Inhaler technique knowledge and skills before and after an educational program in obstructive respiratory disease patients: A real-life pilot study.

INTRODUCTION AND OBJECTIVE: Patients present poor knowledge and skills about their respiratory disease and inhaler device. We aimed to: (1) evaluate COPD and asthmatic patients... ability to manage inhaled drugs (2) identify differences among devices and (3) correlate clinical data with patient ability. MATERIAL AND METHODS: Patients (n=134) admitted for pulmonary rehabilitation (PR) were given an ad-hoc questionnaire covering 0% as the worst and 100% the best value of global ability (indicating the sum of knowledge and skills in managing inhaled drugs) at baseline (T0) and discharge (T1). Educational program was provided during PR. Setting of rehabilitation, age, sex, diagnosis, spirometry, CIRS score, level of autonomy to use medications, if na..ve about PR, educational level, and number/type of prescribed inhaled drugs were recorded. RESULTS: Most patients used 1 drug while 37% used 2 drugs. DPIs were the main device prescribed. At baseline, patients... mean level of knowledge and skills were 73% and 58%, respectively. There was a significant difference in level of skills (p=0.046) among device families, DPIs resulting worst and pMDIs best. Global ability, skills and knowledge improved after educational support (p<0.001) but did not reach the optimal level, 88%, 87% and 89%, respectively. Baseline global ability was positively correlated to female gender, younger age, previous PR access, outpatient status, higher education level and GOLD D class. CONCLUSIONS: At hospital admission, global ability was not optimal. Education may improve this, irrespective of the type of device used, in particular in male, elderly, na..ve to PR, low educational level patients.

Municipal Epidemiological Report (REC): a new fast monitoring tool for exposed population. The experience on Trino municipality, ex nuclear power plant. Mortality 1970-2019.

The law of March 2019 established the municipal epidemiological report to make easier the rapid and lowresource monitoring of the exposed population. Environmental observatory active in Trino since 2014 has equipped this tool and making the first evalution of the risk with census sections from 1970 to 2018. The result highlighted that overall mortality (for total gender) show a decreasing trend while for oncological diseases the results are more difficult to interpret especially in areas close to former industrial sites or contaminated sites. Next step is producing a REC with data for 2019 and divided by gender.

Mast cell and eosinophil interaction in gastric carcinomas: ultrastructural observations.

BACKGROUND: An increase in the number of mastocytes has been described in some human neoplasms, mainly in gastric and colorectal cancer. MATERIALS AND METHODS: A case of diffuse-type gastric carcinoma, mainly infiltrated by eosinophils and mast cells, was studied using light and electron microscopy. RESULTS: Using light microscopy, cell clusters containing one mast cell and one to three eosinophils were found in the tumour stroma. Electron microscopy of this unusual stromal element revealed that mast cells established areas of junctions with eosinophils. Moreover, focal polarized exocytosis of mast cell granules was found in the areas of junctions with eosinophils. Eosinophils in contact with mast cells showed signs of important in situ activation, such as alterations in the size and number of granules, cytoplasmic vacuoles, and scattered extracellular granules. CONCLUSION: Our ultrastructural study provides morphological evidence of cross-talk between activated mast cells and eosinophils that may play an important role in the enhancement of host immunity against cancer cells.

Gastric hepatoid adenocarcinoma with autophagy-related necrosis-like tumor cell death: report of a case.

A case of hepatoid adenocarcinoma of the stomach is presented. The characteristic features of the tumor are summarized on the basis of the authors' experience and the literature. Ultrastructural examination revealed patchy condensations of chromatin throughout the nucleus suggestive of necrosis-like programmed cell death (PCD). These nuclear alterations were associated with the occurrence of vacuoles and lipofuscins, conferring an autophagic phenotype to this PCD. Thus, the case reported here provides an example of autophagic-related necrosis-like PCD. Alternative PCDs are reviewed and their morphologic distinction is discussed.

Pyoderma gangrenosum of the "sinus mammarum" in ulcerative colitis.

The first part of this article deals with the report of a patient suffering from pyoderma gangrenosum of the "sinus mammarum" associated with asymptomatic ulcerative colitis. This is followed by a revision of the present epidemiological, etiological, pathogenetic and clinical knowledges about this systemic manifestation of chronic phlogosis of the colon. The Authors have analysed the treatment for this condition and emphasized the resistance of the cutaneous ulcer encountered to conventional medical therapy of the underlying colonic disease which proved to be efficacious only on the latter; this led to integrate traditional treatment with the use of perilesional injections of small doses of calcic heparin as an alternative to immunosuppressive drugs or surgery. Topical antithrombotic treatment, which can be justified by the histological findings of phenomena of the vasculitis in the edge of pyoderma gangrenosum, demonstrated to be crucial and represents a peculiarity in the case here reported, which is unique in the literature as far as the Authors know, since it has not been experimented by anyone else.

[Hemorrhage and gastric perforation in patients with percutaneous endoscopic gastrostomy (PEG)]. / Emorragia e perforazione gastrica in paziente con gastrostomia endoscopica percutanea (PEG).

INTRODUCTION: PEG is more and more used for those patients who need a medium and above all long term enteral nutrition, especially at home. This is the closest technical system to the requirements to have an ideal nutritional access; however it is burdened, on average in 32.5% of cases, with complications linked to technical mistakes of positioning or to a wrong management, such as haemorrhage and gastric perforation. CASE REPORT: A patient, subjected to supraglottic laryngectomy, to removal of tongue's base and to bilateral laterocervical lymphadenectomy and PEG carrier for 4 months, has arrived to our observation for a clinical outline of acute abdomen for perforation of hollow internal organ, preceded by progressive anaemia due to high digestive haemorrhage. Performed an exploratory laparotomy, it was discovered on the gastric fore face, between body and antrum, in proximity to the small curvature and in front of the PEG gastric access, a perforation with max 2 cm of diameter, crossed by probe's internal disk of retention. They proceeded to remove that, to unstick the gastric stoma from the parietal peritoneum, to suture the access of gastrostomy and the perforation by omentoplasty. Finally they carried out a jejunostomy for enteral feeding. DISCUSSION: We think we can pathogenetically identify the cause of the haemorrhage and of the stomach's perforation, occurred in a short time in the case we have examined, in the probe's movement for incorrect fixing of the plate of external anchorage or for excessive slimming of the patient due to not balanced nutritional supply, as well as in the consequent extension of its intraluminal part with continuous rubbing by internal disk on the gastric wall and with onset decubitus ulcer. Physiopathologic moments, connected with the supposed etiological factor, make both occurred complications as an unique pathologic entity, which has to be observed in the PEG carriers, in order to be able to diagnose it and treat it precociously and above all in order to be able to prevent it. Only a correct technique of positioning and of nursing and of management of nutritional supply is able not to thwart the finality of the PEG device which can be considered, in the elective indications and for the favourable requisites that marks it, a valid access to enteral nutrition realization.

["Switch prophylaxis one a day" with levofloxacin in laparoscopic cholecystectomy]. / "Switch prophylaxis one a day" con levofloxacina nelle laparocolecistectomie.

BACKGROUND: Special attention is paid today to the advisability of carrying out routine antibiotic prophylaxis in laparoscopic cholecystectomy (LC) and to the dosage protocol to be adopted in order to reduce the incidence of infections at the site of the surgical operation which, albeit with lower incidence than in "open" surgery, 5.3% vs 14%, can vanify the advantages of the mini-invasive approach. The demonstrated validity of administering the antibiotic beyond 24 hours after the operation led the authors to verify the clinical effectiveness and tolerance of "switch prophylaxis one a day" (SPOD) with levofloxacin in the prevention of septic complications after LC. METHODS: The experience reported relates to 185 patients suffering from symptomatic and/or complicated lithiasis of the gall-bladder subjected from January 1999 to April 2001 to LC and to antibiotic prophylaxis in accordance with the following dosage protocol: levofloxacin 500 mg i.v. 30 min before operation and 500 mg per os in the 3 days subsequent. RESULTS: The postsurgical evaluation documented the onset of 2 superficial infections in patients in whom LC had been of necessity converted and of a subhepatic abscess in an ASA III patient with acute cholecystitis. Prevention of infections at the surgical site totalled 98.4%. Nausea and slight diarrhoea and an increase in transaminasaemia were observed respectively in 3% and 4% of patients. CONCLUSIONS: The results obtained led the authors to standardise the use of SPOD with levofloxacin in LC operations which, in their opinion represents a rational alternative to the antibiotic prophylaxis regimes most commonly used up to the present (STP and USTP).

Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia.

This paper reports on the effectiveness of oral lamotrigine in 15 patients suffering from "essential" trigeminal neuralgia and in five patients suffering symptomatic trigeminal neuralgia concomitant with multiple sclerosis. We recorded objective and subjective pain ratings and correlated them to daily dosage (400 mg maximum) and plasma levels of the drug. We detected pain relief proportional to daily dosage and to drug plasma levels. Eleven of the cases affected by the "essential" form of neuralgia showed complete pain relief on reaching their maximum daily dosage. All cases affected by the symptomatic form had complete pain relief. We could detect no changes from these results by the end of the follow-up period (3 to 8 months after the study ended).

Randomised, double-blind, placebo-controlled study of pivagabine in neurasthenia.

One hundred and eighteen patients with neurasthenia, as defined by ICD 10 (International Classification of Diseases), participated in a randomised, double-blind, placebo-controlled trial of pivagabine (4-[(2,2-dimethyl-1-oxopropyl)amino]butanoic acid, CAS 69542-93-4, Tonerg). Pivagabine 1800 mg/d was administered orally for four weeks. At the end of the trial, active medication was significantly superior to placebo on the Clinical Global Impression (CGI) improvement of illness scale. In addition, pivagabine treatment reduced the physical and mental fatigability of patients, and increased their sense of well-being.

NMR study of seed hydration: the role of the seed anatomical structures in water uptake of soaked cowpeas.

A NMR method based on the analysis of the transverse magnetization decay curve of water protons, was employed to study the hydration process of commercial cowpeas. In order to investigate the role of the different anatomical parts of the seeds, hilum and micropyle, or alternatively seed coat, were inhibited by a water resistant epoxy resin. The kinetic constant for the hydration of the different sets of beans was measured.

NMR study of seed hydration with deuterated water: dependence of proton signals on hydration level.

Proton NMR signals in seeds are shown to depend on hydration level. In fact at low water amount, as it occurs in many native seeds, protons can have a restricted mobility and are not detectable. A NMR method for measuring the dependence of proton signals on hydration is reported. The method also allows the separation of the contributions of water and non-water protons in a low-resolution NMR experiment. It is based on successive hydrations (with deuterated water) - desiccation steps and on the analysis of the transverse magnetization decay curves.