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

A case of massive subcutaneous emphysema and transient ischemic attack due to argon plasma coagulation following endoscopic pilonidal sinus treatment

Pilonidalsinusisasmallholeaffectingtheskinandsubcutaneoustissue,whichusuallycontainshairandskindebris,resultinginthecreationoftheso-calledpilonidalcyst.Theendoscopicpilonidalsinustreatment(EPSiT)isaminimallyinvasiveprocedureconsistingoftheremovalofhairsandcauterizationofthecavityunderdirectendoscopicvision.Inourinstitution,weusedtoendthisprocedurewithargonplasmacoagulation(APC).Here,wediscussacaseof22-year-oldmanaffectedbypilonidaldisease,whodevelopedamassivesubcutaneousemphysemaandsuspectedtransientischemicattacksecondarytogasreabsorptionafteranEPSiTinwhichAPCwassedforthecoagulation

Beam characterization of a microfading tester: evaluation of several methods

Microfading testing allows to evaluate the sensitivity to light of a specific artwork. Characterization of the illumination spot is important to determine its shape, dimensions, light distribution, and intensity in order to limit and account for possible damage. In this research the advantages and disadvantages of several methods used to determine the beam shape and intensity profiles are described with the aim of providing various options to microfading researchers interested in characterizing their irradiation spots. Conventional and imaging methods were employed and are compared in terms of their accuracy, cost, reliability, and technical features. Conventional methods consisted of an aperture technique using aluminium foil and four different materials namely stainless steel, silicon, muscovite, and Teflon used as sharp edges. The imaging methods consisted of digital photography of illumination spot, direct beam measurement using a CMOS camera, and direct beam measurement using a laser beam profiler. The results show that both conventional and imaging methods provide beam width measurements, which are in satisfactory agreement within experimental error. The two best methods were direct measurement of the beam using a CMOS camera and sharp-edge procedure. MFT illumination beam with a CMOS camera followed by a determination of the beam diameter using a direct method, more specifically one involving a sharp-edge technique