Telemedicine: A cornerstone of healthcare assistance during the SARS-Cov2 pandemic outbreak but also a great opportunity for the near future.

At the end of 2019, Wuhan, China, experienced an outbreak of a novel coronavirus. The SARS-CoV2 epidemiologic burden was constantly evolving, with numbers of infected persons, hospital admissions and deaths growing near exponentially. The pandemic outbreak of COVID-19 worldwide caught the health care systems in every country by storm and without a proper defense mechanism to cope and control such a pandemic, causing an overwhelming burden of illnesses that stressed the Health System capacity. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. During the "lockdown", the AOU "Federico II" was forced to create peculiar pathways to ensure the safety of the patients and medical staff, and to keep an appropriate medical assistance, therefore it was introduced the telemedicine, wherever possible, by modifying the Information Technology (IT) related to the waiting times, rescheduling all booked visits and identifying several outpatient clinics suitable for telemedicine activities. In this paper the Authors reports their own experience with Telemedicine.

Effects of a new combination of plant extracts plus d-mannose for the management of uncomplicated recurrent urinary tract infections.

Urinary tract infections (UTIs) are an economic burden for public health. The increasing prevalence of resistant bacteria which cause UTIs may be related to the inappropriate prescription of antibiotics. The aim of this preliminary study was to evaluate whether three different combinations of plant extracts plus d-mannose are effective in preventing the recurrence of UTIs. Three groups of patients received three combinations of plant extracts in conjunction with d-mannose. These were: berberine, arbutin and birch (group A); berberine, arbutin, birch and forskolin (group B); and proanthocyanidins (group C). The clinical recurrence of cystitis at the end of treatment and during follow-up was determined by comparison with baseline measurements using the microbiological assessment of urine samples, vaginal swabs and vaginal smear slides. Patients in groups A and B had a lower incidence of episodes of recurrent cystitis during treatment and follow-up, samples with a significantly lower median bacterial load and a reduction of the grade of lactobacillary flora compared to patients in group C.

Prevalence of HPV infection among HIV-positive and HIV-negative women in Central/Eastern Italy: Strategies of prevention.

The present cross-sectional-study aimed to determine the prevalence of human papillomavirus (HPV)-genotypes among human immunodeficiency virus (HIV)-positive and -negative women in Central/Eastern Italy, and to identify the optimal strategies for effective HPV-prevention in each group. A representative sample of HIV-negative (150/200) and -positive (50/200) women, who underwent cervico-vaginal-swabbing. Swabs were analysed for a cytological screening and for a HPV-DNA-genotyping-test. A total of 66/200 swabs resulted HPV-positive. The overall HPV-prevalence was 33% with a higher prevalence in the HIV-positive-group (48%) compared with the HIV-negative-group (28%). The most frequent genotypes were: 16, 31, 52, 58, 66, 73 and 89. Furthermore, the prevalence of specific genotypes was different in each group. The results of the present study indicate that HIV infection appears to be an independent risk factor for HPV-infection. In addition, HPV-infection is more common and more likely to persist in HIV-positive compared with in HIV-negative women. The optimal way to counteract HPV infection is through primary prevention. The stage of immunity (cluster of differentiation 4-level) at the time of the HPV-screening is one of the most important parameters for detection of susceptibility to HPV-infection and to evaluate the response to the HPV-vaccine in HIV-positive women. It may be used to determine the sub-group of HIV-positive women that are more prone to HPV-infections or that exhibit a partial response to the HPV-vaccine. At present, a novel type of vaccine with 9-genotypes is available and in the near future, it may serve an essential role in the prevention of HPV infections.

Effectiveness of the Association N-Palmitoylethanolamine and Transpolydatin in the Treatment of Primary Dysmenorrhea.

STUDY OBJECTIVE: To evaluate the effectiveness and safety of the combination of N-palmitoylethanolamine (PEA) and transpolydatin vs placebo in the treatment of primary dysmenorrhea in adolescents and young women. DESIGN, SETTING, AND PARTICIPANTS: Randomized treatment and follow-up of 220 cases of primary dysmenorrhea in the Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. METHODS: Between February 2013 and February 2014, we treated 220 young women aged 16 to 24 years who had primary dysmenorrhea: 110 patients were treated with the oral combination of PEA-transpolydatin: 400 mg + 40 mg (1 tablet a day for 10 days from the 24th day of cycle) and 110 patients with placebo (1 tablet a day for 10 days from the 24th day of cycle). A follow-up was performed after treatment, and all girls were seen at this time. A 10-point visual analog scale was used to measure the improvement of pelvic pain. For categorical variables, the χ(2) test and analysis of variance were performed to value the significance of differences between groups. A value of P < .05 was considered statistically significant. RESULTS: An improvement of pelvic pain was seen in 98.18% (95% confidence interval 97.64% to 98.60%) of cases in group 1 vs 56.36% (95% confidence interval 48.62% to 63.81%) in group 2 (P < .001). The combination of PEA and transpolydatin was more effective than placebo (P < .001). CONCLUSION: The combination of PEA and transpolydatin shows promise as a valid adjuvant therapy in the medical treatment of primary dysmenorrhea in adolescents and young women.

Vulvo-vaginitis in prepubertal girls: new ways of administering old drugs.

STUDY OBJECTIVE: To evaluate the effectiveness and safety of local vs systemic antibiotic treatment in the management of recurrent vulvovaginitis in children. DESIGN: Randomized treatment and follow-up of 90 cases of persistent vulvovaginitis. SETTING: The Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. METHODS: Between January 2009 and December 2012, 90 prepubertal girls (Tanner Stage I) aged 6-12 years, with recurrent discharge not responding to common hygienic measures and not suspected of being sexually abused, were treated, 45 patients with oral antibiotic treatment (group 1) and 45 patients with a local antibiotic treatment (group 2). Vaginal cultures were prepared before treatment and follow-ups were made after 3 months. RESULTS: Bacterial pathogens were isolated in vaginal secretions of 84/90 (93%) girls. There were 6 girls receiving antibiotic treatment who had persistent discharge and repetitive isolations of Escherichia coli. Administration type was selected at random. Symptoms and signs were resolved in all girls, but we observed 1 recurrence (2.22%) in group 2 vs 6 recurrences (13.33%) in group 1 (P = .049). In group 1 we observed 3 cases (6.67%) of gastro-intestinal side effects vs no cases in group 2 (P = .079). CONCLUSION: Topical medication based on netilmicin, associated with Benzalkonium-Chloride, showed a clinical and microbiological effectiveness in first-line treatment of bacterial vulvovaginitis in children, comparable to conventional drugs; so local treatment may be a good alternative to systemic treatment decreasing the use of oral antibiotics in young people and related risks of bacterial resistances.

Conservative Therapy in Two Cases of Non-Hodgkin Lymphoma of the Penis: Case Reports With Review of the Literature.

The malignant lymphomas rarely occur in the genito-urinary tract and particularly penis lymphomas are extremely uncommon. Frequently they do not have any specific symptoms and the diagnosis is delayed even in presence of a penis node. In our hospital we observed two patients affected by Non-Hodgkin Lymphoma (NHL), one of them with a primitive disease. Both cases were sexually active men who did not accept a radical surgery. A conservative polichemotherapy treatment by ciclophosphamide, vincristine and prednisone has been proposed and performed for both cases and a complete resolution of disease was demonstrated. At the same time we assessed the erectile function by the IIEF score, before and after treatments.

Mucinous adenocarcinoma of the urinary bladder.

BACKGROUND: Mucinous adenocarcinoma of the urinary bladder is a rare primary urologic disease, poorly responsive to radiation or chemotherapy as first-line treatment. CASE REPORT: After trans-urethral resection of the bladder, a 62-year-old woman was diagnosed with mucinous adenocarcinoma of the urinary bladder. An upper gastro-intestinal endoscopy and a colonoscopy excluded any primary site of origin from those gastro-intestinal tracts. After whole-body CT staging scans, an anterior pelvectomy was performed, confirming a mucinous adenocarcinoma of the bladder, with no extra-vesical spreading. Some onco markers were sampled before surgery, and Ca 19-9 showed very high values, with a decreasing trend after pelvectomy. Six month after surgery, bilateral inguinal lymph node dissection was performed because of bilateral palpable masses - histologic examination showed a single metastatic node. The patient also received external radiotherapy of the inguinal area. Twenty-eight months after pelvectomy, the patient appears healthy. CONCLUSIONS: Early radical surgery with or without adjuvant radio-chemo-therapy appears to be the best option for mucinous adenocarcinoma of the bladder, and a good outcome is likely to be related with a confined disease and small tumor size. In addition, Ca 19-9 sampling proves to be useful in tumors that produce markers.

Trisomy 1q42-qter associated with monosomy 6q27-qter: a case report.

PURPOSE: Partial trisomy 1q42-qter is a rare chromosomal aberration. Most cases arise from de novo unbalanced translocations or from unbalanced inheritance of parental balanced rearrangements. METHODS: Descriptive case report. RESULTS: A 4-year-old boy had shown an increased neck translucency at the fetal ultrasound examination performed at the 11th week of gestation. Amniocentesis, performed at the 18th week of gestation, did not demonstrate any genetic abnormality. A second fetal ultrasound examination, carried out at the 35th week of gestation, showed congenital clubfeet and hydrocephalus. At birth, clinical examination revealed congenital bilateral ventriculomegaly, bilateral congenital equinovarus clubfeet, low-set ears, plagiocephaly, micrognathia, hypertelorism, prominent forehead, broad nasal bridge, hypertonic syndrome, and inguinal hernia. Ophthalmologic consultation showed the presence of optic pit in his left eye. Genetic counseling was performed. Chromosome analysis demonstrated a partial trisomy 1q42.2-qter associated with a partial monosomy 6q27-qter. Moreover, deletions of the distal region on the long arm of chromosome 6 are frequently associated with both ocular abnormalities and several solid tumor types. Moderate mental and psychomotor retardation has occurred. CONCLUSIONS: This case emphasizes the importance of scheduling a screening test for eye diseases and tumor in these patients.

Third-generation tension-free tape for female stress urinary incontinence.

PURPOSE: We reviewed our experience with the TVT-Secur tension-free tape for stress urinary incontinence in females. We evaluated operative time, complications, the continence rate and patient satisfaction at followup. Ethics committee approval was not required. MATERIALS AND METHODS: A total of 32 hammock-shaped tape interventions were performed between November 2006 and April 2008 at our hospital. All patients had stress urinary incontinence, which was pure in 20 and associated with prolapse of other pelvic organs in 12. Each patient underwent urogynecological assessment with urodynamic evaluation and performed a quality of life questionnaire. We excluded from analysis all patients with intrinsic sphincteric deficiency. Patients were followed for continence and satisfaction. Therapeutic failure was defined as persistent urinary stress incontinence affecting quality of life, as reported by patients and on clinical examination. RESULTS: None of the 32 women had any surgical complication, postoperative pain or blood loss greater than 100 cc. Some minor complications were recorded and the sling eroded in 1 case. Urinary continence was achieved in all patients after surgery and at assessments 12 to 18 months later. All patients confirmed immediate satisfaction with continence and pain on the questionnaire. CONCLUSIONS: TVT-Secur is a minimally invasive, safe and easy surgical technique for stress urinary incontinence in females. To compare this procedure to other tension-free techniques longer and more detailed followup is necessary in more patients. However, this tape may be associated with fewer complications.