Mental Health Consequences of the COVID-19 Pandemic Long-Term Exposure in Italian Dermatologists.

The present study aimed at assessing the consequences of prolonged exposure to COVID-19 distress on mental health in non-frontline health care workers. For this purpose, we have conducted a survey on 425 Italian dermatologists, in the period February-March 2021. The psychopathological symptoms, depression, anxiety, post-traumatic stress symptoms (PTSD), as well as resilience, have been evaluated. The main factors that influence the physician's psychological health have been also investigated. Our study showed that the physicians older than 40 years, as well as those who lived this period in company, reported more personal resources, better managing the distress. Resilience, COVID-19 beliefs, COVID-19 working difficulties, and age were the common predictors of the severe psychopathological symptoms. An interesting result is that the lower level of resilience was the most powerful predictor of a more severe depression, as well as of a higher severity of generalized anxiety disorder, but not of COVID-19 PTSD. The fear of COVID-19 was the most powerful predictor of COVID-19 PTSD. Home conditions and previous SARS-CoV2 infection constituted significant predictors of severe depressive symptoms, but not of anxiety and COVID-19 PTSD. These results are useful in a better understanding of protective and risk factors involved in COVID-19 long-term distress exposure.

Association between burnout and immunological and endocrine alterations.

BACKGROUND: Weather a psychological construct or a clinical entity, numerous studies have been focused on the biological link between stress, burnout, and biomarkers. AIM: The purpose of our study was to search the existing literature and summarize the immunological and endocrine alterations found in burnout patients and, also, to provide updated data for clinicians to use. METHODS: We performed a literature search in PubMed database using specific terms. RESULTS: The primary focus of the literature seems to be the hypothalamic-pituitary-adrenal (HPA) axis, which may be affected due to chronic stress, which can be investigated by measuring hormonal responsiveness [corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, prolactin, thyroid hormones]. An important challenge that this field is faced with is the pulsatile and diurnal fluctuation of them, which may not always be considered and the heterogeneity of burnout measurements. Many studies have explored the linking pathways between the immune system and chronic stress, but only a few have specifically evaluated this process for future diagnostic or prognostic biomarkers. CONCLUSIONS: Burnout has cumulative effects on our body and stress does not affect us in a singular direction, on the contrary, significant clinical implications are found, not only microscopic, but affective symptoms leading to anxiety and depression.

Psychopharmacological Treatment, Intraocular Pressure and the Risk of Glaucoma: A Review of Literature.

Through the years, the available psychopharmacological treatments have expanded with numerous new drugs. Besides weight gain, gastro-intestinal problems or Parkinson-like symptoms, ocular adverse effects of psychiatric drugs have been reported. These adverse effects are not common, but can be dangerous for the patient. This review summarises the current knowledge on the risk of raised intraocular pressure and glaucoma entailed by psychopharmacological treatment. Also, it provides updated data for clinicians involved in the treatment of patients with glaucoma or glaucoma risk factors. For this purpose, we performed an extensive literature search in the PubMed database using specific terms. Selective serotonin and noradrenaline reuptake inhibitors are the best evidenced as having no association with glaucoma. Antipsychotics, and especially first generation, seem to have no correlation with an increased intraocular pressure and therefore possibly with a risk of glaucoma, although a special attention should be paid when using ziprasidone. Tricyclic antidepressants, benzodiazepines and topiramate should be avoided in patients diagnosed with glaucoma or at risk. Clinicians should be aware of the possible psychotropic drug induced glaucoma and monitor at risk patients closely in order to prevent this condition. Irrespective of the psychopharmacological regimen taken into consideration, the glaucoma patient should be under the strict supervision of the ophthalmologist.

Algorithm of Medical-Surgical Treatment in the Peripheral Arterial Disease of the Diabetic Patient.

Introduction: We live in a society with a growing number of diabetics. That is why the number of diabetic patients with peripheral arterial disease is expanding, as is the number of cases of chronic ischemia, which threatens limb viability, or chronic limb-threatening ischemia (CLTI). The appearance of diabetic foot ulcers with an ischemic component represents the maximum risk of amputation in the absence of a firm and rapid revascularization intervention. In our study, we aim at early detection of patients who need infusion treatment immediately after surgical revascularization. Materials and methods: This is a six-year retrospective study of 115 patients with infrainguinal occlusive disease and CLTI. All subjects were classified according to the WIfI system before and after revascularization. We made a score based on the postoperative clinical evolution in the first three days in order to have an objective image of patients who received infusion treatment with PG E1. Results: All patients included in our study had diabetes. They were divided into two groups, one comprising 86 patients who underwent exclusively surgical treatment, and the other comprising 29 patients, who received a combined surgical and medical treatment. We showed that subjects who had a low postoperative score and received infusion treatment had a higher rate of limb rescue in the first year. Conclusions: In diabetic patients with infrainguinal occlusive disease who were treated in the Clinic, without the possibility of endovascular or hybrid interventions, the combination of infusion treatment with PG E1 after surgical revascularization led to a higher rate of limb rescue and healing of ischemic trophic lesions after one year.

Emotional Dysregulation Mechanisms in Psychosomatic Chronic Diseases Revealed by the Instability Coefficient.

In the present work, we analyzed some emotional mechanisms (emotion dysregulation-ED, negative affect-NA, and emotional vulnerability) involved in chronic diseases by means of an interdisciplinary approach. We started from the conceptualization of emotions as a complex dynamic system that can be investigated and understood within a framework inspired by Chaos Theory. An "instability coefficient" Δ was computed to analyze ED mechanisms, NA, and emotional vulnerability in different disease groups (blood cancer, breast cancer, hypertension) as well as in healthy persons. This coefficient, recently defined by our group, computes the Euclidian distance between the pairs of vectors whose components are similar or reverted items of a test measuring ED. The emotional and somatic systems were considered as two complex dynamical systems in interaction. Due to this interaction, and as a result of the laws of complexity, a small perturbation in an inner state of the emotional system could generate an important reaction in the somatic system in time. The emotional vulnerability reflected by high values of Δ was associated with the chronic disease condition. The differences between illness groups and healthy persons, as well as between the three disease groups in Δ values, were analyzed. The results showed that there were significant differences between the chronic disease groups in Δ values. The most highly significant differences in Δ values were reported between the breast cancer group and the healthy group on one hand and between the breast cancer group and the blood cancer group on the other hand. The less significant differences in Δ values were noticed between the hypertension group and the control group. Δ was significant in predicting ED and NA. Compared to the classical approaches, the original contribution of our research is that these results encourage us to propose this interdisciplinary method of assessment as a challenging, valid tool of investigation and understanding of complex phenomena that occur in the emotional and somatic system.

Application of Chaos Theory in the Assessment of Emotional Vulnerability and Emotion Dysregulation in Adults.

In this work, we propose an interdisciplinary chaos analysis of emotion dysregulation (ED) and emotional vulnerability in adults. One of the main goals was the assessment of incongruences that occur in the evaluation of one's own emotional dysregulation mechanisms in the presence of an extremely weak stimulus (Butterfly Effect). Thus, we considered a "flavor" of the Lyapunov Function method based on the assumption that the effort of answering to the test is itself a small perturbation. In this context, we calculated the "instability coefficient" Δ defined as the Euclidean distance between the pairs of vectors that include similar and reverted items of a test. The relationship between Δ, ED, and emotional characteristics as quality (positive/negative) and type (trait/state) was highlighted. We hypothesized that a higher level of Δ should be significantly related with a higher ED and with the type and the quality of emotions. The results suggest that Δ is significantly correlated with trait emotions (positively with negative emotions, and negatively with positive ones) and with ED. Moreover, Δ significantly predicts ED in adults. Thus, we consider that this approach is promising with respect to the evolution of emotional mechanisms across time. The presence of an initial instability to a weak perturbation might predict future abnormal emotional functioning, which could put at risk the mental or psychosomatic systems.

Surgical Revascularization in Chronic Limb-threatening Ischemia in Diabetic Patients.

Introduction: Diabetes mellitus is one of the chronic diseases that showed a steady increase in the number of patients in the last decades. After the diagnosis of diabetes mellitus, evolution towards limb amputation goes, step by step, through neuropathy, leg ulcers and infection appearance. The existence of diabetic arteriopathy prevents ulcer's healing due to the limb's ischemic status. By restoring arterial flow in the lower extremity, we solve the most important cause for diabetic foot ulcers, namely ischemia. Material and Methods: In the Surgery Clinic of Dr I Cantacuzino Clinical Hospital, Surgical Repair of Diabetic Foot Compartment, the first revascularizations were made approx 5 years ago. During this time we have made constant efforts to lower the number of major amputations by diversifying the interventions dedicated almost exclusively to patients with ulcer of the diabetic foot. Results: The number of major amputations is lower after revascularisation and we have obtained complete ulcer's healing and a functional extremity. We have 80 patients in observation who underwent revasculariosation surgery, ages between 40 and 75 years, 46 men and 34 women. All of them were diabetic patients with critical ischemia and various associated comorbidities: 24% arterial hypertension, 14% polineuropathy, 12% dyslipidemia. The complications occured in the first year of follow-up were 14 cases of graft thrombosis and only 6 cases of major amputation. Conclusions: Before tempting any type of amputation, major or minor, after local infection control by treatment, debridement or dressings, and after vascular evaluation, it is essential to restore arterial flow.

Romanian adolescents' knowledge and attitudes towards human papillomavirus infection and prophylactic vaccination.

OBJECTIVES: Since licensure of HPV vaccine in 2006, HPV vaccine coverage among Romanian adolescents remains worryingly low. The objectives of the study were to assess the knowledge and attitudes towards HPV infection and vaccination among Romanian adolescents and to explore the barriers to HPV vaccination with a view to developing strategies for expanding primary HPV infection prevention. STUDY DESIGN: This study was conducted in Bucharest between April and June 2015. A total of 524 adolescents aged 16-18 years old were recruited from the first two general highschools in Bucharest (according to the admission grade) and completed a self-administered questionnaire including demographics, HPV related and Papanicolau smear test knowledge. Odds ratio and 95% confidence intervals were used to identify the strength of association. Logistic regression analysis was used to identify the effect of demographic characteristics on the level of knowledge and HPV vaccination rate. Associations were considered statistically significant at p<0.05. RESULTS: Of the adolescents interviewed, a very small proportion had heard of HPV infection, HPV vaccine and Papanicolau smear test, that is, 20.22%, 67.92% and 22.9%, respectively. The overall vaccination rate for this group was 2.3%. The most common reason for not receiving the HPV vaccine was the lack of information (80.6%) followed by parents' concerns regarding safety (11%), fear of pain (5.59%) and not being sexually active (2.7%). However, 97.7% of the respondents declared interest in receiving more information about HPV. According to demographic characteristics, age at first sexual intercourse over 16 years old, monthly household income over one thousand euros and self-perceived good relationship with family members were statistically associated on a multivariate logistic regression analysis with a high HPV knowledge score and rate of vaccination. CONCLUSIONS: This study shows a low level of knowledge about HPV infection and prophylactic vaccination among Romanian adolescents which may be one of the most important factors for the alarmingly low HPV vaccination rate. We specifically call for HPV knowledge and awareness programs; the implication of health professionals, Romanian media and family members should be included as a centrepiece in the effort to inform this vulnerable population group.