Comunicare in medicina. L'arte della relazione

La deumanizzazione in medicina, che regola le relazioni tra i medici, i pazienti e i familiari secondo i bisogni dell’apparato sanitario, spesso in contrasto con quelli degli umani, e la medicina difensiva, che crea un clima di sospetto reciproco tra il medico e il paziente, minano alle fondamenta ogni possibilità di costruire relazioni efficaci. Il volume ha l’ambizione di raccogliere riflessioni teoriche e prospettive pratiche che siano in grado di rispondere a tali problematiche sempre più urgenti, riconoscendo il valore centrale della comunicazione. La filosofia si configura quindi, nel suo connubio con la medicina, come un’arte della relazione. “Prendersi cura di chi cura” è quindi il motto che accompagna le pratiche filosofiche per la medicina

Le radici della scelta. La vocazione per la professione medica

Il problema che qui viene affrontato è quello relativo alla scelta professionale del medico che è indissolubilmente legata alla sua vocazione. La filosofia va a toccare proprio le radici di tale vocazione, le quali si rivelano – forse un po’ sorprendentemente, ma non casualmente – vicine alle proprie. La vocazione comune è quella di aiutare gli umani a vivere bene; la scelta professionale è ciò che conferisce capacità operativa alla realizzazione di questo scopo. I contributi che compaiono in questo libro vogliono quindi fornire un aiuto alla migliore comprensione del rapporto tra la scelta professionale e la vocazione di fondo in campo medico. La prima sezione (Vocazione e professione) getta uno sguardo di carattere generale sulla vocazione riconducendola alle sue radici esistenziali e antropologiche, e il pensiero filosofico viene applicato ai fenomeni storici e istituzionali che investono oggi il mondo medico. La seconda sezione (Cura di sé e cura di noi) propone alcune possibili risposte filosofiche alla domanda circa come affrontare concretamente problemi così complessi. Il volume porta al centro dell’attenzione alcune testimonianze, narrate in prima persona dai medici, nelle quali vocazione e professione si intrecciano in maniera indissolubile. La vita reale è quindi il fil rouge che compone tra loro le diverse esperienze

Il prosciutto cotto quale sistema modello per lo studio della previsione della shelf-life.

Nella presente ricerca si è inteso valutare comealcune tecniche di conservazione possanoincidere sull’evoluzione della complessiva del prosciutto cotto, scelto qualesistema modello per lo studio della inprodotti alimentari non restrittivi per la crescitadei microrganismi. Predire la shelf-life delprosciutto cotto affettato risulta molto difficilein quanto la contaminazione casuale dopo lacottura e le condizioni igieniche delle zonedi affettamento e confezionamento rendonol’intero sistema estremamente aleatorio. Nellaricerca effettuata, i campioni di prosciutto sonostati inoculati con microrganismi specifici dialterazione precedentemente isolati da prosciuttocotto alterato. In una seconda prova sono statiimpiegati trattamenti con azoto allo stesso finedi diminuire l’aleatorietà del sistema dovuta allacontaminazione casuale

Fungi isolated from food samples for an efficient stereoselective production of phenylethanols

Twenty strains of fungi isolated from food samples were screened for the asymmetric reduction of acetophenone. A dimorphic fungus denominated initially as GZ1 and isolated from a carrot sour rot showed very high reduction activities, and based on phenotypic and genetic characteristics was identified as Galactomyces candidus. The only product of the reduction was confirmed to be (R)-1-phenylethanol. The bioreduction conditions mediated by Gal. candidus GZ1 were investigated, and the optimal conditions in terms of acetophenone concentration, temperature, pH media, co-solvent, the charge of inoculum and shaking speed were established. Under the optimal conditions of 1.875 g/L of acetophenone dissolved in DMSO (1.25% v/v), 112.5 g/L of microorganism cells in 100 mM sterile phosphate buffer solution at pH 7.0, 25 °C and 150 rpm, the conversion and enantiomeric excess values after 48 h reaction were 99% and > 99.9%, respectively. A preparative scale reaction of (R)-1-phenylethanol was made and the isolated yield was 82% with > 99.9 e.e.%. Additionally, a study using several substituted acetophenones was carried out, and the advantages and scope of GZ1 in the production of chiral 1-phenylethanols were established. In this sense, good results were obtained with 3′-hydroxyacetophenone and a preparative scale reaction was performed which give (R)-1-(3′-hydroxyphenyl)ethanol (key intermediate of Rivastigmine) with 53% of isolated yield and > 99.9 e.e.%.Fil: Decarlini, Maria Florencia. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; ArgentinaFil: Aimar, Mario Leandro. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento de Química; ArgentinaFil: Vázquez, Ana M.. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; ArgentinaFil: Vero, Silvana. Universidad de la República; UruguayFil: Rossi, Laura Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; ArgentinaFil: Yang, Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba; Argentina. Area de Ciencias Agrarias, Ingeniería, Ciencias Biológicas y de la Salud de la Universidad Católica de Córdoba; Argentin

Role of Antarctic yeast in biocontrol of Penicillium expansum and patulin reduction of apples

Apple is among the main fruit crops in Uruguay. After harvest apples are stored at low temperatures. Despite this storage condition, Penicilliumexpansum, one of the most important postharvest pathogens worldwide, develops on apples. This fungus produces patulin, a secondary metabolite with toxic effects in mammals. Patulin contamination control of apples currently relies mainly on the use of fungicides. However, the use of biological control agents is a promising friendly alternative and some commercial products have been developed. In this work five psychrotrophic yeasts isolated from cold environments were evaluated as biocontrol agents of P.expansum rot on apples. Experiments were done during 3 months under cold storage conditions, followed by further storage at room temperature. Among the tested Antarctic yeasts, Candida sake 41E effectively controlled fungal growth on apples at cold and room temperature. This yeast also reduced patulin concentration in apple juice at room temperature, without adsorption to the cell walls. These characteristics suggest that this strain may be a promising biocontrol agent of blue mold.Fil: Alvarez, Angie. Universidad de la República; UruguayFil: Gelezoglo, Romina. Universidad de la República; UruguayFil: Garmendia, Gabriela. Universidad de la República; UruguayFil: Gonzalez Pereyra, Maria Laura. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Microbiología e Inmunología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Magnoli, Alejandra Paola. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Microbiología e Inmunología; ArgentinaFil: Arrarte, Eloisa. Universidad de la República; UruguayFil: Cavaglieri, Lilia Reneé. Universidad Nacional de Río Cuarto. Facultad de Ciencias Exactas, Fisicoquímicas y Naturales. Departamento de Microbiología e Inmunología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Vero, Silvana. Universidad de la República; Urugua

The risk of a persistent glucose metabolism impairment after gestational diabetes mellitus is increased in patients with polycystic ovary syndrome

OBJECTIVE-To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS).RESEARCH DESIGN AND METHODS-The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM).RESULTS-At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82-6.58).CONCLUSIONS-Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM

Association between liver fibrosis and decreased myocardial mechano-energetic efficiency in individuals with different degree of glucose tolerance

Aim: Decreased myocardial mechano-energetic efficiency (MEEi) is associated with NAFLD and poorer prognosis in liver cirrhosis. We aim to investigate the association between liver fibrosis severity and MEEi in individuals participating in the CATAnzaro MEtabolic RIsk factors (CATAMERI) study.Methods: Myocardial MEEi, assessed by an echocardiography-derived measure, and fibrosis severity, estimated by the fibrosis-4 index (FIB-4), were evaluated in 2383 subjects with different degree of glucose tolerance. Participants were divided into four groups according to FIB-4 index values: lowest risk of fibrosis (<1.3); low risk of fibrosis (>= 1.3 to < 1.67); moderate risk of fibrosis (>= 1.67 to < 2.67); high risk of fibrosis (>= 2.67).Results: Subjects with higher risk of liver fibrosis displayed a graded decrease in myocardial MEEi compare to those with the lowest risk of liver fibrosis. In a multivariable regression analysis, FIB-4 index was independently associated with MEEi (8 = -0.080, P < 0.001), along with total cholesterol (8 = -0.067, P = 0.01), hsCRP (8 = -0.081, P < 0.001), sex (8 = -0.099, P < 0.001), glucose tolerance status (8 = -0.109, <0.001) and HOMA-IR index (8 = -0.143, P < 0.001).Conclusion: Compromised myocardial MEEi is already reported in individuals with high risk of hepatic fibrosis suggesting that its assessment may help to identify among subjects with NAFLD those with worst prognosis

Liver fibrosis is associated with an increased risk of non-fatal myocardial infarction

IntroductionLiver fibrosis is a risk factor for liver-related adverse outcomes and cardiovascular disease (CVD). Recently, the non-invasive Hepamet fibrosis score (HFS) has been validated as a tool capable to identify with good diagnostic accuracy subjects with advanced liver fibrosis. It is unsettled whether HFS is capable to identify individuals at higher risk of CVD. To investigate whether individuals with liver fibrosis measured with HFS have higher risk of myocardial infarction (MI) in adults participating in the CATAnzaro MEtabolic RIsk factors (CATAMERI) study.MethodsParticipants (n = 2948) were divided into three groups according to HFS: low risk of fibrosis (<0.12); intermediate risk of fibrosis (=0.12 to <0.47); high risk of fibrosis (=0.47). The association between the liver fibrosis risk and MI was analysed by a logistic regression analysis.ResultsAs compared with those having the lowest risk (5.3%), a higher proportion of subjects with moderate or high risk of liver fibrosis had MI (12.9% and 24.4%, respectively; p < 0.001). In a logistic regression analysis, individuals at increased risk of liver fibrosis exhibited a threefold increased risk of having MI as compared to those with low risk (OR 3.18; 95% CI 1.31-7.70) independently of confounders including smoking, cholesterol, triglycerides, anti-hypertensive, lipid-lowering and glucose-lowering therapies.ConclusionsIn this cross-sectional study, individuals with higher values of HFS show a higher risk of MI, suggesting that HFS may be a useful tool to identify not only individuals with liver fibrosis but also those at the increased risk of CVD

Integrating Health Systems and Science to Respond to COVID-19 in a Model District of Rural Madagascar

International audienceThere are many outstanding questions about how to control the global COVID-19 pandemic. The information void has been especially stark in the World Health Organization Africa Region, which has low per capita reported cases, low testing rates, low access to therapeutic drugs, and has the longest wait for vaccines. As with all disease, the central challenge in responding to COVID-19 is that it requires integrating complex health systems that incorporate prevention, testing, front line health care, and reliable data to inform policies and their implementation within a relevant timeframe. It requires that the population can rely on the health system, and decision-makers can rely on the data. To understand the process and challenges of such an integrated response in an under-resourced rural African setting, we present the COVID-19 strategy in Ifanadiana District, where a partnership between Malagasy Ministry of Public Health (MoPH) and non-governmental organizations integrates prevention, diagnosis, surveillance, and treatment, in the context of a model health system. These efforts touch every level of the health system in the district—community, primary care centers, hospital—including the establishment of the only RT-PCR lab for SARS-CoV-2 testing outside of the capital. Starting in March of 2021, a second wave of COVID-19 occurred in Madagascar, but there remain fewer cases in Ifanadiana than for many other diseases (e.g., malaria). At the Ifanadiana District Hospital, there have been two deaths that are officially attributed to COVID-19. Here, we describe the main components and challenges of this integrated response, the broad epidemiological contours of the epidemic, and how complex data sources can be developed to address many questions of COVID-19 science. Because of data limitations, it still remains unclear how this epidemic will affect rural areas of Madagascar and other developing countries where health system utilization is relatively low and there is limited capacity to diagnose and treat COVID-19 patients. Widespread population based seroprevalence studies are being implemented in Ifanadiana to inform the COVID-19 response strategy as health systems must simultaneously manage perennial and endemic disease threats