Bamlanivimab and Etesevimab administered in an outpatient setting for SARS-CoV-2 infection.

The early administration of anti-SARS-CoV-2 monoclonal antibodies (mAb) could decrease the risk of severe disease and the need of inpatients care. Herein, our clinical experience with Bamlanivimab/Etesevimab for the treatment of early SARS-CoV-2 infection through an outpatient service was described. Patients with confirmed COVID-19 were selected by General Practitioners (GPs) if eligible to mAb administration, according to manufacturer and AIFA (Agenzia-Italiana-del-Farmaco) criteria. If suitability was confirmed by the Multidisciplinary Team, the patient was evaluated within the next 48-72 hours. Then, all patients underwent a medical evaluation, followed by mAb infusion or hospitalization if the medical condition had worsened. Overall, from March 29th to June 4th, 2021, 106 patients with confirmed COVID-19 were identified by GPs; 26 were considered not eligible and then excluded, while 9 refused treatment. Among the 71 remaining, 6 were not treated because of worsening of symptoms soon after selection. Finally, 65 received mAb therapy. All treated patients survived. However, 2/65 developed adverse events (allergic reaction and atrial fibrillation, respectively) and 6/65 needed hospitalization. By performing univariate logistic regression analysis, diabetes was the only risk factor for hospitalization after mAb administration [aOR = 9.34, 95%CI = 1.31-66.49, p= .026]. Importantly, subjects who worsened awaiting mAb were more frequently obese (OR = 16.66, 95%CI = 1.80-153.9, p= .013) and received home corticosteroid therapy for COVID-19 (OR = 14.11, 95%CI = 1.53-129.6, p= .019). Establishing a network among GPs and COVID units could be an effective strategy to provide mAb treatment to patients with early SARS-CoV-2 infection to reduce hospitalizations and pressure on healthcare systems.

Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency.

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing "Telemedicine-National guidelines," approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.

The wish 'not to be'. Survey of suicide cases arriving at the Prosecutor's Office of the Court in Bari in the years 2014-2016.

The issue of suicide has always been a very sensitive and important problem, that raises many questions in the society where it occurs, that is not always able to oppose an adequate response. Every scientist in the field agrees that this is an act provoked by multifaceted reasons, which include cultural, social and biographical motives. Therefore, this topic also poses ethical and civil problems, as well as epistemologic and research methodology issues, because of its complexity as a subject of study. The authors propose a case-by-case contribution, evaluating the judicial acts on 73 suicides made available by the Bari Public Prosecutor's Office for the years 2014-2016. The authors believe collected and systematized data, and the ensuing considerations, can offer a contribution to the debate in the field of legal and socio-healthcare actors, who are often the first to deal with and confront this complex and tragic phenomenon.

A singular case of asphyxia by choking on a handkerchief: accidental event or suicide to "shut-up" spirits.

Choking in adults can prove fatal, despite resuscitation attempts. The manner of death can be natural, homicide or accident. When a death is due to choking, one must consider what conditions contributed to or predisposed the person to choking (eg. alcohol, drugs and physical and mental impairments). Homicidal deaths by choking are relatively uncommon, being more frequently accidental. The diagnosis of death by choking is made at autopsy when the airway is found occluded. If the individual had an occluded airway and the object or food was removed during resuscitation, the only way to make the diagnosis would be on the history. Here, we present a case of asphyxia (accidental or suicidal) by choking on a handkerchief in a patient with a long history of schizophrenia. The woman had attempted a previous suicide driven by evil spirits coming from inside her body, especially from the head and throat; in order to "shut-up" the spirit, she was trying to suffocate it with her hands or by a belt from her pants.

Prioritizing genomic applications for action by level of evidence: a horizon-scanning method.

As evidence accumulates on the use of genomic tests and other health-related applications of genomic technologies, decision makers may increasingly seek support in identifying which applications have sufficiently robust evidence to suggest they might be considered for action. As an interim working process to provide such support, we developed a horizon-scanning method that assigns genomic applications to tiers defined by availability of synthesized evidence. We illustrate an application of the method to pharmacogenomics tests.

Surgical interventions for drug-resistant tuberculosis: a systematic review and meta-analysis.

BACKGROUND: With the emergence of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB), surgery, which had been replaced by short-course chemotherapy, is again being considered a viable treatment option. OBJECTIVE: To assess the literature on the effectiveness of surgical interventions in the treatment of drug-resistant TB. METHODS: Medline, EMBASE, and PubMed were searched from 1975 to April 2012 in addition to hand searching reference lists, and the International Journal of Tuberculosis and Lung Disease. Potentially relevant studies were assessed according to pre-defined eligibility criteria: MDR- and XDR-TB patients undergoing surgical and non-surgical treatment. Treatment outcomes were extracted according to internationally accepted definitions and included in meta-analyses using random effects models. RESULTS: Summary meta-analysis of 24 comparison studies revealed a significant association between surgery and successful treatment compared to non-surgical interventions (OR 2.24, 95%CI 1.68-2.97). A meta-analysis from 23 single-arm studies demonstrated that respectively 92% (95%CI 88.1-95) and 87% (95%CI 83-91) of surgical patients achieved successful short- and long-term outcomes. Subgroup analyses showed that favorable surgical outcomes were associated with increased drug resistance in studies reporting surgical and non-surgical treatment outcomes. CONCLUSIONS: While the results suggest that surgical intervention is associated with successful treatment outcomes in patients with drug-resistant TB, there is insufficient evidence to recommend surgery plus chemotherapy over chemotherapy alone, to evaluate the potential harm from surgery and to determine the optimal conditions for surgery. Controlled studies are needed to better assess the effectiveness of surgery and to investigate other contextual issues.

[Prevalence of anti-CCP antibodies in systemic sclerosis]. / Prevalenza degli anticorpi anti-peptide ciclico citrullinato (anti-CCP) nella sclerosi sistemica.

Joint involvement in systemic sclerosis (SSc) commonly occurs as arthralgias, while a true arthritis is less frequent. The most common arthritis developing in SSc is rheumatoid arthritis (RA) and its diagnosis may be misled by concomitant joint contracture or tendon sheath involvement due to SSc. Anti-citrullinated cyclic peptide (CCP) antibodies are an emerging tool to diagnose RA and have shown to be more specific than rheumatoid factor. We assessed the prevalence of anti-CCP antibodies in SSc patients and evaluated their sensitivity and specificity for associated RA. Searching for RF and anti-CCP antibodies and joint examination were carried out in sixty consecutive SSc patients. Hands and feet standard x-rays were performed in patients complaining with arthralgia and/or arthritis. Six out of sixty (10%) SSc patients had RA according to 1987 ARA revised criteria. Anti-CCP were detected in 5 patients (sensitivity 83%) and RF was present in all RA patients (sensitivity 100%). However, anti-CCP antibodies had a much higher specificity (94%) than RF (41%) for RA. Our study suggests that anti-CCP antibodies are a useful test to identify patients with SSc having also RA. This is crucial in the management of SSc because may allow an adequate therapy of RA and prevent further joint damage in patients who already have a poor quality of life.

Tratamiento de las fracturas de cóndilo mandibular en la IAHULA: 1999-2004 / Treatment of the fractures of cóndilo mandibular in the IAHULA: 1999-2004

Se realizó un estudio observacional descriptivo tipo serie clínica en 44 pacientes con fractura de cóndilo mandibular que ingresaron al área de emergencia del Hospital Universitario de Los Andes entre 1999 y 2004. El grupo estaba constituido por 36 hombres (81.8 por ciento) y 8 mujeres (18.2 por ciento). La edad de los pacientes osciló de 7 a 76 años, de ellos el grupo de 20-29 años fue el más afectado reportando el 40.9 por ciento (18 casos). Las fracturas simples representaron 12 casos (27.3 por ciento). Las fracturas combinadas correspondieron a 32 pacientes (72.7 por ciento). El mecanismo traumático fue colisión vehicular con 17 casos (38.6 por ciento). El 50 por ciento (6) de las fracturas condilares simples fueron manejadas sin tratamiento quirúrgico. Por el contrario 22 pacientes (68.75 por ciento) de las fracturas compuestas ameritaron al menos algún tipo de osteosíntesis. El seguimiento de los pacientes fue en promedio de 26 meses (9-60 meses). Se obtuvieron 24 (55 por ciento) excelentes resultados, 16 (36 por ciento) buenos resultados y 4 (9 por ciento) malos resultados. Las complicaciones encontradas fueron: Maloclusión 4 (9 por ciento), laterodesviación mandibular 6 (3 por ciento), hipomovilidad mandibular 4 (9 por ciento). Los resultados en nuestro servicio inclinan la balanza hacia la osteosíntesis con miniplacas como tratamiento para manejar las fracturas condilares cuando éstas tienen indicación quirúrgica.

Environmental modulation of the interoceptive effects of amphetamine in the rat.

The aim of the present study was to investigate the effect of environmental novelty on amphetamine discrimination. Two groups of rats (home group and novelty group) were trained to perform water-reinforced operant behavior in cages equipped with two levers and a retractable liquid dipper (0.1cc cup). The experimental procedures for the two groups were identical except for the fact that home rats were housed and tested in the operant cages whereas novelty rats were transferred daily to these cages for the testing sessions (25min). The rats were trained to discriminate one of two doses of amphetamine (0.25 and 0.5mg/kg) from saline. Saline and amphetamine were administered intraperitoneally immediately before each daily session according to a semi-random schedule for a total of 50 sessions. Reinforcements were delivered according to a fixed ratio that was increased daily from 2 to 30. Successful drug discrimination was achieved when activity on the appropriate lever before the first reinforcement was greater than 80% of total activity, on at least seven out of eight consecutive sessions. When training was conducted with 0.25mg/kg of amphetamine, no home rat acquired drug discrimination whereas 56% of novelty rats reached criterion. When training was conducted with 0.5mg/kg of amphetamine, drug discrimination was achieved by 50% of home rat versus 86% of novelty rats. These findings indicate that environmental novelty can alter the ability of amphetamine to produce interoceptive cues.

Osteodesis con alambre de Kirschner en fractura abierta compleja IIIa de hemimandíbula derecha: a propósito de un caso ocurrido en el Instituto Autónomo Hospital Universitario de Los Andes: marzo 2002 / Osteodesis with wire of Kirschner in complex open fracture IIIa of right hemimandíbula: concerning a case happened in the Instituto Autonomo Hospital Universitario de Los Andes: march 2002

El tratamiento de las fracturas abiertas complejas de la mandíbula se basa inicialmente en la estabilización con mini fijador externo y en un segundo tiempo la estabilización definitiva con placa de reconstrucción y/o aporte biológico (injerto óseo). La reducción cruenta a través de Kirschner tan solo se ha usado en situaciones en las que el cirujano no cuenta para el momento de la emergencia con el recurso ideal; tan solo siente casos se han reportado en la literatura mundial con la utilización de este material6, en el presente trabajo reportamos un caso radiológica y clínicamente demostrado de una fractura abierta compleja iiia de hemimandíbula derecha tratada mediante osteodesis con alambre de Kischner en una paciente femenina de 21 años de edad con una evolución satisfactoria dada por apertura bucal oclusión normal y consolidación ósea ad integrum.

[Tumor markers in some chronic inflammatory diseases in rheumatology: a statistical evaluation]. / Markers neoplastici in alcune malattie infiammatorie croniche in reumatologia: Valutazioni statistiche.

BACKGROUND: Since tumor markers can be high in the course of many inflammatory diseases, the aim of this study is to verify if it also occurs in the course of rheumathologic chronic inflammatory diseases, and if there is any statistical correlation between tumor markers and inflammatory indices. METHODS: Seventy-nine patients (51 females and 28 males) with rheumatologic chronic inflammatory diseases, aged 17-92 years, were studied, all of them took 4 mg of prednisone. alphaFP, CEA, TPA, CA19.9, CA15.3, CA72.4, CA125, ferritina, beta2 microglobuling, betaHCG, and free and total PSA in males, were evaluated as tumor markers; and VES, PCR and Fibrinogen, as inflammatory indices. RESULTS: The results obtained showed that there is a significative correlation between ferritin, beta2 microglobulin, TPA and PCR, and between free and total PSA and Fibrinogen. CONCLUSIONS: PCR is a very good index of an active disease and it can be helpful, along with tumor markers, in the monitoring of chronic inflammatory diseases.

Polarization diversity detection for fiber interferometers using active feedback control of output polarization-mode selection.

The application of an adaptive polarization diversity detection technique in an interferometric fiber sensor system is described. The approach utilizes feedback control of the polarization modes selected at the sensor output and produces the optimum level of total interference signal while allowing the states of polarization of the light in the signal and reference arms of the interferometer to vary randomly.

[An association of diabetic bullosis and diabetic neuropathy. A clinical case report]. / Associazione di bullosis diabeticorum e neuropatia diabetica. Descrizione di un caso clinico.

A case of bullosis diabeticorum, a rare complication of diabetes whose genesis is not yet clear is reported. In the present case, the complication was associated with marked somatic and autonomic neuropathic impairment.

Observation of input-polarization-induced phase noise in interferometric fiber-optic sensors.

It is shown that polarization fluctuations in the input fiber to an interferometric sensor can result in the generation of excess phase noise in the output. Experimental observations of this phenomenon are compared with theoretical models, and the impact of this noise source in interferometric sensors is briefly discussed.

Internal rotation of the birefringence axes in polarization-holding fibers.

An internal rotation of the birefringence axes has been measured in a variety of polarization-holding fibers. The rotation of the axes causes coupling of the major-field components of the fundamental modes, which limits the polarization-extinction ratio in short lengths of birefringent fibers to -45 dB in some cases. A practical consequence of the rotation of the axes is a reduction of the polarization-holding ability of devices such as fiber couplers that are made with these fibers.