The Erice 58 Charter on 'The health of migrants. An equity challenge for the public health system'.

Abstract: The Erice 58 Charter titled "The Health of Migrants: a Challenge of Equity for the Public Health System", was unanimously approved at the conclusion of the 58th Residential Course of the School of Epidemiology and Preventive Medicine 'Giuseppe D'Alessandro' entitled "The Health of Migrants: a Challenge of Equity for the Public Health System. Epidemiological, clinical-relational, regulatory, organisational, training and public communication aspects at international, national and local level', which took place from 28 March to 2 April 2022 in Erice (Sicily, Italy), at the 'Ettore Majorana' Foundation and Centre for Scientific Culture. The Course was promoted by the Italian Society of Migration Medicine (S.I.M.M.) and the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI), with the collaboration and patronage of the Istituto Superiore di Sanità (ISS). 72 learners participated (mainly resident doctors in 'Hygiene and Preventive Medicine' but also other health service professionals), whose average age was 37 years; on the basis of territorial origin, 13 of the 20 Italian regions were represented. During the intense learning experience, which consisted of 18 frontal lessons (with 20 lecturers from the bio-medical, socio-anthropological and journalistic fields) and 7 working group sessions (supported by 4 classroom tutors in addition to the lecturers) in 'blended learning' mode, the various dimensions and critical issues related to the possibility of guaranteeing truly inclusive health policies for foreigners/migrants, throughout the country, were identified and discussed from an 'Health Equity' perspective. This enabled a small editorial group to draw up the basic document that, in the last session of the Course, was discussed and modified by all participants into the version of the 'Erice 58 Charter' presented here.

[Results and development in cancer screening programs]. / Risultati e sviluppi dei programmi di screening oncologici.

In order to contribute to the definition of good model for cancer screening programs, the paper reports an overview of Veneto Local Health Units' results according to required "gold standard" defined by the authors. The analysis was based on a standard attesting that the program is running stabely and a standard for the organisation requiring that general management is performed by a unique central unit, supplied with a unique software and a working group equipped with specific know-how. Ten of the 21 Locale Health Unit of Veneto Region chose to assign to Prevention Department (Public Health Department) all the three screening programs included in the National Prevention Plan. Among these we found the two achieving the defined gold standard (Thiene and Pieve di Soligo). Management model implemented in these units showed a framework for excellence.

Ruptured chordae tendineae of the posterior leaflet of the tricuspid valve as a cause of tricuspid regurgitation following blunt chest trauma.

A 12-year-old boy suffered a blunt chest trauma. Some hours later, a pulsatile bilateral jugular venous distension, a holosystolic murmur heard at the low parasternal border and hepatomegaly were observed. On echocardiography, ruptured chordae tendineae of the posterior leaflet of the tricuspid valve, as well as tricuspid regurgitation were detected. He remained asymptomatic during hospital stay and was discharged home in good condition. Thus, isolated ruptured chordae tendineae of the posterior leaflet of the tricuspid valve is another cause of tricuspid regurgitation following blunt chest trauma.

Trypanosoma cruzi parasitemia observed in immunocompromised patients: the importance of the artificial xenodiagnosis.

Trypanosoma cruzi parasitemia observed in immunocompromised patients (transplant or positive HIV) occurred more frequently by the artificial xenodiagnosis method (10/38) compared with hemoculture (2/38), given the same quantity of blood. Other ways of diagnosis, like mice inoculation (5/38), QBC and buffy coat (2/38), were evaluated also. This result showed the importance of the artificial xenodiagnosis. The other techniques increased only one more patient positive.

[An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)]. / Tentativa de evidenciar o Trypanosoma cruzi no sangue periférico de pacientes com doença de Chagas, em fase crônica, por meio do Quantitative Buffy coat (QBC).

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

Tentativa de evidenciar o Trypanosoma cruzi no sangue periférico de pacientes com doença de Chagas, em fase crônica, por meio do Quantitative Buffy coat (QBC) / An attempt to detect Trypanosoma cruzi in the peripheral blood of patients with Chagas' disease, in chronic phase, using quantitative buffy coat (QBC)

Taking for granted the sensitivity of the Quantitative Buffy Coat (QBC) system, as documented in a murine experimental model, we assayed to detect Trypanosoma cruzi in the peripheral blood of 100 patients with Chagas disease in its chronic phase. By means of the method, no positivity occurred, evently as a consequence of small parasitemias, undetectable by this technique as assessed by the cases in consideration.

Valorizando a sensibilidade do sistema Quantitative Buffy Coat (QBC), documentada em modelo experimental murino, estando os animais com infecção aguda pelo Trypanosoma cruzi houve tentativa de evidenciar esse parasita no sangue periférico de 100 pacientes com doença de Chagas, em fase crônica. Com o emprego desse método, nenhuma positividade ocorreu, evidentemente em virtude das pequenas parasitemias, não reveláveis pela técnica, pelo menos conforme o verificado através da casuística considerada.

[Evaluation of the possible influence of Montenegro's intradermal reaction on a serological assay for the diagnosis of American cutaneous leishmaniasis]. / Avaliação de eventual influência da intradermorreação de Montenegro sobre prova sorológica para o diagnóstico da Leishmaniose tegumentar americana.

Influence of Montenegro skin test for American tegumentar leishmaniasis was evaluated to verify possible interference in serological diagnosis for this disease, performed by immunoenzymatic assay (ELISA). If this interference could occur, it would hamper scientific, epidemiological and patient care; happily we did not find any interference on serological diagnosis by performance of skin testing.

Heller-Belsey and Heller-Nissen operations for achalasia of the esophagus.

From 1972 to 1985, 101 consecutive patients underwent Heller's myotomy and Belsey repair (H + B) (n = 43) or Nissen fundoplication (H + N) (n = 58) for achalasia of the esophagus. There was no operative mortality after either operation; minor pulmonary complications occurred after H + B procedure in 9.3 per cent of the patients. Good to excellent long term results were achieved in 87 per cent of the patients after H + B repair and 83 per cent of the patients undergoing H + N. The failure rates were 2.5 and 11.3 per cent, respectively. The analyses of postoperative esophageal symptoms showed that the incidence of heartburn was greater after H + B repair and the incidence of obstructive symptoms was greater after H + N. The inability to vomit or belch, or both, was 10.2 per cent in the H + B group and 13.1 per cent in the H + N group. Finally, 56.4 per cent of patients after H + B repair and 41.0 per cent of those after myotomy and H + N were considered to be cured after the operative procedure was performed. Patients were improved in 41.0 and 47.3 per cent, respectively.

Belsey and Nissen operations for gastroesophageal reflux.

From 1972 to 1985, 37 consecutive patients underwent primary Belsey repair and 40 consecutive patients underwent primary Nissen fundoplication because of reflux disease. The operative procedures were performed by a single surgeon in each group. For the purpose of comparison, both groups were divided into two subsets: (1) patients with proved reflux, and (2) patients with different indications. The first subset consisted of 30 patients in the Belsey series and 32 in the Nissen series. The remaining patients were included in the second subset. One death occurred in the Belsey series; morbidity consisted of minor pulmonary complications in the Belsey series (10.8%) and spleen injuries requiring splenectomy (5%) in the Nissen series. In patients with proved reflux good-to-excellent results were achieved in 89.3% of subjects of the Belsey series and 86.6% of patients of the Nissen group. The failures rates were 7.1% and 10%, respectively. Inability to vomit and/or belch was reported in 7.1% of patients with proved reflux of the Belsey group and 10% of patients with proved reflux of the Nissen group. In patients with different indications there were no failures after either operation. Finally 82.2% of subjects in the Belsey group and 73.3% of patients in the Nissen group declared that they were satisfied with the operative results. In conclusion the Belsey and the Nissen procedures are equally able to achieve long-term control of reflux disease in comparable groups of patients. Failures and gastrointestinal symptoms are equally frequent after either procedure and do not affect the overall patient acceptance of antireflux surgery.

Total gastrectomy in the treatment of adenocarcinoma of the cardia. Review of the results in 73 resected patients.

Between January 1, 1971, and December 31, 1978, 73 patients with adenocarcinoma of the cardia were treated by total gastrectomy with distal esophagectomy. The continuity of the alimentary tract was restored by esophagojejunostomy using a Roux-Y procedure in 32 patients and jejunal loop interposition in 41 patients. The early postoperative mortality rate was 18 percent. The overall 5 year survival rate was 26.7 percent, and the 5 year survival rate for stage I and II disease was 91.6 percent and 25 percent, respectively, whereas none of the stage III and IV patients survived more than 4 years. Fifty-eight percent of the patients without nodal involvement lived more than 5 years. The 5 year survival rate was only 9.3 percent in the presence of nodal metastases. Our 5 year survival rates suggest the value of elective total gastrectomy for stage I or II adenocarcinoma of the cardia. Jejunal loop interposition is a time-consuming but functionally superior procedure in comparison to other reconstructive procedures after total gastrectomy.