Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

The Brief Negative Symptom Scale (BNSS): Independent validation in a large sample of Italian patients with schizophrenia

BACKGROUND: The Brief Negative Symptom Scale (BNSS) was developed to address the main limitations of the existing scales for the assessment of negative symptoms of schizophrenia. The initial validation of the scale by the group involved in its development demonstrated good convergent and discriminant validity, and a factor structure confirming the two domains of negative symptoms (reduced emotional/verbal expression and anhedonia/asociality/avolition). However, only relatively small samples of patients with schizophrenia were investigated. Further independent validation in large clinical samples might be instrumental to the broad diffusion of the scale in clinical research. METHODS: The present study aimed to examine the BNSS inter-rater reliability, convergent/discriminant validity and factor structure in a large Italian sample of outpatients with schizophrenia. RESULTS: Our results confirmed the excellent inter-rater reliability of the BNSS (the intraclass correlation coefficient ranged from 0.81 to 0.98 for individual items and was 0.98 for the total score). The convergent validity measures had r values from 0.62 to 0.77, while the divergent validity measures had r values from 0.20 to 0.28 in the main sample (n=912) and in a subsample without clinically significant levels of depression and extrapyramidal symptoms (n=496). The BNSS factor structure was supported in both groups. CONCLUSIONS: The study confirms that the BNSS is a promising measure for quantifying negative symptoms of schizophrenia in large multicenter clinical studies

22q11 deletion syndrome: a review of the neuropsychiatric features and their neurobiological basis

Chiara Squarcione, Maria Chiara Torti, Fabio Di Fabio, Massimo Biondi Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy Abstract: The 22q11.2 deletion syndrome (22q11DS) is caused by an autosomal dominant microdeletion of chromosome 22 at the long arm (q) 11.2 band. The 22q11DS is among the most clinically variable syndromes, with more than 180 features related with the deletion, and is associated with an increased risk of psychiatric disorders, accounting for up to 1%–2% of schizophrenia cases. In recent years, several genes located on chromosome 22q11 have been linked to schizophrenia, including those encoding catechol-O-methyltransferase and proline dehydrogenase, and the interaction between these and other candidate genes in the deleted region is an important area of research. It has been suggested that haploinsufficiency of some genes within the 22q11.2 region may contribute to the characteristic psychiatric phenotype and cognitive functioning of schizophrenia. Moreover, an extensive literature on neuroimaging shows reductions of the volumes of both gray and white matter, and these findings suggest that this reduction may be predictive of increased risk of prodromal psychotic symptoms in 22q11DS patients. Experimental and standardized cognitive assessments alongside neuroimaging may be important to identify one or more endophenotypes of schizophrenia, as well as a predictive prodrome that can be preventively treated during childhood and adolescence. In this review, we summarize recent data about the 22q11DS, in particular those addressing the neuropsychiatric and cognitive phenotypes associated with the deletion, underlining the recent advances in the studies about the genetic architecture of the syndrome. Keywords: 22q11 deletion syndrome, microdeletion, neuropsychiatric disorders, cognitive impairment

Psychophysiological aspects in DiGeorge syndrome: psychotic risk and ERPs correlates

Introduction: The 22q11.2 deletion syndrome (Velocardiofacial/DiGeorge syndrome; 22qDS) is aneurogenetic disorder resulting from a hemizygous deletion. Individuals with 22q11DS present with a wide range of clinical manifestations ( congenital cardiac and palate defects, calcium deficiencies, immune problems); an increased risk ofbehavioraland neurocognitive sequelae throughout developmenthave been reported. Approximately 30% of individuals develops a psychotic disorder in adolescenceor early adulthood, making this syndrome one of the largest known genetic risk factors for schizophrenia.Attentional deficits and anxiety disorder are core symptoms of schizophrenia. ERPs could represent an useful approach to detectpsychophysiological changes over the course of the disease. The aim of this study is to evaluate some psychophysiological aspects in patients with DiGeorge syndrome in the attempt to recognize earlier specific features able to provide pre-clinic evidence predictive of a possibleevolution towards schizophrenia. Methods: Eightsubjects with 22q11DS, (median age 28,6-29,8±..ys), eight psychotic patients and eight matched healthy controls underwent a psychophysiological assessment. CNVand P300 (oddball and Novel paradigm) were recorded.CNV amplitude (total area and two temporal windows, W1 and W2), and P3 parameters were measured. Results: A total CNV areadecrease wasfound in 22q11DS patients with respect to psychotic andhealthycontrols (p=0.04 and p=0.07 respectively). A slight difference was evident at W1 in 22q11DS patients and psychotics vs controls.A N1 latency reduction was observed in 22q11DS patients during Novelty P3 paradigm (p=0.03). Conclusions: Psychophysiological changes in CNV and P3 latency and amplitudehave been repeatedly found in schizophrenic patients and interpreted as a deficit in attentional processes. Data related to our Di George subjects suggest a possible frontal involvement of attentional processes in absence of a psychiatric symptoms. A follow-up study could confirm a predictive role of these ERPs findings in this syndrome