Intraoperative ultrasound-assisted approach for endoscopic treatment of vesicoureteral reflux in children

Purpose Despite minimal invasiveness and high success rate, guidelines still prescribe voiding Cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR) in children. The aim of this paper was to analyze whether intraoperative ultrasound (IO-US) could improve surgical accuracy and perioperative counseling, thus potentially decreasing the need for postoperative VCUG. Methods We selected children treated for moderate to high grade VUR, renal scarring or repeated infections under antibiotic prophylaxis from January to December 2015. Endoscopic injection was combined with IO-US to detect optimal needle placement and to guide mound formation. IO-US findings were compared to surgeon opinion and postoperative VCUG, performed 3 months after surgery. All patients were followed-up for 1 year. Results A significant relationship was found between IO-US mound height (p = 0.003) or localization (p < 0.0005) and VCUG. Success of endoscopic treatment vs persistence of reflux groups had a mean mound height of 10.62 \uc2\ub1 1.36 mm and 8.39 \uc2\ub1 1.08 mm respectively (p < 0.0005). Height maintained a significant correlation with success in simple and multivariable regression analysis. ROC curve determined \ue2\u89\ua5 9.8 mm as predictor of reflux resolution (95% CI 0.825 to 0.998; p < 0.0001). Conclusions IO-US facilitates pediatric urologists to find an optimal location, to reach a volcano mound morphology and height, thus increasing intraoperative accuracy. IO-US also helps evaluating high-risk recurrence and guiding prognostic counseling. Type of study Treatment study. Level of evidence II

Impact of communicative and informative strategies on influenza vaccination adherence and absenteeism from work of health care professionals working at the university hospital of palermo, Italy: A quasi-experimental field trial on twelve influenza seasons

Every year, about 20% of health care workers (HCWs) acquire influenza, continuing to work and encouraging virus spreading. Influenza vaccination coverage rates and absenteeism from work among HCWs of the University Hospital (UH) of Palermo were analyzed before and after the implementation of several initiatives in order to increase HCWs’ awareness about influenza vaccination. Vaccines administration within hospital units, dedicated web pages on social media and on the UH of Palermo institutional web site, and mandatory compilation of a dissent form for those HCWs who refused vaccination were carried out during the last four influenza seasons. After the introduction of these strategies, influenza vaccination coverage went up from 5.2% (2014/2015 season) to 37.2% (2018/2019 season) (p<0.001), and mean age of vaccinated HCWs significantly decreased from 48.1 years (95% CI: 45.7–50.5) to 35.9 years (95% CI: 35.0–36.8). A reduction of working days lost due to acute sickness among HCWs of the UH of Palermo was observed. Fear of adverse reactions and not considering themselves as a high-risk group for contracting influenza were the main reasons reported by HCWs that refused vaccination. Strategies undertaken at the UH of Palermo allowed a significant increase in vaccination adherence and a significant reduction of absenteeism from work

Socio-demographic factors involved in a low-incidence phase of sars-cov-2 spread in sicily, italy

Background: The present study analysed SARS-CoV-2 cases observed in Sicily and investigated social determinants that could have an impact on the virus spread. Methods: SARS-CoV-2 cases observed among Sicilian residents between the 1 February 2020 and 15 October 2020 have been included in the analyses. Age, sex, date of infection detection, residency, clinical outcomes, and exposure route have been evaluated. Each case has been linked to the census section of residency and its socio-demographic data. Results: A total of 10,114 patients (202.3 cases per 100,000 residents; 95% CI = 198.4–206.2) were analysed: 45.4% were asymptomatic and 3.62% were deceased during follow-up. Asymptomatic or mild cases were more frequent among young groups. A multivariable analysis found a reduced risk of SARS-CoV-2 cases was found in census sections with higher male prevalence (adj-OR = 0.99, 95% CI = 0.99–0.99; p < 0.001) and presence of immigrants (adj-OR = 0.89, 95% CI 0.86–0.92; p < 0.001). Proportion of residents aged <15 years, residents with a university degree, residents with secondary education, extra-urban mobility, presence of home for rent, and presence of more than five homes per building were found to increase the risk of SARS-CoV-2 incidence. Conclusion: Routinely collected socio-demographic data can be predictors of SARS-CoV-2 risk infection and they may have a role in mapping high risk micro-areas for virus transmission

Evaluation of the burden of HPV-related hospitalizations as a useful tool to increase awareness: 2007–2017 data from the sicilian hospital discharge records

In light of the implementation of human papillomavirus (HPV) prevention strategies, epidemiological studies in different geographical areas are required in order to assess the impact of HPV-related diseases. The purpose of the present study was to describe the burden of HPV-related hospitalizations in Sicily. A retrospective observational study estimated 43,531 hospitalizations attributable to HPV from 2007 to 2017. During the observed period, there was a decrease for all HPV-related conditions with a higher reduction, among neoplasms, for cervical cancer (annual percent change (APC) = −9.9%, p < 0.001). The median age for cervical cancer was 45 years old, with an increasing value from 43 to 47 years (p < 0.001). The age classes with greater decreases in hospital admissions for invasive cancers were women aged 35 years or more (APC range from −5.5 to −9.86) and 25–34 years old (APC = −11.87, p < 0.001) for women with cervical carcinoma in situ. After ten years for vaccine introduction and sixteen years for cervical cancer screening availability, a relatively large decrease in hospital admissions for cervical cancer and other HPV-related diseases in Sicily was observed. Some clinical characteristics of hospitalization, such as increasing age, are suggestive clues for the impact of preventive strategies, but further research is needed to confirm this relationship

Ultrasonographic mound height as predictor of vesicoureteral reflux resolution after endoscopic treatment in children

Purpose: Endoscopic dextranomer/hyaluronic acid copolymer (Dx/HA) injection is a safe and efficacious treatment option for vesicoureteral reflux (VUR) in children. Endoscopic appearance, hydrodistention and amount of injected Dx/HA have been demonstrated not to be reliable predictors of outcome. Aim of this study was to evaluate Dx/HA mounds on ultrasound scans (US) and find out any eventual correlation with reflux resolution. Methods: We selected patients treated with endoscopic injection for moderate to high VUR, renal scaring or repeated infections under antibiotic prophylaxis. Success was defined by absence of VUR at control 3. months after surgery; at 3. months we also measured mound height ultrasonographically. Results: We considered a total of 32 children (15 male, 17 female; 53 ureters) with a median age of 3. years (±. 24. months). Overall success rate was 77% per ureter. Success rate correlates directly with age and inversely with VUR grade. Mound height is the major predictive parameter for reflux resolution (sensitivity 100%, specificity 65.9%); mean mound heights of success-group vs. persistence-of-reflux group were 9.97. ±. 1.61. mm and 7.29. ±. 1.74. mm respectively (p. <. 0.0005). Conclusion: A mound measuring at least 9.8. mm at post-operative US scan is a predictor of reflux resolution. Age and grade also seems to influence success rate

Knowledge, attitudes and self-reported practices of food service staff in nursing homes and long-term care facilities

The aim of this study was to investigate knowledge, attitudes and practices of food service staff in nursing homes and long-term care facilities for the elderly in Sicily, Italy. Association with some demographic and work-related variables was also investigated. This survey provides information and outlines many complex questions concerning the basics of food hygiene. Education level, length of service in the employment and attending courses on food hygiene influenced the knowledge, attitudes and practices of food service staff. This study has evidenced the need for continuous training among food service staff regarding food safety in LTCF and nursing homes

Working-Age Cataract Patients: Visual Results, Reading Performance, and Quality of Life with Three Diffractive Multifocal Intraocular Lenses

Abstract PURPOSE: To compare the visual outcomes, reading performance, and quality of life (QoL) of working-age cataractous patients bilaterally implanted with 3 different diffractive multifocal intraocular lenses (MIOLs). DESIGN: Two-center, randomized, prospective, double-masked study. PARTICIPANTS: Sixty-three consecutive patients (126 eyes) seen at Ophthalmology Section, Palermo and Florence University, Italy, randomized to receive the ReSTOR SN6AD3 (Alcon Laboratories, Inc, Irvine, CA) (20 patients, group A), ReSTOR SN6AD1 (Alcon Laboratories, Inc) (21 patients, group B), or TECNIS ZMA00 (Abbott Medical Optics, Santa Ana, CA) (22 patients, group C) MIOL. INTERVENTION: Phacoemulsification. MAIN OUTCOME MEASURES: One-year follow-up differences among the 3 MIOL groups in visual acuity, reading performance by MNREAD (Minnesota Laboratory for Low-Vision Research, University of Minnesota, Minneapolis, MN) reading acuity (RA), critical print size (CPS), and maximum reading speed (MRS) under mesopic and photopic conditions. SECONDARY OUTCOME MEASURES: Photopic and mesopic contrast sensitivity (CS) by Pelli-Robson test and patient satisfaction by National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI RQL-42) questionnaire. RESULTS: Mean photopic uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and corrected near visual acuity (CNVA) did not differ among groups, with a preferred reading distance greater in group B (P< 0.0005). Photopic distance-corrected intermediate visual acuity (DCIVA) was best in group B (P = 0.001) and better in group C than in group A. Mesopic UNVA and DCNVA were worse in groups A and B compared with group C (P< 0.0005 in both cases), with better DCNVA in group B than in group A (P = 0.031). Mesopic uncorrected intermediate visual acuity (UIVA) and DCIVA were worst in group A, with better results in group C (P< 0.0005 and P = 0.001, respectively). Mesopic MNREAD RA was better in group C (P = 0.02), and mesopic MRS was higher in groups B and C than in group A (P = 0.002). The QoL scores by the NEI RQL-42 test exhibited no differences among groups in 9 over 13 scales. "Near vision" (P = 0.005), "symptoms" (P = 0.001), and "satisfaction with correction" scale scores (P = 0.030) were lowest in group A, and "appearance" scale score was lowest in group B (P = 0.045). CONCLUSIONS: Newer-generation aspheric diffractive MIOLs, especially low-add hybrid apodized or full diffractive, are highly suited for working-age cataractous patients in terms of visual outcomes, reading performance, and QoL. Intrinsic optical differences, such as optimization for computer or dim-light working, or night driving, could be useful tools to customize the IOL in each single case

Cancer patients requiring interruption of long-term warfarin because of surgery or chemotherapy induced thrombocytopenia: the use of fixed sub-therapeutic doses of low-molecular weight heparin.

No data are available regarding the management of cancer patients requiring interruption of long-term vitamin-K antagonist (VKA) therapy. For this purpose, we tested the efficacy and safety of fixed doses of low-molecular weight heparin (LMWH) in substitution of VKA because of invasive procedures or chemotherapy-induced thrombocytopenia. In cancer patients on VKA, therapy was discontinued 5 ± 1 days before surgery or chemotherapy. Heparin was given at prophylactic dosage in patients at low risk and at fixed subtherapeutic doses (3,800 or 4,000 UI anti-FXa, b.i.d.) in those at high-risk for thrombosis. LMWH was reinitiated 12 hr after surgery and VKA the day after. In patients receiving chemotherapy, LMWH was reinitiated 12/24 hr after obtaining a stable platelet count ≥ 30,000 mmc(3) and VKA after a stable platelet count ≥ 50,000 mmc(3) . Thromboembolism and major bleeding events were recorded from the time of VKA suspension to 30 ± 2 days postprocedure or until the next chemotherapy. Overall, 156 patients (56.4% at low risk and 43.5% at high risk for thrombosis) were enrolled; 34.6% underwent major surgery, 40.4% nonmajor surgery, and 25% chemotherapy. Thrombotic events occurred in five patients [3.2%, 95% confidence interval (CI): 1.41-7.27], four belonging to the high-risk and one to the low-risk group. Major bleeding occurred in five patients (3.2%, 95 CI: 1.41-7.27), all belonging to the high-risk group (three during major surgery and two during chemotherapy). In conclusion, LMWH given at fixed subtherapeutic is a feasible and relatively safe approach for bridging therapy in cancer patients on long-term VK