Nociception Coma Scale with personalized painful stimulation versus standard stimulus in non-communicative patients with disorders of consciousness.

INTRODUCTION: Persons with disorders of consciousness (DoC) may perceive pain without being able to communicate their discomfort. Nociception Coma Scale (NCS) and its revised form (NCS-R) have been proposed to assess nociception in coma survivors with DoC. OBJECTIVE: Aim of the present study was to compare, in non-communicative patients with DoC, NCS-R scores obtained with the standard pressure on fingernail bed (standard stimulus, SS) versus other personalized painful stimuli (PS), to verify possible correlations between NCS-R and Coma Recovery Scale-Revised (CRS-R). MATERIALS AND METHODS: Twenty-one patients with DoC were included in the study. Responsiveness and pain perception were assessed by CRS-R and NCS-R with standard stimulus (NCS-R-SS) and personalized stimulation (NCS-R-PS). Statistical analysis was performed with the nonparametric Wilcoxon test for comparison of both total NCS-R-SS and NCS-R-PS scores. RESULTS: NCS-R at admission showed that 9 of 21 patients (42.8%) had higher scores in response to personalized stimulus compared to standard stimulus. Significant correlation with CRS-R were found for both NCS-R-SS (R = 0.701, p = .008) and NCS-R-PS (R = 0.564, p = .045). Discussion: The preliminary results obtained in the present study suggest that NCS-R-PS may disclose pain perception in a larger number of non-communicative patients with DoC, compared to NCS-R-SS.

Depression, apathy and impaired self-awareness following severe traumatic brain injury: a preliminary investigation.

Primary Objective: The primary aim of this study was to determine the frequency of severe impaired self-awareness (ISA) in patients with severe traumatic brain injury (TBI) and the correlates of selected clinical, neuropsychiatric and cognitive variables. The secondary aim of the study was to assess depression and apathy on the basis of their level of self-awareness. Methods: Thirty patients with severe TBI and 30 demographically matched healthy control subjects (HCs) were compared on measures of ISA, depression, anxiety, alexithymia, neuropsychiatric symptoms and cognitive flexibility. Results: Twenty percent of the patients demonstrated severe ISA. Severe post-acute ISA was associated with more severe cognitive inflexibility, despite the absence of differences in TBI severity, as evidenced by a Glasgow Coma Scale (GCS) score lower than 9 in all cases in the acute phase. Patients with severe ISA showed lower levels of depression and anxiety but tended to show more apathy and to have greater difficulty describing their emotional state than patients with severe TBI who showed minimal or no disturbance in self-awareness. Conclusion: These findings support the general hypothesis that severe ISA following severe TBI is typically not associated with depression and anxiety, but rather with apathy and cognitive inflexibility.

Observing Etna volcano dynamics through seismic and deformation patterns.

Geophysical data provide the chance to investigate a volcano's dynamics; considerable information can especially be gleaned on the stress and strain patterns accompanying the internal processes and the effect of magma ascent on the main structures triggering earthquakes. Here, we analysed in detail the seismicity recorded over the last two decades on Etna volcano (southern Italy), focusing on earthquakes distribution and focal mechanism clustering; the ground deformation pattern affecting the volcanic edifice with the inflation and deflation phases was also examined. Analysed data were compared in order to shed light on possible relationships with the volcanic activity and to better understand the internal dynamics of the volcano over time. Significant steps during or shortly before major eruptions in the seismic strain release and ground deformation temporal series highlight a straightforward relationship between seismicity occurring at shallow level, inflation/deflation and volcanism. Furthermore, at depths greater than 5-7 km, down to about 20 km, the orientation of the P- and T-axes clearly indicate the existence of a pressure source in the central part of the volcano. All the results underline that the stress field related to the volcano plumbing system interferes with the regional field, partly overriding it.

New insights on the active degassing system of the Lipari-Vulcano complex (South Italy) inferred from Local Earthquake Tomography.

Seismic tomography is a very powerful and effective approach to look at depths beneath volcanic systems thus helping to better understand their behaviour. The P-wave and S-wave velocity ratio, in particular, is a key parameter useful to discriminate the presence of gas, fluids and melts. We computed the first 3-D overall model of Vp, Vs and Vp/Vs for the Lipari-Vulcano complex, central sector of the Aeolian volcanic archipelago (southern Italy). The investigated area has been characterized in recent times by fumaroles, hydrothermal activity and active degassing. In particular, in the Vulcano Island, several episodes of anomalous increases of fumarole temperature and strong degassing have been recorded in the past decades and the last "crisis", started in September 2021, is still ongoing. For tomographic inversion we collected ~ 4400 crustal earthquakes that occurred in the last thirty years and we used the LOcal TOmography Software LOTOS. The results clearly depicted two low Vp and Vp/Vs anomalies located up to ~ 8 km depths below Vulcano and the western offshore of Lipari, respectively. These anomalies can be associated to the large presence of gas and they furnish a first picture of the gas-filled volumes feeding the main degassing activity of the area.

Changes in Caregivers Lifestyle after Severe Acquired Brain Injury: A Preliminary Investigation.

INTRODUCTION: Severe acquired brain injury (sABI) is considered the most common cause of death and disability worldwide. sABI patients are supported by their caregivers who often exhibit high rates of psychological distress, mood disorders, and changes in relationship dynamics and family roles. OBJECTIVES: To explore lifestyle changes of caregivers of sABI patients during the postacute rehabilitation, by investigating possible differences between primary and secondary caregivers. Primary caregivers spend most of the time with the patient, providing daily care and taking most responsibility for the day-to-day decisions, while secondary caregivers are those who provide additional support. METHODS: Three hundred forty-seven caregivers of sABI patients were asked to fill in an unpublished self-report questionnaire to explore their possible lifestyles changes. RESULTS: A statistically significant difference was found between primary and secondary caregivers in time spent in informal caregiving (p<0.001). The primary caregivers reduced all leisure activities compared to secondary carers (p<0.05). CONCLUSIONS: By comparing the percentage of leisure activities performed by caregivers before and after the patient's sABI onset, all caregivers showed high percentages of changes in lifestyle and habits, even though primary caregivers reported more negative lifestyle changes than secondary caregivers. Further studies are needed to investigate needs and burden experienced by caregivers of sABI patients during the postacute rehabilitation phase, also in relation to the patients' outcome, to address support interventions for them and improve their quality of life.

Is the patient able to watch TV or read the newspaper? A functional semi-structured scale to observe Hemineglect symptoms in Activities of Daily Living (H-ADL).

We developed a functional semi-structured scale to observe Hemineglect symptoms in Activities of Daily Living (H-ADL). The scale could assist clinicians in assessing rehabilitation priorities aimed at correcting any persisting errors or omissions. In addition, the scale could also be used by caregivers to observe patients' progress and improve their participation. Two groups of right brain-damaged patients (25 with hemineglect; 27 without hemineglect) were tested twice: at admission and before discharge from hospital. A control group of healthy individuals matched to patients for age and education and patients' caregivers also participated. Two raters (A; B), experts in neuropsychology, observed patients and healthy individuals using the H-ADL. We found that the H-ADL final scores correlated with the standard hemineglect tests. The three groups differed in performance and differences also emerged between the first and the second assessment, suggesting an improvement due to the remission of hemineglect as a consequence of the treatment. Raters A and B did not differ in their observations, but there were some discrepancies with caregivers' observations. Therefore, although caregivers could help clinicians in detecting persistent hemineglect behaviour, the assessment should be performed by experts in neuropsychology.

Home care for persons with AIds: a case-control study to identify determinants of referral to a hospital-based scheme.

We conducted a multicenter, hospital-based case-control study to identify specific characteristics of AIDS patients which determine referral to hospital care at home. The cases were patients referred to a hospital-based home care scheme, in the metropolitan area of Rome, during 1997. Each case was matched with two controls. Social, demographic and clinical characteristics were collected at referral. Univariate and multivariate analysis were performed. In the study period, 119 cases and 238 controls were recruited. In logistic regression analysis, social characteristics were not found to affect referral to the hospital-at-home scheme. A severely impaired functional status--assessed by the Functional Independent Measure--identified by a score below 100 (Odds Ratio [OR]=15.2, 95% confidence interval [CI] 2.8-82.7), and the need for prolonged intravenous therapy (OR=12.4, 95% CI=3.3-46.3) were the only two independent predictors of home-care referral. We conclude that home care, even in a period when new potent combination antiretroviral therapies are widely available, is an important integrated service component for persons with AIDS with severe functional impairment or requiring intravenous therapy.

Use of chronic sacral nerve stimulation in neurological voiding disorders.

AIM: Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are difficult to manage. Nowadays they can be treated with Sacral Nerve Stimulation (SNS), even if clinical experiences reported in literature are still limited. METHODS: We performed SNS in 6 patients with neurogenic bladder: 3 patients had incontinence-urgency (1 myelitis, 1 multiple sclerosis, 1 autonomic polineuropathy) and 3 patients had urinary retention (1 incomplete spinal cord lesion, 1 operation for discal hernia T5-T6, 1 hysterectomy). RESULTS: Among cases with incontinence-urgency we achieved complete control of the bladder in 2 patients while in 1 patient the number of urinary losses was reduced of the 80%. In 2 patients with urinary retention we obtained complete recovery of the bladder function, while in 1 patient the number of cateterisms/die reduced of 50%, the urinary volume for micturion increased and residual urinary volume decreased. Results were unchanged during the follow-up (maximum 26 months), except for 1 patient in which a partial loss of effectiveness occurred. CONCLUSIONS: Chronic electric stimulation of S3 sacral roots via an implanted neuroprotesis is therefore an effectiveness, save and promising therapeutic option in treatment of neurogenic bladder dysfunctions.

Women attending human immunodeficiency virus counselling and testing site because of pregnancy, and prevalence of newly diagnosed infections.

To evaluate the trend of and the reason for women attending HIV counselling and testing (CT) because of pregnancy or pregnancy planning, and the observed human immunodeficiency virus (HIV) prevalence rate, systematic data was gathered during free pre- and posttest discussion, at a major CT site of Rome, Italy, from July 1985 to June 1996. A total of 3608 women were enrolled, increasing from 0.9% of the total number of female clients in 1986 to 34.6% in 1996. Most women (92.5%) were referred by gynaecologists, mostly without reported risk factors for HIV infection. In 22.5% of cases the test was performed after the first trimester of pregnancy. Prior tested women increased significantly from 6.7% in 1989 to 33.4% in the first half of 1996. Two thirds of women reported their current partners were not tested for HIV. Thirteen (0.36%) newly diagnosed women were observed; four were not aware of being at risk. In Italy HIV testing seems to have been included as a part of routine prenatal care. Efforts should be made to optimise the period when testing is performed. Universal counselling and testing of the couple could be the appropriate way to recognise most cases of newly diagnosed HIV infection.

ANCA in dialysis patients: a role for bioincompatibility?

UNLABELLED: BACKGROUND. Anti-neutrophil cytoplasmic autoantibodies (ANCA) have been described in patients suffering from systemic vasculitis such as Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and other pathological conditions. In this paper we report a greater incidence of ANCA in hemodialysis patients as compared to peritoneal dialysis patients, pre-dialytic uremic patients and non-renal patients; a possible role for dialysis bioincompatibility in ANCA generation was also investigated. METHODS: A total of 335 uremics in substitutive treatment (176 in hemodialytic treatment and 159 in peritoneal dialysis) were examined for ANCA positivity. A total of 189 patients with advanced renal failure in conservative treatment and 100 healthy subjects were used as control. The dialysis techniques were standard hemodialysis (n = 119), low volume hemodiafiltration (n = 26) and hemofiltration (n = 31). ANCA positivity was examined by immunofluorescence (IF): diffuse finely granular staining was considered as classical positive reaction (C-ANCA) and P-ANCA was diagnosed if a perinuclear staining was observed. EIA for proteinase-3 (anti PR-3) and myeloperoxidase-antibodies (anti-MPO) were also performed. RESULTS: In non-renal patients and in patients with pre-dialytic renal insufficiency none were found ANCA positive. In peritoneal dialysis patients all but one were ANCA negative with IF, with all EIA test resulting negative. In hemodialytic patients, a positive IF test was found in 26 (14.7%) for P-ANCA and in 5 (2.8%) for C-ANCA; using the EIA test 23 (13%) patients were positive for MPO and 12 (6.8%) for PR-3. CONCLUSIONS: No correlation with age, primary renal diseases, dialytic age, dialysis membrane materials was found; regarding the different extracorporeal dialytic techniques a higher incidence (p < 0.02) was detected in patients undergoing HDF Backfiltration of contaminated dialysate may induce ANCA via an increased cytokine generation.

[Frequency and mode of use of testing for HIV infection in women hospitalized for childbirth]. / Frequenza e modalità di utilizzo del test anti-HIV in donne ricoverate per l'espletamento del parto.

OBJECTIVE: To assess the use of HIV testing "because of pregnancy". DESIGN: Cross-sectional study. PATIENTS: Parturients admitted to the obstetric divisions of a public hospital located in Rome (February-April 1994). INTERVENTION: Standardized interview during post test counseling. OUT-COMES: Frequency and characteristics of HIV testing "because of pregnancy" and women's know ledge on HIV sexual and vertical transmission. RESULTS: Among the 506 women admitted all consented to be tested and 3 were found HIV seropositive (0.6%). A total of 239 (47%) unselected parturients were interviewed; the remaining differ only for a lower rate of cesarean delivery (13% vs 54%). Of the interviewed, 140 (58%) had been already tested for HIV infection, 91 (38%) during the current pregnancy according to gynaecologist's prescription (79.87%) and without counseling (55.60%) or ascertained risk factors (82.90%); 40% had been tested after the first trimester of pregnancy. Rate of vertical transmission was estimated higher than 50% in 147 cases; 150 women knew the "window period" but less than half estimated it correctly. CONCLUSIONS: The study showed a unsatisfactory use of HIV testing "because of pregnancy" and suggests the need for implementing in Italy information campaigns targeted both to women and gynecologists.

[Adhesion molecules. Current aspects and clinical and therapeutic perspectives]. / Le molecole di adesione. Attualità e prospettive cliniche e terapeutiche.

The study about the adhesion molecules pointed out their pathogenetic role in a lot of diseases within cardiological, nephrological, oncological precincts and in a lot of infectious diseases. Their role was in fact pointed out in the ischemic heart disease and in the reperfusion damage, in the glomerulonephritis, in the tumoural metastatic processes, in the infectious and inflammatory chronic processes. The Authors considered the recent literature and emphasized the therapeutic possibilities that such an experimental approach seems to suggest.

[AIDS-related knowledge and sex behavior: a review of Italian studies of young people]. / Conoscenze e comportamenti sessuali rispetto all'AIDS: rassegna degli studi Italiani condotti sulla popolazione giovanile.

To plan further AIDS health promotion programmes information is needed about knowledge and attitudes relating to HIV infection among the general public. This article reviews the results of Italian studies conducted from 1990 to 1994 on young's knowledge and behaviour related to HIV infection. Eighteen studies were identified. The results show a good level of knowledge of the means of transmitting the virus, but suggest that the information does not necessarily involve a change in attitude and behaviour.