The interplay between risk and protective factors during the initial height of the COVID-19 crisis in Italy: The role of risk aversion and intolerance of ambiguity on distress.

The present study aimed to test a model of relations to ascertain the determinants of distress caused by lockdown for COVID-19. It was hypothesized that the exposure to the COVID-19 increased distress directly and through the mediation of worry, health-related information seeking, and perception of the utility of the lockdown. It was also expected that higher levels of ambiguity intolerance corresponded to higher distress directly and through the mediation of worry, health information seeking behaviors, and perceived utility of the lockdown. Finally, it was expected that risk aversion positively influenced distress directly and through the increasing of worry, health-related information seeking behavior, and more positive perception of the utility of the lockdown The study was conducted in Italy during the mandatory lockdown for COVID-19 pandemic on 240 individuals (age range 18-76). Data recruitment was conducted via snowball sampling. COVID-19 exposure was positively associated with worry and health-related information seeking. Risk-aversion was positively associated with health-related information seeking and perceived utility of the lockdown to contain the spread of the virus. Worry and health-related information seeking were positively associated with distress, whereas the perceived utility of the lockdown was negatively associated with distress. Intolerance for the ambiguity was directly linked to distress with a positive sign. Findings suggest that risk aversion represents both a risk factor and a protective factor, based on what kind of variable mediates the relationship with distress, and that the intolerance to the ambiguity is a risk factor that busters distress.

[Age-adjusted D-dimers and pulmonary embolism]. / D-dimères et suspicion d'embolie pulmonaire: seuil adapté à l'age.

Plasma D-dimer measurement is the first diagnostic test performed in patients with a non-high or an unlikely clinical probability of pulmonary embolism (PE) but its clinical usefulness is limited in elderly patients due to a low specificity in this subgroup. PE can be excluded based on D-dimers and clinical probability only in about 5% of patients over 80 years when using the conventional cut-off. Age-adjusted D-dimer cut-off (adjusted cut-off value = age x 10 in patients over 50) increases the specificity of the test without significantly reducing its sensitivity. Using the age-adjusted D-dimer cut-off markedly reduces the need for further diagnostic studies such as computed tomography pulmonary angiography (CTPA). The age-adjusted cut-off has been widely validated in retrospective cohorts, and more recently in a prospective management study.

[Use of low molecular weight heparin for medical prophylaxis by European geriatricians]. / Utilisation des héparines de bas poids moléculaire en prévention médicale par les gériatres européens.

PURPOSE: Many hospitalised elderly patients are at increased risk of venous thromboembolism (VTE). The aim of this study was to assess the rate and duration of medical utilization of low molecular weight heparin (LMWH) for VTE prevention by European geriatricians. METHOD: A questionnaire was sent to 94 geriatricians of the European Academy for Medicine of Ageing (EAMA), to be filled out for each patient older than 65 years of their institutions who received LMWH during 1 day of December 2000. RESULTS: In the 37 centers that participated (representing 11 different European countries) 2912 patients were present on the day of the study: 857 patients in acute care, 367 in rehabilitation care, 1568 in long-term care and 141 in day hospital. Prophylaxis by LMWH was given to 284 medical patients (9.75%, mean age 82.2 years). Use of LMWH was more frequent in acute and rehabilitation care (22.4% and 9.8%) than in long-term care (3.1%). The main risk factors in patients with LMWH prophylaxis were: bedridden (53%), infectious disease (18%), heart failure (17.6%), venous insufficiency (17.6%), paralysis of lower limbs (16.6%), recent stroke (15%) and malignancy (10%). The duration of the treatment for VTE prophylaxis exceeded 30 days in 51 patients (12%) and one year in 15 patients (3.3%). CONCLUSION: In Europe, VTE prophylaxis by LMWH is widely used in elderly medical patients without specific guidelines in this population. Further studies are necessary to evaluate the appropriate duration of prophylaxis in very prolonged immobilization.

[Physiotherapy for the elderly]. / Physiotherapie beim alten Menschen.

One of the main goals of physical therapeutic procedures in the elderly is the restoration or maintenance of functional autonomy in daily living activities. Whilst necessity for care and assistance in an aged population rises dramatically with age, physical therapy can efficiently reduce these needs. For an optimal therapeutic approach the therapists should take into account the particular characteristics of the ageing process as well as the predominant comorbidities, which should be correctly assessed in order to integrate those context factors into the rehabilitation program. This is only possible with a good functioning teamwork: The team should therefore include physicians, nurses, physiotherapists as well as social workers and other professionals. We describe here the theoretical basis of the particular aspects of physiotherapy for the elderly and we illustrate this approach exemplarily for falls prevention through resistance- and balance training.

A single institution's experience (1982-1999) with plasma-exchange therapy in patients with fulminant hepatic failure.

Fulminant hepatic failure is a rare, but often fatal complication of acute viral hepatitis. This condition, in absence of orthotopic liver transplantation (OLTx) surgery, is associated with a high mortality rate, despite the improvement of general intensive care. Plasma-exchange (PEx) therapy has been long used to treat FHF, in particular by removing toxic substances and correcting the severe coagulopathy. In this study we describe our experience with PEx treatment of FHF, beginning in 1982. Seventy patients affected with FHF due to various causes (HBV = 40; cryptogenic/non-A, non-E = 15; Amanita phalloides = 8; other = 7) were treated with PEx (altogether 348 sessions). Overall survival rate, comprising patients undergoing OLTx, was 51%, a little higher than what we observed in patients (N = 49) treated solely by PEx, i.e., 41%. The best outcome predictor was FHF aetiology, owing to the good survival rate in patients with Amanita phalloides intoxication and the very poor prognosis of patients suffering from cryptogenic/non-A, non-E FHF. Moreover, the marked increase in prothrombin time and alpha-fetoprotein levels after 48 hours from admission was associated with a good prognosis, whereas the patient's age and coma grade were not clearly predictive of survival. Additionally, lymphocyte subpopulation, resulting in a CD4/CD8 ratio lower than 1.0 along with CD8 activation with HLA-DR strong expression, were associated with a high rate of mortality and morbidity. Our data indicate that PEx therapy can improve survival in patients with sufficient residual capacity of liver regeneration. Moreover, the identification of certain prognostic factors may be useful for the rational planning of therapeutic strategy in FHF.

[Serotypes of hepatitis C virus in mixed cryoglobulinaemia]. / Caratterizzazione sierotipica del virus dell'epatite C nella crioglobulinemia mista.

BACKGROUND: Several authors have studied the genotypic distribution of hepatitis C virus (HCV) in mixed cryoglobulinaemia (MC), which represents the most typical extra-hepatic manifestation of the HCV infection. On the other hand, at present no data are available on the HCV serotypic characterization of MC patients. METHODS: Thus, 28 serum specimens from HCV positive patients affected by MC (7 males and 21 females; mean age of 64 yrs, range 35-80) have been evaluated by a serotyping EIA method (Murex HCV Serotyping 1-6 Assay, Murex Diagnostics, Pomezia, Italy). RESULTS: The HCV serotype 1 was found in 13 patients (46.4%), serotype 2 in 5 patients (17.9%) and mixed serotypes in 3 patients (10.7%), showing, respectively, serotypes 1+2, 1+4, and 1+4+5. Moreover, the HCV serotype was not detectable in 7 patients (25.0%). CONCLUSIONS: These results, obtained by using a simple, serologic technique, agree with some literature data concerning MC patients from the same geographic region as ours (Venetian area). In addition, our findings appears to reflect merely the genotypic distribution of the HCV infection in the North Italy.

Anti-hepatitis C virus serology in patients affected with congenital coagulation defects: a comparative study using three second generation ELISA tests.

We determined the prevalence of anti-hepatitis C virus (HCV) antibodies in 34 patients affected with congenital coagulation disorders attending the Haemophilia Centre of Padua, Italy. Serological tests were carried out by three second generation enzyme linked immunosorbent assays (ELISA), two based on recombinant proteins (Ortho and Abbott) and one based on synthetic peptides (Behring) as antigenic substrate. The repeatedly reactive specimens were further assayed by the supplemental 4-antigen recombinant immunoblot assay (RIBA) (Chiron and Ortho). Moreover, we performed the dot-blot Matrix test (Abbott) on the samples showing discrepant results by the three ELISA tests. Twenty-six patients (76.5%) were anti-HCV positive using all three ELISA tests; 25 were confirmed by the supplemental RIBA test, the other one was indeterminate. Two samples were in a gray-zone only using the anti-HCV ELISA Abbott. These were positive by the RIBA; in contrast, such samples showed no reactivity with the Matrix test. In accordance with the current literature, these data show an equivalence between the 2nd generation screening tests (ELISA), at least when applied to a high risk population as in the present study. Further, these screening tests demonstrated a reliable specificity, since most of the ELISA-reactive specimens were confirmed by the supplemental RIBA test. In contrast, combined use of the anti-HCV tests could be useful when high sensitivity is requested, as in the case of blood donor pretransfusion screening.

A multicentric seroepidemiological survey of HTLV-I/II in Italy.

BACKGROUND: Several studies carried out in the USA and in Europe have shown the presence of HTLV-I/II antibodies in subjects belonging to high-risk groups for HIV infection as well as blood donors. Concern about the presence of HTLV-I/II markers in the normal population, as well as the efficient transmission of HTLV-I/II by whole blood or infected blood cells have led several countries to include screening for anti-HTLV-I/II among the mandatory serological testing of blood donors. OBJECTIVE: In order to assess the risk of HTLV-I/II infection related to blood transfusions, a multicentric survey for antibodies against HTLV-I and HTLV-II was carried out involving 10 Italian sites during the spring of 1991. STUDY DESIGN: Serum specimens were collected from 14,598 blood donors, 1,411 injecting drug users, 1,015 thalassemics, 142 hemophiliacs and 138 hemodialysis patients. HTLV antibodies were detected by a screening EIA which combines a viral lysate with a recombinant HTLV-I env protein (p21e). The serological confirmation was performed by a semi-automated dot-blot immunoassay that detects gag p19 and p24 and env p21e specific antibodies, while the discrimination of HTLV-I and HTLV-II reactivities was carried out by EIAs employing synthetic peptides of the ENV region specific for each virus. RESULTS: The seroprevalence of confirmed positives was 0.034% among blood donors and 3.61% among IDUs, while no sample of the other categories could be confirmed, although several were indeterminate and one thalassemic reacted against HTLV-I on peptide testing. HTLV-I reactivity was observed in one blood donor, while all 38 of the 51 confirmed seropositive IDU's reacted only to the HTLV-II synthetic peptide. CONCLUSIONS: These data confirm a high prevalence of HTLV-II among Italian IDUs and show an HTLV-I/II seroprevalence among blood donors very similar to that which was found in the USA volunteer blood donors. A surveillance program among blood donors seems advisable in order to establish the possible need of a mandatory screening for HTLV-I/II.

[Not Available]. / L'insegnamento clinico di Giovan Battista Da Monte (1489-1551): una revisione critica.

In 1808 Giovanni Rasori (1766-1837) credited Giovan Battista Da Monte (Montanus, 1489-1551) with the introduction, around 1543 at the San Francesco Hospital of Padua, of clinical teaching at the bedside as an integral part of medical education. Actually, the Hospital and the University were two completely independent institutions, and Rasori's assertion is founded on the erroneous interpretation of some clinical consultations published by Da Monte's pupils.

[Rasori, Borda and the theory of stimolo and contrastimolo]. / Rasori, Borda e le dottrine dello stimolo e del controstimolo.

Brown's thought represented one of the most successful medical systems which arose in the XVIIIth century, as a consequence of vitalism and as a reaction to the inadequacy of Hippocratic-Galenic medicine. Giovanni Rasori was a strong supporter of Brown's theories in Italy and creator of the scientific movement which was, then, called Rasorism. A fundamental point of Rasori's therapeutic thought was represented by the dynamic action of drugs, so that a pharmacological experimentation became necessary, for medical practice. Siro Borda, who was a follower and personal friend of Rasori, made experiments on 150 substances to identify their dynamic action and, finally, he classified them in three groups: stimolanti, controstimolanti, eterocliti. This last class comprehended all the pharmacological substances of uncertain or not yet determined nature.

"Anatomes peritissimus": Johann Georg Wirsung's unknown experiments on the circulation of the blood.

Andrea Argoli (1570-1657), professor of mathematics at the University of Padua from 1632 to 1657, published at Padua in 1644 in the work Pandosion sphaericum an accurate and succinct exposition of the theory of the circulation of the blood. Argoli's exposition actually is a summary of Jan de Wale's (Walaeus, 1604-1649) first Epistola de motu sanguinis, republished at Padua, just a year prior to the Pandosion, as an appendix to the fourth edition of De motu cordis of William Harvey. Argoli cites a hitherto unknown very expert anatomist at Padua, John George Verden, who carried out experiments at Padua designed to measure the volume of arterial blood emitted from each contraction of the left ventricle in small and large dogs. It is now possible to identify Verden with Johann Georg Wirsung (1589-1643), from Augsburg, the discoverer of the main pancreatic duct by ligation of the chyliferous ducts.

The use of fluorescence flow cytometry in the characterization of Bernard-Soulier syndrome and Glanzmann's thrombasthenia.

We have used flow cytometry analysis of fluorescence to study the binding of murine monoclonal antibodies to platelets. Anti-platelet glycoproteins Ib (AP1), the complex IIb-IIIa (LJP9) and the FITC-conjugated second antibody were added directly to the sample of platelet rich plasma without washing. The analysis was performed in normals and in patients affected by the Bernard-Soulier syndrome and Glanzmann's thrombasthenia and compared to the direct binding of radioiodinated monoclonas. Comparable results were obtained. A symmetric profile of fluorescence for both glycoproteins Ib and IIb-IIIa was observed in normals and in the patient group, which indicates homogeneous distribution of these glycoproteins on the platelet surface. The develop technique allows identification of homozygous and heterozygous carriers of the platelet disorders studied and quantification of the defect, which seems to be due to a homogeneous decrease of specific glycoproteins in all platelet populations.