MEDICAL RESPONSIBILITY, INSURANCE POLICIES, NEW LAWS AND EUROPEAN DIRECTIVES. IS IT TIME TO REFORM THE STATUS OF ITALIAN MEDICAL RESIDENTS?Written by Davide Ferorelli et al.
In Italy there is an ongoing debate on the need to clarify the legal aspects related to the clinical activities of medical residents. While residents attend university medical schools, specific policies should be implemented to guarantee their proper utilization in health organizations also for the direct and indirect legal responsibilities of patients health and safety. It seems necessary to create an uniform and clearer legal framework to surmount criticism of the utilization of residents. We recommend Ministries of University and Health to change the current training contract into a job-training one, in line with experiences for residents of other European countries. This initiative could promote a no-blame culture and also help Italian specialist doctors of future generations to be trained in order to move and be competitive across European country borders and finally promote the sustainability of the Italian public NHS through a patient-centred and inter-professional integrated approach.
Female sexual pain (FSP) is a disorder that can greatly affect women’s health, relationships, work productivity, and quality of life. FSP is characterized by genital pain just before, during, or after sexual intercourse. FSP may depend on many possible causes ranging from anatomical alterations to psychological or social issues. The authors describe a case of a 54-year-old woman, suffering from female sexual pain for nine years. An abdominal echography of the patient was performed and it revealed a retained intra-abdominal foreign body. It was forgotten during a hysterectomy by the surgeon 9 years prior. In cases of injury and/or death caused by a foreign body, the main surgeon and his assistant/subordinate are punishable by law for engaging in markedly imprudent and/or negligent conduct. This conduct includes not scrupulously double-checking the surgical site before its closure to highlight forgotten foreign bodies. Either the circulator nurse or the theatre nurse may be considered liable for this case of malpractice.
HIV-positive patients with surgical diseases are at a higher risk than HIV-negative patients of developing post-surgery complications. The goal of this study was to evaluate the main surgical diseases among HIV positive and HIV negative patients hospitalized in the surgical ward of the Hospital Central da Beira (HCB) in Mozambique. Were collected data before and after surgical procedures in all consecutive adult patients (> 18 years old) admitted and hospitalized at the Surgical Ward of the HCB from January to December 2017. Overall, a total of 237 adult patients were admitted to the surgical ward of Hospital Central of Beira, Mozambique. We reported all surgical information collected from patients. The most frequent surgical site for the operation was the abdomen (n.174; 73.4%), followed by perineum (n.42; 17.7%) and thorax (n.21; 8.8%). For health professionals working in surgery wards, data on the most frequent postoperative complications in HIV-positive patients will offer useful tools for the follow-up of those patients.
METASTATIC ESOPHAGOGASTRIC JUNCTION CANCER: CASE REPORT OF A COMPLETE LONG-TERM RESPONSE AFTER COMBINED CHEMORADIOTHERAPY.Written by Roberto Milazzotto et al.
This paper presents our experience in the treatment of a patient affected by metastatic esophagogastric junction cancer with a high tumor burden and an incipient visceral crisis. The patient was treated with a combination of induction taxane-based chemotherapy, local radiotherapy and microwave ablation of residual liver metastases. The patient experienced a complete and durable response with long-term survival of more than 3 years, without any relevant acute or late side effects.
Advances in DNA sequencing technologies through Next Generation Sequencing (NGS) approaches have enabled genome-wide discovery of chromosomal copy-number variants and single-nucleotide changes. NGS technologies are rapidly expanding our ability to identify and better define disease-causing mutations and genotype-phenotype correlation. Pediatric patients may particularly benefit from the introduction of these new technologies. Pediatricians must keep up with all these new skills, both in their residency programs as well as in their continuing medical education programs.
Work place violence is escalating among Jordanian health care provides, particularly nurses and doctors. However, this issue does not receive much attention from decision makers in the health care sector. The current policy aims to draw the attention of health care decision makers about the importance of developing such policy. A “zero tolerance” policy towards violence in Jordanian hospitals should be immediately established and implemented.
CONTACT DERMATITIS TO METHYLDIBROMOGLUTARONITRILE: EMERGENCE OF SENSITIZATION IN THE CENTRAL REGION OF TUNISIAWritten by Maher Maoua et al.
Methyldibromoglutaronitrile (MDBGN) is a preservative found in cosmetics as well as in products for industrial use. It caused an outbreak of allergic contact dermatitis in Europe in the 1990s and early 2000s. To assess the prevalence of MDBGN sensitization among consultants in the occupational dermato-allergology unit of Farhat Hached University Hospital in Sousse-Tunisia, we carried out a study of all cases of contact dermatitis to MDBGN confirmed by patch-tests from 1 January 2011 to 31 December 2015. The prevalence of allergic contact dermatitis to MDBGN was 4.5% of all cases of contact dermatitis recorded during the same period with an increase from 1.7% in 2011 to 5.4% in 2015. Associated allergens with contact dermatitis to MDBGN were the Peru balsam in 4 cases, nickel sulfate and kathon CG in 3 cases each. Contact dermatitis to Dibromodicyanobutane was associated with sensitization to other preservatives in 4 cases and cosmetic allergens in 6 cases. An increasing rates of sensitization are noticed in our region. The absence of legal restrictions regarding this preservative agent may explain an increase of its use in non-European countries.
A BRIEF ANATOMO-SURGICAL DISSECTION GUIDE TO HUMAN NECK: RESULTS OF THE COLLABORATION BETWEEN THE UNIVERSITY OF PALERMO AND THE UNIVERSITY OF MALTA.Written by Francesco Carini et al.
The aim of this article is to show methods for dissection of the neck. In the summer of 2017 a group of students of the University of Palermo that have already passed the exam of Human Anatomy took a 4 weeks dissection course at the University of Malta. The students were provided with a dissection kit, video recording equipment and cameras for taking pictures. They dissected the skin, the subcutaneous tissue, the muscular bundles, the muscles, the vascular and nervous bundles, the nerves, the larynx, the trachea and the esophagus. This paper presents the results of the dissection course and a small and simple guide to young students and medical doctors who want to learn the bases of neck dissection.
INCIDENCE AND PROGNOSTIC FACTORS OF RECTAL INJURIES DURING PROSTATECTOMY WITH ROBOTIC TECHNIQUE: A SYSTEMATIC REVIEWWritten by Stefano Manno et al.
Rectal fistula is a rare complication that may occur during and after radical prostatectomy, regardless of the applied surgical technique. It accounts for about ≤ 1% of surgical complications. Patients who have undergone radical prostatectomy associated with prior pelvic radiotherapy, previous rectal surgery and transurethral re-section of the prostate have an increased risk for incidence of anorectal fistula. This review analyzes recent original studies and reviews. The studies evaluated deal with important prognosis and incidence rates, while studies related to the therapeutic resolution of the problem were excluded. The four different types of surgical techniques (ORP, RPP, LRP and RARP) to remove the prostate were also compared, in order to identify the best method associated with the fewest complications. This study aims to evaluate specific literature in order to understand which surgical technique is associated with the lowest risk of this complication, and the prognostic factors that lead to a higher risk of rectal injuries.
Respiratory Epithelial Adenomatoid Hamartoma (REAH) is a rare benign lesion that may occur in the nasal cavity and paranasal sinuses. Histology is essential for the differential diagnosis with other lesions that could affect the sinonasal region. Our report focuses on three cases of male patients that were 46, 66 and 73 years old, diagnosed with REAH of the sinonasal region. All cases presented a nasal obstruction and hyposmia, and in one case cephalalgia. The definitive diagnosis of REAH was supported by the endoscopic, radiological and histological examinations. The patients underwent surgical excision with an endoscopic approach and did not experience a local recurrence at the time of writing this manuscript. REAH is a rare and often unrecognized clinical condition. The gold standard for treatment is complete surgical excision, which also allows for a correct histological diagnosis. Recurrence after surgery was not reported in our findings, as described in the literature.
Esophageal atresia is a relatively common congenital anomaly, which is often associated with other anomalies. We report a case of a newborn affected by esophageal atresia with significant post-operative and long-term complications, including feeding and swallowing disorders.
ABSTRACT BOOK ONSP DAYS 2017—14th ITALIAN MEETING OF NATIONAL OBSERVATORY FOR TRAINEES AND YOUNG PAEDIATRICIANSWritten by ONSP
Facial aging is a complex process and often poses a challenge for plastic and aesthetic surgeons. Injectable fillers and autologous adipose tissue are widely used for the restoration of soft tissue volume. However, lipotransfer currently lacks standardization and its unpredictable reabsorption rate remains an unresolved issue. Adipose-derived stem cells (ASCs) are multipotent mesenchymal stem cells that could be responsible for the main rejuvenation capabilities of fat grafts. Currently, ASCs are administered in conjunction with autologous fat, while injectable vehicles such as hyaluronic acid, or other injectable biomaterials, are under study for the treatment of facial aging with promising results. Indeed, bioengineered fillers are at a very early stage of development, and could be further developed as semi-permanent fillers with biological properties of engrafted adipose tissue. ASCs could emerge as an effective and novel anti-aging therapeutic agent. However, extensive analysis of their actual effectiveness and mechanism of action are required.
THE ROLE OF METACOGNITION IN MULTIPLE SCLEROSIS: A CLINICAL STUDY AND ASSESSMENT OF POSSIBLE CORRELATION WITH ANXIETY, DEPRESSION AND COPING STRATEGIES.Written by Maria C. Quattropani et al.
The current study aimed to explore the relationships between metacognition and anxiety, depression, and coping strategies in MS patients, compared to healthy subjects. The study was conducted on a group of 50 MS patients and a control group of 50 healthy volunteers matched for gender, age, level of education and social status. Metacognitions were assessed with the Metacognitions Questionnaire-30, while anxiety and depression were assessed with the Hospital Anxiety and Depression Scale, and coping strategies were assessed with the Brief COPE. Results did not show significant differences between metacognitive factors for MS patients and healthy subjects. However, we found specific, contrasting correlations between the MS group and the control group. The results of this study could have some implications for clinical practice. Given the relationship between metacognitions and negative emotions, “psychological intervention”, based on the metacognitive approach, could have positive effects on MS patients.