COVID-19 pandemic, substance use disorders and body image issues, a worrisome correlation.

The SARS-CoV-2 pandemic has profoundly affected the social fabric and the economic and health care viability and functioning of most countries. Aside from its deeply destructive impact on health care systems and national economies, the pandemic has jeopardized people's emotional and psychological well-being as well. The authors aimed to shed a light on how the pandemic has been affecting patients with addiction issues and body dysmorphic disorder (BDD), which is characterized by negative thoughts about appearance and body misperceptions. People with body dysmorphic disorder are in fact at increased risk of developing substance use disorders, and such a destructive association has only been made more severe by pandemic-related restrictions, emotional distress and anxiety, as well as longer exposure to social media and online interactions. This is a major cause for concern, because substance use worsens symptoms of BDD and contributes to unfavorable treatment outcomes.

Role of meteorological factors in the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic in Italy.

OBJECTIVE: Understanding the evolutionary dynamics of the Coronavirus disease 2019 (COVID-19) pandemic in the coming months is a matter of great importance and urgency for governments worldwide, making fundamental decisions based on what is known about the transmission mechanisms of the virus and its survival in the environment. The present study aimed to evaluate the impact of demographic variables, solar radiation and relative humidity on the spread of the COVID-19 pandemic of the various regions in Italy. MATERIALS AND METHODS: The retrospective longitudinal study was conducted, and data used in this study was obtained from the Italian Health Ministry. Descriptive statistics included mean, frequency, and percentage, and results presented by graphs were calculated. RESULTS: The infection trend was investigated by comparing it with the demographic situation and the irradiation indices of solar ultraviolet light that are detected with the changing seasons. The present study reported that the geographic areas with higher population density and lower solar radiation during the autumn and winter months were most affected by SARS-CoV-2. CONCLUSIONS: The analysis carried out can provide a predictive model for the future phases of the COVID-19 pandemic in Italy, regardless of the adoption of lockdown measures and behavioral factors.

Determination of nine new fentanyl analogues and metabolites in consumers' urine by ultra-high-performance liquid chromatography-tandem mass spectrometry.

OBJECTIVE: New fentanyl analogues have been constantly emerging into the illegal drug market as cheap substitutes of heroin posing a serious health threat for consumers because of their high toxicity. Analytical methods to disclose the presence of these compounds in biological fluids of intoxicated individuals need to be updated to keep up with the new trends. In this study, we updated an ultra-high-performance liquid chromatography-tandem mass spectrometry method previously developed, for detecting some new fentanyl analogues and metabolites (sufentanil and norsufentanil, cis-3-methylnorfentanyl, trans-3-methylnorfentanyl, metabolites of cis and transmethylfentanyl, beta-phenylfentanyl, phenylfentanyl, para-fluoro furanyl fentanyl, isobutyryl fentanyl and ocfentanil) in urine sample. MATERIALS AND METHODS: Urine samples were simply diluted before injection in the chromatograph equipped with a reversed phase microcolumn. Detection was achieved with a triple quadrupole mass spectrometer with an electrospray ionization source in positive ion mode and operated in multiple reaction monitoring. RESULTS: The chromatographic separation was short (5 min) and the method was fully validated with a high sensitivity being limits of quantifications from 0.003 to 0.006 µg/L urine for the analytes under investigation. CONCLUSIONS: The suitability of the method was tested with urine specimens from former heroin addicts, which resulted positive by immunological screening to the class of fentanyl analogues. This method represents a valid tool to document recent exposure to the above-reported compounds for clinical and forensic purposes.

Critical reflections and solutions for health problems of Italian refugees.

BACKGROUND: In recent years, the flow of migrants and refugees to EU nations is recorded in high amounts. By travelling through ships or nonhygienic boats most of them tend to have a high amount of risk in getting health issues. However, getting proper healthcare is a funda-mental human right since refugees or migrants can actively contribute to the development of host countries and their native nationalities. Therefore, in this paper, we try to explore the common diseases that happened to migrants who travel to Italy in recent years. METHODS: We analyzed the Italian refugees' data provided by the Italian health ministry in the years 2013-16, and explore the key pathologies and their medical conditions. All the data correctly clas-sified and analyzed depending on their age, gender, and pathologies that they posses. RESULTS: From 2013 to 2016, in total, 455,912 refugees were trav-elled into Italy. 74% male, 12% female, and 14% of minor refugees were recorded during this period. In pathologies, rashes or skin dis-eases (scabies) were happening in often and after scabies pregnancy issues were observed on a considerable scale. Similarly, brain-related problems and surgeries were recorded at the lowest in number. CONCLUSION: In 2015, about 12% of all workers in the EU nationali-ties were migrants. As of this, it is highly recommended in the provision of proper health facilities to them without making any judgments. This paper is aiming to provide prevention methodologies that are in high demand for health care of refugees and migrants.

Obesity in the European region: social aspects, epidemiology and preventive strategies.

Obesity related to metabolic syndrome is gaining an increasing importance as the main risk factor for diseases and disability in the European region. We herein review the increasing trend of obesity and overweight in males and females from Europe, preventive programs addressed to children, youngsters, adult population and subjects with particular diseases which can profit from healthy nutrition. The main feature is that some European countries have implemented programs on World Health Organization (WHO) proposals, while some others have focused attention only on some aspects. Based on the reported obesity increase over the last twenty years, prevention programs seem to have been ineffective. Most likely, the effects will be observed later on. In this concern, it will be fundamental to continue and finance the countries of the European region, where those programs have been extensively applied, to obtain even better results in terms of obesity prevention.

[Literature review and state of the art of the Italian law on medically assisted reproduction]. / Il difficile percorso normativo italiano sulla Procreazione Medicalmente Assistita: revisione della letteratura e stato dell'arte.

This article analyzes the current situation of medically assisted reproduction in Italy after the promulgation of Law 40 in 2004. This law is actually completely different from the origin version. The controversial points like reproduction for couples who bear genetic diseases, prohibition of heterologous fertilization, cryoconservation of the embryos, obligation to perform just one and contemporaneous implant of all the embryos produced, are today definitively erased. This new situation is due to the jurisprudence of the Italian Courts but especially to the changes introduced by the European Court of Human Rights and by the questions of constitutionality raised by some Italian Courts. After analysis of the legislation, the views of various authors are compared, and the weaknesses and strong points of the law are considered from the point of view of legal medicine, science and bioethics. After ten years of operation of this law Italy has returned to a situation that existed before the law. In fact the old law was only full of prohibitions. Now is possible to do heterologous fertilization and this article photographs the current situation of hospitals for assisted procreation in Italy. The work also comments on procreative tourism, a direct consequence of this law, and on the status of women, who must be the subject and not the object of the legislation.

A new ethical and medico-legal issue: vascular surgery and the postoperative cognitive dysfunction.

Patients undergoing major surgery are at risk for postoperative cognitive dysfunction (POCD). The consciousness of the POCD arises new ethical and medico-legal issues that should be identified, managed and, if possible, prevented. Elderly patients still represent a real challenge for physicians and medical science. This challenge can be surmounted not only through technical progress but also by safeguarding the correct ethical behavior at the base of each relationship between a patient and his physician. Effective communication with the elderly patient is a prerequisite for clear and complete information, involving family members and caregivers when necessary. In every case, the identification of patients with pre-existing risk factors of POCD, shortening the period of time preceding the surgery and a proper technique of the procedure as well as physical and intellectual exercises, nutrition and medication play an important role in decreasing the incidence of neurocognitive deficits in the elderly.

What is the present situation of vascular surgery? Considerations and reflections based on real practice.

"For the best vascular care to every patient, every day" is the goal of our practice, but is it a possible goal? Where are we now? The general idea is that we are pursuing the right way. The evolution of our discipline in the last two decades has been extraordinary and we reaffirm that we are the leaders in diagnose and treatment of the arterial pathology. Unfortunately, we can find some cases in which reality has to be faced as hardly as it can be, remembering us that we still have to go further with our job. The delay in the diagnose and treatment could lead to a permanent deficit and a money loss for the national health system due to prolonged hospitalization, multiple re-hospitalizations, loss of working capacity. This must be avoided. We strongly suggest that a vascular surgeon should be present in all the Emergency Room and should be routinely involved in the management of patients. The routine use of dedicated interdisciplinary protocols should be strongly advocated. Vascular surgery, as medical specialty, should be recognized as single specialty in all countries and as "peculiar" by the National Authority as well as Neurosurgery and Cardiac Surgery.

Claimants in vascular surgery.

AIM: Litigation concerning medical activities is constantly increasing, as society becomes more and more "protective" of citizens who may have suffered any wrong due to malpractice. However, we should bear in mind that the percentage of claims liquidated is minimal. METHODS: From January 2009 to December 2011, 63 claims involving vascular procedures were analyzed. The rate of claimants receiving payment was very low: only 8 of the 63 (12.7%) claims having been settled. The most important thing we noted was that in 5 of the 8 claims settled the key element that defined the sentence was time: time to take a decision, to perform a diagnostic examination, to decide on a surgical procedure. RESULTS: We have sought to assess the role of the "time factor" in the occurrence of errors in a surgical specialty considered at high risk of litigation such as vascular surgery. This analysis of our experience over the past three years has shown that the central element in the genesis of the error was the erroneous timing of intervention. It interesting to note that, in contrast to what might be expected, time-related errors are much more common in cases treated electively than in urgent or emergency cases. CONCLUSION: Our experience demonstrates that the "time factor" plays a primary role in the genesis of errors in vascular surgery. This delay in deciding and acting probably depends on the fact that the vascular surgeon was the patient's first contact in only one of the cases examined. This should emphasize the need to equip all emergency departments with a Vascular Surgery Unit.

Informed consent when taking genetic decisions.

Developments in genetics with diagnostic, pre-symptomatic and predictive testing involve significant changes in the decision-making process, because of the complexity of genetic information and the difficulty related to understanding the causes and mechanism of genetic diseases, ethical, psychological and social implications (psychological stress, anxiety, discrimination in employment and assurance, difficulties in interpersonal relationship), and indirect involvement of third parties. When taking genetic decisions, the patient should receive all the information about the objective and the type of the test, the hypothetical risk, the possibility of obtaining unexpected results, possible psycho-physical repercussion, and means of support for the long time that might pass between the diagnostic predictions and the possible onset of the disease: genetic counseling is a complex but essential operation for acquiring the informed consent of the patient. The outlined peculiarities of the process for informed consent in genetics requires the adequate training of medical personnel to manage the relationship with the patient in these complex cases.

Comparison of fingernail striation patterns in identical twins.

The fingernail ridge patterns of a pair of identical twins were compared to each other, their parents, and an unrelated subject. The patterns of the twins' nails showed regions of strong similarity but were distinguishable from one another. Fewer similarities were found when comparing the nails to those of the parents and the unrelated control. The twins were shown to be monozygotic by means of DNA profiling. This therefore represents the first demonstration of unique fingernail ridge patterns in subjects shown conclusively to be identical twins. When the fingernail ridge patterns were examined with a scanning electron microscope, the backscattered electron (BEI) images were found to have superior contrast when compared to the secondary electron (SEI) images.

Intestinal obstruction at the onset of acute lymphoblastic leukemia in a child.

Surgical complications need not be fatal in acute leukemia. If these are promptly diagnosed and properly treated, the prognosis will improve. This report deals with a case of acute lymphoblastic leukemia presenting with an acute abdomen following surgery for choledochal cyst. A peripheral blood smear and examination of the bone marrow revealed acute lymphoblastic leukemia. The child received transfusions of blood and platelets. Pretreatment with prednisolone was started as therapy for leukemia, and 2 days later, the patient underwent surgery. Therapy was continued until the general condition allowed a more aggressive form of treatment. Complete remission was achieved, and the patient is still in good health 48 months after diagnosis and 15 months after discontinuation of treatment. The favorable outcome in this child shows that prompt surgery is sometimes an essential step in the treatment of childhood leukemia.