[Oral contraceptive pill and thrombotic risk: epidemiological studies]. / Pillola e rischio trombotico: gli studi wpidemiogici.

The venous thromboembolism (VTE) is a rare event during childbearing age and during the assumption of combined oral contraceptive. The absolute risk of VTE in users of combined oral contraceptives is 20-30 per 100000 women years. A number of case-control studies published in recent years have shown an apparent increase in the risk of VTE among users of oral contraceptives (OCs) containing desogestrel, gestodene, drospirenone and cyproterone, relative to the use of levonorgestrel. The data derived from these recent studies is of borderline statistical significance because any important factors are not considered to evaluate the real correlation between the assumption of OCs and risk of venous thromboembolism. Among the factors that should be considered, there are: EE dose, duration of use, coexistance of other risk factors of venous thromboembolism (age, BMI, familiarity, surgical interventions) and other prescription bias. The lack of these factors is likely to contribute to the increased risk of venous thromboembolism observed in users of third-generation OCs when compared to that in users of second-generation OCs. To date, because of the inadequacy of epidemiological studies, the data about the correlation between OCs and TVE, are not conclusive and it will be necessary to carry out other studies to clarify this debating point, definitively.

Epidemiology of dental professional liability.

The aim of this article is to collect data relating to dental professional liability in Italy and provide a common platform for discussions among clinicians, legal medicine practitioners, and experts in law. On the basis of two different dental-legal statistical samples (1,670 reports of legal dental experts and 320 civil court decisions) we analyzed the dental professional liability lawsuit in the areas of distribution of lawsuits among the different dental specialties, recurrence and type of errors, outcome of civil suits, parameters of compensation. Some ideas are also proposed for possible strategies in the management of clinical risk (prevention of errors) and court proceedings.

Intra-vesicle administration of D-cloprostenol for induction of abortion in mid-gestation bitches.

This study evaluated a new method for mid-gestation termination in the bitch, which consisted of ultrasound-guided administration of a single dose of d-cloprostenol, a PGF(2alpha) analogue, into a single gestational sac. Effects on serum progesterone concentration (P(4)) were also investigated. The study was performed between days 28 and 35 of gestation on 15 privately owned crossbred bitches, randomly divided into two groups: group A comprised 10 bitches treated with 15 microg per head d-cloprostenol diluted in 0.8 ml sterile saline (final volume 1 ml); group B comprised 5 bitches treated with 1 ml of sterile saline solution (0.9% NaCl), administered in the same way. In all bitches of group A, fetal death was successfully induced within 5 days (mean: 3.1 days, S.D. 1.2) with no clinical or behavioural complications. Mild adverse effects were observed in two bitches, each weighing less than 10 kg, including salivation, defecation and hyperventilation, which disappeared within 15 min. None of the subjects in group B aborted within 10 days post-treatment. In group A, P(4) declined 2.8 days before pregnancy termination to a mean value below 30 nmol/l (S.D. 2.9 nmol/l). However, two bitches showed a higher concentration of P(4) throughout the sampling period. Our study demonstrates that intra-vesicle administration of a single low dose of D-cloprostenol is an effective and safe technique for induction of abortion, which offers an additional option for termination of unwanted pregnancy in the mid-gestation bitch.

Plasma homocysteine levels in cycling, pregnant, and spayed bitches.

The aim of this study was to evaluate the physiological range of homocysteine (Hcy) exhibited by bitches during the follicular (pro-oestrus), luteal (dioestrus) and anoestrus phases of cycling animals, and in pregnant and spayed bitches. The lowest concentrations of Hcy were observed during dioestrus (3.2+/-1.27micromol/L) and in pregnant bitches (3.9+/-1.72micromol/L), and the highest concentrations during anoestrus (7.8+/-0.6micromol/L) and in spayed bitches (12.1+/-5.16micromol/L).

The effect of calcium-naloxone treatment on blood calcium, beta-endorphin, and acetylcholine in milk fever.

Milk fever is a postpartum syndrome of cows characterized by acute hypocalcemia, which reduces the release of acetylcholine (ACH), inducing flaccid paralysis and recumbency. Our aim was to evaluate the effect of calcium (Ca2+) combined with naloxone (Nx, an opioid antagonist; Ca2+-Nx) on plasma concentrations of ACH, beta-endorphin (betaE), and Ca2+ just before treatment (T0) and at 15, 30, and 90 min after treatment (T15, T30, and T90, respectively). Thirty cows were divided into 3 groups of 10 cows each. In group A1, cows affected by milk fever were treated (i.v.) with a combination of 0.2 mL/kg of body weight (BW) of Ca2+ borogluconate (20%) and 0.01 mg/kg of BW of Nx hydrochloride dihydrate. In group A2, cows affected by milk fever were treated (i.v.) with 2 mL/kg of BW of Ca2+ borogluconate (20%). In group C, healthy cows were treated (i.v.) with a combination of 0.2 mL/kg of BW of Ca2+ borogluconate (20%) and 0.01 mg/kg of BW of Nx hydrochloride dihydrate. Cows underwent treatments within 24 h of calving. Blood samples were collected at T0 and at T15, T30, and T90 for quantitative determination of ACH, betaE, and Ca2+. The cows in groups A1 and A2 recovered within a mean of 20 +/- 10 min, although 4 cows in group A2 underwent a relapse. Blood Ca2+ concentrations in group C increased slightly at T30 and at T90 (T30: 8.8 +/- 0.6 mg/dL; T90: 8.7 +/- 0.6 mg/dL) after treatment, whereas the response in groups affected by milk fever was similar, even though Ca2+ concentrations showed a sharp increase (A1: 8.9 +/- 0.8 mg/dL; A2: 6.0 +/- 0.7 mg/dL), particularly at T15 in group A1. Concentrations of betaE showed a similar pattern in groups A1 and C, with an increase at T15 (A1: 8.2 +/- 1.0 ng/mL; C: 2.7 +/- 0.4 ng/mL) and a subsequent decrease until T90 (A1: 1.4 +/- 0.3 ng/mL; C: 1.4 +/- 0.4 ng/mL), whereas betaE remained constant throughout in group A2. Concentrations of ACH in group A1 decreased significantly between T0 and T15, T30, and T90 (T0: 7.2 +/- 1.1 nmol/L; T15: 4.2 +/- 1.2 nmol/L; T30: 2.9 +/- 0.8 nmol/L; T90: 3.1 +/- 0.3 nmol/L), whereas in group A2, it did not change. In group C, concentrations of ACH decreased at T15 and increased again at T30 (T15: 1.1 +/- 0.3 nmol/L; T30: 3.2 +/- 0.7 nmol/L). Our results suggest that administration of Ca2+-Nx, which restored the physiological Ca2+ concentrations, might have an effect on nicotinic receptors by restoring the normal neuromuscular transmission at the motor endplate.

A 15 years survey for dental malpractice claims in Rome, Italy.

INTRODUCTION: In recent years, dental malpractice claims seems to have increased dramatically worldwide without a clear explanation. The aim of our work is to shed more light on this phenomenon to better understand its magnitude and trend, and to point out possible critical factors that, if changed, can mitigate it. MATERIAL AND METHOD: 458 cases of dental malpractice sentenced by the civil court of Rome, Italy, from 2001 to 2015, were collected. Useful information was extracted, reported in a grid and statistically analyzed. Data was compared between years and overall evaluated. RESULTS: Multiple information were obtained, among which: the number of dental malpractice claims has decreased in most recent years; Dental professionals are found guilty in 74% of cases; the average compensation granted is 18.820,15 €; only 47,7% of the insured dentist found guilty was fully covered by their insurance. CONCLUSIONS: Contrary to what we expected, dental malpractice claims in court have decreased in recent years. The limit liability of dental professional insurances is high compared to the average compensation granted and the insurance doesn't always cover all the expenses for the presence of peculiar clauses in the contract.

Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients.

BACKGROUND: Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear. AIM: To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients. PATIENTS AND METHODS: A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively. RESULTS: Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p

Concentrations of free radicals and beta-endorphins in repeat breeder cows.

Repeat breeding (RB) is one of the major problems that affect the reproductive efficiency and economy of milk production in dairy animals. So far, the etiopathogenesis of this pathology has not been defined completely. Stress has been hypothesized to be a cause of impaired reproductive efficiency. Stress may cause an overproduction of beta-endorphins and free radicals; in particular, reactive oxygen species (ROS). The aim of this work is to determine the concentrations of these substances in RB cows and to evaluate the correlation with the serum level of progesterone. The study was performed on 60 dairy cows: 26 RB and 34 control cows. Blood samples were collected on day 12 and day 16, after artificial insemination (AI) in all subjects, in order to assess the concentrations of progesterone, free radicals and beta-endorphins. The stressors, free radicals and beta-endorphins, that we considered, were higher in repeat breeders (day 12, 93.32(+/-1.91) UCarr and 0.50(+/-0.03) ng/ml; day 16, 94.42(+/-1.91) UCarr and 0.61(+/-0.03) ng/ml), with a lower level of progesterone, which probably is responsible for failure to conceive. The stress factors (free radicals and beta-endorphins) may actually enhance each other and induce an inhibition of progesterone synthesis in repeat breeders.

Anthelmintics efficacy against intestinal strongyles in horses of Sardinia, Italy.

Intestinal strongyles (IS) are the most important parasites of equids, due to their high prevalence worldwide, pathogenicity and the spread of drug-resistant populations. Despite the large number of horses bred in Sardinia Island, Italy, no data are available on the efficacy of anthelmintic compounds in the control of horse strongylosis. Therefore the aim of the present study was to evaluate the efficacy of five commercial anthelmintic formulations containing fenbendazole (FBZ), pyrantel (PYR), moxidectin (MOX) and two ivermectin formulations (IVM1 and IVM2) against IS in Sardinia by performing a fecal egg count reduction test (FECRT) and investigating the egg reappearance period (ERP) after treatment. In total, 74 horses from 7 farms were examined. Coprocultures performed for individual fecal samples collected at the day of the treatment revealed that cyathostomins were the predominant parasitic species (98.6%). The FECR for all horses belonging to the treatment groups after two weeks was ≥ 95% with a 95% C.I. > 90%. The expected ERP did not decrease in any of the treatment group as FECR values < 90% were found at D60 for FBZ, at D90 for PYR and IVM1, at D150 for IVM2. All horses treated with MOX showed FECRT > 90% for the entire duration of the trial until D150. The results of the present survey indicate that drug-resistant cyathostomin populations are not present in the examined horse population, contrariwise to what observed in other Italian and European regions. The reasons and implications of these results are discussed.

Renin and ovarian vascularization in cows with follicular cysts after epidural administration of a GnRH analogue.

The ovarian renin-angiotensin system may play an important role in follicular growth and maturation, as well as in the process of ovulation. The aim of this study was to investigate the effects of administration of a GnRH analogue to cows with ovarian follicular cysts on plasma renin concentrations and ovarian vascularization. This study was performed with 60 Friesian cows, which were diagnosed with follicular cysts, and randomly allocated into two groups: group A (treatment; n=30) received 2ml of lecirelin (Dalmarelin((R)) - Fatro), per head via sacro-coccygeal epidural, and group B (control; n=30) received 2ml saline solution (0.9% NaCl) per head by the same route. Blood samples were immediately collected prior to administration (T0) and then 24h (T1), 48h (T2) and 8 days (T3) after administration of the treatment, for both groups. Ovarian vascularization was evaluated utilizing Power Doppler on these same days in 10 animals from each group. The number of pixels detected by Power Doppler was used as an indicator of the degree of vascularization. Plasma renin concentrations remained relatively constant for the control (group B) animals, but increased as the sampling period progressed (NS) for the treated cows (group A). Similarly, there were no changes in ovarian vascularization (number of pixels) for the control cows, but vascularization increased throughout the sampling period in the treated animals. The number of pixels associated with cysts was significantly higher for treated compared to control cows at 24h after treatment (P<0.001). The epidural administration of a GnRH analogue was determined to be a highly effective therapy for follicular cysts (regression occurred in 82% of treated cows within 8+/-2 days after treatment, but in none of the control cows), which also enhanced ovarian vascularization.

Influence of antibiotic therapy on serum levels of reactive oxygen species in ovariectomized bitches.

This study was conducted on 60 ovariectomized bitches. The objectives were to measure the mean reactive oxygen species (ROS) concentrations before, during and after surgery, and to investigate the effect of the administration of five different antibiotic treatments: amoxicillin, benzylpenicillin/dihydrostreptomycin, sulfametazine/sulfamerazine/sulfathiazole, enrofloxacin, lincomycin/spectinomycin. The first value recorded represented the mean ROS concentration in anestral bitches and constitutes a reference level with which to compare the subsequent measurements. After premedication, induction of anesthesia and during maintenance and surgery, ROS serum concentrations showed constant values until the end of surgery. After surgery and during antibiotic administration, an increase in ROS concentration occurred, which differed among the five groups in relation to the antibiotics employed. The lowest increases occurred in the groups treated with the combination of lincomycin/spectinomycin, and with amoxicillin; whereas the highest increases were detected in the group treated with enrofloxacin. The three other antibiotics showed an intermediate level of influence on oxidative status.