Factores asociados a la depresión, ansiedad y estrés de los trabajadores del sector publico de salud de La Plata y Gran La Plata al inicio de la pandemia por Covid-19 / Factors associated with depression, anxiety and stress of workers in the public health sector of La Plata and Greater La Plata at the beginning of the Covid-19 pandemic

La pandemia por COVID-19 expuso a los trabajadores de salud a una enorme exigencia y presión en su labor cotidiana. Objetivo: Evaluar el nivel de depresión, ansiedad y estrés en trabajadores de salud durante la pandemia por COVID-19 y su asociación con características personales, laborales,sentimientos, experiencias y conductas relacionadas a la pandemia. Materiales y métodos: Estudio analítico de corte transversal. Durante el mes de junio del 2020 se enviaron formularios vía e-mail y redes sociales a trabajadores de la salud del sector público de La Plata y Gran La Plata. Se evaluó el nivel de depresión, ansiedad, y estrés mediante el cuestionario DASS-21. Se relevaron variables personales, laborales, sentimientos, experiencias y conductas vinculados a la pandemia. Se analizó la asociación entre las características de los trabajadores y la presencia de síntomas psicológicos mencionados. Resultados: Participaron 515 trabajadores, 41 años (33;50), 83,3% femenino. El síntoma psicológico más frecuente fue el estrés (58,2 %), seguido por ansiedad (33,1%) y depresión (24,7%). Se hallaron mayores chances de presentar estos síntomas en trabajadores que percibieron sentimientos, experiencias y conductas negativas vinculados a la pandemia. Los trabajadores de enfermería y administración, y aquellos que convivían con personas de riesgo tuvieron mayores chances de presentar ansiedad. Conclusión: Los trabajadores de salud de La Plata y Gran La Plata presentaron diversos grados de depresión, ansiedad y estrés que se asocian a sentimientos negativos relacionados con la pandemia

The COVID-19 pandemic exposed health workers to enormous demands and pressure in their daily work. Objective: To evaluate the level of anxiety, depression and stress in health workers during the COVID-19 pandemic and its association with personal and work characteristics, feelings, experiences, and behaviors related to the pandemic. Materials and methods: Cross-sectional analytical study. During the month of June 2020, forms were sent via e-mail and social networks to health workers in the public sector of La Plata and Gran La Plata. The level of depression, anxiety, and stress was evaluated using the DASS-21 questionnaire. Personal and work variables, feelings, experiences and behaviors linked to the pandemic were surveyed. The association between the characteristics of the workers and the presence of the aforementioned psychological symptoms was analyzed. Results: 515 workers participated, 41 years old (33;50), 83.3% female. The most frequent psychological symptom was stress (58.2%), followed by anxiety (33.1%) and depression (24.7%). Greater chances of presenting these symptoms were found in workers who perceived negative feelings, experiences and behaviors linked to the pandemic. Nursing and administration workers, and those who lived with people at risk had a higher chance of presenting anxiety. Conclusion: Health workers from La Plata and Gran La Plata presented varying degrees of depression, anxiety, and stress that are associated with negative feelings related to the pandemic

Phosphorous(v) Lewis acids: water/base tolerant P3-trimethylated trications.

The water/base intolerance of the previously reported electrophilic phosphonium cations has been overcome by replacing the labile electron-withdrawing groups generally attached to phosphorus (e.g. -F, -OAr, -CF3) with methyl groups. Tri-phosphorus(v) tricationic species, accessible in one-pot from commercially available materials, are air and water/base tolerant, yet are sufficiently Lewis acidic for catalysis.

Generation of a series of Bn fused oligo-naphthalenes (n = 1 to 3) from a B1-polycyclic aromatic hydrocarbon.

A series of Bn-PAHs have been prepared by functionalisation of a B1-PAH, leading to the first only boron doped B3-PAH to the best of our knowledge. These Bn-PAHs represent the first three members of a series of {B-Mes} fused oligo-naphthalenes and trends in key properties of this series have been elucidated.

Air- and water-stable Lewis acids: synthesis and reactivity of P-trifluoromethyl electrophilic phosphonium cations.

A new class of electrophilic phosphonium cations (EPCs) containing a -CF3 group attached to the phosphorus(v) center is readily accessible in high yields, via a scalable process. These species are stable to air, water, alcohol and strong Brønsted acid, even at raised temperatures. Thus, P-CF3 EPCs are more robust than previously reported EPCs containing P-X moieties (X = F, Cl, OR), and despite their reduced Lewis acidity they function as Lewis acid catalysts without requiring anhydrous reaction conditions.

Exercise intolerance at high altitude (5050 m): critical power and W'.

The relationship between work rate (WR) and its tolerable duration (t(LIM)) has not been investigated at high altitude (HA). At HA (5050 m) and at sea level (SL), six subjects therefore performed symptom-limited cycle-ergometry: an incremental test (IET) and three constant-WR tests (% of IET WR(max), HA and SL respectively: WR(1) 70±8%, 74±7%; WR(2) 86±14%, 88±10%; WR(3) 105±13%, 104±9%). The power asymptote (CP) and curvature constant (W') of the hyperbolic WR-t(LIM) relationship were reduced at HA compared to SL (CP: 81±21 vs. 123±38 W; W': 7.2±2.9 vs. 13.1±4.3 kJ). HA breathing reserve (estimated maximum voluntary ventilation minus end-exercise ventilation) was also compromised (WR(1): 25±25 vs. 50±18 l min(-1); WR(2): 4±23 vs. 38±23 l min(-1); WR(3): -3±18 vs. 32±24 l min(-1)) with near-maximal dyspnea levels (Borg) (WR(1): 7.2±1.2 vs. 4.8±1.3; WR(2): 8.8±0.8 vs. 5.3±1.2; WR(3): 9.3±1.0 vs. 5.3±1.5). The CP reduction is consistent with a reduced O(2) availability; that of W' with reduced muscle-venous O(2) storage, exacerbated by ventilatory limitation and dyspnea.

High-altitude exposure reduces inspiratory muscle strength.

It was the aim of the study to assess the maximal pressure generated by the inspiratory muscles (MIP) during exposure to different levels of altitude (i.e., hypobaric hypoxia). Eight lowlanders (2 females and 6 males), aged 27 - 46 years, participated in the study. After being evaluated at sea level, the subjects spent seven days at altitudes of more than 3000 metres. On the first day, they rode in a cable car from 1200 to 3200 metres and performed the first test after 45 - 60 minutes rest; they then walked for two hours to a mountain refuge at 3600 metres, where they spent three nights (days 2 - 3); on day 4, they walked for four hours over a glacier to reach Capanna Regina Margherita (4559 m), where they spent days 5 - 7. MIP, flow-volume curve and SpO (2) % were measured at each altitude, and acute mountain sickness (Lake Louise score) was recorded. Increasing altitude led to a significant decrease in resting SpO (2) % (from 98 % to 80 %) and MIP (from 134 to 111 cmH (2)O) (baseline to day 4: p < 0.05); there was an improvement in SpO (2) % and a slight increase in MIP during the subsequent days at the same altitude. Expiratory (but not inspiratory) flows increased, and forced vital capacity and FEF (75) decreased at higher altitudes. We conclude that exposure to high altitude hypoxia reduces the strength of the respiratory muscles, as demonstrated by the reduction in MIP and the lack of an increase in peak inspiratory flows. This reduction is more marked during the first days of exposure to the same altitude, and tends to recover during the acclimatisation process.

Lung function in beta-thalassemia patients: a longitudinal study.

Patients with beta-thalassemia often present with a restrictive pattern at pulmonary function tests (PFTs) due to several pathogenetic factors. However, the long-term evolution is unknown. We performed a longitudinal study of pulmonary function in asymptomatic, non-smoking patients with beta-thalassemia major and intermedia. We looked for temporal changes in lung function and characteristics that would predict the development of PFT abnormalities. In 1996, 18 patients with major beta-thalassemia (9 males and 9 females; age range: 18-35 years) and 11 patients with intermediate beta-thalassemia (5 males and 6 females; age range: 25-51 years) underwent clinical assessment and PFT, including body plethysmography and gas transfer study (carbon monoxide diffusion capacity, DL(CO)). Patients were reassessed in 2003. An echocardiographic evaluation was also obtained to exclude pulmonary hypertension. In 55.5% of major and 45.4% of intermediate beta-thalassemia patients, a restrictive pattern was found in 1996; in 2003 only 38.8 and 27.2% of patients, respectively, exhibited total lung capacities below the predicted values. DL(CO) was unchanged in both groups of patients, being reduced in 5 thalassemia major patients and within the normal range in intermediate patients. We conclude that asymptomatic patients with beta-thalassemia have a high prevalence of PFT abnormalities, but without significant increases over time. An improvement may be observed when good control of the iron balance is reached with optimal chelation therapy.

Increased frequency dependence of specific airway resistance in patients with laryngeal hemiplegia.

The aim of this study was to investigate whether patients with laryngeal hemiplegia (LH) show a frequency-dependent increase in specific airway resistance (sRaw), measured by body plethysmography. In addition to the flow-volume loop, usually considered in the functional evaluation of upper airway obstructions, variations in sRaw at respiratory frequencies of 30+/-5 (=0.5 Hz), 60+/-5 (=1 Hz) and 90+5 breaths x min(-1) (=1.5 Hz) in 21 never-smoking patients (LH group, mean age+/-SD 55+/-12.09 yrs; 17 females) whose unilateral vocal-cord paralysis was documented by laryngoscopy and who had no signs or symptoms of other respiratory diseases studied. They were compared to 21 healthy control subjects (C group: 50.1+/-15.44 yrs; 10 females). The sRaw values at 30+/-5 breaths min(-1) were similar in the two groups (5.54+/-1.88 versus 5.68+/-1.06 cmH2O x s(-1); p=NS), but at increasing frequencies (30+/-5, 60+/-5 and 90+/-5 breaths min(-1)), they progressively and significantly increased in the LH patients (from 5.54+/-1.88 to 6.63+/-1.96 and 8.05+/-2.6 mH2O x s(-1); p<0.0005), and not significantly in controls (5.68+/-1.06, 5.85+/-0.95 and 5.9+/-1.12 cmH2O x s(-1); p=NS). Linear discriminant analysis using AsRaw (sRaw at 1.5 Hz-sRaw at 0.5 Hz) and forced inspiratory flow at 50% of the vital capacity made it possible to correctly classify all of the controls and 19 of the 21 patients. In conclusion, the multiple, rapid and noninvasive plethysmographical testing of frequency-dependent increase in specific airway resistance with the flow-volume loop, allows the sufficiently satisfactory discrimination of laryngeal hemiplegia patients from controls.

Pollen, mite and mould samplings by a personal collector at high altitude in Nepal.

The new personal portable sampler for detection of environmental biologic particles (Partrap FA52, Coppa, Biella, Italy) was used to evaluate both atmospheric and indoor biologic particles in bedding at high altitudes during two Italian scientific expeditions in Nepal, in 1994 and 1996 respectively. The sampling was performed outdoors and indoors at the following altitudes: Katmandu 1,330 meters (m), LuKla 2,800 m, Namche 3,500 m, Pericle 4,200 m and Piramide 5,050 m. In both expeditions each sample of outdoor and indoor air was obtained by sucking air into the sampler either against the wind during a 6-h period, from 9 am to 3 pm, or from bedding of inhabitants resident at the different altitudes for 5 min. The number of pollens, moulds and mites trapped in each sample were assessed. The statistical analysis of the results by Spearman correlation test revealed a significant inverse correlation (p < 0.02) between altitude and the number of the considered biologic particles for sampling carried out during both the 1994 and 1996 expeditions. Moreover, Wilcoxon paired test showed no significant difference between the biologic sampling obtained in the two expeditions. These results confirm the decrease of the environmental biologic charge in relation to the increase of altitude and prove the efficacy of Partrap FA52 in obtaining reproducible quantitative data.

High altitude exposure reduces bronchial responsiveness to hypo-osmolar aerosol in lowland asthmatics.

It is well-known that many patients with asthma undergo clinical improvement during a stay at high altitude. At high altitude, the atmospheric and climatic conditions (such as hypoxia, cold and dry air inhalation) could modify the bronchial responsiveness in asthmatics. Our study was designed to assess the difference in bronchial responsiveness to hypotonic aerosol between sea level and high altitudes in nonresident asthmatic subjects. The results were obtained during two mountaineering expeditions above 4,000 m i.e. at 4,559 m on Mt Rosa, Italy; and at 5,050 m near the Mt Everest base camp in Nepal. Eleven mild asthmatics performed standard bronchial challenges with ultrasonically nebulized distilled water (5 min inhalation, delivery 2 mL-min-1) at sea level and after staying at least 72 h at the above mentioned altitudes. The decrease in forced expiratory volume in one second (FEV1) from baseline was used as index of bronchial response. There was no significant difference in pre-challenge FEV1 between sea level and high altitude in either study. However, the bronchoconstriction response to ultrasonically nebulized distilled water was significantly reduced at high altitude in both studies. At sea level the mean FEV1 decrease was 22.2% (range 15-35%), whereas as the maximal altitude it was 6.7% (range 2-11%). Our results indicate that there is a reduction in bronchial responsiveness to hypoosmolar aerosol at high altitude. This suggests that atmospheric and climatic conditions, or physiological adaptations, via mediators such as atrial natriuretic peptide, are beneficial to patients with asthma at high altitude.

[Postoperative complications in neurosurgery]. / Le complicazioni post-operatorie in neurochirurgia.

Hemorrhage, ischemia and ischemic edema are among the complications which may occur following neurosurgery and they represent the most frequent cause of neurological deterioration. The mechanisms predisposing vascular complications (hemorrhage, ischemia) are described and discussed in relation to systemic alterations associated with surgery and anesthesia. In addition, the physiopathology of these complications is discussed in the various pathologies: cancer, vascular malformations, trauma and the intra-operative diagnostic possibilities which prevent their onset.

Laser therapy in cerebral obstructive pathology and vascular malformations: a review.

Experimental results suggest the possibility of the use of lasers in the obstructive pathology and vascular malformations of the brain.

[Surgical indications for the treatment of cervico-spinal cord injuries]. / Indicazioni chirurgiche per il trattamento dei traumi cervico-midollari.

The surgical treatment of cervico-medullary traumas is indicated, in unstable lesions, in large lesions of the mobile rachidic segment in the presence of neurological complications or following worsening of prior neurological symptomatology. The purpose of the operation is at least three-fold: to obtain alignment of vertebral structures and decompression of the bone marrow due to bone or disc compression, stabilise the vertebral segment involved, attain early mobilisation of the patient. The conventional radiological examinations allows to detect osteous and artro-ligamentous lesions. The Computed Tomography shows the consequences of the lesions on the roots and the spinal cord. The Nuclear Magnetic Resonance directly shows the oedema, the haemorrhages, the compression and the section of the spinal cord. It gives useful indications for the surgical treatment of the spinal lesions. An immediate and careful assistance at the seat of the accident, during the transport and during the diagnostic steps is essential to avoid the worsening of the primitive spinal cord lesions.

Intraoperative use of laser Doppler in the study of cerebral microvascular circulation.

Laser Doppler (LD) flowmetry has been used for evaluation of microcirculatory flow in a variety of human tissues, including skin, muscle, retina and recently the brain. In the present paper, intraoperative Laser Doppler recordings have been performed in 72 cases, in basal conditions and after stimulation. The morphology of basal recordings obtained from normal cortical areas were analyzed and three different rhythmical variations were identified; these rhythmical variations are described and explained. Several kinds of stimulation have been used: hypotensive drugs, mannitol, nimodipine, eupaverine, hypercapnia, decompressive manoeuvres and temporary occlusion of the ICA in the neck. Laser Doppler recordings obtained during and after these stimulations are reported and explained. The results have been evaluated in order to verify the reliability and the reproducibility of this technique in the study of the cerebral microvascular circulation intraoperatively.

Intraoperative electrical stimulation for functional posterior rhizotomy.

Intraoperative electrical stimulation of dorsal spinal roots from L1 to S1 bilaterally was performed in 80 patients affected by cerebral palsy, in whom spasticity was the main symptom. Clinical examination and EMG recordings showed three main features of reflex responses. We know that they indicate respectively a normal presence, a defect or an excess of inhibitory activity within the spinal circuits examined. Only those roots or rootlets involved in circuits where normal inhibitory processes are reduced or absent are surgically sectioned. Therefore these circuits are interrupted. The theoretical bases and long-term results indicate that this method is a useful and correct approach to the neurosurgical therapy of spasticity. It allows us to utilize a new important criterion to identify the roots or rootlets to be sectioned, based not on the anatomic, but on the functional selection.

Cryoanalgesia. Ultrastructural study on cryolytic lesion of sciatic nerve in rat and rabbit.

The sciatic nerve was exposed to cryoinjury at different freezing patterns in albino rats and rabbits and the frozen nerves were serially examined with electron microscopy from the time of cryolitic lesion (--60 degrees C for 3 minutes) for up to 28 days. The cryolesion was characterized by a total degeneration of the myelin fibers, while non-myelin fibers and vessels seemed less affected. Regeneration began 8 days after cryolysis. A peculiar pattern was the absence of Schwann cells, while the basal membrane around regenerating axons remained intact. The hypothesis that the basal membrane might play a role is discussed.

The effects of new technologies on the surgical management of brainstem tumors.

Nuclear magnetic resonance, real-time and A-scan ultrasonography, and computerized CO2 lasers were recently introduced for diagnosis and surgical treatment of brainstem tumors. These new technologies offer many advantages: safe but aggressive surgery on the brainstem, the possibility of performing a correct histologic diagnosis, and an exact indication for radiotherapy. Eleven tumors were operated on in our series: seven were intrinsic and four protruded out from the axis. Patients with high-grade malignant tumors died from 5 to 12 months after treatment, whereas those with pilocytic astrocytoma are still alive and leading useful lives.