Useful Clinical Criteria for Identifying Neonates with Congenital Cytomegalovirus Infection at Birth in the Context of an Expanded Targeted Screening Program.

Cytomegalovirus (CMV) is the leading infectious cause of brain defects and neurological dysfunctions, including sensorineural hearing loss (SNHL). Targeted screening in neonates failing the hearing screen is currently recommended in Italy according to national guidelines. However, SNHL may not be present at birth; also, congenital CMV (cCMV) may manifest with subtle signs other than SNHL. Therefore, the inclusion of additional criteria for cCMV screening appears clinically valuable. Starting January 2021, we have implemented expanded targeted cCMV screening at our center, with testing in case of maternal CMV infection during pregnancy, inadequate antenatal care, maternal HIV infection or immunosuppression, birthweight and/or head circumference < 10th centile, failed hearing screen, and prematurity. During the first three years of use of this program (2021-2023), 940 (12.3%) of 7651 live-born infants were tested. The most common indication was birthweight < 10th centile (n = 633, 67.3%). Eleven neonates were diagnosed as congenitally infected, for a prevalence of 1.17% (95%CI 0.48-1.86) on tested neonates and of 0.14% (95%CI 0.06-0.23) on live-born infants. None of the cCMV-infected newborns had a failed hearing screen as a testing indication. Implementation of an expanded cCMV screening program appears feasible and of clinical value.

Uterine venous malformations in the puerperium: 2 Atypical cases and literature review.

Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.

[Regional epistemologies in psychiatry]. / La noción de epistemología regional en psiquiatría.

It becomes apparent at the present level of development of the Psychiatry that it is not possible to have a unique theoretical framework or a general principle in the wide field of this discipline. In this article the various theoretical references are reviewed. In some clinical cases the author refers to the lack of a theoretical reference at all. At the present moment, the range of theoretical perspectives leads to deal with the coexistence of regional epistemologies.

[Psychasthenia: history and evolution of the P. Janet concept]. / La psychasthénie: historie et évolution d'un concept de P. Janet.

Description of psychasthenia by P. Janet (1903) sets up at the end of a double reflection, with on the one hand a theorization of asthenia, the notion of which already occupied the medical concepts of the 18th and 19th centuries, and on the other hand a progressive attribution of neurosis to the psychiatric field. Its clinical characteristics (feelings of non-fulfillment in action and emotion, experiences of oddness and depersonalization, obsessions, phobias...) makes psychasthenia a fully-fledged illness, the psychopathological organization of which results from a decrease of psychological tension and from a loss of reality function. Since P. Janet, the term of psychasthenia has not ceased to be used, although its etiopathological references blurred behind the psychoanalytic work, and it is usually synonymous with obsessional neurosis, even with obsessional personality. Description of psychasthenia appears in these rubrics of the DSM III, even though the term itself is ignored.