Smoking habits predict adverse effects following mRNA COVID-19 vaccine: Empirical evidence from a pilot study

Objectives

The aim of this research was to investigate the possible association between smoking habits and the incidence of adverse effects (AE) following mRNA COVID-19 vaccine.

Study design

A longitudinal observational study was conducted in a sample of Italian healthcare workers (HCW).

Methods

HCWs who were administered mRNA COVID-19 vaccine (either BNT162b2 or mRNA-1273) were evaluated for the occurrence of AEs after three vaccine doses. Multivariate Poisson regression analyses were fitted to predict AE risk according to smoking characteristics – such as number of tobacco cigarettes smoked per day, smoking time and use of electronic cigarette (e-cig).

Results

Out of 320 total participants, 72 (22.5%) smoked cigarettes and 50 (15.6%) used e-cig, 49 of which being dual users. Tobacco smoking significantly increased the risks of muscle and joint pain during the primary COVID-19 vaccination cycle, and of chills during the whole vaccination series. The number of cigarettes smoked per day and vaping variously predicted AE onset during the whole cycle, with a tendency to respectively reduce and increase their risks. Duration of smoking did not affect any AE, except for headache after booster dose. Most results remained significant after Bonferroni adjustment of significance level.

Conclusion

Our pilot study indicated a possible effect of smoking habits on AE onset. Our research offers evidence that helps understanding possible predictors of the interindividual variability in COVID-19 vaccine response, serving as a reference for further studies on the effect smoking on vaccine safety and effectiveness.

The use of digital tools to promote health in children: A systematic review of intervention studies

Background

Early childhood health interventions and educational programs are key to keeping children healthy and preventing disease during adulthood. Since several preventive strategies and campaigns targeting children have been proposed, the aim of this systematic review is to evaluate the effectiveness of digital-based interventions (e.g., cartoons, videos, video games, mobile apps, etc.) in promoting healthy behaviours in primary school-aged children.

Methods

Following PRISMA guidelines, we searched three electronic databases (Medline, Embase, and Scopus) up to April 11, 2022. We included randomized and non-randomized experimental studies quantifying the effectiveness of digital or audio-visual-based health promotion interventions in childhood (up to 12 years of age).

Results

The search strategy yielded a total of 1640 articles. Retrieved studies covered a wide range of health interventions - including a healthy diet, physical activity promotion, oral hygiene, skin cancer prevention, and different educational approaches (such as cartoons, interactive video games, etc.), mainly implemented in a school setting and comparing digital interventions to teacher-led interventions or no intervention at all. Data pooling suggests that digital and audio-visual-based health promotion interventions targeting children are effective in improving health literacy and healthy behaviours.

Conclusions

This systematic review adds to the body of knowledge on health promotion in children and provides actionable measures to implement straightforward educational approaches in this specific population, empowering them to adopt preventive behaviours, and ultimately promoting health at the household and societal level.

Key messages

Hospital hand hygiene after COVID-19: has the pandemic heightened healthcare workers’ awareness?

Background

Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities.

Methods

Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice.

Results

Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves).

Conclusions

These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH.

Key messages

• The COVID‐19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures.

• HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era.

Appraising the quality of guidelines for caries management using AGREE II: a systematic review

Background

Caries is one among the most prevalent dental disease and its prevention and treatment are crucial from both dental care and public health perspectives. Yet, caries’ management greatly varies across contexts according to the availability of specific Clinical Practice Guidelines (CPGs). Here, we present the results of a systematic review aimed at the appraisal of the current available CPGs on caries prevention and treatment.

Methods

A literature search was performed in PubMed, EMBASE, SCOPUS, and seven relevant guidelines databases up to March 2022, exploring CPGs published from 2012. The literature review was conducted in accordance with PRISMA guidelines. The Appraisal of Guidelines, Research and Evaluation (AGREE) II checklist was used to measure the methodological rigour and quality of the retrieved CPGs.

Results

The systematic search resulted in a total of 1403 records, and 21 CPGs met the inclusion criteria. Overall, these considered different aspects of caries prevention and treatment. Regarding the appraisal through the AGREE II tool, the overall median score was 60.2% and 11 out of 21 CPGs were classified as “Recommended”, while the others as “Recommended with modification”. The domain analysis showed that the highest median scores were reached for Scope and Purpose (88.9%), Clarity of Presentation (86.9%), and Rigor of Development (67.8%), while the lowest were seen for Stakeholder Involvement (63.3%), Applicability (17.5%), and Editorial Independence (50%).

Conclusions

This systematic review showed that the rigor of CPGs for caries prevention and treatment remained suboptimal according to AGREE II evaluation, and highlighted that more efforts are needed to improve their quality. The AGREE II checklist is a comprehensive and easy-to-use tool for the development of CPGs, and its use ensures that evidence-based approaches are incorporated into consistent recommendations for the translation of evidence into practice.

Key messages

• The rigor of CPGs for caries prevention and treatment is suboptimal according to AGREE II evaluation, however, more efforts are needed to improve their quality.

• The AGREE II checklist is a comprehensive and easy-to-use tool for the development of CPGs.

A new tool for assessing the risk of fall in children with severe disability: development of the ALICE scale

INTRODUCTION

It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities.

STUDY DESIGN

Observational prospective study.

METHODS

We enrolled children (inpatients or day-hospital) admitted to the "Santa Maria Bambina Centre" of the "Fondazione Onlus Sacra Famiglia" in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach's alpha coefficient (α) was used to examine internal consistency, Spearman's rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated.

RESULTS

Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach's alpha (=0.72) were satisfactory.

CONCLUSIONS

The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.

Does smoking have an impact on the immunological response to COVID-19 vaccines? Evidence from the VASCO study and need for further studies

OBJECTIVES

The aim of this study was to investigate the possible impact of smoking on the humoral response to the BNT162b2 mRNA COVID-19 vaccine (also known as the BioNTech-Pfizer COVID-19 vaccine).

STUDY DESIGN

A longitudinal sero-epidemiological study was conducted in sample of Italian healthcare workers (HCWs).

METHODS

HCWs who were administered two doses of the BNT162b2 mRNA vaccine, 21 days apart, between December 2020 and January 2021, were invited to undergo multiple serology tests to identify SARS-CoV-2 S-RBD-specific immunoglobulin G (IgG) antibodies. Participants also responded to questions about their smoking status (i.e. current smokers vs non-smokers) in a survey.

RESULTS

Sixty days after the completion of the vaccination cycle, serological analyses showed a difference in vaccine-induced IgG titre between current smokers and non-smokers, with median antibody titres of 211.80 AU/mL (interquartile range [IQR] 149.80-465.50) and 487.50 AU/mL (IQR 308.45-791.65) [P-value = 0.002], respectively. This significant difference in vaccine-induced IgG titres between current smokers and non-smokers remained after adjusting for age, sex, and previous infection with SARS-CoV-2.

CONCLUSIONS

This study observed that vaccine-induced antibody titres decrease faster among current smokers than non-smokers. Further research to investigate the impact of smoking on the immunological response to COVID-19 and non-COVID-19 vaccines is required.

Use of antidepressants during COVID19 outbreak: a real-world drug-utilization study

Background

Lockdown measures implementation (LMI) to prevent COVID19 disease diffusion was associated to increased depression and anxiety cases. The main aim was to evaluate whether LMI affected prevalence and incidence of antidepressants (ADs) use, and ADs treatment interruption (TI) in the general population.

Methods

Adults (≥18 years) with at least 1 dispensing of ADs between 01/01/2019-26/09/2020 were selected from a regional Italian healthcare administrative database. Patients presenting an AD dispensing in the year preceding the first observation were considered as prevalent otherwise as incident users. We divided the studied period into 3 parts: pre-lockdown (01/01/2019-08/03/2020), lockdown (09/03/2020-14/06/2020) and post-lockdown (15/06/2020-27/09/2020). The weekly prevalence (WP) and incidence (WI) per 10,000 inhabitants were compared among periods. Incidence of TI (no dispensing refill within 30 days of the end of its validity) was computed among prevalent AD users.

Results

The WP (mean of 552.3 per 10,000 pre-lockdown vs 505.5 lockdown phase; relative change: -9%) and WI (5.2 vs 3.7; -29%) of ADs use decreased after LMI. During the post-lockdown phase WP (505.5 vs 495.9; -2%) decreased whereas the WI (3.7 vs 4.3; 16%) slightly increased in relation to the lockdown period, although differences were not statistically significant. Conversely, the incidence of TI increased during lockdown (344.7 vs 384.3; 12%) and post-lockdown (384.3 vs 394.2; 3%) periods, even not always statistically significant.

Conclusions

Our analysis showed a reduction of ADs use during the early phase of lockdown. Several factors might have impacted on the observed phenomenon (i.e, patient reluctance to start new AD treatment). Considering the mutation of the virus and the potential waves that might occur in the next months, a continuous monitoring of the impact of COVID19 on mental diseases onset and treatment adherence are suggested.

Key messages

In Italy, the implementation of lockdown measures was followed by a reduction in antidepressants use, even though evidences are that diagnoses of psychiatric disorders increased.

Future studies should monitor if these phenomena led to an increase in adverse events potentially correlated with inappropriate treatment of depression.

Field evaluation of BNT162b2 COVID-19 vaccine response in healthcare workers: a 3-month follow-up

Background

Effective and rapid immunologic response to vaccines is a crucial strategy for the control SARS-CoV-2 pandemic. Here, we present the results of an ongoing longitudinal observational study conducted among the healthcare workers (HCWs) of the Pineta Grande Hospital (Castel Volturno, Italy), who were administered the two-dose prime-boost mRNA vaccine BNT162b2.

Methods

Volunteer HCWs underwent either (i) six RT-PCR assay for qualitative detection of SARS-CoV-2 nucleic acid in nasopharyngeal/oropharyngeal swabs; (ii) or six quantitative serology testing for the research of virus-specific immunoglobulins (Ig) through chemiluminescent immunoassay with a reactivity cut-off of an Index of ≥ 1.0. The first tests were taken before the administration of the vaccine and then according to a predefined timeline. An active surveillance follow-up of SARS-CoV-2 infections was set amongst the vaccinees after the end of the study.

Results

Overall, among the 435 HCWs who accepted to participated in the study, 9.3% reported a previous laboratory-confirmed infection with SARS-CoV-2, though all subjects tested negative at the time of first vaccine dose. In the swab cohort, seven subjects tested positive in the first 15 days after the first vaccine dose and one about a week from the second dose. At 45- and 60-day follow-ups all vaccinees tested negative, but two positive tests were registered at the third month. In the second cohort, two weeks after the first vaccine dose anti-SARS-CoV-2 antibodies exceeded the reactivity cut-off in 82.5% the participants. At one-month follow-up, almost all (98.4%) the vaccinees had reached the maximum Index value of 10. No statistically significant associations were found between antibody response and HCWs' characteristics.

Conclusions

Our results showed that surveillance is a critical component of providing safe healthcare during COVID-19 pandemic, also after extended vaccination campaigns, thus enhancing the protection of patients and HCWs.

Key messages

All healthcare facilities should implement continuous post-vaccination surveillance programs in order to ensure patients and healthcare workers safety, and limit in-hospital transmission of SARS-CoV-2.

Longer field follow-ups are indispensable to investigate immunogenicity trends and effectiveness of COVID-19 vaccines over time, and to consider booster doses, especially in high-risk population.

The impact of Covid-19 healthcare emergency on the psychological well-being of health professionals: a review of literature

Introduction

The Coronavirus pandemic (Covid-19) was first identified in December 2019 in the city of Wuhan, China, and later caused a severe health crisis, causing massive disruptions to most healthcare systems worldwide. The Covid-19 health emergency has seen healthcare workers in the front line facing all the difficulties related to the care burden. One of the most significant and probably underinvestigated aspects is the psychological stress of the healthcare staff managing the emergency. The aim of the paper is to analyze the literature on the impact of the Covid-19 crisis on the psychological well-being of health professionals.

Methodology

We conducted a systematic review of articles published on this topic during the months from January 2020 to December 2020, searching on Pub Med, Scopus and Web of Science databases.

Results

Most of the issues can be summarized into five conceptual categories: Stress, Depression and Infection Anxiety, Anguish, Insomnia, Post Traumatic Stress Disorder, and Suicide. The literature identifies many factors contributing to the onset of anxiety, depression, and stress, like the fear of contracting the disease and transmitting it to family members and friends, stressful shifts, and little rest among several others. The literature highlights the needs for adequate measures, including proper psychological support.

Conclusion

The conducted review suggests that the behaviours of healthcare professionals during the emergency phase of the Covid-19 pandemic show psychological disorders that can compromise mental health. Therefore, there is a call for those in chief like hospital managers and policymakers to take action, promoting measures like surveillance, monitoring, and psychological support among others, to increase the resilience of healthcare workers, limiting stress and anxiety and allowing them to keep their performance at work.

Induction of mitochondrial dysfunction in patients under cardiopulmonary by-pass: preliminary results

OBJECTIVE

Cardiac surgery is often performed by cardiopulmonary by-pass (CPB), generally associated with organ dysfunction. The aim of this work was to determine if and how this phenomenon is related to mitochondrial damage. To this purpose, the effect of the addition of serum from CPB patients to human fibroblasts cultures on mitochondrial respiratory chain and oxidative phosphorylation (OXPHOS) activities was investigated.

PATIENTS AND METHODS

Serum samples of five patients were obtained before (pre-CPB) and after 6 h CPB weaning (CPB). Mitochondrial OXPHOS activities were examined by polarographic and spectrophotometric assays, and reactive oxygen species (ROS) production was measured by a spectrofluorimeter.

RESULTS

Addition of CPB serum to fibroblasts determined a decrease of mitochondrial oxygen consumption due to an inhibition of mitochondrial respiratory chain and some OXPHOS enzymes activities. This inhibition seems to be mainly related to a reduced activity of complex I.

CONCLUSIONS

Our data represent the first translational research evidence showing that CPB determines mitochondrial dysfunction which leads to impairment of OXPHOX activities and to an increase in ROS production, compromising tissue bioenergetic efficiency.

Economic analysis of the stand-by emergency treatment (SBET) for malaria in travellers

Background

Stand-by emergency treatment (SBET) is a possible approach for malaria prevention in travellers to low transmission areas (such as South-Eastern Asia [SEA]), but current evidence casts doubts on its feasibility and does not allow to decide whether this strategy is economically rational. Thus, this research aimed to appraise SBET in terms of cost-benefit/cost-effectiveness analysis from the perspective of the National Health Service (NHS).

Methods

To design a specific model, SBET benefits (valued as avoided direct and indirect costs of illness) were weighted against the costs associated with SBET doses to be prescribed in order to avoid one imported case of malaria. Direct healthcare costs were obtained allocating last surveillance data for imported malaria to the charge of the corresponding diagnosis-related group category and estimating outpatient care costs. Indirect social costs were calculated in terms of lost productivity. The economic framework was adjusted for the probability of malaria transmission in SEA region and weighed on the Italian context.

Results

In the model, for five malaria cases estimated to be imported from SEA to Italy in 2017, it was calculated that NHS would be charged with around € 22,487·50. Social costs were determined at € 7,100. Thus, the total Italian public expenditure for malaria cases in SEA travellers was of € 29,587·50 in 2017. In contrast, 50,000 doses were considered to be carried to avoid one malaria imported case, with a cost of € 2.5 million.

Conclusions

At cost-effectiveness analysis, reimbursement strategy does not lead to a favourable gain owing to the total cost of the SBET doses to be prescribed for avoiding one malaria case. The appraisal of costs and benefits brings into question the economic validation of SBET, also calling for further strategies to be reassessed for travellers to low-risk areas.

Key messages

Besides the evidence of incorrect SBET use among travellers, the appraisal of costs and benefits brings into question the economic validation of this strategy. Reimbursement for SBET seems to be not cost–effective from the perspective of National Health Services.

The economic impact of air pollution: a European assessment

Background

In 2017, the Global Burden of Disease Study estimated that in Europe 0.42 million deaths and 8.9 million disability-adjusted life years were attributable to air pollution. Monetizing this burden is a key step for estimating benefits of exposure reduction strategies. However, robust and synthetic estimates of direct (e.g. due to hospitalizations or medications) and indirect (e.g. due to premature mortality or loss of productivity) health-related costs of air pollution seem to be still lacking. We carried out a systematic review, aimed at identifying evidence from research in Europe.

Methods

We searched 5 electronic databases (MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web Of Science) in which we applied algorithms tracing keywords such as “cost of illness”, “health care costs”, “economics” and synonyms, together with “air pollution” and synonyms. We limited our search to articles written in English and Italian, without date restriction.

Results

The initial search retrieved 2420 records. 200 were classified as relevant, and 38 fulfilled inclusion criteria. Most of them (68%) were published after 2010. 26% were multi-country studies, while the remaining focused on a single country or city. Investigated pollutants were usually particulate matter (79% of the studies) and nitrogen oxides (37%). The approaches to the economic analysis were heterogeneous: estimates could include direct and/or indirect costs. Among the studies, the most comprehensive one (12 countries) estimated that complying with WHO guidelines would avert €31 billion yearly, of which €19 million due to hospitalizations.

Conclusions

Over the last decade, progress has been made in evaluating the economic burden of air pollution. However, estimates based on indirect costs are affected by high levels of uncertainty, while those based on direct costs are more robust and should be further investigated, since they are crucial information for healthcare policy makers.

Key messages

Air pollution poses a high economic burden on European countries, mainly due to social costs. More attention should be devoted to estimating direct healthcare costs of air pollution, in order to properly inform policy makers about the impact on healthcare systems.

An exploration of cancer-related mortality attributable to infections in Italy

Background

Previous attempts estimated the impact of infectious agents on cancer incidence in Italy, but the burden of carcinogenic infections on cancer mortality remains unknown. Therefore, we aimed to conduct a preliminary analysis in order to estimate this burden at country level.

Methods

We applied the global, regional, or national population attributable fractions for Helicobacter pylori, hepatitis B virus (HBV), hepatitis C virus (HCV), high-risk human papillomavirus (HPV) types, Epstein-Barr virus (EBV), human herpesvirus type 8 (HHV-8), and human T-cell lymphotropic virus type 1 (HTLV-1) - all microorganisms ranked as group 1 carcinogenic agents in human beings by the International Agency for Research on Cancer - to 2015 cancer-related deaths recorded according to the 10th International Classification of Diseases coding system in Italy.

Results

We estimated a total of 14,120 deaths attributable to carcinogenic infections, being 8.3% of the total of cancer-related deaths (n = 170,339). 58.8% of those occurred in men. H. pylori, HCV, HBC, and HPV accounted for 96.4% of the whole mortality burden attributable to carcinogenic infections in both sexes. H. pylori was responsible for 8,116 (57.5%) deaths due to gastric carcinoma (non-cardia and non-Hodgkin lymphoma). Hepatitis-related liver cancer accounted for a total 4,372 deaths: 3,812 due to HCV infection and 560 to HBV. Cancers related to HPV infection represented the third most frequent cause of deaths due to carcinogenic infections in women.

Conclusions

We estimated that one out of 12 cancer deaths in Italy was attributable to an infection sustained by carcinogenic agents. Such mortality burden is potentially avoidable, given that these infections are both potentially preventable and treatable. Thus, these estimates provide actionable metric of the burden for the implementation of specific public health measures. Further analyses will provide more accurate estimates of this disease burden.

Key messages

In Italy, one out of 12 cancer-related deaths is attributable to infections sustained by preventable or treatable carcinogenic agents. These estimates provide metric of carcinogenic infections for the implementation of specific public health measures to avert the related mortality burden.

Intranasal drug administration for procedural sedation in children admitted to pediatric Emergency Room

OBJECTIVE

Pain relief is a very important aspect in Pediatrician's clinical practice. It is often thought that young children, particularly infants, do not perceive as much pain as adults because of their immature nervous system and that untreated pain would not have adverse long-term consequences. Instead, it has been demonstrated that infants and children experience pain in a similar manner to adults. Many factors, particularly emotional factors, can increase the child's pain perception. Children live with anxiety even minor procedures. This suggests the need for an adequate sedation and the way of sedation should be free of pain itself. We believe the route to be followed may be the intranasal (IN) administration of sedative drugs.

MATERIALS AND METHODS

We have conducted a brief review of the literature by Pubmed about the most commonly used sedative drugs: sufentanyl, fentanyl, midazolam, ketamine, nitrous oxide and dexmedetomidine. We have investigated in the literature the type of administration of IN drugs: drop instillation or by a mucosal atomizer device (MAD).

RESULTS

In our study, it was noted that IN drugs administration is an effective and safe method to reduce anxiety and to deliver analgesia because it is practical and non-invasive. Moreover, therapeutic levels of sedatives are low due to the presence of a rich vascular plexus in the nasal cavity, which communicates with the subarachnoid space via the olfactory nerve and reduce the time of medication delivery, that is, the onset of action. The use of MAD even gives as better bioavailability of drugs.

CONCLUSIONS

IN sedation via MAD is effective and safe and should be one of the first choices for procedural sedation in children.

Paroxysmal non-epileptic events in the pediatric emergency department

Paroxysmal non-epileptic events (PNEs), or pseudoseizures (PS) resemble epileptic seizures. They are considered part of a personality disorder and have a higher incidence among adolescents. Patients describe episodes (lasting up to 20 minutes) of loss of consciousness, twitching or jerking and unusual emotional states. Unlike epileptic seizures, they are not associated with electroencephalographic abnormalities. Distinguishing epileptic seizures from PNEs is not easy. 20% of patients with seizures have a final PNEs diagnosis but recognizing them on the first examination is difficult. Due to the severe initial clinical presentation, these patients are often admitted in the Pediatric Intensive Care Unit (PICU) and may be over-treated. We report two cases admitted to our PICU for apparent status epilepticus, in which the final diagnosis was PNEs.

Benign Breast Surgical Biopsies: Are They Always Justified?

Aim of the study

To evaluate the indications for open surgical biopsy of breast lesions resulting in a benign histologic report.

Methods

A consecutive series of 754 benign breast biopsies was collected from six Italian centers previously participating in a multicenter study on the benign/malignant biopsy ratio. Histologic diagnosis, diagnostic tests performed, final clinical diagnosis and the indication for surgical biopsy were compared.

Results

Fibrocystic alterations represented the most frequent histologic type (43.2%), followed by fibroadenomas (34.5%). Atypical hyperplasia, phyllode tumors and cancerlike lesions (radial scar, sclerosing adenosis) accounted for a minority of cases. The diagnostic approach was different among centers, with mammography, ultrasonography or cytology being underused in some of them. Suspicion of cancer was an indication for surgical biopsy in 66.7% of cases. In the remaining cases the final report was negative or benign, but biopsy was advised for growing lesions (11.3%) or for cosmetic (3%) or psychological reasons (8.2%). In 4% of cases surgical biopsy was presumably advised for the concurrent influence of high-risk conditions such as previous breast cancer (0.7%), family history of breast cancer (2%) or contralateral synchronous breast cancer (1.3%). In 6.8% of the cases biopsy was advised elsewhere for unknown reasons. The indications for biopsy differed among centers, with one center having a low rate of suspicious cases (37%) and a high rate of reported “cosmetic” or “psychological” reasons (47%).

Conclusions

Leaving aside differences in diagnostic approach and aggressiveness, two thirds of all lesions were biopsied in order to exclude cancer. The routine use of a more complete diagnostic protocol and/or alternative methods to obtain a histologic diagnosis (e.g. core biopsy) might substantially reduce the need for open surgical biopsy.

Oral Desmopressin Lyophilisate Formulation (MELT): Efficacy and Safety in Children and Adults

Nocturnal enuresis (NE) is a common disorder in childhood and desmopressin is one of the most widely and well-tolerated medications for NE. The recent oral lyophilisate formulation of desmopressin (MELT) is effective in the treatment of NE in children and nocturia in adults. A MEDLINE literature search MEDLINE (2000-July 2017) was performed using the search terms MELT enuresis, MELT desmopressin, sublingual desmopressin, lyophilisate desmopressin. Twenty articles were analyzed with a number of patients of 3448. In 12 articles were reported 1275 pediatric patients (<18 years old), and in 8 articles 2213 adult patients. In pediatric population the indication was enuresis in 1269 patients and central diabetes insipidus in 6 patients. In adult population the indication was nocturia in 1941 patients, renal colic in 259 patients, healthy volunteers 13 patients. In 17 studies desmopressin was administered alone while in 3 studies in association respectively with Tolterodina, Ketorolac and Tamsulosin. In 7 studies were reported side effects in only 81 patients, 60 in pediatric population and 21 in adult population. The reported side effects in pediatric population were nausea, lethargy, lower limb weakness, headache, diarrhea, viral gastroenteritis. The reported side effects in adult population were asymptomatic hyponatriemia, nausea, diarrhea, dizziness, symptomatic hyponatriemia. Our review confirm that the MELT formulation of desmopressin guarantee the same response of other formulations with a lower doses and a lowest number of side effects. We believe according with the literature that this formulation is actually the first line and safety treatment for nocturnal enuresis and nocturia.

Electroclinical features of epilepsy associated with 1p36 deletion syndrome: A review

1p36 terminal deletion is a recently recognized syndrome with multiple congenital anomalies and intellectual disability. It occurs approximately in 1 out of 5000 to 10,000 live births and is the most common subtelomeric microdeletion observed in human. Medical problems commonly caused by terminal deletions of 1p36 include developmental delay, intellectual disability, seizures, vision problems, hearing loss, short stature, brain anomalies, congenital heart defects, cardiomyopathy, renal anomalies and distinctive facial features. Although the syndrome is considered clinically recognizable, there is significant phenotypic variation among affected individuals. Genotype-phenotype correlation in this syndrome is complicated, because of the similar clinical evidence seen in patients with different deletion sizes. We review 34 scientific articles from 1996 to 2016 that described 315 patients with 1p36 delection syndrome. The aim of this review is to find a correlation between size of the 1p36-deleted segments and the neurological clinical phenotypes with the analysis of electro-clinical patterns associated with chromosomal aberrations, that is a major tool in the identification of epilepsy susceptibility genes. Our finding suggest that developmental delay and early epilepsy are frequent findings in 1p36 deletion syndrome that can contribute to a poor clinical outcome for this reason this syndrome should be searched for in patients presenting with infantile spasms associated with a hypsarrhythmic EEG, particulary if they are combined with dismorphic features, severe hypotonia and developmental delay.