Journal of Health and Social Sciences

We report the case of a 50-year-old man who presented with palpitations, without any other sympto... more We report the case of a 50-year-old man who presented with palpitations, without any other symptoms. An electrocardiogram (ECG) showed rapid supraventricular tachyarrhythmia (atrial flutter 2:1). Transthoracic echocardiography showed severe left ventricular dilatation and left atrial enlargement, sustained by the severe dilatation of the aortic root and an ascending aortic aneurysm. A computed tomography (CT) scan of the chest confirmed the aortic dilatation. Thoracic aortic disease presents in many different ways, often incidentally after a chest X-ray is performed for other reasons. Our patient had no such risk factors for an aortic aneurysm. The existing literature features some reports of aortic dissection presenting with supraventricular arrhythmias, but to our knowledge , this is the first report of an arrhythmia as the first sign of an aortic aneurysm (not dissected). The guidelines for the management of atrial fibrillation do not specify the timing of performing echocardiography. We think that during the assessment of a patient who is in the emergency room with paroxysmal tachyarrhythmias, performing echocardiography early can be very useful.

The JC virus (JCV) is well known for causing progressive multifocal leukoencephalopathy (PML), a ... more The JC virus (JCV) is well known for causing progressive multifocal leukoencephalopathy (PML), a potentially fatal, demyelinating disease of the central nervous system (CNS). PML almost exclusively affects immunosuppressed patients, whereas it is rare in immunocompetent subjects. Recently , a new clinical entity, named JCV encephalopathy (JCVE), has been observed. We present the case of a 62-year-old male, with no identifiable immunosuppression, who developed aphasia and progressive reduction in consciousness. He had a six months insidious history of psychiatric symptoms. He passed away 3 weeks after onset of symptoms. On admission, brain MRI demonstrated a prominent grey matter involvement. Serological tests and cerebrospinal fluid analysis were all negative for infectious diseases. A whole-body CT scan was negative for cancer. Several EEGs showed a diffuse anterior theta activity with bilateral parietal epileptic periodic discharges. A second MRI imaging showed a more prominent non-enhancing grey and white matter involvement , compatible with PML. Finally, CSF-PCR for JCV was performed and resulted positive. To the best of our knowledge, our report is the second case of JCVE described so far. Similarly to our patient, the previous case developed symptoms consistent with a CNS disease with progressive clinical course. MRI abnormalities were initially restricted to the hemispheric grey matter and only later extended to the subcortical regions. Our case suggests that JCV infection should be considered even in immunocompetent patients presenting with unexplained cortical lesions and rapidly progressive encephalopathy.

We report the case of a 40-year-old woman presenting during the night to the emergency department... more We report the case of a 40-year-old woman presenting during the night to the emergency department for thoracic pain and pain in the upper arm. An electrocardiogram (ECG) showed diffuse ST segment elevation. A coronarography (CVG) showed spontaneous dissection of the interven-tricular anterior artery. Many patients present with chest pain to emergency departments (ED). Spontaneous coronary artery dissection (SCAD) should be considered in any young patient, especially young women, without a history of coronary heart disease or risk factors, who presents with an acute myocardial infarction or cardiac arrest.

Objective: The aim of this study is to better identify the prevailing emotions and feelings of ca... more Objective: The aim of this study is to better identify the prevailing emotions and feelings of cancer patients during their stay in waiting rooms in a department of oncology.
Methods: In July 2014, patients in the waiting rooms of our Department of Oncology were asked to fill out dedicated questionnaires. Patients had to choose sentences that best described their feelings, thoughts and experiences; this part was differentiated according to the waiting rooms (Consultation Rooms versus Day Hospital). In another section, patients were asked to choose their prevailing primary emotions: joy, fear, sadness, anger, disgust or surprise.
Results: Two hundred eighty questionnaires were considered valid for statistical analysis. Regarding feelings, all patients in the Day Hospital and Consultation Rooms stated that they feel anxious (48% and 53%, respectively). By differentiating patients according to the setting, patients in the Day Hospital answered that they will face chemotherapy, thinking that it will be useful to defeat the disease (56%), and patients in Consultation Rooms answered that time in the waiting rooms goes more slowly (65%). Regarding the prevailing emotions experienced by patients, sadness was the most selected, followed by fear and surprise. Conclusions: A prevalent emotional and cognitive state while waiting is anxiety, followed by positive thoughts. Patients presented anxiety and fear independently from the setting of care. We believe that each oncologist should be aware of the degrees of fear and sadness that patients experience during an oncological examination because these emotions can have an impact on communication and understanding.

Introduction: Modern tattoo removal began as a science approximately 20 years ago, and relatively... more Introduction: Modern tattoo removal began as a science approximately 20 years ago, and relatively few advances have been made since then. The aim of this study is twofold: first, to review the complications of tattoos and tattoo removal methods and second, to investigate both the epidemiology and legal issues of this phenomenon in Italy.
Discussion: Complications of medical tattoos are changes in colour, leading to colour mismatch. The complications of decorative tattoos include infections and allergic and foreign body reactions. Tattoos are popular in Italy, especially among the younger generations. As these people age, the demand for tattoo removal will continue to grow. Q-switched (QS) lasers are widely considered the gold standard for tattoo removal. Although Q-switched lasers are capable of removing tattoos without harming the skin, removal often requires numerous treatments and it can still be incomplete , especially when attempting to remove multicoloured tattoos. Moreover, complications can occur, with an incidence of about 5%. Immediate complications include pain, blisters, crusting and pinpoint haemorrhage. Delayed complications include pigmentary changes, either hypopigmen-tation or hyperpigmentation. Developments leading to removable tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents and, perhaps, even shorter pulse-duration lasers should result in improvements in tattoo removal in the near future.
Conclusions: In Italy there is no specific prescriptive legislation for tattooing, and there is also a great diversity in terms of regional regulatory approaches. Future educational campaigns by school counsellors and primary care physicians should also be aimed at specific groups that are more likely to get tattoos, such as minors and women.

In Italy, the absence of adequate regulatory instruments and guidelines for the proper classifica... more In Italy, the absence of adequate regulatory instruments and guidelines for the proper classification of psychiatric disorders in occupational medicine denies occupational physicians the opportunity to adequately evaluate employees' psycho-physical fitness for work through health surveillance. This applies particularly to the categories of workers who could potentially 'endanger' the health and safety of third parties in the workplace. Although each business organization tries to internally manage these cases, there is an increasingly need to have a common reference framework. It is becoming increasingly urgent that both legal experts and scientific researchers address this issue together to define the psychological requirements necessary for the performance of given activities according to the nosological classification of psychiatric disorders from the DSM-5; this will protect the health and safety of both the workers and third parties.

Introduction: A mass gathering (MG) is when a large number of people come together in a parti- cu... more Introduction: A mass gathering (MG) is when a large number of people come together in a parti- cular location for a specific purpose. Expo 2015 was an universal exposition hosted by Milan, Italy. The Pre-Hospital Emergency Company (AREU) of Lombardy Region (Milan-Italy) was involved in planning and managing the emergency rescue response inside the Expo 2015 area in Milan. In this paper, we review the AREU medical and public health response for the 2015 Milan Expo.

Methods: Existing risk-assessment processes for MGs were used (the Arbon Predictive Score and Maurer Score) to define the expected resources and the impact on the health systems. The objecti- ve of the plan was to reduce the impact of the event by adopting the model of First Aid Points (advanced medical posts) deployed in the event site acting as ‘first health filters’ for the hospital network in Milan.

Results: Our data indicate that 13,579 visitors were rescued in the ‘Red Area’ from 1 May to 31 October (with an average of 73 cases per day); 9,501 of them needed initial treatment or obser- vation time at the First Aid Points, 1,289 of them were hospitalised (1% Red code, 29% Yellow code, 70% Green code); 65% of patients (57% female, with a mean age of 37 years old) had medical problems. Fatigue, light- headedness, dizziness, syncope, loss of consciousness and headache were the prevalent medical diagnoses.

Conclusions: Our study confirms that environmental factors, such as the weather, can contribute to large numbers of ill people at MGs. Overall, the AREU of Lombardy Region demonstrated excel- lent preparation for the Expo 2015 MG. Flexibility, integration and strong cooperation between the pre-hospital settings and hospitals were incorporated into the application of the plan. The final data showed the effectiveness of the adopted model and the reduced impact on the hospital network.

An important regulation, issued by the European Community in 2008, regulates the authorisation an... more An important regulation, issued by the European Community in 2008, regulates the authorisation and supervision of advanced therapy medicinal products (ATMP) and subsequent follow up in Europe. This law contains a Hospital Exemption clause, under which some hospitals in some countries can be exempted from the regulations governing ATMPs. The application of this regulation in Europe has resulted in differences in the costs of cell therapy for cartilage injuries in Germany compared with the costs in other European countries and in the U.S. The present paper argues on the real impact of political decisions on the health of citizens, on economy of healthcare systems, and highlights a possible case of inequality among European citizens with respect to cartilage repair procedures.

Tetanus is a life-threatening infection that is rare in the developed world; it is more frequent ... more Tetanus is a life-threatening infection that is rare in the developed world; it is more frequent in the elderly people and immunocompromised patients. We report a case of a 53-year-old woman who presented with dysphagia, mouth pain and trismus. She did not report any injuries. The suspected diagnosis of tetanus was made. The blood examination showed severe lymphocytopenia and a positive result for the antinuclear antibody (ANA) test, with a suspected diagnosis of Sjogren’s syndrome. It is possible that her immunocompromised conditions could have led to the onset of tetanus, even after casual and minimal contact with Clostridium spores.
Antonio

Introduction: Liposarcomas are considered the most common type of soft tissue sarcoma in adults. ... more Introduction: Liposarcomas are considered the most common type of soft tissue sarcoma in adults. They represent approximately 20% of all mesenchymal malignancies and most frequently involve the retroperitoneum, trunk and extremities. Hypopharyngeal localisation of a liposarcoma is extremely rare. To determine the prevalence of liposarcomas of the hypopharynx, we conducted a systematic review of the literature. Methods: We performed a systematic search of the literature until 2015 using PubMed and Ovid. The search identified 28 cases of hypopharyngeal liposarcomas. The inclusion criteria were: clinical trials, cohort studies, case-control studies, case reports and case series on hypopharyngeal liposarcomas. From an initial 77 articles, 23 articles were selected for this systematic review. The natural history, imaging features, histology, treatment and prognosis were analysed. Results: The incidence peaked in the sixth and seventh decades. Diagnostic procedures were based on the barium swallow test, endoscopic examinations, and computed tomography (CT)/magnetic resonance (MR) imaging. A well-differentiated liposarcoma represented the most frequent histological subtype. Surgical excision was the main treatment. Endoscopic resection appeared to be useful for peduncolated tumours of the hypopharynx. The 1-year disease-free survival rate was 89.47%. Conclusions: A hypopharyngeal liposarcoma is a rare pathology, but it should kept in mind when a mass of the hypopharynx is discovered. A cervical approach is better, irrespective of the size of the tumour, except for cases in which an endoscopic approach is feasible. Local recurrence is common. Therefore, patients should undergo regular examinations, at least for up to 5 years.

Background: The frequency of pulmonary aspergillosis has been increasing for decades. Standard or... more Background: The frequency of pulmonary aspergillosis has been increasing for decades. Standard oral treatment is associated with tolerability problems and interactions with commonly used medications. Present data suggest that terbinafine may be a useful alternative for chronic forms. Methods: A randomised, double-blind, multicentre trial compared terbinafine (500 mg b.i.d) with itraconazole (200 mg b.i.d.) with respect to successful outcomes for up to 6 months in 24 patients with chronic pulmonary aspergillosis. The primary end-point was a global clinical assessment using a 4-point rating scale, including (thorax) X-ray or Tc features. Secondary end-points were mycological response, duration of treatment and tolerability based on adverse events, haematology, biochemistry and urinalyses. Results: The patients were randomly allocated to terbinafine or itraconazole. No patients discontinued terbinafine, while 2 of 12 patients discontinued itraconazole because of protocol violation (n=1) or withdrawal of consent (n=1). The mean ± SD duration of the treatment was longer in the terbinafine group (139.8 ± 43.6 days vs 120.5 ± 41.8 days). The clinical success rate was also higher with terbinafine (91.7% vs 70.0%), as was the eradication rate (100% vs 75%). The proportion of patients who reported adverse events was higher with itraconazole (7 of 12 vs 3 of 12). Conclusions: Terbinafine (500 mg b.i.d. for up to 6 months) is an effective, well-tolerated antifungal agent for the treatment of chronic infectious forms of pulmonary aspergillosis, representing a valid alternative to treatment with itraconazole in these clinical forms, due to better clinical efficacy and safety and lower costs vs new azoles.

The increased incidence of cancer in children and adolescents registered in Italy in the last few... more The increased incidence of cancer in children and adolescents registered in Italy in the last few decades is one of the highest amongst Western countries. The causes are difficult to identify, but recent daily news and some epidemiological surveys, such as the ‘Sentieri’ study, suggest that environmental pollution has an important role. In the past 20 years, epigenetic studies have described how the changes induced by the cell microenvironment on the non-coding parts of the genome can heavily influence gene function, contributing to the carcinogenesis process. Connecting links amongst the external environment, cellular microenvironment and functional epigenetic and genetic mutations promote carcinogenesis. Today, the whole genome sequencing techniques for human cancers can help to formulate a map of mutational signatures in individual tumours, and a list of mutational fingerprints showing exposure to specific environmental mutagens is being developed. Determining the ethical, legal and economic consequences of known cancer causative agents in young people will be a crucial step for a serious reconsideration of primary prevention.

We aimed to identify the psychosocial risks that penitentiary police officers face. To do so, we ... more We aimed to identify the psychosocial risks that penitentiary police officers face. To do so, we developed the police stress risk questionnaire–prison (PSrQ–p), a questionnaire for psychosocial risk assessment at workplace, consisting of 22 items that investigated five macro dimensions: isolation, social image, firearms license, variety of work and roles/responsibilities. We tested this tool on a sample of 1,346 subjects, and testing is on-going. From the data obtained, we confirmed the hypothesis of psychophysical and negative social image relative to the isolation experienced by penitentiary police officers.

Cite this article as - Taino G, Battaglia A, Imbriani M. Workplace conflicts and psychological work-related injuries: our experience in Italy. J Health Soc Sci. 2016;1(1):17-22. DOI 10.19204/2016/wrkp3

Abstract In Europe, all countries regularly recognise mental disorders as workplace accidents (m... more Abstract
In Europe, all countries regularly recognise mental disorders as workplace accidents (mainly post-traumatic stress disorders). However, there has been little emphasis on this emerging issue in Italy. Our discussion focuses on a recent case report regarding an employee who was affected by an acute anxiety disorder after a common workplace conflict with a coworker. Given that prolonged and unresolved relationship conflicts may result in more extreme forms of conflict known as workplace bullying, relationship conflicts should be minimised or prevented as early as possible. These conflicts can also lead to acute stress disorders, particularly in workers who are at-risk for stress disorders. To prevent psychological work-related injuries, occupational stakeholders should use assessments for work-related stress as a framework for addressing all organisational risk factors that are related to workplace relationships and conflict.

Chirico F. Spiritual well-being in the 21st century: it’s time to review the current WHO’s health definition? J Health Soc Sci. 2016;1(1):11-16. DOI 10.19204/2016/sprt2

ABSTRACT Over the years, some critics argue that the dimension of spiritual well-being was missin... more ABSTRACT
Over the years, some critics argue that the dimension of spiritual well-being was missing from the World Health Organization’s (WHO) definition of health. Nevertheless, although the WHO’s definition has been criticized over the past 60 years, it has never been adapted. Spiritual well-being should not be confused with psychological well-being. Moreover, spirituality, personal beliefs and religiousness are not synonymous. Spirituality has received much interest in health care services; it can improve strategies for managing stress and can positively influence immune, cardiovascular (heart and blood vessels), hormonal, and nervous systems. For this reason, it may be implicated in a wide range of physical and mental health conditions, and I believe it’s time to review the WHO’s health definition, adding to it the ‘spiritual well-being’ dimension.

Dear Readers, It gives us enormous pleasure to officially launch the inaugural issue of the Jour... more Dear Readers,

It gives us enormous pleasure to officially launch the inaugural issue of the Journal of Health and Social Sciences.

The Journal is an interdisciplinary, open access journal that focuses on the medical and health sciences. Topics of interest to the journal include all branches of medicine and other disciplines related to health such as psychology, social sciences and public, occupational and environmental sciences. According to the World Health Organization’s definition, health is ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ [1]. Therefore, the leitmotiv throughout Journal of Health and Social Sciences will be “health” in every way.

Table of Contents Journal of Health and Social Sciences 2016;1(2)

Table of Contents J Health Soc Sci 2016,1(1):9-10 Editorial Welcome to the Journal of Health and... more Table of Contents

J Health Soc Sci 2016,1(1):9-10
Editorial
Welcome to the Journal of Health and Social Sciences
Authors: Francesco Chirico*, Giuseppe Ferrari**
*Health Service State Police, Ministry of Interior, Italy
**SIPISS-Italian Society for Psychotherapy and Social Development

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J Health Soc Sci 2016,1(1):11-16
Perspectives
Spiritual well-being in the 21st century: it’s time to review the current WHO’s health definition?
Authors: Francesco Chirico*
* State Police, Health Service Department, Ministry of Interior, Italy

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J Health Soc Sci 2016,1(1):17-22
Commentary
Workplace conflicts and psychological work-related injuries: our experience in Italy
Authors: Giuseppe Taino*, Andrea Battaglia**, Marcello Imbriani**
*IRCCS “S. Maugeri” Foundation – Pavia – Unit Hospital of Occupational Medicine (UOOML)
** Department of Public Health, Experimental Medicine and Forensic – University of Pavia. IRCCS “S. Maugeri” Foundation – Pavia

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J Health Soc Sci 2016,1(1):23-28
Perspectives
Psychosocial risks within prison service
Authors: Giuseppe Ferrari*
*SIPISS-Italian Society for Psychotherapy and Social Development

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J Health Soc Sci 2016,1(1):29-36
Viewpoint
The high cancer incidence in young people in Italy: do genetic signatures reveal their environmental causes?
Authors: Ruggero Ridolfi*
*International Society of Doctors for the Environment (ISDE). ISDE Forlì Cesena, Italy. Honorary President of Italian Melanoma Intergroup (IMI).

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J Health Soc Sci 2016,1(1):37-46
Viewpoint
Is there health inequity in Europe today? The ‘strange case’ of the application of an European regulation to cartilage repair
Authors: Roberto Beretta*
*Biologist, Biotechnology Expert, Milan, Italy

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J Health Soc Sci 2016,1(1):47-56
Original Article
Terbinafine versus itraconazole: a long-term, randomized, double-blind, clinical trial in chronic pulmonary aspergillosis. A pilote study
Authors: Gianfranco Schiraldi1, Salvatore Lo Cicero2, Claudio Rossetti3,Delia Colombo4, Michele Chiericozzi2, Fabio Colombo5, Maurizio Ferrarese6, Elvana Kola2, Luigi Allegra7
1 Pneumology Unit, IRCCS Auxologico, Milan, Italy
2 Pneumology Department, Niguarda Hospital, Milan, Italy
3 Nuclear Medicine Department, Niguarda Hospital, Milan, Italy
4 Novartis Pharma, Italy
5Villa Marelli Institute, Niguarda Hospital, Milan, Italy
6 TB Department, Villa Marelli Institute, Niguarda Hospital, Milan, Italy
7 Respiratory Diseases; Milan University, Italy

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J Health Soc Sci 2016,1(1):57-66
Sistematic review
Liposarcomas of the hypopharynx: a systematic review of the literature
Authors: Andrea Corvino1, Giuseppe Riva1, Matteo Sensini1, Massimiliano Garzaro1, Giancarlo Pecorari1
1 ENT Division, Surgical Sciences Department, University of Turin, Via Genova,3,10126 Turin, Italy

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J Health Soc Sci 2016,1(1):67-70
Case Report
Dysphagia and trismus: an unusual case of tetanus
Authors: Antonio Villa1 , Marianna Gregorio1, Francesca Bassi2, Alessandra Perego1, Maria Francesca Donato2, Vilma Galimberti2, Maria Grazia Bellotti2, Antonella Cheldi2
1 Emergency Department – Desio Hospital (Monza-Brianza), Italy
2 Neurology Department – Desio Hospital (Monza-Brianza), Italy

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