Impact of the Organizational Model Adopted during the COVID-19 Pandemic on the Perceived Safety of Intensive Care Unit Staff.

BACKGROUND: The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of the organizational model adopted on the perceived safety among staff was evaluated. METHODS: Descriptive, structured and voluntary, anonymous, non-funded, self-administered cross-sectional surveys on the impact of the organizational model adopted during COVID-19 on the perceived safety among staff. RESULTS: Response rate to the survey was 67.4% (153 completed surveys). A total of 91 (59%) of respondents had more than three years of ICU experience, while 16 (10%) were employed for less than one year. Group stratification according to profession: 74 nurses (48%); 12 medical-doctors (7%); 11 physiotherapists (7%); 35 nurses-aides (22%); 5 radiology-technicians (3%); 3 housekeeping (1%); 13 other (8%). The organizational model implemented at ISMETT made them feel safe during their workday. A total of 113 (84%) agreed or strongly agreed with the sense of security resulting from the implemented measures. A vast majority of respondents perceived COVID-19 as a dangerous and deadly disease (94%) not only for themselves but even more as vectors towards their families (79%). A total of 55% of staff took isolation measures and moved away from their home by changing personal habits. The organizational model was perceived overall as appropriate (91%) to guarantee their health. CONCLUSION: The vast majority of respondents perceived the overall model applied during an unexpected, emergency situation as appropriate.

Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy.

Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.

New polymorphisms at MTNR1A gene and their association with reproductive resumption in sarda breed sheep.

The aim of this study was to characterize the MTNR1A locus in Sarda sheep breed, in order to identify potential single nucleotide polymorphisms (SNPs) associated with reproductive resumption. The reproductive performance of 200 lactating ewes, aged 3-5 years, with body condition score (BCS) 2.5-4.0, at least at their third lambing were monitored for two consecutive years. In both year the enrolled ewes were exposed for 100 days to 10 adult, fertile rams. Mating, pregnancy and lambing for each ewe were recorded in order to evaluate differences in reproductive performance according to the analysed genotypes. From individual blood samples, DNA was extracted to amplify and to sequence promotor, the coding region, a part of intron and of 3' Untranslated region (3' UTR) of the MTNR1A gene. A total number of 29 SNPs were found (named SNP1 to SNP29), five of which caused also amino acid changes. The polymorphic sites found at positions g.17355452C > T (SNP16, rs430181568) and g.17355358C > T (SNP17, rs407388227) were linked (D' = 1 and r2 = 1) and showed a significant association to DRIL trait (distance in days from ram introduction to lambing). In both years, the ewes carrying C/C genotype in both these polymorphic sites showed the lowest DRIL compared to the other genotypes (P < 0.05). The ewes carrying C/C and T/C genotype exhibited the lambing peak at 170 days, and approximately 60% of the total lambing at 180 days from the ram introduction. Instead, ewes carrying T/T genotype showed the lambing peak around 200 days after ram introduction. Six haplotypes have been identified and the most frequent haplotype was also associated with lower DRIL (P < 0.05). Litter size displayed no statistical significance either among genotypes or among haplotypes. This study provided the major part of the MTNR1A gene in Sarda sheep breed and evidenced that SNP17 is associated with a shorter DRIL. The obtained results underlined the role of this polymorphism in improving reproductive efficiency in Sarda sheep and provides a suitable information for improving genetic selection.

Polymorphism of insulin-like growth factor 1 gene and its relationship with reproductive performances and milk yield in Sarda dairy sheep.

The aim of this research was to detect polymorphisms within the IGF-I gene in dairy sheep and to verify their influence on milk yield and reproductive performances. Four hundred Sarda ewes in their second lactation were selected from 2 farms. Their reproductive traits (fertility rate, interval in days from ram introduction to lambing and litter size) and milk yield were recorded, from the second to the fourth lactation. DNA was extracted from individual blood samples and subjected to amplification and sequencing of the IGF-I gene 5' UTR and Exon 3 regions. Three polymorphic sites were recorded at positions g184028491C>G and g184028489C>T of the 5'UTR, and g184023223G>A of the Exon 3. The C allele at position g184028491 showed a significant association with higher fertility rate (P < 0.05) and a shorter interval in days from ram introduction to lambing (P < 0.01). In addition, a significant effect of the CC genotype was found with higher milk yield for P < 0.05 in the second and third lactation, and P < 0.01 in the fourth lactation compared to the other genotypes. Even, AA genotype at position g184023223 of the exon 3 showed a positive significant effect on milk yield for P < 0.05, in the second and third lactation, and for P < 0.01 in fourth lactation compared to the other genotypes. In conclusion the found SNPs showed a significant influence on reproductive performances and milk yield in Sarda sheep breed suggesting a possible application in sheep selection plans.

Evaluation of Profile Changes in Class II Individuals Treated by Means of Herbst Miniscope Appliance.

BACKGROUND: To evaluate the profile changes following orthopedic/orthodontic treatment with the Herbst Miniscope® appliance in subjects affected with Class II malocclusion with mandibular retrusion. METHODS: A total of 44 patients presenting a skeletal Angle Class II malocclusion (ANB > 4°) due to mandibular retrusion and a cervical maturation stage between CS2 and CS3 were included in the study. Of these 44 patients, 22 (mean age 11.9 ± 1.3, HBT group) were treated using the Herbst appliance, while 22 (mean age 10.6 ± 1.3, CTR group) were followed for a 12-month observational period. A cephalometric tracing was performed at the beginning of treatment (T0) and after 12 months (T1). RESULTS: In both groups there was a significant advancement of soft tissue pogonion (HBT = 3.5 ± 3.0 mm, p < 0.001; CTR = 2.2 ± 2.9 mm, p < 0.001), but the difference between the two groups was not significant (p = 0.172). On the contrary, both groups had a significant advancement of the mandibular sulcus (HBT = 3.7 ± 2.8 mm, p < 0.001; CTR = 1.2 ± 2.2 mm, p < 0.001) and a lower lip protrusion (HBT = 3.45 ± 2.51 mm, p < 0.001; CTR = 1.7 ± 2.7 mm, p = 0.008), but in both cases the HBT group showed a statistically significant greater increase in sulcus protrusion (p = 0.002) and lower lip protrusion (p = 0.029) than controls. There were no statistically significant effects on the upper jaw. CONCLUSIONS: The Herbst appliance advanced the lower jaw soft tissues.

Reproductive response to male joining with ewes with different allelic variants of the MTNR1A gene.

The aims were to evaluate the reproductive response to ram placement with Sarda ewes with different allelic variants at position g.15099485 A > G of the MTNR1 A gene. Ram placements occurred between the early and late spring and there was analysis of whether this polymorphism is associated with other nucleotide substitutions. In each of the eight farms where the study was conducted (named F1-F8), 150 ewes (50 with A/A, A/G and G/G genotypes) were selected. In each group of 150 ewes, eight males were joined with ewes on the following dates: 25 March (T1) for F1-F2, 15 April (T2) for F3-F4, 5 May (T3) for F5-F6, and 1 June (T4) for F7-F8. The lambing dates and number of new born lambs were recorded until 220 days after joining rams with ewes. The ewes with G/G or A/G genotypes had a greater fertility rate compared with those with A/A in T1, T2 (P < 0.01), and in T3 and T4 (P < 0.05). The duration of time in days from the time of ram joining with ewes to lambing was less in the ewes with G/G and A/G compared with those with A/A (P < 0.01). The g.15099485A>G variation was always associated with that at position g.15099391G>A. Results indicate there is a positive effect of the g.15099485A>G variant on reproduction when males were joined with ewes in March or April. The association that was ascertained in this study between the g.15099391G>A and g.15099485A>G polymorphisms for the MTNR1 A gene, could provide new insights to clarify the mechanism of action of melatonin.

Melatonin treatment in winter and spring and reproductive recovery in Sarda breed sheep.

This study aimed to evaluate the effect of melatonin treatment carried out between late winter and early spring on reproductive response in Sarda breed sheep and whether the photo-refractoriness can influence this reproductive response. The study was conducted on 3200 adult ewes, aged 3-6years old, with body condition score (BCS) 2.5-4.0, from 16 commercial sheep farms in Northern Sardinia. In each farm 200 animals were enrolled and subdivided into 2 groups (n=100 each): Group M (treated with one 18mg melatonin implant), and group C (untreated). The melatonin treatments were performed on 10th February; 10th March; 10th April and on 10th May each time in 4 different randomly selected farms. Adult males, treated with 3 melatonin implants 1 week before females, were introduced in each flock 35days after ewes' treatment, and removed after 45days of cohabitation with females. Pregnancy was determined by transabdominal ultrasonography examination between 45th and 90th day after ram introduction. Data showed that melatonin treatment increased the fertility rate significantly (P<0.05), with the higher fertility rate in the ewes treated in April and May. The average time in days from male introduction to lambing was shorter in treated than in control ewes (P<0.05). Further, at the 160th and 170th day after male introduction the group M showed a higher number of lambed ewes compared to C (P<0.01). This effect was observed at 180th and 190th days after ram introduction, also, but with lower significance (P<0.05). In conclusion, melatonin treatment improved reproductive efficiency and advanced breeding season in Sarda sheep, especially when ewes were treated in spring.

Clinical utility of trabectedin for the treatment of ovarian cancer: current evidence.

Among the pharmaceutical options available for treatment of ovarian cancer, attention has been increasingly focused on trabectedin (ET-743), a drug which displays a unique mechanism of action and has been shown to be active in several human malignancies. Currently, single agent trabectedin is approved for treatment of patients with advanced soft tissue sarcoma after failure of anthracyclines and ifosfamide, and in association with pegylated liposomal doxorubicin for treatment of patients with relapsed partially platinum-sensitive ovarian cancer. This review aims at summarizing the available evidence about the clinical role of trabectedin in the management of patients with epithelial ovarian cancer. Novel perspectives coming from a better understanding of trabectedin mechanisms of action and definition of patients subgroups likely susceptible to benefit of trabectedin treatment are also presented.

Electroclinical presentation and genotype-phenotype relationships in patients with Unverricht-Lundborg disease carrying compound heterozygous CSTB point and indel mutations.

PURPOSE: Unverricht-Lundborg disease (EPM1A) is frequently due to an unstable expansion of a dodecamer repeat in the CSTB gene, whereas other types of mutations are rare. EPM1A due to homozygous expansion has a rather stereotyped presentation with prominent action myoclonus. We describe eight patients with five different compound heterozygous CSTB point or indel mutations in order to highlight their particular phenotypical presentations and evaluate their genotype-phenotype relationships. METHODS: We screened CSTB mutations by means of Southern blotting and the sequencing of the genomic DNA of each proband. CSTB messenger RNA (mRNA) aberrations were characterized by sequencing the complementary DNA (cDNA) of lymphoblastoid cells, and assessing the protein concentrations in the lymphoblasts. The patient evaluations included the use of a simplified myoclonus severity rating scale, multiple neurophysiologic tests, and electroencephalography (EEG)-polygraphic recordings. To highlight the particular clinical features and disease time-course in compound heterozygous patients, we compared some of their characteristics with those observed in a series of 40 patients carrying the common homozygous expansion mutation observed at the C. Besta Foundation, Milan, Italy. KEY FINDINGS: The eight compound heterozygous patients belong to six EPM1A families (out of 52; 11.5%) diagnosed at the Laboratory of Genetics of the Galliera Hospitals in Genoa, Italy. They segregated five different heterozygous point or indel mutations in association with the common dodecamer expansion. Four patients from three families had previously reported CSTB mutations (c.67-1G>C and c.168+1_18del); one had a novel nonsense mutation at the first exon (c.133C>T) leading to a premature stop codon predicting a short peptide; the other three patients from two families had a complex novel indel mutation involving the donor splice site of intron 2 (c.168+2_169+21delinsAA) and leading to an aberrant transcript with a partially retained intron. The protein dose (cystatin B/ß-actin) in our heterozygous patients was 0.24 ± 0.02, which is not different from that assessed in patients bearing the homozygous dodecamer expansion. The compound heterozygous patients had a significantly earlier disease onset (7.4 ± 1.7 years) than the homozygous patients, and their disease presentations included frequent myoclonic seizures and absences, often occurring in clusters throughout the course of the disease. The seizures were resistant to the pharmacologic treatments that usually lead to complete seizure control in homozygous patients. EEG-polygraphy allowed repeated seizures to be recorded. Action myoclonus progressively worsened and all of the heterozygous patients older than 30 years were in wheelchairs. Most of the patients showed moderate to severe cognitive impairment, and six had psychiatric symptoms. SIGNIFICANCE: EPM1A due to compound heterozygous CSTB mutations presents with variable but often markedly severe and particular phenotypes. Most of our patients presented with the electroclinical features of severe epilepsy, which is unexpected in homozygous patients, and showed frequent seizures resistant to pharmacologic treatment. The presence of variable phenotypes (even in siblings) suggests interactions with other genetic factors influencing the final disease presentation.

The production of articles on cardiology from Latin America in Medline indexed journals.

INTRODUCTION: Latin America has dramatically increased the number of articles Publisher from 1995 to 2002, but the individual contribution of each country appears to be very unequal. OBJECTIVES: To analyze the production of articles on Cardiology research published in Latin American countries in the past years in international journals. METHODS: A bibliography search was carried out throughout PubMed in regards to biomedical articles in general and on Cardiology in particular, corresponding to the period 1987-2006. RESULTS: A total of 106,871 biomedical articles was identified, and 11,416 on Cardiology published between 1997 and 2006 by Latin American countries. This corresponds to 10.6% of articles on cardiovascular disease over the total. Brazil, Mexico and Argentina contributed with 80% of the publications in Latin America in the same period. The magnitude of growth since 1987 was between 5.9- and 15-fold for these countries. In regards to Brazil, since 1998 a significant increased number of publications was noted compared to Mexico and Argentina (P=0.0001). The impact factor of the journals where each country published during 2006 showed that it was in average higher in the publications from Chile and Argentina compared to Brazil and Mexico (P<0.001). CONCLUSIONS: The scientific production in Cardiology from Latin America shows dramatic differences among the countries, and Brazil, Mexico, and Argentina alone provide 80% of the publications. Brazil seems to have led the region for 20 years, especially since 1998. From the quality of the articles point of view, considering the impact factor, Chile and Argentina appear to be better positioned.

The production of articles on cardiology from Latin America in Medline indexed journals / La producción de artículos cardiológicos latinoamericanos indizados en Medline

Introduction: Latin America has dramatically increased the number of articles published from 1995 to 2002, but the individual contribution of each country appears to be very unequal. Objectives: To analyze the production of articles on Cardiology research published in Latin American countries in the past years in international journals. Methods: A bibliography search was carried out throughout PubMed in regards to biomedical articles in general and on Cardiology in particular, corresponding to the period 1987 - 2006. Results: A total of 106 871 biomedical articles was identified, and 11 416 on Cardiology published between 1997 and 2006 by Latin American countries. This corresponds to 10.6% of articles on cardiovascular disease over the total. Brazil, Mexico and Argentina contributed with 80% of the publications in Latin America in the same period. The magnitude of growth since 1987 was between 5.9- and 15-fold for these countries. In regards to Brazil, since 1998 a significant increased number of publications was noted compared to Mexico and Argentina (P = 0.0001). The impact factor of the journals where each country published during 2006 showed that it was in average higher in the publications from Chile and Argentina compared to Brazil and Mexico (P <0.001). Conclusions: The scientific production in Cardiology from Latin America shows dramatic differences among the countries, and Brazil, Mexico, and Argentina alone provide 80% of the publications. Brazil seems to have led the region for 20 years, especially since 1998. From the quality of the articles point of view, considering the impact factor, Chile and Argentina appear to be better positioned.

Introducción: La estimación de la producción científica en enfermedades cardiovasculares indica que América Latina incrementó el número de artículos publicados desde 1995 hasta 2002, pero la contribución individual de cada país parece ser desigual. Objetivo: Analizar la producción de artículos de investigación cardiológica publicados por los países latinoamericanos en revistas internacionales. Métodos: Se realizó una búsqueda bibliográfica en PubMed de artículos biomédicos y cardiológicos. Correspondientes al periodo de 1987 a 2006. Resultados: Se identificaron 106 871 artículos biomédicos y 11 416 cardiológicos (10.6%) publicados entre 1997 y 2006 por países latinoamericanos. En orden de importancia, Brasil, México y Argentina contribuyeron con 80% de las publicaciones. La magnitud del crecimiento de los artículos cardiológicos desde 1987 estuvo entre 5.9 y 15 veces para estos tres países. En Brasil se observó a partir de 1998, un aumento significativo del número de publicaciones con respecto a México y Argentina (P = 0.0001). El factor de impacto de las revistas en que publicaron sus artículos cardiológicos cada país durante 2006 mostró que éste fue en promedio superior en las publicaciones de Chile y Argentina con respecto a Brasil y México (P <0.001). Conclusiones: La producción científica cardiológica de América Latina tiene marcadas diferencias entre los países, y solamente Brasil, México y Argentina aportan 80% de lo publicado. Brasil lidera la región desde hace 20 años; en cuanto al factor de impacto, Chile y Argentina parecen estar mejor posicionados. Esta información serviría para conocer la situación individual de cada país y para establecer políticas de promoción científica.

Prevalence of hypospadias in Italy according to severity, gestational age and birthweight: an epidemiological study.

BACKGROUND: Hypospadias is a congenital displacement of the urethral meatus in male newborns, being either an isolated defect at birth or a sign of sexual development disorders. The aim of this study was to assess the prevalence rate of hypospadias in different Districts of Italy, in order to make a comparison with other countries all over the world. METHODS: We reviewed all the newborns file records (years 2001-2004) in 15 Italian Hospitals. RESULTS: We found an overall hypospadias prevalence rate of 3.066 +/- 0.99 per 1000 live births (82.48% mild hypospadias, 17.52% moderate-severe). In newborns Small for Gestational Age (birthweight < 10(th )percentile) of any gestational age the prevalence rate of hypospadias was 6.25 per 1000 live births. Performing multivariate logistic regression analysis for different degrees of hypospadias according to severity, being born SGA remained the only risk factor for moderate-severe hypospadias (p = 0.00898) but not for mild forms (p > 0.1). CONCLUSION: In our sample the prevalence of hypospadias results as high as reported in previous European and American studies (3-4 per 1000 live births). Pathogenesis of isolated hypospadias is multifactorial (genetic, endocrine and environmental factors): however, the prevalence rate of hypospadias is higher in infants born small for gestational age than in newborns with normal birth weight.

Homocysteine plasma levels in patients with migraine with aura.

We investigated homocysteine plasma levels in 136 MA sufferers and in 117 sex-and age-matched controls. Mean homocysteine plasma levels - as well as the proportion of subjects with hyperhomocysteinaemia - were significantly higher in patients with MA than in healthy controls. Hyperhomocysteinaemia may be a link between MA and ischaemic stroke.