Creation of a specific and separated pediatric intra-hospital pathway in primary level hospitals during the era of COVID-19

Every new pandemic forces us to start new specific behaviors both in the civil life and within the hospitals trying to contain the spreading of the infection and preserve the more fragile people. In this regard, at the debut of Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2) pandemic, our Local Health Agency had drastically modified every clinical and organizational pathways in order to limit the diffusion of the infection as well as to maintain a good quality of care and preserve healthcare workers. We report how we have modified the usual pediatric intra-hospital pathways in our primary level hospital to avoid mixing children with suspected and non-suspected symptoms of SARS-CoV-2 infection. Before every hospitalization, regardless of symptoms, each child and him/her parent/caregiver are undergone to rapid antigenic and molecular swab to rule out a SARS-CoV-2 infection; hence, positive patients are transferred to Pediatric Unit of third level hospital equipped by a Pediatric COVID Intensive Unit. We think the healthcare behaviors described in this manuscript can help to reduce the intra-hospital spreading of SARS-CoV-2, although children seem to have a minimal role in the dissemination, but we cannot let down your guard. Simultaneously we observed that the overall children requiring inpatient pediatric evaluation and hospitalization have dramatically decreased from the beginning of pandemic

Hashimoto's thyroiditis and autoimmune gastritis

The term "thyrogastric syndrome" defines the association between autoimmune thyroid disease and chronic autoimmune gastritis (CAG), and it was first described in the early 1960s. More recently, this association has been included in polyglandular autoimmune syndrome type IIIb, in which autoimmune thyroiditis represents the pivotal disorder. Hashimoto's thyroiditis (HT) is the most frequent autoimmune disease, and it has been reported to be associated with gastric disorders in 10-40% of patients while about 40% of patients with autoimmune gastritis also present HT. Some intriguing similarities have been described about the pathogenic mechanism of these two disorders, involving a complex interaction among genetic, embryological, immunologic, and environmental factors. CAG is characterized by a partial or total disappearance of parietal cells implying the impairment of both hydrochloric acid and intrinsic factor production. The clinical outcome of this gastric damage is the occurrence of a hypochlorhydric-dependent iron-deficient anemia, followed by pernicious anemia concomitant with the progression to a severe gastric atrophy. Malabsorption of levothyroxine may occur as well. We have briefly summarized in this minireview the most recent achievements on this peculiar association of diseases that, in the last years, have been increasingly diagnosed

Early detection of biochemically occult autonomous thyroid nodules

Objective: Autonomously functioning thyroid areas may be associated with subclinical or overt hyperthyroidism, but may exist even in the presence of normal TSH. This study was aimed at comparing the rate of autonomously functioning areas and their cardiac sequelae in patients with nodular goitre studied with the usual and a novel approach. Design and methods: In total 490 adult outpatients with thyroid nodular goitre, living in a mild iodine-deficient area, were selected in our referral centre for thyroid diseases from 2009 to 2014 on the basis of a suspicion of thyroid functional autonomy. They were divided in three groups according to a non-conventional approach (excessive response to thyroxine treatment: group 1) or conventional approach (low/normal TSH with clinical suspicion or low TSH: groups 2 and 3). All patients of the study with the suspicion of thyroid functional autonomy underwent thyroid scan with radioactive iodine (I131) uptake (RAIU). Results: The percentage of confirmed thyroid functional autonomy was 319/490, being significantly higher in group 3 than in groups 1 and 2 (81.5 vs 64.7 vs 52.6%; chi-square P < 0.0001). However, the diagnosis with non-conventional approach was made at a significant earlier age (P < 0.0001). Cardiac arrhythmias as well as atrial fibrillation were similarly detected by conventional and non-conventional approaches (chi-square test: P = 0.2537; P = 0.8425). Conclusions: The hyper-responsiveness to thyroxine treatment should induce the suspicion of thyroid functional autonomy at an early stage, allowing to detect autonomous functioning areas in apparently euthyroid patients

A case report of thyroid carcinoma confined to ovary and concurrently occult in the thyroid. Is conservative treatment always advised?

Introduction: Struma ovarii is an ovarian teratoma, represented in more than 50% by thyroid tissue. Five percent of struma ovarii cases have been proven to be malignant and, as in the thyroid gland, papillary thyroid carcinoma is the most common histotype arising in struma ovarii. Because of the unusual occurrence of this tumor, its management and follow-up after pelvic surgery is still controversial. Usually, total thyroidectomy followed by radioiodine treatment is the choice treatment in metastatic malignant struma ovarii, while these procedures are still controversial in non-metastatic thyroid cancer arising in struma ovarii. Case Presentation: We report a female with follicular variant of papillary thyroid carcinoma arising in struma ovarii. After pelvic surgery, thyroid morphofunctional examinations were performed and a single nodular lesion in the left lobe was discovered. The patient underwent total thyroidectomy and histological examination showed a papillary carcinoma. Radioiodine-ablation of residual thyroid tissue was performed and levothyroxine mildly-suppressive treatment was started. Conclusions: A more aggressive treatment should not be denied for malignant struma ovarii without any evidence, even when apparently confined into the ovary. However, in selected cases, aggressive treatment may be advisable to decrease the risk of recurrence and to allow an accurate follow-up

Evaluation of skin temperature change as stress indicator in rabbit through infrared thermography

AbstractStress-induced reactions in animals include behavioural and physiological modifications aiming at coping towards the stressor, such as manipulations. Thermography, that is the detection of ..

Wavefront invasion for a chemotaxis model of Multiple Sclerosis

In this work we study wavefront propagation for a chemotaxis reaction-diffusion system describing the demyelination in Multiple Sclerosis. Through a weakly non linear analysis, we obtain the Ginzburg–Landau equation governing the evolution of the amplitude of the pattern. We validate the analytical findings through numerical simulations. We show the existence of traveling wavefronts connecting two different steady solutions of the equations. The proposed model reproduces the progression of the disease as a wave: for values of the chemotactic parameter below threshold, the wave leaves behind a homogeneous plaque of apoptotic oligodendrocytes. For values of the chemotactic coefficient above threshold, the model reproduces the formation of propagating concentric rings of demyelinated zones, typical of Baló’s sclerosis

Thyroxine in Goiter,<i>Helicobacter pylori</i>Infection, and Chronic Gastritis

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First evidence of recruitment in critically endangered Galápagos pink land iguanas (Conolophus marthae)

We present the first estimate of population dynamics parameters for critically endangered Galápagos pink land iguanas, Conolophus marthae, leveraging mark-recapture data collected between 2006 and 2021. Demographic parameters were estimated using the POPAN formulation of the Jolly–Seber model. This approach provided a solid and robust estimate, consolidating the results obtained from previous estimates based on the Lincoln–Petersen method evaluating only two sampling occasions. Our results suggest that the abundance of males was higher than that of females at each sampling occasion, probably due to differences in sex-specific behavior during the reproductive season. Our analyses also provide no evidence of a change in population size during the sampling period, estimated at 150–270 adult individuals, while suggesting positive entry rates. Finally, by comparing the biometric features of first-captured versus recaptured iguanas, we found that the former have more juvenile-like characteristics (i.e., they are, on average, smaller) than the latter. Although juvenile pink iguanas have rarely been recorded (only four sampled juvenile-like individuals in over 16 years of field work), our combined results provide the first clear indication that the only known C. marthae population actively recruits new members from younger age classes. Such recruitment may have prevented any measurable population decline in the last 16 years, but it was also not sufficient to clearly increase the population size. These results are of the utmost importance for the conservation of this species. They will guide future high-priority actions: (i) aiming at increasing population size by removing or mitigating threats and (ii) increasing the number of individuals by implementing a headstart program and/or founding a second viable population, as identified in the recently published IUCN Conservation and Management Plan