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1.
Artigo em Inglês | MEDLINE | ID: mdl-36011895

RESUMO

Campania is the sixth poorest region of Italy, and it is the region with the highest income inequality. The secondary attack rates of SARS-CoV-2 among households are found to be substantially heterogeneous among published studies and are influenced by socio-economic factors. We conducted a retrospective study to describe the role of socio-economic factors in the household transmission of SARS-CoV-2 among patients living in Campania Region and referring to "Federico II" Hospital. We interviewed 413 subjects followed-up for COVID-19 between the 8 March 2020 and the 24 May 2021 with the aim to collect demographic, clinical, economic, and social data regarding their household and the index cases. The variables associated with SARS-CoV-2 attack rate higher than 50% among households were higher age (p = 0.023) and higher Charlson Comorbidity Index of the index case (p = 0.023) and, for household characteristics, higher number of families per house (p = 0.02), location of the houses in Naples' suburbs (Chi2 = 5.3, p = 0.02) and in Caserta City area (Chi2 = 4, p = 0.04), and renting the house compared to owning it (Chi2 = 5.83, p = 0.01). This study confirms the finding described by other authors that household transmission of SARS-CoV-2 is correlated with the income inequality of the analyzed geographical area as well as with the indicators of health and economic wealth of the families, and this correlation also applies to the Campania Region.


Assuntos
COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , Fatores Econômicos , Humanos , Itália/epidemiologia , Estudos Retrospectivos
2.
J Laparoendosc Adv Surg Tech A ; 31(10): 1219-1223, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34492206

RESUMO

Duplication anomalies of the kidney represent common congenital malformations of the urinary tract. A duplex kidney has often one pole that is poorly or nonfunctioning. In this last case, surgery may be indicated to remove the nonfunctioning pole. The most common indications for partial nephrectomy in pediatrics include symptomatic vesicoureteral reflux to the nonfunctioning pole and/or ectopic ureter or ureterocele causing urinary incontinence. In this article, we describe the technique of laparoscopic partial nephrectomy in infants and children with duplex kidney. A surgical procedure properly executed following critical technical steps is the key factor for the success of surgery.


Assuntos
Laparoscopia , Ureter , Criança , Humanos , Lactente , Rim/cirurgia , Nefrectomia , Estudos Retrospectivos , Resultado do Tratamento , Ureter/cirurgia
3.
World J Urol ; 39(11): 4167-4173, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34128079

RESUMO

PURPOSE: This study aimed to standardize the operative technique of indocyanine green (ICG) near-infrared fluorescence (NIRF) laparoscopic partial nephrectomy (LPN) and compare it with the standard technique. METHODS: In the last 4 years, we performed 22 LPN (14 right-sided, 8 left-sided) in children with non-functioning moiety of duplex kidney. Patients included 12 girls and 10 boys with a median age of 3.9 years (range 1-10). Patients were grouped according to the use of ICG-NIRF: G1 included 12 patients operated using ICG-NIRF and G2 included 10 patients receiving the standard technique. We standardized the technique of injection of ICG in three different steps. RESULTS: The median operative time was significantly lower in G1 [87 min (range 68-110)] compared with G2 [140 min (range 70-220)] (p = 0.001). One intra-operative complication occurred in G2. At post-operative ultrasound (US), the residual moiety was normal in all patients. An asymptomatic renal cyst related to the site of surgery was visualized at US in 8/22 (36%), with a significantly higher incidence in G2 (6/10, 60%) compared with G1 (2/12, 16.6%) (p = 0.001). Renogram demonstrated no loss of function of residual moiety. No allergic reactions to ICG occurred. CONCLUSION: ICG-NIRF LPN is technically easier, quicker, and safer compared with the standard technique. The main advantages of using ICG-NIRF during LPN are the clear identification of normal ureter, vasculature of non-functioning pole, and demarcation line between the avascular and the perfused pole. The main limitation of ICG technology remains the need for specific laparoscopic equipment that is not always available.


Assuntos
Verde de Indocianina , Rim/anormalidades , Rim/cirurgia , Laparoscopia/métodos , Nefrectomia/métodos , Imagem Óptica/normas , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Cirurgia Assistida por Computador
6.
BMC Cardiovasc Disord ; 19(1): 250, 2019 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703628

RESUMO

BACKGROUND: Pulmonary embolism (PE) is associated to high mortality rate worldwide. However, the diagnosis of PE often results inaccurate. Many cases of PE are incorrectly diagnosed or missed and they are often associated to sudden unexpected death (SUD). In forensic practice, it is important to establish the time of thrombus formation in order to determine the precise moment of death. The autopsy remains the gold standard method for the identification of death cause allowing the determination of discrepancies between clinical and autopsy diagnoses. The aim of our study was to verify the morphological and histological criteria of fatal cases of PE and evaluate the dating of thrombus formation considering 5 ranges of time. METHODS: Pulmonary vessels sections were collected from January 2010 to December 2017. Sections of thrombus sampling were stained with hematoxylin and eosin. The content of infiltrated cells, fibroblasts and collagen fibers were scored using a semi-quantitative three-point scale of range values. RESULTS: The 30 autopsies included 19 males (63.3%) and 11 females (36.7%) with an average age of 64.5 ± 12.3 years. The time intervals were as follows: early (≤1 h), recent (> 1 h to 24 h), recent-medium (> 24 h to 48 h), medium (> 48 h to 72 h) and old (> 72 h). In the first hour, we histologically observed the presence of platelet aggregation by immunofluorescence method for factor VIII and fibrinogen. The presence of lymphocytes has been identified from recent thrombus (> 1 h to 24 h) and the fibroblast cells were peripherally located in vascular tissue between 48 and 72 h, whereas they resulted central and copious after 72 h. CONCLUSIONS: After a macroscopic observation and a good sampling traditional histology, it is important to identify the time of thrombus formation. We identified histologically a range of time in the physiopathology of the thrombus (early, recent, recent-medium, medium, old), allowing to determine the dating of thrombus formation and the exact time of death. CLINICAL TRIAL NUMBER: NCT03887819. TRIAL REGISTRATION: The trial registry is Cliniclatrials.gov, with the unique identifying number NCT03887819. The date of registration was 03/23/2019 and it was "Retrospectively registered".


Assuntos
Artéria Pulmonar/patologia , Embolia Pulmonar/patologia , Trombose/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Causas de Morte , Feminino , Colágenos Fibrilares/análise , Fibroblastos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/química , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Trombose/mortalidade , Fatores de Tempo
7.
Ann Hum Biol ; 46(5): 388-392, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274338

RESUMO

Background: Endemic fluorosis induced by high concentrations of fluoride in groundwater and soils is a major health problem in several countries, particularly in volcanic areas.Aim: To evaluate the occurrence of dental fluorosis resulting from exposure to high levels of environmental fluoride in 79 AD Herculaneum and close Vesuvius towns.Subjects and methods: The occurrence of dental fluorosis from teeth of the Herculaneum victims of the 79 AD eruption and some individuals from Pompeii (14-37 AD) and Nocera Inferiore (Salerno, IV sec. AD) was detected by means of Particle Induced Gamma-ray Emission technique (PIGE).Results: A clinical and analytical scenario of dental fluorosis resulted from the extreme high fluorine tooth content detected in teeth from Herculaneum and the Vesuvius area inhabitants. The adoption of PIGE technique has proved to be particularly effective in showing moderate as well as milder forms of dental fluorosis, otherwise not clearly detectable by clinical and histological analysis.Conclusions: Morphological, histological and elemental analysis of teeth of the 79 AD Herculaneum population show that in this area fluorosis occurred since Roman times.


Assuntos
Fluorose Dentária/história , Dente/química , Fluorose Dentária/etiologia , História Antiga , Humanos , Itália , Pessoa de Meia-Idade , Erupções Vulcânicas/história
8.
Int J Legal Med ; 133(2): 483-489, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30617766

RESUMO

BACKGROUND: Stillbirth is defined by the WHO as birth of a fetus with no vital signs, at or over 28 weeks of pregnancy age. The estimation of time of death in stillbirth appears crucial in forensic pathology. However, there are no validated methods for this purpose. OBJECTIVE: To perform a systematic review of the available literature regarding the estimation of the time of death in stillborn fetuses, in terms of hours or days. METHODS: Electronic databases were searched from their inception to August 2018 for relevant articles. Macroscopic, histologic, and radiologic parameters were evaluated. RESULTS: Nine studies with 664 stillborns were included. The evaluation of extent and location of fetal maceration signs showed good accuracy in estimating the time of death; by contrast, a dichotomous assessment of maceration (present vs absent) was found to be unreliable in a subsequent study. Histologic assessment of the loss of nuclear basophilia in fetal and placental tissues showed excellent accuracy; an "autolysis equation" was proposed to achieve an even higher accuracy in fetuses who had been dead for < 24 h. Magnetic resonance imaging of the lung parenchyma, pleural fluids, and brain parenchyma could estimate the death-to-autopsy time, but the results appeared weak and conflicting. CONCLUSION: Pathologic examination, based on the assessment of maceration, and even more of the loss of nuclear basophilia, may be a reliable method to estimate the time of death in stillborn fetuses. Further studies should be encouraged to validate these results. Imaging techniques have not yet found application in this field.


Assuntos
Patologia Legal , Mudanças Depois da Morte , Natimorto , Basófilos/patologia , Encéfalo/diagnóstico por imagem , Núcleo Celular , Feminino , Humanos , Pulmão/diagnóstico por imagem , Imageamento por Ressonância Magnética , Placenta/patologia , Gravidez
9.
Eur J Obstet Gynecol Reprod Biol ; 230: 41-54, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30240948

RESUMO

Prenatal carrier screening has expanded to include a large number of genes offered to all couples considering pregnancy or with an ongoing pregnancy. Expanded carrier screening refers to identification of carriers of single-gene disorders outside of traditional screening guidelines. Expanded carrier screening panels include numerous autosomal recessive and X-linked genetic conditions, including those with a very low carrier frequency, as well as those with mild or incompletely penetrant phenotype. Therefore, the clinical utility of these panels is still subject of debate. Priority should be given to carrier screening panels that include a comprehensive set of severe childhood-onset disorders. Psychosocial support and genetic couseling should be available prior to screening and for the return of positive results. Systems are needed to reduce the risk of misinterpreting results. Finally, attention should be paid on the impact of expanded carrier screening on health care organizations and burden of cost.


Assuntos
Triagem de Portadores Genéticos/métodos , Aconselhamento Genético/métodos , Cuidado Pré-Concepcional/métodos , Diagnóstico Pré-Natal/métodos , Feminino , Humanos , Masculino , Gravidez
11.
Open Med (Wars) ; 13: 294-297, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30155519

RESUMO

The risk-delimiting tools available to insurance companies are therefore substantial and it is also possible to argue that a margin of uncertainty is a natural component of the insurance contract. Despite this, businesses look at the potential of predictive medicine, and in particular the growing understanding of genetic mechanisms that support many common diseases. In particular, the rapid development of genetics has led many insurance companies to glimpse in the predictive diagnosis of disease by genetic testing the possibility of extending the calculation of the individual risk of developing a particular disease to appropriate premiums or even denying insurance coverage.

12.
Scand J Psychol ; 59(5): 518-523, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29974974

RESUMO

The "born to read" initiative entails a dialogic reading to children in poor socio-economical conditions aimed at fostering cognitive and relational skills. Reading is professionally delivered by experts to promote psycho-social development of children and their parents. In this study the project was extended to include children positive at early screening for hearing impairment. A total of 26 children were included and 14 parents were taught to read aloud and emphatically. Reading session were delivered for at least 10 minutes at least 3 times/week, usually at bedtime, for one year. The Griffiths scale were applied to explore the expressive and receptive language skills (Scale C) and eye and hand coordination (Scale D), as measures of linguistic and neurocognitive skills. Program sustainability and reactions by the parents were also investigated. All 14 families successfully received the training, becoming capable of reading aloud and emphatically and provided reading sessions for the entire duration of the study. Children receiving the intervention performed slightly better than controls and those who were exposed to increased number of sessions, performed even better although the differences with controls were not significant. Parents enjoyed reading to their children. They expressed satisfaction and gratitude for being able to play an active and productive role in children rehabilitation. The results of this pilot study suggest that the born to read initiative may be considered in adjunct to medical and psychological interventions to enhance the benefits of early screening of hearing function.


Assuntos
Remediação Cognitiva/métodos , Perda Auditiva/reabilitação , Avaliação de Resultados em Cuidados de Saúde , Leitura , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Projetos Piloto
13.
J ECT ; 34(4): 211-219, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29944606

RESUMO

The proven effectiveness of neuromodulation and stimulation techniques for the management of psychiatric disorders has brought strongly needed innovation in psychiatry, given the high prevalence and high costs of treatment resistance. Although evidence-based guidelines in neuromodulation have been implemented to improve the clinical efficacy, safety, and research procedures, practical suggestions on how to design a psychiatric neuromodulation unit (PNU) are not available in the scientific literature. In this contribution, we have combined the results of a literature search with the suggestions of clinical psychiatrists, managers, and bioethicists who have had firsthand experience in building a PNU. Eleven key issues concerning the implementation and management of a PNU were identified: general context, team composition, environment, basic technical equipment, clinical versus research activities, target clinical population, education and training, interdisciplinarity, ethical aspects, regulatory and reimbursement issues, fund-raising, and partnership development. Moreover, a business plan comprising pragmatic solutions and recommendations for designing an efficient PNU was laid out.


Assuntos
Estimulação Encefálica Profunda , Eletroconvulsoterapia , Transtornos Mentais/terapia , Unidade Hospitalar de Psiquiatria/organização & administração , Estimulação Transcraniana por Corrente Contínua , Estimulação Magnética Transcraniana , Humanos , Equipe de Assistência ao Paciente/organização & administração
14.
Eur Arch Otorhinolaryngol ; 275(6): 1569-1577, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29687184

RESUMO

OBJECTIVE: To verify possible relations between vocal disability and aerodynamic measures in selected Parkinson's disease (PD) patients with low/moderate-grade dysphonia. METHODS: Fifteen idiopathic dysphonic PD male patients were examined and compared with 15 euphonic subjects. Testing included the following measures: Voice Handicap Index (VHI), maximum phonation time (MPT), mean estimated subglottal pressure (MESGP), mean sound pressure level (MSPL), mean phonatory power (MPP), mean phonatory efficiency (MPE) and mean phonatory resistance (MPR). RESULTS: Statistical analysis showed: a significant reduction in MPR and MSPL in PD subjects compared to the healthy ones; a significant positive correlation between VHI score and MSPL, MPR, MPP, MESGP and a significant negative correlation between VHI and MTP within PD subjects. Test for multiple linear regression showed a significant correlation between VHI score, MPT, MPR and MSPL. CONCLUSIONS: A relationship between VHI and aerodynamic measures was shown in the present study. Compensatory mechanisms may aggravate vocal disability in PD subjects.


Assuntos
Disfonia/etiologia , Rouquidão/etiologia , Doença de Parkinson/complicações , Doença de Parkinson/fisiopatologia , Fonação/fisiologia , Adulto , Idoso , Avaliação da Deficiência , Disfonia/diagnóstico , Disfonia/fisiopatologia , Feminino , Rouquidão/diagnóstico , Rouquidão/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Som , Qualidade da Voz
15.
Minerva Anestesiol ; 84(10): 1189-1208, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29648413

RESUMO

Minimally invasive surgical procedures have revolutionized the world of surgery in the past decades. While laparoscopy, the first minimally invasive surgical technique to be developed, is widely used and has been addressed by several guidelines and recommendations, the implementation of robotic-assisted surgery is still hindered by the lack of consensus documents that support healthcare professionals in the management of this novel surgical procedure. Here we summarize the available evidence and provide expert opinion aimed at improving the implementation and resolution of issues derived from robotic abdominal surgery procedures. A joint task force of Italian surgeons, anesthesiologists and clinical epidemiologists reviewed the available evidence on robotic abdominal surgery. Recommendations were graded according to the strength of evidence. Statements and recommendations are provided for general issues regarding robotic abdominal surgery, operating theatre organization, preoperative patient assessment and preparation, intraoperative management, and postoperative procedures and discharge. The consensus document provides evidence-based recommendations and expert statements aimed at improving the implementation and management of robotic abdominal surgery.


Assuntos
Abdome/cirurgia , Anestesia/normas , Procedimentos Cirúrgicos Robóticos/normas , Humanos , Cuidados Intraoperatórios/normas , Cuidados Pós-Operatórios/normas , Complicações Pós-Operatórias/prevenção & controle
16.
Forensic Sci Int ; 283: 190-199, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29310023

RESUMO

Nowadays, given the massive migration movements toward and across EU countries, age assessment can be highly useful for estimating the real age of asylum seekers or in medico-legal assessments of age-disputed children charged with criminal acts. Demirjian et al.'s dental maturity score is currently a dental scoring system universally adopted for age assessment of unidentified children. Here we explore the biological compatibility of Demirjian's scores with respect to the estimation of certain chronological ages of forensic interest through an algorithm based on the theory of constrained graphs integrated with combinatory analysis. Rather than simply respect Demirjian's indications (direct method) on a sample of children, we followed a reverse procedure (indirect method) as follows: i. chronological age selection and identification of the corresponding maturity score (MS); ii. determination of all the possible combinations of dental maturity stages whose sum of the scores is equal to the MS under consideration; iii. checking for all such possible combinations the biological congruity of the state of maturity of each tooth compared to the chronological age initially chosen. By evidencing dental development inconsistencies, our mathematical approach explains why Demirjian's method typically overestimates age. Therefore, even if the method in question remains the recommended way to assess individual dental maturity, it should definitely be considered unsuitable for application in certain forensic scenarios, particularly as regards the most disputed age range 14-16 years.


Assuntos
Determinação da Idade pelos Dentes/métodos , Algoritmos , Modelos Estatísticos , Adolescente , Criança , Humanos , Dente/crescimento & desenvolvimento , Ápice Dentário/crescimento & desenvolvimento , Calcificação de Dente
18.
Oral Maxillofac Surg ; 21(2): 171-177, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251364

RESUMO

INTRODUCTION: Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. MATERIALS AND METHODS: Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. RESULTS: One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). CONCLUSIONS: Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.


Assuntos
Complicações Intraoperatórias/etiologia , Má Oclusão/cirurgia , Cirurgia Ortognática , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Humanos , Nervo Lingual , Masculino , Nervo Mandibular , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Traumatismos do Nervo Trigêmeo/etiologia
19.
Clin Immunol ; 180: 1-4, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28347823

RESUMO

Common variable immunodeficiency disorders (CVID) represent a collection of diseases leading to an absent or strongly impaired antibody production. CVID presents a wide range of immunological abnormalities and clinical manifestations, including infections, inflammatory and autoimmune diseases, and malignancies. The aim of this observational study was to analyze the epidemiological and clinical features of a cohort of 75 Italian CVID patients, and evaluate the correlation with comorbidity and mortality. Clinical data were retrospectively collected: the cohort was followed-up for a maximum of 30years (mean time of 10.24years, median of 9years). An higher age at the diagnosis of CVID and an higher age at onset of symptoms were significantly associated with a reduction of patients survival if stratified per median of IgA (less than or >8.00mg/dl). Thus IgA levels at diagnosis are correlated with patients survival contributing to identify a subset with a worse prognostic outcome.


Assuntos
Imunodeficiência de Variável Comum/sangue , Imunoglobulina A/sangue , Adulto , Idoso , Estudos de Coortes , Imunodeficiência de Variável Comum/diagnóstico , Imunodeficiência de Variável Comum/epidemiologia , Imunodeficiência de Variável Comum/imunologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade
20.
J Obstet Gynecol Neonatal Nurs ; 46(2): 267-271, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28068508

RESUMO

Chlorhexidine is a skin antiseptic agent frequently used for off-label indications in NICUs. Changes to the safety labeling of chlorhexidine products for use in preterm infants were recently made because of the risk of severe chemical burns. We provide tips for a safer use of chlorhexidine to prevent injury in newborns and to help health care professionals protect themselves against burn injury claims.


Assuntos
Queimaduras Químicas , Clorexidina/efeitos adversos , Cuidado do Lactente , Recém-Nascido Prematuro/fisiologia , Imperícia/legislação & jurisprudência , Enfermagem Neonatal/legislação & jurisprudência , Higiene da Pele , Anti-Infecciosos Locais/efeitos adversos , Queimaduras Químicas/etiologia , Queimaduras Químicas/prevenção & controle , Humanos , Cuidado do Lactente/métodos , Cuidado do Lactente/normas , Recém-Nascido , Higiene da Pele/métodos , Higiene da Pele/normas
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