Exploring conservative management for cervical intraepithelial neoplasia grade 2 in organised cervical cancer screening programmes: a multicentre study in Italy.

Cervical intraepithelial neoplasia grade 2 (CIN2) lesions may regress spontaneously, offering an alternative to immediate treatment, especially for women of childbearing age (15-45 years).We conducted a prospective multicentre study on conservative CIN2 management, with semiannual follow-up visits over 24 months, biomarkers' investigation and treatment for progression to CIN3+ or CIN2 persistence for more than 12 months. Here, we assess women's willingness to participate and adherence to the study protocol.The study was set in population-based organised cervical cancer screening.From April 2019 to October 2021, 640 CIN2 cases were diagnosed in women aged 25-64 participating in the screening programmes.According to our predefined inclusion and exclusion criteria, 228 (35.6%) women were not eligible; 93 (22.6%) of the 412 eligible refused, and 319 (77.4%) were enrolled. Refusal for personal reasons (ie, desire to become pregnant, anxiety, difficulty in complying with the study protocol) and external barriers (ie, residence elsewhere and language problems) accounted for 71% and 17%, respectively. Only 9% expressed a preference for treatment. The primary ineligibility factor was the upper age limit of 45 years. After enrolment, 12 (4%) women without evidence of progression requested treatment, 125 (39%) were lost to follow-up (mostly after 6-12 months) and 182 (57%) remained compliant. Remarkably, 40% of enrolees did not fully adhere to the protocol, whereas only 5% (20/412) of the eligible women desired treatment.Our study demonstrates a good acceptance of conservative management for CIN2 lesions by the women, supporting its implementation within cervical screening programmes.

Induction of Labor in Women with Previous Cesarean Section and Unfavorable Cervix: A Retrospective Cohort Study.

Background: The efficacy and safety of a cervical ripening balloon (CRB) in women with a previous cesarean section (CS) and unfavorable Bishop score are still controversial. Methods: A retrospective cohort study was performed across six tertiary hospitals from 2015 to 2019. Women with one previous transverse CS, singleton cephalic term pregnancy and BS < 6 were included if submitted to labor induction with a CRB. The main outcome was the rate of vaginal birth after cesarean (VBAC) after CRB ripening. Secondary outcomes were abnormal composite fetal and maternal outcomes. Results: Of the 265 women included, 57.3% had successful vaginal birth. Augmentation improved vaginal delivery (32.2% vs. 21.2%). Intrapartum analgesia was associated with an increased VBAC rate (58.6% vs. 34.5%). Maternal BMI ≥30 and age ≥40 years increased emergency CS rate (11.8% vs. 28.3% and 7.2 vs. 15.9%). Composite adverse maternal outcome occurred in 4.8% of CRB group women and increased to 17.6% when associated with oxytocin. Uterine rupture occurred in one case (0.4%) in the CRB-oxytocin group. Poorer fetal outcome occurred after emergency CS, if compared to successful VBAC (12.4% vs. 3.3%). Conclusions: In women with a previous CS and unfavorable Bishop score, induction of labor with a CRB can be considered safe and effective.

Prolonged prone position in pregnant woman with COVID-19 pneumonia.

The manuscript describes a case report of 2 prolonged prone position cycles (72 h each) of a coronavirus disease 2019 pneumonia in an intubated pregnant woman (at 22 weeks of gestational age), being successfully discharged from intensive care unit after 20 days. There were no signs of fetal sufferance at daily obstetric monitoring during prone position, and the fetus was born fully vital and without consequences.At our knowledge, this is the first case of prolonged prone position in a pregnant woman, and we feel that our manuscript could be a valuable contribution to the literature and help intensivists in providing intensive care in these patients, confirming that prone position seems to be a valid therapeutic choice, limiting maternal and fetal hypoxia, and reducing their morbidity, even if the oculate risk/benefit should be performed. Further studies are however necessary to increase the knowledge and the good management of COVID-19 in pregnancy.

[The result of application's monitoring of NEWS score in a surgery unit of a North Italy hospital]. / Risultati del monitoraggio dell'applicazione dello score National Early Warning Score in area chirurgica di un ospedale del Nord Italia.

INTRODUCTION: In a hospital in Northern Italy was decided to experiment a new standardized methodology for detection and evaluation of vital parameters and effective communication between healthcare professionals, with the applications of NEWS score. Then it was necessary to evaluate the application and usefulness of the score in the specific contest. The aim of this project was adopting a validated and standardized methodology for detecting vital parameters to identificate early the signs and symptoms of a possible clinical deterioration and to create an effective communication between professionals. In the end it was necessary to monitor the correct application of the NEWS score to evaluate the usefulness of extending the score in surgical units. METHODS: The indicators were identified and monitored, consulting a sample of medical Gynecologic records of the 2019. The sample size useful for having a confidence level of 95% was identified, which, according to the Sample Size Calculator, known the population of 865 patients, corresponds to 160 sample units. An ad hoc data set was then developed for data collection. RESULTS: The correctness of the execution of clinical monitoring according to the parameters provided by the score is 75%, while the completeness of score's recording is 99% of the sample analyzed. The days of hospitalization in which there is a score≥5 are 10, equal to 1.5%. An in-depth study of cases with a score ≥5 showed that in 9 out of 10 cases the doctor was alerted. DISCUSSION: The NEWS score is useful in the early identification of risk situations, in rapid and objective communication and in the timely activation of interventions to prevent complications. Furthermore, the application of the score does not involve a waste of time than that used for the collection of vital parameters.

Performance of Pheromone-Baited Traps to Monitor the Seasonal Abundance of Tortrix Moths in Chestnut Groves.

(1) Background: Pammene fasciana (L.), Cydia fagiglandana (Zeller), and C. splendana (Hübner) (Lepidoptera: Tortricidae) are considered key moth pests of chestnut in Europe. (2) Methods: Investigations were performed in 2018-2019 in northern Italy. Sticky traps and commercially available pheromones were used for monitoring; moreover, two experimental pheromone blends were tested. All specimens were identified according to male genitalia and molecular analyses. Newly formed chestnut husks and fruits were randomly collected to evaluate the presence of larvae and/or feeding damage, by comparing it to trap catches. (3) Results: P. fasciana was present in all the sites, whereas Cydia species were recorded in three sites of six, with differences in abundance related to pheromone blends studied. Several non-target species, such as Oegoconia novimundi (Busck) and Cydia ilipulana (Walsingham), were present. Data about the seasonal flight activity are provided. (4) Conclusions: This research contributes to ascertaining the presence and abundance of tortrix moths in Italian chestnut groves, and the presence of non-target species highlights the risk of overestimating catches. Fruit damage recorded did not always reflect catches made by pheromone traps, suggesting that monitoring may underestimate the real size of moths' populations. All of the data acquired are important for planning specific control measures.

Can Nurse-Based Management Screening Ensure Adequate Outcomes in Patients With Gestational Diabetes? A Comparison of 2 Organizational Models.

BACKGROUND: Gestational diabetes mellitus (GDM) is an impaired glucose tolerance with onset or first recognition during pregnancy. The purpose of this study is to evaluate the clinical outcomes of a blood glucose monitoring protocol implemented by nurses and dietitians in a diabetes team to the previously established protocol of direct monitoring of GDM patients by a diabetologist. METHODS: Two groups of patients were formed: The first group was based on a traditional protocol (P1: 230 patients) with patients' blood glucose constantly checked by a diabetologist. In the second structured group (P2: 220 patients) patients were referred to a diabetologist only if they required insulin therapy. RESULTS: The number of medical visits (P2: 1.28 ± 0.70 vs P1: 3.27 ± 1.44; P < .001) and the percentage of patients with hypoglycemia (P2: 6.8% vs P1: 15.2%; P < .006) were found to be lower in group P2 than in group P1. In both groups, a direct relationship was found between a parental history of diabetes and the risk of GDM (odds ratio [OR]: P1 = 2.2 [1.17-4.12]; P2 = 2.5 [1.26-5.12]). In group P1, it was observed that hyperweight gain in patients who were already overweight before becoming pregnant significantly increased the risk of macrosomia (OR: 3.11 [1.39-25.7]), whereas this was not detected in patients in group P2. In group P2, a correlation was found between macrosomia and insulin therapy (OR: 0.066 vs 0.34). In group P1 and group P2, a correlation was observed between insulin therapy and a family history of diabetes (OR: 2.20 vs 2.27), and a body mass index of greater than 30 kg/m in group P2 (OR: 3.0 vs 1.47). CONCLUSIONS: The data we collected show that creating a structured protocol for GDM management reduces the number of medical visits required by patients without increasing the risk of hypoglycemia, macrosomia, or hyperweight gain during pregnancy.

Essure Permanent Birth Control, Effectiveness and Safety: An Italian 11-Year Survey.

STUDY OBJECTIVE: To describe safety, tolerability, and effectiveness results through a minimum 2-year follow-up of patients who underwent permanent sterilization with the Essure insert. DESIGN: A retrospective multicenter study (Canadian Task Force classification II2). SETTING: Seven general hospitals and 4 clinical teaching centers in Italy. PATIENTS: A total of 1968 women, mean age 39.5 years (range, 23-48 years) who underwent office hysteroscopic sterilization using the Essure insert between April 1, 2003, and December 30, 2014. INTERVENTION: The women underwent office hysteroscopic bilateral Essure insert placement, with satisfactory device location and tube occlusion based on hysterosalpingography or hysterosalpingo-contrast sonography (HyCoSy). MEASUREMENTS AND MAIN RESULTS: Placement rate, successful bilateral tubal occlusion, perioperative adverse events, early postoperative (during the first 3 months of follow-up), and late complications were evaluated. Satisfactory insertion was accomplished in 97.2% of women and, in 4, perforation and 1 expulsion were detected during hysterosalpingography. Three unintended pregnancies occurred before the 3-month confirmation test. Two pregnancies were reported among women relying on the Essure inserts. Postprocedure pain was minimal and brief; in 9 women, pelvic pain became intractable, necessitating removal of the devices via laparoscopy. On telephone interviews, overall satisfaction was rated as "very satisfied" by the majority of women (97.6%), and no long-term adverse events were reported. CONCLUSION: The findings from this extended Italian survey further support the effectiveness, tolerability, and satisfaction of Essure hysteroscopic sterilization when motivated women are selected and well informed of the potential risks of the device. Moreover, the results do not demonstrate an increased incidence of complications and pregnancies associated with long-term Essure use. Patients with a known hypersensitivity to nickel may be less suitable candidates for the Essure insert.

Re-establishment of Carabus (Cathoplius) aliai Escalera, 1944 as a separate valid species (Coleoptera, Carabidae).

Carabus (Cathoplius) aliai was described as a separate species by Escalera in 1944 but since the 1950-60s it has been considered as a subspecies of Carabus (Cathoplius) stenocephalus Lucas, 1866. This downgrading was adopted after examining only a few specimens, due to their rarity in collections. In recent years, an important population of this taxon was rediscovered in the Tan-Tan area in southern Morocco. By combining field observations with laboratory breeding experiments including hybridization trials, and through the morphological examination of a representative number of individuals, it is confirmed that Carabusaliai is indeed a valid species. Despite close geographic distribution, the morphological and biological characteristics of Carabusaliai and Carabusstenocephalusifniensis Zarco, 1941, its northern substitutive taxon, are very different. Carabusaliai adults are characterized by a smaller size, a slender silhouette, a more brilliant aspect, a narrower pronotum, a coarser elytral sculpture, longer legs, and a wider and a little more curved apex of the median lobe of the aedeagus. Carabusaliai larvae are also characterized by a much smaller size and the Carabusaliai pupa has a narrower thoracic area and a different chaetotaxy compared to that of Carabusstenocephalusifniensis. Contrary to this, Carabusaliai has a life cycle belonging to the annual univoltine winter semelparous type. Moreover, the duration of its development cycle is shorter. Carabusaliai is a sabulicolous steppe-wandering species with an intensive running activity, while Carabusstenocephalusifniensis is a more sedentary taxon. Crossbreeding experiments showed a marked reproductive isolation between Carabusaliai and Carabusstenocephalusifniensis. When F1 hybrids were crossed with one another, a very high mortality rate during embryonic, larval and pupal development was evident and no vital F2 neo-adults were obtained. Morphological and biological differences, together with the reproductive failure in Carabusaliai × Carabusstenocephalusifniensis hybrids, clearly indicate that Carabusaliai is a separate Cathoplius species that is distributed in an area south of the Anti-Atlas chain, from Plage Blanche (Guelmim) to Lemsid and Bou Kra (south of Laâyoune). Carabusaliai is therefore both a Saharan desert endemic and an Atlantic resident. Moreover, it is the southernmost Carabus species of the western Palaearctic region.

Carabus of Subgenus Cathoplius C.G. Thomson, 1875, with description of their life-way, life-cycle and pre-imaginal morphology (Coleoptera: Carabidae) .

According to current taxonomy, Subgenus Cathoplius C.G. Thomson, 1875, within the Genus Carabus Linnaeus, 1758 (in the broad sense), includes two species: C. (Cathoplius) asperatus (Dejean, 1826), monotypic with a northern distribution, and the southern polytypic substitutive species C. (Cathoplius) stenocephalus Lucas, 1866. The authors describe the life-way, life-cycle and pre-imaginal characters of the taxa currently ascribed to Subgenus Cathoplius, with details never provided before. Cathoplius are ground beetles adapted to live in arid environments and extreme habitats such as sub-desert areas. All of them are strictly helicophagous, both during the pre-imaginal stages and as adults, and are localized in a narrow fringe along the Atlantic coast of northwestern Africa. Several data and observations on the eco-ethology of the different taxa, obtained both in field and in laboratory, are reported. The life-cycle of Cathoplius belongs to the winter breeding type, with an extremely high fecundity rate concentrated in a very short period of time, that has no similarity to any other Carabus species. Eggs, larvae and pupae of the different species and subspecies of Cathoplius are described and illustrated. Larval characters clearly place Subgenus Cathoplius into the lineage of Neocarabi, confirming it as a monophyletic and homogeneous assemblage. Hybridization trials between some taxa led to a reduced survival rate of the progeny, thus confirming their specific or subspecific differentiation as proposed by classical taxonomy. Furthermore, hybridization results suggest that C. (Cathoplius) stenocephalus aliai could be considered as a distinct species. Notes about the origin, biogeography and phylogeny of Cathoplius are also provided.

Toxic megacolon complicating a Clostridium difficile infection in a pregnant woman.

Clostridium difficile infection (CDI) in non-hospitalized patients has been reported with increased frequency, whereas an association between CDI and pregnancy has not been highlighted. We report a case of toxic megacolon complicating a severe CDI during the second trimester of pregnancy in a patient without traditional risk factors, such as antibiotic use, immunodeficiency, and prolonged and recent hospitalization.