Menstrual changes after COVID-19 vaccine administration: a systematic review

OBJECTIVE

During the mass vaccination campaign for COVID-19, cases of menstrual cycle changes in women emerged, so it was thought that the COVID-19 vaccine could affect the menstrual cycle. Over time, these observations have become more frequent, which strengthens the idea. This systematic review aims to show changes in the menstrual cycle after COVID-19 vaccination.

MATERIALS AND METHODS

This study was carried out following the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes.

RESULTS

A suitable bibliography on PubMed/Medline and Scopus was searched by combining text, words, and titles of medical topics. After completing the search, a total of 42 articles were included in this systematic review.

CONCLUSIONS

The COVID-19 vaccines may have an impact on the quality of life of women. The changes in the menstrual cycle tend to resolve within 2-3 months of vaccination and the symptoms are mild to moderate and tend to self-limit over time.

SELNET clinical practice guidelines for bone sarcoma

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Systemic treatment in advanced phyllodes tumor of the breast: a multi-institutional European retrospective case-series analyses

BACKGROUND

We aimed at investigating outcome of systemic treatments in advanced breast PT.

METHODS

All cases of advanced breast PT treated with systemic treatments from 1999 to 2019, in one of the referral sarcoma centers involved in the study, were retrospectively reviewed.

RESULTS

56 female patients were identified. Median age was 52 (range of 25-76) years. Patients received a median number of 2 systemic treatments (range of 1-4). Best responses according to RECIST were 1 (3.7%) CR, 11 (40.7%) PR, 6 (22.2%) SD, 9 (33.3%) PD with anthracyclines plus ifosfamide (AI); 2 (16.7%) PR, 4 (33.3%) SD, 6 (50.0%) PD with anthracycline alone; 3 (18.8%) PR, 4 (25.0%) SD, 9 (56.3%) PD with high-dose ifosfamide given as a continuous infusion (HD-IFX); 3 (20.0%) SD, 12 (80.0%) PD with a gemcitabine-based regimen (with 2 patients not evaluable); 1 (8.3%) PR, 2 (16.7%) SD, 9 (75.0%) PD with trabectedin (with 1 patient not evaluable); 1 (16.7%) PR, 1 (16.7%) SD, 4 (66.7%) PD with tyrosine-kinase inhibitors (TKI). The median PFS were 5.7 (IQR 2.5-9.1) months with AI; 3.2 (IQR 2.2-5.0) months with anthracycline alone; 3.4 (IQR 1.4-6.7) months with HD-IFX; 2.1 (IQR 1.4-5.2) months with gemcitabine-based chemotherapy; 1.8 (IQR 0.7-6.6) months with trabectedin; 3.4 (IQR 3.1-3.8) months with TKI. With a median follow-up of 35.3 (IQR 17.6-66.9) months, OS from the start of first-line systemic treatment was 15.2 (IQR 7.6-39.6) months.

CONCLUSION

In this series of advanced PT (to our knowledge, the largest reported so far), AI was associated with a high rate of responses, however, with a median PFS of 5.7 months. Other systemic treatments were poorly active.

Is there an association between self-reported vaccination knowledge and the immunization behaviour of Health Sciences students

INTRODUCTION

The role of vaccinations is widely acknowledged. However, over the last decades, an alarming reduction in immunization coverage and a rising number of reported cases of vaccine-preventable diseases have been recorded. This multicentre cross-sectional study aimed at examining whether there is an association between self-reported vaccination knowledge and the immunization behaviour of Health Sciences students.

METHODS

A cross-sectional study was performed, using a validated questionnaire. A multivariate logistic regression with stepwise backward selection process with a univariate p-value <0.25 as the main criterion was used. The level of significance chosen for statistical analysis was 0.05.

RESULTS

The sample consisted of 3,131 students (68.1% females). 38.9% of them are medicine and surgery students and 33.1% are nursing students. The multivariate logistic regression analysis shows that, regarding the "suboptimal level of knowledge about vaccine-preventable diseases ", the main and statistically significant independent variables associated are: older age (OR 1.56), having developed a vaccine-preventable disease in the last 5 years (OR 1.38), having been vaccinated against seasonal influenza last year (OR 0.70), having recommended the vaccination to patients or family members during the last influenza season based on clinical evaluation (OR 0.53) and according to the ministerial indications (OR 0.48), planning of recommending the influenza vaccination during the next season based on clinical evaluation (OR 0.67) and according to the ministerial indications (OR 0.69).

DISCUSSION

The study highlighted the importance of academic education on vaccinations in order to build a future generation of health care workers that are aware not only of the usefulness of immunization, but particularly of the major role played by health professionals in promoting a vaccination culture among the general population.

Prevalence of depressive symptomatology among nursing students during the COVID-19 pandemic

Background

COVID-19 and the policies to contain it have been a social problem and public health emergency for people in Italy in 2020. The aim of the study is assessing the prevalence of depression symptoms among nursing students from the University of Palermo during the COVID-19 pandemic.

Materials and methods

The study employed a cross-sectional study design. On April 2020, a survey was performed including all the nursing students of the University of Palermo. The survey was structured into two parts. The first part consisted in the collection of socio-demographic information, the second in the administration of the QIDS-SR16 questionnaire. A multivariable logistic regression model was used to elaborate the results and adjusted Odds Ratios are presented.

Results

The sample consisted of 525 students (70.3% female). The probability to have a moderate/severe/ very severe depressive symptomatology is significantly associated with the following variables: "Female gender" (aOR 1.96), "Low perceived economic status" (aOR 2.32), "Low perceived health status" (aOR 2.30) and "To be a smoker" (aOR 2.24).

Conclusions

The global pandemic and the efforts to contain it represent a unique event and offer the opportunity to advance our understanding of how to provide mental health care focused on online psychoeducation and psychotherapy programs for young students.

Adverse events following immunization and vaccine perception in nursing students

INTRODUCTION

Vaccines are one of the most successful and cost-effective public health interventions of modern times. This cross-sectional study investigated the perception of vaccinations and potential risks of adverse events following immunization among nursing students.

MATERIAL AND METHODS

An anonymous, self-administered questionnaire was distributed to students undertaking a nursing degree course at the University of Palermo. This questionnaire consisted of three sections: the first part focused on socio-demographic information; the second part contained one question regarding the terms associated with vaccination; and the third part posed a question regarding adverse reactions after immunization. A multivariable logistic regression model was used and adjusted Odds Ratios will be presented in this paper.

RESULTS

The sample consisted of 403 students and the mean age was 22.0 years (±3.0). Having considered the dependent variable "Have you ever had adverse reactions after being vaccinated? Moderate-severe", the statistically-significant independent variables were: the second (adjusted Odds Ratios 0.32) and third (adjusted Odds Ratios 0.18) years of study, the nursing students perceiving their economic and health status to be low (adjusted Odds Ratios 3.52 and 15.92 respectively). The following items from questionnaire were found to be associated with the term vaccination: "I associate the term vaccination with fear" (adjusted Odds Ratios 4.98) and "I do not associate the term vaccination with fighting illnesses" (adjusted Odds Ratios 10.02).

CONCLUSION

Although vaccines are generally safe if used correctly, no vaccination is completely risk-free. There was a general awareness of adverse events following immunization among nursing students in this study. The future healthcare workers have been identified as the most important information source regarding potential solutions in a rapidly evolving health scenario in fighting vaccine hesitancy.

Digital epidemiology: assessment of measles infection through Google Trends mechanism in Italy

INTRODUCTION

The primary aim of this study is to evaluate the temporal correlation between Google Trends and the data on measles infection arising from the conventional surveillance system, reported by the Istituto Superiore di Sanità's (ISS) bulletin. Moreover, this study is also aimed at forecasting the trends of the reported infectious diseases cases over time.

MATERIAL AND METHODS

The reported cases of measles were selected from January 2013 until October 2018. The data on Internet searches have been obtained from Google Trends; the research data referred to the first 48 weeks of year 2017 have been aggregated on a weekly basis. The search volume provided by Google Trends has a relative nature and is calculated as a percentage of query related to a specific term in connection with a determined place and time-frame. The statistical analyses have been performed by using the Spearman's rank correlation coefficient (rho). The statistical significance level for such analyses has been fixed in 0.05.

OUTCOMES

We have observed a strong correlation at a lag of 0 to -4 weeks (rho > 0.70) with the cases reported by ISS with the strongest correlation at a lag of -3 weeks (rho > 0.80 both for measles than for the symptoms of the measles). The database containing monthly data has shown a moderate correlation at a lag of -1 to +1 months and a strongest correlation at a lag of -1 (rho = 0.6152 for measles and rho = 0.5039 for symptoms of the measles).

CONCLUSIONS

The surveillance systems based on Google Trends have a potential role in public health in order to provide near real-time indicators of the spread of infectious diseases. Therefore the huge potential of this approach could be used in the immediate future as a support of the traditional surveillance systems.

Why nursing students have sex without condom? A study in the university of Palermo

AIMS

Evaluation of the knowledge and behavioral risks related to sexually transmitted infections (STIs) among the student population of the degree course in nursing at the University of Palermo.

MATERIAL AND METHODS

An anonymous online a survey was provided to students that investigate to socio-demographic information, sexual habits and the level of knowledge of the STIs. Multivariable logistic regression was performed, considering it as a dependent variable "Do you permanently have unprotected sex (without a condom)? Yes", in order to evaluate the role of the variables of the questionnaire. Results are expressed as adjusted Odds Ratio (aOR).

RESULTS

The sample size consists of 405. The average age of the sample is 21.65 years (standard deviation±3.24). The analysis shows that the risk of having permanently unprotected sex (without condom) is significantly associated with the following variables: "Are you engaged or single? Engaged" (aOR 3.24, 95% CI 1.66 - 6.33); "Sexual orientation. Homosexual or Bisexual (aOR 4.45, 95% CI 1.30 - 15.29); "Have you occasionally had unprotected sex (without a condom)? Yes" (aOR 5.09, 95% CI 2.69 - 9.62); "How would you define your knowledge of sexually transmitted diseases? Good" (aOR 2.07, 95% CI 1.05 - 4.08); "How would you define your knowledge about contraceptive methods? Good" (aOR 2.51, 95% CI 1.23 - 5.15); "Have you or have you ever had a sexually transmitted disease? Yes (aOR 4.43, 95% CI 1.71 - 11.53); "Do you know that men can also undergo HPV vaccination? Yes" (aOR 2.57, 95% CI 1.03 - 6.40); "Age. As the unit increase" (aOR 1.14, 95% CI 1.02 - 1.26).

CONCLUSIONS

These results highlight the importance of involving university students in programs aimed at improving the knowledge in terms of STIs and increase of Sexual and reproductive health. Further, because STIs prevention is based mainly on human behavior, tailored intervention is needed especially because behavior change remains a complex challenge.

Gambling in nursing students of the University of Palermo

INTRODUCTION

Gambling disorder is recognized as a psychiatric disorder. It is shown that the prevalence of pathological gambling is on the rise among university students, especially involving students attending the nursing degree course. The aim of the study was to estimate the prevalence of gambling's problem and to analyze the associated factors in the population of nursing students at the University of Palermo.

MATERIAL AND METHODS

It's a cross-sectional study. In April 2019, a self-administered, anonymous and voluntary questionnaire was provided to students who attend daily lessons of the 3-years nursing degree course of University of Palermo, after they gave informed consent. The questionnaire investigates on socio-demographic information, year of study, the perception of the economic and health status, alcohol use disorders and gambling problems.

RESULTS

The average age of the sample is 22.0 years (standard deviation ±4.3), 67.6% of the interviewees are women. The analysis shows that the risk to be "Player at risk/Moderate gambling problems/Serious game problems" is significantly associated with the following independent variables: male gender (aOR 5.15); "Do you live with your family? No" (aOR 2.98); "perceived health status: low" (aOR 2.51); "Risky consumption of alcohol: At Risk" (aOR 3.40).

CONCLUSIONS

It is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. Participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities.

Health status, diseases and vaccinations of the homeless in the city of Palermo, Italy

INTRODUCTION

In Italy, as in the rest of the world, the number of homeless people is increasing considerably. Many of them suffer from chronic conditions, mental health problems and addiction to alcohol, drugs or smoking, and need complex medical care. Their health status is often exacerbated by greater difficulty in accessing primary care. The aim of the present study was to assess health conditions of homeless people living in Palermo, Southern Italy, and to find ways to limit the spread of common infectious diseases that can be prevented by vaccination.

MATERIAL AND METHODS

A self-administered questionnaire was distributed. The questionnaire was structured into two parts including an introduction with socio-demographic information, and a second part investigating health status, chronic diseases and vaccinations. A multivariable logistic regression model was used and adjusted Odds Ratios (aOR) are presented.

RESULTS

The sample consisted of 52 homeless, 35 (67.3%) of whom were male and the most represented age class (55.8%) was < 50 years of age. The average age of the sample was 49.6 years (SD ± 15.2) and 88.5% were born in Italy. A multivariable logistic regression model based on 52 observations was used. The analysis showed that the female gender was significantly associated with: not performing regular physical activity (aOR 4.14, 95% C.I. 1.20 - 14.32, p = 0.025), suffering from chronic diseases (aOR 3.52, 95% C.I. 1.02 - 12.11, p = 0.046) and taking medicines (aOR 3.95, 95% C.I. 1.14 - 13.64, p = 0.030).

CONCLUSIONS

This particularly fragile population is exposed to diseases that are largely preventable or curable through a wider and more early access to care by local health facilities with a subsequent reduction in the worsening of clinical outcomes and related social costs.

Active immunization status against measles, mumps, rubella, hepatitis B in internationally adopted children, surveyed at the university hospital of Palermo, Sicily

INTRODUCTION

The internationally adopted child is a fragile subject who often shows an incomplete health documentation, which hinders the complete assessment of health status.

MATERIALS AND METHODS

Between January 2010 and June 2016, at the University Hospital "AOUP P. Giaccone" of Palermo, we reviewed the health documentations of 111 children recently arrived in Italy following the conclusion of the international adoption procedure. 62.2% of the children were male, of various nationalities and with an average age of 7 years (± 3.4). This study aims to detect, in the observed sample, the reliability of the vaccinal documentation and the real acquired immunization. We intend to estimate the presence of IgG against Measles, Mumps, Rubella and Hepatitis B viruses.

RESULTS

Percentages of subjects with a complete correspondence between documentation attesting the successful vaccination and the effective immunization were: 78% for measles, 66% for mumps, 84% for rubella, 71% for hepatitis B. Percentages of subjects without vaccinal documentation but with positive evidence of IgG were: 50% for measles, 38% for mumps, 71% for rubella, 50% for hepatitis B.

CONCLUSIONS

The partial correspondence found between vaccinations performed and real immune status can be attributed to several reasons: poor reliability of the received health documentation, the complex economic situation of the health services in the countries of origin, the incorrect vaccines storage or the administration beyond the expiration date, the poor immunological response due to concomitant diseases or severe malnutrition, the probable non-administration of the expected booster dose. Particular attention needs to be paid to this population, which may represent a risk group susceptible to vaccine-preventable diseases.

Sexual and reproductive health risk behaviours among Palermo university students: results from an online survey

AIM

Evaluation of the knowledge and behavioral risks related to sexually transmitted infections (STIs) among the students at the University of Palermo.

MATERIALS AND METHODS

Cross-sectional study. An anonymous online questionnaire has been submitted to the students of Palermo University. Survey investigates to socio-demographic information, sexual habits and the level of knowledge of the STIs.

RESULT

The sample consists of 539 students; average age 22.65 (± 2.95). The risk to have unprotected occasional sexual intercourse is related to the following circumstances: the homosexual or bisexual status, the male gender, the age of the occurrence of the first sexual intercourse, that is at 17 year or earlier and the circumstance to have contracted a sexually transmitted infection during life.

CONCLUSION

It is necessary to implement sexual education programs aimed at improving the knowledge in terms of STIs and increase of sexual and reproductive health. The findings presented should be interpreted with a degree of caution. Future studies are needed to assess the effectiveness and cost of education programs.

Factors associated with reporting adverse reactions after immunization, study in a sample of university students

INTRODUCTION

On the day of a workshop (named "Vaccino Day") on vaccinations, organized for the students of the University of Palermo by the ERSU (Regional Office for the Right to University Study), the sample of students were given a questionnaire to fill out. The aim of the survey was to investigate the perception of vaccinations on a sample population made up of university students.

STUDY DESIGN

A self-administered paper questionnaire was given to participants of the workshop. The questionnaire is divided into 3 parts: demographic, economic and habits informations have been asked in the first part; in the second part, they had to answer the question: "What term do you associate with vaccination?"; in the third part, they were posed the question: "Have you ever had any adverse reactions after being vaccinated?". Therefore, the percentage response frequencies and the statistically significant Odds-Ratio (aOR) are presented with a corresponding 95% confidence interval (CI). Statistical analysis was performed using the STATA® 14 software.

METHODS

A total of 350 students were asked to participate and the response rate was 100%, the 61.43% of the interviewed population was made up of females. Taking into account the dependent variable: "at least a moderate-severe adverse reaction after a vaccination" the statistically significant independent variables associated are "Have fear of side effects" (aOR 7.06, 95% CI 1.73-28.57, p=0.006), "I associate the term "vaccination" to Needles/syringes" (aOR 3.82, 95% CI 1.08-13.48, p=0.037), "I associate the term "vaccination" to Protection" (aOR 3.50, 95% CI 1.02-11.98, p=0.046).

DISCUSSION AND CONCLUSIONS

Vaccination is still influenced by emotional factors and lack of campaigns providing adequate information, therefore negative judgement tend to outweigh the real risks and benefits. Considering that the sample was composed of university students, being highly educated and capable of becoming opinion leaders in the future, there is a need to create a more efficient communication protocol that make the student, and then the citizen, better aware of the actual risks associated with vaccinations and their real benefits.

Hackathon Public Health

BACKGROUND

It is necessary to implement current teaching in the healthcare and university sector by promoting new tools for the enhancement of public health, bearing in mind that some health determinants seek to create a context in which to present their own idea of innovative Startup, can represent the opportunity to give your professional contribution to the development of another's idea or to propose an improved solution to the private business. On the other hand, networking with companies and networking between training participants will allow us to recognize the importance of demonstrating their diverse skills as a key element to create a successful Startup or to implement the activities of a reality already consolidated.

METHODS

This paper describes the research protocol of a Hackathon Public Health (HPH) teaching methodology aimed at: a) increasing public health knowledge; b) changing the proactive approach of the healthcare provider, especially by increasing the sectoral training activity; c) to promote educational and training activities in Italian regions. The subjects involved will be healthcare professionals (doctors, nurses, health professions, psychologists, biologists, assistants in training) who are selected to receive or not the intervention through the implementation of a HPH which also includes training activity.

CONCLUSIONS

HPH is an innovation in the national health landscape, with the aim of creating environments and training policies aimed at promoting proper clinical risk management as part of the continuous improvement of the quality of healthcare organizations and proper training activities.

Preclinical and clinical evidence of activity of pazopanib in solitary fibrous tumour

BACKGROUND

To explore the activity of pazopanib in solitary fibrous tumour (SFT).

PATIENTS AND METHODS

In a preclinical study, we compared the activity of pazopanib, sorafenib, sunitinib, regorafenib, axitinib and bevacizumab in a dedifferentiated-SFT (DSFT) xenotransplanted into Severe Combined Immunodeficiency (SCID) mice. Antiangiogenics were administered at their reported optimal doses when mean tumour volume (TV) was 80 mm(3). Drug activity was assessed as TV inhibition percentage (TVI%). From May 2012, six consecutive patients with advanced SFT received pazopanib, on a national name-based programme. In one case sunitinib was administered after pazopanib failure.

RESULTS

In the xenograft model, pazopanib showed the lowest antitumour activity (21%TVI), while regorafenib was the most active (95%TVI). Sorafenib, bevacizumab, sunitinib were markedly active (78/70/65%TVI). Axitinib was marginally active (51%TVI). In the retrospective case-series, three patients carried malignant-SFT (MSFT), three DSFT. Best Response Evaluation Criteria in Solid Tumour (RECIST) responses were: three stable disease (SD), all MSFT, three progressive disease (PD), all DSFT, corresponding to one partial response (PR), two SD, three PD by Choi criteria. Median-progression-free survival was 3 months (range 1-15). In one patient, sunitinib was started after pazopanib failure, with a response.

CONCLUSIONS

In dedifferentiated-SFT xenograft pazopanib induced a marginal antitumour activity, while regorafenib appeared the most active and promising agent. When administered in patients, pazopanib showed a modest activity in terms of tumour growth stabilisation, observed only in non-dedifferentiated cases.

Orthodontic stress Bcl-2 modulation and human odontoblast survival

This study assessed the effect of orthodontic traction on Bcl-2 expression and apoptosis in human dental pulp. It also explored, in absence of noxious stimuli the regeneration of odontoblasts during the entire life of the tooth. Twenty young patients, with Class II malocclusion and severe to moderate crowding, were referred for orthodontic assessment. Whole pulps were removed. Half the pulps were fixed, paraffin-embedded and processed for histology and immunohistochemistry using anti Bcl-2, Caspase 9 cleaved and Caspase 9 not cleaved antibodies. The rest of the samples, both orthodontically treated and not treated dental pulps, were immediately frozen at -80ºC after the extraction and quantitative PCR was performed. Histology showed alterations in pulp microanatomy after 8 months of treatment. Immunohistochemistry depicted a decreasing expression of Bcl-2 in dental pulp over time in the non-treated while a very weak to absent Bcl-2 expression was detected in the orthodontically treated tissues. Active and non-active forms of Caspases, were expressed in both groups of dental pulp, however staining for the non active form was stronger than the corresponding cleaved form in all samples. The increased expression was detected mainly at nuclear level. Real time qPCR results correlated with those of immunohistochemistry and exhibited a decreasing expression of Bcl-2 in the treated samples. Orthodontic traction may inhibit the expression of Bcl-2, favoring the onset of apoptosis and leading us to conclude that the physical stress in the absence of noxious stimuli might make odontoblasts regeneration less likely.

Interstitial deletion 13q syndromes: a report on two unrelated patients

A partial monosomy 13 by interstitial deletion was found in the complement of two patients with mental retardation and mild dysmorphic features. Neither of the patients had a retinoblastoma, even though the second patient had a 13q14 deletion. The karyotype-phenotype correlation in the two patients suggests the need to reconsider the clinical profile of these rare chromosomal syndromes in a large series of subjects.