Comparing the COVID-19-related PTSD symptoms between psychiatric patients and healthy subjects: an observational retrospective study from Northern Italy.

COVID-19 pandemic had a great impact on mental health, both in the general population and psychiatric patients. Little is known about the difference between these two populations in perceiving the pandemic as a traumatic event. The aim of the study was to compare psychiatric patients and healthy controls (HC) in terms of change over time of post-traumatic (PTSD) symptoms. Demographic and clinical variables were collected. Impact of Event Scale Revised (IES-R) scores were registered at T1 as lockdown period (March-April 2020) and T2 as restarting (May-June 2020). Descriptive analyses and linear regression models were performed. A total of 166 outpatients and 57 HC were recruited. Time (F = 15.76; p < 0.001) and diagnosis (F = 4.94; p < 0.001) had a significant effect on the change of IES-R scores, which resulted T1 > T2 (p < 0.001), except for subjects affected by Obsessive-Compulsive Disorder (OCD). Overall, IES-R scores were < in patients than in HC (p = 0.02), particularly in the schizophrenia (SKZ) subgroup (p < 0.001). IES-R scores of subjects with personality disorders (PDs) resulted to be > HC, although not statistically significant. The lockdown period was perceived as more traumatic than the reopening phase by both groups, with the exception of OCD patients, probably because of the clinical worsening associated with the urge of control against risks of contamination. Overall, HC reported more PTSD symptoms than psychiatric patients did, particularly SKZ ones. PD patients, in contrast, may be more vulnerable to PTSD symptoms probably as a result of poor coping skills. Together with OCD patients, subjects with PDs may need closer monitoring during the different phases of the pandemic. Trial Registration: ClinicalTrials.gov Identifier: NCT04694482.

Correlates of elemental-isotopic composition of stream fishes: the importance of land-use, species identity and body size.

The isotopic (δ13 C and δ15 N) and stoichiometric (C:N:P) compositions of four fish species (Family Centrarchidae: Lepomis auritus, Lepomis cyanellus; Family Cyprinidae: Nocomis leptocephalus, Semotilus atromaculatus) were examined across four North Carolina Piedmont streams arrayed along an urbanization gradient. Both isotopic and stoichiometric composition of fishes appeared to track changes occurring in basal resource availability. Values of δ13 C of basal resources and consumers were more enriched at the most urbanized streams. Similarly, basal resources and consumers were δ15 N-enriched at more urbanized streams. Basal resource stoichiometry varied across streams, with periphyton being the most variable. Primary consumers stoichiometry also differed across streams. Intraspecific variation in fish stoichiometry correlated with the degree of urbanization, as the two cyprinids had higher N content and L. cyanellus had higher P content in more urbanized streams, probably due to enrichment of basal resources. Intrinsic factors, specifically species identity and body size also affected stoichiometric variation. Phosphorus (P) content increased significantly with body size in centrarchids, but not in cyprinids. These results suggest that although species identity and body size are important predictors of elemental stoichiometry, the complex nature of altered urban streams may yield imbalances in the elemental composition of consumers via their food resources.

Hidradenitis supurativa: evaluación por resonancia magnética / Hidradenitis suppurativa (hs), evaluation using mri

This corresponds to an inflammatory disease of the apocrine glands, distributed mainly in the axillary, perineal and perianal regions, clinically characterized by pain, swelling, and smelly discharge. Treatment is expensive, long and leaves large scars, generating economic and psychological problems for the patient. Magnetic resonance imaging (MRI) helps to confirm the diagnosis and determine its extension, which allows it to be distinguished from other entities and to choose the best treatment. To our knowledge, there is only one review of literature dedicated to the characteristics of this pathology using MRI, therefore we present an illustrated literature review in different patients treated at our center.

Corresponde a una enfermedad inflamatoria de las glándulas apocrinas, distribuidas principalmente a nivel axilar, perineal y perianal, caracterizado clínicamente por dolor, tumefacción y secreción mal oliente. Su tratamiento es costoso, largo y deja grandes cicatrices, generando problemas económicos y psicológicos para el paciente. La resonancia magnética (RM) ayuda a confirmar el diagnóstico y a determinar su extensión, lo que permite diferenciarlo de otras entidades y elegir el mejor tratamiento. A nuestro conocimiento, existe sólo una revisión de la literatura dedicada a las características de esta patología en resonancia magnética, por lo que presentamos una revisión de la literatura ilustrada en diferentes pacientes tratados en nuestro centro de atención.

Condiloma acuminado gigante (tumor de Buschke Lowenstein): serie de 7 casos clínicos y revisión de la literatura / Giant condylomata acuminata (Buschke - Lowenstein tumor). series of 7 cases and literature review

El condiloma gigante acuminado (Tumor de Buschke-Lowenstein) es una rara enfermedad que afecta frecuentemente a pacientes inmunodeprimidos, presenta un alto porcentaje de malignización, tasa de recidiva y mortalidad. Existe poco consenso respecto de su tratamiento y controles post-operatorios, donde juegan un importante papel los estudios imagenológicos, existiendo escasa literatura al respecto. En la presente revisión, presentamos los casos de 7 pacientes, junto con sus características fundamentalmente en resonancia magnética como también en tomografía computada, además de realizar una revisión de la literatura. En general se observan lesiones exofíticas pediculadas en "coliflor". A la tomografía computada presentan densidad de partes blandas y vascularización. En resonancia magnética son isointensas en T1, levemente hiperintensas en T2, restringen a la difusión y captan heterogéneamente el medio de contraste paramagnético, manteniendo su realce en fases tardías.

Giant condyloma acuminata (Buschke - Lowenstein tumor ) is a rare disease that commonly affects immunocompromised patients, presenting a high percentage of malignancy, recurrence rate and mortality. There is little consensus regarding treatment and post-operative controls, where imaging studies play an important role, existing sparse literature regarding this. In this review, we present the cases of seven patients, along with their characteristics mainly on MRI as well as CT scan, in addition to a revision of the literature. In most cases, pedunculated exophytic "cauliflower-like" lesions are observed. Which are of soft-tissue density and vascularized. In magnetic resonance imaging they are isointense on T1, slightly hyperintense on T2, with restricted diffusion on DWI, and heterogenous enhancement on gadolinium administration, with a late progressive enhancement pattern.

Hidatidosis multiorgánica con compromiso peritoneal: reporte de un caso y revisión de la literatura / Multi-organ hydatidosis with peritoneal involvement: a case report and literature review

La hidatidosis es una parasitosis cuyo agente etiológico es el céstodo del género Echinococcus, siendo las especies más frecuentemente involucradas la E. granulosus y E. multilocularis. Puede afectar a cualquier órgano, aunque con mayor frecuencia se asocia a compromiso hepático y pulmonar. Los hallazgos imagenológicos clásicos en órganos habitualmente comprometidos están ampliamente descritos, no así en localizaciones poco comunes. Presentamos un caso de hidatidosis multiorgánica con compromiso peritoneal y pericárdico, estudiado con ultrasonido y tomografía computada, con revisión de la literatura actualmente disponible al respecto.

Abstract. Hydatidosis is a parasitic disease whose etiologic agent is the tapeworm of the genus Echinococ-cus, the species most frequently involved being E. granulosus and E. multilocularis. It can affect any organ, but most often is associated with liver and lung involvement. The classic imaging findings in organs that are usually involved are fully described, but not so for those in unusual locations. We report a case of multi-organ hydatidosis with peritoneal and pericardial commitment, studied with ultrasound and computed tomography, with a review of the currently available literature regarding this.

CD133 is a selective marker of CRC?

AIM: The aim of our study is to evaluate the surface glycoprotein CD133 as marker of cancer stem cells, as independent prognostic pattern of survival and its positive expression ratio to a chemotherapy increased resistance. METHODS: The study include our patient, affected by colorectal cancer (CRC) and underwent to surgery at University Hospital of Parma, with curative intent, with a follow up of 5 years; 47 cases were considered. All the cancer-case was considered independently by the histological grade. The monoclonal antibody CD133/1 (clone AC133-MAC, Miltenyi Bioetec, Auburn CA 95602, USA) that recognizes the epitope 1 of CD133 was utilized for the immunohistochemical process. RESULTS: On the total of 47 patients taken in exam, 8 were excluded for lack of date, 13 were lost during the follow-up. The final number of patients included in the study was 26(17 males and 9 females), medium age of 72.2 years. 2 Stage I, 8 Stage II A, 1 II B, 2 III A, 5 III B, 5 IIIC and 3 IV. Despite for 1, 25 on 26 patients were positive to CD133 (96.5 %), with different dye intensity, directly related at the positive cell pull. The CD133 positivity wasn't therefore related at any other clinic-pathological characteristic. CONCLUSION: The results obtained from our study goes in the same direction with others, that confirm a high representation of CD133 on the colic tumoral epithelium. It will be appropriate to do prospected and randomized studies, with a larger casistic, utilizing similar methods and a patients populations with more uniform characteristics, to verify the real role of CD133 and other molecules potentially marker of tumoral stem cell (TSC).

Heterozygote excess through life history stages in Cestrum miradorense Francey (Solanaceae), an endemic shrub in a fragmented cloud forest habitat.

Comparisons of genetic diversity and population genetic structure among different life history stages provide important information on the effect of the different forces and micro-evolutionary processes that mould diversity and genetic structure after fragmentation. Here we assessed genetic diversity and population genetic structure using 32 allozymic loci in adults, seeds, seedlings and juveniles of eight populations of the micro-endemic shrub Cestrum miradorense in a highly fragmented cloud forest in central-eastern Mexico. We expected that due to its long history or rarity, this species may have endured the negative effects of fragmentation and would show moderate to high levels of genetic diversity. High genetic diversity (H(e) = 0.445 ± 0.03), heterozygote excess (F(IT) = -0.478 ± 0.034, F(IS) = -0.578 ± 0.023) and low population differentiation (F(ST) = 0.064 ± 0.011) were found. Seeds had higher genetic diversity (H(e) = 0.467 ± 0.05) than the later stages (overall mean for adults, seedlings and juveniles H(e) = 0.438 ± 0.08). High gene flow was observed despite the fact that the fragmentation process began more than 100 years ago. We conclude that the high genetic diversity was the result of natural selection, which favours heterozygote excess in all stages, coupled with a combination of a reproductive system and seed/pollen dispersal mechanisms that favour gene flow.

What are the differences between physician and patient expectation with regard to the management of atrial fibrillation?

BACKGROUND: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with approximately 840,000 people suffering from it nationally. People with AF have an increased risk of stroke which can be mitigated effectively with the use of anticoagulant therapy. Nevertheless, evidence suggests that less than 50% of eligible patients are receiving this form of intervention. METHOD: A comprehensive literature search was undertaken to assess the published evidence in order to understand why clinicians and patients underutilize an effective intervention such as anticoagulation in favor of the less effective antiplatelet agents. RESULTS: The decision to use anticoagulant drugs in patients with AF involves a consideration of the potential benefits versus the risks, inconveniences, and costs. There is however widespread variation in the importance placed on these factors across primary care practices, individual doctors and between and within different patient groups. There is a paucity of literature designed to examine patient expectations. Available studies suggest that patients are prepared to be placed at a higher risk of bleeding than their prescribing doctors would be prepared to accept. Given that this judgement depends on a range of factors, it is not surprising that attempts to understand clinician's barriers to prescribing take precedence. CONCLUSION: The barriers to anticoagulation can be identified, but we still don't understand the importance that clinicians and individuals give them. These barriers continue to limit the use of anticoagulation therapy, a potentially beneficial treatment. Due to these limitations it is unclear what impact the increased range of oral anticoagulants and the alternation to the Quality and Outcomes Framework (QoF) will have on the incentive to primary care physicians to anticoagulate those at risk.

Use of preoperative visceral echo-color-Doppler in patients candidates to colonic surgery: preliminary report.

AIM: Postsurgical paralytic ileus is by definition an ileal paralysis longer than three days (72 hours) after a surgery on the gastrointestinal tract. At colorectal surgery we have performed on all candidates a visceral echo-color-Doppler to find a potential correlation with cardiovascular risk factors. METHODS: We have tested patients undergone to colorectal surgical resection performed by laparoscopic and laparotomic surgery, looking for their atherosclerosis status using ultrasound scan, postsurgical complication, bowel digestive function, anastomotic leak. We have also analyzed for each case the value of glycemia, azotemia, creatinemia, cholesterolemia, triglyceridemia, leukocytemia, mean cell volume, hemoglobinemia, albuminemia and moreover age, disease, pathology localization, kind of surgery, weight and height, body mass index (BMI), ASA status (American Society of Anesthesiologists, electrocardiographic distortions, nicotine dependency, diabetes mellitus type I and II). RESULTS: The study enrolled 23 patients, 10 male and 13 female. Middle age was 68.65 ± 11.85 years (range 39-90). In the female subgroup mean age was 69.48 years (range 39-90), while in the male subgroup it was 68 years (range 54-81). In 17 cases out of 23 (73.9%) there was a delay in digestive function, of over 72 hours, with a mean time duration of the paralytic ileus of 4.74 ± 1.60 days (range 3-9). Furthermore a statistically significant correlation between albuminemia and hemoglobinemia presurgery values and lower sierical albuminemia presurgery values in patients who were canalized too late (P=0.03; P=0.041) was found. The non-parametrical values analysis sec. Kruskal-Wallis emphasized a significant correlation between the canalization day, the elettrocardiographic evidence of the pathological situation (P=0.023) and the patient's smoking history (0.023). Another significant value was the creatininemia value: lower values of creatininemia were related to a delayed canalization (P=0.035). CONCLUSION: The statistical analysis does not allow to highlight any correlation between the ultrasound diagnosis of atherosclerosis and the delayed canalization.

The Casiquiare river acts as a corridor between the Amazonas and Orinoco river basins: biogeographic analysis of the genus Cichla.

The Casiquiare River is a unique biogeographic corridor between the Orinoco and Amazonas basins. We investigated the importance of this connection for Neotropical fishes using peacock cichlids (Cichla spp.) as a model system. We tested whether the Casiquiare provides a conduit for gene flow between contemporary populations, and investigated the origin of biogeographic distributions that span the Casiquiare. Using sequences from the mitochondrial control region of three focal species (C. temensis, C. monoculus, and C. orinocensis) whose distributions include the Amazonas, Orinoco, and Casiquiare, we constructed maximum likelihood phylograms of haplotypes and analyzed the populations under an isolation-with-migration coalescent model. Our analyses suggest that populations of all three species have experienced some degree of gene flow via the Casiquiare. We also generated a mitochondrial genealogy of all Cichla species using >2000 bp and performed a dispersal-vicariance analysis (DIVA) to reconstruct the historical biogeography of the genus. This analysis, when combined with the intraspecific results, supports two instances of dispersal from the Amazonas to the Orinoco. Thus, our results support the idea that the Casiquiare connection is important across temporal scales, facilitating both gene flow and the dispersal and range expansion of species.

[Surgical education: from teledidactics to virtual training]. / Dalla teledidattica alla realtà virtuale: come cambia la formazione del chirurgo.

The assessment of efficacy and quality of computer-assisted learning is today under evaluation. The Authors propose to use distant learning in the surgical knowledge teaching. In Italy, thanks to the Ministry of University and Scientific Research, a Master on distant learning in Medicine is now starting in 11 Italian Universities under the coordination of the second Faculty of Medicine of the University of Rome 'La Sapienza'. Thanks to the help of medicine and surgery teachers and informatics and telecommunication engineers, this Master is a first step to form and to license medical and surgical specialists experts in distant learning and videoconferencing telemedicine. Videoconferencing system can support Telementoring. Telementoring isn't an exclusive methodology but it is an additional methodology to tradictional didactic for clinicians and surgeons. It allows personal virtual trainings using computers and telecommunication systems.

[Rhomboid flap in radical surgical treatment of sacrococcygeal fistulas: technical notes]. / Il lembo di rotazione romboide nel trattameno chirurgico radicale delle fistole sacrocogginee: note di tecnica.

The Authors report their experience in surgical management of sacrococcygeal fistulas treated by radical excision and subcutaneous/cutaneous rhomboid flap. This is a simple, safe surgical technique and the patients can be treated in day surgery by spinal anesthesia.

Why be a honeyless honey mesquite? Reproduction and mating system of nectarful and nectarless individuals.

Populations of Prosopis glandulosa var. torreyana in the Chihuahuan desert have a fixed dimorphic system of nectar production in which half the individuals produce nectar (are nectarful) and the other half are nectarless. We analyzed the impact of nectar production on different estimates of fitness, comparing nectarful against nectarless individuals in size, mating system, seed traits, and fruit set in a 1-ha scrubland. Of the reproductive individuals (358), 46% were nectarful and 54% were nectarless. Neither tree size nor flowering phenology differed between nectar morphs. Fixation indices (F) for both progeny (F = -0.2) and adults (F = -0.45) were negative, and high heterozygosities were found in adults and progeny (H = 0.45). No differences were found between nectar morphs for F, H, and single (t(s) = 1.1) and multilocus (t(m) = 1.03) outcrossing rates. Controlled pollinations showed differences between selfing and control treatments with no differences between nectar morphs. Nectarless individuals produced significantly more pollen grains than did nectar producers, but all other measured floral traits showed no differences. Nectarful trees were visited by pollinators 21 times more often and had a significantly higher overall fruit set than did nectarless trees. No differences between nectar morphs in seed mass or in percentage seed germination were found, but heavier seeds tended to have higher heterozygosities. Both morphs had similar success as females, but nectarless trees had ∼7% higher male function. We discuss three possible scenarios for the evolution of the fixed dimorphism in nectar production, two involving unstable phases (substitution of one morph by the other, and evolution towards dioecy) and one stable scenario (maintenance of the dimorphic system).

Competition intensity as a function of resource availability in a semiarid ecosystem.

Two field experiments were conducted using three dominant perennial species of the Chihuahuan Desert: Hilaria mutica (a tussock grass), Larrea tridentata (a microphyllous shrub) and Opuntia rastrera (a flat-stemmed succulent cactus). Two hypotheses concerning competition in arid plant communities were tested. (1) Marked resource partitioning with no interspecific competition could be expected since the three species belong to different life-forms, and that plant growth in deserts is basically limited by harsh environmental conditions. (2) Alternatively, resource scarcity (particularly water) will result in strong plant competition. In a 1-year removal experiment, water status and plant growth of the three species were monitored in twelve 10 m × 10 m plots randomized in three blocks and assigned to the following treatments: (a) removal of all species, except H. mutica; (b) removal of all species, except L. tridentata; (c) removal of all species, except O. rastrera, and (d) control without any manipulation. In a watering experiment, under two neighbourhood conditions (growing isolated or in associations of plants of the three species in plots of 20 m2), the water status of the three species and the growth of H.mutica and L.tridentata were studied for 32 days after an irrigation equivalent to 30 mm of rain, similar to a strong storm event at the site. In the removal experiment, where plants were free to capture water, no evidence of competition was observed. However, during the watering experiment, in which water was forced into the soil, competitive effects were observed. Associated individuals of L. tridentata had lower xylem water potentials and osmotic potentials (OPs) and produced shorter twigs and less leaves and nodes. Although less pronounced, neighbours also had a negative effect on the OP in O. rastrera. According to these results, the intensity of the interspecific competition for water seems to depend on the level of resource availability in the soil. Thus, the validity of the two hypotheses tested in this study also depends on the level of resources. Competition could be absent or very low in years of low precipitation, as in the year of this study (173 mm against a 25-year average of 264 mm). However, when soil water availability is high, e.g. following heavy rain, the negative interactions between species could be more intense.