Evaluation of the accuracy of a multi-infection screening test based on a multiplex immunoassay targeting imported diseases common in migrant populations.

BACKGROUND: We aimed to evaluate the performance of a novel multiplex serological assay, able to simultaneously detect IgG of six infections, as a screening tool for imported diseases in migrants. METHODS: Six panels of 40 (n = 240) anonymized serum samples with confirmed infections were used as positive controls to assess the multiplex assay's sensitivity. One panel of 40 sera from non-infected subjects was used to estimate the seropositivity cutoffs, and 32 non-infected sera were used as negative controls to estimate each serology's sensitivity and specificity. The multi-infection screening test was validated in a prospective cohort of 48 migrants from endemic areas. The sensitivity of the Luminex assay was calculated as the proportion of positive results over all positive samples identified by reference tests. The specificity was calculated using 32 negative samples. Uncertainty was quantified with 95 % confidence intervals using receiver operating characteristic analyses. RESULTS: The sensitivity/specificity were 100 %/100 % for HIV (gp41 antigen), 97.5 %/100 % for Hepatitis B virus (HBV-core antigen), 100 %/100 % for Hepatitis C virus (HCV-core antigen), 92.5 %/90.6 % for strongyloidiasis [31-kDa recombinant antigen (NIE)], 97.5 %/100 % for schistosomiasis (combined serpin Schistosoma mansoni and S.haematobium antigens) and 95 %/90.6 % for Chagas disease [combined Trypanosoma cruzi kinetoplastid membrane protein-11 (KMP11) and paraflagellar rod proteins 2 (PFR2) antigens]. In the migrant cohort, antibody response to the combination of the T.cruzi antigens correctly identified 100 % individuals, whereas HBV-core antigen correctly identified 91.7 % and Strongyloides-NIE antigen 86.4 %. CONCLUSIONS: We developed a new, robust and accurate 8-plex Luminex assay that could facilitate the implementation of screening programmes targeting migrant populations.

Survival and complication rate of zygomatic implants: a systematic review.

AIM:  To evaluate the available literature reporting the survival and complication rate of zygomatic implants, assessing factors (such as surgical technique, surgical/restorative plan, population, study design and characteristics, etc.)  associated with these outcomes. MATERIALS AND METHODS:   A comprehensive search was performed in three electronic databases, together with a manual search, to identify clinical studies reporting the survival and/or complication rates following zygomatic implant therapy, to quantify relative rates for both stated outcomes.  Results:  101 articles were included: 69 were retrospective in nature, 29 were prospective non-randomized studies and 3 were randomized trials (RCTs). The mean survival rate among retrospective studies was 97.61%, while among prospective non-RCTs and RCTs was 98.53% and 95.92%, respectively. The survival rate was not associated with the surgical technique, nor with the surgical/restorative plan. A trend towards higher survival rate, although not statistically significant (p>0.05), was observed in more recent vs less recent studies. Forty-eight articles reported data on complications related to zygomatic implants, with labial laceration, orbital cavity penetration, hematoma, epistaxis, maxillary sinusitis, infection and oro-antral communication being among the most common adverse event. A lower incidence of maxillary sinusitis was observed for zygomatic implants placed using the extrasinus approach compared to the other surgical approaches (p<0.01). The incidence of maxillary sinusitis and oro-antral communications was found to be less likely in "recent" vs "less recent" studies (p<0.05). CONCLUSIONS:   Zygomatic implant therapy is a reliable treatment option for rehabilitating the severely atrophic maxilla, with high implant survival rate and relatively low complication rate. Several factors were found to be associated with the incidence of post-operative complications. Nevertheless, the evidence from the literature is mainly based on non-RCTs and therefore these findings have to be interpreted with cautions.

Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry.

Skin and soft tissue infections (SSTIs) represent a heterogenous group of pathological conditions involving the skin or the underlying subcutaneous tissues, fascia and muscle, characterised by a considerable variety of clinical presentations, severity and possible aetiological pathogens. Although previous analyses on restricted types of SSTIs and population have already been published, we conducted a large nationwide surveillance program on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients and their management. Twenty-nine Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. We included in our database all cases managed by ID specialists participating to the study, independently from their severity or the setting of consultation. Here, we integrated previous preliminary results analysing and reporting data referring to a 3-year period (October 2016-October 2019). During this period, the study population included 478 adult patients with diagnosis of SSTI. The type of infection diagnosed, the aetiological agent involved and some notes on antimicrobial susceptibilities were collected and reported herein. We also analysed the most common co-morbidities, the type and duration of therapy executed, before and after ID intervention and the length of stay. The results of our study provide information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.

Oral rehabilitation with unilateral zygomatic implants: A case series of 32 patients.

AIMS: Zygomatic implants are successful alternatives to conventional dental implants for oral rehabilitation of patients with severely atrophic maxillae; however, the use of unilateral zygomatic implants needs to be studied further to validate their efficacy. The present investigation aimed to evaluate unilateral zygomatic implant placement in the oral rehabilitation of partially edentulous patients with extremely atrophic maxillary bone and/or previous implant failures. MATERIALS AND METHODS: This retrospective clinical study included patients with partially edentulous maxillae who underwent unilateral zygomatic implant insertion. The primary outcome was implant survival. Intraoperative, postoperative and prosthetic complications were also assessed based on patients' clinical records. RESULTS: A total of 32 patients (34 zygomatic implants) with a mean age of 60.45 ± 8.74 years (range 47 to 78 years) were included in the study. The mean follow-up period was 34.3 ± 25.5 months, and the overall implant survival rate was 100%. No intraoperative or postoperative complications developed in any of the patients, and no prosthesis failures or complications were recorded. CONCLUSIONS: The results indicate that unilateral zygomatic implant insertion for oral rehabilitation of patients with partially edentulous posterior maxillae with severely atrophic bone and/or previous implant failures can be considered a successful alternative to use of conventional dental implants associated with advanced bone grafting procedures.

Continuous subcutaneous apomorphine infusion allowing awake deep brain stimulation in a Parkinson's disease patient.

BACKGROUND: Subthalamic Deep Brain Stimulation (DBS) have demonstrated in the last decades to determine an important clinical improvement in advanced and selected Parkinson's disease (PD) patients. However, only a minority of parkinsonian patients meet the criteria to undergo DBS, and the surgical procedure itself is often stressful, especially for patients experiencing severe OFF state. Subcutaneous Apomorphine continuous administration is suitable as an adjunctive therapy capable of improving a suboptimal DBS result. Here we hypothesize a possible role for subcutaneous apomorphine infusion to alleviate severe OFF state in parkinsonian patients undergoing DBS, thus allowing intraoperative microrecording and patient's collaboration during clinical testing. CASE PRESENTATION: A 68-year-old man, suffering from a very long PD-history, characterized by a severe akinetic status and dramatic non-motor features while in OFF, underwent Subthalamic-DBS keeping a slight but continuous apomorphine infusion (1.8 mg/hour), able to guarantee the right degree of patient's collaboration without interfering with microelectrode recordings. There were no intra or perioperative complications and after the procedure he experienced a marked clinical benefit, being able to stop apomorphine administration. CONCLUSIONS: Here we described the first Subthalamic DBS procedure performed with a low and stable dopaminergic stimulation guaranteed by subcutaneous Apomorphine continuous infusion. For its rapidity of action and prompt reversibility, apomorphine could be particularly suitable for use during difficult surgical procedures in PD, allowing more therapeutic opportunities for patients who would otherwise be excluded from the DBS option.

Immediate Oral Rehabilitation With Quad Zygomatic Implants: Ultrasonic Technique vs Conventional Drilling.

Inserting zygomatic implants is a challenging surgery and requires special care and great precision. Piezoelectric surgery offers several advantages: more precise bone cutting with improved intraoperative visibility and a low temperature increase. The aim of this case-control study was to evaluate whether ultrasonic instruments can be as effective as standard drilling instruments for zygomatic implant surgery in terms of clinical outcomes. Ninety-two patients with atrophic maxilla were included in the study. Implant sites were prepared with the ultrasonic technique (test group = 47 patients) or traditional drilling (control group = 45 patients). In total, 368 zygomatic implants were inserted (202 with the extrasinus technique, 77 with the sinus slot technique, and 89 with the Brånemark technique). Complete arch provisional prostheses were delivered 3 to 5 hours after the surgical operations. The mean follow-up after surgery was 24 months (range = 12-32 months). The primary outcome evaluations were based on implant survival rates and postoperative complications. Operative time and surgeon's stress were evaluated as secondary outcomes. Implant survival rate was 100% in the test and 98.89% in the control group. Postoperative complications were seen in 9 patients (4 in the test and 5 in the control group); the difference was not statistically significant. Operative time was longer in the test group; however, surgeons were more comfortable using ultrasonic instruments. Within the limitations of this preliminary study, the ultrasonic technique was a feasible alternative to traditional drilling for zygomatic implant surgery.

The functional architecture of the stomatognathic system and orofacial aesthetic repositioning during the aging process

Introduction: Facial aging implies special care and personalized treatment. Thus,the new strand of Neomodern Dentistry seeks, through Orofacial Harmonization,the functional and aesthetic balance between the stomatognathic system and thefacial aspect. Objective: This article seeks to disclose, through a literature review, the aesthetical consequences of the stomatognatic system repositioning andorofacial aging. Data source: The present literature review consisted in researchesup to May 2019 using PubMed and Google Academic electronic databases. A 10-year publication limit was applied in the research. No language restriction wasapplied. Inclusion criteria were clinical investigations, books, dissertations, thesisor literature reviews that addressed the topics of interest. Data synthesis: A totalof 231 articles were retrieved from databases. After applying a 10-year publicationlimit, 111 remained and, based on the inclusion and exclusion criteria, 20 articleswere selected and included in this review. Conclusion: Considering the limitationsof the present study, it can be concluded that the aging process is natural andpredictable and can be changeable and malleable through procedures that restorethe support nutrients that were lost. The aesthetics can be achieved as a functionalconsequence of the stomatognathic system repositioning due to orofacial aging.

Introdução: O envelhecimento facial implica em cuidados especiais e um tratamento diferenciado. Desse modo, a nova vertente da Odontologia Neomoderna busca, por meio da Harmonização Orofacial, o equilíbrio funcional e estético entre o aparelho estomatognático e a face. Objetivo: Esse artigo busca compreender, por meio de uma revisão de literatura, as consequências estéticas do reposicionamento do aparelho estomatognático e envelhecimento orofacial. Fonte dos dados: A presente revisão de literatura consistiu em um viés qualitativo nas plataformas PubMed e Google Acadêmico, nos últimos 10 anos, sem restrição de idiomas. Os critérios de inclusão consistiram em estudos clínicos, livros, dissertações, teses ou revisões de literatura que abordavam os tópicos de interesse. Síntese dos dados: Foram recuperados nas bases de dados 231 artigos. Após a aplicação de um limite de publicação de 10 anos, 111 permaneceram e, com base nos critérios de inclusão e exclusão, 20 artigos foram selecionados e incluídos nesta revisão. Conclusão: Com as limitações do presente estudo, pode-se concluir que o processo de envelhecimento é natural e previsível e pode ser mutável e maleável por meio de procedimentos que restauram os nutrientes de suporte perdidos. A estética pode ser alcançada como uma consequência funcional do reposicionamento do sistema estomatognático e do envelhecimento orofacial.

Gelation of the internal core of liposomes as a strategy for stabilization and modified drug delivery II. Theoretical analysis and modelling of in-vitro release experiments.

PEG-DMA was incorporated in unilamellar liposomes. PEG-DMA crosslinking by photo-induced radical reaction transforms the liquid aqueous core of the liposome into a hydrogel. The molecular weight of PEG-DMA significantly influences both structural and release properties of these hybrid nanosystems, by affecting both membrane permeability and diffusional properties of the inner core. Release studies of 5-(6) carboxyfluorescein from Conventional Liposomes (CL) and Gel-in-Liposome (GiL) systems were carried out in a vertical Franz Diffusion Cell. A detailed transport model is proposed, aimed at describing the entire drug diffusive pathway from the vesicles' inner core, through the double-layer membrane, into the buffer solution in the donor chamber of the Franz Cell and from there to the receptor chamber, where withdrawals are performed to evaluate the released drug concentration. The model permits to give a quantitative estimate of the diffusional resistances offered by the inner core (liquid or gelled) and by the double-layer membrane for CLs and different GiLs systems. The theoretical analysis of experimental release data strongly supports the basic assumption that, by varying the molecular weight of PEG-DMA, a different arrangement of the polymer within the liposomal structure and a different interaction with the membrane occur. PEG750-DMA decreases the transport resistance of the double layer membrane with respect to CLs, while PEG4000-DMA plays the opposite role. After gelation of the internal core, the diffusional resistance to drug transport inside GiLs becomes controlling, thus significantly slowing down drug release from these systems. Therefore, the combination of PEG-DMA with phospholipid vesicles appears an interesting strategy to develop sustained drug delivery systems.

Epidemiology and Microbiology of Skin and Soft Tissue Infections: Preliminary Results of a National Registry.

Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016-September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.

[Pulmonary tuberculosis mimicking a severe community-acquired pneumonia with rhabdomyolysis]. / Tubercolosi polmonare che mima una polmonite comunitaria grave con rabdomiolisi.

We relate the case of a 17 year old girl with active pulmonary tuberculosis which mimicked a severe community-acquired pneumonia (CAP) associated to rhabdomyolysis. This report underlines the importance of excluding the diagnosis of pulmonary tuberculosis in any case of CAP which does not respond to standard antibiotic therapy, remembering that the empiric use of fluoroquinolones could delay the initiation of anti-tuberculosis treatment. This is, to our knowledge, the first description of a case of pulmonary tuberculosis complicated with rhabdomyolysis in a young girl without comorbidities.

Psychoemotional assessment changes in patients treated with orthognathic surgery: pre- and postsurgery report.

AIM: To evaluate a sample of patients treated with orthognathic surgery, establishing the emotional and self-perception differences between the pre- and postsurgical assessment. MATERIAL AND METHODS: Several questionnaires (Body Dysmorphic Disorder Examination, State Trait Anxiety Inventory, Self-Rating Depression Scale, Oral Health Status Questionnaire, Post-Surgical Satisfaction Questionnaire) were administered to the sample of 30 patients; these were used to study the data related to body image, level of anxiety, eventual depressive status, quality of life, and postsurgical satisfaction. RESULTS: The longitudinal study results outline the impact of orthognathic surgery on the psychological and emotional well-being of the patient and the need for the specialist to understand the emotional status and expectations of the patient.

Técnica mediata para clareamento de dentes desvitalizados: uma comparação clínica entre agentes clareadores: relato de caso clínico / Non-vital bleaching: a comparison between bleaching agents: case report

Neste relato foram descritos os passos clínicos empregados durante a técnica mediata para clareamento de dentes desvitalizados, sem aplicação de calor. O objetivo foi comparar clinicamente o resultado obtido no clareamento dos dentes 11 e 21, utilizando como agentes clareadores pasta de perborato de sódio + água destilada e peróxido de carbamida a 37 por cento, respectivamente. Concluiu-se que a técnica mediata utilizando o peróxido de carbamida a 37 por cento em cinco sessões, com intervalos de uma semana, mostrou-se mais eficaz para o clareamento de dentes desvitalizados que a mesma técnica utilizando a pasta de perborato de sódio + água destilada