Consultation-Liaison Psychiatry-From Theory to Clinical Practice: an Observational Study in a Psychiatric Unit in the General Hospital of Perugia.

BACKGROUND: Subjects suffering from psychiatric disorders are frequently hospitalized due to medical comorbidities. In the present study, we analyzed consultation-liaison psychiatry (CLP) activity in a General Hospital, describing the sociodemographic, diagnostic, and therapeutic characteristics of the evaluated subjects, as well as reasons for consultation requests. SUBJECTS AND METHODS: Data concerning psychiatric consultation performed at the Perugia General Hospital during a 1-year period (01/06/2022-20/06/2023) were collected and analyzed by means of descriptive statistics. RESULTS: A total of 707 psychiatric consultations were performed. The primary reason that led to psychiatric consultations was psychomotor agitation. 85 (18.5%) patients attempted suicide; the most frequent modality was the assumption of drugs at non-therapeutic doses. The 72% of the sample (n=509) presented a clear-cut medical comorbidity. In most cases, subjects were referred to Community Mental Health and Addiction services (n=22, 32.4%). CONCLUSIONS: CLP plays a crucial role in the perspective of the overall well-being of hospitalized subjects, but also for the overall management of complex cases. Despite this, a homogeneous approach with standardized guidelines is needed in this field.

Effect of time and storage temperature on canine and feline erythrocyte sedimentation rate.

We aimed to test the influence of storage temperature and time for canine and feline ESR. Forty dogs and 12 cats were included and randomly allocated in "room temperature" and "refrigerated" groups. Both groups had the T0 ESR measures few minutes after complete blood count. Afterwards, room temperature group had ESR measured at 2, 4, 6 and 8h after T0, whereas the "refrigerated" group had the blood sample stored at 4-6°C for 24 and then T24h ESR was measured. In each ESR measurement, [1] blood samples were put on a tube rocker waiting for ESR analysis; [2] before inserting the blood tube in the MINI-PET ESR instrument, samples were gently mixed again by complete inversion 10 times; (3) each mixed blood tube was inserted in the one of the four MINI-PET tubes position; (4) on the machine display, patient's species has to be chosen and the 14 minutes countdown started; (5) after the 14 minutes optical reading, the ESR result (mm/h) is displayed on the machine. ESR of canine samples at room temperature were significantly stable until T6, while feline samples remained stable at T8. After 24h at refrigerated temperature, both canine and feline samples were stable. • MINI-PET is an ESR automatic continuous-loading instrument that can analyze up to four EDTA blood samples simultaneously using an optical system that measures the erythrocytes sedimentation level • We aimed to test influence of storage temperature and time for canine and feline ESR • At room temperature, dogs' samples were stable within 6 hours from collection, and cats' samples were stable until 8h. At refrigerated temperature, there was no difference in T0-T24 ESR in both canine and feline samples.

Maternal and Neonatal Evaluation of Derived Reactive Oxygen Metabolites and Biological Antioxidant Potential in Donkey Mares and Foals.

Our aim was to measure the concentrations of derived reactive oxygen metabolite (d-ROMs) and biological antioxidant potential (BAP) of donkey mares and foals at delivery and to verify the protective role of the placenta against fetal oxidative stress. A total of 15 Amiata jennies with a physiological gestation length and delivery were included together with 17 foals (two twin foalings). After delivery, maternal and foal venous blood samples were collected along with blood from the artery. Circulating lactate and plasma d-ROMs and BAP were evaluated. The Wilcoxon test for paired data was applied to verify differences in d-ROMs and BAP values, while the Spearman test was used to evaluate correlations. A significantly higher d-ROMs concentration was found in jennies compared to their foals, and to the umbilical artery blood. The BAP was higher in jennies than in their foals, but no differences were observed in the umbilical artery blood. No difference was found between foals and their umbilical cord. Blood lactate was higher in foals than in their dams. Positive correlations were found between mares and umbilical cord for BAP and d-ROMs, and between mares and foals and umbilical cord for BAP. In conclusion, the placenta may be a protective factor for the fetus. As with equine foals, the antioxidant system of donkey foals does not seems to be effective at birth.

Serum Total Thyroxine Evaluation in Critically Ill Feline Patients.

This retrospective case control study compared serum total thyroxine (tT4) concentrations in hospitalized critical cats (CCs) and non-hospitalized cats with non-thyroidal chronic diseases (chronic group, CG) and evaluated the relationship between the serum tT4 concentration of CCs and systemic inflammation (systemic inflammatory response syndrome (SIRS)), disease severity (Acute Patient Physiologic and Laboratory Evaluation (APPLEfast)), and prognosis. Cats with previously suspected or diagnosed thyroid disease were excluded. Serum tT4 was evaluated in surplus serum samples at the time of admission for CCs and CGs. The APPLEfast score of the CC group was calculated at admission. The systemic inflammatory response syndrome (SIRS) in CCs was determined using proposed criteria. Cats were divided into survivors and non-survivors according to the discharge outcome. Forty-nine cats were retrospectively included. Twenty-seven cats died during hospitalization. The CG group was composed of 37 cats. The CC group showed a significantly lower tT4 compared to the CG group (1.3 ± 0.7 vs. 2 ± 0.9; p < 0.0001). Among SIRS, APPLEfast, and tT4, only tT4 was associated with mortality (p = 0.04). The tT4 cut-off point for mortality was 1.65 µg/dL (sensitivity 81%, specificity 57%, odds ratio (OR) 5.6). Twenty-five cats (51%) had SIRS that was not associated with tT4. Non-thyroidal illness syndrome can occur in critically ill cats and the evaluation of tT4 in hospitalized cats could add prognostic information.

The Canine Erythrocyte Sedimentation Rate (ESR): Evaluation of a Point-of-Care Testing Device (MINIPET DIESSE).

The erythrocyte sedimentation rate (ESR) in canine medicine has been replaced by the evaluation of a few sensitive markers of the acute-phase proteins. The aim of the study was to evaluate the ESR using a point-of-care (MINIPET, DIESSE Diagnostica Senese S.p.A.) device (ESR-MP) and to compare the results with the gold standard Westergren method (ESR-W) in dogs. One hundred and nineteen K3-EDTA blood samples for complete blood count were randomly selected and assayed for ESR. The reference interval (RI) was established using the percentile method. The coefficient of variation (CV) in intra-assay and interassay precision of ESR-MP was calculated. The analytical sensitivity (Se), specificity (Sp), positive predictive values (PPVs), and negative predictive values (NPVs) were calculated. Agreement between ESR-MP and ESR-W was assessed with Pearson correlation coefficient (r), Cohen concordance test (K), Passing-Bablok regression, and Bland-Altman plots. Ten canine samples (8.4%) were ruled out because of flag-error by the MINIPET instrument (4.2%) or because they showed the diphasic pattern in ESR-W (4.2%). The canine RI of ESR-MP was 0-10 mm/h. Precision was excellent in intra-assay (CV = 0.02) and interassay (CV = 0.32). The analytical characteristics of ESR-MP in nonanemic samples were as follows: Se = 0.82, Sp = 0.95, PPV = 0.82, and NPV = 0.95. The accuracy of ESR-MP was better than ESR-W in nonanemic samples (r = 0.87; K = 0.77) and lower in anemic subjects (Hct <37%) (r = 0.76; K = 0.69). The Passing-Bablok regression showed the presence of systematic error and the absence of proportional error only in nonanemic blood samples. The Bland-Altman plots gave negative average values due to the difference in RIs and an agreement in both ESRs. The ESR-MP results can be obtained with the same K3-EDTA tubes used for the blood count, in shortcut time, and at reduced costs using the MINIPET device. These investigations highlight that ESR-MP could be useful in canine clinical settings.

Role of body condition score and adiponectin expression in the progression of canine mammary carcinomas.

Obesity has been identified as a risk factor for developing breast cancer in post-menopausal period in humans and has been suspected to be associated with a worse prognosis also in the bitch. The aims of this study were to investigate the association between body condition score (BCS) and the prognosis of canine mammary carcinomas (CMCs) and the relationships between adiponectin expression and tumour behaviour. Seventy-three bitches with tubular, tubulopapillary, solid or complex carcinomas were included in the present study. For each dog, evaluation of BCS was conducted using a nine-point BCS system and the study population was divided into normal weight (4-5/9 points; n = 42), overweight (6-7/9 points; n = 19) and obese (8-9/9 points; n = 12). Type of diet (commercial, homemade or mixed) was recorded. After surgical excision, histological type, tumour size and nodal status were assessed and adiponectin expression was determined and quantified by immunohistochemistry and morphometric analysis. CMC histotype was not correlated with BCS, while a positive correlation between BCS and histological grade (p < .01) was observed. Overweight and obese bitches combined showed a shorter cancer-specific survival than normal weighted bitches (p < .01). Bitches fed with a homemade diet had a higher BCS than dogs fed with a commercial one, although no relationship was observed between diet and  cancer-specific survival. Thirty-six CMCs scored positive for adiponectin expression (49%), but no correlation was found between the hormone expression and either CMC characteristics or prognosis. In conclusion, a higher BCS seems to be related with a higher prevalence of more aggressive CMCs and negatively affects the survival time in bitches with these mammary tumours.

Follicular dendritic cells display microvesicle-associated LMP1 in reactive germinal centers of EBV+ classic Hodgkin lymphoma.

Expression of the latent membrane protein-1 (LMP1) of Epstein-Barr virus (EBV) was investigated in 153 cases of EBV+ classic Hodgkin lymphoma (cHL); 120 cases were pediatric patients (< 14 years of age) from Iraq, and 33 cases were adult patients from Italy. We describe for the first time the presence of LMP1 protein in EBV-encoded RNA (EBER)-negative follicular dendritic cells (FDCs) of reactive germinal centers (GC) associated with EBV+ cHL. Presence of LMP1+ GCs was independent of geographic region and age of patients. Variable numbers of reactive GCs were present in 22.2% of cases (34 of 153), whereas LMP1 staining of FDCs was present in about a third of cases (10 of 34) with reactive GC. Most cases with LMP1+ GC were mixed-cellularity (MC) subtype, but some nodular sclerosis (NS) was also present. GC cells with LMP1+ FDCs were surrounded by numerous EBV-infected cells which were positive for EBER, LMP1, and CD30. Double immunolocalization analysis revealed that LMP1 was associated with CD63, an exosomal marker, and with CD21. The possibility is discussed that peri-follicular EBV-infected cells release LMP1 protein, perhaps through exosomes, and that the protein is then captured by FDCs and is presented to EBER-negative GC B cells.

Substance-related psychopathology and aggressiveness in a nightlife holiday resort: Results from a pilot study in a psychiatric inpatient unit in Ibiza.

OBJECTIVES: We aimed to describe a sample of subjects admitted to a psychiatric unit after the intake of psychoactive substances for recreational purposes. METHODS: Between June and September 2015, 49 subjects were included. Sociodemographic characteristics and psychopathological aspects were investigated, and urine samples for further analysis were collected. Three subgroups (cannabinoids, stimulants, and depressors users) were identified, according to the structured interview regarding substance use and urinalysis. RESULTS: Level of aggressiveness was found to be significantly higher (p < .05) in the cannabinoids subgroup. Self-reported symptom severity was comparable among groups, but trends could be identified: SCL-90 results showed a prevalence of anxiety symptoms among depressors users, hostility or aggression in the tetrahydrocannabinol subgroup, and psychoticism in the stimulants subgroup. CONCLUSIONS: The use of psychoactive substances was be characterised by poly-use of both traditional and novel substances. The presence of aggressiveness emerged as a main feature associated with the use of cannabis and other cannabinoids. Binge drinking and sleep deprivation also represented a relevant component in almost all the evaluated subjects.

Difficulty describing feelings and post-traumatic symptoms after a collective trauma in survivors of L'Aquila earthquake.

BACKGROUND: The association between alexithymia and post-traumatic stress disorder (PTSD) symptoms has been demonstrated in several studies, but never in victims of a collective trauma such as a natural disaster, which has an impact on an entire community. AIMS: The aim was to assess the relationship between alexithymia and post-traumatic symptoms in a group of people who lived in L'Aquila exposed to the earthquake that hit the town in 2009. METHODS: Eighty-seven participants were included and assessed for alexithymia, PTSD symptoms, depression, anxiety, and psychiatric symptoms. Linear regression models were used to test the hypothesis. RESULTS: The main finding was an association between "Difficulty-Describing-Feelings" and the intensity of post-traumatic symptoms in the worst month after trauma. Depression, anxiety and psychiatric comorbidity also showed a significant association with PTSD symptoms. CONCLUSIONS: In the present study of a collectively shared trauma, the alexithymic factor "difficulty-describing-feelings" was significantly associated with the intensity of post-traumatic symptoms.

Longitudinal study of sleep behavior in normal infants during the first year of life.

STUDY OBJECTIVES: To longitudinally examine sleep patterns, habits, and parent-reported sleep problems during the first year of life. METHODS: Seven hundred four parent/child pairs participated in a longitudinal cohort study. Structured interview recording general demographic data, feeding habits, intercurrent diseases, family history, sleep habits, and parental evaluation of the infant's sleep carried out at 1, 3, 6, 9, and 12 months. RESULTS: Nocturnal, daytime, and total sleep duration showed a high inter-individual variability in the first year of life associated with changes in the first 6 months and stability from 6 to 12 months. Bedtime was at around 22:00 and remained stable at 6, 9, and 12 months of age. Approximately 20% of the infants had more than 2 awakenings and slept more often in the parent bed. Nearly 10% of the infants were considered as having a problematic sleep by parents and this significantly correlated with nocturnal awakenings and difficulties falling asleep. CONCLUSIONS: Sleep patterns change during the first year of life but most sleep variables (i.e., sleep latency and duration) show little variation from 6 to 12 months. Our data provide a context for clinicians to discuss sleep issues with parents and suggest that prevention efforts should focus to the first 3-6 months, since sleep patterns show stability from that time point to 12 months.

Retrospective and Prospective Investigations about "Quatrefoil" Erythrocytes in Canine Blood Smears.

The presence of unusual two RBCs patterns (so-called "quatrefoil RBCs," qRBCs) on canine blood smears at Optical Microscope (OM) was seen during routine evaluation of CBCs. Two consecutive retrospective investigations were arranged including about 7,000 CBCs and clinical records and laboratory data from dogs showing qRBCs. Few samples with qRBCs were prepared for Scanning Electron Microscope (SEM). qRBCs were found in 6.89% (139 of 2016) and 8.47% (133 of 1569) of dogs and in 3.89% (154 of 3,958) and 4.47% (138 of 3,081) of CBCs (some dogs were tested more than once). Statistical analysis was significant for age groups (Chi squared, P < 0.0001), decreased total leukocyte and neutrophil counts (ANOVA, P < 0.0001), RBCs anisocytosis, polychromasia, and Howell-Jolly bodies (ANOVA, P < 0.018, <0.005, and <0.003, respectively). qRBCs were distributed in the area of feathered edge and at the smear side of body-feathered edge area in blood films. SEM ruled out the possibility of an optical illusion or an accidental overlap. qRBCs are associated with ageing of dogs, total leukocyte and neutrophil counts, and RBC anisocytosis, polychromasia, and Howell-Jolly bodies. Few hypotheses were discussed to explain the origin and meaning of this RBC arrangement.

UDP-glucuronosyltransferases 1A expression in human urinary bladder and colon cancer by immunohistochemistry.

UDP-glucuronosyltrasferases (UGTs) are detoxifying enzymes, which convert endogenous substrates, dietary constituents and potential carcinogens to inactive hydrophilic glucuronides. Although the liver is considered the most important organ for glucuronidation, UGTs are also expressed in extrahepatic tissues. Since UGTs may be important to protect cells from cancer in organs naturally exposed to potential carcinogens such as smoking and diet derivatives, we investigated the UGT expression in normal and malignant tissues from urinary bladder and large intestine. The study was carried out by immunohistochemistry, using an antiserum recognizing all the UGT1A isoforms. Our results showed that UGTs were highly expressed on the surfaces of the normal bladder as well as in normal large bowel mucosa. The neoplastic counterpart showed a general protein down-regulation associated with a different cellular localization. We found that 3/11 papillary and 3/6 invasive urothelial carcinomas were virtually negative, whereas 2/2 papillomas and 8/11 papillary bladder carcinomas still expressed the protein. In colon cancer the enzyme down-regulation was even more dramatic. In fact, a faint diffused cytoplasmic expression or scattered cell positivity was observed only in adenomas with low grade dysplasia (5/5) and in 2/11 carcinomas. Interestingly, 5/5 adenomas with high grade dysplasia, 9 carcinomas, the lymph nodes and liver metastases were UGT-negative, suggesting that the loss of UGT is associated with the early phase of neoplastic transformation. Based on our results we suggest that UGTs constitutive expression in the normal mucosa could protect these organs from carcinogens released in the bladder or introduced directly with the diet in the colon.

Increased expression of Met protein is associated with up-regulation of hypoxia inducible factor-1 (HIF-1) in tumour cells in papillary carcinoma of the thyroid.

Met protein, the high affinity receptor for hepatocyte growth factor (HGF), was highly expressed by the tumour cells of 64 well-differentiated papillary carcinomas of the thyroid. The p145 mature form and the p170 precursor form of the protein were both isolated from the tumours. Enhanced expression of Met protein was associated with a 9.5 +/- 5-fold increase in MET RNA transcript levels, suggesting increased transcription of the gene. In the same tumours, the levels of RNA transcripts for hypoxia inducible factor-1 (HIF-1), a potent stimulator of met gene transcription, were 4.5 +/- 3-fold higher than those present in the surrounding normal thyroid tissues. HIF-1 is generally induced by hypoxia. Histological features suggestive of a hypoxia were observed in 37 of 50 tumours and included coagulative necrosis, psammoma bodies, cystic changes, intratumoural haemorrhage, and hyalinization of the fibrous stroma. Immunostaining for Met protein was particularly intense in some cells located at the tumour periphery which were characterized by an invasive phenotype. Microdissection of tumour cell nests from the invading front revealed that the levels of RNA transcripts for MET/HIF were higher than in the centre of the tumour in four of nine cases. Taken together, the findings of this study suggest that HIF-1, perhaps driven by hypoxia, may be one of the factors leading to the increased transcription of met gene in papillary carcinoma and that this event is often more pronounced at the tumour periphery.