Showing papers in "Clinica Terapeutica in 2023"

Therapeutic educational workshops for caregivers of patients with severe acquired brain injury.

Abstract: Abstract Severe acquired brain injury (sABI) leads to a wide range of functional limitations in cognitive, moto and behavioural abilities. These changes impact the patient's family in terms of the feeling of emotional and physical health, social life and financial condition. Caregivers are often intensely involved in the patient's management exposing them to negative effects of caregiving including stress, mood disorders and decreased quality of life. Implementing forms of active involvement of caregivers in the rehabilitative program could be useful. Thus, in the present study, therapeutic educational workshops (TEWs) for caregivers during the post-acute intensive hospitalization were organized during the post-acute intensive hospitalization of patients with sABI. The caregivers were asked to participate in the workshops to actively involve them in the patient's care and neurorehabilitation program. Each workshop session provided indications regarding the management of the patient with aphasia, neglect, behavioural and swallowing disorders. A questionnaire of 22 items has been designed in order to represent possible indicators of usefulness and effectiveness of the TEWs. The primary aim of this study was to develop a reliable and valid questionnaire able to assess the caregivers' satisfaction with the modalities of carrying out the TEW as a novel activity during the post-acute hospitalization of patients with sABI. The second aim was to assess the caregivers' satisfaction with the utility of the TEW as a tool to enhance their skills in the management of patients' disabilities. 100 caregivers of patients with sABI who attended at least one TEW session and completed the questionnaire were included in the analysis. In conclusion the administered questionnaire has proven to be a valid and reliable tool to evaluate sABI caregivers' satisfaction with TEW. Moreover, caregivers were satisfied with the organization of the TEW and with their usefulness in the management of the patients with sABI.

Attitudes of Italian Infertile Women Toward Ethical and Regulatory Limits of Medically Assisted Procreation (MAP).

Abstract: Objective Outline the views of Italian women, with fertility problems, on Medically Assisted Procreation. Methods We have collected the opinions of 448 infertile women. The items used in the questionnaire were created with a qualitative method based on the Medically Assisted Procreation's most important bioethics issues and on the basis of the limits imposed by Law. The questions of the first part of the questionnaire were open; in the second part was closed ("Yes/No"); for each method they were asked whether they would introduce a legal limit to prohibit it. The tests have been standardized with test-retest method. Results We found that much of the disputes that have, over time, been made to Law 40 of 2004 by Italian Courts, are shared by patients with infertility problems. Italian women do not share the legal limit for Medically Assisted Procreation in over 43 women, heterologous in-semination with seed donation and egg donation. Moreover, our sample show that Italian women do not share legal limit to pre-implantation genetic diagnosis and cryopreservation of embryos. Moreover, it emerges that many Italian infertile patients disagree with the Medically Assisted Procreation for homosexual couples. Conclusion It will be important, in the event of a legislative reform in Italy on the Medically Assisted Procreation, also consider the point of view of women with infertility problems.

Survival of osseointegrated implants: a 10-year retrospective study.

Abstract: Introduction New techniques, surgical protocols, dental implant designs, and prosthetic rehabilitation have been used in dentistry, most of which have yielded good results in the literature. This retrospective survey assessed the clinical results of patients rehabilitated with dental implants between January 2011 and December 2021. Load protocols (immediate and conventional), types of connections of the installed implants, external hexagon (EH), and cone morse (MC) were evaluated. Material and methods Two evaluators were selected and calibrated to perform the analyses. The inclusion criteria were records with complete and legible information of patients rehabilitated with dental implants who were followed for at least 1 year after rehabilita-tion. The medical records were divided into two groups, G1 (implants with conventional load) and G2 (implants with immediate load), and further subdivided according to implant type. Information about the rehabilitation failures was noted and descriptive statistics of the results were obtained. Results Among the 432 evaluated medical records of patients rehabilitated with implants, the study included 319 records: 223 from women and 96 from men, aged 20-79 years. In total, data were available on 1,227 implants with dimensions of 10-13 mm and diameters of 3.75-4 mm. The G1 (n=1.188) survival rates were 94.95% for EH implants and 99.5% for MC implants. In G2 (n=39), the survival rates were 93.75% for EH implants and 91.3% for MC implants. The implant survival rates were relatively high among all groups evaluated; however, the discrepancy between the number of implants in the groups may compromise the comparison between them. Understanding and respecting the biomechanical and technical principles of each protocol was the main factor influencing the success of rehabilitation. Conclusion The results of this study showed that, according to medical records, rehabilitation with dental implants showed excellent results regardless of the connection type (EH or MC) or loading protocol (conventional or immediate). The two loading protocols and two connection types had excellent results and scientific support. Therefore, the choice should be based on the clinical needs of each patient.

The role of Carcinine treatment on glico-lipidic imbalance of patients with altered blood glucose pattern.

Abstract: Objective Several studies support the active role of Carcinine, an L-carnosine metabolite, in insulin resistance and dyslipidaemia, to modulate the insulinemic/glycaemic profile and fat metabolism. Materials and methods 100 (50 women and 50 men) volunteers, aged between 40 and 85 years with a body mass index (BMI) between 25 and 34,9 kg/m2, spontaneously addressed to our "Second Opinion Medical Consulting Network" (Modena, Italy) between 2019 and 2020, were included in this anecdotal, observational, retrospective trial. The aim of the study was to find an adequate possibly natural treatment for unbalanced insulin resistance pattern notwithstanding ongoing administration of statins, and hypoglycaemic chemical agents in healthy overweight/obese subjected. All the patients were divided in two groups: 1) the first group included 50 patients that were admi-nistered with a specific galenic nutraceutical product containing 20 mg of carcinine, and 2) the second group included 50 patients, which were administered with lithothamnion calcareum alga (190 mg) and three-time day for two months. The waist circumference, glycaemia, homeostasis model asses-sment (HOMA-IR), glycated haemoglobin, total cholesterol values were detected at time 0, and time 1 (after treatment). At the same time, the pre versus post treatment, Advanced Glycation End products (AGEs), that play an important role in the development of diabetic va-scular complications, were instrumentally measured at time 1 and 2. Results After 60 mg/day of Carcinina treatment, glycaemia (p=0,001), glycated haemoglobin (p<0,001), total cholesterol (p<0,003), serum insulin (p<0.05) were significantly reduced, respect to placebo period. Abdominal circumference (p<0.2), HOMA index (p<0.03) progressively were reduced as well. No cardiovascular risk and untoward effects were observed at the prescribed dosages. The AGE reader test showed a statistically meaningful reduced risk due to reduced amount. Conclusions Carcinine, at the daily dose of 60 mg/day, was able to modify, safely, the AGEs that induced cardiovascular risk, the waist circumference, and some glycolipid-metabolic parameters in over-weight/obese patients with altered blood glucose pattern, improving significantly the impending metabolic syndrome.

Dirofilariosis infestation of pectoralis major muscle in Italy, a case report.

Abstract: Abstract Zoonotic dirofilariasis infestation, caused by Dirofilaria Repens, is described worldwide in different countries. A 31-years-old male patient presented thoracic muscle pain after growth of an ovoidal undefine cyst in left parasternal region. Patient reported several contacts with different species of animals for a familiar activity. In absence of blood inflammatory indices and systemic symptoms, imaging studies showed a suspected muscle cyst infection. Surgical excision was performed and microbiology confirmed parasite nature. Dirofilaria Repens, probably adult female, was identified. Treatment resulted to be definitive and any other clinical and surgical approach was needed. Healing time was uneventful and follow-up showed no further systemic relapses. The case highlights the effectiveness of surgical treatment in this subcutaneous infestation for an increasing number of human cases reported in endemic areas such as Central Italy.

Susceptibility of Bacillus subtilis to Zinc Oxide Nanoparticles Treatment.

Abstract: Aim With the characteristics such as low toxicity, high total surface, ability to inhibit the growth of pathogenic microorganisms, zinc oxide nanoparticles (ZnO NPs), as one of the metallic nanoparticles, have been chosen as an antibacterial agent to treat various skin infections. The present study was aimed to determine the antibacterial potential of ZnO NPs on Bacillus subtilis, the Gram-positive bacterium that can cause skin and wound infections. Methods B. subtilis was exposed to 5 to 150 μg/mL of ZnO NPs for 24 h. The parameters employed to evaluate the antimicrobial potential of ZnO NPs were the growth inhibitory effect on B. subtilis, the surface interaction of ZnO NPs on the bacterial cell wall, and also the morphological alterations in B. subtilis induced by ZnO NPs. Results The results demonstrated a significant (p <0.05) inhibition of ZnO NPs on B. subtilis growth and it was in a dose-dependent manner for all the tested concentrations of ZnO NPs from 5 to 150 μg/mL at 24 h. Fourier transformed infrared (FTIR) spectrum confirmed the involvement of polysaccharides and polypeptides of bacterial cell wall in surface binding of ZnO NPs on bacteria. The scanning electron microscopy (SEM) was used to visualize the morphological changes B. subtilis illustrated several surface alterations such as distortion of cell membrane, roughening of cell surface, aggregation and bending of cells, as well as, the cell rupture upon interacting with ZnO NPs for 24 h. Conclusion The results indicated the potential of ZnO NPs to be used as an antibacterial agent against B. subtilis. The findings of the present study might bring insights to incorporate ZnO NPs as an antibacterial agent in the topical applications against the infections caused by B. subtilis.

Lifestyle behaviors among Canadian nurses working night shifts in the COVID-19 era: a pilot study.

Abstract: Abstract Working night shifts has been associated with negative mental health consequences such as depression, anxiety, and sleep problems. The objectives of this study were to determine the lifestyle behaviors (prevalence of nicotine, caffeine, cannabis, sleep-promoting medication, and alcohol use) and the association between job stress, sleep quality, anxiety, and depression among registered nurses working night shifts in the Canadian province of Saskatchewan in the COVID-19 era. Twenty-two registered nurses ranging from ages 25-65 that work permanent or rotating night shifts participated in an online survey from April 11th to July 15th, 2022. The results showed a strong positive association between sleep disturbance, and depression r (19) = 0.50, [p = 0.029, 95% CI, 0.06, 0.78]. A positive correlation was found between higher levels of reported anxiety and sleep disturbance r (19) = 0.69, [p = 0.001, 95% CI, 0.34, 0.87]. There was a positive correlation between depression and occupational exhaustion r (17) = 0.56, [p = 0.021, 95% CI, 0.10, 0.82]. Anxiety was significantly related to occupational exhaustion r (17) = 0.65, [p = 0.005, 95% CI, 0.24, 0.86] and depersonalization r (17) = 0.52, [p = 0.005, 95% CI, 0.06, 0.80], but not significantly related to personal accomplishment r (17) = -0.34, [p = 0.185, 95% CI, -0.70, 0.17]. In conclusion, a sample of Canadian nurses working night shifts in the province of Saskatchewan during the COVID-19 pandemic showed a significant positive relationship among sleep disturbance, anxiety, and depression. Furthermore, most nurses reported using at least one or more of the following substances: sleep-promoting medication, nicotine, alcohol, and cannabis.

Characteristics of oocytes that failed to fertilize after intracytoplasmic sperm injection.

Abstract: Background We assessed the morphologies of meiotic spindles in oocytes that failed to fertilize following intracytoplasmic sperm injection (ICSI) and identified factors contributing to failed fertilization. Methods A total of 225 unfertilized oocytes were collected after ICSI. Oocytes were fixed and stained for tubulin and chromosomes. Meiotic spindle morphologies, chromosome alignment, and sperm nuclear decondensation were assessed to identify contributing factors to fertilization failure. We identified relationships between several factors and both abnormal spindle morphologies and sperm nuclear decondensation in oocytes that failed to fertilize. Results Three causes for unfertilized oocytes after ICSI were identified: (I) the absence of a sperm nucleus in the ooplasm; (II) failed oocyte activation; and (III) defects in pronucleus formation or migration. The rate of disarranged polar spindles in oocytes collected from women older than 35 years (73.3%; 33/45 oocytes) was significantly higher than that of those collected from women 35 years and younger (50.4%; 68/135 oocytes; odds ratio [OR]: 2.71, 95% confidence interval [CI]: 1.29-5.69, p = 0.009). The proportion of unfertilized oocytes with abnormal spindles and chromosome misalignment was significantly higher in oocytes collected from women older than 35 years than those from women 35 years and younger (62.2% vs. 41.5%, p = 0.016). The proportion of partially decondensed chromatin in the abnormal sperm morphology group was significantly higher than in the normal sperm morphology group (66.7% versus 52.9%, OR: 1.78, 95% CI: 1.01-3.11, p = 0.044). Conclusions The main contributor to the failure of oocytes to fertilize after ICSI is failed oocyte activation. The ICSI technique used, the maternal age, and sperm morphology are also contributing factors in fertilization failure after ICSI.

Informed consent and compulsory treatment on individuals with severe eating disorders: a bio-ethical and juridical problem.

Abstract: Background The problem concerning the activation of the measure of Compulsory Health Treatment (CHT) for subjects suffering from Eating Disorders (ED) represents a legal paradox that places health professionals in the position of frequently doubting the real usefulness of the measure within the hospital context. This issue is mainly related to anorexia nervosa, which puts the subject in a higher life-threatening situation than other EDs. Method and materials To outline the current state of the art, the most recent national and international scientific publications concerning informed consent and CHT in EDs were searched. In addition, Italian rulings in various degrees of judgement were evaluated with the suggestion of a possible resolution of these issues. Results The analysis of the literature showed that although a multitude of psychometric instruments has been created to identify the ability to give informed consent, there are still not all the elements necessary to identify the actual degree of disease awareness of ED subjects. An important factor could be the exploration of the person's interception, which has been seen to be very high in individuals with AN who are known not to experience the sensation of hunger. At present, reviews of the bibliography and judgments have shown that the measurement of CHT remains crucial if it is intended as a life-saving treatment. However, it is evident that in terms of BMI, CHT is not a definitive intervention and therefore the adoption of this practice is necessary with extreme caution taking into account the person's actual ability to consent. Conclusions Future studies will have the task of determining the psychic factors necessary to better understand the state of the person in his or her physical and mental wholeness, giving due weight to these characteristics and orienting knowledge in a practical sense to more profitable direct treatment for individuals with ED.

Oral THC: CBD cannabis extract in main symptoms of Alzheimer disease: agitation and weight loss.

Abstract: Objectives Ten million new cases of dementia are recorded annually worldwide, with agitation and idiopathic weight loss being the most common symptoms. Several pharmacological therapies have emerged in recent years, but the clinical use of cannabis extracts in older patients with AD is constantly growing. This retrospective, analytical, observational, spontaneous trial aimed to enhance the clinical action of THC: CBD cannabis extract administration in AD patients with severe symptoms such as agitation, weight loss, cognitive impairment, and sleep disturbance. Methods Thirty patients (9 men and 21 women) diagnosed with mild, moderate, or severe AD, aged 65-90 years, appealing to our Second Opinion Medical Consultation (Modena, Italy), were enrolled and required to use oil-diluted cannabis extract, Bedrocan® (22% THC, 0.5% CBD, Olive Oil 50 ml), twice a day for 12 weeks. The efficacy of cannabinoid therapy was evaluated at baseline and 12 weeks after therapy, employing three self-administered questionnaires completed by the parents of the enrolled patients: NPI-Q, CMAI, and MMSE. Key findings The NPI-Q demonstrated a reduction (p<0.0001) in agitation, apathy, irritability, sleep disturbances, and eating disturbances, consequently improving caregiver distress. Levels of physically and verbally aggressive behaviours, measured using the CMAI questionnaire, were lower (p<0.0001) in all patients. The MMSSE questionnaire confirmed a significant decrease (p<0.0001) in cognitive impairment in 45% of the patients. Conclusion Our anecdotical, spontaneous, and observational study demonstrated the efficacy and safety of oil-diluted cannabis extract in patients with AD. The limitations of our study are: 1) small patient cohort, 2) absence of control group, 3) self-administered questionnaires that are the most practical but not objective instruments to assess the neurologic functions of AD patients.

What to remove from the work environment: the sick worker or the cause of his sickness? Workplace bullying, a form of violence that causes sickness.

Abstract: Abstract Although there are many different definitions of workplace bullying in the scientific literature, it can be defined as a form of psychological and relational violence conducted systematically and continuously by one or more individuals, towards another individual, with the aim of causing him physical and mental harm and exclude him from the workplace. The elements common to all definitions are the work context, the duration for at least six months, the frequency of bullying actions, which must occur at least once a week, the evolution in phases and the power differential between aggressor and victim. The purpose of this article is not only to provide the most important definitions of workplace bullying and to identify the common elements, but also to report the most recent findings concerning gender and personality differences of both victim and aggressor, to report the most investigated professional sectors, to describe the causes and the consequences on both the worker and the organization and to present the legislative framework. Workplace bullying can be considered an emerging public health problem that requires preventive interventions. Secondary and tertiary prevention interventions are important, but the aim is to prevent the phenomenon when it has not yet developed. Primary prevention interventions promote a healthy work environment that reduces the development of work-related violence, including workplace bullying.

A rapid review of time management strategies among nurse managers.

Abstract: Background Time management practice is the act of influencing one's behavioural dimensions to complete as many tasks as possible within a specified amount of time. These behavioural dimensions include work organization and the continued application of time management techniques. Good time management, such as setting goals and priorities, as well as planning and delegating tasks, can facilitate productivity and success, contributing to work effectiveness, maintaining balance and job satisfaction. Conversely, poor time management has been associated with poor quality of work, low productivity, negative influence on the career path, and high levels of stress. Aim The study aims to identify the strategies used by middle nurse managers in time management. Methods A rapid review of biomedical databases was undertaken during the month of June 2021. The included studies were published in English and in Italian. Results Findings reveal that the most used and effective time management strategies for nurse managers are setting goals, and priorities and delegating tasks. Other useful strategies also found to be fundamental are discussed in detail. Conclusion A manager should prioritize the concept of planning, which can be counted as an efficient time management technique and educate himself on delegating. Time management has an impact not only on productivity and organizational success, but also on the balance between private and working life of managers.

Sex differences in minutiae frequencies of thumbprint with respect to dermatoglyphic patterns.

Abstract: Abstract The present study is an attempt to study the sex differences in minutiae frequencies of thumbprint with respect to dermatoglyphic patterns. A sample of 100 subjects (50 males and 50 females) were gathered from Shimla, Himachal Pradesh (North India). In regards to pattern type, maximum number of minutiae was present in loop pat-tern followed by whorls and least minutiae were in the arches in the right hand of both the sexes and left hand of females only, whereas in left hand of the males highest frequency of minutiae were noticed in whorls followed by loops and lowest in the arches, thereby indicating the lessened bimanual symmetry in males. It can be inferred from the present study that the simple pattern (arch) has less discontinuance in the regular flow of the ridges, while the complex patterns (loops and whorls) exhibited more interruptions in the dermal ridges.

Association between nonalcoholic fatty liver disease and carotid intima-media thickness.

Abstract: Background Many non-invasive methods have been studied for assessing the severity of fatty liver disease and carotid intima-media thickness (CIMT). However, the correlation between hepatic steatosis and CIMT has not been fully studied, either globally or in Vietnam. This study investigated the association between nonalcoholic fatty liver disease (NAFLD) and CIMT. Methods A cross-sectional study was performed on 125 patients at the Cardiology Department, the Emergency Interventional Cardiology Department, and the Internal Cardiology Clinic of Thong Nhat Hospital. Results Among the 125 patients in our study population, NAFLD was diagnosed in 56%, and the mean CIMT was 0.89 ± 0.48 mm. Normal CIMT was measured in 21% of patients, whereas 79% had an elevated CIMT. The NAFLD rates were significantly different between patients with normal and increased CIMT, at 26.9% and 69.6%, respectively (p = 0.001). Conclusions Our study revealed a strong association between NAFLD and CIMT. NAFLD is currently considered a feature of metabolic syndrome, and an increase in the prevalence of NAFLD might result in an increase in the incidence of cardiovascular disease.

Efficacy of ultrasound therapy combined with cryotherapy in pain management and rehabilitation in patients with Achilles tendinopathy: a retrospective observational study.

Abstract: Background Achilles tendinopathy (AT) is characterized by pain, reduced performance, and swelling in and around the tendon. The aim of our study was to evaluate and compare the effects of ultrasound therapy alone or associated with cryotherapy. Methods We analyzed retrospectively amateur runner patients who run at least 3 times a week, with medical and ultrasound diagnosis of subacute AT of the midportion. All patients underwent 10 sessions of ultrasounds' therapy with qmd® ultrasound cryo and a therapeutic exercise with stretching and eccentric exercises. The Cryo-Ultrasound Group (CUG, 15, 8M and7/F), during the ultrasound treatment, underwent a session of cryo-ultrasound therapy. The Ultrasound Group (UD, 15, 7M and 8F) only performed ultrasound therapy. Results All evaluations performed show significant improvement over time in both groups. The CUG shows at T1 a greater increase in pain and function compared to the UG. Friedmann's repeated measures analysis shows that both groups improved when assessed separately over time. From the subsequent post hoc analysis, a statistically significant difference is highlighted between the values evaluated at T0 and T3. Conclusions The possible simultaneous delivery of the two treatment modalities, in patients suffering from tendinopathies, therefore represents a good possibility of synergistically exploiting their therapeutic actions. Future studies with a larger patient sample and longer follow-up are also needed to better evaluate the benefits of this treatment.

A two-window mini-open approach for suprapectoral tenodesis for traumatic ruptures of the long head of the biceps tendon.

Abstract: Abstract Traumatic rupture of the long head of biceps tendon (LHBT) in the young is rare and it is often related to sports. We describe a technical note of a mini open supra-pectoral tenodesis fixed by the "ToggleLoc™" (Zimmer Biomet, Warsaw, IN, USA) and performed by a two-window approach. The proposed technique guarantees an optimal visualization with low risk of complications and without arthroscopic assistance.

Spina bifida occulta with the persistent spinous process in living: A three-dimensionally reconstructed sacrum from computed tomographic imaging.

Abstract: Background Here we aim to report the persistent spinous process in the 'pan sacral type' of spina bifida occulta in an asymptomatic male and discuss its clinical significance. The presence of this type of dorsal wall defect with a bony spur attached to it has never been described in the literature to the best of our knowledge after extensive literature search. Our work presents the first anatomic description where the spinous and paraspinous cleft are seen in a sacrum of a live subject. Case Report During a morphometric study of the sacra, normal subject computed tomography imaging (CT) was procured from the Department of Radio-diagnosis. A three-dimensional (3D) image of the sacrum was created using Dicom to Print and Geomagic freeform plus software. A complete dorsal wall defect was observed in a 3D reconstructed sacrum of an adult male. The sacral canal was converted into a groove with a bony spur hanging in the centre. The longitudinal bony spur attached to the lamina was the persistent spinous process. Conclusion Such congenital defects are clinically significant for the anaesthetist during caudal epidural block and for orthopaedic surgeons before any surgical procedure. It may be misdiagnosed as an abnormal bony injury on CT. Thus, it is essential to ensure that patients with congenital anomalies are not treated unnecessarily for spinal fractures.

Antibiofilm effect of cleaning agents for ocular prostheses.

Abstract: Introduction This study aimed to evaluate the antibiofilm effect of different agents (neutral soap, 4% chlorhexidine, Efferdent effervescent tablets, 1% triclosan, and citronella essential oil) used for ocular prosthesis cleaning. Material and Methods Biofilms of S. aureus and S. epidermidis were formed on 60 ocular prosthesis acrylic resin specimens. The specimens were cleaned with the studied agents with different techniques. Microorganism counting was performed. Data were submitted to ANOVA and HSD Tukey-Kramer (p<.01). Results When compared to the control group, all cleaning protocols promoted a reduction in growth of microorganisms. The 4% chlorhexidine, effervescent tablets, and 1% triclosan cleaning agents eliminated biofilm in all groups. Conclusion Therefore, immersion in 4% chlorhexidine, effervescent tablets, and 1% triclosan could be the best protocols indicated for ocular prosthesis cleaning due to their ability to eliminate biofilm.

Investigating the synergistic effect of socio-demographic fac- tors on behaviors and attitudes concerning alcohol and illicit drug use among Italian students: a large cross-sectional study.

Abstract: Background Alcohol, drug consumption and polysubstance use are some of the most important causes of illnesses and mortality among adolescents, who have been identified as common users of these substances. Aim of this study was to assess and describe the current scenery of alcohol and other drugs consumption habits among a wide sample of Italian high school and university students. Methods A cross-sectional study was carried out using an online survey. The questionnaire was developed and administered via an internet forum for middle school, high school and university students named "Skuola.net". The statistical analysis included descriptive statistics, univariate and multivariate analysis. Additive interactions were assessed by calculating the synergy index. Results A total of 11,379 Italian students answered the questionnaire. The prevalence of alcohol drinkers was 34.2%; among these, 17.8% of the individuals showed unhealthy drinking behaviors (frequency of alcohol use of four times or more per week); 10.3% of individuals declared daily assumption of six or more glasses of alcohol. Concerning drugs, 15.7% of the responders classified themselves as illicit drug users, with cannabis getting the highest prevalence rates (6.9%). Finally, concerning alcohol, a synergistic effect was recorded for male and adult individuals (SI = 1.04); while concerning illicit drugs, a synergistic effect was found between male gender and older age (SI = 1.42), and between university students and male gender (SI = 1.10). Conclusions This study gives an overview about the attitudes of a wide sample of Italian students concerning alcohol and drugs habits. These results are in line with evidences from the scientific literature and will be helpful for developing future prevention strategies towards this target population.

Total intravenous anesthesia (TIVA) with propofool and remifentanil during operative endoscopy tracheobronchial laser therapy.

Abstract: Background The aim of our study was to assess how total intra-venous anaesthesia (TIVA) achieved by propofol and remifentanil continuous infusion could ensure proper success of the endobronchial laser therapy, in optimal conditions for the endoscopist, determining at the same time an adequate hypnosis and a good analgesia. Methods We studied 50 patients (28M - 22F), ASA class I-IV, mean age 42 ± 32.5 years , subjected to laser endoscopy to repair tracheal stenosis. TIVA was performed in all patients, and spontaneous breathing was maintained. Results 10.2% of patients experienced episodes of coughing during induction. The depth of the anaesthesia plan, monitored by BIS, was 55 ± 5. The awakening was fast in all patients, with an Aldrete score of 7.71 ± 1.14 at 1 minute and 9.31 ± 1.12 at 10 minutes. Conclusion The results of this study allow us to state that the continuous infusion of propofol and remifentanil proved to be the gold standard in patients ASA I-II-III undergoing endobronchial laser therapy. The use of TIVA has also allowed to perform endoscopic intervention on patients who suffered from a significant decrease of both cardiac and respiratory functions.

Bilateral femur fracture as the first manifestation of multiple myeloma: a case report.

Abstract: Abstract The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.

Bilateral Bifid Tendon of Palmaris Longus - Advantageous in Tendon Transfer?

Abstract: Background Variable insertions of Palmaris longus (PL) muscle tendon is described by various authors. Presence of extra PL tendon is also described in literature. As autologus tendon grafting is a blooming arena of clinical research at present time, an additional tendinous slip of PL has promising scope for use as an autograft. Case Report We report here bilateral bitendinous distal attachment of PL muscle encountered during routine cadaveric dissection. The additional PL tendon in a multitendinous insertion pattern with optimum length and thickness is indeed an additional advantage from the point of view of autograft harvesting. This has also importance in understanding the unusual, altered symptomatology in compressive conditions. Conclusion Although relatively common, surgeons should be well aware of the various possible aversion of distal attachment of PL which might have significant impact in alteration of symptomatology of neurovascular compressions in the forearm and hand and while choosing an appropriate tendon autograft.

Entrapment and rupture of the guide wire during PTCA: case report and medico-legal considerations.

Abstract: Background In recent years, due to the increase of complaints for medical malpractice, the Sicilian Regional Health System has adopted proceedings for the direct management of claims by each healthcare facility with the aim of reducing costs of insurance premiums and their relative taxes. Thus this management has led to increased awareness and management of clinical risk through the introduction of mandatory sentinel event monitoring. Case report A 55-year-old man with acute ischemic heart disease, due to three-vasal coronary diasease, underwent angioplasty perfomed on the second diagonal branch of the anterior descending artery. Simultaneously following the discovery of a major middle tract stenosis, he underwent further angioplasty surgery during which guidewire entrapment occurred, precisely in the proximal section of the vessel, resulting in the rupture and persistence of some fragments despite attempts to extract them. Subsequent antiplatelet therapy was prescribed and no further procedures were indicated for the removal of the guide wire, meanwhile a persistent reactive anxious-depressive state was established. Conclusion The medico-legal analysis of the case excluded liabilty since it was a fortuitous, unpredictable and inevitable event. However, the patient had not been adequately informed about the possibility of the complication presented, which resulted in prolonged hospitalization and compensation for the psychological disorder suffered as a result of the adverse event. The attempted economic agreement was unsuccessful. A civil lawsuit was subsequently filed by the patient and the Judge's report confirmed the corporate CMC assessment and ruled out that the side effects related to the guideline fragment.

Anal Cryptitis: A misdiagnosed condition.

Abstract: Introduction Crypts are small anatomical structures situated between the anal papillae, which do not cause any symptoms unless they become inflamed. Cryptitis is a localized infection of one or more of the anal crypts. Case presentation A 42-year-old woman presented to our practice, complaining intermittently of anal pain and pruritus ani over a span of 1 year. She was referred multiple times to various surgeons, and she was treated conservatively for anal fissure without any evident improvement. The referred symptoms were increased often after defecation. Under general anesthesia, a hooked fistula probe was introduced into the inflamed anal crypt and the whole length of the crypt was layed open. Conclusion Anal cryptitis is a misdiagnosed condition. The un-specific symptomatology of the disease can easily mislead. The clinical suspicion is fundamental for the diagnosis. Patient's history, digital ex-amination, and anoscopy are essential for the diagnosis of anal cryptitis.

Complete Ossification of Transverse Acetabular Ligament - Embryological and Clinical Perspective.

Abstract: Abstract Transverse acetabular ligament (TAL) is one of the important ligaments, which provide stability to the hip joint. On rare occasions, it can get ossified leading to limited mobility of the hip joint. Ossified TAL also converts acetabular notch to a foramen and neurovascular structures passing through the notch can get compressed leading to ischaemic symptoms. During routine demonstration of hip bone to undergraduate students, complete ossification of TAL was found in a right sided hip bone. Present case report with this rare finding also includes a short review of literature impressing on embryological and clinical perspectives of ossified TAL. Ossification of this ligament can be caused by defective ossification of hip bone as three secondary ossification centres develop around the acetabulum in triradiate carti-lage. Also, this can be caused due to heterotopic ossification of TAL after an inflammatory or traumatic injury. This ligament is extremely important in total hip replacement surgery being utilised in determining the position of the acetabular component. Anatomical knowledge of abnormal ossification of TAL is imperative in diagnosis and treatment of various pathologies of the hip joint.

COVID-19 and its aftermath, new drivers of infertility?

Abstract: Abstract Law 40/2004, the Italian piece of legislation governing access to assisted reproductive technologies (ART), is relatively young, compared to the number of years that have passed since the first attempts at ART in the world. Still, such a law has undergone several revisions in recent years, mostly by court rulings, and such changes are indeed necessary in light of the constant evolution in ART innovations. Then, the COVID-19 pandemic struck on a global scale, disrupting virtually all aspects of social and economic life. COVID-19's impact on fertility has to do, although it is not limited to, the distribution and function of ACE2 in the female reproductive system: such receptors are in fact expressed extensively in the ovaries, uterus, vagina and placenta. We point out that overcoming the "demographic winter" Italy has been going through, compounded by the pandemic, will require major adjustments in the way we ensure access to ART services in an equitable, sustainable and affordable fashion for all who wish to fulfill their reproductive potential and have been prevented to do so by legal, regulatory and financial factors.

COVID-19 Risk Management: a Survey among Italian physicians.

Abstract: Abstract The COVID-19 pandemic had a significant global impact on public health. The increasing demand for intensive care and the closure of several health facilities has led to a reduction in the assistance of non-COVID patients. In our study, we investigated what changes health professionals have experienced in their professional activities and how they coped with them. A questionnaire was sent to 146 doctors, focused on three subjects: type of activity carried out during the pandemic; use of personal protective equipment (PPE) and recourse to vaccination; current medical liability profiles related to COVID-19. The questionnaire was completed by 111 doctors. The study showed no significant differences in the questionnaire response as regards the demographic and work variables of the participants (gender, age, area of specialties). Most of doctors assisted potentially positive patients, which also imposed derogations on their safety. Most of the complaints were about the low adequacy of PPE provision and about the compromission of specialist medical care. The interest in safety among participants was revealed by the high compliance to vaccination, with almost complete coverage. The questionnaires showed that most doctors (72,7%) believe that specialist medical care has been impaired during the COVID-19 pandemic. Secondly, a high percentage of participants (79.8%) expressed the need for both civil and criminal limitation of liability in connection with work in the management of SARS-Cov-2 patients. In conclusion, this survey tried to contribute to the identification of the main problems presented by healthcare professionals. Their versatility was a crucial element for the management of the pandemic, but also highlighted the need for health institutions to prepare pandemic plans in the future, with adequate and constant updating. Concerns were raised regarding financial deficits and legal protection. Political decisions must be entrusted to enhance medical assistance and to avoid the increasing phenomenon of defensive medicine.

Papilledema in childhood for diagnosis of pseudotumor cerebri or late hydrocephalus: a case report.

Abstract: Abstract A case of hydrocephalus is presented in a 13-year-old female with transient loss of vision from 1 week and papilledema, previous ophtalmological history was negative. Visual field was performed, and neurogical examination proved to be hydrocephalus. In literature few cases of Papilledema in adolescent children with hydrocephalus has been reported. The aim of this case report is to decode the signs, symptoms and factors associated with papilledema in children with hydrocephalus at an early stage in order to prevent a poor visual-functional residual (permanent low vision).

"Fare male farsi male" project - Are cyberbullying and cyber victimisation associated with physical activity levels? a cross sectional study in a sample of Italian adolescents.

Abstract: Background The aim of this project is to study the prevalence of cyberbullies (CB) and cybervictims (CV) and cyberbully-victims(CBV) in Italian adolescent students and a possible correlation with physical activity (PA) levels and as potential protective factor. Methods The Italian version of the European Cyberbullying Intervention Project Questionnaire (ECIPQ) was used for categorized cyberbullies (CB) and cybervictims (CV). Six items of the IPAQ-A Italian version were considered to measure the PA levels. Results 2112 questionnaires were collected, with response rate of 80.5%. The sample reported 9% was CV only, 5% was CB only, and 6% was cyberbully-victims (CBV). The factors that are significant associated to the CV students were: female gender (OR=1.7; 95%CI:1.18-2.35); stay at middle school (OR=1.56; 95%CI:1.01-2.44); spent more than 2 hours on IT devices (OR=1.63; 95%CI:1.08-2.47). The variables significant associated to the CB students were: gender male (OR=0.51 95%CI:0.320.80); spent more than 2 hours on IT devices (OR=2.37; 95%CI:1.32-4.26); tobacco use (OR=2.55; 95%CI:1.63-3.98); an inverse proportion with the number of days spent in vigorous physical activities (OR=0.82; 95%CI:0.68-0.98). The CBV students were significant associated with a male gender (OR=0.58; 95%CI:0.38-0.89) and tobacco consumption (OR=2.22; 95%CI:1.46-3.37). Conclusions The physical activity at vigorous level seem to be related to less involvement in cyberaggression, so it is recommended that those responsible for training adolescents' favour this aspect. Research on effective prevention is insufficient and evaluation of policy tools for cyberbullying intervention is a nascent research field an any prevention or intervention program could consider this factor.

Percutaneous transhepatic endoscopic thulium laser vaporesection for management of severe and focal benign biliary strictures.

Abstract: Background Biliary lithiasis and strictures in the bile ducts have a causality. Dilation or stent placement is routinely used to treat strictures but fibrosis can lead to their recurrence. Thulium laser vaporesection with percutaneous transhepatic endoscopy is a novel therapeutic modal-ity for managing severe, focal benign biliary strictures (BBSs). There are few reports about this method of treating BBSs. Our study aimed to determine the safety and efficacy of this technique. Methods Fifteen patients (six males and nine females) with BBSs underwent stricture ablation with thulium laser via percutaneous transhepatic endoscopy. The immediate and short-term technical success and complication rates were evaluated. Results Biliary strictures appeared in segmental branches of two patients, in the left or right hepatic duct of twelve patients, and in the common bile duct of one patient. The immediate and short-term technical success rates of the thulium laser procedure were 100%. The lumen of the strictures measured 1-3 mm before the procedure and improved to 4-5 mm in six (40%) patients, 5-10 mm in five (33.3%) patients, and 10-15 mm in four (26.7%) patients after the procedure. No mortality and major procedure-related complications were observed. One patient experienced a minor complication (hemobilia). Conclusions Percutaneous transhepatic endoscopic thulium laser ablation appears to be safe and effective for treating short-segment BBSs. However, further studies with large samples and long follow-up periods are necessary to fully determine the long-term outcomes of this technique.