An Original Approach for the Treatment of Varicose Veins of the Lower Limbs

BACKGROUND: The Triplex method is a three-step treatment approach to reducing the appearance of small and medium-sized varicose veins and phlebological imperfections of the lower limbs. OBJECTIVE: This study evaluated the effectiveness, duration of results, adverse events, patient satisfaction, and improvements in quality of life in patients with small and medium-sized varicose veins who were treated with the Triplex method. METHODS: We conducted a six-year follow-up study of 4,000 patients from the years 2012 to 2018. Patients with chronic venous insufficiency of the lower limbs were included. Patients with active or previous phlebitis or phlebostatic ulcers were excluded. An average of three sessions was performed on each patient in the Triplex group. Follow-up assessments were performed 1, 3, 6, and 12 months after the completion of the treatment, and they included a morphofunctional study, histological examination, and photographic documentation. The first step of the treatment approach utilized an injectable shrinkage solution consisting of sodium salicylate, physiological solution with 10% glycerol, and lidocaine, which was injected into the varices to trigger a reduction of the vessel lumen. For patients in whom the targeted vessels were not sufficienty narrowed by the shrinkage solution, the second step - ultrasound-guided foam sclerotherapy, or scleromousse - was utilized, which consisted of either lauromacrogol 1% or sodium tetradecyl sulfate 1%, with one group of patients (n=50) receiving the former and the other group of patients (n=50) receiving the latter. All patients were administered Step 3 of the treatment approach, which usually included varicose treatment with low concentrations of sodium tetradecyl sulfate (STS) 0.2 to 0.50% or lauromacrogol 0.25%, with compression additionally prescribed in some patients. RESULTS: Over a follow-up period of six years, in patients who underwent full Triplex treatment, we observed 1) a greater duration of the narrowing of the vessel's caliber, with disappearance of the varices; 2) reduced utilization of the foam solution at the reflux point due to the narrowing of the gauge; and 3) no relevant hemodynamic effects emerged in patients with recanalization. In patients who underwent Steps 1 and 2 of the treatment approach, reflux was not hemodynamically significant. No significant differences were observed in the lauromacrogol group of patients compared to the sodium tetradecyl sulfate group. CONCLUSION: Compared to patients in whom only scleromousse was performed at the reflux site, the narrowing of the varicose wall that is achieved using the Triplex method is associated with longer lasting results in the treatment of small and medium-sized varicose veins, with physiological recovery of superficial venous circulation

Benzodiazepine prescriptions on merchant ships without a doctor on board: analysis from medical records of Centro Internazionale Radio Medico (CIRM)

Background: Benzodiazepines are drugs widely used for the treatment of anxiety and insomnia. The present study has analysed the prescriptions of this class of drugs among sailing seafarers, to evaluate the appropriateness of prescribed therapies. Materials and methods: This study assessed the benzodiazepine prescriptions made by Centro Internazionale Radio Medico (CIRM) doctors from 2011 to 2015. A total of 17,844 medical records were examined. Analysis considered the prescriptions of benzodiazepines in monotherapy, or in association with other drugs. Diagnoses of pathologies for which benzodiazepines were prescribed were made according to the ICD-10 classification system proposed by the World Health Organisation. Results: Among medical records analysed, benzodiazepines were prescribed in 765 cases (3.29% of total cases assisted by CIRM). Benzodiazepines were prescribed as a single-drug treatment in 626 (81.83%) cases, whereas in 139 cases they were associated with other classes of drugs. In case of opioids prescribed in association with benzodiazepines, the drug used was codeine. This therapeutic association was prescribed in cases of severe pain. Conclusions: Although the “off label” use of benzodiazepines is not uncommon in medical practice, clear evidence indicates their potential side effects for human health. In this respect, medical professionals should comply with international guidelines on the use of benzodiazepines, both when prescribed as a single drug or in combination with other classes of drugs. These recommendations should be considered seriously in case of limited medical facilities such as on board of sailing ships.

Iron deficiency anemia caused by nonspecific (idiopathic) small bowel ulceration: an uncommon presentation of an uncommon disease.

Ulcers of the small bowel are rare, and in most cases are due to infections, inflammatory bowel diseases, malignancies or drugs. When none of these causes is recognized, they are classified as 'nonspecific' or idiopathic. Such lesions are uncommon, and in most cases present with occlusion. A case of a middle-aged woman with iron deficiency anemia due to occult bleeding, with negative gastroscopy and colonoscopy is presented. The diagnosis of a small bowel pathology resembling Crohn's disease was made by small bowel follow through and small intestine contrast ultrasonography. An ileal ulcer was identified at surgery, and after resection the patient experienced a stable recovery from the anemia without ulcer recurrence. Neither histology nor clinical or biochemical features suggested the diagnosis of an inflammatory bowel disease. Other possible causes were unlikely and the lesion was therefore diagnosed as idiopathic. This report also focuses on the need and the modality to investigate the small bowel in iron deficiency anemia patients

Factors affecting the quality and reliability of online health information

Background: Internet represents a relevant source of information, but reliability of data that can be obtained by the web is still an unsolved issue. Non-reliable online information may have a relevance, especially in taking decisions related to health problems. Uncertainties on the quality of online health data may have a negative impact on health-related choices of citizens. Objective: This work consisted in a cross-sectional literature review of published papers on online health information. The two main research objectives consisted in the analysis of trends in the use of health web sites and in the quality assessment and reliability levels of web medical sites. Methods: Literature research was made using four digital reference databases, namely PubMed, British Medical Journal, Biomed, and CINAHL. Entries used were “trustworthy of medical information online,” “survey to evaluate medical information online,” “medical information online,” and “habits of web-based health information users”. Analysis included only papers published in English. The Newcastle Ottawa Scale was used to conduct quality checks of selected works. Results: Literature analysis using the above entries resulted in 212 studies. Twenty-four articles in line with study objectives, and user characteristics were selected. People more prone to use the internet for obtaining health information were females, younger people, scholars, and employees. Reliability of different online health sites is an issue taken into account by the majority of people using the internet for obtaining health information and physician assistance could help people to surf more safe health web sites. Conclusions: Limited health information and/or web literacy can cause misunderstandings in evaluating medical data found in the web. An appropriate education plan and evaluation tools could enhance user skills and bring to a more cautious analysis of health information found in the web

Comparative analysis of the medicinal compounds of the ship’s “medicine chests” in European Union maritime countries. Need for improvement and harmonization

Background: The contents of the ship pharmacy, namely “medicine chest” and its compliance with the respective regulations concerning the type of drugs to be provided for merchant vessels involved in long distance voyages and without a doctor on board were analysed. The current existing disparity between regulations can make medical assistance more complicated, and more often of low quality, due to frequent off-label use of supplied drugs. This study may represent a starting point leading to a model high-quality medicine chest on board ships.  Materials and methods: A comparative analysis between the medicine chest requirements of 12 European countries and the CEE Directive 31 March 1992 n.92/29 was made. Prescriptions of the aforementioned Directive were compared with the WHO Model List of Essential Medicines (third Edition).  Results: The investigation showed a lack of homogeneity of contents. It emerged that some medicine chests lack of several pharmaceutical categories required by the reference standards. The subsequent comparison of the European Directive with the WHO Model List of Essential Medicines has highlighted the absence of some therapeutic categories that in the ship environment can be of important to ensure adequate therapy in many situations.  Conclusions: There are disparities regarding regulations concerning the ship medicine chests. It is crucial to harmonize these and create a single medicine chest for all the ships without a doctor on board, undergoing periodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcare to seafarers around the world.

telemedicine practice review of the current ethical and legal challenges

n/

Design and evolution of the Seafarer’s Health Passport for supporting (tele)-medical assistance to seafarers

Background: Seafarers undergo periodic medical examination for their employment. This information in most cases is not effectively used when requesting for medical assistance during service on board ships. The medical history of an individual is important for provision of medical care and can be critical to the outcome. There is growing adoption of digital applications and electronic health records that are adding great value to the care provided. The Seafarer’s Health Passport (SHP) is an application specifically designed for improving the quality of medical assistance provided to seafarers both through telemedicine or classic medical check-ups in ports/hospitals worldwide. The SHP provides a secure and unique way to archive and retrieve the seafarer’s medical history in an electronic support.  Materials and methods: The SHP that we have developed is a product with specific hardware and software specifications. The basic features of this software are Linux operating system Debian/Ubuntu, Apache Web server 2.x, Server database MySQL/Maria DB PHP programming language 5.6.xx, and secure connection in https.  Results: The SHP represents a helpful hint to physicians providing medical advices to seafarers enabling them to make more decisions that are informed and curtailing possible complications due to misdiagnosis.  Conclusions: Provision of high quality medical assistance requires knowledge of patient’s medical history. The availability of an easy access and friendly use system of own medical history is useful for a population of travellers, such as seafarers to guarantee a reasonable level of medical care at any time.

TelePharmaSea: proposing a novel approach to automate, organize and simplify management of medical chest on board commercial vessels.

Background: The on-board pharmacy is the kit that allows the implementation healthcare on board ships, since it should contain everything that may be needed to guarantee proper and efficient health care interventions for seafarers. There are several problems that can lead to a difficult and non-optimal management of the on-board pharmacy. This work illustrates the "TelePharmaSea" software, specifically developed to optimise the management of the on-board pharmacy of commercial vessels without medical personnel. Materials and methods: We collected the Medical Scales of the various Flag States and brought them all into a standardised format which could be used. The Active Ingredients and Pharmaceutical form of each medicine is linked with the ATC Codes. Active Ingredients having similar effect are linked by ATC codes. Items that did not have an ATC code were given a unique system-generated code. Due to the proprietary nature of the software of which the database structure and functioning is unique, we cannot share the exact structure; however, the approach regarding the same has been highlighted. Results and Conclusions: The proposal of the TelePharmaSea software can be an effective tool capable of a significant improvement of the overall quality of medical and pharmacological assistance provided on ships without a doctor on board. The system can guarantee a better management of the on-board pharmacy's inventory, and it may also reduce the risks of mistakes in drugs administration

Classification of micro-Doppler radar hand-gesture signatures by means of Chebyshev moments

In this paper a method capable of automatically classify radar signals of human hand-gestures exploiting the micro-Doppler signature is designed. In particular, the methodology focuses on the extraction of the Chebyshev moments from the cadence velocity diagram (CVD) of each recorded signal. The algorithm benefits from interesting properties of these moments such as the fact that they are defined on a discrete set and hence computed without approximations, as well as the symmetry property that allows to minimize the computational time. The experiments computed on the challenging real-recorded DopNet dataset show interesting results that confirm the effectiveness of the approac

Unearthed opium. Development of a UHPLC-MS/MS method for the determination of Papaver somniferum alkaloids in Daunian vessels

Introduction: The analysis of organic residue in ancient vessels to investigate early-age civilization habits is an important archeological application that needs advanced analytical methods. However, these procedures should meet inherent requisites such as low sampling invasiveness and high sensitivity for trace analysis. This study deals with the development of advanced analytical methods for the detection of opium alkaloids in ceramic vessels and its first application to the study of Daunian pots dating back to the VIII-IV sec BC.Methods: All the stages of the analytical procedure, from sampling to analysis, were carefully optimized. Concerning sampling, the traditional scraping approach was compared with a swabbing strategy which permitted minimizing sample encroachment. Extraction was based on pressurized liquid extraction or ultrasound-assisted liquid extraction, followed by dispersive liquid-liquid microextraction, which allowed concentration enrichment. On the other hand, a UHPLC-MS/MS method was specifically developed and validated to obtain reliable data. Some Daunian pots, belonging to the Ceci-Macrini private archeological collection, were selected for sample withdrawal as their iconography could suggest opium usage.Results: Several of the analyzed samples resulted positive to thebaine and less frequently to morphine and codeine; furthermore, 70% of the analyzed items tested positive for at least one opium alkaloid. Positive findings were common to all the samples collected in the pots, suggesting that scraping and swabbing provided comparable results and validating this unusual sampling strategy. All samples were additionally analyzed by UHPLC-HRMS to further improve the confidence level of the identified compounds. The obtained results shed new light on the hypothesis of opium usage by the ancient Daunian civilization. Furthermore, this study provided suitable analytical tools for further investigations on the same topic, with a good level of confidence in the quality of the results