AMASI epidemiological study on children living in L'Aquila

AIM

The aim of the study is to observe the statistical relationship between children's habits, oral heath, pregnancy history and breastfeeding.

METHODS

A cross-sectional study was carried out on the pupils of the first and second grades of the primary schools of the "Silvestro" and "Amiternum" school districts of L'Aquila (Italy). The study population consisted of 496 (244 females and 252 males) students. The data were collected through anamnesis carried out by qualified health personnel before dental examination. According to the WHO criteria clinical teething examination standard, the presence of caries was determined by the dmft index (decayed-filled-missing deciduous teeth). Shapiro-Wilk test, Chi-square test and t test used. P values below 0.05 were considered statistically significant.

CONCLUSION

There is not enough evidence to advise against breastfeeding lasting more than one year due to the risk of tooth decay. Supportive practices need to be implemented to counteract risk factors. A larger sample is needed to study the role of human milk.

Food insecurity, home ownership and income-related equity in dental care use and access: the case of Canada

Background

It has been documented that income is a strong determinant of dental care use in Canada, mostly due to the lack of public coverage for dental care. We assess the contributions of food insecurity and home ownership to income-related equity in dental care use and access. We add to the literature by adding these two variables among other socio-economic determinants of equity in dental care use and access to dental care. Evidence on equity in access to and use of dental care in Canada can inform policymaking.

Methods

We estimate income-related horizontal inequity indexes for the probability of 1) receiving at least one dental visit in the last 12 months; and 2) lack of dental visits during the 3 years before the interview. We conduct the analyses using data from the 2013–2014 Canadian Community Health Survey (CCHS) at the national and regional level.

Results

There is pro-rich inequity in the probability of visiting a dentist or an orthodontist and in access to dental care in Ontario. Inequities vary across jurisdictions. Housing tenure and food insecurity contribute importantly to both use of and access to dental care, adding information not captured by standard socio-economic determinants.

Conclusions

Redistributing income may not be enough to reduce inequities. Careful monitoring of equity in dental care is needed together with interventions targeting fragile groups not only in terms of income but also in improving house and food security.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12760-6.

Vertical Equity in Healthcare Financing: A Progressivity Analysis for the Italian Regions

Background: The aim of this paper is to measure for the first time in Italy the progressivity of healthcare financing systems at the regional level by using the Kakwani index (KI), the most widely used summary measure of progressivity in the healthcare financing literature. Methods: KIs were reported by region and by health financing sources for the year 2015. Results: There were significant vertical inequities in healthcare financing at both national and regional level. OOP (out-of-pocket) payments and value added tax were slightly regressive; income taxation on firms and households was progressive. Conclusions: After the introduction of fiscal federalism during the 90s, the healthcare financing system became regressive. A regional divide emerged: Overall regressivity is higher in the south and lower in the north, partly compensated by the interregional equalization mechanism, based on the redistribution of VAT from northern to southern regions. In times of policy interventions aiming at recovering the economy during the COVID-19 pandemic, it is important to monitor equity in healthcare financing.

Response to COVID-19: was Italy (un)prepared?

On 31st January 2020, the Italian cabinet declared a 6-month national emergency after the detection of the first two COVID-19 positive cases in Rome, two Chinese tourists travelling from Wuhan. Between then and the total lockdown introduced on 22nd March 2020 Italy was hit by an unprecedented crisis. In addition to being the first European country to be heavily swept by the COVID-19 pandemic, Italy was the first to introduce stringent lockdown measures. The SARS-CoV-2 outbreak and related COVID-19 pandemic have been the worst public health challenge endured in recent history by Italy. Two months since the beginning of the first wave, the estimated excess deaths in Lombardy, the hardest hit region in the country, reached a peak of more than 23,000 deaths. The extraordinary pressures exerted on the Italian Servizio Sanitario Nazionale (SSN) inevitably leads to questions about its preparedness and the appropriateness and effectiveness of responses implemented at both national and regional levels. The aim of the paper is to critically review the Italian response to the COVID-19 crisis spanning from the first early acute phases of the emergency (March-May 2020) to the relative stability of the epidemiological situation just before the second outbreak in October 2020.

Corona-regionalism? Differences in regional responses to COVID-19 in Italy

The paper discusses the responses to the COVID-19 crisis in the acute phase of the first wave of the pandemic (February-May 2020) by different Italian regions in Italy, which has a decentralised healthcare system. We consider five regions (Lombardy, Veneto, Emilia-Romagna, Umbria, Apulia) which are located in the north, centre and south of Italy. These five regions differ both in their healthcare systems and in the extent to which they were hit by the first wave of COVID-19 pandemic. We investigate their different responses to COVID-19 reflecting on seven management factors: (1) monitoring, (2) learning, (3) decision-making, (4) coordinating, (5) communicating, (6) leading, and (7) recovering capacity. In light of these factors, we discuss the analogies and differences among the regions and their different institutional choices.

Carotid Stenting and Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Tandem Occlusions: Antithrombotic Treatment and Functional Outcome

BACKGROUND AND PURPOSE

There is no consensus on the optimal antithrombotic medication for patients with acute ischemic stroke with anterior circulation tandem occlusions treated with emergent carotid stent placement and mechanical thrombectomy. The identification of factors influencing hemorrhagic risks can assist in creating appropriate therapeutic algorithms for such patients. This study aimed to investigate the impact of medical therapy on functional and safety outcomes in patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions.

MATERIALS AND METHODS

A multicenter retrospective study on prospectively collected data was conducted. Only patients treated with carotid stent placement and mechanical thrombectomy for tandem occlusions of the anterior circulation were included. Univariate and multivariate analyses were performed on preprocedural, procedural, and postprocedural variables to assess factors influencing clinical outcome, symptomatic intracranial hemorrhage, stent patency, and successful intracranial vessel recanalization.

RESULTS

Ninety-five patients with acute ischemic stroke and tandem occlusions were included. Good clinical outcome (mRS ≤ 2) at 3 months was reached by 33 (39.3%) patients and was associated with baseline ASPECTS ≥ 8 (OR = 1.53; 95% CI, 1.16-2.00), ≤2 mechanical thrombectomy attempts (OR = 0.71; 95% CI, 0.55-0.99), and the absence of symptomatic intracranial hemorrhage (OR = 0.13; 95% CI , 0.03-0.51). Symptomatic intracranial hemorrhage was associated with a higher amount of intraprocedural heparin, ASPECTS ≤ 7, and ≥3 mechanical thrombectomy attempts. No relationships among types of acute antiplatelet regimen, intravenous thrombolysis, and symptomatic intracranial hemorrhage were observed. Patients receiving dual-antiplatelet therapy after hemorrhagic transformation had been ruled out on 24-hour CT were more likely to achieve functional independence and had a lower risk of symptomatic intracranial hemorrhage.

CONCLUSIONS

During carotid stent placement and mechanical thrombectomy for tandem occlusion treatment, higher intraprocedural heparin dosage (≥3000 IU) increased symptomatic intracranial hemorrhage risk when the initial ASPECTS was ≤7, and mechanical thrombectomy needs more than one passage for complete recanalization. Antiplatelets antiplatelets use were safe, and dual-antiaggregation therapy was related to better functional outcomes.

Combined use of daily and hourly data sets for the source apportionment of particulate matter near a waste incinerator plant

A particulate matter (PM) source apportionment study was carried out in one of the most polluted districts of Tuscany (Italy), close to an old waste incinerator plant. Due to the high PM10 levels, an extensive field campaign was supported by the Regional Government to identify the main PM sources and quantify their contributions. PM10 daily samples were collected for one year and analysed by different techniques to obtain a complete chemical characterisation (elements, ions and carbon fractions). Hourly fine (<2.5 μm) and coarse (2.5-10 μm) aerosol samples were collected by a Streaker sampler for a shorter period and hourly elemental concentrations were obtained by PIXE. Positive Matrix Factorization (PMF) analysis of daily and hourly data allowed the identification of 10 main sources: six anthropogenic (Biomass Burning, Traffic, Secondary Nitrates, Secondary Sulphates, Incinerator, Heavy Oil combustion), two natural (Saharan Dust and Fresh Sea Salt) and two mixed sources (Local Dust and Aged Sea Salt). Biomass burning turned out to be the main source of PM, accounting for 30% of the PM10 mass as annual average, followed by Traffic (18%) and Secondary Nitrates (14%). Emissions from the Incinerator turned out to be only 2% of PM10 mass on average. PM10 composition and source apportionment have been assessed in a polluted area near a waste incinerator, by PMF analysis on daily and hourly compositional data sets.

TENS effects on salivary stress markers: A pilot study

Transcutaneous electrical nerve stimulation (TENS) is extensively used as pain relief through endorphins release. Moreover, recent findings showed a role in the activation of the autonomic nervous system (ANS); it was evidenced by modification in the heart rate variability and ANS-related marker. The objective of this pilot study is to evaluate salivary alpha amylase (sAA) as a marker of stress in two groups of healthy subjects, one receiving ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS) and one without stimulation. Sixty healthy people were enrolled. The test group consisted of 30 participants (15 men, 15 women). The control group consisted of 30 participants (15 men, 15 women). Statistical analysis showed that sAA levels were statistically different between men and women independently from TENS; we hypothesize that treatment could influence sAA levels because it is thought to activate μ opioid receptors. The results of this study seem to indicate that the analysis of sAA, through a non-invasive saliva sample, could be an efficient aid for understanding the functions of the autonomic nervous system.

Migrant integration policies and health inequalities in Europe

BACKGROUND

Research on socio-economic determinants of migrant health inequalities has produced a large body of evidence. There is lack of evidence on the influence of structural factors on lives of fragile groups, frequently exposed to health inequalities. The role of poor socio-economic status and country level structural factors, such as migrant integration policies, in explaining migrant health inequalities is unclear. The objective of this paper is to examine the role of migrant socio-economic status and the impact of migrant integration policies on health inequalities during the recent economic crisis in Europe.

METHODS

Using the 2012 wave of Eurostat EU-SILC data for a set of 23 European countries, we estimate multilevel mixed-effects ordered logit models for self-assessed poor health (SAH) and self-reported limiting long-standing illnesses (LLS), and multilevel mixed-effects logit models for self-reported chronic illness (SC). We estimate two-level models with individuals nested within countries, allowing for both individual socio-economic determinants of health and country-level characteristics (healthy life years expectancy, proportion of health care expenditure over the GDP, and problems in migrant integration policies, derived from the Migrant Integration Policy Index (MIPEX).

RESULTS

Being a non-European citizen or born outside Europe does not increase the odds of reporting poor health conditions, in accordance with the "healthy migrant effect". However, the country context in terms of problems in migrant integration policies influences negatively all of the three measures of health (self-reported health status, limiting long-standing illnesses, and self-reported chronic illness) in foreign people living in European countries, and partially offsets the "healthy migrant effect".

CONCLUSIONS

Policies for migrant integration can reduce migrant health disparities.

Biomass burning contributions estimated by synergistic coupling of daily and hourly aerosol composition records

Biomass burning (BB) is a significant source of particulate matter (PM) in many parts of the world. Whereas numerous studies demonstrate the relevance of BB emissions in central and northern Europe, the quantification of this source has been assessed only in few cities in southern European countries. In this work, the application of Positive Matrix Factorisation (PMF) allowed a clear identification and quantification of an unexpected very high biomass burning contribution in Tuscany (central Italy), in the most polluted site of the PATOS project. In this urban background site, BB accounted for 37% of the mass of PM10 (particulate matter with aerodynamic diameter<10 μm) as annual average, and more than 50% during winter, being the main cause of all the PM10 limit exceedances. Due to the chemical complexity of BB emissions, an accurate assessment of this source contribution is not always easily achievable using just a single tracer. The present work takes advantage of the combination of a long-term daily data-set, characterized by an extended chemical speciation, with a short-term high time resolution (1-hour) and size-segregated data-set, obtained by PIXE analyses of streaker samples. The hourly time pattern of the BB source, characterised by a periodic behaviour with peaks starting at about 6 p.m. and lasting all the evening-night, and its strong seasonality, with higher values in the winter period, clearly confirmed the hypothesis of a domestic heating source (also excluding important contributions from wildfires and agricultural wastes burning).

Homocysteine plasma levels in psoriasis patients: our experience and review of the literature

BACKGROUND

People with psoriasis are at higher cardiovascular risk. Plasma levels of homocysteine over the normal range have been recognized as marker of cardiovascular risk. Psoriasis patients express higher levels of plasma homocysteine than healthy people.

OBJECTIVE

Our study aims to investigate the correlation between homocysteinaemia, severity and duration of psoriasis and psoriasis arthritis, and to evaluate the effect of a 12-week administration of a target therapy for psoriasis on homocysteinaemia.

METHODS

Fifty-two psoriasis patients (study group) submitted to different kind of therapy for psoriasis (biological, systemic not biological and topical) and 24 healthy Italian subject (control group) were evaluated for their plasmatic homocysteine levels, both at baseline (T0) and 12 weeks after they a specific therapy for psoriasis.

RESULTS

A significant difference between the homocysteinaemia of psoriasis patients (mean 19.71 ± 11.16) and control group (13.90 ± 11.18), P < 0.05 (Fig. 1), was found at baseline (T0). The mean plasma levels of homocysteine were directly correlated with disease severity (P = 0.0401), but not with disease duration (P = 0.6018) or presence of arthritis (P = 0.6221) at baseline. None among the treatments administered to psoriasis patients caused a significant reduction in homocysteinaemia after 12 weeks of treatment.

CONCLUSION

Our results confirm that psoriasis patients with more severe disease, can have hyperhomocysteinaemia, without regard to disease duration or joint involvement. Hyperhomocysteinaemia is not influenced by a target therapy for psoriasis and it is as greater as psoriasis severity. However, limitation of our study is the relatively small number of cases. Homocysteine plasmatic levels should be advisable as a further independent risk factor for cardiovascular disease in psoriasis patients.

Skin features in myotonic dystrophy type 1: an observational study

Poor data regarding skin involvement in Myotonic Dystrophy, also named Dystrophia Myotonica type 1, have been reported. This study aimed to investigate the prevalence and types of skin disorders in adult patients with Myotonic Dystrophy type 1. Fifty-five patients and one hundred age- and sex-matched healthy subjects were referred to a trained dermatologist for a complete skin examination to check for potential cutaneous hallmarks of disease. No difference in prevalence of preneoplastic, neoplastic, and cutaneous lesions was detected between the two groups. Among morphofunctional, proliferative and inflammatory lesions, focal hyperhidrosis (p < 0.0001), follicular hyperkeratosis (p = 0.0003), early androgenic alopecia (p = 0.01), nail pitting (p = 0.003), pedunculus fibromas (p = 0. 01), twisted hair (p = 0.01), seborrheic dermatitis (p = 0.02), macules of hyperpigmentation (p = 0.03) were significantly more frequent in patients compared with controls. In patients with Myotonic Dystrophy type 1 significant differences according to sex were found for: early androgenic alopecia, twisted hair and seborrheic dermatitis, whose prevalence was higher in males (p < 0.0001). Our preliminary results seem to rule out an increased prevalence of pre-neoplastic, and neoplastic skin lesions in Myotonic Dystrophy type 1. On the other hand, an increased prevalence of morphofunctional, inflammatory, and proliferative diseases involving adnexal structures seems to characterize adult patients with Myotonic Dystrophy type 1.

Advanced glycation end products: possible link between metabolic syndrome and periodontal diseases

On a planetary scale, Metabolic Syndrome (MetS)is the third cause of inability after malnutrition and nicotinism, even higher than water shortage and sedentariness. In the USA, the prevalence is estimated at over 25 percent of the population; in Italy, it involves approximately 25 percent of men and even 27 percent of women. These are very high figures, corresponding to approximately 14 million affected individuals. The prevalence is alarming and must not be underestimated, particularly in the dental field, where more than one patient out of four sitting in a dentist chair is affected. The etiology of periodontal disease has not yet been clarified, and recently the idea to consider it as a multifactor pathology has been developed. Cofactors such as the formation of free radicals of oxygen (ROS), oxidative stress, lipid peroxidation, and formation of glycation end-products (AGEs) probably play an important role in the onset of periodontal disease. The AGEs are compounds physiologically produced by the cells. However, they accumulate and cause pro-inflammatory conditions, when the cellular clearance fails, or in hyperglycemic and oxidative states. All these conditions can be clinically summarized as Metabolic Syndrome. The purpose of this literature review is to establish a relationship between two pathologies with very high prevalence: Metabolic Syndrome and Periodontal Disorder. The literature seems to have clarified that MetS involves a pro-oxidation status, which induces AGE formation. AGEs play a very important role in the course and severity of periodontal diseases.

Determinants of health disparities between Italian regions

Background

Among European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy.

Methods

We use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health.

Results

We find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions.

Conclusion

The implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

Apoptosis in the kidneys of patients with type II diabetic nephropathy

The occurrence and extent of apoptosis in the kidneys of patients with diabetic nephropathy is largely unknown. We evaluated apoptosis in renal biopsies obtained from patients with early or advanced type II diabetic nephropathy. Apoptosis was about 6- and 3-fold higher, respectively, in glomeruli and tubules in kidneys of patients with early nephropathy than in the normal kidney and this was not further increased in advanced diabetic nephropathy. Glomerular apoptosis was related directly to hemoglobin A1(c) and systolic blood pressure, whereas tubular cell apoptosis correlated to diabetes duration and low-density lipoprotein-cholesterol. Fas, Fas ligand, and p38 mitogen-activated protein kinase expressions were enhanced in glomeruli and tubules; however, this did not correlate with apoptosis. In patients with proteinuria, apoptosis was associated with the subsequent loss of kidney function. When these parameters were subjected to multivariate analysis, only glomerular apoptosis retained a significant independent predictive value. Our findings suggest that apoptosis might be a clinically relevant mechanism of glomerular and tubular cell loss in proteinuric type II diabetic patients.

Neuromuscular diagnosis in orthodontics: effects of TENS on maxillo-mandibular relationship

AIM

This study was conducted in order to assess the changes in the occlusal position of the mandible after Ultra Low Frequency (ULF)-TENS relaxing procedure in children with diagnosed functional mandibular lateral deviation.

METHODS

This study was performed on 20 children, aged between 8 and 12 years, with a mean age of 10 years (SD 0.79) with functional mandibular lateral deviation, diagnosed by clinical and cephalometric evaluation, referred to the Dental Clinic for paediatric dental care. Diagnostic neuromuscular registrations were made for all children, and their casts mounted on articulator Galetti at the myocentric position and compared to casts provided of a wax bite registration in intercuspal position.

RESULTS

The alignment of the midline after TENS was not punctual (p >0.05). Compared with the existing intercuspal position, neuromuscular registration showed improvement in 10 (50%) patients, 6 patients (30%) showed no changes, while worsening of the tooth-midline discrepancy was assessed in the remaining 4 (20%). The molar relationship did not follow the same trend of the midline because of the three-dimensional changes in the maxillo-mandibular relationship induced by TENS. After TENS there was a significant correlation between midline and right side deviation (r >0.65), there was no correlation between midline and the left side (r <0.65). Furthermore, right molar movement showed no correlation with the contralateral molar (r <0.65). The posterior areas of the arch were moving in a very unpredictable way, resulting in the diagnosis and prognosis of mandibular lateral deviation as absolutely individual and unpredictable. Conclusion This study suggests that TENS recorded occlusion is an interesting diagnostic approach in orthodontics since it allows visualising the trends of the neuromuscular system.

Caries-risk assessment: the role of salivary tests

Although the incidence of caries has diminished dramatically over the past 3 decades, small groups of subjects remain highly susceptible and do not respond to conventional preventive programs. An accurate individual caries-risk assessment allows to identify the etiological factors responsible for the disease and design a rational approach to treatment, addressed to the specific needs of the patients. The use of appropriate caries-risk prediction models, which include the use of simple chairside caries-susceptibility salivary tests, is the most suitable and modern approach to the problem. A review of the literature on salivary tests, at present available, able to identify the factors contributing to caries susceptibility, is presented. Each test is accurately described, with regard both to its procedure and the interpretation of its results:

Visual input effect on EMG activity of masticatory and postural muscles in healthy and in myopic children

AIM

The purpose of this study was to evaluate the activity of Anterior Temporal, Masseter, Sternocleidomastoid and Anterior Digastric muscles in response to changes in visual input in subjects with defective vision by means surface electromyography.

METHODS

A total of 20 children, aged between 7 and 13 years, were evaluated. In the study group 10 children with myopic defects were enlisted, selected among patients afferent to the paediatric dentistry clinic. Ten subjects with normal vision, the control group, were chosen through the Pair Matching procedures, so that each myopic child had a matching age case control. Both study group and control group patients maintained mandible at rest with teeth apart and were submitted to a 15-sec electromyography (EMG) recording with closed eyes followed by a 15-sec EMG recording with open eyes.

RESULTS/STATISTICS

The Root Mean Square (RMS) values were elaborated to obtain means and standard deviation. Statistical analysis was undertaken using the Student's T-test for independent samples. Analysis of the results demonstrated a marked difference in tonic activity of temporal anterior muscles at open eyes between the myopic and the normal groups.

CONCLUSION

The findings suggest that in the evaluation of masticatory muscles tenderness, such as episodic tension type headaches, attention should be paid to vision defects.

Some tools for the identification of high caries risk individuals. A review

As a consequence of the polarisation of dental caries, which occurred over the last 3 decades in industrialised countries, the usefulness of risk assessment, both for individuals and for groups of subjects, became evident. At individual level, the early identification of high and medium caries-risk subjects allows to plan specific preventive measures for each subject's needs, based on the risk grade and the causally-directed diagnosis. At population level, risk assessment helps to increase the efficiency and to reduce the costs of caries preventive programmes. In this study, a review of caries-risk indicators is proposed: these indicators, collected through the analysis of relevant background data, clinical examination and salivary tests are indispensable to achieve a correct caries-risk assessment. A review of the studies on the attempts to produce prediction models for caries-risk assessment is presented: in view of the multifactorial nature of caries etiology and the complexity of the prediction of individual caries-risk, a multivariate approach is necessary. Finally, some suggestions on the clinical usefulness and on indications of caries-risk determination are given.

Relationship between mandibular deviation and ocular convergence

Recent studies have confirmed the relationship between head posture, mandibular position and visual focusing. A case-controlled study was conducted to assess the occurrence of ocular convergence defects between subjects with functional mandibular latero-deviation and healthy subjects in pediatric age. Sixty subjects (the study group) presented mandibular latero-deviation classified as functional according to the use of a clinical examination and frontal and basal tele-radiography. Sixty subjects without functional mandibular laterodeviation (control group) were selected randomly from all subjects seeking pediatric dental care and matched by gender and age to study group. All one hundred and twenty subjects were submitted to orthoptic tests performed by the same operator. These results seemed to confirm that in mandibular latero-deviation subjects ocular convergence defects occurred in greater frequency than in controls underlining the importance of role of pediatric dentistry among interdisciplinary cooperation.

Gender and the progression of chronic renal diseases: does apoptosis make the difference?

Several studies in patients with chronic kidney diseases have shown that men have a more rapid disease progression than women. Also, with ageing, men exhibit greater decrements in renal function and increased glomerular sclerosis than women. Data from meta-analysis studies indicate that women with several non-diabetic renal diseases such as membranous nephropathy, IgA nephropathy and polycystic kidney disease present a slower progression, but in diabetic renal disease this is not yet established. Thus, men appear to be at greater risk for renal injury than are women, but the underlying mechanisms are unknown. Sex hormones may mediate the effects of gender on chronic renal disease, through the interaction with the renin-angiotensin system, the modulation of nitric oxide synthesis and the downregulation of collagen degradation. New observations indicate that androgens may contribute to continuous loss of kidney cells though the stimulation of apoptotic pathways. Apoptosis is an unique type of programmed cell death which is activated in several chronic kidney diseases. Studies in vitro indicate that androgens prime a Fas/FasL dependent apoptotic pathway in kidney tubule cells. This apoptotic cell death pathway is receptor-linked and interacts with the mitochondrial pathway, which may be activated by other mechanisms, such as toxins and ischemia. Therefore, the mechanisms to cell death which are primed by androgens may interact with others occurring in several conditions leading to the loss of renal cells. These findings are consistent with a role for androgens to promote chronic renal injury in men.

[Complications of the nephrotic syndrome]

We described the case of a 27-year-old man presenting pulmonary embolism and hyperlipidaemia. Subsequent investigation revealed that he was affected by renal vein thrombosis and nephrotic syndrome due to membranous glomeruloephritis. Nephrotic syndrome complications are numerous and may represent the first sign of the syndrome. Among these complications we find thromboembolism, infections, negative nitrogen balance and renal failure. There are very few prognostic indicators that enable the prediction of nephrotic syndrome complications. Recent advances in the understanding of alterations in the metabolism of circulating and somatic proteins associated with proteinuria and hypooncotic condition have led to new insights into the pathophysiologic processes associated with the syndrome.

[Oral cancer]

Oral cancer (OC) is a rather frequent pathology representing about 30% of head and neck malignant neoplasms. After many years the incidence of the pathology shows constant values; the male:female ratio is continuously decreasing and at present, it is about of 2:1. The delay in diagnosis is the main cause of unsuccessful treatment and of the high values of poor outcome. OC shows three clinical aspects: exophytic, ulcerative and infiltrative; lips and margins of tongue are the most interested sites. For the diagnosis a correct clinical examination and a biopsy, possibly made with incisional criteria are necessary.

The anxiety in bruxer child. A case-control study

BACKGROUND

The etiopathogenesis of bruxism in children is not clear although different authors would associate it with several factors, changes in dentition, malocclusions, certain parasomnias and most notably emotional stress. This study was performed to test the hypothesis that anxiety states measured by "Anxiety Scale for evolutive age" may affect the development of bruxism.

METHODS

A total of eighty-six children, aged between 7 and 1, were evaluated. In the study-group were enlisted forty-three children with bruxism selected among patients afferent to the paediatric dentistry clinic. The forty-three non bruxer children, the control group, were chosen through the Pair Matching procedures, so that each bruxer child had a matching age case control. The gravity of bruxism was scored by means of 0 to 3 graduated scale of dental wear. The psychological aspects were estimated by means of an Anxiety Scale for evolutive age. Statistical analysis was undertaken using the "Odds Ratio" on statistically significant values. The most significant level was evaluated by the Mc Nemar test.

RESULTS

Remarkable differences in anxiety levels were found among the children of the two groups; 72% of bruxers showed significant anxiety scores versus 12% of non bruxers. The results of Odds Ratio reveal that a bruxer child has a 16 times greater probability to be anxious than an non bruxer one.

CONCLUSIONS

The data provide support for the concept that anxiety state is a prominent factor in the development of bruxing behaviour in children.

The Chernobyl accident: EPR dosimetry on dental enamel of children

The radiation dose on tooth enamel of children living close to Chernobyl has been evaluated by EPR. The sample preparation was reduced to a minimum of mechanical steps to remove a piece of enamel. A standard X-ray tube at low energy was used for additive irradiation. The filtration effect of facial soft tissue was taken into account. The radiation dose for a group of teeth slightly exceeds the annual dose, whereas for another group the dose very much exceeds the annual dose. Since the higher dose is found in teeth whose enamel have much lower EPR sensitivity to the radiation, it can be suggested that for these teeth the native signal could alter the evaluation of the smaller radiation signal.

[Use of Electronic Spin Resonance in the study of dental enamel caries. Preliminary results]

BACKGROUND

By means of the Electron Spin Resonance technique (EPR) it is possible to detect carbonate-related paramagnetic centers in human tooth enamel. Several arguments indicate that the radicals formed after X-ray irradiation (CO2- and CO3(3-)) are ascribed to carbonate which is the most important constituent of hydroxyapatite. There is experimental evidence that the distribution of the orientation of these centers is related to microcrystal alignment in dental enamel, which might be responsible for caries susceptibility. The results reported in the literature, however, should be interpreted very carefully.

METHODS

In our own preliminary research we studied twenty-seven samples of dental enamel taken from the buccal face of upper molars. Fifteen were carious and the other ones were sound. We used the R-parameter and the S-parameter to convert our experimental results into numerical values. The R-parameters, as introduced by Cevc et al. (1976-1980) is the ratio of the amplitude for the high field and the low component of the EPR signal. The S-parameter is the ratio of the amplitude of the A2 component and the low one.

RESULTS

No significant difference was found between the R and S-value of carious and sound dental enamel samples. The degree of microcrystal alignment in enamel of clinically sound upper molar from their buccal site is very high. However, this result is not sufficient to evaluate the caries susceptibility or the caries resistance of tooth enamel.

CONCLUSIONS

Therefore, we can conclude that it is not sufficient to ascribe the caries susceptibility to the R-value, because other factors (such as etiological factors and the structure of the teeth) should be considered.

[Polishing of composite resins. Instrumental notes]

BACKGROUND

The polishing is the last procedure in the application of composite fillings. The surface morphology and the marginal seal, that are indispensable for integration of composite fillings with dental tissue and oral environment, are tightly dependent on polishing procedure.

METHODS

The authors tried out experimental therapeutic procedure in order to examine the surface of any composite resin polymerizated under matrix on a slide before and after polishing made by abrasive disease and finally after application of a new resin layer on a polished composite surface. These composite surfaces was examined with AFM and SEM.

RESULTS

The images prove that in the polished specimens there is a restoration of composite morphology surface because of the partial removal of organic part during the polishing. The polymerization of a new resin layer on polished surface make this one more regular and even as a substitute for partial removal of organic part during the polishing.

CONCLUSIONS

The experimental procedure prove that the ideal composite surface is that polymerizated under matrix because every treatment on this surface affect the composite filling's quality.

[Single-contrast enema after colon lavage in the elderly patient]

Double-contrast enema is often unsuccessful in elderly patients because of their poor cooperation and colon cleaning. This work was aimed at showing that a well-done single-contrast exam with simple colon lavage can make a very good alternative to double-contrast enema in elderly patients. Thus, 66 consecutive elderly patients (age range: 70-90 years) were submitted, over a 6-month period (June-December, 1994), to single-contrast enema, after colon cleaning with oral whole-gut lavage, using an osmotically balanced electrolyte solution (Isocolan, Bracco) containing polyethylenglycol (PEG 4000). We examined, in each patient: a) the tolerance to and effectiveness of bowel cleaning, according to the liquid volume drunk by each subject, needed to obtain clear diarrhea; b) radiograph quality. Successful colon cleaning was achieved with a mean (2.5-3 liters) and a large (3.5-4 liters) amount of solution, in 80% and 20% of our patients, respectively. Tolerance was good in the whole series except for 3 patients with emesis. Moreover, radiograph quality was good in 85% of the subjects. Finally, barium enema results, compared with endoscopic results, yielded 27 true positives, 3 false negatives (small neoplastic lesions) and 1 false positive. Therefore, in our opinion, these results confirm the role of single-contrast enema, combined with gut lavage, in elderly patients.

[Fine needle aspiration in the cytologic diagnosis of swellings in the parotid and submandibular regions. Cytologic-histologic correlations in 49 cases]

Fine needle aspiration biopsy (FNAB) has been widely used for a number of years and offers considerable advantages in comparison to conventional surgical biopsy. A number of organs can be subject to this diagnostic procedure with good results, including the salivary glands. This paper aimed to compare the cytological diagnosis of biopsy material obtained using FNAB and the subsequent histological diagnosis formulated after surgery in 49 patients with swellings in the parotid or submandibular region who were referred to the Department of Anatomy and Pathological Histology in L'Aquila. Cytohistological concordance was present in 87.7% of the cases in this series, a percentage that is in line with that reported by other authors. The most frequent causes of diagnostic error may be ascribed to moderate nodule size and/or the scanty material obtained not suitable for diagnosis. In this series all cases of malignant neoplasia were correctly diagnosed. In spite of the limitations of this method, the authors consider that it plays an important role in the preoperative diagnosis of salivary gland pathologies.

[Epidermoid carcinoma of the oral cavity. Considerations of the role of the papillomavirus]

Human papilloma virus (HPV) may have an important role in oral carcinoma etiology. Our work compares the presence of HPV in the epithelium of oral mucosa of patients with oral carcinoma with other factors of risk (smoking, alcohol, chronic mucosal trauma). We studied 33 patients operated for oral cancer at St. Salvatore Hospital in l'Aquila, in January-December 1990. The presence of HPV was proved by a direct valuation of morphological signs (coilocytosis, nuclear inclusions, etc.) and by immunohistochemical technique with primary antibodies against structural virus antigens. Among the 33 patients 19 (57.6%) were positive for HPV and 14 (42.4%) were negative. Among the HPV positive subjects 13 were smokers, 11 usually assumed alcohol and 6 had chronic mucosal trauma. Among the HPV negative subjects 9 were smokers, 7 assumed alcohol and 3 had chronic mucosal trauma. The statistical evaluation of data showed the lack of significance of viral infection compared to other factors of risk. In spite of a few cases examined, we suppose that HPV doesn't play a primary role in oral cancerogenesis, but is a concomitant cause with other factors of risk.

Color Doppler sonography of salivary glands

OBJECTIVE

We used color Doppler sonography to evaluate the vascular anatomy of the salivary glands and to analyze physiologic changes that occur during salivary stimulation in normal subjects and the flow alterations that occur in diseased glands.

SUBJECTS AND METHODS

The vascular appearance of the three major salivary glands was examined in healthy volunteers (n = 24); in patients with chronic autoimmune diseases, including Sjögren's syndrome (n = 23) and salivary sarcoidosis (n = 2); and in a variety of benign (n = 49) and malignant (n = 13) nodules. Physiologic changes were assessed in healthy volunteers by means of a stimulation test with lemon and were quantified with color images and spectral analysis. Tumor vascularity was graded on a four-step analog scale of 0 to (+3) and classified as either peripheral or hilar, depending on the distribution of vessels.

RESULTS

In the control subjects, color Doppler imaging accurately reflected the complex vascular anatomy of the salivary glands and showed dramatic changes occurring in parenchymal vessels during lemon stimulation as a result of the intense hyperemia associated with the secretion of saliva. Sjögren's syndrome and sarcoidosis showed a diffuse hypervascular pattern when morphologic changes of salivary parenchyma were seen on gray-scale sonograms. Benign tumors showed a lower grade of vascularity than did malignant tumors. All but one of the hypovascular nodules graded as 0 (n = 8) and + (n = 23) were benign. Conversely, eight of 11 nodules labeled with the highest grade of tumor vascularity (+3) were malignant. When the pattern of tumor flow signals was peripheral, it could be considered specific enough to aid in diagnosing pleomorphic adenoma. Peak systolic velocities greater than 60 cm/sec were never detected in benign tumors and were seen in only 44% of malignant tumors.

CONCLUSION

Color Doppler sonography is a promising technique for analyzing the vascularity of the salivary glands and for characterizing some pathologic conditions. Our experience suggests that color Doppler sonography can provide additional diagnostic information in patients with chronic inflammatory diseases or suspected malignant tumors and can help in differentiating pleomorphic adenomas from other salivary gland tumors.

[Artifacts in echo-Doppler and color-Doppler]

It is well known that artifacts can be observed during US examinations; the same is true also for Doppler and color-Doppler images of blood flow. Recognizing these artifacts is important to avoid image misinterpretations and, when possible, to overcome them by modifying either techniques or unit settings, or both. This work was aimed at presenting the several artifacts which can be observed during Doppler investigations, at classifying them, and trying to understand the physical and/or technical principles underlying their origin. Doppler and color-Doppler artifacts can be divided into four large groups: 1) artifacts regarding evaluation of the presence of flow; 2) artifacts regarding evaluation of the direction of flow; 3) artifacts regarding determination of the velocity of flow; 4) artifacts affecting spatial location, on the screen, of the examined vessel. Each of the above can cause severe diagnostic misinterpretations, if not correctly recognized and interpreted. It must be kept in mind that an accurate analysis of unit settings during scanning, and the meticulous evaluation of the obtained color images are of the utmost importance for the proper use of this valuable but difficult diagnostic technique.

[Echography in laryngeal tumors]

During sonographic (US) studies of the neck for the nodal staging of patients with laryngeal neoplasms, the authors observed that, especially in advanced cases, also the primary lesion could be imaged with this method. Therefore, US capabilities were investigated in assessing the local stage of laryngeal neoplasms; the results were compared with clinical and surgical findings. Fifty normal subjects of various ages were previously examined to assess the normal US anatomy of laryngeal structures. The presence of calcifications within the thyroid cartilage is the major obstacle to US imaging of the larynx and is directly related to age; indeed, only 40% of subjects can be examined at the age of 70. Seventeen patients with advanced laryngeal tumors were examined by US. Laryngeal imaging was possible, either in part or completely, in 16 of 17 cases. The results were in agreement with clinical staging in 14 cases; in 2 cases US proved clinical understaging by detecting lesion spread to anterolateral perilaryngeal structures. To conclude, US is not suggested as the method of choice in patients with laryngeal neoplasms. However, in subjects with advanced tumors, also US can image the lesion directly, and even detect tumor spread to surrounding tissues, especially in the anterior and lateral directions. In a few cases, this can contribute to preoperative staging and to select the correct therapeutic approach.

[Papilloma of the palate. Clinical and histopathology]

An asymptomatic, exophytic and unusually large mass of hard and soft palate is presented. Its papillary surface architecture is characteristic of an oral squamous papilloma. The cause is unknown. Recurrent or malignant change, or both, are possible.

[Subcutaneous emphysema during intraligamental anesthesia]

Periodontal ligament anaesthesia (PDLA) is a good choice to most common local anaesthesia methods. In the present work the Authors report a case of subcutaneous emphysema as adverse effect of this injection technique.

[Epidemiological and clinical study of dental agenesis]

This work realized thanks to exchange by IFMSA happened at Medical School Praga's invitation, describes two researchs. The first presents the casuistry of scholastic czechoslovak population; the second 87 cases with multiple teeth agenesis observed at Pedodontic's Clinical of Praga's Hospital Motol. The Authors, after describing the review of literature about epidemiology, etiopathogenetic, symptomatology and diagnosis aspects, present a personal contribution in accordance with existing literature.

[A clinical study of cyclopyroxolamine versus clotrimazole in the treatment of mycotic vulvovaginitis]

The therapeutic efficacy and tolerability of the antifungal agent ciclopiroxolamine have been verified with a double-blind study versus clotrimazole in 46 patients affected by vulvovaginal candidiasis. The patients of the first group (23) have been treated with ciclopiroxolamine globules, one 100 mg globule nightly for six days; the second group (23 patients) received clotrimazole vaginal tablets, one 200 mg tablet nightly for six days. Ciclopiroxolamine treatment showed an equivalent effectiveness to that of clotrimazole both on signs and symptoms and on vaginal smear culture. No local or systemic adverse reaction was observed.

[Removal of impacted teeth. Indications and contraindications]

After reporting the classification and the etiopathogenesis of the dental inclusions, the Authors discuss the advisabilities and the drawbacks for their removal, on the basis of a personal study.