Bariatric surgery related proximal myopathy: A partially reversible complication.

Deficiency neuropathies and rhabdomyolysis have previously been reported after bariatric surgery (BS) but never myopathies. We report cases of five patients with morbid obesity who developed within 2 to 4 months of a BS, proximal myopathy following significant and rapid weight loss worsened by postoperative gastrointestinal complications. Muscle weakness concerned lower limbs in particular in quadriceps and less frequently in upper limbs and diaphragm, sometimes mimicked a Guillain-Barré syndrome. Muscle biopsy performed in 1 patient, revealed selective atrophy of type 2 fibers. Weakness slowly decreased with refeeding with vitamins supplementation. We enlarge here the clinical pattern of post-BS complications.

Microbiological surveillance of endoscopes and implications for current reprocessing procedures adopted by an Italian teaching hospital.

BACKGROUND: Hospital acquired infections have been associated with the contamination of flexible endoscopes caused by a failure of the reprocessing procedure. Microbiological surveillance of endoscope reprocessing is valuable for assessing contamination by pathogens. The aim of this study is to evaluate microbiological contamination of endoscopes after reprocessing, and the involvement of reprocessing procedures adopted in endoscopy units of an Italian teaching-hospital. METHODS: The study was carried out, on several dates in 2014, in 11 endoscopic operation units equipped with 100 endoscopes (18 bronchoscopes, 41 gastroduodenoscopes, 29 colonoscopes, 12 laryngoscopes) and 9 Automated Endoscope Reprocessors. Presence/absence of common pathogens and indicator micro-organisms (including multi-drug resistant bacteria) and Total Microbiological Count (TMC) were obtained from the biopsy channels of endoscopes after reprocessing, from final rinse water of automated endoscope reprocessors and from tap water applying standard microbiological culture methods. Following the European Guidelines for quality assurance in reprocessing, the post-reprocessing criteria were "absence of indicator micro-organisms and absence of TMC in samples obtained from endoscopes' channels". RESULTS: A total of 180 samples were collected (143 endoscopes, 25 Automated Endoscope Reprocessors and 12 water supply). Compliance to the European Guidelines was achieved for 112 out of the 180 (62.2%) samples analyzed. Presence of indicator micro-organisms (mainly Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and other Gram-negative non-fermenting bacteria) was found in 51 out of 143 endoscopes (35.7%). Multi-drug resistant bacteria were also found. Presence of pathogen micro-organisms was statistically associated with the increase of TMC level, but not with time after reprocessing. CONCLUSION: The study provides information about the microbiological quality of endoscope reprocessing procedures adopted by different endoscopic operation units. The high prevalence of contaminated endoscopes provides evidence of the need to improve the quality of reprocessing.

Determining the time of death by morphological and immunohistochemical evaluation of collagen fibers in postmortem gingival tissues.

The estimation of the post mortem interval (PMI) is still one of the most challenging variables to determine and the different approaches currently used in its estimation generally yield to large post mortem windows. In the present study we combined morphological and immunohistochemical analysis in order to reach a more detailed knowledge on tissue organization and degradation after death. Ultrastructural cellular changes and the extracellular matrix of gingival tissues, collected at different post mortem intervals, were observed by a Transmission Electron Microscopy (TEM), in combination with the immunohistochemical detection of extracellular matrix proteins (i.e. collagen type I and collagen type III) as potential post mortem biochemical markers. The final goal was to find a correlation between morphological modifications, biomarkers expression and the time of death. Samples of gingival tissues obtained from 10 cadavers at different post mortem intervals (short post mortem interval, 1-3 days; mid post mortem interval, 4-6 days; long post mortem interval, 7-9 days) were processed for light microscopy and TEM and they were also immunostained with anti-collagen type I and type III antibodies. Results showed gradual degradation of extracellular matrix in the suboral connective tissue in relation to the different time of death. Moreover PMI was related to an increase of nuclear chromatin condensation and cytoplasmic vacuolization both in epithelial and connective tissues. In conclusion, in addition to traditional forensic approaches to estimate PMI, the combined analyses of cellular morphology, ultrastructure and immunohistochemical expression of collagen proteins allow to better infer the PMI.

Obsessive-compulsive disorder in the elderly: A report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS).

INTRODUCTION: Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD≥65years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample. METHODS: Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age

Checklists to manage pain induced by exercise and mobilization (PIEM) during physical therapy programs: PIEM checklists for practitioners and physiotherapists.

OBJECTIVES: Identify key informational and educational items ("messages") to provide to physicians (general practitioners and specialists) and physiotherapists for the management of pain induced by exercise and mobilization (PIEM). Develop checklists to improve this management in daily practice. MATERIAL AND METHODS: The Delphi method for consensus-building was used to identify informational and educational messages for health professionals who deal with PIEM. Informed by the results of an extensive qualitative study, a panel of experts from 5 medical and paramedical disciplines concerned with PIEM and a representative of a patients' association were interviewed individually and iteratively in order to obtain a single, convergent opinion. RESULTS: Delphi consultation helped to determine 9 areas corresponding to 54 key messages of information and education for doctors and physiotherapists who deal with PIEM. These messages relate to: defining, characterizing, identifying, and evaluating PIEM; identifying factors that may cause or increase this pain; informing the patient in order to avoid misinterpretation of PIEM; preventing and treating PIEM; and dealing with it during physical therapy sessions. The method also enabled us to develop 2 synthetic instruments (checklists) - 1 for physicians and 1 for physiotherapists - to help with the management of this pain. CONCLUSION: Consulting a panel of experts comprising different categories of actors dealing with PIEM on the basis of a thorough qualitative diagnosis in order to identify messages for a training program makes it possible to harmonize programs with the expectations of patients and the problems encountered by professionals. The formulation of this program and the institutionalization of two checklists should enable health professionals to identify, qualify, and deal more effectively with PIEM.

[The scientific contributions by the Roman School of Hygiene on the microbiological quality of the surface waters of Rome and her County from 1890 to 2010. A systemic review]. / La produzione scientifica della Scuola Romana di Igiene sulla qualità microbiologica dei corpi idrici superficiali di Roma e Provincia dal 1890 al 2010. Una review sistematica.

Research on quality of surface waters has been performed also in Italy during the development of the large urban areas, and in Rome this has been the duty of the Istituto di Igiene of the Sapienza University since 1890. Using MedLine--and also traditional consultation for papers printed before 1968--we identified 100 articles printed in the period 1890-2010. Thirty of them met the inclusion criteria (to have been written by researchers belonging to the Rome universities and to contain microbiological informations about the surface waters of Rome). The majority of papers identified (46.6%) were produced during the years Sixties and Seventies of the 20th century, and 30% in the twenty years to follow (1980-1999). The most frequent microbiological descriptors were "Total coliforms" and "Streptococci". The waterbodies most investigated were the Tiber river and the coastal waters around Fiumicino, where the Tiber flows into the Tyrrhenian sea. The quality of surface waters has always been a central interest of the research performed by the Hygienists of the Roman School. The good quality of the past research and the renovated interest of International Organizations and of the European Union should encourage the public health researchers toward a strategic field of investigation which has strong interconnections with the protection of the individual and community health and also with the protection of the environment.

[Revision of the behavior of Italian universities towards the HBV vaccination and tuberculosis prophylaxis]. / Revisione del comportamento degli Atenei italiani nei con- fronti della vaccinazione anti-HBV e della profilassi anti tubercolare.

Diagnostic screening for hepatitis B and tuberculosis infection bears a very important role for health care professionals even considering the decreasing epidemiological trends. According to the WHO predictions in 2030 these diseases will remain at third and fourth places among the causes of death for infectious diseases in industrial countries. The aim of this study is to verify the presence of hepatitis B and tuberculosis prophylaxis among the entry requirements for Medical Schools (MED) and Healthcare Professions Degree (PS) courses in 2011/2012 enrollment announcements. We examined 39 websites of Italian Public and Private Universities and we discovered 38 different announcements for MED and PS courses looking for any reference about hepatitis B and tuberculosis vaccinations and Mantoux skin test. The statistical analysis is descriptive (frequency tables). Hepatitis B vaccination was required in 7 (18.4%) enrollment announcements for MED and 6 (13.6%) for PS, respectively. Tuberculosis vaccination and/or Mantoux skin test were found among requirements of only 10 announcements for MED and 7 for PS, respectively. According to this study there is a great and unexpected variability among the different universities. A homologation of these requirements would be strongly desirable among Italian regions and on the entire national territory.

Mesotelioma maligno de túnica vaginal de testículo: caso clínico y revisión de la bibliografía / Malignant mesothelioma of tunica vaginalis testis; a case report

El mesotelioma maligno de túnica vaginal testicular es un tumor muy raro. Se publicaron menos de 90 casos. El tratamiento indicado inicialmente es la orquituniculectomía inguinal; no hay tra-tamientos estandarizados para la recurrencia local ni para la diseminación a distancia del tumor. Los resultados con quimioterapia y radioterapia son pobres. Presentamos un caso de mesotelioma maligno de la túnica vaginal testicular en un hombre de 37 años, con tumor localizado, que fue sometido a orquifuniculectomía inguinal como único tratamiento; luego de 18 meses de segui-miento se encuentra asintomático y sin signos de recurrencia local ni diseminación a distancia. Realizamos una revisión de la literatura.

Mesotelioma maligno de túnica vaginal de testículo: caso clínico y revisión de la bibliografía / Malignant mesothelioma of tunica vaginalis testis; a case report

El mesotelioma maligno de túnica vaginal testicular es un tumor muy raro. Se publicaron menos de 90 casos. El tratamiento indicado inicialmente es la orquituniculectomía inguinal; no hay tra-tamientos estandarizados para la recurrencia local ni para la diseminación a distancia del tumor. Los resultados con quimioterapia y radioterapia son pobres. Presentamos un caso de mesotelioma maligno de la túnica vaginal testicular en un hombre de 37 años, con tumor localizado, que fue sometido a orquifuniculectomía inguinal como único tratamiento; luego de 18 meses de segui-miento se encuentra asintomático y sin signos de recurrencia local ni diseminación a distancia. Realizamos una revisión de la literatura. (AU)

Cáncer de vejiga: tabaco como factor de riesgo / Bladder cancer: tobacco like risk factors

Entre setiembre de 1997 y marzo de 1998 se diagnosticaron y trataron en nuestro servicio 45 pacientes con cáncer de vejiga, de los cuales 41 casos fueron carcinomas superficiales, 3 infiltrantes y el restante carcinoma "in situ". El objetiv o del presente trabajo fue observar cuáles eran los factores de riesgo para el desarrollo de esta neoplasia. Se detectó que en el 85 por ciento de estos pacientes el hábito de fumar se encontraba presente (p<0,01), determinándose además la relación entre la cantidad de cigarrillos consumidos por día y el grado de diferenciación celular. Se registró también que los pacientes que fumaban tabaco negro desarrollaron tumores de mayor estadio de infiltración. En los restantes pacientes los factores de riesgo fueron labvorales (4 por ciento); hereditarios (2 por ciento); o dfesconocidos (9 por ciento)

Cáncer de vejiga: tabaco como factor de riesgo / Bladder cancer: tobacco like risk factors

Entre setiembre de 1997 y marzo de 1998 se diagnosticaron y trataron en nuestro servicio 45 pacientes con cáncer de vejiga, de los cuales 41 casos fueron carcinomas superficiales, 3 infiltrantes y el restante carcinoma "in situ". El objetiv o del presente trabajo fue observar cuáles eran los factores de riesgo para el desarrollo de esta neoplasia. Se detectó que en el 85 por ciento de estos pacientes el hábito de fumar se encontraba presente (p<0,01), determinándose además la relación entre la cantidad de cigarrillos consumidos por día y el grado de diferenciación celular. Se registró también que los pacientes que fumaban tabaco negro desarrollaron tumores de mayor estadio de infiltración. En los restantes pacientes los factores de riesgo fueron labvorales (4 por ciento); hereditarios (2 por ciento); o dfesconocidos (9 por ciento)(AU)

[Calcified periarthritis. Disappearance of periarticular calcification after laser therapy]. / Periartrite calcifica. Scomparsa di calcificazioni periarticolari dopo laserterapia.

The authors report their results in the laser therapy of 30 calcific shoulder joint periarthritis. In two out of the ten radiographed cases, at the end of therapy, the complete disappearance of calcifications has been shown and in one case a decrease in calcification volume has been demonstrated. In the follow up after 6 months, 80% of clinically checked patients had no painful relapse.