Acta Biomedica Atenei Parmensis

Donation of the body and its parts in the construction of parenthood

Linda Alfano — 2023-02-13

The developments of science and technology make possible today unprecedented exchanges of body parts by multiplying the figures and links that intervene in the process of building parenthood and generating significant ethical and judicial controversies.

Body donation in the procreative field constitutes an anthropological and social phenomenon of increasing attention, which contributes to one of the most intimate and profound aspirations of the human being and which requires a careful evaluation of the various interests involved and a thorough reflection on the statute and characteristics of the parental bond.

The interest of the child, the dignity of women and the quality of human relations are the parameters of this analysis and, at the same time, the perimeter of the judgment. However, the approach to these issues is complicated not only by the extreme heterogeneity of legislation but also by suspicions and prejudices that hinder reflection appropriate to the complexity of the issues involved.

Investigate the reasons for the choice of donation, the criticalities, and possible drifts, without closing in their subjective value horizon, is an unavoidable prerequisite for a comparison with the new social realities of the family that respects the fundamental rights of the person.

Bibliometric analysis of the literature on von Willebrand disease: Research status and trends

Nada Jaber Aldossary — 2023-02-13

Background and aim: Von Willebrand disease (VWD) is considered the most prevalent inherited bleeding disorder. The current study aims to demonstrate the research status and trends on VWD worldwide. Methods: Bibliometric analysis was used to investigate the global research productivity and trends on VWD. The publications on VWD from 1956 to 2021 were extracted using the Web of Science database. In the VWD domain, a total of 3,643 records were analyzed for authorship and collaboration patterns, yearly productivity, highly cited documents, relevant source of publication, most prolific scholars, productive countries, and organizations. Results: The most productive journal, author, organization, and country were 'Haemophilia' with 439 publications, 'Favaloro EJ' with 119 publications, the 'University of Milan' with 192 publications, and the United States of America (USA) with 1,048 publications, respectively. The document with the highest citations was 'Srivastava A, 2013, Haemophilia,' which received 1,154 citations in total. In 2016, the highest number of publications shared by two author patterns was 28. With 199 publications, the year 2021 remained on the top, while the citation-wise analysis identified 2006 as the top year with 5,379 citations. Conclusions: Research productivity and publication trends on VWD revealed that the USA emerged as the most significant contributing country. The 'University of Milan' was the most significant contributing organization, while ‘Favaloro EJ’ was the most significant author. 'Hemophilia' was found to be the most significant journal in the field of VWD. It is recommended that researchers from countries with significant contributions to the field should collaborate with researchers from Asian countries and other countries that lack behind in research in the domain of VWD.(www.actabiomedica.it)

2022 - Pros and Cons in General Internal Medicine and Geriatrics

Domenico Cucinotta — 2023-02-13

Anti-Sars-CoV-2 vaccination campaign in children aged 5-11 years: the experience of a mass vaccination center in the city of Milan

Elisa Astorri — 2023-02-13

Background and aim: After the approval of the anti-Sars-CoV-2 vaccines for the pediatric population, it is necessary to encourage the immunization of children aged 5-11 years, as this can reduce intergenerational transmission. Therefore, this goal has become a priority for the COVID 19 vaccination campaign in Italy. In the city of Milan, the mass vaccination center (MVC) Fiera Milano City, previously settled for general population, became the main site to host pediatric vaccinations. The center was consequently remodeled to ensure a suitable space for children. This paper provides an overview on the organization strategy implemented by Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico. The modular structure and the wide surface available in the center allowed the administration of hundreds of vaccines per day, especially in the first opening phase.

Methods: All the data for the entire period of activity of Fiera MCV, from December 16^th2021 to February 20^th 2022, were analyzed using descriptive statistics.

Results: During the entire period of activity, from 16 December 2021 to 20 February 2022, 23% of the population in the province of Milan aged 5-11 years has been reached and vaccinated with at least one shot of vaccine in this center.

Conclusions: Despite an enthusiastic response in the first weeks of the campaign, a progressive reduction in vaccination adherence was observed, maybe due to the absence of restrictive measures for unvaccinated children in Italy.

COVID-19 restrictions and hygiene measures reduce the rates of respiratory infections and wheezing among preterm infants

Davide Scarponi — 2023-02-13

Background and aim: During the 2020 and 2021 Italian COVID-19 pandemic social restrictions and strict hygiene measures were recommended to limit the spread of SARS-CoV-2. We aimed to assess whether rates of respiratory infections and wheezing in preterm infants have changed during the pandemic.

Methods: Single center, retrospective study. Preterm infants in the first 6 months of life discharged home prior to (Period 1, January 2017 - December 2019) or during the pandemic (Period 2, January 2020 - March 2021) were compared. Rates of respiratory infection and wheezing in preterm infants with or without bronchopulmonary dysplasia (BDP) were assessed.

Results: During period 2 premature infants had lower rates of respiratory infections (36 out of 55 in Period 1 vs 11 out of 28 in Period 2, P=0.023) and wheezing (20 out of 55 in Period 1 vs 1 out of 28 in Period 2, P=0.001). This difference remained significant when infants with BPD (all grades) were analyzed separately (respiratory infections 26 out of 40 in Period 1 vs 7 out of 24 in Period 2, P=0.005; wheezing 16 out of 40 in Period 1 vs 1 out of 24 in Period 2, P=0.001). In contrast, respiratory infections and wheezing in preterm infants without BPD did not change after pandemic.

Conclusions: Episodes of respiratory infections and wheezing among preterm infants were reduced during pandemic. We highlight the importance of proper family education for preventing respiratory tract infections in preterm infants with BPD, beyond the extraordinary conditions of the COVID-19 pandemic.

The acute bronchiolitis rebound in children after COVID-19 restrictions: a retrospective, observational analysis

Antonietta Curatola — 2023-02-13

Background and aim: Bronchiolitis represents the main cause of illness and hospitalization in infants and young children. The aim of this study was to compare the Pediatric Emergency Department (PED) admissions for bronchiolitis during the post-COVID (Coronavirus disease) period to those of previous seasons and to analyze their etiology during COVID and post-COVID period. Methods: We compared demographics, clinical and microbiological data of children admitted to PED with bronchiolitis between September 2021 and March 2022 (post-COVID period) to the previous seasons (COVID and pre-COVID period). Results: During the post-COVID period the bronchiolitis season started earlier than usual, with a peak reached in November 2021; a gradual reduction was subsequently observed between December 2021 and January 2022. Our data showed a prevalence of High Priority code in children admitted to the PED with bronchiolitis during the post-COVID period (61.4%) compared the pre-COVID period (34.8%) (p=0.00). Also regarding the hospitalization of these patients, we found a major rate of hospitalization during this epidemic season (p=0.035). In addition, only 4 (1.5%) of the tested children resulted positive for SARS-CoV-2 and all of them were admitted to PED during the post-COVID period. The search for the other respiratory viruses showed during the current season a prevalence of respiratory syncytial virus (RSV) (60.2%), followed by Human Rhinovirus (30.1%). Conclusions: The post-COVID period was characterized by an early and short-term peak in acute bronchiolitis, with an increased rate of hospitalization. In addition, SARS-CoV-2 infection was rarely cause of bronchiolitis in children under 2 years old.

Baseline serum vitamin A and vitamin C levels and their association with disease severity in COVID-19 patients

Gulseren Yilmaz — 2023-02-13

Aim: We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19.

Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed.

Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001).

Conclusion: COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.

Polymorphism of tmprss2 (rs12329760) but not ace2 (rs4240157), tmprss11a (rs353163) and cd147 (rs8259) is associated with the severity of COVID-19 in the Ukrainian population

Igor Kaidashev — 2023-02-13

Background and aim: Angiotensin-converting enzyme 2 (ACE2), transmembrane serine 2 and serine 11A proteases (TMPRSS2, TMPRSS11A), and a cell surface cluster of differentiation 147 (CD147) might be a gene candidate that exerts the susceptibility to and mortality from coronavirus disease 19 (COVID-19). The aim of this study was to investigate the associations between ace2, tmprss2, tmprss11a, and cd147 polymorphic variants and the severity of COVID-19 in the Ukrainian population. Methods: The study population consisted of the Ukrainian population with COVID-19: patients without oxygen therapy (n=62), with non-invasive (n=92) and invasive (n=35) oxygen therapy, as well as control subjects (n=92). Allelic polymorphisms of ace2 rs4240157, tmprss2 rs12329760, and tmprss11a rs353163 were determined by real-time PCR, and cd147 rs8259 polymorphism was detected by PCR with subsequent restrictase analysis. We compared investigated polymorphisms distribution with other populations by meta-analysis. Results: Our study is the first to obtain data about the distribution of investigated gene polymorphisms in the Ukrainian population: tmprss2 rs12329760 – CC 60.9%, CT 35.9%, TT 3.2%; tmprss11a rs353163 – CC 46.7%, CT 40.2%, TT 13.1%; ace2 rs4240157 – CC 7.6%, C 18.5%, CT 22.8%, TT 19.6%, T 31.5%; cd147 rs8259 – TT 60.9%, AT 32.6%, AA 6.5%. This distribution was similar to the Northern, Western and Southern European populations. There was a statistically significant difference in the frequency of tmprss2 polymorphic genotypes CC 57.1%, CT 28.6%, and TT 14.3% (P<0.05) in COVID-19 patients with invasive oxygen therapy in comparison with non-invasive oxygen therapy. This tmprss2 mutation occurs in the scavenger receptor cysteine-rich (SRCR) domain and might be important for protein-protein interaction in a calcium-dependent manner. Conclusions: Our study indicated the presence of an association between the tmprss2 rs12329760 polymorphism and the severity of COVID-19 in the Ukrainian population.

SIMED-New Doc course, a matter of reflection

Giuseppe Stirparo — 2023-02-13

Background and aim: Obtaining a degree in medicine in Italy qualifies for the medical profession; this fact has entailed a newly qualified doctor’s remarkable involvement on the medical activities of the National Health Service, especially during the Covid-19 pandemic. It is important to understand the knowledge of the newly qualified doctors and to create specific courses oriented to them. The aim of the study is to evaluate the impact of a peer learning course for the students who attend the last year of medicine school, with the purpose of defining the formal requests to integrate on the course. Methods: A pre and post qualitative research has been carried out on SIMED-NEWDOC course. The course consisted on peer teaching lectures, as lecturers were resident doctors part of SIMED board. At the end of the course it has been submitted a survey to the participants, and data has been analyzed. Results: The students enrolled were 139, the average of the participants was 27% of the registered. A qualitative evaluation questionnaire was submitted, the responses were 32 (86%). Average age was 25. Participants attending the last year of medicine school were 30 (95%). 40% of them declared to have attended at least 5 lessons. Among the course participants, 96% judged the course as very useful. Conclusions: All questionnaire results are useful to reflect on future projects. It is necessary to implement further educational projects to better understand the phenomenon, considering the positive impact that participants declared.

Role and challenges to digital technologies in community health promotion programs in Italy during the COVID-19 pandemic: a multiple embedded case study protocol

Marco Del Riccio — 2023-02-13

Background and aim: Due to the COVID-19 pandemics, The Italian League Against Cancer (LILT), a national federation of local associations promoting cancer prevention, had to face the challenge to find new ways and technologies to promote health in their territories. This study aims to explore how LILT associations led their health promotion interventions during the COVID-19 pandemic and to understand which interventions had a greater impact, for which population group, and why.

Methods: In this descriptive multiple embedded case study, each case will focus on the activities of a local LILT association and their collaborators on the perception and experience of the use of digital technology for health promotion and prevention, through interviews, observations, and a study of products and artifacts. A general overview of each case study will be provided, along with an introduction of the unit(s) of more in-depth analysis. The logical models that emerge from the analysis of each case will be described by using realist analysis, producing a list of possible CMO configurations (Context; Mechanisms; Outcomes). The final report will consist of a cross-case analysis (a comparison between the different case studies).

Discussion: This multiple case study will help generate a first "theory of the use of digital technology in health promotion in local LILT communities. The observation of what local LILT associations in Italy have done during COVID-19 will help identify new and useful health promotion strategies based on these technologies.

Education nursing students' in Palliative Care and Pain Therapy: an observational study

Rachele La Sala — 2023-02-13

Background and aim: University education plays an important role in the preparation of future nurses, especially in the care of dying patients, which is one of the most emotionally engaging aspects. The objectives of the study were to describe the attitudes of students in end-of-life care and to analyze the possible relationship with some socio-demographic variables, through an observational study.

Methods: Preliminarily, an analysis of the educational context of the Nursing Course of the University of Parma was started, through a comparison of the university course with the recommendations of the MIUR concerning the teaching and learning of Palliative Care and Pain Therapy. Subsequently, a questionnaire containing the Frommelt Attitude Toward Care of the Dying Scale Form B and some socio-demographic context variables was administered to a sample of 109 students belonging to the CoS of Nursing in Parma.

Results: From the data collected, it emerged that university planning partly reflects the recommendations of the MIUR and how, on average, nursing students have described positive attitudes in all the dimensions investigated. Interesting is the presence of a positive relationship between the personal experiences of bereavement and the attitudes of the students.

Conclusions: Nurses are essential in ensuring the quality of care provided to patients at the end of life; Nursing training in Palliative Care and Pain Therapy should include a complete and varied program (frontal activity, simulation, internship paths...) in order to develop positive student attitudes associated with high levels of satisfaction and improvement of the quality of care provided.

Informal caregivers in Italy: the ‘phantom zone’ of welfare

Andrea Cioffi — 2023-02-13

Medical progress and the consequent gradual ageing of the population increase the number of people in Europe who require continuous care, as they suffer from chronic diseases or senility. This demand is disproportionate if compared to the economic resources of health systems and is, therefore, heavily supported by the activity of the so-called "informal caregivers". With our article we propose to depict the current scenario in Italy, dwelling on the safeguards, to date, aimed at informal caregivers, which are insufficient to correct the criticalities associated with the burdensome assistance provided by such figures. Such critical issues result in a real risk for the health of informal caregivers and their loved ones and require urgent action by the health system. If it is true that health welfare is not able to protect the increasing number of people who are not self-sufficient, it is necessary to invest at least on specific measures to preserve the health and skills of those who are at the forefront of this hidden welfare. (www.actabiomedica.it)

Evaluation of pain in the paediatric patient admitted to sub-intensive care: a scoping review protocol

Carlotta Granata — 2023-02-13

Background and aim: pain is considered as the 5^th vital sign thus it's paramount that healthcare professionals are equipped with validated tools for his correct assessment. There are different paediatric pain assessment scales that take into account patients’ age. Actually, the “Face, Legs, Activity, Cry, Consolability” (FLACC), Wong-Baker and NRS scales are regarded as the gold standard in low intensity clinical areas, while the COMFORT-Behavior (COMFORT-B) and Behavioral Pain Scale (BPS) ones are used for high intensity clinical areas where paediatric patients are sedated/intubated. It’s unclear which pain assessment scale should be used in sub-intensive areas such as Sub-Paediatric Intensive Care Unit (Sub-PICU) e Sub-Neonatal Intensive Care Unit (Sub-NICU).

The aim of this protocol is to map the literature in order to identify what evidences are available regarding the assessment of pain in the paediatric sub-intensive clinical areas.

Research question: “What is the literature available on pain assessment in paediatric patients in sub-intensive clinical areas such as Sub-PICU and sub-NICU?”.

Source of evidence: literature search will be performed through the following databases: PubMed, Scopus, CINAHL, Cochrane Library, Open Dissertations (EBSCO) and DOAJ. Furthermore, Cochrane CENTRAL and ClinicalTrials.gov will also be included.

Methods: this scoping review will be conducted in accordance to the Joanna Briggs Institute guidelines and the results presented through a PRISMA flowchart.

Review registration: Open Science Framework https://doi.org/10.17605/OSF.IO/8KBRQ

How knowledge time influenced anxiety, depression, stress and quality of life levels in patients suffering from Crohn disease: a cross-sectional multicenter study

Elsa Vitale — 2023-02-13

Background and aim of the work. The diagnosis of Crohn Disease (CD) represents a turning point in the life of patients, which inevitably marks them. The present study represents a direct "feed-back" from patients suffering from Crohn disease, in order to reveal how the diagnosis of CD changed lifestyles and psychological conditions in their patients. Methods. An observational, cross sectional, online, snowball sampling study was conducted through participants suffered from CD and belonged to social networks and Facebook groups. For each participant, sampling characteristics, a series of lifestyle habits Before to After the diagnosis of CD and anxiety, depression, and stress conditions were investigated. Results. A total of 785 participants agreed to participate. As Participants underwent significant challenges in their lifestyles after the CD diagnosis (p<0.001), specifically their reduced their smoking habits, alcohol and drugs intakes and also their diets both in high sugar and fatty compositions. Anxiety and stress levels were not statistical different among participants according to years of the knowledge of their CDs. Meanwhile, as regards depression condition, significantly higher levels were recorded among participants who knew their CD until 5 and 25 years, respectively (p=0.031). Conclusions. From the study emerges several aspects of quality of life compromised, a fact supported by the analysis of psychophysical sequelae, which allowed to lay the groundwork for further studies, studying the comorbidity of this disease with other factors. Future randomized controlled trials should deepen the correlation between eating disorders and CD, a link little explored in the literature.

Choosing nasal devices: a dilemma in clinical practice

Attilio Varricchio — 2023-02-13

Background and aim: Upper airway diseases are frequent and recognize different etiopathogenetic mechanisms, including infection, inflammation, and allergy. Therefore, topical treatments are preferable in comparison with systemic medications. Several delivery devices are available on the market, including nasal drops, syringes, sprays, nebulizers, and douches. However, it is clinically relevant to know the better way to use it.

Methods: The present experience compared five different devices that were tested: i) a nasal dropper, ii) a standard nasal spray device, iii) a mucosal atomization device with a nozzle tip, iv) a nebulizer device, and v) a nasal douche. Saline solution with methylene blue was the marker to evaluate the intranasal distribution.

Results: The findings showed an apparent difference in area distribution among these delivery devices.

Conclusion The present experience showed that doctors should choose the most appropriate device for the current disease in clinical practice.

Longitudinal study of ICET-A on glucose tolerance, insulin sensitivity and β-cell secretion in eleven β-thalassemia major patients with mild iron overload

Vincenzo De Sanctis — 2023-02-13

Background: Iron chelation therapy (ICT) is the gold standard for treating patients with iron overload, though its long-term effects are still under evaluation. According to current recommendations regarding transfusion-dependent (TD) β-thalassemia major (β-TM) patients, their serum ferritin (SF) levels should be maintained below 1,000 ng/mL and ICT should be discontinued when the levels are <500 ng/mL in two successive tests. Alternatively, the dose of chelator could be considerably reduced to maintain a balance between iron input and output of frequent transfusions. Study design: Due to the paucity of information on long-term effects of ICT in β-TM with low SF levels on glucose homeostasis, the International Network of Clinicians for Endocrinopathies in Thalassemia and Adolescence Medicine (ICET-A) promoted a retrospective and an ongoing prospective observational study with the primary aim to address the long-term effects of ICT on glucose tolerance and metabolism (β-cell function and peripheral insulin sensitivity) in adult β-TM patients with persistent SF level below 800 ng/mL. Patients and Methods: 11 β-TM patients (mean age: 35.5 ± 5.5 years; SF range: 345-777 ng/mL) with normal glucose tolerance test (OGTT) or abnormal glucose tolerance (AGT) for a median of 5.3(1.1-8.3) years. Results: Abnormal glucose tolerance (AGT) was observed in 7 patients (63.6%) at first observation and ) persisted in 6 patients (54.5%) at last observation. None of them developed diabetes mellitus. AGT was reversed in two patients.

One patient with NGT developed early glucose intolerance (1-h PG ≥155 and 2-h PG <140 mg/dL). Three out of 5 patients with isolated impaired glucose tolerance presented a variation of ATG. Stabilization of low indices for β-cell function and insulin sensitivity/resistance was observed. One patient developed hypogonadotrophic hypogonadism. Three out of 6 patients with SF below 500 ng/dL had hypercalciuria. Conclusion: Despite low SF level, the burden of endocrine complications remains a challenge in β-TM patients. The ability to keep iron at near "normal" level with acceptable risks of toxicity remains to be established.

Study of the hepcidin level in pregnant women with and without anemia

Raisa Aringazina — 2023-02-13

Background and aim: Currently, a wide range of laboratory markers characterizing iron metabolism is available to clinicians. However, they are mainly limited by determining the hemoglobin content, iron concentration and erythrocyte morphology, which makes it impossible to differentiate iron deficiency anemia from other hypochromic anemia forms. The study aimed to evaluate the diagnostic value of hepcidin as a ferrokinetics marker under the development of anemia during pregnancy. Methods: The study included 60 pregnant women (average age 26.0±0.74 years). They were divided into two groups. The participants of the Main group had hypochromic microcytic anemia with the reference values of the red blood cells 4.15 million/µL and the hemoglobin level 105 g/L. The reference values of these marks in the Control group were 4.54 million/µL and 124.50 g/L respectively. Results: Low levels of Fe, ferritin, and hepcidin were detected in pregnant women with anemia. The serum hepcidin concentration of women with anemia was 0.55 ng/mL. The anemia-diagnosed group had a reduced ferritin level by 32% (4.5 ng/mL). This point for the Control group was 14.0 ng/mL. A positive moderate relationship was indicated for hepcidin and Fe (r=0.39; P=0.05). At the same time, a negative moderate relationship (r=-0.56; P=0.05) was found between hepcidin and ferritin. Conclusions: Data from pregnant women with anemia showed hypochromic microcytic anemia with a serum ferritin level of 4.5 ng/mL and hepcidin level of 0.55ng/mL. The present research furtherly supports the valid role of hepcidin in the diagnosis of iron deficiency anemia in pregnant women. (www.actabiomedica.it)

Air microbial sampling in operating theatres by active and passive methods: equation correlation from the GISIO-ISChIA study results and comparison with the EU GGMP recommendation, towards the definition of threshold values

Cesira Isabella Maria Pasquarella — 2023-02-13

The aim of this study was to calculate the equation of correlation between the microbial air contamination values obtained by active sampling (colony-forming units per cubic metre, CFU/m³) and by passive sampling (Index of microbial air contamination, IMA), by using the data from the ISChIA study, and to compare the values obtained with the recommended limits defined by the EU Guidelines to Good Manufacturing Practice (EU GGMP), 2008, for clean areas used to manufacture sterile medicinal products.

Air sampling was performed during 335 elective prosthesis procedures. Correlation between CFU/m³ and IMA values was evaluated using the Spearman test; p<0.05 was considered to indicate significance. This equation was used to calculate the IMA values corresponding to the CFU/m³ recommended threshold values by EU GGMP for the different Grades of microbial contamination.

The following correlation equation was obtained: y = 1.86 + 0.12x, where “x” = cfu/m³ value and “y” = IMA value. The relationships between CFU/m³ and IMA values obtained from active and passive sampling during the ISChIA study showed to be in line to those suggested by the EU GGMP for pharmaceutical manufacturing for Grade C and D.

This study shows that the EU GGMP relationship could be considered valid also for operating theatres. Both methods, active and passive samplings, can be used to evaluate microbial air quality and highlight critical situations; however, in particular during the activity, passive sampling estimating the risk posed by airborne microorganisms to the surgical wound, can be considered more relevant, and for its simplicity, economy and standardization, can be suggested for routine microbial monitoring.

Spinal cord injuries in the absence of post-traumatic radiographic anomalies (SCIWORA): the traumatic moment between patient anterior state and efficient/concurrent causes of injury

Giuseppe Basile — 2023-02-13

Background and aim:Spinal Cord Injury without Radiographic Abnormality (SCIWORA) represents acute traumatic myelopathy in the absence of instrumental evidence of fractures and/or dislocations of the cervical vertebrae.
Methods:In this article we present 4 cases of SCIWORA that came to our observation and the medico-legal implications associated with them.
Results:In defining the compensation in the context of a private accident policy for traumatic pathologies of the spinal cord, an in-depth medical-legal assessment is essential, based on an accurate examination of the health documentation including the instrumental investigations performed, the anamnesis and an accurate evaluation of the trauma dynamic. The paraphysiological deterioration of organ-tissue structures, identifiable in the concept of "natural variability of biological risk", should be included in the same definition of insured risk by age group, with the consequence that physical conditions that fall within the physiological or paraphysiological definitions, although potentially contributing to injury, do not necessarily exclude compensation. A different concept dominates the variability of the compensation according to a paraphysiological pre-existing condition. The two arguments therefore call for thorough consideration of both the paraphysiological contributing causes of injury and/or impairment as necessarily subject to a preliminary study, which through the clinical and instrumental investigation method, will define the perimeter of functionality.

CT-guided ozone mixture injection in treatment of symptomatic lumbar facet synovial cysts

Salvatore Masala — 2023-02-13

Background and aim: To evaluate the clinical and radiological outcomes, in terms of safety and efficacy, of a new treatment method for symptomatic lumbar facet synovial cysts (LFSC), based on ozone injection inside the cyst.

Methods: We retrospectively reviewed clinical records and imaging studies of 77 patients who underwent CT-guided ozone treatment of symptomatic facet joint synovial cysts in our department over a 5-year span.

Clinical outcome was assessed with Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) evaluations, obtained prior to the intervention and at 1-, 3-, 6- and 12-months follow-up.

Follow-up MRI imaging at 6 and 12 months were obtained and confronted with the pre-procedural MRI to analyse cyst modification after the intervention.

Results: Ozone administration was technically successful in 100% of procedures; no immediate complications occurred. At 1 month evaluation, 92% of the patients referred partial or complete symptomatic response; 86% of patients at 3 months and 84% at 6 months confirmed symptoms improvement; final assessment, at 12 months after intervention, outlined overall significant clinical improvement in 81% of patients. During the 12 months of follow-up only 3 patients had a relapse of the cyst (at 6 months) that were retreated with a 100% success.

Conclusions: CT-guided ozone therapy for symptomatic LFSC is a safe and innovative treatment option, with good clinical results at 12 months follow-up in a significative percentage of patients, thus reducing the need for invasive surgical interventions.

Effects of benralizumab in a population of patients affected by severe eosinophilic asthma and chronic rhinosinusitis with nasal polyps: a real life study

Carla Santomasi — 2023-02-13

Background. Chronic rhinosinusitis with nasal polyps (CRSwNP) is a frequent comorbidity in severe eosinophilic asthma (SEA), which may contribute to the loss of asthma control. CRSwNP and SEA share a T2-mediated mechanism and the use of some anti-asthma monoclonal antibodies has recently been extended to CRSwNP. Unlike dupilumab and omalizumab, benralizumab approval for CRSwNP is ongoing. We aimed to evaluate the efficacy of benralizumab efficacy on SEA and on CRSwNP in patients affected by both pathologies in a real life setting.

Methods. 17 patients affected by both SEA and CRSwNP participated to our study. At baseline (T0) and at one year after benralizumab initiation (T1), all participants underwent spirometry, exhaled nitric oxide (FeNO), Asthma Control Test (ACT), nasal endoscopy with Nasal Polyp Score (NPS), nasal cytology and Sino-Nasal Outcome Test 22 (SNOT 22).The continuous oral corticosteroid therapy (OCS), the number of year exacerbations and the need for sinus surgery were also evaluated for each patient.

Results. At T1, a marked reduction of SNOT-22, NPS, nasal eosinophils and neutrophils count were shown compared to T0. Moreover, at T1 ACT was significantly increased and FeNO, exacerbations/year and mean OCS dosage were significantly reduced compared to T0.

Conclusions. Our real-life study demonstrates the efficacy of benralizumab not only on SEA but also on nasal cytology and on nasal polyposis, confirming that patients affected by both SEA and CRSwNP may receive a considerable benefit from anti-IL5 receptor, treating both the comorbidities at once.

Forensic application of foot dimensions in ethnic differentiation among Ghanaians

Collins Adjei-Antwi — 2023-02-13

Background and aim: Foot dimensions are known parameters for height estimation and personal identification in most developed countries but there appears to be dearth of information about their utilization in developing countries. Therefore, the present study sought to provide ethnic-specific baseline data on foot dimensions and bring to light the differences that exist between some ethnic groups in Ghana. Methods: One hundred and ninety-three undergraduate students consisting of Ashantis, Fantes and Ewes were recruited. Plantar surfaces were scanned and foot dimensions were taken. Results: The left 1^st, right 2^nd and 3^rd toe-pternion lengths and the right breadth at ball were the only dimensions that exhibited differences between the Ashanti and Fante ethnic groups. However, differences were recorded between the Ashanti and Ewe feet for all the measurements taken. Also, with the exception of the right 5^th toe-pternion length, all the dimensions exhibited differences. Conclusions: Inter-ethnic differences exist for the dimensions of the foot between the ethnic groups that were involved in the present study. The present study has provided ethnic specific baseline data on foot dimensions for identification purposes.

Knowledge, attitudes, and practice of leadership skills among undergraduate medical students

Ghita Hjiej — 2023-02-13

Background and aim: Medical knowledge alone is insufficient to provide excellent medical care. Modern healthcare challenges require that all physicians have leadership skills in order to better cooperate and collaborate with other healthcare professionals and effectively lead their teams to provide the best possible care to their patients. The objective of this study was to describe medical students’ prior knowledge of leadership concepts, to assess their common practice of its main skills and to explore their general perception of its application by their seniors.

Methods: Non-graduated medical students enrolled in the 5th year of medicine or above were invited to fill-in an anonymous online questionnaire. 267 students (66% women) from different medical faculties took part in the study.

Results: 44% of the participants had a vague idea about leadership and 29% were completely ignorant of the concept. 52% of them thought that leadership was not to be expected from medical students, and 65% did not know that leadership in healthcare would benefit the patient. In their responses to simulated situations, the participants presented optimal attitudes embracing leadership attributes regarding self-awareness, receiving feedback, teamwork, stress and conflict management, however they present more contrasting attitudes when it came to time management and questioning oneself. Seniors with good leadership skills were perceived as few by half the participants.

Conclusions: This survey highlighted the need of introducing specific leadership training programs within the curriculum of medical studies in Morocco.

Exploring real-world practices and challenges of sarcoma diagnosis in Morocco: A survey-based study among 144 pathologists

Jinane Kharmoum — 2023-02-13

Background and aim: Sarcoma diagnosis is a challenge for laboratories of cytopathology and anatomic pathology. We conducted this survey-based study to better elucidate real-world practices and challenges of sarcoma diagnosis.

Methods: This was a cross-sectional study using an anonymous questionnaire. The survey was distributed among pathologists using snowball sampling. Descriptive statistics were used to report the finding of this survey.

Results: A total of 144 Moroccan pathologists were surveyed. Most respondents were from academic institutions (41.7%) and those with a specialization in sarcoma diagnosis represented 57%, through training using post-graduate fellowships followed by internships abroad and inter-university diplomas. Remarkably, 36.8% of participants reported no training on sarcoma pathology during their career. Regarding frequency of sarcoma diagnosis, 64.6% of pathologists reported having received less than one case of sarcoma per week and more than 70% did not receive sufficient information from referring clinicians. The majority of pathologists reported their nonattendance in multidisciplinary meetings. Morphology and immunohistochemistry were the most frequently used diagnostic tools, while fluorescence in situ hybridization and other molecular biology techniques were accessible for only 27% and 20.1% of pathologists, respectively. Response time during pathological diagnosis of sarcoma was 14 days according to 52.8% of surveyed participants. In addition, a second opinion was needed for 66% of pathologists.

Conclusions: Specialized training on sarcoma pathology in Morocco is lacking. A national working group on sarcoma pathology is needed to provide second opinions, and therefore, improve the management of this malignancy of poor prognosis. (www.actabiomedica.it)

Femoral neck fractures treated with cannulated screws: can surgeons predict functional outcomes and minimize the risk of necrosis?

Silvia De Franco — 2023-02-13

Background and aim: Femoral neck fractures are among the most frequent in mankind. Screw fixation is considered a suitable approach specially for undisplaced or slightly displaced fractures that occur to young patients. We conducted our study in order to evaluate both functional outcomes and complication rates of patients who received this treatment in our institution. A particular focus was given to the aseptic necrosis of the head, trying to identify if anamnestic, clinical or radiological data could play a significant role as prognostic factors.

Methods: For each case who was treated with screw fixation due to a femoral neck fracture, we recorded data regarding, among the others, BMI and whether they used tobacco products or corticosteroids on a regular basis. Necrosis of the femoral head and mechanical complications were recorded. Functional outcome was evaluated using the Harris Hip Score.
Results: 74 cases were included in our study. The mean Harris Hip score was 89.5. Aseptic necrosis of the femoral head occurred in 9 cases (12.2%). Regular use of tobacco was associated with a higher risk to develop necrosis (p=0.007). The Body Mass Index was significantly higher in cases who had necrosis compared to the rest of our population (p=0.043) and was inversely proportional to the post-operative Harris hip score (p=0.001).

Conclusions: While considering screw fixation to treat cases with femoral neck fractures, patient’s weight and use of tobacco should be considered as prognostic factors. (www.actabiomedica.it)

The importance microRNAs as a biomarker in lung cancer

Duran Canatan — 2023-02-13

Introduction: Lung cancer (LC) is the most common cancer in the world.Well known causes are long term smoking, environmental influences and genetic variations. LC is divided into two main types based on their histological phenotypes; small cell lung cancer (SCLC), and non-small cell lung cancer (NSCLC). The high specificity of these new screening methods, which are non-invasive, safe, inexpensive and simple to perform, is important in the early diagnosis and prognosis of cancer. MicroRNAs are significant biomarkers on the diagnosis metastasis and targeted therapies of NSCLC. In our study, we aimed to investigate the potential of using microRNAs as a biomarker in the early diagnosis of lung cancer.

Material and method: Twenty patients diagnosed with lung cancer and twenty healthy individuals of the same age and gender were selected as the control group. Sixteen microRNAs were studied from blood samples.

Result: Sixteen miRNAs (Let -7c, Let-7g, miR-1, miR-21, miR-29a, miR-31, miR-34a, miR 103a, miR-141, miR-155, miR-193b, miR-200b, miR-205, miR-340, miR-486, miR-708) were selected for tests and MiR 181 and miR 192 were used as the endogenous control group in line with their binding potentials and gene expression levels. The most specific and sensitive miRNAs were mirR-29a, miR-103a, and miR486 according to endogen controls in patients and healthy subjects.

Discussion: A meta-analysis study showed that circulating miRNAs could be promising biomarkers for early diagnosis of lung cancer. Overall, 17 studies were included evaluating 35 miRNA markers and 19 miRNA panels in serum or plasma. The potential role of circulating miRNAs for non-invasive lung screening has been highlighted.

In conclusion, there is a need for further validation studies for the use of three miRNAs as a biomarker in the early diagnosis and prognosis of lung cancer.

Novel Psychoactive Substances and legislative harmonization in Europe: addressing a extremely elusive public health threat

Federica Umani Ronchi — 2023-02-13

It's never endometriosis, except when it's endometriosis

Alessandro Libretti — 2023-02-13