The interplay between risk and protective factors during the initial height of the COVID-19 crisis in Italy: The role of risk aversion and intolerance of ambiguity on distress.

The present study aimed to test a model of relations to ascertain the determinants of distress caused by lockdown for COVID-19. It was hypothesized that the exposure to the COVID-19 increased distress directly and through the mediation of worry, health-related information seeking, and perception of the utility of the lockdown. It was also expected that higher levels of ambiguity intolerance corresponded to higher distress directly and through the mediation of worry, health information seeking behaviors, and perceived utility of the lockdown. Finally, it was expected that risk aversion positively influenced distress directly and through the increasing of worry, health-related information seeking behavior, and more positive perception of the utility of the lockdown The study was conducted in Italy during the mandatory lockdown for COVID-19 pandemic on 240 individuals (age range 18-76). Data recruitment was conducted via snowball sampling. COVID-19 exposure was positively associated with worry and health-related information seeking. Risk-aversion was positively associated with health-related information seeking and perceived utility of the lockdown to contain the spread of the virus. Worry and health-related information seeking were positively associated with distress, whereas the perceived utility of the lockdown was negatively associated with distress. Intolerance for the ambiguity was directly linked to distress with a positive sign. Findings suggest that risk aversion represents both a risk factor and a protective factor, based on what kind of variable mediates the relationship with distress, and that the intolerance to the ambiguity is a risk factor that busters distress.

[Age-adjusted D-dimers and pulmonary embolism]. / D-dimères et suspicion d'embolie pulmonaire: seuil adapté à l'age.

Plasma D-dimer measurement is the first diagnostic test performed in patients with a non-high or an unlikely clinical probability of pulmonary embolism (PE) but its clinical usefulness is limited in elderly patients due to a low specificity in this subgroup. PE can be excluded based on D-dimers and clinical probability only in about 5% of patients over 80 years when using the conventional cut-off. Age-adjusted D-dimer cut-off (adjusted cut-off value = age x 10 in patients over 50) increases the specificity of the test without significantly reducing its sensitivity. Using the age-adjusted D-dimer cut-off markedly reduces the need for further diagnostic studies such as computed tomography pulmonary angiography (CTPA). The age-adjusted cut-off has been widely validated in retrospective cohorts, and more recently in a prospective management study.

[Use of low molecular weight heparin for medical prophylaxis by European geriatricians]. / Utilisation des héparines de bas poids moléculaire en prévention médicale par les gériatres européens.

PURPOSE: Many hospitalised elderly patients are at increased risk of venous thromboembolism (VTE). The aim of this study was to assess the rate and duration of medical utilization of low molecular weight heparin (LMWH) for VTE prevention by European geriatricians. METHOD: A questionnaire was sent to 94 geriatricians of the European Academy for Medicine of Ageing (EAMA), to be filled out for each patient older than 65 years of their institutions who received LMWH during 1 day of December 2000. RESULTS: In the 37 centers that participated (representing 11 different European countries) 2912 patients were present on the day of the study: 857 patients in acute care, 367 in rehabilitation care, 1568 in long-term care and 141 in day hospital. Prophylaxis by LMWH was given to 284 medical patients (9.75%, mean age 82.2 years). Use of LMWH was more frequent in acute and rehabilitation care (22.4% and 9.8%) than in long-term care (3.1%). The main risk factors in patients with LMWH prophylaxis were: bedridden (53%), infectious disease (18%), heart failure (17.6%), venous insufficiency (17.6%), paralysis of lower limbs (16.6%), recent stroke (15%) and malignancy (10%). The duration of the treatment for VTE prophylaxis exceeded 30 days in 51 patients (12%) and one year in 15 patients (3.3%). CONCLUSION: In Europe, VTE prophylaxis by LMWH is widely used in elderly medical patients without specific guidelines in this population. Further studies are necessary to evaluate the appropriate duration of prophylaxis in very prolonged immobilization.

Characterization of hyperlipidemia in two patients with analbuminemia.

The results of plasma lipid and lipoprotein analysis in two related patients, brother (R.U.) and sister (R.R.) with analbuminemia, and three first-degree relatives (parents and sister) are reported. Both patients showed a remarkable increase in cholesterol and phospholipid levels, and there was a corresponding increase in serum apo B and apo A-I. This hyperlipidemia is due to a selective increase in LDL and HDL concentrations. R.U. showed an increase in both HDL2- and HDL3-cholesterol, R.R. only in HDL3-cholesterol. VLDL concentration was reduced in R.U. and normal in R.R. The plasma lipoprotein electrophoretic pattern did not correspond to any of the phenotypes in Fredrickson's classification. Composition of the different lipoprotein fractions was normal in the patients and family members. Serum FFA level in R.R. was very low. An increase in the plasma protein fractions, particularly the transport fractions, was confirmed in both patients. The possible pathophysiology of the hypercholesterolemia in these patients is discussed. Unlike other reported cases, clinical signs of atherosclerotic complications were absent.

Therapy of acute pancreatitis in systemic lupus erythematosus with plasmapheresis and corticosteroids.

A 24-year-old woman with systemic lupus erythematosus had, after reduction of corticosteroid therapy, a severe relapse of the disease with hepatitis, nephritis and pleurisy. After admission to the hospital, she was given 60-80 mg/day of prednisone and acute pancreatitis developed on the third day. Plasmapheresis, followed by injection of 1 g of methylprednisolone, was started. This combined therapy induced a prompt and complete recovery in a few days.

Hyper-IGD syndrome: a new case treated with colchicine.

We report a new case of hyper-IgD syndrome, a recently described disease characterized by recurrent episodes of fever with headache, bilateral cervical lymphadenopathy and, more rarely, abdominal pain and diarrhoea. Polyclonal increase of serum IgD is the most important laboratory finding. Etiopathogenesis and differences with familial Mediterranean fever are discussed. Moreover, good results obtained with colchicine treatment are also reported.

Serum copper level in non-Hodgkin's lymphomas.

Serum copper level (SCL) was studied by the atomic absorption technique in 103 patients with non-Hodgkin's lymphoma. SCL was increased in 61% of patients at diagnosis or during active disease; values within normal range were found in 88% of patients in complete remission. The difference between mean SCL during active disease and in remission was highly significant, independently of stage and histologic type, so that: a) Within the same clinical stage high SCL at diagnosis was associated with poorer response to therapy in stage II and stage III (respectively P = 0.033 and P = 0.049), but not in stage IV, where the complete remissions were only 8 out of 42. A shorter 5-year survival was also shown in stages III and IV with high SCL at diagnosis (respectively P less than 0.025 and P less than 0.05), but not in stage II where the deaths were only 3 out of 24. b) Within histologic types, SCL is a useful prognostic index of response to therapy and survival, although a statistically significant difference was only reached for poorly differentiated lymphocytic lymphoma. We conclude that SCL may be a good parameter of disease activity and a useful index of response to therapy and survival in non-Hodgkin's lymphoma.

A single institution's experience (1982-1999) with plasma-exchange therapy in patients with fulminant hepatic failure.

Fulminant hepatic failure is a rare, but often fatal complication of acute viral hepatitis. This condition, in absence of orthotopic liver transplantation (OLTx) surgery, is associated with a high mortality rate, despite the improvement of general intensive care. Plasma-exchange (PEx) therapy has been long used to treat FHF, in particular by removing toxic substances and correcting the severe coagulopathy. In this study we describe our experience with PEx treatment of FHF, beginning in 1982. Seventy patients affected with FHF due to various causes (HBV = 40; cryptogenic/non-A, non-E = 15; Amanita phalloides = 8; other = 7) were treated with PEx (altogether 348 sessions). Overall survival rate, comprising patients undergoing OLTx, was 51%, a little higher than what we observed in patients (N = 49) treated solely by PEx, i.e., 41%. The best outcome predictor was FHF aetiology, owing to the good survival rate in patients with Amanita phalloides intoxication and the very poor prognosis of patients suffering from cryptogenic/non-A, non-E FHF. Moreover, the marked increase in prothrombin time and alpha-fetoprotein levels after 48 hours from admission was associated with a good prognosis, whereas the patient's age and coma grade were not clearly predictive of survival. Additionally, lymphocyte subpopulation, resulting in a CD4/CD8 ratio lower than 1.0 along with CD8 activation with HLA-DR strong expression, were associated with a high rate of mortality and morbidity. Our data indicate that PEx therapy can improve survival in patients with sufficient residual capacity of liver regeneration. Moreover, the identification of certain prognostic factors may be useful for the rational planning of therapeutic strategy in FHF.

Acute reactive stage proteins in gynaecologic cancers.

The authors report the plasmatic variations of ARPS (acute reactive proteins stage) in fifty eight women, admitted to the Obstetric and Gynaecological Clinic of Padua's University in the years 1978-1979 aged between 35 and 80 years old; those patients were affected by different types of gynaecological neoplasms: twenty three had cervical cancer, eight endometrial cancer, twenty six ovarian cancer. An evident increase was seen in the ARPS in the patients studied. In particular there was an increase in he haptoglobin in the ovarian cancer patients as well as an increase in the alpha-1 antitrypsin in the cervical cancer patients. Regarding ARPS and the clinical stage of the tumour the variations were important between T0 and T1 that is between tumours localized in the affected organ and those outside the primitive site but always in the pelvis. No evident alterations were found between T1 or T2; there was no other increase in the ARPS in neoplasm outside the pelvis.

[Serotypes of hepatitis C virus in mixed cryoglobulinaemia]. / Caratterizzazione sierotipica del virus dell'epatite C nella crioglobulinemia mista.

BACKGROUND: Several authors have studied the genotypic distribution of hepatitis C virus (HCV) in mixed cryoglobulinaemia (MC), which represents the most typical extra-hepatic manifestation of the HCV infection. On the other hand, at present no data are available on the HCV serotypic characterization of MC patients. METHODS: Thus, 28 serum specimens from HCV positive patients affected by MC (7 males and 21 females; mean age of 64 yrs, range 35-80) have been evaluated by a serotyping EIA method (Murex HCV Serotyping 1-6 Assay, Murex Diagnostics, Pomezia, Italy). RESULTS: The HCV serotype 1 was found in 13 patients (46.4%), serotype 2 in 5 patients (17.9%) and mixed serotypes in 3 patients (10.7%), showing, respectively, serotypes 1+2, 1+4, and 1+4+5. Moreover, the HCV serotype was not detectable in 7 patients (25.0%). CONCLUSIONS: These results, obtained by using a simple, serologic technique, agree with some literature data concerning MC patients from the same geographic region as ours (Venetian area). In addition, our findings appears to reflect merely the genotypic distribution of the HCV infection in the North Italy.

[Physiotherapy for the elderly]. / Physiotherapie beim alten Menschen.

One of the main goals of physical therapeutic procedures in the elderly is the restoration or maintenance of functional autonomy in daily living activities. Whilst necessity for care and assistance in an aged population rises dramatically with age, physical therapy can efficiently reduce these needs. For an optimal therapeutic approach the therapists should take into account the particular characteristics of the ageing process as well as the predominant comorbidities, which should be correctly assessed in order to integrate those context factors into the rehabilitation program. This is only possible with a good functioning teamwork: The team should therefore include physicians, nurses, physiotherapists as well as social workers and other professionals. We describe here the theoretical basis of the particular aspects of physiotherapy for the elderly and we illustrate this approach exemplarily for falls prevention through resistance- and balance training.

[Not Available]. / L'insegnamento clinico di Giovan Battista Da Monte (1489-1551): una revisione critica.

In 1808 Giovanni Rasori (1766-1837) credited Giovan Battista Da Monte (Montanus, 1489-1551) with the introduction, around 1543 at the San Francesco Hospital of Padua, of clinical teaching at the bedside as an integral part of medical education. Actually, the Hospital and the University were two completely independent institutions, and Rasori's assertion is founded on the erroneous interpretation of some clinical consultations published by Da Monte's pupils.

[Rasori, Borda and the theory of stimolo and contrastimolo]. / Rasori, Borda e le dottrine dello stimolo e del controstimolo.

Brown's thought represented one of the most successful medical systems which arose in the XVIIIth century, as a consequence of vitalism and as a reaction to the inadequacy of Hippocratic-Galenic medicine. Giovanni Rasori was a strong supporter of Brown's theories in Italy and creator of the scientific movement which was, then, called Rasorism. A fundamental point of Rasori's therapeutic thought was represented by the dynamic action of drugs, so that a pharmacological experimentation became necessary, for medical practice. Siro Borda, who was a follower and personal friend of Rasori, made experiments on 150 substances to identify their dynamic action and, finally, he classified them in three groups: stimolanti, controstimolanti, eterocliti. This last class comprehended all the pharmacological substances of uncertain or not yet determined nature.

"Anatomes peritissimus": Johann Georg Wirsung's unknown experiments on the circulation of the blood.

Andrea Argoli (1570-1657), professor of mathematics at the University of Padua from 1632 to 1657, published at Padua in 1644 in the work Pandosion sphaericum an accurate and succinct exposition of the theory of the circulation of the blood. Argoli's exposition actually is a summary of Jan de Wale's (Walaeus, 1604-1649) first Epistola de motu sanguinis, republished at Padua, just a year prior to the Pandosion, as an appendix to the fourth edition of De motu cordis of William Harvey. Argoli cites a hitherto unknown very expert anatomist at Padua, John George Verden, who carried out experiments at Padua designed to measure the volume of arterial blood emitted from each contraction of the left ventricle in small and large dogs. It is now possible to identify Verden with Johann Georg Wirsung (1589-1643), from Augsburg, the discoverer of the main pancreatic duct by ligation of the chyliferous ducts.

[Parameters of fetal maturity in Rh-isoimmunization (author's transl)]. / Parametri di maturitá fetale nella isoimmunizzazione Rh.

On 79 samples of amniotic fluid coming from 50 cases of Rh-isoimmunization submitted to amniocentesis one or more times, the following tests were done: a) creatinine; b) proteins; c) uric acid; d) urea; e) lecithin/sphingomyelin ratio. The results were related to the degree of immunization as determined by spectrophotometric curve of the amniotic fluid. For reasons of comparison, the same tests were performed on samples of amniotic fluid from 79 pregnant non-immunized patients. Determinations of creatinine, uric acid and lecithin/sphingomyelin ratio have pointed out a delayed fetal maturity in Rh-isoimmunized pregnant women, more marked in the more severe cases. The proteins level were increased, probably also because of the transfer of IgG antibodies into the amniotic fluid, whereas the estimation of fetal maturity based on urea concentrations is quite unreliable.