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Rivista Di Psichiatria 2020The aim of the article is to present the evolution of professional liability in psychiatry from law 36 of 1904 to today. Through an examination of the doctrinal... (Review)
Review
The aim of the article is to present the evolution of professional liability in psychiatry from law 36 of 1904 to today. Through an examination of the doctrinal positions and of the jurisprudential expression it was possible to highlight three distinct phases in which professional responsibility has declined over the years. A custodial phase, in which the spirit that animated the law of psychiatric assistance was inspired by principles of social defense and the responsibility of the psychiatrist was recognized mainly in the lack of custody of the psychiatric patient. A phase of indulgence, in which, like other disciplines, the psychiatrist was recognized with "reduced impunity" due to an alleged "special difficulty" in exercising the medical profession. A phase of empowerment, in which the doctor in general, and the psychiatrist in particular, was confronted with empowering positions that led to convictions. An examination of the application of the guarantee position to psychiatry allows us to highlight current difficulties, sometimes a legacy of the past.
Topics: Empowerment; Humans; Italy; Liability, Legal; Physician-Patient Relations; Psychiatry
PubMed: 33349716
DOI: 10.1708/3504.34899 -
The Journal of Surgical Research Jul 2022The aim of this study is to evaluate risk factors for non-attendance to post-discharge, hospital follow-up appointments for traumatically injured patients who underwent...
BACKGROUND
The aim of this study is to evaluate risk factors for non-attendance to post-discharge, hospital follow-up appointments for traumatically injured patients who underwent exploratory laparotomy.
METHODS
This is a retrospective chart review of patients who underwent exploratory laparotomy for traumatic abdominal injury at an urban, Midwestern, level I trauma center with clinic follow-up scheduled after discharge. Clinically, relevant demographic characteristics, patients' distance from hospital, and the presence of staples, sutures, and drains requiring removal were collected. Descriptive statistics of categorical variables were calculated as totals and percentages and compared with a chi-squared test or Fisher's exact when appropriate.
RESULTS
The sample included 183 patients who were largely assaultive trauma survivors (68%), male (80%), and black (53%) with a mean age of 35.4 ± 14.9 years. Overall, 18.5% no-showed for their follow-up appointment. On multivariate analysis for clinic no-show; length of stay (odds ratio = 0.92 [0.84-0.99], P = 0.04) and the need for suture, staple, or drain removal were protective for clinic attendance (odds ratio = 5.59 [1.07-7.01], P = 0.04). Overall, 12 patients (6.4%) were readmitted. Forty patients (18.3%) had their follow-up in the emergency department (ED). On multivariate regression of risk factors for ED visits, the only statistically significant factors (P < 0.05) were clinic appointment no-show (OR = 2.81) and self-pay insurance (OR = 4.78).
CONCLUSIONS
Abdominal trauma patients are at high risk of no-show for follow-up appointments and no-show visits are associated with ED visits. Future work is needed evaluating interventions to improve follow-up.
Topics: Abdominal Injuries; Adult; Aftercare; Emergency Service, Hospital; Follow-Up Studies; Humans; Male; Middle Aged; No-Show Patients; Patient Discharge; Retrospective Studies; Young Adult
PubMed: 35219246
DOI: 10.1016/j.jss.2021.12.021 -
Journal of Cutaneous Medicine and... 2022
Topics: Humans; Epidermal Cyst; Skin Diseases; Ear Auricle
PubMed: 35603862
DOI: 10.1177/12034754221102009 -
Journal of Translational Medicine Oct 2020Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.
BACKGROUND
Tocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.
METHODS
A multicenter, single-arm, hypothesis-driven trial was planned, according to a phase 2 design, to study the effect of tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints, a priori expected rates being 20 and 35%, respectively). A further prospective cohort of patients, consecutively enrolled after the first cohort was accomplished, was used as a secondary validation dataset. The two cohorts were evaluated jointly in an exploratory multivariable logistic regression model to assess prognostic variables on survival.
RESULTS
In the primary intention-to-treat (ITT) phase 2 population, 180/301 (59.8%) subjects received tocilizumab, and 67 deaths were observed overall. Lethality rates were equal to 18.4% (97.5% CI: 13.6-24.0, P = 0.52) and 22.4% (97.5% CI: 17.2-28.3, P < 0.001) at 14 and 30 days, respectively. Lethality rates were lower in the validation dataset, that included 920 patients. No signal of specific drug toxicity was reported. In the exploratory multivariable logistic regression analysis, older age and lower PaO2/FiO2 ratio negatively affected survival, while the concurrent use of steroids was associated with greater survival. A statistically significant interaction was found between tocilizumab and respiratory support, suggesting that tocilizumab might be more effective in patients not requiring mechanical respiratory support at baseline.
CONCLUSIONS
Tocilizumab reduced lethality rate at 30 days compared with null hypothesis, without significant toxicity. Possibly, this effect could be limited to patients not requiring mechanical respiratory support at baseline. Registration EudraCT (2020-001110-38); clinicaltrials.gov (NCT04317092).
Topics: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal, Humanized; Betacoronavirus; COVID-19; Cohort Studies; Coronavirus Infections; Female; Humans; Italy; Male; Middle Aged; Mortality; Off-Label Use; Pandemics; Pneumonia, Viral; SARS-CoV-2; Treatment Outcome; Validation Studies as Topic
PubMed: 33087150
DOI: 10.1186/s12967-020-02573-9 -
Journal of the College of Physicians... Apr 2021To describe the features of facial seborrheic keratosis, verruca plana, and nevus pigmentosus by dermatoscopy and reflective confocal microscope (RCM). (Observational Study)
Observational Study
OBJECTIVE
To describe the features of facial seborrheic keratosis, verruca plana, and nevus pigmentosus by dermatoscopy and reflective confocal microscope (RCM).
STUDY DESIGN
Cross-sectional observational study.
PLACE AND DURATION OF STUDY
Dermatology Department of The Affiliated Hospital of Xuzhou Medical University from January 2017 to January 2019.
METHODOLOGY
Patients of either gender and age, clinically diagnosed as seborrheic keratosis, verruca plana, and nevus pigmentosus without any prior treatment, were enrolled. Patients with extremities and trunk involvement were excluded. One typical skin lesion was chosen from each patient and subjected to dermatoscopy and RCM separately; imaging features were recorded and analysed.
RESULTS
A total of 402 patients (183 men and 219 women) between 6 and 88 years of age (mean age 41.8 years) were inducted. The duration of disease was between one week and 10 years. Seborrheic keratosis on dermatoscopy presented as acne-like openings (122/172; 70.93%, milia-like cysts (113/172; 65.70%), hairpin-like vessels (108/172; 62.79%, brain-like structures (103/172; 59.88%, worm-like pharyngeal margins (17/172; 9.88%), and fingerprint-like structures (8/172; 4.65%). On RCM, it showed epidermal cerebral gyrus structure (165/172; 95.93%), superficial vasodilatation and hyperemia (81/172; 47.09%), and keratinous cysts (73/172; 42.44%). Verruca plana on dermatoscopy showed a number of punctate hemorrhages scattered against a light-red background (108/114; 94.74%); on RCM it showed rose-like concentric structures (89/114; 78.07%). The features of nevus pigmentosus observed by dermatoscopy were homogeneous mode (23/52; 44.23%), light brown color (30/52; 57.69%) for intradermal nevus; mesh mode (18/41; 43.90%, dark brown color, little black dots and spherical structure (both 18/41; 43.90%) were visible for junctional nevus; globular mode, reticular and cobblestone structures (both 11/23; 47.83%) for compound nevus. On RCM, there were a few nevus cells visible within the dermal papilla (52/52; 100%) for intradermal nevus; bright pebble-like structures accumulated in the basal layer, nested round and elliptical nevus cells (40/41; 97.56%) for junctional nevus; nevus cells in the epidermis and dermis (21/23; 91.30%) for compound nevus.
CONCLUSION
Used in combination with clinical manifestations, the application of dermatoscopy and RCM may help distinguish seborrheic keratosis, verruca plana, and nevus pigmentosus on the basis of their respective dermatoscopic and RCM features. Key Words: Dermatoscopy, Reflective confocal microscope, Seborrheic keratosis, Verruca plana, Nevus pigmentosus, Brain-like structures, Rose-like structure.
Topics: Adult; Cross-Sectional Studies; Dermoscopy; Female; Humans; Keratosis, Seborrheic; Male; Microscopy, Confocal; Nevus; Skin Neoplasms; Warts
PubMed: 33866733
DOI: 10.29271/jcpsp.2021.04.450 -
SAGE Open Medical Case Reports 2023Milia are common in children. They are small, keratinizing cysts that arise either as primary epidermoid cysts or secondary to other dermatoses, trauma or certain...
Milia are common in children. They are small, keratinizing cysts that arise either as primary epidermoid cysts or secondary to other dermatoses, trauma or certain medications. In the paediatric population, milia are most frequently congenital and resolve spontaneously. Infantile hemangiomas are relatively common in neonates. They typically arise within the first few weeks of life, undergo a proliferative phase in the first 6 months, then begin to involute at around 12 months of age. After involution, residual skin changes may be observed, such as telangiectasia, fibrofatty tissue and redundant skin. However, there is a gap in the literature regarding concomitant milia and infantile hemangiomas. We report a case of a 5-months-old female who presented with a large, segmental infantile hemangioma of the posterior neck with milia.
PubMed: 37077804
DOI: 10.1177/2050313X231164265 -
Journal of Translational Medicine Oct 2021
PubMed: 34674735
DOI: 10.1186/s12967-021-03094-9 -
The Journal of Clinical and Aesthetic... Nov 2023Basaloid follicular hamartoma is an uncommun benign neoplasm of the hair follicule. The linear form of basaloid follicular hamartoma can be associated with basal cell...
BACKGROUND
Basaloid follicular hamartoma is an uncommun benign neoplasm of the hair follicule. The linear form of basaloid follicular hamartoma can be associated with basal cell carcinoma. We report a case of a patient with multiple basal cell carcinomas developing on a congenital lesion allowing the diagnosis of basaloid follicular hamartoma on histopathology.
METHODS
Each lesion was evaluated by two dermatologists. All biopsy specimens were routinely stained with hematoxylin-eosin.
RESULTS
A 76 year-old-man consulted our dermatology departement for erythematous papules spread over the left lower limb. The lesion had been evolving since birth with flesh-colored to pinkish papules following Blaschko's lines from the root of the thigh to the foot. Three months before consultation, the papules increased in size leading to nodules with sometimes an ulcerated center. Dermoscopy under polarized mode displayed for ulcerated lesions (A) yellow-brownish crusts and ulceration surrounded by blue-grey ovoid nests, subtle short white streaks, brown dots and linear/arborising vessels. For nodular lesions (B), dermoscopic features are white pinkish hue, dotted and linear vessels, brown dots, blue-grey structureless areas and white prominent shiny streaks. There were some more erythematous inflamed and eroded areas in the background with a reversed honeycomb white network on dermoscopy (C), polymorphous vessels, whitish scales, ulcerations and milia-like cysts. The background lesion showed varied dermoscopic structures on a flesh colored slightly pinkish bottom (D). Histolopathology concluded for lesions A to an infiltrating and nodular basal cell carcinoma, (B) and (C) to fibroepithelioma of Pinkus and (D) to basaloid follicular hamartoma.
CONCLUSION
Several case reports have documented dermoscopic features of a solitary basaloid follicular hamartoma. However, further studies are required to specify any reproducible features.
PubMed: 38076655
DOI: No ID Found -
Frontiers in Medicine 2021To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma. Patients with lesions suspicious of syringoma on vulva...
To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma. Patients with lesions suspicious of syringoma on vulva were enrolled in the study. After informed consent was taken, the lesions were photographed and imaged with RCM. The features of the lesion in confocal images were then analyzed and compared with the biopsy findings for histology correlation. Eleven cases in total were included in the study. The typical RCM features observed in syringoma are the presence of round to oval high refractive, and relatively monomorphous mass of varying sizes in the superficial and middle dermis, usually surrounded with 1-2 layers of light-dark line structures, which were further confirmed by histological evaluation. Ten cases showed classic features of syringoma and 1 case exhibited milia in RCM images. Syringoma has distinct features in RCM imaging, which correlates well with histological findings, highlighting the potential role of RCM in the diagnosis and differential diagnosis of vulva syringoma.
PubMed: 33732725
DOI: 10.3389/fmed.2021.649438 -
Rivista Di Psichiatria 2020Instances in the increase of homophobic bullying mean a major interest in order to develop strong bullying prevention programming which should be a major priority for...
Instances in the increase of homophobic bullying mean a major interest in order to develop strong bullying prevention programming which should be a major priority for adults, governments and institutions responsible to promote and ensure a responsible development of society. The complexity of the problem requires a multidisciplinary approach of a comprehensive nature. Starting from the construction of gender identities, and taking into account and understanding the biological aspects, external influences, and arising contrasts during the process, a young person faces adolescence: a transition period when sexual orientation or preference faces higher risks as the person has to come to terms with a mismatch between scales of knowledge. The outcome will result in an inter-generational conflict which becomes a prejudice. By acquiring the desired characteristics of mind and body, adolescents develop their own cognitive skills. Thus we can consider homophobic bullying in its psycho-sociological implications. The aim of this paper is to delineate an explanation of the topic in a scientific, educational and professional way, and at the same time to take into account all legal and institutional issues.
Topics: Adolescent; Adolescent Development; Bullying; Gender Identity; Homophobia; Humans; Italy; Schools; Sexual Behavior
PubMed: 33349720
DOI: 10.1708/3504.34903