SARS-CoV-2 Circulation in the School Setting: A Systematic Review and Meta-Analysis

The contribution of children to viral spread in schools is still debated. We conducted a systematic review and meta-analysis of studies to investigate SARS-CoV-2 transmission in the school setting. Literature searches on 15 May 2021 yielded a total of 1088 publications, including screening, contact tracing, and seroprevalence studies. MOOSE guidelines were followed, and data were analyzed using random-effects models. From screening studies involving more than 120,000 subjects, we estimated 0.31% (95% confidence interval (CI) 0.05–0.81) SARS-CoV-2 point prevalence in schools. Contact tracing studies, involving a total of 112,622 contacts of children and adults, showed that onward viral transmission was limited (2.54%, 95% CI 0.76–5.31). Young index cases were found to be 74% significantly less likely than adults to favor viral spread (odds ratio (OR) 0.26, 95% CI 0.11–0.63) and less susceptible to infection (OR 0.60; 95% CI 0.25–1.47). Lastly, from seroprevalence studies, with a total of 17,879 subjects involved, we estimated that children were 43% significantly less likely than adults to test positive for antibodies (OR 0.57, 95% CI 0.49–0.68). These findings may not applied to the Omicron phase, we further planned a randomized controlled trial to verify these results

SARS-CoV-2 Circulation in the School Setting: A Systematic Review and Meta-Analysis

The contribution of children to viral spread in schools is still debated. We conducted a systematic review and meta-analysis of studies to investigate SARS-CoV-2 transmission in the school setting. Literature searches on 15 May 2021 yielded a total of 1088 publications, including screening, contact tracing, and seroprevalence studies. MOOSE guidelines were followed, and data were analyzed using random-effects models. From screening studies involving more than 120,000 subjects, we estimated 0.31% (95% confidence interval (CI) 0.05–0.81) SARS-CoV-2 point prevalence in schools. Contact tracing studies, involving a total of 112,622 contacts of children and adults, showed that onward viral transmission was limited (2.54%, 95% CI 0.76–5.31). Young index cases were found to be 74% significantly less likely than adults to favor viral spread (odds ratio (OR) 0.26, 95% CI 0.11–0.63) and less susceptible to infection (OR 0.60; 95% CI 0.25–1.47). Lastly, from seroprevalence studies, with a total of 17,879 subjects involved, we estimated that children were 43% significantly less likely than adults to test positive for antibodies (OR 0.57, 95% CI 0.49–0.68). These findings may not applied to the Omicron phase, we further planned a randomized controlled trial to verify these results

High-resolution ultrasound of spigelian and groin hernias: a closer look at fascial architecture and aponeurotic passageways

From the clinical point of view, a proper diagnosis of spigelian, inguinal and femoral hernias may be relevant for orienting the patient's management, as these conditions carry a different risk of complications and require specific approaches and treatments. Imaging may play a significant role in the diagnostic work-up of patients with suspected abdominal hernias, as the identification and categorization of these conditions is often unfeasible on clinical ground. Ultrasound imaging is particularly suited for this purpose, owing to its dynamic capabilities, high accuracy, low cost and wide availability. The main limitation of this technique consists of its intrinsic operator dependency, which tends to be higher in difficult-to-scan areas such as the groin because of its intrinsic anatomic complexity. An in-depth knowledge of the anatomy of the lower abdominal wall is, therefore, an essential prerequisite to perform a targeted ultrasound examination and discriminate among different types of regional hernias. The aim of this review is to provide a detailed analysis of the fascial architecture and aponeurotic passageways of the abdominal wall through which spigelian, inguinal and femoral hernias extrude, by means of schematic drawings, ultrasound images and video clips. A reasoned landmark-based ultrasound scanning technique is described to allow a prompt and reliable identification of these pathologic conditions

Chronic Giardia intestinalis infection presenting with clinical features mimicking lichen planus.

Sir, Human giardiasis, caused by Giardia intestinalis, a agellate protozoan parasite that colonizes the small bowel, is a worldwide infection (1). Giardia infection is usually asymptomatic but intestinal illness may occur (2–5). Several reports describe the association of allergy with increased levels of total serum IgE antibodies and of speci c IgE antibodies against food allergens in patients aVected by giardiasis, and Giardia infection may determine altered absorption of food antigens causing allergic sensitization (6). Cutaneous signs may be virtually indistinguishable from those of atopic dermatitis (7, 8). Acute reactions such as urticaria or asthma have also been described (9–11). We here report a patient aVected by giardiasis, with lichen-planus-like lesions as the sole clinical feature

Cytogenetics of Premature Ovarian Failure: An Investigation on 269 Affected Women

The importance of X chromosome in the aetiology of premature ovarian failure (POF) is well-known but in many cases POF still remains idiopathic. Chromosome aneuploidy increase is a physiological phenomenon related to aging, but the role of low-level sex chromosome mosaicism in ovarian function is still undiscovered. Standard cytogenetic analysis was carried out in a total of 269 patients affected by POF: 27 chromosomal abnormalities were identified, including X chromosome and autosomal structural and numerical abnormalities. In 47 patients with 46,XX karyotype we performed interphase FISH using X alpha-satellite probe in order to identify X chromosome mosaicism rate. Aneuploidy rate in the patient group was significantly higher than the general population group. These findings underline the importance of X chromosome in the aetiology of POF and highlight the potential role of low-level sex chromosome mosaicism in ovarian aging that may lead to a premature onset of menopause

Cytogenetics of Premature Ovarian Failure: An Investigation on 269 Affected Women

The importance of X chromosome in the aetiology of premature ovarian failure (POF) is well-known but in many cases POF still remains idiopathic. Chromosome aneuploidy increase is a physiological phenomenon related to aging, but the role of low-level sex chromosome mosaicism in ovarian function is still undiscovered. Standard cytogenetic analysis was carried out in a total of 269 patients affected by POF: 27 chromosomal abnormalities were identified, including X chromosome and autosomal structural and numerical abnormalities. In 47 patients with 46,XX karyotype we performed interphase FISH using X alpha-satellite probe in order to identify X chromosome mosaicism rate. Aneuploidy rate in the patient group was significantly higher than the general population group. These findings underline the importance of X chromosome in the aetiology of POF and highlight the potential role of low-level sex chromosome mosaicism in ovarian aging that may lead to a premature onset of menopause

Sunny holidays before and after melanoma diagnosis are respectively associated with lower breslow thickness and lower relapse rates in Italy

Background: Previous studies have reported an association between sun exposure and improved cutaneous melanoma (CM) survival. We analysed the association of UV exposure with prognostic factors and outcome in a large melanoma cohort. Methods: A questionnaire was given to 289 (42%) CM patients at diagnosis (Group 1) and to 402 CM patients (58%) during follow-up (Group 2). Analyses were carried out to investigate the associations between sun exposure and melanoma prognostic factors and survival. Results: Holidays in the sun two years before CM diagnosis were significantly associated with lower Breslow thickness (p=0.003), after multiple adjustment. Number of weeks of sunny holidays was also significantly and inversely associated with thickness in a dose-dependent manner (p=0.007). However when stratifying by gender this association was found only among women (p=0.0004) the risk of CM recurrence in both sexes was significantly lower in patients (n=271) who had holidays in the sun after diagnosis, after multiple adjustment including education: HR=0.30 (95%CI:0.10-0.87; p=0.03) conclusions: Holidays in the sun were associated with thinner melanomas in women and reduced rates of relapse in both sexes. However, these results do not prove a direct causal effect of sun exposure on survival since other confounding factors, such as vitamin D serum levels and socio-economic status, may play a role. Other factors in sun seeking individuals may also possibly affect these results

Consensus based recommendations for diagnosis and medical management of Poland syndrome (sequence)

Background Poland syndrome (OMIM: 173800) is a disorder in which affected individuals are born with missing or underdeveloped muscles on one side of the body, resulting in abnormalities that can affect the chest, breast, shoulder, arm, and hand. The extent and severity of the abnormalities vary among affected individuals. Main body The aim of this work is to provide recommendations for the diagnosis and management of people affected by Poland syndrome based on evidence from literature and experience of health professionals from different medical backgrounds who have followed for several years affected subjects. The literature search was performed in the second half of 2019. Original papers, meta-analyses, reviews, books and guidelines were reviewed and final recommendations were reached by consensus. Conclusion Being Poland syndrome a rare syndrome most recommendations here presented are good clinical practice based on the consensus of the participant experts

Occupational risk of scabies among healthcare workers: problem focus and personal experience

Background: scabies (causative agent: Sarcoptes scabiei var. hominis) is a contagious parasitic disease, widespread in the general population, which can cause hospital outbreaks, with possible involvement of sanitary staff, and considerable economic and managerial implications. The Policlinico San Matteo of Pavia (Italy) adopts (since 2005) a protocol for the management of index cases, based on early patient isolation, identification of close contacts, and their prophylactic treatment (with temporary removal from duty). Objectives: acquiring descriptive data on reported cases of scabies in the hospital under study, and on the preventive effectiveness of the operative protocol adopted for their management. Methods: retrospective study (2005-2014) of the index cases, collected in ad hoc computer archive. For each case, personal and clinical data were collected, as well as information on the healthcare workers who had dealt with the patient within the 6 weeks (maximum scabies incubation period) preceding the diagnosis. Results: 30 index cases were identified: 11 females and 19 males; mean age 60 years; range: 2 months - 92 years. 9 patients had been transferred to the Policlinico from other health facilities. 11 were immunosuppressed: of these, 3 were suffering from Norwegian scabies (or crusted scabies: a highly contagious variant, difficult to diagnose, in which the number of mites on the patient’s skin is very high, up to several millions). Close contacts included 894 health professionals, mainly nurses, physicians and students; of these, 158 had provided assistance to cases of Norwegian scabies: 15 (1.7% of the entire sample) were infected. This percentage is below the rates of infection (sometimes > 30%) reported in other case series. Almost all involved personnel received (prophylactic or therapeutic) acaricide treatment. Conclusions: scabies is a major occupational hazard in hospitals, especially for nursing staff, including students in training. Caution is particularly needed for immunocompromised patients, since they develop with greater frequency Norwegian scabies. The operative protocol adopted by the Policlinico San Matteo is effective for risk containment

Scabbia occupazionale in ambito ospedaliero: studio retrospettivo

Introduzione: la scabbia (agente eziologico: Sarcoptes scabiei var. hominis) è una malattia parassitaria contagiosa, diffusa nella popolazione generale, che può essere all’origine di focolai epidemici in ambito ospedaliero, con possibile coinvolgimento del personale e notevoli ripercussioni economiche e gestionali. Il Policlinico San Matteo di Pavia adotta (dal 2005, con revisioni triennali) un protocollo operativo per la gestione dei casi indice, basato sul precoce isolamento del paziente infestato, sull’identificazione dei contatti stretti e sul loro trattamento profilattico, con temporaneo allontanamento dalla mansione. Obiettivi: acquisizione di dati descrittivi sui casi di scabbia riscontrati nell’ospedale oggetto dello studio e verifica dell’efficacia preventiva del protocollo adottato per la loro gestione. Metodi: studio retrospettivo (2005-2014) dei casi indice, raccolti in apposito archivio informatico. Per ognuno di essi, sono stati raccolti i dati anagrafici e clinici, e informazioni sugli operatori sanitari che erano venuti in contatto con il paziente nelle 6 settimane precedenti la diagnosi (periodo massimo d’incubazione della malattia). Risultati: sono stati identificati 30 casi di scabbia tra i ricoverati (11 femmine e 19 maschi; età media 60 anni; range: 2 mesi – 92 anni); 9 di loro risultavano trasferiti da altre strutture sanitarie; 11 pazienti erano immunodepressi: di questi, 3 erano affetti da scabbia norvegese (o scabbia crostosa: variante clinica ad alta contagiosità, di difficile diagnosi, nella quale il numero di acari sulla cute dell’ammalato è assai elevato, fino ad alcuni milioni). I contatti comprendevano 894 operatori sanitari, in prevalenza infermieri, ausiliari e studenti infermieri; tra questi, 158 avevano prestato assistenza ai casi di scabbia norvegese: 15 (1,7% dell’intero campione) risultavano contagiati. Questa percentuale è molto inferiore ai tassi di contagio (talora > 30%) riportati in altre casistiche. Tutti gli operatori identificati come contatti stretti sono stati sottoposti a trattamento (profilattico o terapeutico) con permetrina crema al 5% o ivermectina per os (200 µg/kg), ad eccezione di 6 che -a un’indagine più approfondita- sono stati riclassificati come contatti occasionali con casi di scabbia classica, a rischio di contagio trascurabile. La compliance al trattamento è stata totale. Conclusione: la scabbia continua a essere un importante rischio professionale in ambito ospedaliero, soprattutto per il personale infermieristico, compresi gli studenti in formazione. Particolarmente pericolosi, sotto questo punto di vista, sono i pazienti immunocompromessi, nei quali può con maggior frequenza manifestarsi la scabbia norvegese. Il protocollo operativo adottato dal Policlinico San Matteo risulta efficace per il contenimento del rischio