Corrigendum to "Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs" [Heliyon 9(4) (April 2023) e15047].

[This corrects the article DOI: 10.1016/j.heliyon.2023.e15047.].

Going for a stroll on lurasidone: Considerations on an atypical case of acute compartment syndrome of both legs.

Non-traumatic acute bilateral compartment syndrome is a rare condition that may lead to limb ischemia. We describe a case of this syndrome occurring after a five-kilometer walk in a young woman receiving chronic treatment with lurasidone, leading to a bilateral foot-drop and rhabdomyolysis of the anterolateral compartment of both legs. Due to her late presentation in the emergency department, we opted for a conservative approach, closely monitoring her renal function. We noticed a subsequent clinical and biochemical improvement over the following days, with the patient returning to her daily routine in a matter of weeks, despite a persisting bilateral foot drop. Since atypical antipsychotics are known to be associated with rhabdomyolysis, while possibly exerting a toxic effect on mitochondria, we hypothesize that a mild aerobic physical exertion might have triggered the event, in the context of an iatrogenic muscle susceptibility to oxidative distress.

The identification of pathogens associated with periprosthetic joint infection in two-stage revision.

OBJECTIVE: Identification of periprosthetic joint infection (PJI)-related pathogens is crucial to decide what is the correct surgical strategies and the most secure timing to re-implant in case of two-stage revision. The purpose of the present study is to review the literature to identify the features of each exams which are used to identify the pathogens associated with PJI, to evaluate which are the most sensitive and specific and to set up an algorithm to decide when, in the field of two-stage revision, it's the ideal timing to re-implant. MATERIALS AND METHODS: We did a systematic review of the literature to look for peer-reviewed papers of any evidence level focusing on: (1) Microbiological and molecular exams for identification of PJI-related pathogens. (2) Nuclear imaging methods, which can help in the identification of a PJI. Special attention was focused to analyse which is the sensitivity and specificity of these exams. RESULTS: Overall, 64 manuscripts met the criteria of the systematic search at point 1 and 7 manuscripts at point 2. Among microbiological and molecular exams, the average of sensitivity and specificity were respectively 65.6% and 94.4% for cultural exams, 74.1% and 95.2% for molecular diagnosis and 86.9% and 96% for MicroDTTect. Among nuclear imaging methods, the average of sensitivity and specificity were respectively 94% and 69 % for three-phase bone scintigraphy and 100% and 62.5% for [18F] Fluoro-2-deoxyglucose-positron emission tomography/computed tomography. CONCLUSIONS: In two-stage revision after PJI, taking into account the sensitivity and specificity values, just a few microbiological and molecular exams and nuclear imaging methods should be considered in the decision process to re-implant the components.

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

OBJECTIVE: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. METHODS: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. RESULTS: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. CONCLUSION: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Correction to: The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

[This corrects the article DOI: 10.1007/s40200-018-0358-2.].

Two cases of colon LST in transplanted liver patients.

Long-life immunosuppressive therapy increases the risk of de novo tumors in liver transplant recipients by decreasing the immune surveillance against malignant cells and oncogenic viruses. However, no cases of colon precancerous lesions have been reported in these subjects. Patient n. 1, a 73 yrs old male treated with calcineurin and purine synthesis inhibitors, showed at a per-protocol colono-scopy a 3 cm laterally spreading tumor (LST). Patient n. 2, a 73 yrs old male treated with calcineurin inhibitors, showed at a screening colonoscopy an LST occupying one third of the lumen circumference. Both subjects were asymptomatic, had been transplanted 14 years before, and in both cases, lesions showed severe dysplasia. LSTs represent 17.2% of advanced colorectal neoplasia (CRC) and risk factors are multifactorial. Immunosuppression may play a role which is however not completely understood. Based on this report, surveillance colonoscopy in liver transplanted patients should be considered.

The influence of interoceptive awareness on functional connectivity in patients with irritable bowel syndrome.

Irritable bowel syndrome (IBS) is characterized by visceral hypersensitivity likely related to altered processing of sensory stimuli along the brain-gut axis. Previous neuroimaging studies demonstrated structural and functional alteration of several brain areas involved in bodily representation, e.g. the insula, in patients with IBS. By means of resting-state functional magnetic resonance imaging (rs-fMRI) we searched for alteration of functional connectivity within the network involved in self-bodily consciousness. We found significant inverse correlation between hypochondriasis assessed through a clinical questionnaire and connectivity between posterior cingulate cortex and left supramarginal gyrus, extending into the adjacent superior temporal gyrus. Moreover, we observed a significant and positive correlation between a clinical questionnaire assessing interoception and connectivity between left anterior ventral insula and two clusters located in supramarginal gyrus bilaterally.Our findings highlight an "abnormal network synchrony" reflecting functional alteration, in the absence of structural and micro-structural changes, which might represent a possible therapeutic target for Irritable Bowel Syndrome.

Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children.

BACKGROUND: Very preterm infants are exposed to adverse stressful experiences, which may result in long-term behavioural outcomes. The developmental care practices, including pain management and environmental support, can minimize the effects of stress exposure. However, developmental care quality levels may vary among Neonatal Intensive Care Units (NICUs) and little is known about how differences in developmental care quality affect long-term behavioural outcomes. The aim of this study was to examine the relation between quality levels NICUs developmental care and behaviour problems at 18 months corrected age in preterm children. METHODS: The behaviour of 134 preterm children from 22 NICUs and 123 full-term controls was examined using the questionnaire Child Behaviour Checklist 1½-5. We compared the behavioural profile of children by splitting NICUs into units with high- and low quality of developmental care according to two main care factors: (1) infant centered care (ICC) index, and (2) infant pain management (IPM) index. RESULTS: Preterm children from low-care units in IPM group reported higher scores in Internalizing Problems, compared to children from high-care units. No differences were found between preterm children from high-care in IPM and full-term children. No significant IPM effect was found for externalizing problems. No significant ICC effect emerged both for internalizing and externalizing problems. CONCLUSIONS: Findings suggest that higher quality of developmental care related to infant pain management can mitigate behavioural problems at 18 months in children born preterm, to such an extent that preterm children exhibit a behavioural profile similar to that displayed by full-term children.

Language outcomes at 36 months in prematurely born children is associated with the quality of developmental care in NICUs.

OBJECTIVE: The aim of this study was to examine the relationship between the quality levels of NICU developmental care (DC) and language skills at 36 months in very preterm (VPT) children. STUDY DESIGN: Language skills of 78 VPT children from 19 NICUs and 90 full-term controls was assessed using a standardized language test. We compared children' language task performance by splitting NICUs into units with high- and low-quality of DC according to two main factors: (1) infant centered care (ICC), and (2) infant pain management (IPM). RESULTS: VPT children from low-care units with respect to ICC obtained lower scores in sentence comprehension, compared to children from high-care units. No differences were found between preterm children from high-quality ICC NICUs and full-term children. CONCLUSIONS: Findings suggest that higher quality of DC related to infant centered care can mitigate delays in language skills at 36 months in children born VPT.

Continuous intra jejunal infusion of levodopa-carbidopa intestinal gel by jejunal extension tube placement through percutaneous endoscopic gastrostomy for patients with advanced Parkinson's disease: a preliminary study.

OBJECTIVE: Levodopa is the gold standard in the pharmacological treatment of Parkinson's disease (PD) and its oral administration is associated with the development of disabling motor and non-motor complications in advanced disease. Levodopa is rapidly metabolized and has a short plasma half-life thus requiring frequent, repeated dosing. Impaired gastric emptying is common in PD, and likely contributes to the unpredictable motor responses observed with orally-dosed levodopa. A new therapeutic protocol for patients with advanced PD include a carbidopa/levodopa combination using continuous, modulated enteral administration achieved inserting a Jejunal Extension Tube Placement through Percutaneous Endoscopic Gastrostomy (PEG-J). The aim of this work is to assess efficacy and safety of levodopa-carbidopa intestinal gel (LCIG) delivered continuously through an intrajejunal percutaneous tube (PEG-J). PATIENTS AND METHODS: We enrolled 11 adults with advanced PD and preserved sensitivity to L-dopa. For pre-procedural endoscopic evaluation each patient underwent a diagnostic esophagogastroduodenoscopy (EGD) 7 days before PEG-J placement to evaluate the presence of gastric anatomical or wall anomalies and the presence of oesophageal or gastric varices. Treatment with LCIG, consisting of a water-based suspension containing micronized levodopa (20 mg/mL) and carbidopa (5 mg/mL) in methylcellulose (Duodopa®), was administered by continuous jejunal infusion for 12h/day using a portable pump (CADD-Legacy) by PEG-J. Clinical evaluations were performed at baseline (T0) before LCIG initiation, and after 3 (T3) and 6 (T6) months of therapy. The efficacy and safety outcomes were assessed by using the Unified Parkinson's Disease Rating Scale (UPDRS) parts II, III and IV. RESULTS: Mean age of patients was 71.18 ± 5.4 SD at LCIG initiation. Out of the 11 patients, 2 (18%) dropped-out LCIG at T3. Patients showed statistically significant (p < 0.05) higher performances in activities of daily living and a statistically significant (p < 0.001) lower incidence and severity of motor fluctuations, as rating by UPDRS part IV, compared to their best oral therapy. During observational period, 5 patients experienced adverse events. Success rate for PEG-J placement was 100%. CONCLUSIONS: Our work shows that continuous intrajejunal infusion of LCIG ensures a reduction in motor Fluctuations compared to oral administration of levodopa-carbidopa in advanced PD. Based on our results and on the evidence emerging in the literature, this therapeutic approach should be the gold standard for therapy in these patients.

Refractory gastric antral vascular ectasia: a new endoscopic approach.

Gastric antral vascular ectasia (GAVE) is an uncommon disorder observed in patients with liver cirrhosis, causing upper gastro-intestinal haemorrhage. GAVE is diagnosed through esophagogastroduodenoscopy and is characterized by the presence of visible columns of red tortuous enlarged vessels along the longitudinal folds of the antrum (i.e., so-called watermelon stomach). Pharmacological, endoscopic and surgical approaches have been proposed for the treatment of GAVE. Endoscopy represents the gold standard for GAVE treatment. The most widely used endoscopic approach is represented by Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser. Argon plasma coagulation (APC) has been proven to be more efficient in terms of costs and complication rates than and equally effective as Nd:YAG. Other endoscopic procedures proposed for this treatment are banding ligature (EBL) and sclerotherapy with Polidocanol. Refractory GAVE represents a therapeutic challenge because it may cause persistent anemia, often leading to repeated blood transfusions due to the inefficacy of pharmacological and endoscopic therapeutic approaches. Endoscopic band ligation (EBL) has been shown to be superior to APC in the treatment of refractory GAVE. Surgical antrectomy by Billroth I anastomosis can be considered in selected cases. In this study, we report a successful endoscopic treatment of refractory GAVE by using a combination of submucosal injection of 1% Polidocanol at the four antral quadrants and subsequent application of APC on the visible antral lesions in two patients.

Anti-Fas (CD95/Apo-I) autoantibodies and soluble Fas levels concur in T cell depletion in HIV type 1 infection.

Deregulation of the Fas/FasL pathway in activated T cells is suspected to contribute to the abnormal apoptosis that drives their progressive depletion during HIV-1 infection. However, the role of serum soluble Fas (sFas) is unclear. Here we investigated both sFas and anti-Fas IgG levels in a cohort of 227 HIV-1-infected patients with respect to their T cell apoptosis. By using optimized ELISAs, we found that serum titers of sFas and anti-Fas were linearly correlated in 17 severely lymphopenic subjects as compared with other patients grouped in relation to their single expression of anti-Fas and sFas, or with double-negative control patients. Cytofluorimetric measurement of the subdiploid DNA-containing cell population by both PI and TUNEL revealed an increased occurrence of cell death in vitro, in particular in patients with elevations of sFas. We also found that fresh CD4(+) cells from these patients showed high levels of both caspase 3 (CPP32) and its molecular targets, namely PARP and CK18. In addition, their in vitro proliferative rate was inhibited by sFas, in particular in patients with undetectable levels of the soluble receptor in vivo as well as in normal donors. In these subjects the Fas-related caspase 8 (FLICE) was significantly increased in cells treated with the recombinant Fas. These results support the contention that functionally exhausted T cells may undergo apoptosis in response to the persistent in vivo stimulation by sFas. This may elucidate the described occurrence of enhanced cell death in advanced HIV-1 infection in association with serum elevations of the soluble receptor.

Long-term effects of befunolol on the corneal endothelium and the consensual ophthalmotonic reaction.

In a double-blind study, 30 patients with ocular hypertension were randomly assigned to receive one drop of 0.5% befunolol or placebo (the drug vehicle) in each eye twice daily for 120 days. The befunolol used contained no preservatives. Before and after treatment the number and shape of the endothelial cells of the five corneal sectors were evaluated. After 120 days of twice-daily application of befunolol or placebo, no changes in the shape or density of the corneal cells were found in any patient. No differences in the patients receiving befunolol or placebo were noted. The consensual ophthalmotonic reaction was studied in 15 of the patients before and after befunolol administration. A significant decrease in intraocular pressure was noted at 30 minutes and at 1, 2, 3, 4, 5, and 6 hours after befunolol. Intraocular pressure also decreased significantly at 1 to 4 hours after placebo, and then returned to pretreatment levels at 6 hours.

Whipple's disease. Description of a case and survey of the literature.

A case of Whipple's disease (WD) personally observed is described. A 28-year-old male was admitted to hospital for evaluation of weakness, intermittent fever and weight loss arisen since a month. On clinical investigation, he complained of vomit and diarrhea since three months. He had neither familial and personal past history of gastrointestinal diseases, nor any other important diseases. He denied use of drugs. Physical examination was negative. Laboratory findings showed anemia, low blood lymphocytes, low serum iron and total iron binding capacity, low total serum protein and low serum albumin and high level of ESR. Stool were negative for parasites and occult blood. Cultures of blood and urine were negative. Stool fat assay was > 7 g/24 h and D-xylose test showed a two-hour serum concentration < 25 mg/dl. Abdominal TC showed lumbo-aortic and mesenteric enlarged lymph nodes. An upper video endoscopy showed a duodenal lymphangectasia. Histological examination showed villar atrophy with massive infiltration of large PAS-positive diastase-resistant foamy cells. Ziehl-Nielsen staining was negative. WD was diagnosed and patient underwent therapy based on cotrimoxazole. This report emphasizes the difficulty to diagnose WD correctly, because of its rareness and clinical polymorphism. Recently, studies have identified a bacillus, Tropheryma whippelii, associated with WD, so that, in the next future, the diagnosis of WD will be faster and more accurate. Finally, it is important to administer antibiotics which can cross the blood brain barrier for at least one year, in order to prevent neurological relapse, often lethal.

Allergic rhinoconjunctivitis: diagnostic and clinical assessment.

In allergic rhinoconjunctivitis not only the nasal mucosa but also the conjunctiva and, in severe cases, the cornea are affected by reactive phenomena. This pathological process is often encountered in clinical practice, its incidence ranging from 10% to 30% of the whole population, as reported by many authors. Up to now, the pathogenetic mechanisms of allergic reactivity are not completely understood. In our opinion this is due to insufficient standardization of the diagnostic procedures; even the clinical picture of such a pathological process seems to be insufficient, especially with regard to the analogies between the nasal and conjunctival pathologies. To a great extent this depends on the different clinical pictures both in otorhinolaryngology and ophthalmology. Our study has been carried out on 98 patients suffering from rhinoconjunctivitis, and presents an accurate documentation with regard to the existence of analogies in reactivity at the immunoallergic level, in both the nose and conjunctiva. These are evident when we refer not only to specific routine allergological tests but, mainly, to local examinations. The evaluation of the selected data enables us to formulate a single classification of allergic rhinoconjunctivitis, taking into account the common reactive phenomena.

[Monitoring of body temperature during fiber optics phototherapy]. / Monitoraggio della temperatura corporea durante l'uso della fototerapia a fibre ottiche.

Fiberoptic phototherapy is a new technique for treatment of neonatal hyperbilirubinemia; in comparison with conventional phototherapy this new technique shouldn't increase body temperature during treatment. We have recorded body temperature of 13 term newborns with hyperbilirubinemia during 18 periods of treatment and compared the records with physiologic body temperature in the same babies. No increase over normal value during treatment nor significative difference during and after treatment has been observed.

[Therapy of neonatal infection caused by group B beta-hemolytic Streptococcus]. / La terapia dell'infezione neonatale da streptococco beta-emolitico di gruppo B.

Expectant therapy for early Group B Streptococcus onset septicemia must provide coverage against other microorganism, such as L. Monocytogenes, H. Influenzae and S. Pneumoniae. It is possible to administer a combination of antimicrobial agents with activity against all or the most likely pathogens. Thus initial expectant therapy includes a broad spectrum semisynthetic penicillin (e.g. ampicillin) and an aminoglycoside (e.g. netilmicin). Vancomicin, teicoplanin and cefotaxime may also be used. Supportive therapy consists on temperature control, i.v. administration of fluids, acid-base balance and electrolytes monitoring, seizures control and ventilation. IV immunoglobulins, granulocyte and serum transfusion are also used. The G-Colony Stimulating Factor (G-CSF, filgastrim) usage is also reported.

A facebook survey to obtain alcohol-related information by young people and adolescents. An Italian study.

BACKGROUND: Alcohol consumption by adolescents and young adults is an issue of significant public concern. Internet-based Social Networking sites, such as Facebook, are potential avenues to reach young people easily. OBJECTIVE: to underline the innovation in proposing surveys to collect health-related information regarding young people alcohol consumption and other substances abuse by using Social Networking Websites, particularly Facebook. METHODS: A questionnaire investigating modalities of alcohol consumption, drinking patterns' risk behaviors and other substances abuse was proposed through a "Facebook event" to young Italian Facebook users aged between 16 and 32. Each Facebook user invited to the event was free to participate, to answer to the questionnaire and to invite his "Facebook friends". RESULTS: During the 89 days of permanence on the Social Network, 1846 Facebook users participated the event and 732 of them decided spontaneously to answer the questionnaire. The frequency of answering was 8.2 people per day. About 200 users wrote a positive comment to the initiative on the wall of the event. Sixty% of subjects participating the survey were females. Ninety-one% of people answering the questionnaire were alcohol consumers. More than 50% of alcohol consumers were also smokers. Approximately 50% of subjects were binge drinkers. Illegal drugs were used by the 22.2% of the interviewed people. CONCLUSIONS: Facebook resulted an efficient and rapid tool to reach young people from all over Italy and to propose surveys in order to investigate alcohol consumption and alcohol-related health problems in the youth.