Vitamin D deficiency in refugees in Italy.

The objective of the research is to determine 25[OH]D serum levels in refugees in Italy. In the following research we have taken into consideration the results of the monitoring of Vitamin D levels in 46 refugees of the Italian Service for protection of refugees and asylum seekers (SPRAR) system. The indicator of overall vitamin D status used was the circulating serum level of 25(OH)D. Data was analyzed using Microsoft Excel. In the refugees tested, the mean level of 25(OH)D resulted 9.18 ng/mL. The standard deviation was 4.8, with a minimal level of 4.3 and a maximum of 27.4. This figure indicates a clear condition of hypovitaminosis in refugees. While it is general assumption that migratory phenomena may induce the spread of tropical or infectious diseases, widely attested literature demonstrates how chronic pathologies and diseases related to altered lifestyles are the most relevant for Italian case records. Indeed, among the aforementioned diseases, Vitamin D deficiency so far lacks acknowledgement at a national level. Considering the results of lower-than-desirable vitamin D levels found in refugees in Italy, it is necessary to take this parameter into consideration when analyzing individuals who have faced migratory phenomena in order to mitigate the effects of hypovitaminosis D.

[Muscle activation patterns and gait biomechanics in patients with ankylosing spondylitis]. / Pattern di attivazione muscolare e biomeccanica del passo in pazienti con spondilite anchilosante.

UNLABELLED: Patients with ankylosing spondylitis (AS) may experience a progressive spinal kyphosis, which induces a forward and downward displacement of the centre of mass (COM) of the trunk with consequent use of mechanisms to compensate for the displacement of the trunk. The analysis of patterns of movement gives an important opportunity for follow-up of patients and is an useful tool to plan a therapeutic and rehabilitative program. OBJECTIVE: The aim of our study was to contribute to the description of abnormalities of gait biomechanics in patients with AS and to individualize, if existing, a typical pattern of these patients. METHODS: Five patients with AS (3 men, 2 women) were evaluated by gait analysis. Each patient was assessed with dynamic electromyography, with survey of phases of gait cycle and 3D video-analysis of gait related to data of platform (Digivec) which allows to display real time the force vector of reaction foot-ground overlapping the screen image of patient. RESULTS: The dynamometric platform located the following problems: increasing of the medium-lateral component of the reaction force on the ground in the mild and terminal stance. The anterior-posterior reaction force is diminished in both the initial and the terminal component. The timing of activation of the tibialis anterior results prolonged while the timing of activation of the gastrocnemius medialis results delayed. CONCLUSION: The patients with AS prefer therefore an eccentric contraction of the tibial anterior in comparison to a concentric contraction of the gastrocnemius medialis, "opting" for a gait strategy that confers greater stability but limited power.

[Comparation of levels of anxiety and depression in patients with autoimmune and chronic-degenerative rheumatic: preliminary data]. / Comparazione dei livelli di ansia e depressione in soggetti affetti da patologie reumatiche su base autoimmune e cronico-degenerative: dati preliminari.

UNLABELLED: Scientific research on rheumatic diseases was often focused on the link between psychological features and disease. Depression and anxiety are frequently observed with an higher incidence among rheumatic patients in comparison to general population. In autoimmune diseases, such as rheumatoid arthritis, an important role for psychiatric symptoms could be played by the alteration of cytokines levels. In the chronic-degenerative diseases, psychological factors such as stress and depression, can be involved in perception of pain. OBJECTIVE: We aimed at evaluating in a sample of 50 patients (25 with rheumatoid arthritis and 25 with osteoarthritis) levels of pain, anxiety and depression. METHODS: We evaluated two group of patients with rheumatic disease, group A (25 with Rheumatoid Arthritis, mean age = 45.1; DS =15.24) and group B (25 with osteoarthritis, mean age = 54.3; DS =14.74) by clinic examination and with the following tests, SF-MPQ, HAQ, HAM-A, HAM-D. RESULTS: We found in group A higher levels of depression and anxiety but lower levels of pain, which was more expressed in group B. CONCLUSION: Depression and anxiety were observed with an higher prevalence in patients with autoimmune disease, whereas pain was stronger in patients with osteoarthritis, a degenerative disease. We could explain this phenomenon considering the aetiopathology of the two conditions. As regard to autoimmune disorders, these symptoms may reflect the direct effect of cytokines on the central nervous system. As far as it concerns chronic-degenerative diseases, anxiety and depression are usually considered "reactive" to pain, not "constitutive".

Rheumatic symptoms in patients with human immunodeficiency virus are related to levels of tumor necrosis factor-alpha but not to viral load.

Infection with human immunodeficiency virus (HIV) can lead to osteoarticular involvement, usually in the late stages. The pathogenesis of these symptoms has usually been attributed to viral load or to dysregulated cytokine production. We evaluated the presence of rheumatic symptoms and levels of tumor necrosis factor (TNF)-alpha viral load and CD4 count in 46 patients with HIV from southern Italy. The prevalence of rheumatic symptoms was 23.9%; CD4 count and viral load presented no statistically significant differences between patients with rheumatic symptoms and patients without osteoarticular involvement, whereas TNF-alpha levels were increased in HIV patients with arthralgias compared with those in patients without arthralgias (p = 0.02). Evidence that TNF-alpha is increased in patients with osteoarticular or soft tissue involvement is a clear index of the pivotal role this cytokine plays in the pathogenesis of these manifestations.

Ultrasonography in the early diagnosis of psoriasis-associated enthesopathy.

The aim of the present study was to detect entheseal abnormalities by means of ultrasonography (US) in patients with psoriasis. We evaluated 24 patients with psoriasis who underwent clinical and ultrasonographic examination of both lower limbs at the calcaneal insertions of the Achilles tendons and at the flexor and extensor tendons of all fingers of the hand. Fourteen patients with psoriatic arthritis were used as controls. US was performed using a real-time scanner (ATL SDI 3000) with a 5-12 MHz linear array transducer. Longitudinal and transverse scans of the talocrural joints, Achilles tendons and both the flexor and extensor tendons of the fingers of both hands were obtained at rest and during active and passive movements. On clinical examination no entheseal site was abnormal, but on US examination 33% of patients showed abnormalities. In particular, six psoriasis patients (25%) who were asymptomatic showed effusion around the extensor tendon of the first digit of the left hand and around the extensor tendon of the third and fourth digits of both hands; two patients (8.3%) showed a hypoechoic nodular formation of the flexor tendon sheath of the left hand. We conclude that entheseal abnormalities not detected at clinical examination were present in 33% of patients with psoriasis who underwent US examination. Therefore, we suggest the routine use of ultrasonography in the early diagnosis and in treatment and follow-up of patients with tendon enthesopathy, since these factors may have implications for therapy.

Factors influencing pain, physical function and social functioning in patients with osteoarthritis in southern Italy.

The aim of this study was to assess factors influencing bodily pain (BP), physical function (PF) and social functioning (SF) in patients with osteoarthritis (OA) from southern Italy A total of 1,782 patients (mean age 66.08 years, 570 men and 1,212 women) with knee, hip, spine or hand OA underwent a structured assessment comprising demographic data and the Short Form 36 (SF-36) BP, PF and SF scales. Separate multiple linear regression models were employed for statistical analysis. The mean disease duration was 9.18 years and the mean body mass index (BMI) was 27.06. The mean BP, PF and SF scores of 34.93 (SD 19.37), 63.58 (SD 26.53) and 47.89 (SD 21.83) for the study subjects were substantially lower than those expected for the general Italian population. Subjects who were younger with a shorter disease duration and lower BMI had better PF and SF Younger subjects with a lower BMI and a longer disease duration had less BP. Female sex was associated with more BP, worse SF and better PF. In conclusion, demographic and disease-related factors influence BP, PF and SF in southern Italian patients with OA.

Clinical improvement and serum amino acid levels after mud-bath therapy.

Spa therapy is an ancient approach to degenerative diseases such as osteoarthritis, but until today this tradition has been predominantly empiric and intuitive and few studies have focused on the biological changes derived from this treatment. We assessed the clinical efficacy and variations in amino acid concentrations in serum samples from patients with knee osteoarthritis who underwent spa therapy and put forward an explanation of their role in clinical improvement. Thirty-one patients with knee osteoarthritis who underwent spa therapy underwent a clinical evaluation, and serum amino acid levels were assayed before and after a cycle of balneotherapy and mud-pack therapy. The thermal treatments were carried out in Sciacca. Analysis of the data showed a significant reduction in pain and improvement in joint motility. Serum concentrations of tryptophan, cysteine and citrulline were significantly higher than at baseline. No significant differences were observed in serum levels of the remaining free amino acids. The results of this study confirm the efficacy of spa therapy in the treatment of osteoarthritis. A possible role for changes in serum amino acid concentration is discussed.