The main aim of the study is to critically analyze the impact of defense medicine in the Italian healthcare system, considering the rapid spread of this phenomenon in the last years and its influence in the everyday medical practice. The authors use the Amenable Mortality Index (i.e. the number of premature deaths which could have been avoided in individuals younger than 74 years of age) to rate the performance status of the analyzed healthcare system and to compare different countries and Italian regions. The result of the study is that the Italian health system is valid, despite the economic difficulties of the last years, but much can be done to ameliorate its status. In fact, the authors want to promote a “no-blame culture” as an important factor for the overall improvement of the NHS, focusing only on patients’ health.
NURSES' STUDENTS' ATTITUDES TOWARD DEATH AND CARING FOR DYING CANCER PATIENTS DURING THEIR PLACEMENTWritten by Loai Abu Sharour et al.
Caring of cancer patients requires special skills and knowledge that facilitates the professionals’ care during the patients' illness and palliative phases. This study was conducted to explore the nursing students' attitudes toward death and caring for dying cancer patients during their Placement. A descriptive study was conducted using the Formmelt Attitude toward Care of the Dying (FATCOD) scale and Death Attitude Profile-Revised (DAP-R) scale. Nursing students from AL-Zaytoonah University of Jordan. A sample of one hundred nursing students was recruited. The current study showed statistically significant difference among age group in relation to total score of death scale (p-value: 0.000) and fear of death, neutral acceptance, approach acceptance, and escape- acceptance subscales. The results indicated that younger students have more negative thoughts, attitudes, and emotions toward caring for dying cancer patients. In addition the results indicated that students with higher academic levels have a more positive attitude and are more eligible to provide nursing care for dying cancer patients as compared to students with less experience. In addition, the results showed that students with less experience had a greater fear of death than students with a higher academic level. According to the study results, Nurses' attitudes toward caring for dying and dead cancer patients can be considered an important predictor of quality of life among cancer patients.
Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. In this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistulectomy, fistula plugging or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24.5%) and fistulotomy (15.6%). High transsphincteric fistulas were more likely to predict failure compared to low transsphincteric, intersphincteric and subcutaneous fistulas (37.5% versus 9.5%, 7.3% and 0%, respectively). In conclusion, the scales seem to support fistulotomy. However, no standardized algorithm exists to guide the care of patients and the choice of operation is based on patient-related factors, the patient’s surgical history, and the surgeon’s experience and familiarity with the various techniques for treating anal fistula.
A NOVEL METHOD FOR ANALYZING ELECTRIC FIELD DISTRIBUTION OF ELECTRO CAPACITIVE CANCER TREATMENT (ECCT) USING WIRE MESH ELECTRODES: A CASE STUDY OF BRAIN CANCER THERAPY.Written by Linahtadiya Andiani et al.
Electric field distribution analysis generated by ECCT in a human head model with or without brain cancer using wire mesh electrode has been conductedsuccessfully. The analysis of electric field distribution was done using simulation in a human head model with ECCT Apparel Helmet system type A which is three dimensional model. The electric field distribution was measured with and without a wire mesh electrode which was either passive or active using COMSOL Multiphysics 5.2 software and was then processed using MATLAB R2010a. The aim of the research was to assess the performance of wire mesh electrode in detecting electric field distribution. ECCT which is utilized in brain cancer therapy with input 10 V is able to produce an electric field with an average of 178.8 V/m. The input voltage influences electric field distribution whereas the signal frequency does not affect the electric field distribution. Wire mesh electrode which is either active or passive can measure the electric field distribution generated by ECCT that neither the active nor the passive wire mesh electrode changed the pattern of the electric field distribution and the change in the measured electric field value is not significant.
This paper summarizes, in a modern fashion and with a number of molecular, functional and magnetic resonance imaging details, the main morphological data about the trigeminal complex (i.e., trigeminal nerve, ganglion and nucleus). Indeed, this information is the basis to understand pathophysiology and semiotics of diseases involving these anatomical structures.
VALUE-BASED EVIDENCES TO FACE THE NEW CHALLENGES OF HEALTH PROMOTION IN A SUSTAINABLE HEALTHCARE SYSTEM.Written by Claudia Marotta et al.
Thirty years ago, starting from a new awareness of the limits of biomedical power and healthcare services to solve all population’ health problems, the Ottawa Conference coined a New Public Health by defining Health Promotion (HP) as “the process of enabling people to increase control over and to improve their health and well-being”. Since then and over the next 30 years, several programs have been developed all over the world to translate HP concepts into practical actions and many health successes have been achieved as well. Nowadays, even if the global health context has strongly changed, the original principles of HP still provide a solid ground for action, being the community engagement and empowerment of women and men still at the heart of any health strategy, in a shared responsibility of all society’s sectors approach. However, since now HP promotion efforts have been directed toward priority health problems in a issue- settings-based approach, but in a sustainable and ethical prospective this will be not enough now: a deeper attention on effectiveness is request and an evidence- and value-based HP approach is needed to support the Public Health community and the policy-making, including the new challenges related to Public Health Genomics.
CEREBRAL CAVERNOUS MALFORMATION COEXISTING WITH PITUITARY ADENOMA, HASHIMOTO THYROIDITIS AND MENTAL ILLNESS: FIRST CASE REPORT.Written by Sara Guido
Cerebral Cavernous Malformations (CCMs) are vascular lesions involving brain capillaries. They may occur sporadically or be inherited as autosomal dominant character. Due to incomplete penetrance, CCMs incidence is underestimated and, overall sporadic cases, are often accidentally diagnosed. Rarely CCMs are linked to other pathological conditions. Here we present the first case in literature of a young woman affected by sporadic CCM, pituitary adenoma, Hashimoto thyroiditis and mental illness of unknown etiology. Symptoms’ analysis suggests that she may suffer of Hashimoto encephalopathy (HE), a condition that in very few cases develops together with Hashimoto thyroiditis. Genetic bases of HE are still unknown and symptomatology is very heterogeneous. This paper is a preliminary report of the case and is focused on complexity of clinical manifestations that makes the diagnosis uncertain. If our hypothesis will be confirmed by further analysis, our aim will be to clarify genetic causes of HE.
CEREBRAL SINUS THROMBOSIS AFTER SPINAL ANAESTHESIA: PREDISPOSING FACTORS, OPERATING DIFFICULTIES AND DIAGNOSTIC PROBLEMS.Written by Edoardo De Robertis et al.
The authors describe a case of cerebral venous sinus thrombosis following subarachnoid anaesthesia, characterized by operative difficulties and lack of patient collaboration. After anaesthesia, the patient reported a positional headache and on the 5th day following surgery, he developed a frontal tensive headache with dysphoric and depressive symptoms. On the 9th day he presented with emesis, hypostenia of the upper left limb and ipsilateral positive Babinsky. The diagnosis was made only on the 10th day. Genetic analyses showed a homozygous mutation of methylene-tetrahydrofolate-reductase associated to hyperhomocysteinemia (21,7μM). The recurrence of post-dural puncture headaches is very frequent in patients undergoing subarachnoid anesthesia, but special attention is required in the event of headache, as well as associated clinical signs and other risk factors, in order to achieve a precocious diagnosis and allow the physician to start a suitable therapy.
Causality assessment is an algorithm proposed by WHO to identify a causal relationship between vaccines and adverse events following immunization (AEFIs), mostly for serious adverse events. It can be considered consistent, inconsistent, indeterminate or unclassifiable. This study describes AEFIs reported in Puglia from 2013 to 2016 and analyzes the differences between the causality assessments performed on AEFI case-report information and the causality assessments performed after the examination of clinical documentation. 292 AEFI were reported: 191 (65.4%) non serious, 59 (20.2%) serious and 42 (14.4%) undefined. Causality assessment performed on the AEFI case-report information classified 59.2% (n=29/49) of serious AEFIs as consistent while assessment performed after clinical review only classified 30.6% (n=15/49) of serious AEFI as consistent (X2=65.0; p=0,000). In the first approach, inconsistent serious AEFIs were 18.6% (n=11/49) and then became 45.8% (n=27/49) after examination of clinical documentation. Indeterminate serious AEFIs were 6.8% (n=4) at first, and then 3.4% (n=2). Unclassifiables did not change.
THE APPLICATION OF 3D PRINTING IN PLASTIC AND RECONSTRUCTIVE SURGERY: CASE-CONTROL STUDY IN FACIAL RECONSTRUCTIONWritten by Luigi Di Rosa et al.
The aim of this study was to explore the efficiency and usefulness of tridimensional printing in plastic and reconstructive surgery for lesions of the maxillofacial region. This was comparison study between two groups of patients. Six patients underwent surgical reconstruction, using a three-dimensional model built on the basis of CT scans (group 1); and six patients underwent surgical reconstruction, without the use of a three-dimensional model (group 2). The following variables were evaluated: age, gender, histological diagnosis, cancer location, size of bone lesion, type of reconstruction, complications and surgical timing. A statistically significant difference was found in microsurgical flap survival (p = 0.019), with a survival rate higher in group 1 than in the controls. This study provides preliminary evidence and partially confirms the validity of three-dimensional technology in plastic and reconstructive surgery. The results so far obtained, however, lead to hope for future uses of this ever-increasing technique.
Genetic testing is a medical tool employed to screen changes in genes linked to cancer and other genetic diseases. Genetic tests are available for breast, ovarian, colon, thyroid, and some other cancers and they represent the main tool for early identification of the “risk” subjects. The choice to undergo genetic testing by a healthy or affected cancer patient with family history of the cancer has to be the fruit of a careful and prudent assessment of the advantages and disadvantages discussed during oncogenetic counselling. The latter, in turn, in the case of a patient's positive and informed choice, must constantly affiliate the genetic testing, in order to preserve the prediction and information role of the test as much as possible.
Allergic rhinitis is a common problem increasing greatly over the past three decades. Several studies have found a possible link between dyslipidemia and allergic disease but the relating causal mechanisms remain elusive. The aim of this study is to investigate the association between blood lipid levels and the presence of allergic rhinitis. A multicentre prospective study was carried out on 160 allergic rhinitis patients and 160 volunteers as a control according to age, gender, body mass index (BMI) values and full blood lipid profile. A possible correlation between abnormal dyslipidemia parameters and the severity of allergic rhinitis was studied too. Demographic characteristics didn’t differ between groups. While levels of LDL-C, total cholesterol, as well as TC/HDL ratio and LDL/HDL ratio, were significantly higher (p<0.001) in patients with allergic rhinitis, there was a positive correlation between abnormal dyslipidemia parameters and moderate/severe allergic rhinitis symptomatology ( p<0.001). We support the hypothesis that dyslipidemia might play a role in in the manifestation of allergic rhinitis.
The hyoid bone is the only "suspended bone" in our body, and its suspension system has an important role in posture maintenance. We studied postural modification in a group of patients affected by Obstructive Sleep Apnea Syndromewho had undergone surgical treatment including hyoid suspension. The surgical procedure performed was section of supra- and infrahyoid muscle and mobilization of the hyoid bone through its suspension to the thyroid cartilage. We studied the postural changes with stabilometric tests. In the early post-operative (one week) follow-up, we performed a posturography test with closed eyes and occlusal disjunction, and saw a worsening of the average parameter of the centre of pressure with antero-posterior oscillations. However, we would like to highlight that by the time of the one year follow up, a compensatory mechanism had been established which allowed for a return to normal hyoid bone kinematics.
The aim of the study was to evaluate individual inflammatory response after inguinal hernioplasty by measuring baseline and post-operative serum IL-6 response to surgery and quantifying the variability of the serum response in a homogeneous group of patients.Patients enrolled in the study underwent inguinal hernioplasty. Blood samples were used to analyze serum IL-6, TNF-alpha, LOOH and GSH levels. To identify high and low IL-6 responders, patients were divided into 2 groups according median values of the peak levels of IL-6. Mean levels of the cytokine were comparable at baseline but reached peak at 6 h and persisted elevated at following hours among high responders whereas remained significantly lower over time among low responders.Patients identified as low responders showed not significant changes in serum IL-6 levels over the post-operative period. In contrast, high responders demonstrated a significant response reaching the peak level of IL-6 after 6 hours post operation.