Proposal to amend the requirements for green certification

The paper illustrates a proposal to make green certification protection against the SARS-COV2 virus more efficient and cheaper and make it easier the access to working places. Furthermore, the paper offers critical reflections on the goal of reaching the vaccination level for herd immunity, which is ineffective if the immune status of neighboring countries is not taken into account.

By devaluing the serological test we throw the baby out with the dirty water

According to a quite diffuse opinion, also amplified by the media, the serologic test has a limited diagnostic value and is of no use as an indication to the booster dose of a COVID-19 vaccine. In addition, this point of view was strengthened by a hasting criticism, which appeared in television, social networks and newspapers and was based on a personal interpretation of a paper published in NEJM Oct 2021. The current article shows how the NEJM paper asserts just the opposite thesis, supporting the serologic test instead. Details are here provided, especially about the effective antibody/infectivity correlation and the possible threshold value between diseased and healthy people. The conclusion is that the NEJM paper strongly supports the serologic test, while the quick criticism derived from a biased lecture, in search of the confirmation of a preconception.

Heparin prophylaxis in major sclerotherapy (the Prosclep study)

Objective To study the incidence and the possibility of preventing thrombotic complications during major sclerotherapy for venous insufficiency of lower limbs. Methods A total of 2489 sclerotherapy sessions were performed on 2010 patients. 1087 sessions (43.7%) were carried out without heparin prophylaxis while in 1402 sessions (56.3%) a prophylaxis with low molecular weight (LMWH) was used. Thrombotic complications were divided into a) post sclerotherapy transient extension (POSTE) if they consisted of a simple extension of sclerotherapy, and b) deep venous thrombosis (DVT) when the complication occurred in a location separate from that of sclerosis. Results The overall incidence of a thrombotic complication was 0.52%. Out of 2489 sessions, 8 cases of POSTE (0.32%) and 5 thromboses of a gastrocnemius vein (0.2%) were diagnosed The most significant figures were reached in the great saphenous vein (GSV) subgroup, where the incidence of complications was 1.91% without prophylaxis and 0.31% (p = 0.009) with prophylactic heparin. Conclusions In this study prophylaxis with LMWH significantly reduced the incidence of thrombotic complications when sclerotherapy of the great saphenous vein was performed.

Dynamic Fractioning of the Gravitational Hydrostatic Pressure: A hemodynamic model for the venous pressure control by the valvo-muscular pump

Dynamic Fractioning of the Gravitational Hydrostatic Pressure (DFGHSP) is a pillar of a hemodynamic model of the venous pathophysiology. It describes how the valvo-muscular pump varies the distal venous pressure in the lower limbs. It results from an inductive reasoning based on clinical signs and instrumental data at rest and during the action of the valvo-muscular pump of the calf. It does not claim to be the final truth, but a new "as if" model that improved the diagnosis and the treatment of the venous insufficiency (CHIVA, French acronym for Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire) according to several randomized studies and meta-analyses. That approach overturns the classic diagnosis and treatment of venous insufficiency because it is conservative and opposes the widely spread destructive based view. It needs a minimal study of basic fluid mechanics which can explain venous hemodynamics, the core of venous pathophysiology. The proposed DFGHSP fluid mechanics model is compared with the hemodynamic clinical and instrumental data in order to assess its pathophysiologic relevance.

The measurement of venous pressure by Doppler: is it a hemodynamic evaluation ?

Since 1980 using the Doppler method, planned by Bartolo, we have studied several patients by means of the measurement of venous pressures, both in orthostatism and in clinostatism. In a normal subject, in orthostatism the value of average pressure is 60 mmHg in the posterior tibial vein, and 60 mmHg in the long saphenous vein. When there are varicose veins, the average pressure is 90 and 96 mmHg respectively in the deep veins and in the superficial ones. In the case of post-thrombotic syndrome, the average values are 101 and 102 mmHg in the deep and superficial veins, respectively. In clinostatism, the normal values are under 20 mmHg and in subjects with vein thrombosis the value increase to 30 mmHg and more. After more than 30 years we discuss the reliability of the method, the hemodynamic basis and its clinical application in phlebological practice.