Malaria in an asylum seeker paediatric liver transplant recipient: diagnostic challenges for migrant population

Transplanted patients are particularly exposed to a major risk of infectious diseases due to prolonged immunosuppressive treatment. Over the last decade, the growing migration flows and the transplant tourism have led to increasing infections caused by geographically restricted organisms. Malaria is an unusual event in organ transplant recipients than can be acquired primarily or reactivation following immunosuppression, by transfusion of blood products or through the transplanted organ. We report a rare case of Plasmodium falciparum infection in a liver transplanted two years-old African boy who presented to one Italian Asylum Seeker Center on May 2019. We outlined hereby diagnostic challenges, possible aetiologies of post-transplantation malaria and finally we summarized potential drug interactions between immunosuppressive agents and antimalarials. This report aims to increase the attention to newly arrived migrants, carefully evaluating patients coming from tropical areas and taking into consideration also rare tropical infections not endemic in final destination countries

La Gestione infermieristica del paziente colpito da ictus dopo la dimissione dall’ospedale a domicilio. Una revisione sistematica e GRADE

  AIM. Stroke is the second cause of death worldwide and the third cause of death in industrialized countries. To investigate the effectiveness of the nurse's role the management for people affected by stroke after discharge from hospital to home. METHOD. A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was carried out. MEDLINE, CINAHL, Web of Science and Scopus were searched for studies on the effectiveness of the nurse's role in managing the stroke rehabilitation process after discharge from the home hospital from 2000 to June 2018 in English. The methodological quality was assessed by the Cochrane Collaboration’s tool for assessing Risk of Bias (RoB). The GRADE system was used for evaluating evidence quality of each outcome. RESULTS. 7,025 studies were identified, 12 met the inclusion criteria. The outcomes in the literature are quality of life related to the degree of independence and depression, to the perception and health management and to the adaptation and stress tolerance. No primary outcome is reported in the literature with a high degree of confidence. DISCUSSION. The nurse's role the management for people affected by stroke after discharge from hospital to home represent an effective strategy for an improvement in the functional outcome, quality of life and reduction of costs.  SCOPO. L'ictus è la seconda causa di morte in tutto il mondo e la terza causa di morte nei paesi industrializzati. Scopo di questo lavoro è fornire una sintesi della letteratura sull'efficacia del ruolo dell'infermiere nella gestione del processo di riabilitazione delle persone colpite da ictus dopo la dimissione dall'ospedale a casa. METODO. Revisione sistematica della letteratura di tipo quantitativo effettuata seguendo il metodo PRISMA. La ricerca è stata condotta su: Cinhal-EBSCO, Medline-PUBMED, Web of Science e Scopus. Sono stati ricercati studi sulla efficacia del ruolo dell’infermiere nella gestione del processo di riabilitazione del paziente colpito da ictus dopo la dimissione dall’ospedale a domicilio in lingua inglese dal 2000 al 2018. La selezione è stata effettuate utilizzando criteri di inclusione ed esclusione. La qualità degli articoli è stata valutata con il Risk of Bias (RoB) della Cochrane Collaboration. Il sistema GRADE è stato utilizzato per valutare la qualità delle prove di ciascun risultato. RISULTATI. Sono stati identificati 7.025 studi, di questi 12 hanno soddisfatto i criteri di inclusione. I risultati in letteratura sono la qualità della vita correlata al grado di indipendenza e depressione, alla gestione della percezione e della salute, all’adattamento e alla tolleranza allo stress. Nessun risultato primario è riportato in letteratura con un alto grado di sicurezza. DISCUSSIONE. Il ruolo dell'infermiere nella gestione delle persone colpite da ictus dopo dimissione dall'ospedale a casa rappresenta una strategia efficace per un miglioramento del risultato funzionale, della qualità della vita e della riduzione dei costi

Otolaryngology fantastica: the ear, nose, and throat manifestations of Munchausen's syndrome

OBJECTIVES/HYPOTHESIS: Munchausen's syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausen's syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP.STUDY DESIGN: A systematic literature review carried out in a tertiary university referral center.METHODS: An appropriate string was run on PubMed to retrieve articles dealing with ENT manifestations of MS and MSBP. A double cross-check was performed on citations and full-text articles found using selected inclusion and exclusion criteria.RESULTS: In total, 24 articles were finally included in the study, describing 30 cases of MS or MSBP involving the ENT region; 15/30 (50%) cases involved the face, most often presenting as facial pain or facial swelling; and 7/30 (23.3%) cases presented with symptoms involving the ear. Six cases out of 30 (20%) were MSBP.CONCLUSIONS: MS and MSBP may present with symptoms involving the head and neck area, particularly the face and external ear canal. The ENT specialist should suspect MS in patients with strange and long-lasting symptoms, so as to avoid misdiagnosis and unnecessary treatments that waste time and money in the healthcare sector

Electroencephalographic Abnormalities in Autism Spectrum Disorder: Characteristics and Therapeutic Implications

A large body of literature reports the higher prevalence of epilepsy in subjects with Autism Spectrum Disorder (ASD) compared to the general population. Similarly, several studies report an increased rate of Subclinical Electroencephalographic Abnormalities (SEAs) in seizure-free patients with ASD rather than healthy controls, although with varying percentages. SEAs include both several epileptiform discharges and different non-epileptiform electroencephalographic abnormalities. They are more frequently associated with lower intellectual functioning, more serious dysfunctional behaviors, and they are often sign of severer forms of autism. However, SEAs clinical implications remain controversial, and they could represent an epiphenomenon of the neurochemical alterations of autism etiology. This paper provides an overview of the major research findings with two main purposes: to better delineate the state-of-the-art about EEG abnormalities in ASD and to find evidence for or against appropriateness of SEAs pharmacological treatment in ASD

Exploring the relationships between executive functions and personality dimensions in the light of "Embodied Cognition" theory: A study on a sample of 130 subjects

The Executive Functions and the dimensions of the personality seem to have numerous points of convergence both on the psychological and neurobiological sides. Current studies interpret this relationship as a linear concatenation that starts from a damage of the prefrontal cortical areas, produces a deficit of the executive functions and finally evolves towards the development of pathological character traits. In an "enacted cognition" perspective, the relationship between executive functions and personality should be interpreted according to a circular causality model that appears ecologically more realistic and adequate to empirical data. The present study evaluates executive functions and personality dimensions in a sample of 130 subjects using the Frontal Assessment Battery, the Temperament and Character Inventory, respectively. The results show that subjects with low empathic and emotional propensities, detected through 9 items of Temperament and Character Inventory, while not presenting any kind of disturbances, show Executive Functions that are not efficient or even inadequate. These data are not easily explained according to the classic linear model and seem to confirm the circular perspective proposed by the "embodied cognition" theory. However, an expansion of the sample is essential to obtain confirmation of the data that emerged

Beneficial effects of pasta during pregnancy: The positive effects of mediterranean diet

Pregnancy is a physiological state during which the woman's body undergoes profound modifications. During this time, every woman must be nourished in such a way as to maintain herself in good health and at the same time allow the fetal tissues to form and develop in the best way. Proper nutrition is one of the fundamental prerequisites for the normal evolution of both pregnancy and fetal growth: the quantity and quality of food and drinks must be scrupulously controlled. Contrariwise, it is important to avoid the excess calories and macronutrients. In fact, during pregnancy, it may be just as harmful as their shortage, especially in overweight and obese women, for which the risk of miscarriage, gestational diabetes, fetal growth disorders and preeclampsia increases. The pasta constitutes the foundation of the Mediterranean diet food. The dough can be seen, therefore, so it represents an excellent ally of the diet from a nutritional point of view. The nutritional values of the pasta change depending on the type, based on the fact that the dough is traditional or integral semolina. It also contains Vitamin B and has an abundance of minerals, among which potassium. The pasta is an easily digestible food, ensuring energy ready to use (such as all carbohydrates); moreover, it possesses a great satiating power. In case of overweight, however, it is possible to reduce the number of carbohydrates in the diet, taking care not to make them ever miss. In conclusion, the consumption of pasta is very important during pregnancy: a diet without carbohydrates can be dangerous for all physiological pathways

The effects of the endocrine disruptors and of the halogens on the female reproductive system and on epigenetics: A brief review

Introduction: An endocrine-disrupting chemical (EDC) is defined as "an exogenous chemical or a mixture of chemicals that interfere with any aspect of the hormonal action". Endocrine systems are a physiological interface with the environment and genetic-environmental interactions are disrupted by EDCs. Today, there are almost 1000 chemicals reported to have endocrine effects: the prevalence of EDC in our environment and in our bodies represents a major global health challenge. This review gathers the studies that have investigated the correlations between exposure to EDC and pathologies of the female reproductive system and fetal development. Methods: A PubMed research was conducted using the keywords, their variants, and their combinations (BPA, DES, MXC, pesticides, phthalates, plasticizers, PCBs, dioxins, ovaries, oocytes, ovaries, fallopian tubes, follicles, vagina, uterus, fibroids, fertility, infertility, puberty, polycystic ovary syndrome, premature ovarian failure, birth, preterm birth, birth outcome, steroid, hormone, female, girl and menopause). Results: The endocrine system plays a central role in all vertebrates and regulates critical biological functions such as metabolism, development, reproduction, and behavior. Epidemiological studies link EDCs with reproductive effects, neuro-behavioral and neurodevelopment alterations, metabolic syndrome, bone disorders, immune disorders, and cancers in humans. Human investigations confirm the results of the studies carried out on animal showing associations with many additional effects on health, including asthma, learning and behavior problems, premature puberty, infertility, breast and prostate cancer, Parkinson's disease, obesity and other diseases. Conclusions: It is important to undertake research with follow-up methodologies and/or longitudinal studies to detect the extent of exposure of pregnant women to EDCs and halogenated substances and the effects of such exposure on brain development. A future research hypothesis may consider the effect that these substances have on neuro-development and, more specifically, how EDCs are involved in pathogenic disorders such as autism spectrum disorders (ASD). In addition, a scientific study could be performed on the correlations between this type of substance and the inconveniences found in the field of executive frontal functions

Neuropeptides' Hypothalamic Regulation of Sleep Control in Children Affected by Functional Non-Retentive Fecal Incontinence

Functional non-retentive fecal incontinence (FNRFI) is a common problem in pediatric age. FNRFI is defined as unintended loss of stool in a 4-year-old or older child after organic causes have been excluded. FNRFI tends to affects up to 3% of children older than 4 years, with males being affected more frequently than females. Clinically, children affected by FNRFI have normal intestinal movements and stool consistency. Literature data show that children with fecal incontinence have increased levels of separation anxiety, specific phobias, general anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder. In terms of possible relationship between incontinence and sleep, disorders of sleep organization have been observed in the pathogenesis of enuresis so generating the hypothesis that the orexinergic system may have a crucial role not only for the sleep organization per se but also for the sphincterial control in general. This study aimed to focus on specific neurophysiological aspects to investigate on the possible relationship between sleep organizational abnormalities and FNRFI. Specifically, we aimed to measure orexin serum levels in children with FNRFI and assess their polysomnographic sleep macrostructure patterns. Two study groups were considered: FNFRI (n = 45) and typically developed (TD) (n = 45) group. In both groups, sleep patterns and respiratory events were assessed by polysomnographic recordings (PSG) during a period of two nights at least, and plasma levels of Orexin-A were measured in each participant. The findings of this initial investigation seem to support a major role of Orexin-A in sleep organization alterations in children with FNFRI. Also, our data suggest that sleep habits evaluation should be considered as screening and complementary tool for the diagnosis of fecal incontinence in children