Anatomy in dentistry: From the beginnings to contemporary reality.

The history of dentistry and medicine has a deep and ancient bond with the history of anatomy. From the ancient times to the present, the study of the human body represents the basis for research and clinical therapy. The historical contribution of anatomists to the development of dental medicine also helped in its characterization as an integrated but special and independent branch of medicine. From Galen's studies on animals to the discoveries of dental hard tissues characteristics using a microscope, this paper provides a brief literature review of how anatomy broadly contributed to the development of the dental sciences and how it still allows us to direct critical and fundamental anatomical-clinical paths for modern patient care. The history of the anatomy of teeth, description of skull bones, maxillary sinus characterization, the salivary glands, the tongue and labial musculature, and the microscopic anatomy of dental hard tissues will be examined. Historical research on the understanding of and progress in the oral field is of utmost importance in current clinical practice, thus inducing a future orientation in research. Most of the research especially that connected to the more distant historical periods has seen as main characters great personalities of morphological sciences, which contributes constituted fundamental basis for dental clinical aspects. Through a punctual and continuous historical assay, the ancient insights are reconnected to more recent knowledge and distinct research, thus permitting a detailed reconstruction of the historical-anatomical course in the progress of knowledge regarding the oral cavity and related anatomical structures.

[Working modes and evaluation of perceived stress during the Covid-19 pandemic]. / Modalità di lavoro e valutazione dello stress percepito durante la pandemia di Covid-19.

SUMMARY: Introduction. The global sanitary crisis due to covid 19 has had an unprecedent impact on human health and on the global economy creating unexpected challenges on work life. In Italy in order to limit the velocity of virus transmission, measures aimed towards social distancing were adopted by suspending all non essential working activities, with the recommendation of the maximum use of smart working (DPCM 01 MARCH 2020). Literature regarding precedent experiences worldwide on the impact of epidemic or pandemic flu viruses on the working enviroment report of a strong presence of correlated work stress. Objectives. The study is focalized in identifying the individual stress level correlated to work percieved in workers in the context of the unexpected scenario in adapting to work in a short time period relative to the emergency context. Materials and Methods. An epidemiological observational survey was conducted on the web during the months of May and June. The workers were invited in answering a questionnaire using a dedicated link. The questionnaire consisted in a introductive scheme(card) built ad hoc for the study containing information for the socio-demographic variables and work experience. The Evaluation Rapid Stress scale (VRS) was used for the rating of the subjective stress. The t Student test was used for the independant samples in the assay for the average scores of the VRS for sex and age. The ANOVA test was used in order to compare the various scores of the VRS in the three different working modes investigated (work on site, smart working or for both the modalities). A p0.05 was considered as level of significance. The statistical assay was conducted with the STATA software packet. Results. 337 workers answered the questionnaire. The rating of the VRS scores for sex highlighted significative differences between men and women in the levels of anxiety, depression, somatization and aggression showing higher values in women. The highest total scores of the VRS questionnaire and those related to the anxiety and somatization dimensions express higher levels of stress levels in response to the emergency situation in workers who carry out their activity in a on-site mode over the age of 40 and in parents. The comparison with the scores reported between the different working modes was resulted statistically significant. Conclusions. The results of our investigation are an expression of the perception of a widespread danger, linked to the threat of contracting the COVID-19 virus, whose mode and speed of transmission is surprising and for which therapy and in definitive treatment is not yet available. This leads to a series of emotional reactions in which stress is the main condition. The timely exploration aimed at the individuation of a stress problem in the working environment is extremely important especially in emergency situations in order to implement appropriate strategies of prevention.

Analysis of Risk Factors Independently Associated with Cognitive Impairment in Patients with Permanent Atrial Fibrillation: A Cross-sectional Observational Study.

BACKGROUND AND OBJECTIVE: Atrial Fibrillation (AF) is associated with an increased risk of stroke and development of cognitive impairment. Our cross-sectional study aims to identify risk factors for cognitive impairment in patients with permanent AF. MATERIALS AND METHODS: 212 consecutive outpatients with history of permanent AF lasting more than 1 year were enrolled and the Short Portable Mental Status Questionnaire (SPMSQ) was used to assess cognitive impairment (number of errors ≥5). The type of antithrombotic therapy, the time in therapeutic range (TTR) in case of treatment with warfarin and the degree of heart rate (HR) control (upon Holter ECG monitoring) were also assessed. RESULTS: ROC curve analysis indicated that TTR was associated with cognitive impairment (AUC 0.85 ± 0.03; 95% CI 0.77-0.88; p < 0.0001). Multivariate logistic regression analysis showed an independent association of previous cerebrovascular or cardiovascular events (OR 7.24, 95% CI 1.37-38.25; p = 0.020), aspirin therapy instead of anticoagulant therapy (OR 24.74, 95% CI 1.27-482.12; p = 0.034), warfarin use with TTR ≤60% (OR 21.71 , 95%CI 4.35-108; p < 0.001) and an average daily HR either <60 bpm or >100 bpm (OR 6.04, 95% 1.09-33.29; p = 0.039) with cognitive impairment. CONCLUSION: Among patients with permanent AF, cognitive impairment is more frequent in those with inadequate antithrombotic therapy (aspirin therapy instead of anticoagulant therapy) and with suboptimal oral anticoagulation (TTR ≤60%) or heart rate control. Efforts should be made to optimize therapies related to these parameters.

[Health status and access to health services by the population of L'Aquila (Abruzzo Region, Italy) six years after the earthquake]. / Stato di salute e accesso alle prestazioni sanitarie nella popolazione terremotata del comune di L'Aquila. Un bilancio a sei anni dal sisma.

Natural disasters, such as the earthquake that occurred in the province of L'Aquila in central Italy, in 2009, generally increase the demand for healthcare. A survey was conducted to assess perception of health status an d use of health services in a sample of L'Aquila's resident population, five years after the event, and in a comparison population consisting of a sample of the resident population of Avezzano, a town in the same region, not affected by the earthquake. No differences were found in perception of health status between the two populations. Both groups reported difficulties in accessing specialized healthcare and rehabilitation services.

[Accident prevention in agriculture in the ASL1 Abruzzo Local Health Service: protection facilities for tractors]. / Prevenzione degli infortune in agricoltura nella ASL1 Abruzzo: strutture di protezione nei trattori agricoli.

BACKGROUND: The ASL1 workplace prevention and safety service in Abruzzo has been conducting workplace inspections on agricultural and livestock farms in the province of L'Aquila since 2011, mainly in the areas of Avezzano, Sulmona and L'Aquila. The agricultural sector in Abruzzo is characterized by high rates of accidents and the ratio of fatal injuries/total injuries is higher than the industry and services sector. OBJECTIVES: To evaluate the presence or absence of safety devices , i.e. compliance or otherwise with regulations for tractors, and of any variable factor that could be associated with the safety of the vehicle. METHODS: Between 2011 and 2013, 98 farms in the province of L'Aquila were inspected. The data resulting from the inspections was collected by the use of a checklist. An univariate logistic regression analysis was conducted in which the vehicles that complied with regulations were considered as the dependant variable, and the age of the tractor owner, the acres of worked land and the type of farm were considered as explanatory variables. Statistical elaboration was carried out using the Stata 12 programme. RESULTS: Out of a total of 298 tractors that were checked, 64.8% did not comply with regulations due to absence or unsuitability of one or more safety devices such as: a protective device in case of overturning; retention system of the driver; mounting and dismounting from the vehicle; protection of moving parts and hot parts; PTO (Power Take Off) protection device. A significant association between non-compliance of vehicles and the age of the owner and acres worked was observed, whereas no statistical significance was observed for the association with the farm type variable. CONCLUSION: Our study showed that farms where the owner's age is between 50 and 64 years and where more acres of land are worked are those where the agricultural or forestry tractors had lower levels of compliance with regulations.

SARS-CoV2 Infection and Comorbidity in Inmates: A Study of Central Italy.

BACKGROUND AND OBJECTIVE: The presence of multiple chronic diseases is associated with an increase in mortality when related to COVID-19 infection. THE AIMS OF OUR STUDY WERE: (i) to evaluate the association between the severity of the COVID-19 disease, defined as symptomatic hospitalized in prison or symptomatic hospitalized out of prison, and the presence of one or more comorbidities in two prisons in central Italy: L'Aquila and Sulmona; (ii) to describe the profiles of inmates using multiple correspondence analysis (MCA). METHODS: A database was created including age, gender and clinical variables. The database containing anonymized data was password-protected. The Kruskal-Wallis test was used to evaluate a possible association between diseases and the severity of COVID-19 stratified by age groups. We used MCA to describe a possible characteristic profile of inmates. RESULTS: Our results show that in the 25-50-year-old age group (COVID-19-negative) in the L'Aquila prison, 19/62 (30.65%) were without comorbidity, 17/62 (27.42%) had 1-2 comorbidities and only 3.23% had >2 diseases. It is interesting to note that in the elderly group, the frequency of 1-2 or >2 pathologies was higher than in the younger group, and only 3/51 (5.88%) inmates did not have comorbidities and were COVID-19 negative (p = 0.008). The MCA identified the following profiles: the prison of L'Aquila showed a group of women over 60 with diabetes, cardiovascular and orthopedic problems, and hospitalized for COVID-19; the Sulmona prison presented a group of males over 60 with diabetes, cardiovascular, respiratory, urological, gastrointestinal and orthopedic problems, and hospitalized or symptomatic due to COVID-19. CONCLUSIONS: our study has demonstrated and confirmed that advanced age and the presence of concomitant pathologies have played a significant role in the severity of the disease: symptomatic hospitalized in the prison; symptomatic hospitalized out of the prison.

The Burden of Modifiable Cardiovascular Risk Factors in a Population of Central Italy: A Pilot Study.

BACKGROUND: By the mid-20th century, cardiovascular disease (CVD) had become an important cause of mortality and morbidity in developed countries. The aim was to set up a pilot study to screen citizens aged 45-59 in order to identify modifiable risk factors (RFs). METHODS: Our study was conducted from February 2019 to February 2020 on citizens of a population of central Italy, aged 45-59, contacted by letter. The variables evaluated were lipid profile, glycemia, anthropometric parameters, lifestyle and utility of screening. RESULTS: It is important to underline that from the comparison with Italian national data, our results showed that blood pressure and lipid profile had better values. On the contrary, there were some alarm bells: a high percentage (57%) of smokers (63.9 in men and 37.1 in women), a sedentary lifestyle (24.5%), and a significantly higher waist circumference than the reference cut-offs for both men and women. The organization of the screening was considered excellent by 56.3% of women and 48.4% of men, and good by 37.5% of women and 46.5% of men. CONCLUSIONS: Our study provides a picture to stakeholders of the state of the health of citizens in the area under study, in the immediate pre-pandemic period; however, it is important to underline that their state of health may be modified after the pandemic period. Furthermore, cardiovascular (CV) screening was perceived by the citizens to be important for health care.

Impact of the COVID-19 Lockdown on Patients with Chronic Tinnitus-Preliminary Results.

The COVID-19 pandemic and the lockdown measures are both causes of psychological distress. The aim of the current study was to evaluate the psychological effects of lockdown measures on patients with subjective chronic tinnitus diagnosed before the COVID-19 pandemic. A sample of n = 77 patients with chronic tinnitus was contacted by mail/phone for a survey between June 2021 and September 2021. All patients filled out questionnaires on tinnitus distress (Tinnitus Handicap Inventory, THI), anxiety (Beck Anxiety Inventory, BAI) and depression (Beck Depression Inventory, BDI) and eight items of the Tinnitus Sample Case History (TSCH) about tinnitus history (i.e., loudness, pitch, perception, tinnitus location), stress, and related conditions (noise annoyance, vertigo/dizziness, headache). Forty patients with chronic tinnitus filled out the survey. No significant differences of total THI mean scores (p > 0.05) were found compared to the results obtained before the COVID-19 pandemic and after lockdown. Regarding depression and anxiety, the female population showed a significant increase in scores obtained from the BDI (p < 0.0170) and the BAI (p < 0.049). Only two patients (0.5%) were infected by COVID-19 (positive RT-PCR), and they did not report any worsening of tinnitus. According to the data of the literature, our patients experienced a heterogeneous course of tinnitus, and the severity of tinnitus was not significantly affected by lifestyle changes during the COVID-19 pandemic and lockdown.

Burden of COVID-19 and Vaccination Coverage in the Italian Population as of October 2021.

Following the pandemic scenario, researchers from all over the world, including Italians, have undertaken fervent research activity using the epidemiological data available on the sites of government and national and international research institutes. The objectives of our study were: (1) to analyze the load and trend of the COVID-19 pandemic in Italy, from the beginning to October 2021; (2) to analyze vaccination coverage by age groups and types of vaccines administered and check how the vaccination campaign has influenced the course of the disease and deaths; (3) to evaluate the Italian situation in the European context, comparing the incidence and mortality of Italy with respect to European countries; (4) finally, to evaluate how much vaccination coverage may have had an effect on mortality in the various European countries. Databases were structured to archive Italian and European COVID-19 data provided by Our World in Data, and data came from the Ministry of Health, to evaluate percentage of vaccines administered. The monthly trend of the cumulative incidence per 100,000 inhabitants in the period January 2020-October 2021 was evaluated. It is important to underline 3 peaks of incidence and mortality rates that occurred during the three waves of COVID-19: March-April-May 2020, October-November-December 2020, and March-April-May 2021. There is a slight increase in incidence in August 2021 and in mortality in September 2021. The three mortality rate peaks, related to the three waves of COVID-19, are always higher in Italy than in Europe, particularly in April 2020, December 2020, and March 2021. From May 2021 to October 2021, the mortality trend reversed, and it turned out to be higher in Europe than in Italy. Regarding vaccination, Italy currently has an important coverage, not only in the most fragile population, where it exceeds 90%, but also in the 12-19 age group, with percentages above 65%. The Pfizer/BioNTech vaccine was used widely in all age groups (first and second dose), with highest administration in 12-19 age groups and 80+, while the lowest was recorded in the 70-79 age group. In conclusion, these data confirm the importance of vaccination in the management of the COVID-19 pandemic.

Evaluation of Lower Dental Arch Crowding and Dimension after Treatment with Lip Bumper versus Schwarz Appliance. A Prospective Pilot Study.

Aim: The treatment of patients with mixed dentition, with inferior moderate dental crowding (the so-called borderline cases, between extraction and expansion) is not yet clear. Two examples of widely used appliances for increasing lower dental arch dimensions are the Schwarz's appliance and lip bumper. The aim of this prospective study was to compare dental crowding and arch dimensions from pre- to post-treatment with lip bumper versus Schwarz's appliance. Subjects and Methods: Pre- and post-treatment orthodontic records of twenty subjects (10 males and 10 females) were analyzed in the present study. Inclusion criteria were: first/second molar class malocclusion; crowding of the mandibular arch, from mild to moderate (4-6 mm); mixed dentition; age ≤ 9 years at the beginning of the treatment; stage CS1 or CS2 of maturation of the cervical vertebrae analysis (CVM) at the beginning of the treatment. Ten subjects were treated with a lip bumper, and ten with the removable Schwarz appliance. The primary outcomes were the variations in dental crowding and arch dimensions from pre- to post-treatment. Results: Both the two appliances caused a statistically significant mean improvement/reduction in crowding, of 3.5 mm and 2.9 mm, for the Schwarz appliance and lip bumper, respectively. The Schwarz appliance resulted more effective in increasing arch dimension at the intercanine level, and arch perimeter, while the lip bumper achieves a higher increase in arch length. Conclusions: A lip bumper and Schwarz appliance are both useful in reducing crowding in mixed dentition. This improvement is due to the increase in dental arch dimensions, although the distribution of space resulted slightly differently between the two appliances.

Analysis of the audiological characteristics and comorbidity in patients with chronic tinnitus.

Tinnitus is defined as perception of a sound without sound stimulation. This study aims to investigate the correlation between chronic tinnitus and the most significant clinical comorbidities and pharmacological treatments. We recruited 130 consecutive outpatients with a tinnitus for least from three months and 100 subjects without tinnitus. All patients had a full medical and audiological evaluation and all filled in Tinnitus Handicap Inventory questionnaire and Khalfa's Hyperacusis questionnaire. We also analyzed the qualitative variables: audiometry exam, tinnitus characteristics and psychometric questionnaires. Univariate logistic regression was performed to evaluate the associations between the presence of tinnitus and the presence of comorbidities and drug intake. The statistical analysis provided the following results in the group of patients with tinnitus. We obtained an Odds Ratio statistically significant for the following categories taken into consideration: the presence of anxiety and depression, neurological diseases, headache, temporomandibular joint (TMJ) disorders, intake of levothyroxine and proton-pump inhibitor. In this study, we tried to evaluate the audiological characteristics in the subjects affected by chronic tinnitus in order to find a possible correlation with the comorbidities and any drugs intake. We found a statistically significant correlation between tinnitus and comorbidities like anxiety, depression, TMJ disorders, dysthyroidism, headache and levothyroxine and PPI intake.

[Prevalence of asthma, respiratory symptoms and allergic disorders among adolescents in the province of Aquila]. / Diffusione di asma, sintomi respiratori e patologie allergiche negli adolescenti della provincia dell'Aquila.

OBJECTIVE: Estimates the prevalence of asthma and other allergic disorders in a random group of adolescents living in the L'Aquila area, which was not covered by SIDRIA (Italian Studies on Respiratory Disorders in Children and the Environment). The second phase of the study showed considerable regional variations within Italy, with a higher prevalence of asthma and wheezing in Central Italy. DESIGN: This study used the same standardised questionnaire of SIDRIA and included 1100 adolescents aged 13-14 years, between January-March 2004. RESULTS: Prevalence of lifetime asthma was 6.7%, cumulative and current prevalence of wheezing were 19.1% and 9.0% respectively. A relatively high proportion of adolescents, 29.2%, reported night cough and 3.6% symptoms of severe asthma. Lifetime prevalence of hay fever and eczema were respectively 17.8% and 6.7%. Prevalence rates of allergic rhinitis and atopic-eczema symptoms were higher in females. The risk of asthma was associated to exposure to: pollen, to house dust mite and to paternal smoking, whereas current smoking in the adolescents was significantly associated to wheezing during the previous 12 months. CONCLUSION: Although asthma prevalence is relatively low in L'Aquila area, it represents an important public health problem that requires further researches into genetics, environmental and medical care factors.

Temporal trends in hospitalization for rotavirus gastroenteritis: A nationwide study in Italy, 2005-2012.

AGE severity is linked to etiology, and Rotavirus (RV) accounts for most of severe cases. In 2009 the World Health Organization recommended RV vaccination for all children. Worldwide a number of Countries implemented RV vaccination in their pediatric immunisation programmes, but only a limited number in Europe. This study was designed to estimate the proportion of RVGE among children aged <6 y who were diagnosed with AGE and admitted to hospitals in Italy during the years 2005-2012. A total of 334,982 hospital discharge forms were collected, being 79,344 hospitalizations associated with RV. The average hospitalization rate (HR) was 146/100,000 children for RVGE in primary diagnosis (PD) and 150/100,000 children for RVGE in secondary diagnosis (SD). Since 2008 the RVGE hospitalization figures and rates (HRs) in SD exceed those in PD. The majority of RVGE hospitalizations (33.67%) were reported among children aged ≤ 2 years. Despite some limitations due to the hospital discharge database (HDD) synthetic contents and low potential for clinical interpretation, the analysis of national HDD, including PD and SD, documents that RV still represents a consistent cause of pediatric hospitalizations in Italy.

Steroid-Eluting Ethmoidal Stent Versus Antero-Posterior Ethmoidectomy: Comparison Of Efficacy And Safety In Allergic Patients.

BACKGROUND: Allergic and chronic rhinosinusitis is a disabling pathological condition with an 8% prevalence in the European population and 5% in the Italian one. The ethmoidal sinus is the first one involved in the inflammation. The typical surgical procedure to manage ethmoidal sinusitis is an endoscopic antero-posterior ethmoidectomy. Recently introduced on the European market balloon called Relieva Stratus MicroFlow Spacer can be inserted within the ethmoid, with a local slow release of a steroid drug. This study had the aim to evaluate the efficacy and safety of the steroid-eluting ethmoidal stent in the management of allergic chronic rhinosinusitis in comparison with the traditional endoscopic ethmoidectomy. Methodos: 70 allergic patients who presented chronic rhinosinusitis were randomly divided into 2 groups and receive respectively the steroid-eluting ethmoidal stent or endoscopic ethmoidectomy. RESULTS: The most significant observation coming from the comparative analysis of the results is the substantial equivalence of the treatment with the steroid-eluting ethmoidal stent (SEES) compared with endoscopic ethmoidectomy in the management of ethmoid chronic rhinosinusitis with the exception of a reduction of overall discomfort and nasal secretion and better functional results at rhinomanometry in the steroid-eluting ethmoidal stent group. CONCLUSION: in our experience, the SEES was efficacious in the treatment of allergic patients with ethmoidal CRS when conventional medical treatment had failed, or when wishing to avoid the classic endoscopic ethmoidectomy (EE). However, further long-term studies will be performed in order to confirm the safety and stability, over time, of the results obtained.

Association between vasomotor rhinitis and irritable bowel syndrome.

BACKGROUND: Vasomotor rhinitis (VMR) and irritable bowel syndrome (IBS) are two of the most widespread pathologies in industrialized countries, and they have a substantial impact on health-related quality of life. OBJECTIVE: To investigate the relationship between VMR and IBS to provide evidence to classify VMR and IBS as a sole disorder. METHODS: The study included 150 patients from San Salvatore Hospital, L'Aquila: 50 with VMR, 50 with IBS, and 50 healthy volunteers. RESULTS: With regard to a probable link between VMR and IBS, 62 patients of the whole population, 150 patients (41.3%) were affected by both VMR and IBS, 33 subjects (22%) were not affected by VMR or IBS, 25 patients (16.67%) only had VMR, and 30 patients (20%) only had IBS. When considering the 87 subjects affected by VMR, 62 of them also had IBS (71.26%). In turn, when considering all 92 subjects with IBS, 62 (67.39%) had VMR. We found a significant association among IBS and nasal obstruction, rhinorrhea, and turbinates, and among VMR and a change in stool consistency and abdominal pain. Among the patients affected by nonallergic rhinitis (NAR), we found a prevalence of NAR with eosinophils (31%) compared with the other cytologic types. CONCLUSION: This study expanded the knowledge of the link between VMR and IBS, also the correlation between typical VMR symptoms and IBS, and about the correlation between typical IBS symptoms and VMR. For future implications, the diagnosis of NAR indicated the need to check for the presence of IBS, by using the Rome III criteria, and a diagnosis of IBS indicated the need to check for the presence of VMR. More studies are needed to find the pathogenetic mechanisms to explain the clinical correlation between VMR and IBS as seen in the present study.