Burden of acute stroke and hospital resources in the Campania region of Italy

We examined all the official hospital records referring to admissions for acute stroke (AS) (DRG 14) from January 1 to December 31, 1996 in Campania (Italy), a large region with 10% of the Italian population. Related healthcare burden and available resources were evaluated. During the study period, a total of 9,003 discharges were reported. We counted 11 neurological care units (NCU) committed to emergency in the region, with 230 hospital beds. The 4,890 admissions in NCU represented 54.3% of the total AS hospitalizations per year. A large number of strokes (45.7%) had no access to specialist assistance and were hospitalized mainly in general wards with a mean hospital stay of 12.7 days, compared with 9.5 days in NCU (p < 0.01). In our region, the number of hospital beds available for neurological emergencies do not meet the demand.     

Investing in Justice: Ethics,Evidence, and the Eradication Investment Cases for Lymphatic Filariasis and Onchocerciasis

It has been suggested that initiatives to eradicate specific communicable diseases need to be informed by eradication investment cases to assess the feasibility, costs, and consequences of eradication compared with elimination or control.A methodological challenge of eradication investment cases is how to account for the ethical importance of the benefits, burdens, and distributions thereof that are salient in people’s experiences of the diseases and related interventions but are not assessed in traditional approaches to health and economic evaluation.We have offered a method of ethical analysis grounded in theories of social justice. We have described the method and its philosophical rationale and illustrated its use in application to eradication investment cases for lymphatic filariasis and onchocerciasis, 2 neglected tropical diseases that are candidates for eradication.The eradication of smallpox was a signature success of global public health in the 20th century, but it is an open and contentious question whether global eradication as opposed to regional elimination or control is warranted for other potentially eradicable infectious diseases.1–4 The box on page 630 provides our definitions of eradication, elimination, and control, as explained by Dowdle.4

Definitions of Eradication, Elimination, and Control

Effect of palmitoylethanolamide–polydatin combination on chronic pelvic pain associated with endometriosis: Preliminary observations

Objective

Endometriosis is a chronic oestrogen-dependent gynaecological disorder, the most common symptom of which is pain. Inflammation can be considered one of the major causes of pain in endometriosis. In particular, degranulating mast cells have been found in significantly greater quantities in endometriotic lesions than in unaffected tissues. The increase in activated and degranulating mast cells is closely associated with nerve structures in painful endometriotic lesions. These observations indicate that inflammation due to mast cells may contribute to the development of pain and hyperalgesia in endometriosis. Controlling mast-cell activation may therefore relieve the pain associated with endometriotic lesions.

Study design

Four patients presenting an endometriosis-related pain intensity ≥5 (visual analogue scale for pain, or VAS) were enrolled and monitored during 3 months of the following treatment: oral palmitoylethanolamide 400 mg and polydatin 40 mg, twice daily for 90 days. Deep dyspareunia, dyschezia, dysuria, dysmenorrhoea and analgesic drug use during the 3-month follow-up period were also monitored, with the aim of demonstrating a reliable reduction in chronic pelvic pain.

Results

The preliminary results indicate that all patients enrolled experienced pain relief as early as 1 month after starting treatment. Furthermore, a reduction in the analgesic drugs usually employed for pain control was observed in all subjects treated. Additionally, some improvements in endometriotic lesions seemed to be demonstrated by imaging.

Conclusions

The palmitoylethanolamide–polydatin combination seems to be very useful in controlling chronic pelvic pain associated with endometriosis. As a result of these findings we have initiated a multi-centre pilot study to verify the effectiveness of this treatment in controlling the chronic pelvic pain associated with endometriosis.     

Obstetric brachial plexus palsy: a population-based retrospective case-control study and medicolegal considerations

Aims: The aim of this study was to examine 24 cases of obstetric brachial plexus palsy (OBPP) in 41,002 deliveries occurred at San Camillo–Forlanini Hospital in Rome, during the period 2000–2012.

Materials and methods: A population-based retrospective case-control study was designed and the database of the hospital was searched; for each case, maternal and fetal records were examined and some risk factors were evaluated.

Results: A statistically significant association between the 24 cases OBPP and the following risk factors: primiparity (p?p?p?p?p?Conclusions: The absence of OBPP cases in cesarean deliveries highlighted in this study supports the option of proposing an elective cesarean in the presence of known risk factors after a full disclosure with the mother of risks and benefits in order to obtain a valid consent. Furthermore, when cases of OBPP occur, communication between the physician and the parents of newborns is crucial and it may represent a valid risk-management tool to reduce malpractice lawsuits.     

Central Neuropathic Pain: An Unusual Case of Painful Ejaculation Responding to Topiramate

IntroductionPainful ejaculation (PE) is an uncommon condition and it is usually associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, ejaculatory duct obstruction, radical prostatectomy, and prostate radiation. Topiramate (TPM) is a new antiepileptic drug with recognized efficacy in neuropathic pain.AimThe study is aimed to evaluate TPM efficacy in ejaculation pain.MethodsFollowing a spinal cord injury, a 53‐year‐old man was referred to our institute for persistent PE. Neurological examination showed mild hypoesthesia of the genital area. Urogenital examination, neurophysiological tools, and computed tomography of the dorso‐lumbar spine were normal.Main Outcome MeasuresThe main outcome measure was the visual analogue scale.ResultsSince pain was refractory to conventional neuropathic pharmacological therapies, TPM was introduced up to 150 mg daily with a dramatic improvement of PE.ConclusionTPM may be considered as a valid therapeutic option for the treatment of PE. Calabrò RS, Marra A, Quattrini F, Gervasi G, Levita A, and Bramanti P. Central neuropathic pain: An unusual case of painful ejaculation responding to topiramate. J Sex Med 2012;9:3274–3278.     

Epidemiology of achondroplasia: A population‐based study in Europe

Achondroplasia is a rare genetic disorder resulting in short‐limb skeletal dysplasia. We present the largest European population‐based epidemiological study to date using data provided by the European Surveillance of Congenital Anomalies (EUROCAT) network. All cases of achondroplasia notified to 28 EUROCAT registries (1991–2015) were included in the study. Prevalence, birth outcomes, prenatal diagnosis, associated anomalies, and the impact of paternal and maternal age on de novo achondroplasia were presented. The study population consisted of 434 achondroplasia cases with a prevalence of 3.72 per 100,000 births (95%CIs: 3.14–4.39). There were 350 live births, 82 terminations of pregnancy after prenatal diagnosis, and two fetal deaths. The prenatal detection rate was significantly higher in recent years (71% in 2011–2015 vs. 36% in 1991–1995). Major associated congenital anomalies were present in 10% of cases. About 20% of cases were familial. After adjusting for maternal age, fathers >34 years had a significantly higher risk of having infants with de novo achondroplasia than younger fathers. Prevalence was stable over time, but regional differences were observed. All pregnancy outcomes were included in the prevalence estimate with 80.6% being live born. The study confirmed the increased risk for older fathers of having infants with de novo achondroplasia.     

FcgammaRIII discriminates between 2 subsets of Vgamma9Vdelta2 effector cells with different responses and activation pathways

Upon recognition of nonpeptidic phosphoantigens, human Vdelta2 T lymphocytes enter a lineage differentiation pattern that determines the generation of memory cells with a range of effector functions. Here, we show that within the effector memory Vdelta2 population, 2 distinct and complementary subsets with regard to phenotype, mode of activation, and type of responses can be identified: Vdelta2 T(EMh) cells, which express high levels of chemokine receptors, but low levels of perforin and of natural killer receptors (NKRs) and which produce large amounts of interferon gamma (IFN-gamma) and tumor necrosis factor alpha (TNF-alpha) in response to T-cell receptor (TCR)-specific stimulation by phosphoantigens; and Vdelta2T(EMRA) cells, which constitutively express several NKRs, high amounts of perforin, but low levels of chemokine receptors and of IFN-gamma. These NK-like cells are refractory to phosphoantigen but respond to activation via FcgammaRIII (CD16) and are highly active against tumoral target cells. Thus, circulating Vdelta2T lymphocytes comprise 2 functionally diverse subsets of effector memory cells that may be discriminated on the basis of CD16 expression.