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At the end of 2019, Wuhan, China, experienced an outbreak of a novel coronavirus. The SARS-CoV2 epidemiologic burden was constantly evolving, with numbers of infected persons, hospital admissions and deaths growing near exponentially. The pandemic outbreak of COVID-19 worldwide caught the health care systems in every country by storm and without a proper defense mechanism to cope and control such a pandemic, causing an overwhelming burden of illnesses that stressed the Health System capacity. In this context, telemedicine has been promoted and scaled up to reduce the risk of transmission. During the "lockdown", the AOU "Federico II" was forced to create peculiar pathways to ensure the safety of the patients and medical staff, and to keep an appropriate medical assistance, therefore it was introduced the telemedicine, wherever possible, by modifying the Information Technology (IT) related to the waiting times, rescheduling all booked visits and identifying several outpatient clinics suitable for telemedicine activities. In this paper the Authors reports their own experience with Telemedicine.

© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd. Aim: To develop an instrument to investigate knowledge and predictive factors of needlestick and sharps injuries (NSIs) in nursing students during clinical placements. Design: Instrument development and cross-sectional study for psychometric testing. Methods: A self-administered instrument including demographic data, injury epidemiology and predictive factors of NSIs was developed between October 2018–January 2019. Content validity was assessed by a panel of experts. The instrument's factor structure and discriminant validity were explored using principal components analysis. The STROBE guidelines were followed. Results: Evidence of content validity was found (S-CVI 0.75; I-CVI 0.50–1.00). A three-factor structure was shown by exploratory factor analysis. Of the 238 participants, 39% had been injured at least once, of which 67.3% in the second year. Higher perceptions of “personal exposure” (4.06, SD 3.78) were reported by third-year students. Higher scores for “perceived benefits” of preventive behaviours (13.6, SD 1.46) were reported by second-year students.

Urinary tract infections (UTIs) are an economic burden for public health. The increasing prevalence of resistant bacteria which cause UTIs may be related to the inappropriate prescription of antibiotics. The aim of this preliminary study was to evaluate whether three different combinations of plant extracts plus d-mannose are effective in preventing the recurrence of UTIs. Three groups of patients received three combinations of plant extracts in conjunction with d-mannose. These were: berberine, arbutin and birch (group A); berberine, arbutin, birch and forskolin (group B); and proanthocyanidins (group C). The clinical recurrence of cystitis at the end of treatment and during follow-up was determined by comparison with baseline measurements using the microbiological assessment of urine samples, vaginal swabs and vaginal smear slides. Patients in groups A and B had a lower incidence of episodes of recurrent cystitis during treatment and follow-up, samples with a significantly lower median bacterial load and a reduction of the grade of lactobacillary flora compared to patients in group C.

The present cross-sectional-study aimed to determine the prevalence of human papillomavirus (HPV)-genotypes among human immunodeficiency virus (HIV)-positive and -negative women in Central/Eastern Italy, and to identify the optimal strategies for effective HPV-prevention in each group. A representative sample of HIV-negative (150/200) and -positive (50/200) women, who underwent cervico-vaginal-swabbing. Swabs were analysed for a cytological screening and for a HPV-DNA-genotyping-test. A total of 66/200 swabs resulted HPV-positive. The overall HPV-prevalence was 33% with a higher prevalence in the HIV-positive-group (48%) compared with the HIV-negative-group (28%). The most frequent genotypes were: 16, 31, 52, 58, 66, 73 and 89. Furthermore, the prevalence of specific genotypes was different in each group. The results of the present study indicate that HIV infection appears to be an independent risk factor for HPV-infection. In addition, HPV-infection is more common and more likely to persist in HIV-positive compared with in HIV-negative women. The optimal way to counteract HPV infection is through primary prevention. The stage of immunity (cluster of differentiation 4-level) at the time of the HPV-screening is one of the most important parameters for detection of susceptibility to HPV-infection and to evaluate the response to the HPV-vaccine in HIV-positive women. It may be used to determine the sub-group of HIV-positive women that are more prone to HPV-infections or that exhibit a partial response to the HPV-vaccine. At present, a novel type of vaccine with 9-genotypes is available and in the near future, it may serve an essential role in the prevention of HPV infections.

Purpose Partial trisomy 1q42-qter is a rare chromosomal aberration. Most cases arise from de novo unbalanced translocations or from unbalanced inheritance of parental balanced rearrangements. Methods Descriptive case report. Results A 4-year-old boy had shown an increased neck translucency at the fetal ultrasound examination performed at the 11th week of gestation. Amniocentesis, performed at the 18th week of gestation, did not demonstrate any genetic abnormality. A second fetal ultrasound examination, carried out at the 35th week of gestation, showed congenital clubfeet and hydrocephalus. At birth, clinical examination revealed congenital bilateral ventriculomegaly bilateral congenital equinovarus clubfeet, low-set ears, plagiocephaly micrognathia, hypertelorism, prominent forehead, broad nasal bridge, hypertonic syndrome, and inguinal hernia. Ophthalmologic consultation showed the presence of optic pit in his left eye. Genetic counseling was performed. Chromosome analysis demonstrated a partial trisomy 1 q42.2-qter associated with a partial monosomy 6q27-qter. Moreover, deletions of the distal region on the long arm of chromosome 6 are frequently associated with both ocular abnormalities and several solid tumor types. Moderate mental and psychomotor retardation has occurred. Conclusions This case emphasizes the importance of scheduling a screening test for eye diseases and tumor in these patients.

We reviewed our experience with the TVT-Secur tension-free tape for stress urinary incontinence in females. We evaluated operative time, complications, the continence rate and patient satisfaction at followup. Ethics committee approval was not required.A total of 32 hammock-shaped tape interventions were performed between November 2006 and April 2008 at our hospital. All patients had stress urinary incontinence, which was pure in 20 and associated with prolapse of other pelvic organs in 12. Each patient underwent urogynecological assessment with urodynamic evaluation and performed a quality of life questionnaire. We excluded from analysis all patients with intrinsic sphincteric deficiency. Patients were followed for continence and satisfaction. Therapeutic failure was defined as persistent urinary stress incontinence affecting quality of life, as reported by patients and on clinical examination.None of the 32 women had any surgical complication, postoperative pain or blood loss greater than 100 cc. Some minor complications were recorded and the sling eroded in 1 case. Urinary continence was achieved in all patients after surgery and at assessments 12 to 18 months later. All patients confirmed immediate satisfaction with continence and pain on the questionnaire.TVT-Secur is a minimally invasive, safe and easy surgical technique for stress urinary incontinence in females. To compare this procedure to other tension-free techniques longer and more detailed followup is necessary in more patients. However, this tape may be associated with fewer complications.

To evaluate the effectiveness and safety of the combination of N-palmitoylethanolamine (PEA) and transpolydatin vs placebo in the treatment of primary dysmenorrhea in adolescents and young women.Randomized treatment and follow-up of 220 cases of primary dysmenorrhea in the Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy.Between February 2013 and February 2014, we treated 220 young women aged 16 to 24 years who had primary dysmenorrhea: 110 patients were treated with the oral combination of PEA-transpolydatin: 400 mg + 40 mg (1 tablet a day for 10 days from the 24th day of cycle) and 110 patients with placebo (1 tablet a day for 10 days from the 24th day of cycle). A follow-up was performed after treatment, and all girls were seen at this time. A 10-point visual analog scale was used to measure the improvement of pelvic pain. For categorical variables, the χ(2) test and analysis of variance were performed to value the significance of differences between groups. A value of P.05 was considered statistically significant.An improvement of pelvic pain was seen in 98.18% (95% confidence interval 97.64% to 98.60%) of cases in group 1 vs 56.36% (95% confidence interval 48.62% to 63.81%) in group 2 (P.001). The combination of PEA and transpolydatin was more effective than placebo (P.001).The combination of PEA and transpolydatin shows promise as a valid adjuvant therapy in the medical treatment of primary dysmenorrhea in adolescents and young women.

Study Objective To evaluate the effectiveness and safety of local vs systemic antibiotic treatment in the management of recurrent vulvovaginitis in children. Design Randomized treatment and follow-up of 90 cases of persistent vulvovaginitis. Setting The Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. Methods Between January 2009 and December 2012, 90 prepubertal girls (Tanner Stage I) aged 6–12 years, with recurrent discharge not responding to common hygienic measures and not suspected of being sexually abused, were treated, 45 patients with oral antibiotic treatment (group 1) and 45 patients with a local antibiotic treatment (group 2). Vaginal cultures were prepared before treatment and follow-ups were made after 3 months. Results Bacterial pathogens were isolated in vaginal secretions of 84/90 (93%) girls. There were 6 girls receiving antibiotic treatment who had persistent discharge and repetitive isolations of Escherichia coli. Administration type was selected at random. Symptoms and signs were resolved in all girls, but we observed 1 recurrence (2.22%) in group 2 vs 6 recurrences (13.33%) in group 1 (P = .049). In group 1 we observed 3 cases (6.67%) of gastro-intestinal side effects vs no cases in group 2 (P = .079). Conclusion Topical medication based on netilmicin, associated with Benzalkonium-Chloride, showed a clinical and microbiological effectiveness in first-line treatment of bacterial vulvovaginitis in children, comparable to conventional drugs; so local treatment may be a good alternative to systemic treatment decreasing the use of oral antibiotics in young people and related risks of bacterial resistances.

Summary Background: Mucinous adenocarcinoma of the urinary bladder is a rare primary urologic disease, poorly responsive to radiation or chemotherapy as first-line treatment. Case Report: After trans-urethral resection of the bladder, a 62-year-old woman was diagnosed with mucinous adenocarcinoma of the urinary bladder. An upper gastro-intestinal endoscopy and a colonoscopy excluded any primary site of origin from those gastro-intestinal tracts. After whole-body CT staging scans, an anterior pelvectomy was performed, confirming a mucinous adenocarcinoma of the bladder, with no extra-vesical spreading. Some onco markers were sampled before surgery, and Ca 19-9 showed very high values, with a decreasing trend after pelvectomy. Six month after surgery, bilateral inguinal lymph node dissection was performed because of bilateral palpable masses – histologic examination showed a single metastatic node. The patient also received external radiotherapy of the inguinal area. Twenty-eight months after pelvectomy, the patient appears healthy. Conclusions: Early radical surgery with or without adjuvant radio-chemo-therapy appears to be the best option for mucinous adenocarcinoma of the bladder, and a good outcome is likely to be related with a confined disease and small tumor size. In addition, Ca 19-9 sampling proves to be useful in tumors that produce markers.

Keywords Gestational diabetes.Glucokinase.MODY-2AbbreviationsHAPO Hyperglycemia Adverse Pregnancy OutcomeLGA Large for gestational ageSGA Small for gestational ageTo the Editor: We read with interest the paper by E. A. Ryan[1] concerning the new criteria suggested by the Hypergly-cemia Adverse Pregnancy Outcome (HAPO) study for thediagnosis of gestational diabetes [2]. Ryan showed thatapplying these criteria would result in a doubling of thenumber of pregnant women diagnosed with gestationaldiabetes without a clear demonstration of the benefitsderived from this new classification. As he observes,maternal obesity represents a stronger predictor of large-for-gestational-age (LGA) babies than glucose levels in allexcept the highest glucose category [1, 3]. This suggeststhat not all gestational hyperglycaemia has the sameaetiology. As was the case in paediatrics, where for manydecades we wrongly diagnosed all children with hyper-glycaemia as having type 1 diabetes [4], we risk includingin this generic categorisation of gestational diabetes theundetected monogenic forms that are often underdiagnosed[5, 6]. For example, in those patients belonging to thelowest glucose categories of HAPO those with MODY-2obtain no benefit from the treatment of their hyperglycae-mia. In the 11 patients with MODY-2 that we followed up

The malignant lymphomas rarely occur in the genito-urinary tract and particularly penis lymphomas are extremely uncommon. Frequently they do not have any specific symptoms and the diagnosis is delayed even in presence of a penis node. In our hospital we observed two patients affected by Non-Hodgkin Lymphoma (NHL), one of them with a primitive disease. Both cases were sexually active men who did not accept a radical surgery. A conservative polichemotherapy treatment by ciclophosphamide, vincristine and prednisone has been proposed and performed for both cases and a complete resolution of disease was demonstrated. At the same time we assessed the erectile function by the IIEF score, before and after treatments.

Evaluation of psychological and social aspects of women with diagnosed genital HPV-infection.A retrospective study of 40 women with a diagnosis of HPV-genital infection has been made. INTERVENTIONS AND MEASURES: A questionnaire for gathering information on social life, sexuality and emotional relationship with the partner was submitted to the patients.There is a high percentage of sexual impairments after diagnosis of HPV-infection.HPV infections, as many genital pathologies, lead to problems with sexuality as well as hypochondriac fears.

CIN is the most frequent neoplasm in pregnancy. At present, in Italy, Pap test and colposcopy are not included in routine examinations in prenatal visits.In this study, we submitted 560 pregnant women to Pap test during prenatal visits. In case of abnormal or doubtful smears a colposcopy and target biopsy were performed.Of the 560 women studied, 124 had genital bleeding and the other 436 were asymptomatic. Six cases of CIN symptomatic women and 5 cases in the asymptomatic ones. In no cases we thought necessary a therapeutic operation. We limited the therapy to a follow-up.In our opinion, it is necessary to treat CIN during pregnancy.

The validity of tryptoreline treatment in uterine myomatosis is demonstrated, both as alternative therapy to surgery in patients in fertile age and as preoperative therapy reducing myomatosis volume.In the outpatients department of Gynecologic and Obstetric Institute of the Second University of Naples, eighteen women, from 35 to 56 years old, with symptomatic uterine myomas, diagnosed by clinical examination and confirmed by pelvic ultrasonographic were treated with a delayed-release microcapsule preparation of D-Trp-6-LHRH (triptorelin) injected im, every 28 days. The duration of treatment was 6 months.The results are statistically significant for 16 patients that have completed the therapy with maximal reduction in uterine and leiomyomas volumes after 3 months of treatment. Minor side effects such as hot flushes, vaginal dryness, headache, dyspareunia were frequently encountered, but they disappeared progressively after the end of therapy.Four months after treatment, no significant increase in uterine and myoma volume, was noted.

We have read with great interest the article by Chakera et al. (1) describing two cases of gestational diabetes mellitus due to a mutation in the glucokinase ( GCK ) gene. As a result of antenatal genetic testing, the fetuses had inherited the GCK mutation. Neither fetuses nor mothers received insulin treatment for established maternal hyperglycemia in the third trimester, and the children had a normal birth weight and no metabolic complications. The data of Chakera et al. seemed to confirm our published theory; therefore, a nonmutated GCK child from a maturity-onset diabetes of the young type 2 (MODY2+) mother may have the same complications as a diabetic mother's son and, in this …

The Authors examine serum levels of HPRL in basal conditions and after TRH and sulpiride test in 15 patients with endometrial lesions (hyperplasia) and in 15 patients with endometrial adenocarcinoma included in a age range between 44 and 62 years, in which 7 patients present obesity, 10 patients present hypertension and 2 patients are hyperglycemic. The same examination is carried out in a control group of 30 healthy patients. Then the 15 patients with adenocarcinoma and 3 patients with adenomatosa hyperplasia are subjected to surgery and they estimate HPRL levels in endometrium. The results prove that there is no correlation between HPRL plasma levels and endometrium lesions and between endometrium HPRL. The Authors conclude that HPRL does not play a significant role in the pathogenesis of endometrial lesions; use of HPRL plasma levels as a marker of endometrial lesions is not possible.

The effects of estrogen-therapy on bone mineral density and the incidence of fractures in 132 women with postmenopausal osteoporosis have been studied.The patients were randomly assigned to receive placebo or estrogens (0.15 or 0.3 or 0.625 mg) for 64 months. Bone mineral density of the lumbar spine was measured by dual-energy X-ray absorptiometry with the use of Hologic QR-1000 densitometers, in all women.A significant increase in bone mineral density was observed in women receiving estrogens, whereas in those receiving placebo there was a decrease in bone mineral density.

To ascertain whether the prognostic value of desmoplastic reaction and lymphocytic infiltration are a good prognostic index to estimate survival in breast cancer patients.From 1987 to 1994, the authors have evaluated the prognostic value of desmoplastic reaction and lymphocytic infiltration related to rode state in 34 patients with breast cancer. For statistical analysis and comparison of means the "t"-test was used. The significance level was 0.01.The group of patients with abundant desmoplastic reaction shows an overall survival rate lower than the group with poor desmoplastic reaction (p0.01) and the survival of the group with abundant desmoplastic reaction was related to lymphnodal status.Many prognostic factors have been shown during these years, some connected to patient, some connected to neoplasm and others connected to the treatment. Recently many other prognostic factors have been recognized, among which the possible prognostic role of desmoplasia has been carefully valued. Certainly, today the prognostic value of desmoplastic reaction and lymphocytic infiltration cannot take the place of usual prognostic factors in the evaluation of breast cancer patient yet the desmoplastic reaction is a good prognostic index to estimate the survival in these patients.

Neuroendocrine tumours are a heterogeneous group of separate clinico-pathological entities which have a common characteristic, i.e., expression of potential endocrine differentiation. In the ovary, the term "neuroendocrine" relates mainly to widely known carcinoids, but it may also be applied to rare neuroendocrine carcinomas as non-small cell type and small cell carcinomas of pulmonary type. In the literature only 11 cases of primary ovarian non-small cell neurendocrine carcinomas have been described and ten of these were associated with a surface epithelial ovarian tumour. Small cell neuroendocrine carcinoma of the ovary is a rare malignant tumour of the ovary. Advanced small cell carcinoma of the ovary is a very aggressive tumour with an overall poor prognosis and unfavourable outcome.The case reported is unique in the literature because the authors describe a rare case of endometrial metastasis of a primary ovarian non-small cell neurendocrine carcinoma without any surface epithelial ovarian tumour association. The tumour invaded up to less than half of the myometrium. The first symptoms were related to endometrial metastasis as metrorrhagia and pelvic pain while the asymptomatic presence of primary ovarian carcinoma was not acknowledged with physical examination, routine biochemistry, tumour markers, blood count and traditional transvaginal greyscale ultrasound.Magnetic resonance and three-dimensional (3D) ultrasonography with power Doppler are a great help in the diagnosis of ovarian localisation but only immunohistochemistry on histological material can provide a correct diagnosis. Immunohistochemistry expression of Ki67 is a useful marker of malignancy. Due to the rarity of this neoplasm, a general consensus for optimal treatment has yet to emerge. The reported biological aggressiveness of these tumours prompts combined treatment with radical surgery and adjuvant polychemotherapy.

Since a continuous administration of adequate doses of luteinizing hormone-releasing hormones (LHRH) or of an agonist leads to a hypogonadism-like condition, it is possible to use this effect for the treatment of endometriosis. The present study reports the results obtained in the Gynaecology and Obstetrics Institute of the Second University of Naples, with a long-acting formulation of a GnRH analogues (D-Trp6-LHRH) in biodegradable microcapsules, at monthly intervals.The study was carried out on 40 women with endometriosis diagnosed by laparoscopy or laparotomy. The duration of treatment in patients in stage I-II was of 6 months, in patients in stage III or IV was of 9 months.After 12 months from the end of therapy, 27 patients did not show any sign of endometriosis with ultrasound and clinical examination; 13 patients still showing endometriosis were from III or IV stage.This long-acting formulation should offer a better approach for chronic treatment.

The paper discusses the genesis of vestibular papillomatosis: some researchers affirm that it is epithelio-paraphysiological whereas others maintain that it is a subclinical stage of HPV infection. In some cases "true" symptomatic papillomatosis may be remedied by human leucocyte alpha-IFN treatment.