La Clinica Terapeutica

The obligation of the physician to save the life of the detainee on a hunger strike: the opinion of the Italian National Bioethics Committee.

M. Ottaviani — 2024-04-02

The Cospito case has highlighted a widely debated bioethical issue regarding the need to choose between safeguarding the life of a detainee and their right to self-determination through the practice of a hunger strike. Recently, the Italian National Bioethics Committee has been called upon to give an opinion on this matter. On the other hand, the media resonance of this case has shed light on the need to pose an ethical and social question regarding such situations: does the physician have an obligation to protect the detainee's health at the expense of their free choice? To be able to answer, it is necessary to understand whether law no. 219/17 is applicable to this context.

Tumefactive Primary Central Nervous System Vasculitis: Dynamic Susceptibility Contrast Perfusion-Weighted Magnetic Resonance Imaging Findings With Histological Correlation.

C.F. Muccio — 2024-04-02

Purpose Primary central nervous system vasculitis (PCNSV) is a rare inflammatory disease affecting the central nervous system. In some cases, it presents with large, solitary lesion with extensive mass effect that mimic intracranial neoplasms. This condition results in a diagnostic confusion for neuroradiologists because the differentiation is almost impossible on conventional MRI sequences. The aim of this study is to reveal the significance of dynamic susceptibility contrast (DSC) perfusion-weighted imaging in differentiating of tumefactive PCNSV (t-PCNSV) lesions from intracranial neoplasms such as glioblastomas and metastasis.

Methods In this retrospective study, DSC of 8 patients with biopsy-proven t-PCNSV has been compared with DSC obtained in 10 patients with glioblastoma, 10 patients with metastasis, who underwent surgery and histopathological confirmation. The ratio of relative cerebral blood volume (rrCBV) was calculated by rCBV (lesion) / rCBV (controlateral normal-appearing white matter) in the gadolinium-enhancing solid areas.

Results: The mean rrCBV was 0.86±0.7 (range: 0.76-0.98) in the patients with t-PCNSV, 5,16±0.79 in patients with glioblastoma (range: 3.9-6.3), and 4.27±0.73 (range: 2.8-5.3) in patients with metastases.

Conclusion DSC-PWI seems to be useful in the diagnostic work-up of t-PCSNVs. A low rrCBV, i.e. a rCBV similar or lower to that of the contralateral normal white matter, seems to be consistent with the possibility of t-PCSNV.

Occupational Therapy Task Observation Scale (OTTOS) and Comprehensive Occupational Therapy Evaluation Scale (COTES): Italian translation, adaptation, and validation

A. Berardi — 2024-04-02

Objective: We developed an Italian version of the Occupational Therapy Task Observation Scale (OTTOS)¹ and an Italian version of the Comprehensive Occupational Therapy Evaluation Scale (COTES)² and examined their reliability and validity.

Methods: The original scales were translated from English to Italian using the “Translation and Cultural Adaptation of Patient Reported Outcomes Measures–Principles of Good Practice” guidelines³. Both scales were administered to adults with mild and moderate intellectual disabilities. People under eighteen years, with severe and profound intellectual disabilities and deaf people were excluded from the study. Their reliability and validity have been examined. Reliability was analyzed via internal consistency (Cronbach's alpha) and stability (intra/inter-rater coefficient), while validity was investigated via construct validity (p-value) and criterion validity using Pearson's correlation coefficients between them and with the Mini Mental State Examination and the Barthel Index Scale.

Results: The OTTOS and the COTES were administered to 30 subjects. Cronbach’s α for the COTES was 0,91 and Cronbach’s α for the OTTOS was 0,92. Regarding the criterion of validity, the two scales have numerous statistically positive correlations, particularly with the Mini Mental State Examination in the Orientation and total part. Furthermore, the correlation with the Barthel scale is present in the total scores, the COTES's third subscale, and the OTTOS's first.

Conclusions: The OTTOS and the COTES were reliable and valid outcome measures for assessing behavior in the Italian population.

Prevalence of Orthorexia Nervosa in a sample of italian young adults

M. Lupi — 2024-04-02

There is only limited epidemiological information on Orthorexia Nervosa; the aim of the present study is, therefore, to assess the prevalence of ON in a population of young adults and to identify possible specific features and eventual psychopatological dimensions.

1317 participants completed a battery containing the orthorexia measure (ORTHO-15), statements about demographic characteristics as well as physiological parameters.

Our results showed a 11.9% prevalence of ON; analyzing the characteristics of the orthorexic group, the prevalence in females compared to males appears to be statistically very significant; moreover shows higher and statistically significant scores in each of the 15 items of the reference test compared to the comparison group.

Our data confirming that ON might be a relevant and potentially underestimate phenomenon in the community. Further studies are warranted in order to explore the diagnostic boundaries of this syndrome, its course and outcome, and the possible therapeutic strategies

A prospective cohort study with serum anti-mullerian hormone levels change in patients undergoing uterine preservation after gestational trophoblastic neoplasia treatment with a methotrexate regimen

D. Tuan Dat — 2024-04-02

Objectives

To monitor changes in serum anti-Mullerian hormone (AMH) levels of the patients with gestational trophoblastic neoplasia (GTN) with uterine preservation during treating with Methotrexate (MTX) regimen and associations with AMH variation.

Methods

This prospective study included 35 patients with low-risk GTN with uterine preservation during single – agent MTX chemotherapy at Hanoi Obstetrics and Gynecology Hospital from August 2021 to August 2022. Serum AMH levels were measured before initiation of chemotherapy and after the 1^st, 2^nd and 3^rd chemotherapy cycles. AMH evolution and its associations with some factors were analyzed.

Results

The median basal AMH level before chemotherapy was 2.87 ng/mL (0.96 – 7.9 ng/mL) and negatively correlated with age. The serum AMH levels decreased significantly after each chemotherapy cycle (2.87 vs. 1.16; 0.91; 0.41 ng/mL). The magnitude of the AMH levels decline after 1^st, 2^nd and 3^rdchemotherapy cycles were 47.4 ± 24.98%; 65.9 ± 26.75% and 74.7 ± 25.3% (p<0.001), respectively. AMH variation was associated with the basal AMH level, but not with age, βhCG at diagnosis and menstrual status.

Conclusion: Our study has shown that the serum AMH levels declined rapidly and steadily in all patients during chemotherapy for GTN. Although AMH cannot be used to monitor fertility potential lonely, these new studies improve our knowledge of ovarian toxicity and ovarian reserve during chemotherapy and strongly support the use of fertility preservation strategies.

Wound healing capacityo f using mesenchymal stem cellderived exosomes originated from human adipose tissue and cold atmospheric plasma

D.T. Quynh — 2024-04-02

Background: Recently, cold atmospheric plasma (CAP), as well as adipose mesenchymal stem cells derived exosomes (ADMSCs-EX), have been applied separately to wound healing treatment. However, no study has investigated the additive effect on the healing mechanism of these two methods in the same skin lesion treatment model.

Aim: We conduct this study to describe the results of using CAP and human ADMSCs-EX on in vitro wound healing.

Methods: The diabetic rat model was induced using an intravascular injection of streptozotocin then categorized into four subgroups which were those treated by CAP, MSC-Exo, CAP combined ADMSCs-EX and PBS (Control group). The animal objects were examined on blood glucose, C reaction protein, total blood count and microbiological tests during the experiment. Wound healing was measured through digital image and histological analysis.

Results: Experimental results to evaluate the ability to stimulate fibroblast migration, showed that cell migration speed in the group supplemented with ADMSCs-EX was equivalent to the group with a combination of CAP and ADMSCs-EX and had the highest rate with 87.8 ± 4.2 % and 84.4 ± 5.3 % while in the control group it was the lowest with 61.9 ± 11.4% (p<0.05). The group supplemented with CAP gave fibroblast proliferation and migration results similar to the control group (p>0.05), showing the safety of CAP with the growth of the cells.

Conclusions: Therefore, in animal models, we intend to use a combination of these two therapies by using ADMSCs-EX injection therapy into the dermis at the wound edge to avoid the impact of CAP affecting the cell proliferation.

A Southern addiction evaluation project: investigating the impact of addiction through a survey HBSC based.

C. Genovese — 2024-04-02

Background: Adolescence is a critical stage of development characterized by numerous physical, psychological, and social changes. During this phase, individuals may engage in experimentation and risk-taking behaviors, leading to a heightened vulnerability to addiction. This article aims to present the results of a survey based on the HBSC surveillance model in a province of southern Italy for students of primary and secondary school.

Methods: we conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to health care professional (HCP) students at University of Messina and students of primary and secondary school, made up by 19 items and based on HBSC surveillance.

Results: we collected a total of 664 questionnaire. We detected that smoking habits increase with age: about 31% of secondary students refer to be actual smoker’s vs 40% of HCP students. At least once, in the three cohort in study experienced drinkness at different rates with younger more propense to drink before than olders students. Luckily, in our sample, no middle school students have tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data.

Conclusions: the presence of addiction behaviors in our sample was widely spread although it was in line with national trend. Furthermore, we observed a reduction in the last years that must be investigated to evaluate the behind reasons. Primary prevention is probably the principal weapon in the hands of policymaker, and it must be applied early in school and community settings in order to reduce prevalence.

A patient with Fibromyalgia and Chronic Recurrent Multifocal Osteomyelitis: the importance of psychosomatic assessment.

A. Olivero — 2024-04-02

Background: Many patients affected by FM present different comorbidities, but to date no case of FM in patients with CRMO has been reported in literature. Several studies show the importance of psychosomatic assessment in FM, but only one reported the presence of allostatic overload.

Case presentation: In April 2022, a 21-year-old female patient, a third-year medical student, came to our clinic to be assessed and treated for FM. She presents with a diagnosis of CRMO made in 2014 and a diagnosis of FM made in 2019.

Results: At the psychiatric evaluation she presented symptoms of anxiety, depression, insomnia and reported widespread pain with the presence of almost daily headaches. From the psychosomatic point of view using DCPR-revised she presented diagnostic criteria for allostatic overload, related to study and periodic flare-ups of painful symptoms due to CRMO, persistent somatization, with musculoskeletal and gastroenterological symptoms, demoralization and type A behaviour.

Conclusion: This case shows how useful a psychosomatic assessment of the patient can be for offering insights into what stressors at the origin of allostatic overload may be present in different FM patients.

Fatal Viral and Bacterial Septicemia in a Seventeen-Year-Old Woman with Immunodepressive Influenza A H1N1: An Autopsy Case

L. Tomassini — 2024-04-02

The Influenza A H1N1 subtype can present with a wide spectrum of severity, from mild symptoms of influenza to severe respiratory distress. The morbidity and mortality connected to influenza are mostly associated with secondary bacterial infections. The influenza syndrome alone can cause a massive release of cytokines with dysregulation of the immune system, and it can act in synergy with other bacteria which can enhance cytokines secretion. This article deals with a case of severe pneumonia of H1N1 in a 17-year-old woman with bacterial superinfection with Staphylococcus aureus characterized by a high level of interleukine-6 (105900 pg/mL) and the appearance of severe leukopenia with immuno-suppression, such that HIV infection and hematological diseases were included in the initial differential diagnosis. After death, the autopsy confirmed the presence of severe pneumonia, in addition to an hepatic steatosis in absence of other risk factors. This case reports the rapid and lethal course of influenza A /H1N1 in a young and healthy subject without co-morbidities, in an age group in which mortality is about 0.3 deaths per 100,000. The case underlines the importance of quickly diagnosis of viral infections and the differential diagnoses with other immunosuppressive diseases, which can be fatal even in adolescent and healthy subjects.

Art-based observational training for medical students and surgical residents in two Dutch museums.

Pien de Ruiter — 2024-04-02

Background

Art-based education is gaining interest in the medical field, particularly in specialties with a strong visual focus. Visual arts are increasingly used for the development of observational skills and social competencies. In this report, we explore the value of art-based observational training for medical students and surgical residents in two prominent Dutch museums in Amsterdam and Rotterdam, respectively.

Methods

Our program, conducted at the Rijksmuseum in Amsterdam and Depot Boijmans van Beuningen Museum in Rotterdam engaged medical students and surgeons (in training) in an interactive workshop focused on art observation led by an experienced art-educator and a clinical professional. A post-workshop survey evaluated participants’ perceptions, with a specific focus on contribution of the program to professional development.

Results

Both residents and surgeons acknowledged that the program had a positive impact on their professional skills. Notably, medical students, comprising 85% of participants, believed in the program’s potential contribution to their professional development. Surgeons were more critical in their evaluation, emphasizing the challenge of sustainable improvement of skills within the limited duration of the course.

Conclusions

An art-based medical education program was offered to medical students, PhD students, house officers, surgical residents and surgeons in two well known Dutch museums. Participants expressed enthusiasm for the innovative educational approach they experienced at the museums. They recognized the importance of critical observation in their professional work and the opportunity to practice both observational and communication skills in a creative manner. Both surgeons as students underscored the positive value of art-based observational training for their professional development.

Radiomic Application for Head and Neck Squamocellular Tumor: Systematic Review

D. Messineo — 2024-04-02

Radiomics represents the convergence of artificial intelligence and radiological data analysis, primarily applied in the diagnosis and treatment of cancer. In the head and neck region, squamous cell carcinoma is the most prevalent type of tumor. Recent radiomics research has revealed that specific bio-imaging characteristics correlate with various molecular features of Head and Neck Squamous Cell Carcinoma (HNSCC), particularly Human Papillomavirus (HPV). These tumors typically present a unique phenotype, often affecting younger patients, and show a favorable response to radiation therapy. This study provides a systematic review of the literature, summarizing the application of radiomics in the head and neck region. It offers a comprehensive analysis of radiomics-based studies on HNSCC, evaluating its potential for tumor evaluation, risk stratification, and outcome prediction in head and neck cancer treatment

Virgin coconut oil – its methods of extraction, properties and clinical usage: a review

Y. L. Rao — 2024-04-02

The virgin coconut oil (VCO) is a processed edible oil, which is removed from the mature coconuts. It is a colourless water insoluble liquid and obtained by the hot and cold extraction processes. Majorly the nutritional components of VCO are contributed by the lauric acid, which is its main content. VCO has shown its anticancer, antimicrobial, analgesic, antipyretic and anti-inflammatory properties. Because of these medicinal property, VCO has gained the wider attention among the medical field. Most evidently VCO has shown its potential antioxidant property, because of its phenolic compounds and medium chain fatty acids. It is one of the beneficial compounds used to prevent and treat the oxidative stress induced neurological disorders like stress, depression and Alzheimer’s disease. Dietary supplementation of VCO is easy and economical as well as safer in the day to day life among all the age groups. It is also beneficial for the cardiovascular, respiratory, dermatological, reproductive and bone health. It can also be used as a skin applicant in the paediatric age group. Hence, exploration of antioxidant property as well as other beneficial effects of VCO in various health conditions will be valuable.