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1.
Reumatismo ; 72(4): 189-196, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33677945

RESUMO

The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (<20 ng/mL) and 57.4% had 25-OHvitamin D <15 ng/mL. Patients with arterial PaO2 <60 mmHg had significantly lower mean 25-OH-vitamin D levels compared to patients with PaO2 ≥60 mmHg (13.3 ng/mL vs 20.4 ng/mL respectively, p=0.03). Vitamin D deficiency was associated with 3-fold higher risk of having arterial pO2 <60 mmHg. 25-OH-vitamin D deficiency was associated with increased CRP and dyspnea. 25-OH-vitamin D deficiency was associated with more severe systemic inflammatory response and respiratory failure in COVID-19 patients.


Assuntos
/sangue , Vitamina D/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Comorbidade , Suscetibilidade a Doenças , Dispneia/etiologia , Feminino , Fibrinogênio/análise , Humanos , Itália/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Pressão Parcial , Prevalência , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia
2.
Orphanet J Rare Dis ; 15(1): 228, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867855

RESUMO

During the COVID-19 outbreak, the European Reference Network on Rare Bone Diseases (ERN BOND) coordination team and Italian rare bone diseases healthcare professionals created the "COVID-19 Helpline for Rare Bone Diseases" in an attempt to provide high-quality information and expertise on rare bone diseases remotely to patients and healthcare professionals. The present position statement describes the key characteristics of the Helpline initiative, along with the main aspects and topics that recurrently emerged as central for rare bone diseases patients and professionals. The main topics highlighted are general recommendations, pulmonary complications, drug treatment, trauma, pregnancy, children and elderly people, and patient associations role. The successful experience of the "COVID-19 Helpline for Rare Bone Diseases" launched in Italy could serve as a primer of gold-standard remote care for rare bone diseases for the other European countries and globally. Furthermore, similar COVID-19 helplines could be considered and applied for other rare diseases in order to implement remote patients' care.


Assuntos
Betacoronavirus , Doenças Ósseas/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Doenças Raras/complicações , Consulta Remota/normas , Idoso , Algoritmos , Doenças Ósseas/terapia , Criança , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Gravidez , Doenças Raras/terapia , Ferimentos e Lesões
3.
Eur J Paediatr Dent ; 20(2): 147-150, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31246093

RESUMO

AIM: This study offers an overview regarding news and main themes which have been introduced by Law n. 24/2017 (the so called "Gelli-Bianco" law) in Italy. The normative content deals with the features of civil liability for healthcare professionals. More specifically, this article is referred to the contractual and extra-contractual liability of paediatric dentists. Dentists often provide services combining healthcare and dental procedures as well as aesthetic activities. Thanks to the case law and doctrine tradition, the distinction between contracts of employment and contracts of work is clearly stated. This examination is focused on highlighting methods employed by paediatric dentists to prevent possible actions of suing for compensation.


Assuntos
Responsabilidade Legal , Imperícia , Criança , Assistência Odontológica , Odontólogos , Humanos , Itália
4.
J Endocrinol Invest ; 42(9): 1029-1039, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30762200

RESUMO

BACKGROUND AND AIMS: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors determine a wide reduction of LDL cholesterol, greater than other lipid-lowering agents. The present meta-analysis is aimed at the assessment of PCSK9 inhibitors effect on LDL Cholesterol, cardiovascular morbidity and all-cause mortality. METHODS AND RESULTS: A Medline and Clinicaltrials.gov search for eligible studies until December 1, 2017, was performed. All randomized trials (> 12 weeks) comparing PCSK-9 inhibitors with placebo or active drugs were retrieved. Primary endpoints: (a) LDL cholesterol at endpoint; (b) Major cardiovascular events (MACE); (c) All-cause mortality. Data extraction was performed independently by two of the authors, and conflicts resolved by a third investigator. A total of 38 trials fulfilling the inclusion criteria were identified, with mean duration of 36.4 weeks. The reduction of LDL cholesterol at endpoint, versus placebo, ezetimibe, and high-dose statins was - 65.3 [- 69.6, - 60.9]%, - 57.7 [- 68.3;- 47.0]%, and - 34.5 [- 40.8;- 28.1]%, respectively, with alirocumab possibly showing a smaller effect than the other drugs of the class. Treatment with PCSK9 inhibitors was associated with a reduction in the incidence of MACE (Mantel-Haenszel Odds Ratio [MH-OR] 0.83 [0.78, 0.88]), with significant effects of alirocumab and evolocumab only. The number needed to treat for 2 years for preventing one event was 89. All-cause mortality and cardiovascular mortality were not reduced by treatment with PCSK-9 inhibitors (MH-OR 0.94 [0.84, 1.04] and 0.97[0.86;1.09]). CONCLUSIONS: PCSK-9 inhibitors are effective in reducing LDL cholesterol and the incidence of major cardiovascular events in high-risk patients. Bococizumab does not show significant effects on MACE. REGISTRATION NUMBER: PROSPERO-CRD42018087640.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Doenças Cardiovasculares/mortalidade , LDL-Colesterol/metabolismo , Pró-Proteína Convertase 9/antagonistas & inibidores , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/metabolismo , Humanos , Morbidade , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de Sobrevida
5.
Musculoskelet Surg ; 102(1): 11-19, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28717988

RESUMO

Flatfoot is a common condition in growing-age patients. Despite its common presentation, nowadays surgical indications and treatments are still debated. Arthroereisis is a widely used technique, and several implants designs have been proposed over time. Despite the good results shown in the literature, the main drawback of these techniques has always been the need for a second surgery for implant removal. Bioabsorbable devices have been introduced to overcome this necessity.Correct approach to the patient, indications and contraindications and available studies on bioabsorbable implants for subtalar arthroereisis in pediatric flatfoot were analyzed in this narrative review. Even if only a few studies have been published in the literature, bioabsorbable implants showed good clinical results comparable to non-absorbable implants and with a rare necessity for implant removal or revision. When correct indications and proper surgical technique are followed, arthroereisis with bioabsorbable implants appears to be an effective solution for the treatment of pediatric flexible flatfoot.


Assuntos
Implantes Absorvíveis , Pé Chato/cirurgia , Procedimentos Ortopédicos/métodos , Criança , Humanos , Satisfação do Paciente , Articulação Talocalcânea/cirurgia , Resultado do Tratamento
6.
J Endocrinol Invest ; 40(11): 1251-1258, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28569363

RESUMO

BACKGROUND: The pharmacological stimulation of GLP-1 receptors is associated with an increase in heart rate. A pooled analysis of patient-level data from phase III trials with albiglutide revealed a significant increase in the risk of atrial fibrillation. Aim of the present meta-analysis is to summarize all available evidence on the effects of individual GLP-1 receptor agonists (RA), and of the whole class, on the incidence of atrial fibrillation. METHODS: A Medline search for GLP-1 RA (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥12 weeks, enrolling patients with type 2 diabetes and comparing a GLP-1 RA with placebo or any other non-GLP-1 RA drug. RESULTS: Of the 113 trials fulfilling the inclusion criteria, 19 did not report information on atrial fibrillation, whereas 63 reported zero events in all treatment groups. In the remaining trials (enrolling 17,966 and 15,305 patients in GLP-1 RA and comparator arms, respectively, 55.3% women, with a mean age of 57.0 ± 3.8 years), treatment with GLP-1 RA was not associated with a significant increase in the incidence of atrial fibrillation [Mantel-Haenszel OR (95% CI) 0.87 (0.71-1.05), p = 0.15]. CONCLUSIONS: In conclusion, available data suggest that GLP-1 RA is not associated with atrial fibrillation, with the only possible exception of albiglutide. Newly onset atrial fibrillation deserves to be investigated as an event of special interest in future trials with GLP-1 RA.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas , Hipoglicemiantes/uso terapêutico , Fibrilação Atrial/metabolismo , Fibrilação Atrial/patologia , Humanos , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Injury ; 48(7): 1319-1324, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28529013

RESUMO

INTRODUCTION: Severe post-traumatic ankle arthritis poses a reconstructive challenge in young and active patients. Although technically demanding and despite unsolved immunological issues, bipolar fresh total osteochondral allograft (BFTOA) represent an intriguing option to arthrodesis and prosthetic replacement. The purpose of this paper is to evaluate the outcomes of a series of 48 ankle BFTOA at 10 years follow up and to investigate the rate of survival long term. METHODS: 58 patients underwent BFTOA, of these 48 were available for follow up. The allograft was prepared with the help of specifically designed jigs and the surgery was performed using either a lateral or a direct anterior approach. Patients were evaluated clinically and radiographically preoperatively, and at a mean 121±18months of follow-up. RESULTS: The AOFAS score improved from 31±11 pre operatively, to 65±25 at the last (p<0.0005). Fourteen failures occurred, with 70.8% allograft rate of survival. All the surviving allografts showed a reduction of the ankle joint movement, still associated with a satisfactory clinical result. CONCLUSION: The use of BFTOA represents an intriguing option to arthrodesis or arthroplasty. A satisfactory clinical result associated to a good movement of the transplanted joint is to be expected up to short-mid-term, overtime. Long term, the range of motion (ROM) is progressively decreased up to spontaneous arthrodesis in some cases, still the joint results pain free and patient's perception is of a well functioning ankle. A deeper knowledge of the immunological behavior of transplanted cartilage is needed in order to improve the durability of this fascinating technique.


Assuntos
Aloenxertos , Traumatismos do Tornozelo/cirurgia , Artrodese , Transplante Ósseo/métodos , Cartilagem Articular/citologia , Osteoartrite/cirurgia , Transplante Homólogo/métodos , Adolescente , Adulto , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/fisiopatologia , Artrodese/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto Jovem
8.
Injury ; 48(7): 1287-1295, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28551052

RESUMO

Osteochondral allografts are used to treat many different conditions as acute traumatic large-sized lesions, degenerative osteoarthritis, osteochondritis dissecans, avascular necrosis or in case of failure of previous procedures particularly in young patients for whom primary prosthesis is not desirable. Fresh allografts present the advantage of having mature viable hyaline cartilage, not causing donor morbidity, allowing the restoration of even large defects in a single surgical session. Conversely, they could account for risks of disease transmission, immunologic reactions, and for limited availability. The present review aimed to analyze published studies of the last decade in which patients received fresh osteochondral allografts by dividing them for knee or ankle regenerative purposes. We wish to report the observed failure rates and particularly to collect any other reported side effect or outcome for identifying major problems and limits linked to the procedure and for delineating possible future researches and approaches. The overall success rates resulted ranging from 5.3% to 48.3% in the ankle at a mean follow up of 3.3 years and from 0% to 85.7% in the knee at a mean follow up of 7.1 years. Among other outcomes, occurrence or progression of arthritis, osteolysis, graft instability, fractures, nonunions, edema and infections were recorded. Overall, the lack of well designed randomized and controlled clinical trials, of immunological determination of the anti-donor antibodies development and of local and systemic biomarkers to detect reaction to the graft seems to be the major drawback. Improvements in these limiting factors might be desirable in order to enhance the clinical scenario of a well-established and successful procedure to give, especially for young patients, a real regeneration of the joint.


Assuntos
Articulação do Tornozelo/cirurgia , Transplante Ósseo , Articulação do Joelho/cirurgia , Osteoartrite/cirurgia , Osteocondrite Dissecante/cirurgia , Osteonecrose/cirurgia , Transplante Homólogo , Articulação do Tornozelo/imunologia , Articulação do Tornozelo/fisiopatologia , Transplante Ósseo/efeitos adversos , Cartilagem Articular/citologia , Cartilagem Articular/cirurgia , Seguimentos , Rejeição de Enxerto , Humanos , Articulação do Joelho/imunologia , Articulação do Joelho/fisiopatologia , Estudos Observacionais como Assunto , Osteoartrite/fisiopatologia , Osteocondrite Dissecante/fisiopatologia , Osteonecrose/fisiopatologia , Estudos Prospectivos , Regeneração/imunologia , Estudos Retrospectivos , Transplante Homólogo/efeitos adversos , Falha de Tratamento
9.
J Endocrinol Invest ; 40(10): 1091-1098, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28401528

RESUMO

PURPOSE: C-peptide has been shown to exert several, previously unknown, biological effects. A recent cross-sectional study demonstrated an association between low C-peptide serum levels and low lumbar bone density of postmenopausal women not affected by diabetes. To date, very little research attention has been directed toward the association between C-peptide and osteoporotic fractures. To contribute toward filling this gap, we investigated the association between C-peptide and fractures in postmenopausal women. METHODS: A cohort of 133 non-diabetic postmenopausal women with and without a history of fractures was evaluated in this cross-sectional investigation. Standardized interviews were performed to gather information on the patients' fracture history. All of the participants underwent a bone mineral density assessment by DXA, radiographs, and a serum C-peptide measurement. RESULTS: Thirty-four women presented fractures. Bivariate analysis revealed an inverse correlation between C-peptide and fractures (r = -0.27, p = 0.002). A significant difference in mean C-peptide levels was also found between women with vs. without fractures (p = 0.01, adjusted for age, BMI and glucose). Logistic regression analysis showed that C-peptide levels, femoral and vertebral BMD were all negatively associated with fracture status (B = -1.097, ES = 0.401, p = 0.006, 95% CI 0.15-0.73; B = -15.6, SE = 4.17, p < 0.001, CI 0.001-0.002; B = -24.8, SE = 5.23, p < 0.001, CI 0001-0.002; respectively). CONCLUSIONS: This study confirms an inverse association between serum C-peptide levels and a history of fractures in postmenopausal women without diabetes. These results suggest that C-peptidemay exert an effect on bone mineral density. However, further large-scale studies are needed to corroborate this finding and investigate the potential underlying mechanisms involved.


Assuntos
Biomarcadores/sangue , Densidade Óssea , Peptídeo C/deficiência , Diabetes Mellitus , Osteoporose Pós-Menopausa/diagnóstico , Fraturas por Osteoporose/diagnóstico , Idoso , Peptídeo C/sangue , Estudos Transversais , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/sangue , Osteoporose Pós-Menopausa/epidemiologia , Fraturas por Osteoporose/sangue , Fraturas por Osteoporose/epidemiologia , Pós-Menopausa , Prevalência , Prognóstico , Fatores de Risco
10.
Am J Transplant ; 17(7): 1791-1801, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28009476

RESUMO

One of the key unmet needs to improve long-term outcomes of heart transplantation is to develop accurate, noninvasive, and practical diagnostic tools to detect transplant rejection. Early intragraft inflammation and endothelial cell injuries occur prior to advanced transplant rejection. We developed a novel diagnostic imaging platform to detect early declines in microvascular perfusion (MP) of cardiac transplants using contrast-enhanced ultrasonography (CEUS). The efficacy of CEUS in detecting transplant rejection was tested in a murine model of heart transplants, a standard preclinical model of solid organ transplant. As compared to the syngeneic groups, a progressive decline in MP was demonstrated in the allografts undergoing acute transplant rejection (40%, 64%, and 92% on days 4, 6, and 8 posttransplantation, respectively) and chronic rejection (33%, 33%, and 92% on days 5, 14, and 30 posttransplantation, respectively). Our perfusion studies showed restoration of MP following antirejection therapy, highlighting its potential to help monitor efficacy of antirejection therapy. Our data suggest that early endothelial cell injury and platelet aggregation contributed to the early MP decline observed in the allografts. High-resolution MP mapping may allow for noninvasive detection of heart transplant rejection. The data presented have the potential to help in the development of next-generation imaging approaches to diagnose transplant rejection.


Assuntos
Modelos Animais de Doenças , Rejeição de Enxerto/diagnóstico , Transplante de Coração/efeitos adversos , Ultrassonografia/métodos , Animais , Meios de Contraste , Rejeição de Enxerto/diagnóstico por imagem , Rejeição de Enxerto/etiologia , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Transplante Homólogo
11.
Musculoskelet Surg ; 100(3): 207-211, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27878768

RESUMO

BACKGROUND: Congenital forward shoulder with clavicular hypoplasia is a rare disease which can be caused by an alteration of clavicular development in such a way that the clavicles are short. Symptoms are often absent; in most cases the main problem is represented by the cosmetic implications. There is no general consensus about the correct management, and surgery is the only way to correct the deformity. MATERIALS AND METHODS: The aim of the study is to describe a new surgical treatment in patients with congenital forward shoulder and clavicular hypoplasia. In 2010, three patients suffering from bilateral congenital forward shoulder were managed surgically by a intercalary graft positioning with plate fixation aimed at the elongation of the clavicles. RESULTS: Patients were followed by up to 2 years. All the patients treated were satisfied with the results, regarding the resolution of mild pain, but especially from the cosmetic point of view. CONCLUSION: The intercalary graft positioning was found to be easy to perform and allowed an elongation of the clavicles with immediate stability.


Assuntos
Placas Ósseas , Clavícula/anormalidades , Clavícula/cirurgia , Osteogênese por Distração/métodos , Ombro/anormalidades , Ombro/cirurgia , Irmãos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Amplitude de Movimento Articular , Transplantes , Resultado do Tratamento
12.
Injury ; 47 Suppl 4: S138-S146, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27492063

RESUMO

The optimal treatment of calcaneal fractures (CF) is currently controversial and is still under debate. It is well established that conservative treatment of these fractures is associated with poor results. Several surgical techniques are described in the literature; however, there is no consensus on which of these is more effective. The main goals of surgery are to restore the subtalar joint congruence, and calcaneal width, height, shape and alignment, thus avoiding medial and lateral impingement and enabling the patient to resume a normal lifestyle. ORIF is the most popular technique for these fractures, but it is associated with high rates of wound complications, hardware failure and infections. Several minimally-invasive techniques have been developed recently for the treatment of CF, with the common aim to be as simple, effective and inexpensive as possible and to reduce surgical times, complications and length of hospital stay.


Assuntos
Calcâneo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Radiografia , Adulto , Placas Ósseas , Fios Ortopédicos , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Feminino , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Resultado do Tratamento
13.
Reumatismo ; 68(1): 1-39, 2016 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-27339372

RESUMO

Osteoporosis poses a significant public health issue. National Societies have developed Guidelines for the diagnosis and treatment of this disorder with an effort of adapting specific tools for risk assessment on the peculiar characteristics of a given population. The Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS) has recently revised the previously published Guidelines on the diagnosis, riskassessment, prevention and management of primary and secondary osteoporosis. The guidelines were first drafted by a working group and then approved by the board of SIOMMMS. Subsequently they received also the endorsement of other major Scientific Societies that deal with bone metabolic disease. These recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on leading experts' experience and opinion, and on good clinical practice. The osteoporosis prevention should be based on the elimination of specific risk factors. The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk, and this is the case only when the risk of fracture is rather high as measured with variables susceptible to pharmacological effect. DeFRA (FRAX® derived fracture risk assessment) is recognized as a useful tool for easily estimate the long-term fracture risk. Several secondary forms of osteoporosis require a specific diagnostic and therapeutic management.


Assuntos
Absorciometria de Fóton , Densidade Óssea , Osteoporose , Reumatologia , Absorciometria de Fóton/métodos , Medicina Baseada em Evidências , Humanos , Incidência , Itália/epidemiologia , Metanálise como Assunto , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/prevenção & controle , Osteoporose/terapia , Fraturas por Osteoporose/prevenção & controle , Medição de Risco , Fatores de Risco , Sociedades Médicas
14.
Osteoporos Int ; 27(11): 3155-3164, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27289533

RESUMO

Our meta-analysis demonstrates that people with nephrolithiasis have decreased bone mineral density, an increased odds of osteoporosis, and potentially an elevated risk of fractures. INTRODUCTION: People with nephrolithiasis might be at risk of reduced bone mineral density (BMD) and fractures, but the data is equivocal. We conducted a meta-analysis to investigate if patients with nephrolithiasis have worse bone health outcomes (BMD), osteoporosis, and fractures versus healthy controls (HCs). METHODS: Two investigators searched major databases for articles reporting BMD (expressed as g/cm2 or a T- or Z-score), osteoporosis or fractures in a sample of people with nephrolithiasis, and HCs. Standardized mean differences (SMDs), 95 % confidence intervals (CIs) were calculated for BMD parameters; in addition odds (ORs) for case-control and adjusted hazard ratios (HRs) in longitudinal studies for categorical variables were calculated. RESULTS: From 1816 initial hits, 28 studies were included. A meta-analysis of case-control studies including 1595 patients with nephrolithiasis (mean age 41.1 years) versus 3402 HCs (mean age 40.2 years) was conducted. Patients with nephrolithiasis showed significant lower T-scores values for the spine (seven studies; SMD = -0.69; 95 % CI = -0.86 to -0.52; I 2 = 0 %), total hip (seven studies; SMD = -0.82; 95 % CI = -1.11 to -0.52; I 2 = 72 %), and femoral neck (six studies; SMD = -0.67; 95 % CI = --1.00 to -0.34; I 2 = 69 %). A meta-analysis of the case-controlled studies suggests that people with nephrolithiasis are at increased risk of fractures (OR = 1.15, 95 % CI = 1.12-1.17, p < 0.0001, studies = 4), while the risk of fractures in two longitudinal studies demonstrated trend level significance (HR = 1.31, 95 % CI = 0.95-1.62). People with nephrolithiasis were four times more likely to have osteoporosis than HCs (OR = 4.12, p < 0.0001). CONCLUSIONS: Nephrolithiasis is associated with lower BMD, an increased risk of osteoporosis, and possibly, fractures. Future screening/preventative interventions targeting bone health might be indicated.


Assuntos
Densidade Óssea , Fraturas Ósseas/complicações , Nefrolitíase/complicações , Osteoporose/complicações , Adulto , Humanos , Fatores de Risco
15.
Radiat Prot Dosimetry ; 170(1-4): 433-6, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27012882

RESUMO

Individual monitoring for both external and internal exposures is well regulated in Switzerland. The article gives an overview on the occupational exposure to external radiation of workers based on the data collected in the Swiss national dose registry (NDR) in 2013. The NDR records the monthly doses of radiation workers since the introduction of ICRP 60 recommendations and is manifested in the Swiss ordinance since 1994. Annual dose limits for effective dose are typically exceeded once a year in Switzerland, mostly in medicine. The NDR is a useful optimisation tool to identify and characterise areas with the highest exposures. While exceeded dose limits were often related to accidental acute exposure in the past, they are now more related to continuous exposure during normal work, especially in medicine.


Assuntos
Exposição Ocupacional/análise , Monitoramento de Radiação/normas , Proteção Radiológica/normas , Bases de Dados Factuais , Órgãos Governamentais , Física Sanitária , Humanos , Exposição Ocupacional/legislação & jurisprudência , Exposição Ocupacional/prevenção & controle , Saúde do Trabalhador/legislação & jurisprudência , Roupa de Proteção , Doses de Radiação , Sistema de Registros , Medição de Risco , Suíça
16.
J Biol Regul Homeost Agents ; 29(4 Suppl): 73-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26652492

RESUMO

Bone metastases from carcinomas are epidemiologically rising because of the increased survival rate of oncologic patients, related to several factors such as improvement of primary and secondary screening, advancement of medical research and technology and the better understanding of mechanisms underlying bone metastases origination from primary tumor. Skeletal Related Events (SREs) can seriously affect quality of life in patients with metastatic disease. These events include the necessity of radiotherapy or bone surgery, malignant hypercalcemia, pathologic fractures and spinal cord compression. Among the SREs, pathologic fractures are the most disabling events and represent an emergency in these delicate patients. A pathologic fracture is defined as a fracture that occurs at the level of a pre-existing bone lesion (that is often a tumor), spontaneously or as the result of low-energy trauma (1). The pre-existence of the metastatic lesion in the bone, its evaluation and the assessment of progression can make these complications predictable and preventable. Pathologic fractures imply several severe consequences, including patient immobilization (in the case of fractures involving the lower limbs), loss of autonomy, anaemia, need of blood transfusion, discontinuation of medical therapies or radiotherapy and protracted hospitalization. Secondary effects of prolonged immobilization and loss of autonomy further lengthen this list of complications in patients who are already significantly limited in their activities. In the present paper, the authors present a review on the main aspects involved in bone metastastic disease: biology, quality of life, economic impact and survival.

17.
Eur Rev Med Pharmacol Sci ; 19(19): 3543-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26502841

RESUMO

OBJECTIVE: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent vestibular disorders. BPPV as a complication of Osteotome Sinus Floor Elevation (OSFE) is a complication that rarely occurs. The aim of this paper is to better understand the mechanisms underlying the BPPV after SFE with the osteotomes. This could be important for all the dental and maxillofacial surgeons that should know and manage this clinical occurrence. DISCUSSION: The osteotome sinus floor elevation (OSFE), firstly described by Summers requires the use of a surgical mallet for striking the bone, until the optimal depth is reached. The surgical mallet develops a mechanical trauma, even if the striking is performed with a gentle percussion. The recent literature describes an average occurrence of OSFE-induced BPPV quite low, but the symptoms show to be unpleasant and severe, often able to alter the patient's daily life. CONCLUSIONS: A successful remission of BPPV following treatment with a particle repositioning maneuver will be necessary and relatively urgent for the surgeons who have experienced this clinical complication. The surgeons, therefore, must be aware of these complications and about the ways to manage them.


Assuntos
Vertigem Posicional Paroxística Benigna/etiologia , Osteotomia/efeitos adversos , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Humanos , Posicionamento do Paciente
18.
Acta ortop. mex ; 29(5): 271-274, sep.-oct. 2015. ilus
Artigo em Espanhol | LILACS | ID: lil-782706

RESUMO

Osteoarthritis secondary to developmental dysplasia of the hip is a surgical challenge because of the modified anatomy of the acetabulum which is deficient in its shape with poor bone quality, torsional deformities of the femur and the altered morphology of femoral head. Particularly in Crowe type III and IV, additional surgical challenges are present, such as limb-length discrepancy and adductor muscle contractures. This is a bilateral hip dysplasia case where bilateral hip replacement was indicated, on the left side with a resurfacing one and on the other side a two stage procedure using a iliofemoral external fixator to restore equal leg length with a lower risk of complications. This case report shows both the negative clinical outcome of the left and the excellent one of the right hip where the dysplasia was much more severe. Patient selection and implant positioning are crucial in determining long-term results.


La osteoartritis secundaria a displasia del desarrollo de la cadera es un reto quirúrgico debido a la anatomía modificada del acetábulo que es deficiente en su forma, con mala calidad del hueso, deformidades de torsión del fémur y la morfología alterada de la cabeza femoral; en particular en los tipos III y IV de Crowe, retos quirúrgicos adicionales están presentes, tales como dismetría y contracturas musculares de los aductores. En este caso de displasia de cadera bilateral se indicó el reemplazo bilateral, en el lado izquierdo con una prótesis de resuperficialización y en el otro lado se realizó un procedimiento de dos etapas utilizando un fijador externo iliofemoral para restaurar la longitud de la pierna con un menor riesgo de complicaciones. Este caso muestra tanto el resultado negativo de la cadera izquierda como el excelente resultado de la cadera derecha, donde la displasia fue mucho más grave. La selección del paciente y la colocación del implante son cruciales en la determinación de resultados a largo plazo.


Assuntos
Humanos , Prescrições de Medicamentos , Erros de Medicação , Polimedicação , Padrões de Prática Médica , Acidentes por Quedas/prevenção & controle , Fatores de Risco
19.
Eur Rev Med Pharmacol Sci ; 19(6): 927-30, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25855914

RESUMO

OBJECTIVE: The main goal of the modern surgery is to get a low invasiveness and a high rate of clinical healing: in the last years, it has been introduced the concept of a "regenerative surgery", and many techniques has been widely described in the literature. The most used are PRP, PRGF and PRF techniques. Aim of this research is to compare the three protocol of PRP, PRF and PRGF in their essential features, so to suggest to the practitioners the best blood product to use in the regenerative surgery. DISCUSSION AND CONCLUSIONS: Among the advantages that shows the PRF, compared to PRP and PRGF, we can cite a greater simplicity of production for the absence of manipulation that leads to a reduced possibility of alteration of the protocol due to an error of the operator. The special texture of the PRF and its biological features shows clearly an interesting surgical versatility and all the characteristics that can support a faster tissues regeneration and high-quality clinical outcomes.


Assuntos
Fibrina/administração & dosagem , Peptídeos e Proteínas de Sinalização Intercelular/administração & dosagem , Plasma Rico em Plaquetas/fisiologia , Cicatrização/fisiologia , Humanos , Cicatrização/efeitos dos fármacos
20.
Osteoporos Int ; 26(5): 1639-46, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25616509

RESUMO

UNLABELLED: In this population-based, cross-sectional study in Italian postmenopausal females not affected by diabetes, we showed a link between serum C-peptide and lumbar bone mineral density, suggesting that C-peptide exerts an insulin-independent effect on bone mass. INTRODUCTION: It is well known that type 1 (T1) diabetes, characterized by insulin and C-peptide deficiency, is associated with a low lumbar bone mineral density and an increased risk for fracture. While a role for insulin in the pathogenesis of osteoporosis has been demonstrated, the association between C-peptide and the bone mineral density has not been investigated. We conducted a study in a cohort of 84 postmenopausal women without diabetes to clarify the association between serum C-peptide and the lumbar bone mineral density. METHODS: Participants underwent a bone mineral density evaluation by DXA and biochemical analysis including the C-peptide assay. RESULTS: rteen percent of the population had osteoporosis and 38% had osteopenia. With ANOVA test, we showed that women with the lowest C-peptide concentration had lower lumbar mineral density in comparison to those in all other C-peptide concentration group (p = 0.02 among groups after adjustment). The univariate and multivariate analysis showed that C-peptide was positively associated with both lumbar T-score and Z-score besides other well-known factors like age (with T-score p < 0.001; beta = -0.38) and BMI (with T-score p = 0.009; beta = 0.34), while insulin was not correlated with the lumbar bone mineral density. The area under the receiver operating characteristic (ROC) curve for C-peptide to predict the absence of lumbar osteoporosis was 0.74 (SE = 0.073; p = 0.013). CONCLUSIONS: These results suggest that C-peptide may exert an insulin- and BMI-independent effect on lumbar bone mineral density and that further large-scale studies are needed in order to clarify its role in bone mineralization especially in subjects without diabetes.


Assuntos
Doenças Ósseas Metabólicas/sangue , Peptídeo C/deficiência , Vértebras Lombares/fisiopatologia , Absorciometria de Fóton/métodos , Idoso , Biomarcadores/sangue , Índice de Massa Corporal , Densidade Óssea/fisiologia , Doenças Ósseas Metabólicas/fisiopatologia , Peptídeo C/sangue , Estudos Transversais , Diabetes Mellitus/sangue , Feminino , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/sangue , Osteoporose Pós-Menopausa/fisiopatologia , Sensibilidade e Especificidade
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