EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic

The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of “from distance” and “timely delivered” are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic

Polynuclear Complexes: Two Amino-Phenol Macrocycles Spaced by Several Linear Polyamines; Synthesis, Binding Properties, and Crystal Structure

The synthesis and characterization of the new polytopic ligands 1,14-bis(3,6,9-triaza-15-hydroxybicyclo[9.3.1]pentadeca-11,13,115-trien-6-yl)-3,6,9,12-tetraazatetradecane L1, 1,15-bis(3,6,9-triaza-15-hydroxybicyclo[9.3.1]pentadeca-11,13,115-trien-6-yl)-3,6,10,13-tetraazapentadecane L2, and 1,16-bis(3,6,9-triaza-15-hydroxybicyclo[9.3.1]pentadeca-11,13,115-trien-6-yl)-3,7,10,14-tetraazahexadecane L3, containing two equal amino-phenol macrocycles spaced by several linear tetraamines, are reported. The basicity and coordination behavior toward the Cu(II) ion were potentiometrically determined in aqueous solution at 298.1 K. All the ligands show similar acid-base properties behaving as octaprotic bases in the examined pH range (pH = 2-12). The acid protons of L1-L3 cannot be removed under the experimental conditions used; thus, the main deprotonated species obtainable in aqueous solution are the neutral ligands, having amphionic character as demonstrated by UV-vis experiments. These species are able to form mono-, di-, and trinuclear Cu(II) complexes having stoichiometry [CuL]2+, [Cu2L]4+, and [Cu3L]6+, respectively, that can lose one or two protons giving rise to [CuH-1L]+, [Cu2H-2L]2+, and [Cu3H-2L]4+. Depending on the used ligand to metal molar ratio, the mono-, di-, or trinuclear species prevail over the others in solution. Both di- and trinuclear complexes are able to add secondary ligands (such as OH-), and in some cases two Cu(II) can cooperate to stabilize themby coordinating the guest in a bridged conformation. The structure of the [Cu2L3]4+ cation was resolved by X-ray analysis of the {[Cu2L3](ClO4)4 3 3H2O}2 3 H2O crystalline complex. It shows that each Cu(II) is penta-coordinated by one phenolate oxygen, two amine functions, belonging to one macrocyclic unit, and two amine functions of the spacer; in this species the distance between the two Cu(II) is about 5.3 Å

Making patient centered care a reality: A survey of patient educational programs in Italian Cancer Research and Care Institutes

Background: Educational intervention represents an essential element of care for cancer patients; while several single institutions develop their own patient education (PE) programs on cancer, little information is available on the effective existence of PE programs at the level of research and care institutes. In Italy such institutes - Istituti di Ricovero e Cura a Carattere Scientifico - are appointed by the Ministry of Health, and 11 (Cancer Research & Care Istitute-CRCI) of the 48 are specific for cancer on the basis of specific requirements regarding cancer care, research and education. Therefore, they represent an ideal and homogeneous model through which to investigate PE policies and activities throughout the country. The objective of this study was to assess PE activities in Italian CRCI. Methods: We carried out a survey on PE strategies and services through a questionnaire. Four key points were investigated: a) PE as a cancer care priority, b) activities that are routinely part of PE, c) real involvement of the patients, and d) involvement of healthcare workers in PE activities. Results: Most CRCI (85 %) completed the survey. All reported having ongoing PE activities, and 4 of the 11 considered PE an institutional activity. More than 90 % of CRCI organize classes and prepare PE handouts, while other PE activities (e.g., Cancer Information Services, mutual support groups) are less frequently part of institutional PE programs. Patients are frequently involved in the organization and preparation of educational activities on the basis of their own needs. Various PE activities are carried out for caregivers in 8 (73 %) out of 11 institutes. Finally, health care workers have an active role in the organization of PE programs, although nurses take part in these activities in only half of CRCI and pharmacists are seldom included. Conclusions: The information arising from our research constitutes a necessary framework to identify areas of development and to design new strategies and standards to disseminate the culture of PE. This may ultimately help and stimulate the establishment of institutional integrated PE programs, including policies and interventions that can benefit a significant proportion of cancer patients

COVID-19 and schools: what is the risk of contagion? Results of a rapid-antigen-test-based screening campaign in Florence, Italy

INTRODUCTION: in the COVID-19 era, the debate around the risk of contagion at school, is intense in Italy. The Department of Welfare and Wealth of Florence promoted a screening campaign with antigen rapid tests for all the students and school personnel. The aim of this study is to assess the SARS-Cov2 circulation in the school setting by means of a mass screening conducted in every primary and middle school of Florence. METHODS: All the students attending primary and middle schools of Florence and the school personnel were asked to take part. The campaign started on 16(th) November 2020 and was completed on 12(th) February 2021. If the antigen rapid test resulted positive, a molecular test was provided to confirm the result. RESULTS: 18,414 subjects were tested with 15,233 students (82.7%) and 3,181 members of the school personnel (17.3%). Only in 27 cases (0.15%) the rapid test gave a positive result. Moreover, only 14 of the 27 positive rapid tests were confirmed as positive by the molecular test. These results show a very low number of SARS-CoV-2 cases among the people tested (0.08% of the total). CONCLUSIONS: These results show that the spread of SARS-CoV-2 infection at school, during the months of the screening and with the respect of strict preventive measures was low

Bortezomib-induced muscle toxicity in multiple myeloma

Multiple myeloma (MM) accounts for ~13% of all hematologic malignancies. Bortezomib treatment is effective in MM, but can be complicated with neurological side effects. We describe a patient with symptomaticMM who had a reversible metabolic myopathy associated with bortezomib administration and pathologically characterized by excessive storage of lipid droplets together with mitochondrial abnormalities. In a single-center prospective study, 14 out of 24 patients with symptomatic MM were treated with bortezomib and, among these, 7 developed muscular signs and/or symptoms. The myopathy was characterized by a proximal muscle weakness involving lower limbs and was an early complication. Complete resolution of muscle weakness occurred after treatment discontinuation. Conversely, none of the patients who received a treatment without bortezomib developed muscular symptoms. Experimental studies demonstrate that in primary human myoblasts bortezomib at low concentrations leads to excessive storage of lipid droplets together with structural mitochondrial abnormalities, recapitulating the pathologic findings observed in patient's muscle. Our data suggest that patients treated with bortezomib should be monitored for muscular signs and/or symptoms and muscle weakness should alert the clinician to the possibility of myopathy. Bortezomib-induced metabolic myopathy is a potentially reversible entity with important implications for management and treatment of patients with MM

Caracterização molecular de microrganismos isolados do ecossistema agrícola do cerrado. I. Bactérias endofíticas do milho.

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Clinical assessment of skin phototypes: watch your words!

Fitzpatrick skin phototype classification is widely used to assess risk factors for skin cancers. This skin type evaluation is easy to use in clinical practice but is not always applied as initially described, nor practiced in a standardised way. This can have implications on the results of relevant dermato-epidemiological studies. To demonstrate, in a large multinational setting, that the phrasing of questions on sun sensitivity can have a strong impact on the perception and reporting of skin phototype, as well as the importance of a standardised procedure for phototype assessment. Using data collected from 48,258 screenees of the Euromelanoma campaign in six European countries from 2009 to 2011, we analysed the impact of change in the question phrasing on phototype classification in each country. Changing the wording of a question to assess the phototype of a person also significantly influenced the classification of phototypes in different countries (p<0.001 for each country). The difference essentially corresponded to a shift towards a less sun-sensitive skin type when a shorter question that did not include skin colour description was used. The only exception was Portugal where phototype was not patient-assessed and classification shifted towards a more sun-sensitive phototype. Results were statistically significant and highly consistent, irrespective of gender. The phrasing of questions on skin type is important and substantially influences reporting. A standardized procedure to classify phototypes should be used in order to obtain comparable data between studies

Use of complementary and alternative medicine (CAM) in cancer patients. An italian multicenter survey

INTRODUCTION: Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. PATIENTS AND METHOD: We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. RESULTS: Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. CONCLUSION: Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision