De novo appearance of multiple chemical sensitivity syndrome in a patient affected with lateral meningocele syndrome: unlucky coincidence?

Although the coexistence of rare pathologies in the same patient is considered an exceptional event, the possibility to contend with a condition such like this may occur in clinical practice. In these cases, a multidisciplinary approach is required in order to find the most appropriate therapeutic strategy. Here we describe the clinical case of a 61 years old female affected with a rare genetic pathology known as lateral meningocele syndrome (LMS) who developed a pathological condition that could be framed in the context of a multiple chemical sensitivity syndrome (MCSS) characterized by intolerance to several drugs, foods as well as environmental and chemical agents

Low back pain among healthcare workers in a surgical environment: a research protocol

BACKGORUND: Nurses and surgeons are among the healthcare categories with the highest risk of developing low back pain (LBP). The aim of this study is to present the research protocol of a survey for assessing the presence of low back pain among healthcare workers of a surgical ward and its associated factors. METHODS: The survey will be conducted in the Orthopaedics ward of the teaching hospital “Policlinico Umberto I” in Rome, during the year 2018. The low-back pain will be measured using the Italian version of the Nordic Questionnaire musculoskeletal disorders. Socio-demografic and clinical data will be collected, such as: aghe, gender, heaight, weight, body mass index (BMI), type of work, years of work, working timetable. LBP intensity will be assessed with the Numerical Rating Scale. This is a one-dimension numerical scale with possible score from 0 (no pain) to 10 (the worst possible pain). The general health status will be assessed with the SF-12 questionnaire, for calculating the Mental and Physical component scales, MCS and PCS respectively. The physical activity will be assessed with the Italian version of the International Physical Activity Questionnaire. Moreover, work-related stress will be assessed using the Karasec-15 questionnaire. CONCLUSION: This research protocol will be useful for assessing the prevalence of LBP and its associated factors. These informations will be used for planning primary and tertiary prevention

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of theOrthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP wasassessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain.The type of physical activity carried out as prevention was investigated by use of theInternational Physical Activity Questionnaires. The overall state of health and lifestyle wasdeter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stresswere assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low backpain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess theassociations between socio-demographic and working variables. Multiple logistic regression mod- elswere used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period-prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP.Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groupswith high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (fordecision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI:0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and issuitable for prevention programmes. The protective effect of physical activity and work-relatedstress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of the Orthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP was assessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain. The type of physical activity carried out as prevention was investigated by use of the International Physical Activity Questionnaires. The overall state of health and lifestyle was deter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stress were assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low back pain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess the associations between socio-demographic and working variables. Multiple logistic regression mod- els were used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period- prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP. Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groups with high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (for decision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI: 0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and is suitable for prevention programmes. The protective effect of physical activity and work-related stress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Tap block in chronic pain treatment: a case of entrapment syndrome of iliohypogastric and ilioininguinal nerves

The patient is a 42 years old woman with entrapment syndrome of the “nerves of passage” – ilioinguinal (IING) and Iliohypogastric (IHPO) – after abdominal surgery. The patient was suffering for IV stage infiltrating endometriosis and went through 13 abdominal surgical interventions (laparoscopic and open). Consequently, she developed chronic neuropathic pain in the IING and IHPO areas, unresponsive to drug therapy. Ultrasound images showed a subverted anatomy with fibrosis of the involved nerves. After three TAP (transversus abdominis plane) block sessions the ultrasound sight resulted improved: a significant amount of preexistent adhesions had lysed and pain was considerably reduced. Temporarily, pain totally disappeared and gradually resume with different features in terms of intensity and continuity. This case highlights the possibility to treat this kind of painful iatrogenic syndromes of injurious and adhesive nature with this technique, with variations in imaging aspects as well as in clinical symptoms. In this particular case we did not get a total resolution of pain, maybe due to the long history of the symptoms and their chronicity. The study of a number of pain cases of more recent onset could be extremely useful in the evaluation of this technique, as suggested by this case history

Epidural anesthesia for cesarean section in patients with hypertrophic cardiomyopathy: A report of three cases

[No abstract available

Dietary Protein Supplementation Helps in Muscle Thickness Regain after Abdominal Wall Reconstruction for Incisional Hernia

A modern approach to incisional hernia is oriented toward midline restoration to re-establish abdominal wall physiology and to restore muscular strength. A high-protein diet has been demonstrated to improve muscle function and mass. The aim of this prospective study was to evaluate the effect of a high-protein diet on abdominal muscle remodeling in patients submitted to abdominal wall reconstruction (AWR). Forty-five patients submitted to elective AWR were prospectively divided into two groups depending on pre- and postoperative daily protein assumption: Group A patients were submitted to a standard 2300 kcal diet with 103 g of protein intake (males) and 1800 kcal diet with 80 g of protein intake (females) starting one month before surgery and lasting for three months postoperatively; Group B patients were submitted to the same dietary regimen plus 34 g of purified proteins daily. Patients underwent ultrasound scan preoperatively and three and six months after surgery, to evaluate the widest thickness of the rectus abdominis muscle on the transverse umbilical line. Three patients reporting hernia recurrence were excluded. No significant difference among the two groups in muscle thickness growth after surgery was observed at three months after surgery, even if a favorable trend in Group B was noted (10% vs 19%, P = not significant). At six months after surgery, Group B patients showed a significant difference in muscle thickening (13% vs 32%, P < 0.05 ). The study demonstrates a positive effect of a protein diet on the rectus abdominis muscle thickening after AWR. Further studies are needed