Fatal Viral and Bacterial Septicemia in a Seventeen-Year-Old Woman with Immunodepressive Influenza A H1N1: An Autopsy Case.

Abstract: The Influenza A H1N1 subtype can present with a wide spectrum of severity, from mild symptoms of influenza to severe respiratory distress. The morbidity and mortality connected to influenza are mostly associated with secondary bacterial infections. The influenza syndrome alone can cause a massive release of cytokines with dysregulation of the immune system, and it can act in synergy with other bacteria which can enhance cytokines secretion. This article deals with a case of severe pneumonia of H1N1 in a 17-year-old woman with bacterial superinfection with Staphylococcus aureus characterized by a high level of interleukine-6 (105900 pg/mL) and the appearance of severe leukopenia with immuno-suppression, such that HIV infection and hematological diseases were included in the initial differential diagnosis. After death, the autopsy confirmed the presence of severe pneumonia, in addition to an hepatic steatosis in absence of other risk factors. This case reports the rapid and lethal course of influenza A /H1N1 in a young and healthy subject without comorbidities, in an age group in which mortality is about 0.3 deaths per 100,000. The case underlines the importance of quickly diagnosis of viral infections and the differential diagnoses with other immunosuppressive diseases, which can be fatal even in adolescent and healthy subjects.

A Literature Systematic Review with Meta-Analysis of Symptoms Prevalence in Covid-19: the Relevance of Olfactory Symptoms in Infection Not Requiring Hospitalization.

PURPOSE OF REVIEW: To investigate the association between the olfactory dysfunction and the more typical symptoms (fever, cough, dyspnoea) within the Sars-CoV-2 infection (COVID-19) in hospitalized and non-hospitalized patients. RECENT FINDINGS: PubMed, Scopus and Web of Science databases were reviewed from May 5, 2020, to June 1, 2020. Inclusion criteria included English, French, German, Spanish or Italian language studies containing original data related to COVID19, anosmia, fever, cough, and dyspnoea, in both hospital and non-hospital settings. Two investigators independently reviewed all manuscripts and performed quality assessment and quantitative meta-analysis using validated tools. A third author arbitrated full-text disagreements. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 11 of 135 studies fulfilled eligibility. Anosmia was estimated less prevalent than fever and cough (respectively rate difference = - 0.316, 95% CI: - 0.574 to - 0.058, Z = - 2.404, p < 0.016, k = 11 and rate difference = - 0.249, 95% CI: - 0.402 to - 0.096, Z = - 3.185, p < 0.001, k = 11); the analysis between anosmia and dyspnoea was not significant (rate difference = - 0.008, 95% CI: - 0.166 to 0.150, Z = - 0.099, p < 0.921, k = 8). The typical symptoms were significantly more frequent than anosmia in hospitalized more critical patients than in non-hospitalized ones (respectively [Q(1) = 50.638 p < 0.000, Q(1) = 52.520 p < 0.000, Q(1) = 100.734 p < 0.000). SUMMARY: Patient with new onset olfactory dysfunction should be investigated for COVID-19. Anosmia is more frequent in non-hospitalized COVID-19 patients than in hospitalized ones.

Enhancing adherence to antipsychotic treatment for bipolar disorders. Comparison of mobile app-based psychoeducation, group psychoeducation, and the combination of both: protocol of a three-arm single-blinded parallel-group multi-centre randomised trial.

Group Psychoeducation (PE) is an effective strategy to enhance adherence to antipsychotic treatment in Bipolar Disorders (BD). However, it requires attendance to weekly sessions during a period of about 6 months. This may impede its application for those patients living far from mental health centres, resulting inequality in access to evidence-based care. Therefore, there is an increasing need to find new efficient strategies to deliver and extend PE programs to a wider population of BD patients. Mobile apps are a cost-effective way to deliver PE. In the Italian healthcare context, no evidence about the use of apps is available. The current paper presents the protocol about the development of a smartphone app to deliver PE for BD and the protocol for a trial assessing its effectiveness. In euthymic BD patients, the study will compare the adherence rates to antipsychotics between PE delivered through Bipolar mobile Application (Bip.App), group PE and a combination of both, will investigate demographic, socio-cultural and clinical predictors of lower adherence in the arms, and will investigate whether PE combined with Bip.App is associated with lower risk of recurrence of (hypo)manic and depressive episodes than group PE alone, and assess the feasibility and satisfaction for Bip.App. Participants will be recruited from mental health centres and included if they are 18-65 year-old, have primary BD in the euthymic phase, they have been prescribed a second-generation oral antipsychotic as a maintenance/prophylactic therapy for at least 1 year, they have not undergone a structured protocol of PE for BD, they have access to a smartphone and sufficient competence in using it. Participants will be excluded if they have neurological disease, mental retardation or learning disability, psychosis, limited fluency in Italian. Adherence will be assessed through count pills, blood levels, and self-reported adherence. A single-blinded parallel-group superiority multi-centre randomised controlled trial design will be used.

Clinical risk management in High-Security Forensic Psychiatry Residences. Protecting patients and health professionals: perspectives and critical issues of the Law 81/2014.

The Italian Law n. 9/2012 provided the Italian Regions with a new decisional role by demanding the management/rehabilitation of prisoners judged as partially/fully mentally ill to care and protection delivered by the psychiatric services of the Regional Health Service. Healthcare has to be guaranteed by the so-called High-Security Forensic Psychiatry Residences (Italian: Residenze per l'Esecuzione delle Misure di Sicurezza: REMS) and by community mental health centres. Ensuring patients' and professionals' health and safety is a complex issue which requires effective strategies to cope with several structural, technological, and organisational problems. The present paper summarises the historical evolution of the Italian laws towards the development of the High-Security Forensic Psychiatry Residences in Italy, focusing specifically on the Tuscany Region situation. The paper also presents the key issues emerging after the implementation of the Law 81/2014 which complemented the Law 9/2012. Since these reforms included the need for assessing to what extent the patient may be considered as a danger to society and for ensuring the safety of National Health Service (NHS) professionals, they underscored the importance of a preventive use of specific clinical governance tools aimed to reduce risk of adverse events. The present work has the strength of proposing a new, evidence-based scientific approach to the implementation of assessment and care pathways in High-Security Forensic Psychiatry Residences.

Overview on surgical management of papillary thyroid microcarcinoma.

Particular interest is now being given to the best treatment of papillary thyroid microcarcinoma (PTMC) due to its significantly increased incidence. PTMC typically shows indolent organic behavior but, in a low percentage of cases, it can express a relative aggressive behavior. Several risk factors have been shown to negatively influence the rate of regional recurrences and metastases such as tumor diameter, Romaage, sex, multifocality, capsular invasion, extracellular diffusion, lymph node metastases, histological variants, mutated Braf and incidentality. The identification of patients with aggressive PTMCs among the majority with low risk lesions is very important to plan an adequate clinical management, thus the most appropriate surgical treatment. The latter includes thyroid lobectomy and total thyroidectomy with central compartment lymphadenectomy, though several studies did not show statistically significant differences in terms of recurrence and mortality rates between the two techniques. At last, it seems crucial to better define those biological features able to improve selection making process of patients with PTMCs aiming to reserve more radical surgery to those patients carrying more aggressive clinicopathologic features and worse prognosis.

Papillary thyroid microcarcinoma in super obese patient.

Papillary thyroid microcarcinoma (PTMC) typically has an indolent behavior with a good prognosis but it is not always completely harmless. Surgical treatment varies from thyroid lobectomy to total thyroidectomy eventually associated with lymph node dissection and radioiodotherapy. The ability to identify patients with aggressive PTMCs from the majority of low risk patients is critical to planning proper clinical management. Several studies don't report any statistically significant differences about recurrence and mortality among patients undergone lobectomy and patients undergone total thyroidectomy. Recently, higher body mass index (BMI) has been associated with aggressive pathologic features of papillary thyroid carcinoma. For differentiated thyroid cancers, an elevated BMI has been linked to a higher incidence of thyroid cancer in some cohorts. The risk factors for a more aggressiveness of PTMC don't yet clearly defined such as their biological features enable to condition the surgical treatment. In order to elucidate the precise mechanism contributing to the relationship between obesity and thyroid cancer aggressiveness, future studies must be performed.

Workers safety in public psychiatric services: problems, laws and protections.

The dramatic case of murder of a psychiatrist during her service in her public office (Centro di Salute Mentale of Bari-Libertà) has led the authors to reflect on the safety of workplaces, in detail of public psychiatric services. It is in the light of current legislation, represented by the Legislative Decree of April 9th, 2008 no. 81, which states the implementing rules of Law 123/2007. In particular, the Authors analyzed the criticalities of the application of this Law, with the aim of safeguarding the health and safety of the workers in all psychiatric services (nursing departments, outpatient clinics, community centers, day care centers, etc.). The Authors suggest the need to set up an articulated specific organizational system of risk assessment of psychiatric services, that can prevent and protect the workers from identified risks, and finally to ensure their active participation in prevention and protection activities, in absence of which specific profiles of responsibility would be opened up to the employers.

Static magnetic field effect on the Fremy's salt-ascorbic acid chemical reaction studied by continuous-wave electron paramagnetic resonance.

Static magnetic field effect in the framework of the radial pair mechanism (RPM) theory was studied on the biologically significant chemical reaction between ascorbic acid and Fremy's salt. The data indicate that the reaction rate depends on the applied magnetic field strength. The time scale of the studied reaction and the improved continuous-wave electron paramagnetic resonance system allowed for the first time the direct comparison of the amplitude differences between exposed and control samples in the strictly same boundary conditions. Until now the RPM was studied in a different time scale, focusing only on faster reactions by time-resolved techniques or by spectrophotometer measurement. The magnetic field effects presently measured can not be extended tout court to living systems; however the understanding of magnetic field sensitivity in basic chemical reaction in vitro could help clarifying the underlying basic step of interaction between magnetic fields and biological systems.

Autologous chondrocytes implantation: indications and results in the treatment of articular cartilage lesions of the knee.

Articular cartilage lesions of the knee constitute a frequent event and one that is difficult to treat. In time, different surgical methods have been used with results that are often contradictory. The authors report the indications and results of different methods used in the treatment of cartilage lesions: in particular, the experience initiated in 1997 with autologous chondrocytes implantation is discussed. Between 1997 and 2000, a total of 40 patients were submitted to autologous chondrocytes implantation injected in suspension under a periosteal flap. This method includes wide exposure of the joint lesion by arthrotomy. Between 1999 and 2001, a total of 30 patients were submitted to autologous chondrocytes implantation using a tridimensional matrix. The availability of biomaterial simplified the implant method and made arthroscopy possible. All of the patients were submitted to serial clinical follow-ups. MRI was also conducted for a second arthroscopic look. The results obtained in both series after a mean follow-up of 4 years (range 2 to 6 years) are good, and confirm the effectiveness of the method that allows for complete morphological and structural repair of lesions of the joint cartilage.

Hip prosthesis revisions with LS stem: indications and results.

The authors present a study that includes 350 patients affected with loosening of hip arthroplasty and submitted to revision with a Wagner LS stem at the 4th Division of the Rizzoli Orthopaedic Institute. Several different types of cotyle (Fitek, Wagner, Standard Cup, cemented cotyle with support ring, Octopus system) were used depending on the anatomopathologic findings, combined with autoplastic grafts. Staging and grading of loosening were based on the four G.I.R. grades. A clinical evaluation of results was based on the Merle D'Aubigné parameters modified by Charnley. For radiographic evaluation the De Lee Charnley areas were studied for cotyle, the Gruen areas for the femoral stem. Overall, good results were obtained in 175 patients, fair in 137, poor in 38.

Hip arthroplasty in coxarthrosis secondary to Paget's disease.

A total of 5 hip arthroplasties implanted between 1997 and 2000 in 5 patients affected with coxarthrosis secondary to Paget's disease were reviewed. The quality of the pagetic bone (sclerotic and very vascularized) resulted in a slightly longer amount of time required for surgery because of the difficulty preparing prosthetic placement and intra- and postoperative blood loss exceeding the norm. Complications were not observed. Clinical results were good in 100% of cases. Radiographically, 2 stems were assembled in varus.

Microsynteny between the Medicago truncatula SYM2-orthologous genomic region and another region located on the same chromosome arm.

A synteny based positional cloning approach was started to clone the pea SYM2 gene by using locally conserved genome structure with the model plant Medicago truncatula. We reported that a pea marker tightly linked to SYM2 was used to screen a M. truncatula BAC library, and two contigs named C1/C2 and C3 were constructed that are both located on the long arm of M. truncatula chromosome 5 and separated by 9 cM. C1/C2 is highly microsyntenic to the pea SYM2 genomic region and corresponds to the M. truncatula SYM2-orthologous region, which is delimitated to 350 kbp. In this manuscript we analyze the distribution in the three contigs of 22 sequences and their homologues, including eight C1/C2 and two pea RFLP markers linked to SYM2. Among the analyzed sequences are several different (receptor) kinase-like gene sequences and two classes of LRR-containing resistance protein-like sequences. From all the studied sequences only four detected homologous sequences in C3, and their distribution is comparable in C1/C2 and C3, suggesting that a 70-kbp and a 120-kbp segments of these two contigs, respectively, arose through a duplication. The implications of these findings for the cloning of SYM2 are discussed.

The results of the surgical treatment of 64 patients with thoracic and lumbar fracture.

A total of 64 patients surgically treated for vertebral fractures were evaluated clinically and radiographically after a mean time of 49.55 months (from 1 to 124). There were 50 males and 14 females. Mean age at the time of surgery was 40.67 years (from 17 to 71). Fractures were divided based on the Denis classification system: comminuted fractures: 45; fractures caused by flexion-distraction: 2; fracture-dislocation: 17; 31 of the fractures were localized at the lumbar level, 30 in the dorsal region, 3 at the dorsolumbar passage. Neurologic evaluation was carried out on admission and at follow-up using the Frankel classification system: type A: 22; type B: 13; type C: 7; type D: 6; type E: 16. 56.25% of the patients (36 cases) were classified as having multiple trauma. Of the 64 patients, 38 had reduction and stabilization within 6 hours of trauma, 26 were treated after a mean time of 2.7 days (from 1 to 6). Harrington-Luque stabilization was carried out in 5 patients, using the Hartshill rectangle in 59. The mean time for hospitalization was 27.68 days (from 9 to 91). Follow-up showed neurologic recovery in all of the patients operated on, with the exclusion of those classified as Frankel A, without sacral sparing. Despite the residual kyphosis and the final anatomic findings which were not always satisfactory, the methods used allowed us to obtain results that could be compared to those obtained by other means of fixation and more complex techniques.

Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate.

A newly formulated and reinforced bisphenol-a-glycidyl dimethacrylate (bis-GMA) resin (Cortoss/Orthovita, Malvern, Pa.) was compared with Simplex P polymethyl methacrylate (Stryker Howmedica Osteonics, East Rutherford, N.J.) in rabbits for up to 52 weeks and in sheep for up to 78 weeks. As seen in scanning electron microscopy and histology examinations, both implant materials were surrounded by bone at late time periods, with fibrous layers of connective tissue seen in half the Simplex P specimens. No clinically significant safety differences between implant materials were apparent. Interfacial bond strengths between the implant and bone generally increased with time, but were 4.5-fold greater with Cortoss than Simplex P at 24 weeks, and 100-fold greater at 52 weeks. Forces required to displace 316SS rods held in place with Cortoss were consistently greater than forces to displace rods held in place with Simplex P. No statistically significant differences in displacement forces were found between rods held in place with Cortoss polymerized in situ and rods held with prepolymerized Cortoss. Interfacial bond strengths were greater for Simplex P that was polymerized in situ than for prepolymerized polymethyl methacrylate specimens. Cortoss synthetic cortical bone void filler is a good candidate material to fix implants in bone. It has characteristics consistent with long-term safety and has a better ability to bond to bone than Simplex P.

Effects of temporins on molecular dynamics and membrane permeabilization in lipid vesicles.

Temporins are a novel family of small (10-13 residues) cationic antimicrobial peptides recently isolated from the skin of the European red frog Rana temporaria. Although recently acquired evidence shows that temporins have the potential to kill bacteria by permeabilizing the cytoplasmic membrane, the molecular mechanisms of membrane selectivity and permeabilization are largely unknown. In this study, it was found that temporins cause the release of fluorescent markers entrapped in phosphatidylcholine liposomes in a manner that depends significantly on the size of the solute. Temporins were also shown to lack a detergent-like effect on lipid vesicles, indicating that marker leakage caused by these peptides is not due to total membrane disruption but to perturbation of bilayer organization on a local scale. Binding of temporins to liposomes did lead to a small increase in lipid hydrocarbon chain mobility, as revealed by EPR spectroscopy of nitroxide-labeled fatty acids incorporated in the bilayer. Reference experiments were conducted using the bee venom peptide melittin, whose properties and behavior in natural and model membrane systems are well known. Our findings for temporins are discussed in relation to the models proposed to date to account for the action of antimicrobial peptides on membranes.