Working Paper of Public Health

PANDAS Syndrome: diagnosis, physiopathology, etiology and treatments

Chiara Volpini — 2024-11-07

The aim of this paper is to carry out a narrative review of the main contributions in the literature relating to PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) Syndrome. The literature search was carried out using Pubmed, Psycinfo, and PsycArticles databases.

The diagnostic criteria and etiology are still debated and objects of research. Several studies suggest that streptococcal infections induce an immunological response that causes basal ganglia modifications. Currently, treatments in practice are pharmacological, immunological, surgical, and psychological, used in combination for greater efficacy. Given the complexity of the syndrome, further studies are needed to better define the syndrome and lead towards targeted treatments.

Analysis of geographical distribution of high-grade glioma diagnoses in the Alessandria province: pilot study preliminary results

Marianna Farotto — 2024-10-14

Background: one under-researched line of investigation is gliomas, which are a group of malignant brain tumours with highly poor prognoses. Despite efforts to identify environmental risk factors for gliomas, their etiology still remains unclear. It turns out that several future developments are needed in order to understand other potential risk factors. To this end, the primary objective of the present pilot study is to conduct an assessment of the spatial distribution of high-grade brain tumor cases in the province of Alessandria, where possible risk factors such as the presence of chemical industries and asbestiform fibers are found.

Materials and Methods: the study sample consisted of all patients diagnosed with high-grade glioma between January 2018 and April 2023, residents in the province of Alessandria at the time of diagnosis and referred to the health facilities of the "Azienda Sanitaria Locale di Alessandria" and the "Azienda Universitario-Ospedaliera di Alessandria". Biographical and pathological history variables were collected, and finally, data were processed in aggregate and anonymized form. A total of 103 deceased patients were enrolled, stratified by age and type of diagnosis.

Results: it was seen that the city with the most cases was Alessandria, with 27 diagnoses found during the period under review (26.2%), followed by cities of Acqui Terme, Casale Monferrato, and Novi Ligure with seven diagnoses (6.8%). Preliminary results presented in this paper were compared with data already published.

Conclusions: analyses performed to arrive at an initial geographical distribution of high-grade glioma diagnoses are consistent relative to the population density of each municipality considered.

Psychological care of cancer patients in the diagnostic and therapeutic care pathway: the experience of the AOU Alessandria

Simona Giribone — 2024-10-25

Cancer is still the second leading cause of death in the world after cardiovascular disease, even though technological advances have led to a significant increase in survival in recent years. Cancer patients, precisely because of the complexity and nature of the problems they face, need a global and integrated multidisciplinary and multidimensional approach in their diagnostic-therapeutic pathway.
The reference model is bio-psycho-social: the traditional body-centered medical model is replaced by a person-centered approach, with the integration of physical, psychological, and social dimensions of the individual.

Psycho-oncology is placed in this area of multidisciplinarity and multidimensionality, on one hand constantly interfacing with other medical disciplines, and on the other developing personalized care paths for the patient and his family, which consider not only phys- ical but also psychological, existential and welfare needs.
This article describes the activity of the Psychology service of the AOU AL in taking charge of cancer patients, from the moment of diagnosis (or diagnostic suspicion) throughout the treatment and follow-up pathway, with reference to the moments of evaluation/assessment and interdisciplinary comparison.

Data managers and clinical research coordinators: a tool to collect the hourly activity

Giorgia Piceni — 2024-11-13

Background and Aims: the main purpose of this paper is analyzing the hourly activities performed by Data Managers (DMs) and Clinical Research Coordinators (CRCs) in a Clinical Trial Center (CTC) of an Italian Public Hospital in order to define and monitor the relevant job descriptions of these professionals

Materials and Methods: the CTC of the Research and Innovation Departments (DAIRI) has created a tool to collect the hourly activity of DMs and CRCs. In the period between January 1 and December 31, 2022; the activities were collected and grouped in 24 macro areas.

Results: the main activities conducted by staff are found in the macro areas "Study Management" (15.78%); "Briefing/Planning" (12.86%) and “Data Management/Data Entry” (12.42%). A difference was found between the activities carried out by CRCs and those conducted by DMs.

Conclusions: the results of this monitoring, compared with data obtained at the national level, confirm the heterogeneity of the tasks performed by these professional figures. These differences increasingly underscore the need to obtain recognition of the figure by the National Health System (NHS) with the definition of a precise “job description”.

Intervention with strategic metacognitive training in a population of elders with subjective cognitive decline

Daniele D'Alessio — 2024-07-17

Objectives: this research, conducted at the University Hospital of Alessandria, aimed to assess the impact of strategic metacognitive training on cognitive abilities, well-being, and the reduction of depressive symptoms in an elderly population. Materials and Methods: the study included a sample of 11 subjects, aged 66 to 81 years, exhibiting subjective cognitive decline. They had to learn mnemonic strategies and, through the metacognitive task, reflecting on the learning and application processes. The training included 10 sessions, once a week. Cognitive functioning was assessed using the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) in pre-test and post-test evaluations. Ad hoc tests were employed to investigate the effects of practice and generalization. Well-being, measured through the Psychological Wellbeing Questionnaire (BEN-SSC), and depressive status, assessed with the 15-item short form Geriatric Depression Scale (sfGDS), were also evaluated before and after the intervention. Results: the cognitive measurements yielded no significant findings, except for a tendency toward significance in the visuospatial and language ability index of the RBANS, indicating a slight improvement. Regarding well-being and mood, also here no results emerged in favor of significance. The only significant data was a reduction in personal satisfaction according to the BEN-SSC. Conclusions: the obtained results may be explained by potential inadequacies in the methodology, specifically in the structure and planning of the training. However, participants expressed interest in this type of intervention, demonstrating adherence in other training program.

Evaluation of the appropriateness of control measures related to nosocomial transmission of multidrug-resistant microorganisms within the SS Multipurpose Intensive Care Unit: observational study

Paola Toselli — 2024-06-17

Background: Healthcare-Associated Infections (HAIs), by definition, occur 48 hours or more after admission or within 30 days after discharge or surgical procedure; they represent a significant challenge for the healthcare system due to their prevalence in Italy and the involvement of multi-drug resistance. Intensive Care Units (ICU) exhibit the highest prevalence of such infections due to lapses in adherence to safety protocols. The primary cause of hospital-acquired infections is poor adherence to guidelines for the prevention and control of these infections. This study aims to evaluate infection control measures in a mixed ICU. Materials and Methods: a cross-sectional observational single-center study was conducted in the Mixed ICU at the University Hospital of Alessandria. The study used an assessment tool based on the DVA 91 rev 03 issued on 07/22/22. This tool provides guidance on isolation type (airborne, contact, droplet), patient accommodation, care measures, cleaning and disinfection protocols, patient transportation, and visitor management. Results: overall, 220 observations were included, primarily involving nurses (75.4%) and female personnel (65.9%), with a mean age of 35.8 years and a median length of service of 36 months in the Mixed ICU. Notably, all observations were made on patients in contact isolation. In 199 observations (92.6%), healthcare providers performed hand hygiene immediately after glove removal. Conclusions: the findings highlight a strong adherence to infection control protocols at Alessandria Hospital-University. These efforts promote a safety culture among healthcare providers, ensuring the effective implementation of preventive measures.

Assessment of the adequacy of bowel preparation in patients undergoing colonoscopy: a retrospective study

Roberta Di Matteo — 2024-06-07

Background: a colonoscopy is crucial for detecting Colorectal Cancer (CRC), and its success is reliant on various fac- tors, notably colon cleansing. Investigating the frequency of procedure interruptions due to inadequate bowel prepara- tion and associated predictive factors could inform targeted interventions. This study aimed to retrospectively assess inadequate bowel preparation rates in outpatient and inpatient settings. Materials and Methods: this observational, retrospective, and single-center study examines patient records from a sin- gle hospital in northern Italy. This investigation involves individuals who underwent colonoscopies from January 1, 2021, to December 31, 2021, regardless of whether they were receiving outpatient or inpatient care. Results: this study included 1977 participants. The median age of all participants was 64 years, with ages ranging from 41 to 86. Among males, the median age was 65 years, varying from 56 to 74, whereas for females, it was 64 years, rang- ing from 55 to 74. The majority (78.7%) of participants came from their homes. The type of product used for colon preparation was evaluated in 1783 patients: 92% of them used an osmotic action product (55.7% high volume, 36.3% low volume). The adequacy of the colon preparation for the procedure, assessed using the Boston Bowel Preparation Scale, was found to be poor (score≤5) for 24.2% of the participants, with 13.5% scoring 0. Conclusions: the study suggests healthcare providers should enhance patient education for colonoscopy preparation, especially focusing on hospitalized patients with higher rates of inadequate preparation. Strategies should align with guidelines but also prioritize personalized approaches.

An investigation on nurses’ competencies and practices regarding enteral tube medication administration: a cross-sectional study

Roberta Di Matteo — 2024-06-03

Background: understanding how healthcare professionals correctly administer medications through enteral routes is necessary to reduce patient morbidity and mortality. The study’s objective is to evaluate nurses’ competencies and management methods in administering oral medications to hospitalized patients who have enteral feeding tubes. Materials and Methods: an observational cross-sectional study involving nurses employed at the University Hospital for at least six months. A survey consisting of 16 questions related to medication dilution, pharmaceutical form management, and enteral medication administration techniques was administered. Results: a total of 218 nurses were recruited, with a mean age of 30.95 years (SD 6.15), of whom 132 (60.5%) were female, and 173 (78.9%) held a bachelor’s degree. Approximately half of the responses (49.3%) were incorrect. Conclusions: nurses should improve their knowledge regarding enteral medication administration. Nurses are responsible for pharmacological management, and their level of knowledge directly impacts the health and safety of these patients. Therefore, specific training addressing the identified gaps would be appropriate.

Prognostic evaluation of KRAS and BRAF mutations in relation to Mismatch Repair protein status: preliminary survival analysis of patients with Colorectal Cancer

Carlotta Bertolina — 2024-05-15

Aims: prognostic impact of mutations in BRAF and KRAS genes in patients with colorectal cancer was evaluated to detect variations in survival among patients with these mutations, in relation to different morphologic features identified at diagnosis and the expression of mismatch repair proteins. The final purpose of the project will be to establish models to predict variations in survival in different subsets of patients with colorectal cancer. Materials and Methods: partial survival analyses were conducted on 32 subjects in relation to three different variables: mutation in BRAF or KRAS genes, expression of mismatch repair system and morphological features of the tumor. Results: preliminary results of this study provide evidence that survival in different subsets of patients with colorectal cancer can be influenced by several factors, which include, in addition to immunohistochemical and molecular investigations, the assessment of different morphological features. Conclusions: Integrating different characteristics may reveal which factors have a more significant impact on survival in these subgroups. More patients will be needed to design different survival models and to check these preliminary results more effectively.

From Emergency Department to clinic center: management of patients with Heart Failure with Reduced Ejection Fraction

Jacopo Mambella — 2024-05-13

Aims: primary outcomes - cardiovascular and all-cause mortality evaluation within 1 year in elderly patients enrolled with Angiotensin Receptor Inhibitor (ARNI) and/or Sodium Glucose Co-Transporter Type 2 Inhibitors (SGLT2-i) in an Internal Medicine Department; recurrent hospitalization assessment for acute Heart Failure with Reduced Ejection Fraction (HFrEF); length of hospitalization analysis compared to not-enrolled patients. Secondary endpoints - to identify any parameters predicting the length of hospitalization; safety assessment through the incidence of complications and treatment interruption. Materials and Methods: prospective observational real-life cohort study that analyzes the recruitment during hospitalization and follow-up 3-6-12 months after discharge. Several clinical parameters were recorded for each patient of any ethnicity, considering a diagnosis of acute HFrEF with NT-proBNP and chest x-ray. Results: the enrolled group (34 patients) showed a hospitalization period lower than the not-enrolled one. The rehospitalizations percentage was inferior to Randomized Clinical Trials (RCTs) for ARNI. Cardiovascular-cause mortality, symptomatic hypotension, and Urinary Tract Infections (UTI) were lower than RCTs data. Age, eGFR, NT-proBNP, Cumulative Illness Rating Scale (CIRS), and severe comorbidities, except for EF, predicted the lengthening of hospitalization. Hypoglycemia wasn’t recorded. Conclusions: ARNI/SGLT2-i are effective and safe in elderly patients. Comorbidities and bio-humoral features influence HFrEF and quality of life. The future aim is to confirm the results obtained so far.

A survey on prostate symptoms and quality of life in men with comorbidities at the Public Hospital SS. Antonio e Biagio e Cesare Arrigo of Alessandria

Alessia Francese — 2024-03-26

Background: Benign Prostatic Hyperplasia (BPH) is a pathological condition characterized by an increase in the size of the prostate gland which can lead to Lower Urinary Tract Symptoms (LUTS) that affect the quality of life. Methods: the International Prostatic Symptoms Score (IPSS) questionnaire was used to assess the symptoms of benign prostatic hyperplasia in male individuals with comorbidities, patients over 30 years of age who had not been diagnosed with urological or prostatic disease. Results: a total of 102 IPSS questionnaires were analyzed. According to age, 62.1% of patients reported mild symptoms, 34% had moderate symptoms, and 3.9% had severe symptoms, consistent with increasing age. Among patients who completed the questionnaire, a higher percentage (67%) had voiding dysfunction during the filling phase. Conclusions: in agreement with the literature, the IPSS questionnaire can be used as a screening model for the early detection and management of LUTS. As demonstrated by our results, symptoms worsen with age, therefore early detection may reduce the risk of complications and anticipate a visit to a specialist.

Contextual analysis of the first SARS-CoV-2 RNA screening period in nasopharyngeal swabs, 2020-2022: a comparison of two diagnostic tests

Elisabetta Scomparin — 2024-05-03

Background: exceptionally consistent COVID-19 laboratory diagnostics are crucial for case identification, patient management and contact tracing. The Coronavirus-2019 (COVID-19) pandemic affected over 771.407.825 people up until October 2023, with over 6.9 million deaths. The current process of clinical laboratory consolidation, impacting large geographic areas, presents an opportunity for the efficient and cost-effective implementation of novel laboratory technologies, as well as advancements in translational research and development. The aim of this study was to assess which of the two instruments could offer the most effective support to our laboratory’s activities, minimizing errors during the pre-analytical phase, optimizing human resources, and reducing the Turn-Around-Time (TAT). Materials and Methods: the diagnostic instruments available in the Microbiology laboratory of the Azienda Ospedaliero- Universitaria SS Antonio e Biagio e Cesare Arrigo (AOUAL) were the COBAS 6800 and the ALINITY platforms. Conclusions: the Alinity platform offers clinicians a more user-friendly approach to understanding patient infectivity, compared to the closed Cobas system. It permits clinicians to review curves and access a cumulative Cycle Threshold (Ct), facilitating the hypothesis of acute or initial/final infection stages. This positions Alinity by Abbott as the preferred system over other instruments.

New forms of reproduction between juridical aspects and psycho-analytical questions

Patrizia Santinon — 2024-05-03

The new reproductive techniques represent a challenge to the traditional boundaries within which generating was conceived with a transition from a cultural world based on gender and role differences to a semantic range of genders, roles, positions, functions. This article will discuss the issues of reproductive health, generative identity, and fertility in the therapist-patient relationship based on excerpts from consultations. It will highlight how new types of motherhood open both bioethical and psychoanalytic questions between nature and nurture that are difficult to translate into legal terms.

Implementation and impact of Fast-track in an Emergency Room: pre-post study

Carlo Alboreo — 2024-04-24

Background: overcrowding and long waiting times are major problems in Emergency Departments (EDs). Fast-Track (FT) is a process developed to more effectively manage patients admitted to EDs with non-urgent conditions. The aim of the study was to evaluate the impact of the FT method regarding access in an ED. Materials and Methods: pre-post implementation study of the FT method. All patients attending the emergency department of the ASL of Barletta presenting minor emergencies with problems in the obstetric/gynaecological, ophthalmological, paediatric, otorhinolaryngological and orthopaedic areas were included. Results: of the 38,024 services performed in the ED, 1606 (4.22 %) were FT accesses. Analysing the data from the period May 2017 (pre) and calculating in minutes the waiting time from triage to discharge is 55 minutes; instead in the period May 2022 (post) it is 20 minutes. Conclusions: the FT method seems to be a useful and safe strategy to improve the management of patients admitted to emergency rooms with minor disorders.