Haemorrhagic Presentation of a Craniopharyngioma in a Pregnant Woman

Objective. Craniopharyngioma is a rare tumour, and, consequently, acute clinical presentation and diagnosis, during pregnancy, of this pathology are quite difficult to find. Only few cases are reported in the literature, and no one describes these two conditions in association. Methods. We report a particular case of craniopharyngioma presenting both of the above conditions. Results. The patient was successfully operated with endoscopic technique. Conclusions. Rare and difficult cases, created by the superposition of different clinical conditions, need multidisciplinary management, with collaboration, integration, and cooperation between different medical specialists

Determinants of vaccine hesitancy in Switzerland: study protocol of a mixed-methods national research programme

Vaccine hesitancy is a complex public health issue referring to concerns about the safety, efficacy or need for vaccination. Relatively little is known about vaccine hesitancy in Switzerland. This ongoing study (2017-2021) focuses on biomedical and complementary and alternative medicine (CAM) providers and their patients since healthcare professionals play important roles in vaccination decision-making. This national research programme seeks to assess the sociocultural determinants of vaccine hesitancy regarding childhood and human papillomavirus vaccines in Switzerland. We aim to provide a detailed characterisation of vaccine hesitancy, including CAM and biomedical perspectives, patient-provider interactions, and sociocultural factors, to establish the mediating effects of vaccine hesitancy on underimmunisation, and to design an intervention to improve vaccination communication and counselling among physicians, parents and adolescents.; Our transdisciplinary team employs a sequential exploratory mixed-methods study design. We have established a network of more than 150 medical providers across Switzerland, including more than 40 CAM practitioners. For the qualitative component, we conduct interviews with parents, youth, and biomedical and CAM providers and observations of vaccination consultations and school vaccination information sessions. For the quantitative component, a sample of 1350 parents of young children and 722 young adults (15-26 years) and their medical providers respond to questionnaires. We measure vaccine hesitancy with the Parent Attitudes about Childhood Vaccines 15-item survey and review vaccination certificates to assess vaccination status. We administer additional questions based on findings from qualitative research, addressing communication with medical providers, vaccine information sources and perceptions of risk control vis-à-vis vaccine-preventable diseases. The questionnaires capture sociodemographics, political views, religion and spirituality, and moral foundations.; The study was approved by the local ethics committee. The results will be published in peer-reviewed journals and disseminated to healthcare professionals, researchers and the public via conferences and public presentations

Outcome of elderly patients undergoing intracranial meningioma resection: a single center experience

Higher life expectancy and higher mean age in general population created growing interest in medical and surgical management of meningiomas in elderly. It is well known that, due to possible complications, pre-operative status and comorbidities, expecially in aged people, should be carefully considerated in the decision-making process. We described our experience with this kind of patients and analized the influence of complications on the outcome

Direct fascia lata reconstruction to reduce donor site morbidity in endoscopic endonasal extended surgery: a pilot study

Objective: Fascia lata is a validated source of autologous grafts, adopted by many surgical figures throughout different types of reconstructive procedures. Postoperative pain and muscle prolapse are frequent complications after harvesting fascia lata; donor site morbidity causes delayed mobilization and increased lenght of hospital stay. In our department fascia lata is used as autologous graft in reconstruction of skull base after extended endoscopic transsphenoidal surgery (EETS) and the thigh defect is usually repaired with allograft to restore tissue continuity and avoid muscle prolapse. Our aim was to evaluate the post-operative pain and muscle prolapse in a group of patients who underwent EETS with fascia lata reconstruction with allograft. Methods: We retrospectively analyzed clinical data of 11 patients who underwent harvesting and reconstruction of fascia lata during EETS, collected in our department of Neurosurgery between January 2012 and September 2015. "Pain on rest" and "pain on walking" data were collected daily according to the Numerical Rating Scale (NRS) system, during hospital stay until sutures removal and 1 month after surgery. Furthermore, the degree of muscle prolapse was analyzed at the time of sutures removal and 1 month following surgery. Results: 11 patients were studied between January 2012 and September 2015: 4 men and 7 women (1:1.75). Mean age 53.6±11.1years. During the post-operative stay, "pain on rest" and "pain on walking" values of all patients did not exceed grade 4 of NRS. While removing sutures, "pain on rest" resulted grade 1 of NRS in 27.3% (3/11) patients, while "pain on walking" was grade 1 of NRS in 18.2% (2/11) and grade 2 in 9.1% (1/11). After a month of surgery "pain on rest" reduced to NRS grade 1 in 9.1% (1/11), while patients NRS results for "pain on walking" were the same as the previous evaluation. Mean duration of hospital stay was 5.7±2.28 days. 10 patients were discharged home, only 1 patient was transferred to a rehabilitation ward. No visible nor palpable muscle prolapse was found in our group of patients during the entire assessment. Conclusion: Findings show how fascia lata reconstruction with allograft reduced post-operative discomfort and muscle prolapse in our serie; it also permitted their early mobilization and discharge. These are promising results. However further studies are needed to see this technique approved

Transcranial color-coded duplex sonography for evaluation of midline-shift after chronic-subdural hematoma evacuation (TEMASE): A prospective study

Abstract OBJECTIVE: The incidence of chronic Subdural hematoma (cSDH) is increasing and its rate of recurrence varies from 5 to 33%. A postoperative brain midline-shift (MLS) on computed tomography (CT) equal or larger than 5mm is a risk factor for recurrence. Transcranial color-coded duplex sonography (TCCDS) is a noninvasive bedside reproducible technique useful to detect MLS. The aim of our study was to compare in patients affected by cSDH, the values of MLS obtained pre- and post-operatively by TCCDS and brain CT. PATIENTS AND METHODS: 32 patients affected by cSDH entered the study between July 2016 and January 2017. MLS values obtained by TCCDS and brain CT were compared using Bland-Altman plot and linear regression analysis. Using the same techniques we also explored if the agreement between the two imaging modes was comparable in pre- and post-operative data pairs. RESULTS: 64 data pairs of MLS values obtained by TCCDS and CT were analysed. Bland-Altman diagrams did not show any systematic bias of the data and linear regression indicated a significant correlation between the two measures both before and after hematoma evacuation. CONCLUSION: In patients affected by cSDH, MLS values obtained before and after surgery by TCCDS are comparable to those obtained by CT; TCCDS might be considered an alternative to CT scan in the management of patients after cSDH evacuation. We suggest that close clinical bedside examination and TCCDS might be appropriate for the post-operative management of cSDH, reserving CT scan only to patients with overt clinical deterioration and/or increasing MLS

Orbital Meningoencephalocele Due to Extraventricular Neurocytoma: Case Report

Extraventricular Neurocytoma (EVN) is a rare primary tumor of Central Nervous System (CNS). To date, no cases have been reported in International Literature, about EVN associated to meningoencephalocele as manifestation of subacute increased intracranial pressure.We report the first case of EVN that manifested with diplopia and ocular motor disorders due to intraorbital meningoencephalocele through a bone gap in the orbital roof.Diagnosis of EVN is challenging and its differential diagnosis with more aggressive lesions is mandatory. Complete surgical removal does not need any adiuvant therapies and permits to control tumor growth and symptoms related to intracranial pressure.</p

Can scoliosis lead to spinal cord ischaemia? Early diagnosis and rehabilitation: A paradigmatic case report and literature review

INTRODUCTION: Scoliosis is frequently associated with pain and radiculopathy, but it is not considered a possible cause of acute spinal cord injury (SCI). Here we present a case report in which scoliosis was apparently linked to spinal cord ischaemia.CASE PRESENTATION: A 20-year-old woman with conservatively treated severe scoliosis presented with acute spinal cord infarction, which occurred during a spinal flexion while she was tidying up the bed. Other causes of SCI were excluded. Early rehabilitation was started and the patient progressively regained motor and sensory functions, with an AIS reduction from A to C. Bowel and bladder disorders persisted and were autonomously managed with a trans-anal irrigation device and intermittent catheterisation after voluntary micturition.DISCUSSION: Early detection and management of spinal curvature disorders are essential in preventing long-term complications of scoliosis. Although the aetiology of spinal cord ischaemia in severe scoliosis should be better clarified, this rare case report suggests that scoliosis might be involved in its pathogenesis. Thus, we recommend early diagnosis of spinal curvature disorders and adequate rehabilitative treatment in order to prevent potential subsequent neurological complications

Haemorrhagic presentation of a craniopharyngioma in a pregnant woman

Objective. Craniopharyngioma is a rare tumour, and, consequently, acute clinical presentation and diagnosis, during pregnancy, of this pathology are quite difficult to find. Only few cases are reported in the literature, and no one describes these two conditions in association. Methods. We report a particular case of craniopharyngioma presenting both of the above conditions. Results. The patient was successfully operated with endoscopic technique. Conclusions. Rare and difficult cases, created by the superposition of different clinical conditions, need multidisciplinary management, with collaboration, integration, and cooperation between different medical specialists

Quantitative assessment of transferable antibiotic resistance in zebrafish (Danio rerio) fed Hermetia illucens-based feed

Antibiotic resistance (AR) is an issue in aquaculture since the excessive use of antibiotics administered both for prophylaxis and metaphylaxis may lead to selection for resistant bacteria, that can be found in edible products (e.g., seafood) marketed for human consumption. There is a paucity of data in the scientific literature on the dynamics of AR genes in fish feeds, including those with insect meal as an ingredient. This study represents the first attempt to assess the dynamics of genes conferring resistance to antibiotics conventionally used in clinical practice such as macrolide-lincosamide-streptogramin B (MLSB) [erm(A), erm(B), erm(C)], vancomycin (vanA, vanB), tetracyclines [tet(M), tet(O),tet(S), tet(K)], -lactams (mecA, blaZ) and aminoglycosides [aac(6\u2019)-Ie aph(2\u201d)-Ia]. For this purpose, zebrafish (Danio rerio) fed Hermetia illucens-based diets was used as an experimental model. AR genes were assessed using optimized quantitative PCR (qPCR) assays. The dynamics of the selected AR genes were studied during a 6-month feeding trial with zebrafish fed diets including increasing levels of H. illucens (Hi) larvae (25%, 50%, 75%, and 100%) that were previously reared on coffee silverskin supplemented with 10% Schizochytrium sp. microalgae. A diet with no insect additions was used as the control. qPCR detected erm(B), tet(K), tet(M), tet(O) and tet(S) genes in all the analyzed diet samples, whereas the same samples were negative for mecA, vanA, vanB and aac-aph. In zebrafish at their larval, juvenile and reproductive stages, erm(A), erm(C), vanB and aac-aph genes were never detected, whereas erm(B), tet(M) and tet(S) genes were widespread irrespective of the stage of development or feed. According to principal component analysis, a clear separation among fish fed diets containing the highest or the lowest insect inclusion levels was generally observed. These results showed a significant contribution of insect-based feed to the spread of the studied AR genes compared with control diets. This finding suggests the occurrence of complex interactions between the microbiota and the resistome occurring in feed and in the fish gut. Notably, when present, AR genes could be transferred to commensal or pathogenic microorganisms that may reach the food chain. These results represent a first baseline for future AR risk assessments in the edible insect feed chain. Until then, prudent use of antibiotics during rearing of edible insects is recommended