Assessment of Nontechnical Skills During Resuscitation: Validation in the Italian Version of the TEAM.

SUMMARY STATEMENT: Nontechnical skills (hereinafter referred to as NTS), such as task management, leadership, situational awareness, communication, and decision making contribute to safe and efficient team performance. The importance during cardiopulmonary resuscitation is being increasingly emphasized. We carried out the intercultural adaptation of the TEAM score in Italian and to evaluate the reliability and validity of the resulting Italian version (i-TEAM). A forward-backward translation was made with the author called i-TEAM. Psychometric properties of the i-TEAM score were evaluated, including acceptability, construct validity, and interrater reliability. We divided the participants into 3 groups based on their experience, and we verified if there was a correlation between the final score NTS of i-TEAM and the groups. The Cronbach coefficient was 0.91 for the Total i-TEAM score. The descriptive statistics showed that there was no correlation between NTS score and experience (group). Our results show that i-TEAM has psychometric properties similar to the original score.

A Rare Case of Breast Metastasis from a Primary Lung Tumor: Case Report.

Breast metastasis originating from a primary lung tumor is exceedingly rare and can present challenges in distinguishing it from primary breast cancer. This case report discusses the management of a 64-year-old woman who initially presented with a nodule in her left breast. A biopsy revealed an infiltrating ductal carcinoma. Despite negative BRCA genetic testing, her significant family history of cancer and the presence of a newly detected right breast lesion led to a bilateral mastectomy. Post-operative imaging identified multiple hypodense nodules and a spiculated pulmonary nodule, necessitating further investigation. An endoscopic lung biopsy confirmed a primary pulmonary carcinoma with histological features similar to the breast carcinoma, suggesting the lung as the primary source. This case highlights the complexity of differentiating breast metastasis originating from a lung tumor and primary breast cancer. It underscores the importance of comprehensive diagnostic evaluations and the consideration of extramammary origins in metastatic cases. The findings emphasize the role of multidisciplinary teams in managing such rare and challenging cases and highlight the necessity for thorough and repeated assessments in atypical breast cancer presentations.

Insights from a Long-Term Follow-Up Evaluation of Early Breast Cancer Outcomes by Tumor Subtype.

INTRODUCTION: Our understanding of the granularity of breast cancer (BC) clinical outcomes by biologic subtype may be impaired by limited study follow-up times. OBJECTIVE: We evaluated the impact of modern immunohistochemistry (IHC)-based BC subtypes on long-term mortality. METHOD: We used a cohort of 200 women diagnosed with stage I-III BC in the period 1985-1990. Surgical samples underwent centralized pathology review. Multivariate models assessed associations of subtype with overall survival (OS) and BC-related survival (BCRS). RESULT: 42.0% women had luminal A-like, 32.5% luminal B-like/human epidermal growth factor receptor (HER)2-negative, 8.5% had HER2-positive, and 17.0% had triple-negative BC. 53.0% had tumor size (T) >2 cm and 47.5% had a positive nodal status (N). Over 18.7 years of median follow-up (range 0.3-32.0 years),140 deaths were recorded (75 BC-related). Median OS was longest for patients with luminal A-like tumors (21.2 years; 95% confidence interval [CI] 17.4-24.9]). The luminal B-like/HER2-negative subtype was significantly associated with worse BCRS (adjusted hazard ratio [HR] = 1.86; 95% CI 1.09-3.16). After multivariable analysis, T >2 cm (HR [vs. ≤2 cm] = 1.71 [95% CI 1.03-2.84]) and positive N (HR [vs. negative] = 2.19 [95% CI 1.03-4.65]) impacted BCRS. CONCLUSION: IHC-defined subtype will continue informing treatment algorithms for BC, until more precise tools like molecular profiling become widely available. Although confirmation in larger and adequately powered studies is warranted, modern surrogate subtype definitions produced a valid long-term prognostic stratification in this mature cohort.

Full-length genome sequence of a dengue serotype 1 virus isolate from a traveler returning from Democratic Republic of Congo to Italy, July 2019.

We report the full-genome sequence of a Dengue serotype-1 virus (DENV-1) isolated from a traveler returning in July 2019 to Italy from Democratic Republic of Congo (DRC), which is currently affected by Ebola and measles outbreaks. The sequence shows high similarity with two 2013 strains isolated in Angola and China.

Severe hypoglycemia in patients with known diabetes requiring emergency department care: A report from an Italian multicenter study.

AIMS: To describe the characteristics and associated risk factors of patients with established diabetes who required Emergency Department (ED) care for severe hypoglycemia. METHODS: We performed an observational retrospective study to identify all cases of severe hypoglycemia among attendees at the EDs of three Italian University hospitals from January 2010 to December 2014. RESULTS: Overall, 520 patients with established diabetes were identified. Mean out-of-hospital blood glucose concentrations at the time of the hypoglycemic event were 2.2 ± 1.3 mmol/L. Most of these patients were frail and had multiple comorbidities. They were treated with oral hypoglycemic drugs (43.6%), insulin (42.8%), or both (13.6%). Among the oral hypoglycemic drugs, glibenclamide (54.5%) and repaglinide (25.7%) were the two most frequently used drugs, followed by glimepiride (11.3%) and gliclazide (7.5%). Hospitalization rates and in-hospital deaths occurred in 35.4% and in 2.3% of patients, respectively. Cirrhosis (odds ratio [OR] 6.76, 95% confidence interval [CI] 1.24-36.8, p < 0.05), chronic kidney disease (OR 2.42, 95% CI 1.11-8.69, p < 0.05) and center (Sapienza University OR 3.70, 95% CI 1.57-8.69, p < 0.05) were the strongest predictors of increased rates of hospital admission. CONCLUSIONS: Severe hypoglycemia is a remarkable burden for patients with established diabetes and increases the risk of adverse clinical outcomes (in-hospital death and hospitalization), mainly in elderly and frail patients. This study further reinforces the notion that careful attention should be taken by health care providers when they prescribe drug therapy in elderly patients with serious comorbidities.

TNF-α and IL-10 modulation induced by polyphenols extracted by olive pomace in a mouse model of paw inflammation.

BACKGROUND: Polyphenols from olive are known to possess antioxidant and anti-inflammatory properties. AIM: The aim of this study was to study whether or not 10 consecutive days i.p. administration of a blend of olive (Olea europaea L.) polyphenols (10 mg/kg) containing mostly hydroxytyrosol could have an effect on cytokines playing important roles in inflammatory processes as TNF-α and IL-10. MATERIALS AND METHODS: Inflammation was induced in the mouse paw by 2 carrageenan injections (50 µl vol, 5 mg/kg each). TNF-α and IL-10 were measured by enzyme-linked immunosorbent assay. RESULTS: Carrageenan decreased IL-10 in the paws, however, this reduction appeared to be less evident in mice treated with carrageenan but administered with polyphenols. As for TNF-α, our findings did not reveal differences between groups but an increase in the polyphenol and carrageenan group if compared to the carrageenan only group. As for antioxidant polyphenols' properties, no differences between groups in the serum glutathione were found. CONCLUSIONS: Altogether, this investigation shows that olive polyphenols in the mouse may modulate the levels of cytokines having a role in the process of inflammation as TNF-α and IL-10.

Cutaneous metastasis from primary gastric cancer: a case report and review of the literature.

Cutaneous metastases of internal neoplasms are uncommon. They can be metachronous or synchronous to the primary tumor and typically appear late in the course of advanced malignant disease. Gastric cancer rarely is reported as a cause of cutaneous metastasis; the most common metastatic sites are the liver, peritoneal cavity, and lymph nodes. We report a case of cutaneous metastasis from a primary gastric tumor that had been treated 6 years prior. There was no visceral invasion. The patient was treated successfully via a relaparotomy to exclude any macroscopic abdominal recurrence and complete excision of the lesion with a plastic flap to compensate for the tissue lost in the resection. Treatment plans vary depending on the diameter and number of lesions, the presence of visceral metastases, and the physical status of the patient. Therapy generally includes local excision, irradiation, or chemotherapy.

Gastrointestinal bleeding due to suspected anisakiasis: challenging differential diagnosis for a rare disease.

As compared with Eastern countries, the incidence of gastrointestinal diseases caused by the ingestion of nematode eggs is very low in Europe, in spite of the fact that the consumption of raw fish has increased in these countries as well in recent years. The authors present here, a rare case of gastrointestinal bleeding due to Anisakis simplex. This is a very uncommon clinical presentation which rise several problems in diagnosis and management.