Pelvic floor rehabilitation for defecation disorders.

Pelvic floor rehabilitation is frequently recommended for defecation disorders, in both constipation and fecal incontinence. However, the lack of patient selection, together with the variety of rehabilitation methods and protocols, often jeopardize the results of this approach, causing difficulty in evaluating outcomes and addressing proper management, and above all, in obtaining scientific evidence for the efficacy of these methods for specific indications. The authors represent different gastroenterological and surgical scientific societies in Italy, and their aim was to identify the indications and agree on treatment protocols for pelvic floor rehabilitation of patients with defecation disorders. This was achieved by means of a modified Delphi method, utilizing a working team (10 members) which developed the statements and a consensus group (15 members, different from the previous ones) which voted twice also suggesting modifications of the statements.

Mental health among the Moroccan population during SARS-CoV-2 outbreak: MAROCOVID study.

BACKGROUND: The SARS-CoV-2 pandemic's unpredictability and ambiguity, combined with the lockdown, social distancing, containment measures, and economic impact could increase the risk of mental health issues. OBJECTIVE: To assess the magnitude of mental health outcomes and risk factors among Moroccans, using an online survey, during the SARS-CoV-2 outbreak. METHODS: This cross-sectional, survey-based study collected demographic data and mental health measurements from 11,123 participants. The degree of depression, anxiety, and insomnia symptoms were assessed by the 9-item Patient Health Questionnaire, the 7-items Generalized Anxiety disorder, and the 7-items Insomnia Severity Index. RESULTS: The survey was completed by 11,123 individuals out of a total of 15,008 contacts. 7315 (65.8%) were women, and 7182 (64.6%) were aged 18 to 34. A significant proportion of respondents experienced depression (5894 [53%]), anxiety (5544 [49.8%]), and insomnia (4410 [39.6%]). Multivariable logistic regression analysis showed that being a woman, being married, and being a parent of children aged less than five years were associated with severe symptoms of depression and anxiety (e.g. severe depression among women vs. men (OR, 1.19; 95%CI, 1.06-1.33; P = .003), severe depression among married compared to unmarried respondents (OR, 1.92; 95%CI, 1.71-2.16; P < .000), e.g. severe anxiety among women vs. men (OR, 1.40; 95%CI, 1.24-1.58; <0.000), severe anxiety among married people compared to unmarried (OR, 1.14; 95%CI, 1.00-1.28; P < .003). CONCLUSION: Our findings reported a significant mental health burden on the general public during the COVID-19 lockdown. In addition to efforts deployed to prevent the spread of the disease, timely and culturally-specific mental health care needs to be developed urgently.

Use and efficacy of abciximab in an unselected population with acute myocardial infarction treated with primary angioplasty: data from AMI-Florence registry.

AIMS: We sought to evaluate the determinants and the potential benefit of abciximab use in unselected patients with acute myocardial infarction treated with primary angioplasty. METHODS AND RESULTS: Based on the AMI-Florence registry, we analyzed 461 consecutive acute myocardial infarction patients treated with primary angioplasty, 280 (61%) of whom received abciximab. For each patient, a propensity score indicating the likelihood of abciximab treatment was calculated. Compared to those not treated, patients treated with abciximab were at lower risk. At multivariate analysis, the direct admission to a hospital with angioplasty facilities significantly increased the probability of receiving abciximab (OR 1.99, 95% CI 1.30-3.03, p=.001), while older age (OR 0.97, 95% CI 0.95-0.98, p<.0001), non-anterior location (OR 0.58, 95% CI 0.38-0.88, p=.011) and Killip class >1 (OR 0.53, 95% CI 0.32-0.87, p=.013), were negative predictors of abciximab use. Primary angioplasty had a higher success rate in patients treated with abciximab (99.3% versus 96.5%, p=.03). In-hospital and 1-year mortality were significantly lower in patients treated with abciximab (2.5% versus 13.3%, p<.0001, and 7% versus 21%, p<.0001, respectively). At multivariate analysis patients treated with abciximab had a significantly lower risk of in-hospital mortality (OR 0.35, 95% CI 0.14-0.93, p=.035), and a marginally lower risk of death at 1-year follow-up (HR 0.58, 95% CI 0.32-1.03, p=.065). These results did not change when the propensity score was included into the analyses. CONCLUSIONS: In the real practice, abciximab is more frequently used in patients at lower risk, particularly when directly admitted to a hospital with angioplasty facilities. Abciximab use is associated with a significant reduction in early mortality. A trend toward a reduced mortality is maintained also at 1 year.

[Epicardial pacing: clinica evaluation and comparison with transvenous pacing (author's transl)]. / Elettrostimolazione epicardica. Valutazione clinica e confronto con la stimolazione endocardica.

Clinical experience with permanent epicardial pacing during a five year-period in our centre is presented. The report is based on 37 epicardial and 656 transvenous pacemaker implantations. Intraoperative and early postoperative mortality were absent in the epicardial pacing group. Late hospital mortality, morbidity and electro-mechanical complications were less than with transvenous pacing. Among the complications peculiar to the epicardial pacing technique, we observed 3 cases of breakage of a lead, at the level of its epicardial connection. We conclude that the use of epicardial leads represents a safe and effective technique of cardiac pacing.