sep 16.

Institute of Clinical Physiology, National Research Council (CNR), 20162 Milan, Italy.

Exercise generates reactive oxygen species (ROS), creating a redox imbalance towards oxidation when inadequately intense. Normobaric and hyperbaric oxygen (HBO) breathed while not exercising induces antioxidant enzymes expression, but literature is still poor. Twenty-two athletes were assigned to five groups: controls; 30%, or 50% O; 100% O (HBO) at 1.5 or 2.5 atmosphere absolute (ATA). Twenty treatments were administered on non-training days. Biological samples were collected at T0 (baseline), T1 (end of treatments), and T2 (1 month after) to assess ROS, antioxidant capacity (TAC), lipid peroxidation, redox (amino-thiols) and inflammatory (IL-6, 10, TNF-α) status, renal function (i.e., neopterin), miRNA, and hemoglobin. At T1, O mixtures and HBO induced an increase of ROS, lipid peroxidation and decreased TAC, counterbalanced at T2. Furthermore, 50% O and HBO treatments determined a reduced state in T2. Neopterin concentration increased at T1 breathing 50% O and HBO at 2.5 ATA. The results suggest that 50% O treatment determined a reduced state in T2; HBO at 1.5 and 2.5 ATA similarly induced protective mechanisms against ROS, despite the latter could expose the body to higher ROS levels and neopterin concentrations. HBO resulted in increased Hb levels and contributed to immunomodulation by regulating interleukin and miRNA expression.
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http://dx.doi.org/10.3390/ijerph18189755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468581PMC
September 2021

Opening Schools and Trends in SARS-CoV-2 Transmission in European Countries.

Int J Public Health 2021 18;66:1604076. Epub 2021 Aug 18.

Department of Medicine, DAME, University of Udine, Udine, Italy.

Benefits of school attendance have been debated against SARS-CoV-2 contagion risks. This study examined the trends of contagion before and after schools reopened across 26 countries in the European Union. We compared the average values of estimated before and after school reopening, identifying any significant increase with a one-sample -test. A meta-analysis and meta-regression analysis were performed to calculate the overall increase in for countries in the EU and to search for relationships between before schools reopened and the average increase in afterward. The mean reproduction number increased in 16 out of 26 countries. The maximum increase in was reached after a mean 28 days. We found a negative relationship between the before school reopening and its increasing after that event. By 45 days after the first day of school reopening, the overall average increase in for the European Union was 23%. We observed a significant increase in the mean reproduction number in most European countries, a public health issue that needs strategies to contain the spread of COVID-19.
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http://dx.doi.org/10.3389/ijph.2021.1604076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408313PMC
September 2021

Adult emergency department visits during the COVID-19 pandemic in Veneto region, Italy: a time-trend Analysis.

Intern Emerg Med 2022 01 30;17(1):285-289. Epub 2021 Jul 30.

Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Via Loredan 18, 35131, Padova, Italy.

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http://dx.doi.org/10.1007/s11739-021-02815-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8321884PMC
January 2022

Endothelial Nitric Oxide Production and Antioxidant Response in Breath-Hold Diving: Genetic Predisposition or Environment Related?

Front Physiol 2021 9;12:692204. Epub 2021 Jul 9.

DAN Europe Research Division, DAN Europe Foundation, Roseto degli Abruzzi, Italy.

Introduction: Nitric oxide (NO) is an essential signaling molecule modulating the endothelial adaptation during breath-hold diving (BH-diving). This study aimed to investigate changes in NO derivatives (NOx) and total antioxidant capacity (TAC), searching for correlations with different environmental and hyperbaric exposure.

Materials And Methods: Blood samples were obtained from 50 breath-hold divers (BH-divers) before, and 30 and 60 min after the end of training sessions performed both in a swimming pool or the sea. Samples were tested for NOx and TAC differences in different groups related to their hyperbaric exposure, experience, and additional genetic polymorphism.

Results: We found statistically significant differences in NOx plasma concentration during the follow-up (decrease at T30 and increase at T60) compared with the pre-dive values. At T30, we found a significantly lower decrease of NOx in subjects with a higher diving experience, but no difference was detected between the swimming pool and Sea. No significant difference was found in TAC levels, as well as between NOx and TAC levels and the genetic variants.

Conclusion: These data showed how NO consumption in BH-diving is significantly lower in the expert group, indicating a possible training-related adaptation process. Data confirm a significant NO use during BH-diving, compatible with the well-known BH-diving related circulatory adaptation suggesting that the reduction in NOx 30 min after diving can be ascribed to the lower NO availability in the first few minutes after the dives. Expert BH-divers suffered higher oxidative stress. A preliminary genetic investigation seems to indicate a less significant influence of genetic predisposition.
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http://dx.doi.org/10.3389/fphys.2021.692204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300565PMC
July 2021

Emergency Medicine Cases in Underwater and Hyperbaric Environments: The Use of Simulation as a Learning Technique.

Front Physiol 2021 21;12:666503. Epub 2021 May 21.

Environmental and Respiratory Physiology Laboratory and Master Level II in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Padua, Italy.

Introduction: Hyperbaric chambers and underwater environments are challenging and at risk of serious accidents. Personnel aiming to assist patients and subjects should be appropriately trained, and several courses have been established all over the world. In healthcare, simulation is an effective learning technique. However, there have been few peer-reviewed articles published in the medical literature describing its use in diving and hyperbaric medicine.

Methods: We implemented the curriculum of the Master's degree in hyperbaric and diving medicine held at the University of Padova with emergency medicine seminars created by the faculty and validated by external experts. These seminars integrated traditional lectures and eight simulation scenarios.

Results: For the hyperbaric medicine seminar, simulations were carried out inside a real hyperbaric chamber at the ATIP Hyperbaric Treatment Centre, only using air and reproducing compression noise without pressurization to avoid damages to the manikins. The four scenarios consisted of hyperoxic seizures, pneumothorax, hypoglycemia, and sudden cardiac arrest. Furthermore, we added a hands-on session to instruct participants to prepare an intubated patient undergoing hyperbaric oxygen treatment with a checklist and simulating the patient transfer inside and outside the hyperbaric chamber. The diving medicine seminar was held at the Y-40 The Deep Joy pool in Montegrotto Terme (Italy), also involving SCUBA/breath-hold diving (BHD) instructors to rescue subjects from the water. These diving medicine scenarios consisted of neurologic syndrome ("taravana/samba") in BHD, drowning of a breath-hold diver, pulmonary barotrauma in BHD, and decompression illness in a SCUBA diver.

Conclusion: With this experience, we report the integration of simulation in the curriculum of a teaching course in diving and hyperbaric medicine. Future studies should be performed to investigate learning advantages, concept retention, and satisfaction of participants.
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http://dx.doi.org/10.3389/fphys.2021.666503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176206PMC
May 2021

Intravascular access routes while wearing personal protective equipment: are we close to the bone or not?

Kardiol Pol 2021 03 25;79(3):246-247. Epub 2021 Mar 25.

Division of Emergency Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy

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http://dx.doi.org/10.33963/KP.15890DOI Listing
March 2021

Role of health simulation centres in the COVID-19 pandemic response in Italy: a national study.

BMJ Simul Technol Enhanc Learn 2021 10;7(5):379-384. Epub 2021 Feb 10.

DIMED, Università degli Studi di Padova, Padova, Veneto, Italy.

Introduction: The COVID-19 pandemic has dramatically affected the Italian health systems and drastically impacted healthcare workers' daily routine and training. Simulation is an efficient tool to provide medical education, especially in the case of incoming public health emergencies. This study investigated the role and activities of Italian simulation centres (SCs) during the acute phase of the COVID-19 pandemic.

Methods: The population was identified through a web search. The directors of Italian SCs were contacted via email and then enrolled. A structured interview was created, internally validated and administrated by phone to participants.

Results: Following the government's ordinance, 37 (88.37%) SCs had to be closed to the public. Twenty (46.51%) SCs organised in situ simulation while 7 (16.28%) of them organised simulation inside the centre. Twenty-three (53.49%) SCs resorted to telematic modalities to provide training about COVID-19 and 21 (48.84%) of them for other training. Up to date, 13 SCs are still closed to the public.

Conclusions: Italy has been severely hit by COVID-19, with differences between the regions. Almost all the SCs were closed, with only a few delivering training. The SCs took advantage of emergent technologies to create new ways to train people safely. Unfortunately, nearly one-fourth of Italian SCs have not reopened yet. The evolution of the COVID-19 epidemic calls for reconsideration about training activities including adequate safety measures implemented for all individuals involved.
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http://dx.doi.org/10.1136/bmjstel-2020-000813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936561PMC
February 2021

Nitric Oxide and Oxidative Stress Changes at Depth in Breath-Hold Diving.

Front Physiol 2020 7;11:609642. Epub 2021 Jan 7.

Divers Alert Network (DAN) Europe Research Division, Roseto degli Abruzzi, Italy.

Background: Several mechanisms allow humans to resist the extreme conditions encountered during breath-hold diving. Available nitric oxide (NO) is one of the major contributors to such complex adaptations at depth and oxidative stress is one of the major collateral effects of diving. Due to technical difficulties, these biomarkers have not so far been studied while at depth. The aim of this study is to investigate nitrate and nitrite (NOx) concentration, total antioxidant capacity (TAC) and lipid peroxidation (TBARS) before, during, and after repetitive breath-hold dives in healthy volunteers.

Materials And Methods: Blood plasma, obtained from 14 expert breath-hold divers, was tested for differences in NOx, TAC, and TBARS between pre-dive, bottom, surface, 30 and 60 min post-dive samples.

Results: We observed a statistically significant increase of NOx plasma concentration in the "bottom blood draw" as compared to the pre-dive condition while we did not find any difference in the following samples We found a statistically significant decrease in TAC at the bottom but the value returned to normality immediately after reaching the surface. We did not find any statistically significant difference in TBARS.

Discussion: The increased plasma NOx values found at the bottom were not observed at surface and post dive sampling (T0, T30, T60), showing a very rapid return to the pre-dive values. Also TAC values returned to pre- diving levels immediately after the end of hyperbaric exposure, probably as a consequence of the activation of endogenous antioxidant defenses. TBARS did not show any difference during the protocol.
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http://dx.doi.org/10.3389/fphys.2020.609642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818785PMC
January 2021

Hyperbaric Oxygen Therapy and A-PRF Pre-Treated Implants in Severe Periodontitis: A Case Report.

Int J Environ Res Public Health 2021 01 7;18(2). Epub 2021 Jan 7.

Department of Biomedical Sciences, Environmental and Respiratory Physiology, University of Padova, Via Marzolo 3, 35131 Padova, Italy.

Implantation is currently the best option for tooth replacement in periodontitis. Some major contraindications for the immediate implant are acute periodontitis and active infection. We present the case of a 51-year-old female patient with the highest grade and stage periodontitis treated with advanced platelet-rich fibrin-enriched zirconia implants and with hyperbaric oxygen therapy (HBOT). In particular, HBOT before and after implantation promoted bone regeneration and implant integration, also providing an antiseptic effect. After six months, the implants were well established and fully healed from periodontal disease within 14 months. Further research could confirm a new indication for HBOT in treating periodontitis and dental implantation.
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http://dx.doi.org/10.3390/ijerph18020413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825644PMC
January 2021

Life-Saving Procedures Performed While Wearing CBRNe Personal Protective Equipment: A Mannequin Randomized Trial.

Simul Healthc 2021 Dec;16(6):e200-e205

From the Department of Medicine (DIMED) (G.M., M.P., C.A., S.S., F.F.), University of Padova, Padova; Venice Emergency Medical Service Operations Center (N.B., D.P.), Venezia; and Istituto di Anestesia e Rianimazione-Azienda Ospedaliera Universitaria di Padova (A.G., P.N.), Padova, Italy.

Introduction: Chemical-biological-radiological-nuclear-explosive (CBRNe) are complex events. Decontamination is mandatory to avoid harm and contain hazardous materials, but can delay care. Therefore, the stabilization of patients in the warm zone seems reasonable, but research is limited. Moreover, subjects involved in biological events are considered infectious even after decontamination and need to be managed while wearing personal protective equipment (PPE), as seen with Ebola and COVID-19 pandemic. With this simulation mannequin trial, we assessed the impact of CBRNe PPE on cardiopulmonary resuscitation and combat casualty care procedures.

Methods: We compared procedures performed by emergency medicine and anesthesiology senior residents, randomized in 2 groups (CBRNe PPE vs. no PPE). Chest compression (CC) depth was defined as the primary outcome. Time to completion was calculated for the following: tourniquet application; tension pneumothorax needle decompression; peripheral venous access (PVA) and intraosseous access positioning; and drug preparation and administration. A questionnaire was delivered to evaluate participants' perception.

Results: Thirty-six residents participated. No significant difference between the groups in CC depth (mean difference = 0.26 cm [95% confidence interval = -0.26 to 0.77 cm, P = 0.318]), as well as for CC rate, CC complete release, and time for drugs preparation and administration was detected. The PPE contributed to significantly higher times for tourniquet application, tension pneumothorax decompression, peripheral venous access, and intraosseous access positioning. The residents found simulation relevant to the residencies' core curriculum.

Conclusions: This study suggests that cardiopulmonary resuscitation can be performed while wearing PPE without impacting quality, whereas other tasks requiring higher dexterity can be significantly impaired by PPE.Trial Registration Number: NCT04367454, April 29, 2020 (retrospectively registered).
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http://dx.doi.org/10.1097/SIH.0000000000000540DOI Listing
December 2021

Use of backboards in cardiopulmonary resuscitation: a systematic review and meta-analysis.

Eur J Emerg Med 2021 Jun;28(3):180-188

Centro Interdipartimentale di Didattica Innovativa e di Simulazione in Medicina e Professioni Sanitarie, Simnova, Università del Piemonte Orientale, Novara, Italy - Via Lanino 1, Novara, Italy.

To achieve optimal chest compression depth, victims of cardiac arrest should be placed on a firm surface. Backboards are usually placed between the mattress and the back of a patient in the attempt to increase cardiopulmonary resuscitation (CPR) quality, but their effectiveness remains controversial. A systematic search was performed to include studies on humans and simulation manikins assessing CPR quality with or without backboards. The primary outcome of the meta-analysis was the difference in chest compression depth between these two conditions. Out of 557 records, 16 studies were included in the review and all were performed on manikins. The meta-analysis, performed on 15 articles, showed that the use of backboards during CPR increases chest compression depth by 1.46 mm in manikins. Despite statistically significant, this increase could have a limited clinical impact on CPR, due to the substantial heterogeneity of experimental conditions and the scarcity of other CPR quality indicators.
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http://dx.doi.org/10.1097/MEJ.0000000000000784DOI Listing
June 2021

Quality Improvement Project of a Massive Transfusion Protocol (MTP) to Reduce Wastage of Blood Components.

Int J Environ Res Public Health 2021 01 1;18(1). Epub 2021 Jan 1.

TEAMHealth Anesthesia, Tampa General Hospital, Tampa, FL 33606, USA.

Massive transfusion protocols (MTPs) facilitate the organized delivery of blood components for traumatically injured patients. MTPs vary across institutions, and ratios of blood components can change during clinical management. As a result, significant amounts of components can be wasted. We completed a review of all MTP activations from 2015 to 2018, providing an in-depth analysis of waste in our single Level 1 trauma center. An interdepartmental group analyzed patterns of blood component wastage to guide three quality improvement initiatives. Specifically, we (1) completed a digital timeline for each MTP activation and termination, (2) improved communications between departments, and (3) provided yearly training for all personnel about MTP deployment. The analysis identified an association between delayed MTP deactivations and waste (RR = 1.48, CI 1.19-1.85, = 0.0005). An overall improvement in waste was seen over the years, but this could not be attributed to increased closed-loop communication as determined by the proportion of non-stop activations (F(124,3) = 0.98, not significant). Delayed MTP deactivations are the primary determinant of blood component waste. Our proactive intervention on communications between groups was not sufficient in reducing the number of delayed deactivations. However, implementing a digital timeline and regular repetitive training yielded a significant reduction in wasted blood components.
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http://dx.doi.org/10.3390/ijerph18010274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7795105PMC
January 2021

Demographic and socio-economic factors, and healthcare resource indicators associated with the rapid spread of COVID-19 in Northern Italy: An ecological study.

PLoS One 2020 28;15(12):e0244535. Epub 2020 Dec 28.

Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padova, Padova, Italy.

Background: COVID-19 rapidly escalated into a pandemic, threatening 213 countries, areas, and territories the world over. We aimed to identify potential province-level socioeconomic determinants of the virus's dissemination, and explain between-province differences in the speed of its spread, based on data from 36 provinces of Northern Italy.

Methods: This is an ecological study. We included all confirmed cases of SARS-CoV-2 reported between February 24th and March 30th, 2020. For each province, we calculated the trend of contagion as the relative increase in the number of individuals infected between two time endpoints, assuming an exponential growth. Pearson's test was used to correlate the trend of contagion with a set of healthcare-associated, economic, and demographic parameters by province. The virus's spread was input as a dependent variable in a stepwise OLS regression model to test the association between rate of spread and province-level indicators.

Results: Multivariate analysis showed that the spread of COVID-19 was correlated negatively with aging index (p-value = 0.003), and positively with public transportation per capita (p-value = 0.012), the % of private long-term care hospital beds and, to a lesser extent (p-value = 0.070), the % of private acute care hospital beds (p-value = 0.006).

Conclusion: Demographic and socioeconomic factors, and healthcare organization variables were found associated with a significant difference in the rate of COVID-19 spread in 36 provinces of Northern Italy. An aging population seemed to naturally contain social contacts. The availability of healthcare resources and their coordination could play an important part in spreading infection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244535PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769459PMC
January 2021

Critical Review and Meta-Analysis of Postoperative Sedation after Adult Cardiac Surgery: Dexmedetomidine Versus Propofol.

J Cardiothorac Vasc Anesth 2021 Apr 17;35(4):1134-1142. Epub 2020 Oct 17.

Team Health Research Institute, Tampa General Hospital, Tampa, FL. Electronic address:

Objective: To evaluate reports from the published literature of all randomized clinical trials (RCT) comparing postoperative sedation with dexmedetomidine versus propofol in adult patients, after open cardiac surgery.

Design: A computerized search on Medline, EMBASE, Web of Science, and Agency for Healthcare Research and Quality databases was completed through June 2020. Meta-analysis of all published RCT comparing dexmedetomidine versus propofol utilization in the postoperative phase, using the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.

Setting: Assemblage and critical discussion of 11 RCTs comparing postoperative sedation from standard published reports from 2003 to 2019.

Participants: The study comprised 1,184 patients and analyzed critical discussion of time-based parameters (time to extubation, intensive care unit length of stay, and hospital length of stay) and nontime-dependent factors (delirium, bradycardia, and hypotension).

Measurements And Main Results: Time to extubation was significantly reduced in the dexmedetomidine group (standardized mean difference [SMD] = -0.70, 95% confidence interval [CI] -0.98 to -0.42, p < 0.001); however, no difference in mechanical ventilation time was observed (SMD = -0.72, 95% CI -1.60 to 0.15, N.S.). Dexmedetomidine significantly reduced the intensive care unit length of stay (SMD = 0.23, 95% CI -1.06 to -0.16, p = 0.008), but this did not translate into a reduced hospital length of stay (SMD = -1.13, 95% CI -2.43 to 0.16, N.S). For nontime-dependent factors, incidence of delirium was unaffected between groups (odds ratio [OR]: 0.68, 95% CI 0.43-1.06, N.S), and higher rates of bradycardia (OR: 3.39, 95% CI: 1.20-9.55, p = 0.020) and hypotension (OR: 1.68, 95% CI 1.09-2.58, p = 0.017) were reported with propofol.

Conclusions: Despite the ICU time advantages afforded by dexmedetomidine over propofol, the former did not seem to contribute to an overall reduction in hospital length of stay or improvement in postoperative outcomes of heart valve surgery and CABG patients.
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http://dx.doi.org/10.1053/j.jvca.2020.10.022DOI Listing
April 2021

Change in Oxidative Stress Biomarkers During 30 Days in Saturation Dive: A Pilot Study.

Int J Environ Res Public Health 2020 09 28;17(19). Epub 2020 Sep 28.

Department of Biomedical Sciences, Environmental and Respiratory Physiology, University of Padova, 35122 Padova, Italy.

Saturation diving allows divers to reduce the risk of decompression sickness while working at depth for prolonged periods but may increase reactive oxygen species (ROS) production. Such modifications can affect endothelial function by exacerbating oxidative stress. This study investigated the effects of saturation diving on oxidative stress damage. Redox status was evaluated through: ROS production; total antioxidant capacity (TAC); nitric oxide metabolites (NOx); nitrotyrosine (3-NT); and lipid peroxidation (8-iso-PGF2α) assessment. Creatinine and neopterin were analyzed as markers of renal function and damage. Measurements were performed on saliva and urine samples obtained at four time points: pre; deep; post; and 24 h post. Four divers were included in the study. After the saturation dive (post), significant ( < 0.05) increases in ROS (0.12 ± 0.03 vs. 0.36 ± 0.06 µmol.min), TAC (1.88 ± 0.03 vs. 2.01 ± 0.08 mM), NOx (207.0 ± 103.3 vs. 441.8 ± 97.3 µM), 3-NT (43.32 ± 18.03 vs. 18.64 ± 7.45 nM·L), and 8-iso-PGF2α (249.7 ± 45.1 vs. 371.9 ± 54.9 pg·mg creatinine) were detected. Markers of renal damage were increased as well after the end of the saturation dive (creatinine 0.54 ± 0.22 vs. 2.72 ± 1.12 g-L; neopterin 73.3 ± 27.9 vs. 174.3 ± 20.53 μmol·mol creatinine). These results could ameliorate commercial or military diving protocols or improve the understanding of symptoms caused by oxygen level elevation.
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http://dx.doi.org/10.3390/ijerph17197118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579105PMC
September 2020

The Role of Hyperbaric Oxygen Treatment for COVID-19: A Review.

Adv Exp Med Biol 2021 ;1289:27-35

Emergency Medicine, University of Maryland, Baltimore, MD, USA.

The recent coronavirus disease 2019 (COVID-19) pandemic produced high and excessive demands for hospitalizations and equipment with depletion of critical care resources. The results of these extreme therapeutic efforts have been sobering. Further, we are months away from a robust vaccination effort, and current therapies provide limited clinical relief. Therefore, several empirical oxygenation support initiatives have been initiated with intermittent hyperbaric oxygen (HBO) therapy to overcome the unrelenting and progressive hypoxemia during maximum ventilator support in intubated patients, despite high FiO2. Overall, few patients have been successfully treated in different locations across the globe. More recently, less severe patients at the edge of impending hypoxemia were exposed to HBO preventing intubation and obtaining the rapid resolution of symptoms. The few case descriptions indicate large variability in protocols and exposure frequency. This summary illustrates the biological mechanisms of action of increased O pressure, hoping to clarify more appropriate protocols and more useful application of HBO in COVID-19 treatment.
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http://dx.doi.org/10.1007/5584_2020_568DOI Listing
January 2021

Predicted Effects of Stopping COVID-19 Lockdown on Italian Hospital Demand.

Disaster Med Public Health Prep 2020 10 18;14(5):638-642. Epub 2020 May 18.

Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.

Objectives: Italy has been one of the first countries to implement mitigation measures to curb the coronavirus disease 2019 (COVID-19) pandemic. There is currently a debate on when and how such measures should be loosened. To forecast the demand for hospital intensive care unit (ICU) and non-ICU beds for COVID-19 patients from May to September, we developed 2 models, assuming a gradual easing of restrictions or an intermittent lockdown.

Methods: We used a compartmental model to evaluate 2 scenarios: (A) an intermittent lockdown; (B) a gradual relaxation of the lockdown. Predicted ICU and non-ICU demand was compared with the peak in hospital bed use observed in April 2020.

Results: Under scenario A, while ICU demand will remain below the peak, the number of non-ICU will substantially rise and will exceed it (133%; 95% confidence interval [CI]: 94-171). Under scenario B, a rise in ICU and non-ICU demand will start in July and will progressively increase over the summer 2020, reaching 95% (95% CI: 71-121) and 237% (95% CI: 191-282) of the April peak.

Conclusions: Italian hospital demand is likely to remain high in the next months. If restrictions are reduced, planning for the next several months should consider an increase in health-care resources to maintain surge capacity across the country.
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http://dx.doi.org/10.1017/dmp.2020.157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276503PMC
October 2020

Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure.

Disaster Med Public Health Prep 2020 08 27;14(4):541-550. Epub 2020 Mar 27.

CRIMEDIM - Research Center in Emergency and Disaster Medicine, Università del Piemonte Orientale, Novara, Italy.

Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health-care system with challenges that have limited science to guide the staff, stuff, and structure surge response.This study reviewed the available surge science literature specifically to guide an emergency department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident surge capability apply to the process to expand COVID-19 pandemic surge structure response?The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as gray literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the emergency department team's COVID-19 surge structural response.
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http://dx.doi.org/10.1017/dmp.2020.57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156581PMC
August 2020

Training of Italian emergency medicine residents in prehospital emergency medicine: state of the art and perspectives of improvement.

Intern Emerg Med 2020 04 25;15(3):519-522. Epub 2020 Jan 25.

Emergency Medicine Residency Program, Department of Medicine (DIMED), University of Padova, Via Giustiniani, 2, 35128, Padua, Italy.

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http://dx.doi.org/10.1007/s11739-020-02280-9DOI Listing
April 2020

Hyperbaric Oxygen Treatment for Carbon Monoxide Poisoning in Italy: Retrospective Validation of a Data Collection Tool for the Italian Registry of Carbon Monoxide Poisonings (IRCOP).

Int J Environ Res Public Health 2020 01 16;17(2). Epub 2020 Jan 16.

Italian Association of Patients Treated with Hyperbaric Oxygen (ASPATI), 40036 Fidenza, Italy.

: Carbon Monoxide (CO) poisoning is a frequent cause of intoxication. However, CO poisoning incidence is globally underreported, as well as its features, especially in Italy. The aim of this study was to investigate such characteristics of CO intoxication and foster the creation of the Italian Registry of Carbon Monoxide Poisonings. : A data collection tool was developed and organized in five sections: Patient's characteristics; CO intoxication modality; emergency medical service and emergency department; hyperbaric facility; outcomes. The tool was validated through a retrospective analysis, including CO intoxicated patients treated in 14 Italian hyperbaric facilities between 2015 and 2016. : A total of 1383 patients were included. The high completion ratio (85%) of the collection tool suggests its feasibility in practical terms. CO intoxications were mostly accidental (93.64%) and caused by solid fuel (48.59%). There was not a uniform application of hyperbaric oxygen treatment protocols, but most of the patients were adequately treated at least at 2.5 ATA for more than 60 min (44.97%). : This analysis provided new information that was previously unavailable in this country. Furthermore, this tool proved to be a valid base for future registry aiming to consolidate the body of knowledge about CO intoxications in Italy.
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http://dx.doi.org/10.3390/ijerph17020574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7013710PMC
January 2020

Arterial blood gases in divers at surface after prolonged breath-hold.

Eur J Appl Physiol 2020 Feb 7;120(2):505-512. Epub 2020 Jan 7.

Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC, USA.

Purpose: Adaptations during voluntary breath-hold diving have been increasingly investigated since these athletes are exposed to critical hypoxia during the ascent. However, only a limited amount of literature explored the pathophysiological mechanisms underlying this phenomenon. This is the first study to measure arterial blood gases immediately before the end of a breath-hold in real conditions.

Methods: Six well-trained breath-hold divers were enrolled for the experiment held at the "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Before the experiment, an arterial cannula was inserted in the radial artery of the non-dominant limb. All divers performed: a breath-hold while moving at the surface using a sea-bob; a sled-assisted breath-hold dive to 42 m; and a breath-hold dive to 42 m with fins. Arterial blood samples were obtained in four conditions: one at rest before submersion and one at the end of each breath-hold.

Results: No diving-related complications were observed. The arterial partial pressure of oxygen (96.2 ± 7.0 mmHg at rest, mean ± SD) decreased, particularly after the sled-assisted dive (39.8 ± 8.7 mmHg), and especially after the dive with fins (31.6 ± 17.0 mmHg). The arterial partial pressure of CO varied somewhat but after each study was close to normal (38.2 ± 3.0 mmHg at rest; 31.4 ± 3.7 mmHg after the sled-assisted dive; 36.1 ± 5.3 after the dive with fins).

Conclusion: We confirmed that the arterial partial pressure of oxygen reaches hazardously low values at the end of breath-hold, especially after the dive performed with voluntary effort. Critical hypoxia can occur in breath-hold divers even without symptoms.
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http://dx.doi.org/10.1007/s00421-019-04296-2DOI Listing
February 2020

Clinical and morphological effects of hyperbaric oxygen therapy in patients with interstitial cystitis associated with fibromyalgia.

BMC Urol 2019 Nov 5;19(1):108. Epub 2019 Nov 5.

TEAMHealth Research Institute, TGH, Tampa, Florida, USA.

Background: Interstitial Cystitis (IC) is a debilitating disorder of the bladder, with a multifactorial and poorly understood origin dealing with microcirculation repeated damages. Also Fibromyalgia (FM) is a persistent disorder whose etiology is not completely explained, and its theorized alteration of pain processing can compromise the quality of life. Both these conditions have a high incidence of conventional therapeutic failure, but recent literature suggests a significant beneficial response to Hyperbaric Oxygen Therapy (HBOT). With this study, this study we evaluated the effects of HBOT on quality of life, symptoms, urodynamic parameters, and cystoscopic examination of patients suffering from both IC and FM.

Methods: We structured an observational clinical trial design with repeated measures (questionnaires, urodynamic test, and cystoscopy) conducted before and 6 months after a therapeutic protocol with hyperbaric oxygen for the treatment of patients suffering from both IC and FM. Patients were exposed to breathing 100% oxygen at 2 atm absolute (ATA) in a multiplace pressure chamber for 90 min using an oro-nasal mask. Patients undertook a cycle of 20 sessions for 5 days per week, and a second cycle of 20 sessions after 1 week of suspension.

Results: Twelve patients completed the protocol. Changes after HBOT were not significant, except for hydrodistension tolerance (mean pre-treatment: 409.2 ml; mean post-treatment: 489.2 ml; p < 0.05). A regression of petechiae and Hunner's ulcers was also noted 6 months after the completion of HBOT.

Conclusions: Our study showed no improvement of symptoms, quality of life, and urodynamic parameters, except for hydrodistension, and a slight improvement in cystoscopic pattern. However, to date, we could not demonstrate the significance of overall results to justify the use of HBOT alone in patients with IC and FM. This observation suggests that additional studies are needed to better understand if HBOT could treat this subset of patients.

Trial Registration: NCT03693001 ; October 2, 2018. Retrospectively registered.
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http://dx.doi.org/10.1186/s12894-019-0545-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6833196PMC
November 2019
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