Neuropsychological Functioning in Bilateral versus Unilateral Temporal Lobe Epilepsy

Although relatively specific anatomo-electro-clinical features of temporal lobe epilepsy (TLE) with bilateral ictal involvement (bitemporal epilepsy-BTLE) have been described, differentiating between BTLE and unilateral TLE (UTLE) remains challenging. Surgery is often the treatment of choice for drug-resistant UTLE, whereas its use is more controversial in BTLE. It is currently unclear whether neuropsychological assessment can contribute to the differential diagnosis. We retrospectively reviewed the neuropsychological evaluation of 46 consecutive patients with refractory TLE. Eighteen patients were diagnosed with BTLE on the basis of ictal electro-clinical data, in particular a video EEG recording of at least one seizure simultaneously involving the two temporal lobes without the possibility of lateralizing its onset or at least two different seizures independently arising from the two temporal lobes. Twenty-eight patients were classified as UTLE. Presurgery evaluation data were used in this study. Compared with UTLE, BTLE was associated with a lower intelligence quotient (IQ) and more severe impairment in long-term memory, the latter remaining significant even after controlling for IQ. No significant differences were found between right and left UTLE. In conclusion, BTLE and UTLE are associated with relatively distinct neuropsychological profiles, further supporting their classification as different disorders within the TLE spectrum.

Coeliac disease in the COVID-19 pandemic: does HLA have a protective effect?

BACKGROUND

The coronavirus disease 2019 (COVID-19), an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2), is emerging as a worldwide public health emergency. Several scientific contributions reported the potential relevance of human leukocyte antigen (HLA) polymorphism and susceptibility to viruses, such as SARS-CoV. In our study, we examined a population of coeliac subjects presenting the HLA haplotype DQ2 and/or DQ8. Our aim was to evaluate whether HLA DQ2 and/or DQ8 haplotype play a role in SARS-CoV-2-infection. The aim was also to evaluate the difficulty in following the gluten-free diet due to all the adversities produced by the pandemic, such as the food supply disruption, and the difficulties in managing the clinical follow-up.

METHODS

191 consecutive coeliac patients completed a questionnaire on their current clinical status, psychological effects, and management of the gluten-free diet experienced during the COVID-19 pandemic and questions regarding possible SARS-CoV-2 infection.

RESULTS

Out of the 191 patients who participated in the study, 42 were full-blown coeliac and 149 were in remission. From the answers provided, 84.8% of patients declared that they no longer consider themselves vulnerable to COVID-19 as they suffer from coeliac disease; 94.2% of patients did not encounter any difficulties in managing the gluten-free diet or in acquiring specific foods and 64.9% of patients in our study underwent diagnostic testing for SARS-CoV-2. Out of this number, 31.5% did so due to contacts with subjects affected by COVID-19, 26.6% for work related reasons, 11.3% due to flu-like symptoms and 30.6% for other reasons. Only 5.8% of the enrolled patients received a diagnosis of COVID-19. Out of all the patients in our population who were diagnosed with COVID-19, 94.8% developed no symptoms and none of them needed hospitalization or intensive care.

CONCLUSION

The hypothesis that the HLADQ2 and/or DQ8 haplotype plays a protective role against SARS-CoV-2 infection, as against other viral infections, is intriguingly suggestive.KEY MESSAGESCOVID-19 as a public health emergency;SARS-CoV-2 and possible complications in coeliac disease;Role of HLA DQ2 and/or DQ8 in SARS-CoV-2 infection.

Coeliac disease in the COVID-19 pandemic: does HLA have a protective effect?

BACKGROUND

The coronavirus disease 2019 (COVID-19), an acute respiratory disease caused by a novel coronavirus (SARS-CoV-2), is emerging as a worldwide public health emergency. Several scientific contributions reported the potential relevance of human leukocyte antigen (HLA) polymorphism and susceptibility to viruses, such as SARS-CoV. In our study, we examined a population of coeliac subjects presenting the HLA haplotype DQ2 and/or DQ8. Our aim was to evaluate whether HLA DQ2 and/or DQ8 haplotype play a role in SARS-CoV-2-infection. The aim was also to evaluate the difficulty in following the gluten-free diet due to all the adversities produced by the pandemic, such as the food supply disruption, and the difficulties in managing the clinical follow-up.

METHODS

191 consecutive coeliac patients completed a questionnaire on their current clinical status, psychological effects, and management of the gluten-free diet experienced during the COVID-19 pandemic and questions regarding possible SARS-CoV-2 infection.

RESULTS

Out of the 191 patients who participated in the study, 42 were full-blown coeliac and 149 were in remission. From the answers provided, 84.8% of patients declared that they no longer consider themselves vulnerable to COVID-19 as they suffer from coeliac disease; 94.2% of patients did not encounter any difficulties in managing the gluten-free diet or in acquiring specific foods and 64.9% of patients in our study underwent diagnostic testing for SARS-CoV-2. Out of this number, 31.5% did so due to contacts with subjects affected by COVID-19, 26.6% for work related reasons, 11.3% due to flu-like symptoms and 30.6% for other reasons. Only 5.8% of the enrolled patients received a diagnosis of COVID-19. Out of all the patients in our population who were diagnosed with COVID-19, 94.8% developed no symptoms and none of them needed hospitalization or intensive care.

CONCLUSION

The hypothesis that the HLADQ2 and/or DQ8 haplotype plays a protective role against SARS-CoV-2 infection, as against other viral infections, is intriguingly suggestive.KEY MESSAGESCOVID-19 as a public health emergency;SARS-CoV-2 and possible complications in coeliac disease;Role of HLA DQ2 and/or DQ8 in SARS-CoV-2 infection.

Plasmonic Metasurfaces for Specific SERS Detection of Shiga Toxins

The interest in the development of nanoscale plasmonic technologies has dramatically increased in recent years. The photonic properties of plasmonic nanopatterns can be controlled and tuned via their size, shape, or the arrangement of their constituents. In this work, we propose a 2D hybrid metallic polymeric nanostructure based on the octupolar framework with enhanced sensing property. We analyze its plasmonic features both numerically and experimentally, demonstrating the higher values of their relevant figures of merit: we estimated a surface-enhanced Raman spectroscopy (SERS) enhancement factor of 9 × 10⁷ and a SPR bulk sensitivity of 430 nm/RIU. In addition, our nanostructure exhibits a dual resonance in the visible and near-infrared region, enabling our system toward multispectral plasmonic analysis. Finally, we illustrate our design engineering strategy as enabled by electron beam lithography by the outstanding performance of a SERS-based biosensor that targets the Shiga toxin 2a, a clinically relevant bacterial toxin. To the best of our knowledge, this is the first time that a SERS fingerprint of this toxin has been evidenced.

Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability

Background

The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales.

Results

Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings — the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status.

Discussion

Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05719-9.

How lockdown measures, during COVID-19 pandemic, matter on psoriatic patient's perception: Study on 600 patients on biologic therapy

Background

The outbreak of coronavirus disease-2019 (COVID-19) is a public health crisis of global proportion. In psoriatic patients treated with biologic agents, evidence is not yet available on susceptibility to infection with the novel SARS-CoV-2 coronavirus, and data about the perception of COVID-19 and its impact on these patients are lacking.

Aims

The aim of this observational, spontaneous study was the evaluation of the impact of anti COVID-19 measures in “fragile population” such as patients with a chronic inflammatory disease. Thus, we evaluated the impact of perceived risk on quality of life of patients with moderate to severe psoriasis, in our outpatient clinic, and how their perceptions changed before and after the adoption of Covid-19 emergency measures following the Italian Ministerial Decree in March 9, 2020.

Methods

Using a series of questions, our study surveyed adult patients with moderate to severe psoriasis receiving treatment with biologic agents (n = 591), before and after the adoption of COVID-19 emergency measures.

Results

Most patients (97%) had been sufficiently informed by healthcare staff about COVID-19 spread. A significant change was observed in social activity reduction before and after the adoption of the measures (18% vs. 90% of patients; P < 0.0001). Similarly, patients were more likely to suspend ongoing therapy after the measures were adopted than before (87% vs. 34% of patients; P < 0.0001). Following the measures, older patients were significantly more inclined to suspend therapy and reduce social activities than younger patients.

Conclusions

Government COVID-19 emergency measures further curtailed already reduced social activities in psoriatic patients, and led to a greater inclination to suspend biologic therapy, more so in older patients, despite there being no evidence to support this suspension. These vulnerable patients may need support from clinicians in order to maintain treatment adherence.

A versatile and compact surface plasmon resonance spectrometer based on single board computer

The widespread diffusion of low-cost but high-performance hardware is enhancing the realization of scientific equipment with features at the research laboratory level. In this paper, we demonstrate hardware implementation of a surface plasmon resonance compact device with high accuracy and measurement times appropriate for many applications. Image acquisition is realized by a Raspberry Pi single board computer with a camera module, and a Python code is used to process data. A flexible optical setup can work in two different configurations, namely, the inspection mode and angle resolved measurement mode. The inspection mode is used to precisely locate the light-emitting diode interrogation beam on the sample, avoiding uneven or faulty regions. The measurement mode allows us to monitor in real time the position of the minimum reflectivity with subpixel resolution. Performance tests show a resolution in the bulk refractive index of 4.9 × 10^-6 refractive index units for 10 s acquisition time.

Becoming a young adult with cerebral palsy

AIMS

This paper aims to describe the functioning profile of a clinical sample of patients with Cerebral Palsy at the time of transition.

METHODS AND PROCEDURE

For this retrospective observational study, we considered data concerning 389 patients born from 1967 to 1997 with a diagnosis of CP and discharged at the age of 18 ± 3 from "La Nostra Famiglia" Children Care Centres. We reported data concerning: identifiable risk factors, the type of CP, the level of motor, manual and communication abilities, the occurrence of associated impairments and environmental factors, and examine the trends over the decades.

OUTCOME AND RESULTS

The disorder was mainly bilateral (86%): 57% of patients had quadriplegia and 43% had diplegia. Most of patients had a spastic disorder (86%). Comorbidities were frequent, mainly intellectual developmental disorder (63.5%). One fifth of patients showed a severe impairment of motor, manual and communicative skills in addition to a severe intellectual development disorder. Over decades, the outcome as expressed by the motor functioning profile improved but the outcome as expressed by the global functioning profile worsened because of the growing number of severe multi-disabilities.

CONCLUSION AND IMPLICATION

Knowledge about the functioning profile of young adults with cerebral palsy can support health services in the provision of developmentally appropriate care.

Benefits of Centralized Scheduling in a Postacute Residential Rehabilitation Program for People With Acquired Brain Lesions: A Pilot Study

OBJECTIVE

To determine whether the use of a designated staff person to coordinate and schedule therapy services in a postacute residential rehabilitation program for people with acquired brain lesions results in (1) a higher-intensity treatment and a reduced length of stay; (2) reduced rehabilitation costs; and (3) increased patient and staff satisfaction.

DESIGN

This nonrandomized retrospective study from 2009 through 2012 uses data collected relative to 2 different methods of scheduling: (1) self-planning, in which each single team member makes appointments that are then displayed on a shared board; and (2) managed planning, in which appointments are made by a designated staff person.

SETTING

A residential center for people with postacute acquired brain lesions.

PARTICIPANTS

Patients (N=20) with acquired brain lesions who had similar clinical and demographic characteristics comprised the managed planning group (n=10) and the self-planning group (n=10).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Organizational measures (length of stay in rehabilitation, number of treatment hours, total cost of rehabilitation), clinical outcome scales (Disability Rating Scale, FIM, and Barthel Index), perceived quality of treatment by patients (questionnaire), and perceived satisfaction of team members (Job Descriptive Index).

RESULTS

All patients improved on all clinical rating scales at the time of discharge (all effect sizes are large). In the managed planning group, the number of treatment hours increased (Cohen's d=2.15), resulting in reduced length of stay (Cohen's d=.95) and cost of rehabilitation (Cohen's d=1.22). In addition, the quality of treatment perceived by the patients and their families increased, while team member satisfaction did not change.

CONCLUSIONS

The use of a designated staff person to manage therapy services improves efficiency and efficacy of a patient-centered health care system. The proposed scheduling system results in a remarkable cost saving for the National Health System.

Risk of atrial fibrillation among bisphosphonate users: a multicenter, population-based, Italian study

Bisphosphonate treatment is used to prevent bone fractures. A controversial association of bisphosphonate use and risk of atrial fibrillation has been reported. In our study, current alendronate users were associated with a higher risk of atrial fibrillation as compared with those who had stopped bisphosphonate (BP) therapy for more than 1 year.

INTRODUCTION

Bisphosphonates are widely used to prevent bone fractures. Controversial findings regarding the association between bisphosphonate use and the risk of atrial fibrillation (AF) have been reported. The aim of this study was to evaluate the risk of AF in association with BP exposure.

METHODS

We performed a nested case-control study using the databases of drug-dispensing and hospital discharge diagnoses from five Italian regions. The data cover a period ranging from July 1, 2003 to December 31, 2006. The study population comprised new users of bisphosphonates aged 55 years and older. Patients were followed from the first BP prescription until an occurrence of an AF diagnosis (index date, i.e., ID), cancer, death, or the end of the study period, whichever came first. For the risk estimation, any AF case was matched by age and sex to up to 10 controls from the same source population. A conditional logistic regression was performed to obtain the odds ratio with 95% confidence intervals (CI). The BP exposure was classified into current (<90 days prior to ID), recent (91-180), past (181-364), and distant past (≥365) use, with the latter category being used as a reference point. A subgroup analysis by individual BP was then carried out.

RESULTS

In comparison with distant past users of BP, current users of BP showed an almost twofold increased risk of AF: odds ratio (OR) = 1.78 and 95% CI = 1.46-2.16. Specifically, alendronate users were mostly associated with AF as compared with distant past use of BP (OR, 1.97; 95% CI, 1.59-2.43).

CONCLUSION

In our nested case-control study, current users of BP are associated with a higher risk of atrial fibrillation as compared with those who had stopped BP treatment for more than 1 year.

Individual and group treatment for patients with acquired brain injury in comprehensive rehabilitation

PRIMARY OBJECTIVE

The aim of this study was to investigate the hypothesis that group rehabilitation is more effective than individual treatments and provides an improvement in clinical outcomes similar to that achieved by individual treatments alone.

RESEARCH DESIGN

Two groups of patients were placed in different rehabilitation settings treated using the same rehabilitation approach. One received only individual treatments and the second group received a combination of both individual and group treatments. The independent variables were measured both pre- and post-treatment and compared between the two groups.

METHODS AND PROCEDURES

Seventy-four patients treated with a comprehensive rehabilitation approach were divided into two groups: (a) individual treatment only and, (b) combined treatments (both individual and group). The outcome scales were LCF (Rancho Los Amigos Level of Cognitive Functioning), DRS (Disability Rating Scale) and FIM™ (Functional Independence Measure).

RESULTS

The whole sample had obtained statistically significant improvements in all of the outcome scales: LCF (χ(2) = 45.26; p < 0.001), DRS (z = -3.92; p < 0.001) and FIM (z = -4.9; p < 0.001). The comparison between groups did not reveal any pre-treatment difference. Analysis of post-treatment, however, showed a greater improvement in the FIM scale for those in combined individual and group treatment (z = -0.2544, p = 0.01).

CONCLUSIONS

Group rehabilitation integrated with individual treatments is more effective than individual treatments alone in improving independence measured by the FIM™ scale. Both groups had obtained statistically significant clinical improvements, the improvement in the FIM™ scale was significantly better in the combined treatment group.

A Long Term Effects of a New Onset Psychosis after DBS Treated with Quetiapine in a Patient with Parkinson's Disease

Deep Brain Stimulation represents a therapeutic option for PD patients. In this paper, we present and discuss a case of acute delirium and psychosis manifesting after DBS in a 58-years-old man affected by Parkinson's Disease. We highlight the importance of an exhaustive psychiatric evaluation in candidates for DBS and we underline the severity and non-reversibility of some adverse events associated with the implantation, suggesting the use of Quetiapine in the management of these effects. Acute psychosis may be listed as a potential severe adverse event associated with DBS, even in patients without a clear cut previous history of psychiatric disorders.

Prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: a blinded sonographic evaluation

Objectives:

To verify the prevalence of chronic cerebrospinal venous insufficiency in patients affected by different clinical forms of multiple sclerosis and in healthy subjects using the Zamboni ultrasound protocol combined with M-mode ultrasound examination.

Materials and methods:

We enrolled 112 patients with multiple sclerosis and 67 healthy subjects from 20 to 67 years of age. All the patients underwent Duplex and color-Doppler sonography of the neck vessels, transcranial colour duplex sonography, M-mode study of the valve system and of venous abnormalities. Subjects were positive for chronic cerebrospinal venous insufficiency when at least two of five hemodynamic criteria of the Zamboni protocol were fulfilled. Chronic cerebrospinal venous insufficiency condition was further analyzed by a multivariate analysis including age, sex, disease duration, subtypes of multiple sclerosis and expanded disability status scale score as independent variables.

Results:

No healthy subjects was positive for chronic cerebrospinal venous insufficiency, while in the sample of patients affected by multiple sclerosis the diagnosis was made in 59.8% of cases ( p < 0.0001). The first criterion was the most frequent in patients affected by multiple sclerosis and chronic cerebrospinal venous insufficiency (respectively 54.4% and 76.1%, p < 0.001). The second, third and fourth criteria were never present in healthy subjects but were detected in patients with multiple sclerosis. The positivity of the second criterion was associated with diagnosis of chronic cerebrospinal venous insufficiency in 100% of cases. The third criterion had a prevalence of 52.2% in the subgroup of chronic cerebrospinal venous insufficiency patients. It was positive in 36 multiple sclerosis patients and was associated with chronic cerebrospinal venous insufficiency diagnosis in all cases except one. The multivariate analysis showed that age, disease duration, sex, subtypes of multiple sclerosis and expanded disability status scale score were not considered predictors of this haemodynamic condition.

Conclusion:

Chronic cerebrospinal venous insufficiency is a haemodynamic condition strongly associated with multiple sclerosis and is not found in normal controls. The addition of M-mode ultrasound to the diagnostic protocol allows improved observation of venous valve abnormalities.

Assessing the risk of osteonecrosis of the jaw due to bisphosphonate therapy in the secondary prevention of osteoporotic fractures

SUMMARY

There is evidence that the use oral bisphosphonates can lead to osteronecrosis of the jaws (ONJ). Although the occurrence of ONJ appears rare among oral bisphosphonates (BPs) users, it is important to know that it exists and can be opportunely minimized.

INTRODUCTION

The purpose of this study is to evaluate the association between BPs prescribed for the secondary prevention of osteoporotic fractures and the occurrence of ONJ.

METHODS

An Italian record linkage claims database with a target population of around 18 million individuals (6 million over 55 years of age) constituted the data source. We conducted a nested case-control study within a cohort of individuals aged 55+ years old, who were discharged from hospitals with a primary diagnosis of incident osteoporotic fracture. The date related to the discharge diagnosis of ONJ was the index date. Conditional logistic regression for matched data was fitted to estimate the odds ratio (OR) along with 95 % confidence intervals (95 % CI) for the likely association between use of BPs and the risk of ONJ.

RESULTS

Any one of the 61 ascertained cases of ONJ (incidence rate, 36.6 per 100,000 person-years) was matched to 20 controls for a total of 1120 controls. When the exposure to BPs was modeled according to recency (i.e., exposure time window prior to the index date) of use, the adjusted OR (95 % CI) for current users was 2.8 (1.3-5.9) against never users. The cumulative use of BPs has shown to increase the incidence of ONJ among patients with primary osteoporotic fractures, although not statistically significant risk has been observed.

CONCLUSIONS

Although the risk of BP-related ONJ appears low in non-oncological indications, it is important to be aware that it exists and to know how it may be predicted and possibly minimized.

Recurrent gallstone ileus: case report and literature review

The gallstone ileus is a rare complication of cholelithiasis and it represents the 1-4% of small intestinal mechanical obstruction. Gallstone is generally wedged in the terminal ileum, even if unusual locations have been described. The literature reports a very high morbidity and mortality, often because misdiagnosis or delayed diagnosis. There is no unique opinion in literature about the choice between one-stage and two-stage surgery. We report a clinical case that summarizes the diagnostic and therapeutic difficulties of gallstone ileus.

SPR detection of human hepcidin-25: a critical approach by immuno- and biomimetic-based biosensing

The human hepcidin-25 hormone has a key role in iron regulation in blood. The clinical relevance of this hepatic ~2.8 kDa cysteine-rich peptide is rapidly increasing, since altered levels can be associated with inflammatory events and iron dysfunctions, such as hereditary hemochromatosis and iron overload. Moreover, hepcidin has also attracted the anti-doping field for its possible role as indirect marker of erythropoietin blood doping. Methods currently reported are based on immunoassays (ELISA and RIA), or various types of mass spectroscopy (MS)-based protocols, semi-quantitative or quantitative. Despite the great effort in optimizing robust and simple assays measuring hepcidin in real matrices, at present this challenge remains still an open issue. To explore the possibility to face hepcidin detection through the development of affinity-based biosensors, we set up a comparative study by surface plasmon resonance (SPR) technology. An immuno-based, on anti-hepcidin-25 IgG, and a biomimetic-based, on a synthetic peptide corresponding to the hepcidin-binding site on ferroportin (HBD), biosensors were developed. Here we report behaviors and analytical performances of the two systems, discussing limits and potentialities.

Mammographic features in infertile women as a potential risk for breast cancer: a preliminary study

The purpose of the present study was to evaluate breast mammographic features, particularly mammographic density in a selected population of infertile women and to assess if these women should be considered at higher risk for breast cancer. The prevalence of female infertility in Western countries is approximately 10-15% and since causes affecting the female are involved in 35-40%, concerns have developed about the future health of these women, specifically whether infertility could represent a risk factor for future cancer development. Moreover, infertility is now often treated with medication and procedures that could modify the hormonal environment and be cofactors in the cellular changes towards cancer development. Mammographic breast density is a useful marker for breast cancer risk and breast density is considered one of the strongest risk factors for breast cancer. Breast density is associated with known breast cancer risk factors such as reproductive and menstrual factors including serum estrogen and progesterone concentrations. In Italy the National Federation for Breast Cancer (FONCAM) guidelines suggest the usefulness of mammography from 35 years of age for women who undergo infertility hormone therapy (FONCAM Guidelines, 2005). According to this recommendation 294 women aged > or = 35, with primary infertility, sent to our breast service before joining an IVF program were recruited and then underwent clinical examination and X-ray mammography. Women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Univariate analysis was employed to evaluate if there was an association between mammographic density and other risk factors. Evaluation of mammographic features showed the presence of BI-RADs C and D in the sample of 200 (68%) patients with DB and in 94 (32%) patients with NDB BI-RADS A and B. Univariate analysis showed that there were no statistically significant differences between the groups BD and NDB as regards age at mammography, age at menarche, BMI and family history for breast cancer, while ovulatory etiology of infertility was found to be associated with high mammographic density (p < 0.05). In conclusion, bearing in mind that 68% of our study sample had high breast density, we can assume that patients with primary infertility might represent a group at high risk for breast cancer, particularly if infertility is due to an ovulatory factor. We suggest breast screening from the age of 35 in infertile patients who undergo treatment with fertility drugs in accordance with FONCAM recommendations. This might allow the identification of higher risk patients who need more closely monitored breast examinations.

Early childhood caries underweight or overweight, that is the question

AIM

The purpose of this retrospective case study is to describe the body mass index in a group of children, from 3 to 6 years old with ECC and a similar group of caries-free children.

MATERIALS AND METHODS

This case-control analysis involves two groups of children: the first was of 244 healthy children, 3 to 6 year-old and caries-free; the second was of 586 otherwise healthy children, same age, with Early Childhood Caries divided into three subgroups according the AAPD definition. Demographics, dmft, number teeth with pulpal involvement, BMI percentile, weight at birth, weight and height of both parents were measured during the clinical evaluation. Statistical analyses were performed using standard statistical software (SPSS Version 13). BMI distribution of the subjects with caries was graphically compared with the use of confidence intervals to a similar caries-free sample.

RESULTS

Results are expressed as mean ± SD and frequencies (percentages), depending on the data type. The distribution of BMI percentiles of the ECC group was: underweight = 10%; normal weight = 55.90%; at risk of overweight = 22.22 %; overweight = 11.11%. Significantly, more children in the case group were underweight than in the control group (10% vs. 4.94%).

CONCLUSION

The ECC population does not have a typical weight distribution, and the underweight finding in a significant number of Severe ECC (S-ECC) children may be due to the chewing alteration related to the dental pain due to caries and to missing teeth after hard tissues breakdown.

Minilaparotomic myomectomy for large symptomatic uterine myomas: a prospective study

AIM

The aim of this paper was to evaluate the feasibility, morbidity, and reproductive performance of fertile women undergoing minilaparotomic myomectomy for large uterine myomas.

METHODS

Ninety-nine consecutive women with symptomatic myomas underwent myomectomy through a skin incision ≤8 cm. Operative, postoperative and reproductive data were prospectively collected.

RESULTS

Median (range) age and Body Mass Index (BMI) were 37 years (23-44) and 23 (18-43), respectively. Median (range) myoma diameter was 7 cm (4-20), and the median number of myomas removed was 1 (range 1-31). Myomas were intramural in 76 (76%) cases. Median incision length was 7 cm (range 4-13) and median duration of surgery was 70 min (range 40-180). Operative time and length of skin incision were not correlated with the progressive number of interventions. An incision larger than 8 cm was necessary in 7 (7%) patients and the length of incision was significantly correlated with the diameter of the largest myoma (P<0.01). The feasibility of minilaparotomy was significantly reduced when the diameter of the largest myoma was >12 cm (P<0.05). Operative time was significantly longer in patients having >1 myoma (P<0.05). Three (3%) patients underwent blood transfusion. Median (range) postoperative stay was 2 days (range 2-12). Fever occurred in 8 (8%) patients, and wound complications in 5 (5%).

CONCLUSION

Myomectomy by minilaparotomy is a feasible procedure in more than 90% of unselected patients with large symptomatic myomas. Feasibility is questionable when the myoma is >12 cm. This technique is a mini-invasive option to treat patients with large and multiple myomas.

[Oral health and pregnancy: promotion of oral health during the pre-natal training in the Latina province]

The aim of this study, conducted in the Province of Latina, was to verify knowledge, attitudes, and lifestyles in relation to oral health in a sample of pregnant women, assessing their subjective perception of oral health, and highlight prenatal dental prevention need specialist in the area and provide adequate information on the importance of good oral hygiene in order to achieve a better health level both of the mother and the child. The study was conducted on a sample of pregnant women between the 26th and 39th gestational week, in the period from June to October 2009, during the childbirth training courses in the Province of Latina. Each patient was administered a questionnaire for the assessment of oral habits during pregnancy and for the definition of specific knowledge on and perception of themselves and their own oral condition. The survey shows that more than one third of the sample reported visiting a dentist only in case of pain, over half (56.9%) did not undergo any dental visit during the gestational period, only 24 subjects (33.3%) having applied to a dental hygienist for professional oral hygiene and that only 7 out of 72 women had been prescribed a dental checkup by a gynecologist. The study showed that knowledge about dental problems that may arise during pregnancy is insufficient to guarantee a good threshold to oral health care for the mother hence the need to promote information programs, oral health and pregnancy prevention and training in the territory mainly directed to health-care specialists (gynecologists and obstetricians) and to pregnant women.

[Factors associated with ileal-pouch related fistulas in 100 consecutives patients who underwent restorative proctocolectomy]

OBJECTIVE

The pouch-related fistulas range in literature from 2% to 16% and they can be cause of failure of the intervention of restorative proctocolectomy. Aim of this study was to examine factors associated with theirs development and to identify theirs possible etiology and pathogenesis.

MATERIALS AND METHODS

Retrospective study focusing on 100 consecutive patients who underwent restorative proctocolectomy with pouch-anal anastomosis (IPAA). Patients with fistula and patients without fistula have been identified and the fistula type, the time from surgery and the site relative to IPAA have been recorded. Patients' demographics, co-morbidity or related medical history, clinical indication for treatment, surgical method, histological diagnosis, length of follow-up, early and late postoperative complications have been reviewed, and data collected have been compared among the two groups through univariate analysis.

RESULTS

The overall incidence of fistulas was of 10% (10 cases); 8 cases had pouch-vaginal fistulas, involving the distal tract of the vagina, and associated with pouch-perineal fistulas in 2 cases; 1 case had pouch-vulval fistula; 1 case had a complex pouch-perineal fistula. Three fistulas were precocious, all associated with an IPAA leak; 2 of these cases also had pelvic sepsis while the third had delayed diagnosis of Crohn’s disease. Seven fistulas had a late development. Four fistulas occurred at the level of the IPAA; 5 fistulas were located below the IPAA, and 1 fistula originated above and below the IPAA. When the two groups of patients were compared we found that there was an higher percentage of perineal or anal disease (40.0% vs 2.2%; p <0.001), of extraintestinal manifestations of inflammatory bowel disease (IBD) (40.0% vs 3.3%, p <0.001), and of leak of the IPAA (40.0% vs 11.1%; p <0.05) in the group with fistula vs the group without fistula.

CONCLUSIONS

A direct link with the leak of the IPAA appears in all the early fistulas, while the cryptoglandular infection was suggested as a possible cause of the late fistulas located below the IPAA; the association with the extraintestinal manifestations of IBD could show a correlation between the fistulas and an higher specific activity of the underlying chronic inflammatory disease.

Hippocampal remodelling after MDMA neurotoxicity: a single case study

Acute ingestion of MDMA (ecstasy) causes a transient marked increase in serotonin and dopamine at central synapses. Recent studies demonstrated that MDMA induces damage of serotonergic nerve terminals and alters hippocampal processing. Pronounced cognitive deficits in MDMA users affect learning and memory abilities. This pattern of predominant and long-lasting memory dysfunction suggests that the functioning of the hippocampus might be affected by the neurotoxic effects of MDMA. We present the case of a 16-year-old girl who developed an acute organic and psychotic syndrome caused by occasional use of low to moderate dose of MDMA. Serial neuroimaging ((18)F-FDG-PET and brain MRI) were correlated with her neurocognitive performance and clinical evolution. The structural and metabolic changes correlated with a severe cognitive impairment. After 16 months of intensive neuropsychological rehabilitation she showed significant improvement in hippocampal-related memory cognitive functions, which correlated with normalization of her (18)F-FDG-PET and remarkable hippocampal remodelling. This case report indicates that even non-chronic MDMA use may cause subacute toxic encephalopathy in which the clinical evolution is paralleled by neuroimaging changes in specific cerebral areas. The most relevant aspect is the reversibility of the volumetric changes, which may be the structural correlate of an ongoing hippocampal remodelling.

Effectiveness of plaque indicators and air polishing for the sealing of pits and fissures

AIM

Sealing of pits and fissures is one of the most effective techniques in caries prevention: however incomplete removal of plaque debris, can cause lack of retention of the sealant.

MATERIALS AND METHODS

Sixty first permanent molars were sealed for this study. The teeth were divided into four groups. All teeth were isolated with a dental dam before cleaning and coronal polishing was performed with synthetic bristles or air polishing. Disclosing solution was used to reveal plaque. Three different operators performed cleanings and sealing.

RESULTS

The results show that the plaque indicator was necessary to ensure complete cleansing of pit and fissures. PROPHYflex3 was the easiest and most effective device for removing plaque and debris. Synthetic bristles failed to thoroughly cleanse the surface in most attempts.

CONCLUSION

Results suggest that pits and fissures should be cleaned with a plaque indicator and air polishers before placing a sealing material to ensure complete removal of plaque from the tooth.

Preoperative T and N staging of gastric cancer: magnetic resonance imaging (MRI) versus multi detector computed tomography (MDCT)

BACKGROUND AND AIM

Multi Detector Computed Tomography (MDCT) is widely used in the preoperative staging of gastric cancer. MRI has an emerging role in the evaluation of intestinal diseases, although its role in the staging of gastric cancers is still to be defined. The aim of our study was to compare the diagnostic accuracy of MDCT and Magnetic Resonance Imaging (MRI) in the diagnosis and preoperative staging of gastric cancer, in comparison with histopathology.

MATERIALS AND METHODS

Twenty-five patients with an endoscopic diagnosis of gastric cancer underwent preoperative contrast-enhanced MDCT and MRI, blind to the results of endoscopy. MDCT (64 slices) was performed after oral administration of 800-1000 mL of tap water and scopolamine injection five minutes before the examination. The scan was performed in the axial plane before and after intravenous injection of iodinate contrast medium. Multiplanar reconstruction images were obtained on coronal and sagittal planes. MRI was performed with a 1.5 T Magnet, using the same patient's preparation, by acquiring T2-weighted HASTE sequences, with or without fat saturation (FS), True FISP (True fast imaging with steady state precession) and T1-weighted VIBE (Volumetric interpolated breath-hold examination) sequences, with and without FS, before and after contrast agent (gadolinium) i.v. injection. Gold standards (GS) were surgical and histopathological findings. Two groups of radiologists, blind each other, analyzed MRI images and MDCT findings, and related to GS results.

RESULTS

Detection rate of gastric lesions and T staging for gastric cancer were similar for MRI and MDCT (92%); MRI imaging was superior than MDCT in staging the T parameter (60% versus 48%); the accuracy of MRI imaging and 64-MDCT did not differ significantly in the evaluation of N staging (68% versus 72%).

CONCLUSIONS

Both MRI and MDCT were comparable in staging gastric cancer. MRI was more accurate in evaluation of T stage than MDCT, although both imaging modalities showed low accuracy in detection of early gastric cancer and in differentiation of T2 from T3 stage.

Subclinical vascular alterations in young adults with type 1 diabetes detected by arterial tonometry

BACKGROUND

Diabetes mellitus is characterized by a very high prevalence of atherosclerotic disease. Aims of this study were to determine arterial compliance parameters in type 1 diabetes (T1D) patients as an expression of early pre-clinical endothelial dysfunction and to evaluate the impact of glucose exposure parameters such as the duration of diabetes and glycosylated haemoglobin (HbA(1c)) on the risk of developing alterations in vascular compliance.

METHODS

23 patients with uncomplicated type 1 diabetes (mean age: 32.78 +/- 9.06 years, mean disease duration: 10.78 +/- 7.51 years, mean HbA(1c) levels: 7.7 +/- 1.9) and 26 age- and sex-matched healthy subjects (mean age: 32.3 +/- 8.51 years) were recruited. In these subjects, we evaluated arterial compliance by calibrated tonometry (HDI/Pulsewave() CR-2000). Parameters included the following: large artery elasticity (C1), small artery elasticity (C2), systemic vascular resistance (SVR) and total vascular impedance (TVI).

RESULTS

Patients with longer duration of T1D (>10 years) showed significant alterations in C2 (4.97 +/- 2.7 mL/mmHg x 100) and in SVR (1464.67 +/- 169.16 dina x s x cm(-5)) when compared with both healthy individuals (C2: 8.28 +/- 2.67 mL/mmHg x 100, p = 0.001; SVR: 1180.58 +/- 151.55 dina x s x cm(-5), p = 0.01) and patients with recent-onset disease (<or=10 years) (C2: 10.02 +/- 3.6 mL/mmHg x 100, p < 0.001; SVR: 1124.18 +/- 178.5 dina x s x cm(-5), p < 0.000). Both disease duration and HbA(1c) independently predicted impaired arterial compliance.

CONCLUSIONS

Young adult T1D patients with no signs of disease complication have detectable vessel wall abnormalities, particularly of small arteries, suggestive of hyperglycaemia-related early endothelial dysfunction.

Evaluation of customer satisfaction at the Department of Paediatric Dentistry of "Sapienza" University of Rome

AIM

Healthcare facility management requires the optimisation of the quality of services offered.

METHODS

The Authors adopted a questionnaire as a means to assess customer satisfaction and needs. The Questionnaire has been designed to address adults, i.e., parents or guardians of children attending the Paediatric unit as patients. To estimate their degree of satisfaction, either regarding the environment where children are treated or about the direct interactions between the parents and the structure (waiting room, waiting time, treatment time and time needed to make the payments, costs, etc.), the questionnaire was submitted to a sample of approximately 600 customers, between March and June of 2005.

RESULTS

On one hand results provide a pleasant confirmation on customers' perception of the service, especially regarding the direct relationship between the parties; on the other, they highlight aspects that could be improved (waiting room, optimisation of waiting time), distinguishing between factors that need extra funding to be implemented, and those that, instead, could be simply improved through a better and more efficient organisation of labour and time.

CONCLUSION

The present analysis and previous experiences confirm that appraisal of the degree of customers' satisfaction by means of questionnaires is a valid and necessary instrument for the quality improvement of a healthcare service. Doing so, economic and human resources can be more efficiently allocated.

[Treatment of mild malnutrition and reduction of morbidity in major abdominal surgery: randomized trial on 153 patients]

OBJECTIVES

Severe malnutrition (defined as weight loss more than 10% in a period of six months) is considered an important risk factor in major abdominal surgery, because of a higher post-operative mortality and morbidity. The aim of our study is to assess the role of mild malnutrition (weight loss low than 10% in a period of six months) as a risk factor in major abdominal surgery and to evaluate the efficacy of therapy in order to improve outcomes in terms of in-hospital mortality, length of hospital stay and post-operative complications. Moreover, we evaluated serum albuminemia and lymphocyte count, important nutritional index, as predictive risk factors.

MATERIALS AND METHODS

We performed a randomized prospective trial, and admitted in our institution 153 adult patients, 43 with mild malnutrition and 110 without. The malnourished patients were randomized in two groups: the first one received oral immunonutrition (Impact Oral) for 7-10 days before surgery (22 pz), the second one received no nutritional support.

RESULTS

We observed a higher number of complications in the non-treated malnourished patients (57%) versus both the treated malnourished patients (13.6%) and the normal group (19%) (p<0.001). Increased morbidity was observed in patients with serum albuminemia <2.8 gr/dl (69.2%) and with lymphocyte count <1.500 mm3 (57%).

CONCLUSIONS

Nutritional enriched support demonstrated his efficacy in reducing morbidity, and length of hospital stay. Pre-operative oral immunonutrition might be suggested and established in all the patients with mild malnutrition that will be operated on major abdominal surgery.

Hereditary breast/ovarian cancer families: The impact of mutation prediction models on BRCA1/2 mutation screening costs

20027

Background: The considerably high costs of BRCA1/2 mutation screening together with the expanding request for inherited breast/ovarian cancer genetic counselling and testing, dictates the need for more accurate selection of the appropriate candidates for analysis. The aim of the present study was to evaluate, the impact that careful selection of appropriate candidates by means of BRCAPRO, Myriad tables and IC software prediction models might exert on reduction of societal costs. Methods: 86 unrelated high risk breast/ovarian cancer families were selected for mutation screening; BRCA1/2 entire coding sequences and each intron/exon boundary were screened by direct sequencing (PTT limited to BRCA1 exon 11). The a priori probability of carrying a pathologic BRCA1/2 germline mutation was calculated by either BRCAPRO or IC software (country-customized versions of BRCAPRO), or by the Myriad prevalence mutation tables (2004). We classified our index cases as “carrier-positive” when their carrier probability exceeds 10%. According to recent literature, our analysis assumed a cost of $1,713 for genes sequencing of each proband. Results: We observed 19 pathogenic germline mutations with an overall detection rate of 22.1%. IC software and Myriad tables were more efficient in predicting mutated cases, showing higher sensitivity (95% and 84%, respectively) and a better negative predictive value (NPV, 96% and 91%, respectively) compared to BRCAPRO (sensitivity 74% and NPV 87%). Particularly, the IC software misclassified a pathogenic mutation carrier in only one case. The costs afforded for genetic testing on the whole sample was $147,318. The family selection assisted by the IC software, BRCAPRO, Myriad tables could result in a total cost of $104,493, $78,798 and $90,789, respectively. Even maintaining high accuracy in carrier status prediction, the country-customized version of BRCAPRO imparted more than 30% cost reduction. Conclusions: Considering a balance between economical advantages and the different performances in mutated status prediction, our analysis suggest that the country-customized versions of BRCAPRO and Myriad Tables allow efficient selection of candidates for BRCA1/2 mutation analysis and a significant impact on societal costs.

No significant financial relationships to disclose.

Black stains in the mixed dentition: a PCR microbiological study of the etiopathogenic bacteria

The aim of this work is to emphasize that particular stains on the third cervical of the buccal and lingual surfaces in mixed dentition, called "black stain." Previous research showed the microbiological etiology of this discoloration by chromogen bacterias. Our study shows bacteria spp involved in stains by means of PCR process and electrophoresis gel on the agarose medium. Sample was formed by 100 subject with black stain and 100 control subjects stain-free. A statistical analysis (SPSS 10.0) using X2 was performed in this study. Porphyromonas gingivalis and Prevotella melaninogenica, were not involved in both in black stain subjects and in the control. On the contrary, Actinomyces could be involved in the pigmentation process.

BRCA1 and BRCA2 genetic testing in Italian breast and/or ovarian cancer families: mutation spectrum and prevalence and analysis of mutation prediction models

BACKGROUND

Breast cancer is an extremely complex disease, characterized by a progressive multistep process caused by interactions of both genetic and non-genetic factors. A combination of BRCA1 and BRCA2 gene mutations appears responsible for about 20%-30% of the cases with breast cancer familial history. The prevalence of BRCA1/2 pathogenic mutations largely varies within different populations; in particular, the rate of mutations in Italian breast and/or ovarian cancer families is rather controversial and ranges from 8% to 37%.

PATIENTS AND METHODS

Of the 152 breast/ovarian cancer families counseled in our centre, 99 were selected for BRCA1/2 mutation screening according to our minimal criteria. The entire coding sequences and each intron/exon boundary of BRCA1/2 genes were screened by direct sequencing (PTT limited to BRCA1 exon 11). For each proband, the a priori probability of carrying a pathogenic BRCA1/2 germline mutation was calculated by means of different mutation prediction models (BRCApro, IC and Myriad Table) in order to evaluate their performances.

RESULTS

Our analysis resulted in the identification of 25 and 52 variants in the BRCA1 and BRCA2 genes, respectively. Seventeen of them represent novel variants, including four deleterious truncating mutations in the BRCA2 gene (472insA, E33X, C1630X and IVS6+1G>C). Twenty-seven of the 99 probands harbored BRCA1 (n = 15) and BRCA2 (n = 12) pathogenic germline mutations, indicating an overall detection rate of 27.3% and increasing by more than 15% the spectrum of mutations in the Italian population. Furthermore, we found the lowest detection rate (19.4%) in pure hereditary breast cancer family subset. All of the prediction models showed praises and faults, with the IC software being extremely sensitive but poorly specific, compared to BRCApro. In particular all models accumulated most false-negative prediction in the HBC subset. Interestingly preliminary results of a study addressing the presence of genomic rearrangements in HBC probands with BRCApro or IC prediction scores >/=95%, provided evidence for additional mutations undetectable with our conventional screening for point mutations.

CONCLUSIONS

Altogether our results suggest that HBC families, the largest pool in our series, represent an heterogeneous group where the apparently faulty performances of the prediction models might be at least partially explained by the presence of additional kinds of BRCA1/2 alteration (such as genomic rearrangements) or by mutations on different breast cancer related genes.

Local pressure protocol, including Meniett, in the treatment of Ménière's disease: short-term results during the active stage

Treatment of Ménière's disease (MD) is still controversial and pressure changes transmitted to the inner ear have been reported to have effects similar to those of other non-surgical therapies. This paper reports on a clinical trial of MD patients which has been carried out using a portable piece of equipment, called Meniett, which delivers a pulsed, controlled, positive pressure to the middle ear, provided that a ventilation tube (VT) has previously been inserted. A comparison was made of the number of vertigo spells during the 2 months before treatment and during the 40-day treatment period. In addition, within this latter period a comparison was made between use of VT and use of VT + Meniett. Use of VT only had a positive effect in 90% of patients, with either absence (n = 10: 50%) or marked reduction (n = 8; 40%) in episodes of vertigo. When Meniett was also applied, stabilization of the positive effect on vertigo was registered, with a concomitant improvement in hearing threshold in 2 patients (10%). Although a longer and more reliable long-term follow-up of this treatment is needed, it is possible to propose the use of this therapeutic approach as it has been proven to induce a dramatic improvement in the symptoms affecting patients with Ménière's disease during reactivation of the disease.

[Use of mechanical staplers in the surgical treatment of rectal cancer in the elderly]

The aim of this study was to analyze the changes in surgical treatment of rectal cancer and in postsurgical complications as a result of the introduction of staplers in surgical practice, with particular reference to elderly patients (> or = 75 years). Since 1976, 320 patients have undergone rectal surgery in our department (207 colo-rectal or colo-anal anastomoses and 113 Miles operations have been performed). The patients were subdivided into two groups on the basis of age (> or = and < 75 years) and then further divided into subgroups operated on before and after 1983 (the year staplers were introduced). The morbidity rate (fistulas) was 16% in patients < 75 years old and 12% in elderly patients (P = n.s.); the mortality rate was 1% in patients < 75 years old and 12% in the more elderly group (P < 0.001). The utilization of staplers in surgical treatment of rectal cancer allows the surgeon to perform sphincter-sparing resections even in elderly patients without any changes in specific morbidity. Nevertheless, the complications are more severe in the elderly, with a higher mortality rate.