Racionalnost u mentalnim poremećajima: previše ili premalo?

The idea that mental illnesses are impairments in rationality is very old, and very common (Kasanin 1944; Harvey et al. 2004; Graham 2010). But is it true? In this article two severe mental disorders, schizophrenia and delusional disorder, are investigated in order to find some defects in rationality. Through the analysis of patients’ performances on different tests, and the investigation of their typical reasoning styles, I will show that mental disorders can be deficits in social cognition, or common sense, but not in rationality (Sass 1992; Johnson-Laird et al. 2006; Bergamin 2018). Moreover, my claim is that psychopathological patients can also be, in some circumstances, more logical than normal controls (Kemp et al. 1997; Owen et al. 2007). From a philosophical point of view these data seem to be very relevant, because they help us to reconsider our idea of rationality, and to challenge the common way to look at sanity and mental illness.Ideja da su mentalne bolesti poremećaji racionalnosti vrlo je stara i uobičajena (Kasanin 1944; Harvey et al. 2004; Graham 2010). No je li istinita? Ovaj članak razmatra dvije ozbiljne mentalne bolesti, shizofreniju i poremećaj deluzije, s ciljem utvrđivanja grešaka u racionalnosti. Analizom uspjeha pacijenata na različitim testovima i razmatranjem njihovog tipičnog načina zaključivanja, pokazat ću da mentalne bolesti možemo smatrati manjkavostima socijalnog spoznavanja ili zdravog razuma, ali ne i racionalnosti (Sass 1992; Johnson-Laird et al. 2006; Bergamin 2018). Nadalje, tvrdim da pacijenti u psihopatološkim stanjima u određenim okolnostima pokazuju viši stupanj logičkog zaključivanja od kontrolne skupine (Kemp et al. 1997; Owen et al. 2007). Filozofski gledano, ovi relevantni podaci mogu nam pomoći u preispitivanju same ideje racionalnosti i uobičajenog shvaćanja duševnog zdravlja i mentalnih bolesti

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

To compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019

The Changing Landscape of Neonatal Diabetes Mellitus in Italy Between 2003 and 2022

Context In the last decade the Sanger method of DNA sequencing has been replaced by next-generation sequencing (NGS). NGS is valuable in conditions characterized by high genetic heterogeneity such as neonatal diabetes mellitus (NDM).Objective To compare results of genetic analysis of patients with NDM and congenital severe insulin resistance (c.SIR) identified in Italy in 2003-2012 (Sanger) vs 2013-2022 (NGS).Methods We reviewed clinical and genetic records of 104 cases with diabetes onset before 6 months of age (NDM + c.SIR) of the Italian dataset.Results Fifty-five patients (50 NDM + 5 c.SIR) were identified during 2003-2012 and 49 (46 NDM + 3 c.SIR) in 2013-2022. Twenty-year incidence was 1:103 340 (NDM) and 1:1 240 082 (c.SIR) live births. Frequent NDM/c.SIR genetic defects (KCNJ11, INS, ABCC8, 6q24, INSR) were detected in 41 and 34 probands during 2003-2012 and 2013-2022, respectively. We identified a pathogenic variant in rare genes in a single proband (GATA4) (1/42 or 2.4%) during 2003-2012 and in 8 infants (RFX6, PDX1, GATA6, HNF1B, FOXP3, IL2RA, LRBA, BSCL2) during 2013-2022 (8/42 or 19%, P = .034 vs 2003-2012). Notably, among rare genes 5 were recessive. Swift and accurate genetic diagnosis led to appropriate treatment: patients with autoimmune NDM (FOXP3, IL2RA, LRBA) were subjected to bone marrow transplant; patients with pancreas agenesis/hypoplasia (RFX6, PDX1) were supplemented with pancreatic enzymes, and the individual with lipodystrophy caused by BSCL2 was started on metreleptin.Conclusion NGS substantially improved diagnosis and precision therapy of monogenic forms of neonatal diabetes and c.SIR in Italy

Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach

BackgroundPerforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure.MethodsA retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared.ResultsA total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 +/- 37.2 vs LapA 88.47 +/- 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 +/- 12 vs LapA 10.3 +/- 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2.ConclusionsBased on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay

Gastro-intestinal emergency surgery: Evaluation of morbidity and mortality. Protocol of a prospective, multicenter study in Italy for evaluating the burden of abdominal emergency surgery in different age groups. (The GESEMM study)

Gastrointestinal emergencies (GE) are frequently encountered in emergency department (ED), and patients can present with wide-ranging symptoms. more than 3 million patients admitted to US hospitals each year for EGS diagnoses, more than the sum of all new cancer diagnoses. In addition to the complexity of the urgent surgical patient (often suffering from multiple co-morbidities), there is the unpredictability and the severity of the event. In the light of this, these patients need a rapid decision-making process that allows a correct diagnosis and an adequate and timely treatment. The primary endpoint of this Italian nationwide study is to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18. Secondary endpoints will be to evaluate to analyze the prognostic role of existing risk-scores to define the most suitable scoring system for gastro-intestinal surgical emergency. The primary outcomes are 30-day overall postoperative morbidity and mortality rates. Secondary outcomes are 30-day postoperative morbidity and mortality rates, stratified for each procedure or cause of intervention, length of hospital stay, admission and length of stay in ICU, and place of discharge (home or rehabilitation or care facility). In conclusion, to improve the level of care that should be reserved for these patients, we aim to analyze the clinicopathological findings, management strategies and short-term outcomes of gastrointestinal emergency procedures performed in patients over 18, to analyze the prognostic role of existing risk-scores and to define new tools suitable for EGS. This process could ameliorate outcomes and avoid futile treatments. These results may potentially influence the survival of many high-risk EGS procedure

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Donne tra Comune e Regnum. Lettere femminili dal carteggio Acciaiuoli della Medicea-Laurenziana di Firenze

Attestazioni “femminili” da un fondo epistolare “maschile” Le poche decine di lettere di donne del carteggio Acciaiuoli della Biblioteca Medicea Laurenziana costituiscono i resti di una dimensione epistolare verosimilmente più intensa, estesa e coerente di quanto si possa in prima istanza supporre. La scarsezza delle epistole conservate potrebbe in prima istanza suggerire una frettolosa svalutazione della capacità di mettere sulla carta volontà e saperi da parte delle scriventi, e indurre a u..

SERUM URIC ACID IS INCREASED IN NORMOTENSIVE OBESE CHILDREN WITH A PARENTAL HYSTORY OF HYPERTENSION

Introduction: Increased uric acid levels are associated with new-onset hypertension in children. Nevertheless, controversy remains concerning a direct causative role of serum uric acid (SUA) in the pathogenesis of essential hypertension (EH). Aim: To determine if normotensive obese children and adolescent offspring of adults with EH show SUA levels different than those of paediatric subjects in whom there is no family history of EH. Methods: Fifty-nine obese normotensive children and adolescents, aged between 8 and 17 years, attending for metabolic assessment the Paediatric Diabetes Unit, Children’s Hospital ‘‘G. Di Cristina’’, and for cardiovascular evaluation the ESH Hypertension excellence center of the University of Palermo, underwent routine blood chemistry and oral glucose tolerance test with glucose and insulin determinations. All subjects had BP determinations below the 90th percentile and had no previous history of elevated BP. Results: There were 14 subjects whose parents were both normotensive (FH-), and the remaining 45 subjects whose one or both parents were hypertensive (FH?). FH? did not differ regarding age, sex distribution, BP values, body mass index, waist circumference, serum glucose levels when compared to FH-. Among the metabolic parameters assessed, only SUA was significantly higher in FH? than in FH- (p = 0.007). This difference held after adjusting for age, gender and BMI (p = 0.01) (Figure 2). Conclusions: Our results, showing higher values of SUA in normotensive obese children and adolescents with parental history of EH, seem to support the hypothesis that increased SUA may precede and determine the development of hypertension