Quarantine and Mental Health Challenges for Occupational Medicine: The Case Report of a Nurse Infected With SARS-CoV-2.

This case study draws attention to the psychosocial difficulties that emerged in the context of the coronavirus disease 2019 (COVID-19) outbreak in relation to the remote management of subjects with psychiatric vulnerabilities following exposure to prolonged quarantine. The case involves a 56-year-old hospital nurse, followed by the Occupational Health Department of a major university hospital in central Italy for mood instability in the context of a cyclothymic temperament. She was quarantined for occupationally acquired COVID-19 and remained positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via swab test for more than 2 months between March and May 2020. In this case study, we discuss the challenges presented by the risk of a prolonged quarantine in a psychologically vulnerable employee, the need for occupational medicine to provide adequate health surveillance of all health care workers during the COVID-19 pandemic, the effectiveness of telepsychiatry, and the difficulties in formulating a proper treatment strategy.

Efficacy of lung volume optimization maneuver monitored by optoelectronic pletismography in the management of congenital diaphragmatic hernia.

Newborns affected by congenital diaphragmatic hernia (CDH) need cardio-respiratory stabilization before undergoing surgical repair. Open lung strategy is a well-established approach to optimize lung volume in preterm infants with Respiratory Distress Syndrome (RDS), using both High Frequency Oscillatory Ventilation (HFOV) and Conventional Mechanical Ventilation (CMV). We report a case of left CDH with severe lung hypoplasia, managed applying open lung strategy in HFOV (pre-surgery period) and in Assist-Control with Volume Guarantee (post-surgery period), guided by SpO2 changes, TcPO2 and TcPCO2 monitoring. Opto-electronic plethysmography was used to measure end-expiratory chest wall volume changes (ΔEEcw) related to lung volume variations occurring during pressure changes. OEP confirmed the efficacy of using SpO2 and transcutaneous gas monitoring during this recruitment maneuver.

Outcome of congenital diaphragmatic hernia: analysis of implicated factors.

AIM: Congenital diaphragmatic hernia remains a significant challenge for neonatologists and pediatric surgeons. Over the last years, new therapeutic approaches, as high-frequency oscillatory ventilation, inhaled nitric oxide, permissive hypercapnia, extracorporeal membrane oxygenation, have been used for the management of these newborns. We conducted a retrospective study of all infants who were managed for congenital diaphragmatic hernia in our NICU in order to identify possible clinical characteristics which were predictive for survival. METHODS: We reviewed a single institution's experience with 42 consecutive neonates with congenital diaphragmatic hernia admitted to our NICU from 1993 to 2009. RESULTS: Prenatal data and side of congenital diaphragmatic hernia were similar in survivors and no-survivors infants except for the lung-to-head ratio (LHR), which was higher and measured later in survivors than non-survivors. Multiple regression analysis showed that a gestational age ≥39 weeks, Apgar score at 5 min ≥7, FiO2<0.35, MAP<13 cmH2O, OI<10 and AaDO2 >282 before surgical repair, and the absence of persistent pulmonary hypoplasia were independent predictive factors of survival. CONCLUSION: Our study suggests that the outcome of newborns with congenital diaphragmatic hernia still depends on the severity of lung hypoplasia, despite the different respiratory and therapeutical approaches.

MR imaging and proton spectroscopy of the breast: how to select the images useful to convey the diagnostic message.

PURPOSE: The purpose of this study was to propose a short way to summarise a breast magnetic resonance (MR) examination including a precontrast and contrast-enhanced dynamic study and proton spectroscopy (1H-MRS) in order to convey the diagnostic message. MATERIALS AND METHODS: At the Department of Radiology of the Policlinico San Donato (University of Milan), breast MR is routinely performed at 1.5 T as follows: 36-slice axial 2D short-time inversion-recovery (STIR) sequence; 128-partition 3D gradient-echo coronal sequence (1-mm3 siotropic voxel) before and after rapid automatic intravenous injection of 0.1 mmol/kg of Gd-DOTA (one precontrast and four postcontrast phases). Postprocessing includes temporal subtraction (postcontrast minus precontrast), maximum intensity projections (MIPs), percent enhancement-to-time curves for small regions of interest, and axial and/or sagittal multiplanar reconstructions. Single-voxel 1H-MRS is acquired to characterise focal lesions. Applying this protocol, more than 1,200 images are generated for each examination. We select only four MIPs of an early subtracted dynamic phase: one axial similar to craniocaudal x-ray mammographic views, one coronal, and two lateral similar to lateral 90 degrees x-ray mammographic views. For each lesion described in the report, we select five items, including three images, one graph, and one table: STIR image, precontrast and subtracted postcontrast images (morphology), percent enhancement-to-time curves and a table of raw data generating the curves (dynamics). If 1H-MRS has been performed, we add other five items: two postprocessed spectra (metabolism) and three images localising the volume of interest. Only the selected items are printed on films and attached to the report. RESULTS: The selected items range usually from four (no detected lesion) to 14 (one lesion, studied also with 1H-MRS), to 44 (five lesions, one of them studied also with 1H-MRS). The percentage of items presented with the report if compared with the total number of generated images is equal to 0.33% (4/1,200), 1.17% (14/1,200), and 2.83% (34/1,200), respectively. CONCLUSIONS: Breast MR imaging and 1H-MRS can be effectively summarised presenting only a minimal fraction of all generated images.

[Analgesia, sedation and neuromuscular block in pediatric intensive care units: present procedures and recent progress]. / Analgesia sedazione e blocco neuro muscolare in terapia intensiva pediatrica. Procedure attuali e recenti sviluppi.

Anxiolysis and pain control are a duty for physicians and must be treated very carefully in the Pediatric Intensive Care Units, although it is very difficult to assess them: in critically ill children sedatives and/or analgesic medications are routinely provided and titrated to obtain a satisfactory level of sedation, but different evaluation scores are needed to discriminate between light or inadequate and deep or excessive sedation, especially when the clinical examination is unavailable. It is usual to associate a benzodiazepin with an opioid, more often Midazolam and Morphine or Fentanyl; other drugs as Propofol, Clonidine and Ketamine have specific indications, brief painful procedures and weaning from long periods of sedation to avoid withdrawal. Sometimes it can be useful to add a neuromuscular blocking agent to help mechanical ventilation. Adverse sedation events are relatively frequent, associated with drug overdoses and drug interactions, particularly when 3 or more drugs are used: all class of medications and all routes of administration are involved.

Differences in prepuberal neonatally estrogenized or androgenized male rats.

The main objective of this work was to analyze the different effects produced in prepuberal male rats by neonatal androgenization or estrogenization. For this purpose male Wistar rats were injected on day one of life with 500 micrograms of estradiol benzoate (estrogenized animals), 500 micrograms of testosterone propionate (androgenized animals) or olive oil (control animals) and decapitated on day 15. At the moment of decapitation estrogenized animals showed decreases in body, testes, prostate and adrenal weights, increases in pituitary, seminal vesicles and epididymis weights, an increase in prolactin plasma levels and a decrease in those of androgens. Androgenized animals showed only decreased testes and epididymis weights and androgen plasma levels. These results evidence the presence of important qualitative differences in prepuberal neonatally estrogenized or androgenized rats, especially in the accessory sex organs.

In vitro antioxidant activity of calcium antagonists against LDL oxidation compared with alpha-tocopherol.

The dose-dependent (1, 5, 10, 50 microM) antioxidative activity of calcium antagonists (verapamil, diltiazem, nifedipine, amlodipine, isradipine or lacidipine) and alpha-tocopherol against copper-induced LDL (0.25 mg/ml) oxidation was compared by measuring the diene formation and the content of TBARS. For diltiazem no antioxidant effect could be found, whereas the other calcium antagonists and alpha-tocopherol have demonstrated antioxidant activity at least at concentrations of 10 and 50 microM: alpha-tocopherol > lacidipine > nifedipine > isradipine, verapamil, amlodipine. Additionally, alpha-tocopherol and lacidipine were able to attenuate LDL-oxidation significantly at 1 and 5 microM. These results indicate in vitro antioxidative activity of calcium antagonists especially from the dihydropyridine-type with greatest activity for the strongly lipophilic lacidipine. This might be one possible antiatherogenic mechanism of calcium antagonists, since oxidative modification enhances the atherogenic potential of LDL.

Dissecting the mode of action of various HIV-inhibitor classes in a stable cellular system.

We describe a stable and sensitive HIV evaluation system, which discriminates HIV-specific membrane fusion and early transcription events and is suitable for high-throughput inhibitor screening. A human lymphocytic line, constitutively producing infectious HIV-1, serves as Env-positive donor. A second indicator cell line carries a silent HIV-1 LTR lacZ reporter plasmid. A bicellular cocultivation setup allows titration and standardization of "fusion-induced gene stimulation (FIGS)" events. With few manipulations aspects of fusion and/or LTR induction can be distinguished and simultaneously assayed. Anti-Env-V3 antibodies prevent fusion and subsequent lacZ induction, and a Tat-specific inhibitor blocks only lacZ induction in a dose dependent manner without affecting membrane fusion. The LTR reporter is readily activated by Tat from HIV-1, HIV-2, or SIV and it responds to exogenous Tat protein. The reporter system is sensitive enough to detect single infection events on pre-seeded layers of indicator cells, which renders it potentially useful for direct virus quantification in patients' material. Moreover, our system allows to control and normalize DNA transfection efficiencies of HIV-derived plasmids. This aspect is particularly valuable for studies of RT- and protease-inhibitors and resistances, where p24 or supernatant reverse transcriptase, otherwise standard virus readouts, can be directly affected by inhibitors or mutations.