Eye-related emergencies incidence at a tertiary referral center in Southern Italy during COVID-19 related lockdown

Background: In order to contain the community spread of coronavirus disease (COVID-19) in Italy, a stringent lockdown was imposed, which also impacted the healthcare services. The purpose of this study is to investigate the drop in the number of outpatients in the Ophthalmic Emergency Service (OES) in the Eye Clinic of University of Bari during the COVID-19 lockdown. Methods: A retrospective analysis of electronic medical records from a tertiary referral center in Southern Italy was performed. Demographics and medical characteristics of patients examined in the OES between March 10th, 2020 and May 3rd, 2020 were assessed and compared with records from the same period in 2019. We categorized the patients by sex, age group, and by the type of eye disease that was recorded as the principal diagnosis. The change (%) in the number of patients and diseases between the study periods was analyzed. Results: We observed a reduction in the number of OES visits during the lockdown (-63.4%) compared to the number of visits in 2019. The greatest changes were observed in the youngest (≤20 years; -76.6%) and the most elderly patients (≥81 years; -70.9%). The decrease in the number of patients presenting with each pathology ranged from -82% to -28.5%, depending on the pathology, and mainly involved the orbital and palpebral pathologies, anterior segment disorders, non-specific visual symptoms, and minor injuries. The diagnosis of chronic pathologies, rhegmatogenous retinal detachment, and vitreous haemorrhage increased by 134%, 100%, and 75%, respectively. Conclusions: Our results revealed the impact of the COVID-19 lockdown on OES activities in the Eye Clinic of University of Bari. A drop in number of visits across all age groups was observed. The number of patients presenting with minor and nonurgent conditions decreased, whereas the number of patients presenting with chronic diseases and urgent but deferrable conditions increased

Multivariate analysis of the influence of peri-implant clinical parameters and local factors on radiographic bone loss in the posterior maxilla: a retrospective study on 277 dental implants

Objectives: The aim of the present study was to investigate whether peri-implant clinical parameters (modified plaque index (mPI), bleeding and/or suppuration on probing (B/SOP)) and local factors (type of prostheses, screw emergence, platform diameter, and abutment angulation) might contribute to the development of additional bone loss and peri-implantitis around dental implants. Materials and methods: Two hundred seventy-seven external hex connection implants placed in the posterior maxilla of 124 patients were retrospectively evaluated. They were divided into two groups: physiologic bone loss < 2 mm (PBL) or additional bone loss ≥ 2 mm (ABL). GEE logistic regression was applied to evaluate the influence of type of prostheses (implant-supported single crown (ISSC), fixed partial denture (ISFPD), and full denture (ISFD)) and clinical parameters (mPI and S/BOP) on bone loss. Results: Among the 277 implants, 159 (57.4%) presented PBL and 118 (42.6%) presented ABL. Within the ABL group, 20.6% implants were diagnosed with peri-implantitis. mPI significantly correlated with the type of prosthesis and the highest value of mPI (index = 3) was observed in ISFD (23.8%). Moreover, peri-implantitis was more frequently associated with ISFD (32.79%) than ISSC and ISFDP (13.79% and 13.48, respectively) Conclusions: ISFD in the posterior maxilla presented high rates of ABL and showed a higher prevalence of peri-implantitis. None of the local factors seemed to contribute to the development of these conditions. Further investigations are needed to prospectively support the results of the present study. Clinical relevance: Patients rehabilitated with ISFD should be carefully monitored and have more frequent maintenance visits to prevent or control peri-implant bone loss

Nazivi četvorni metar i kubni metar

The aim of this study was to determine the perioperative behavior of C-reactive protein (CRP) in Crohn's disease (CD) patients undergoing elective ileo-cecal (IC) resection and to identify association between perioperative CRP levels and endoscopic recurrence at 1 year. Study hypothesis was that perioperative CRP changes are disease specific and could detect subset of patients with more aggressive pathopysiology. Seventy-five patients undergoing IC resection for CD were prospectively enrolled. Serial CRP levels were assessed: preoperative, postoperative day 1 (POD1) and day 5 (POD5). CD patients' values were compared against same interval assessments of control groups undergoing right colectomy and appendicectomy. At POD1, the serum concentration increase was significantly higher in CD patients than in controls. Comparing with control groups, CRP levels remained remarkably high and showed a lower reduction in CD at POD5. Difference between groups was statistically significant. Optimal cutoff levels have been identified: serum CRP concentrations of >39.8 mg/l at POD1 and of >23.2 mg/l at POD5 have shown a significant association to endoscopic recurrence when using bivariate correlation. In this preliminary series, binary logistic regression could not demonstrate statistical relationship between endoscopic recurrence and any of the variables evaluated as prognostic factor. This is the only study so far that investigates and confirms a disease-specific upregulation of CRP response in the perioperative period for CD patients undergoing surgery. The postoperative CRP levels and kinetics seem to be related to the grade of mucosal inflammation and recurrence rate according to our 12 months endoscopic evaluation

BEVACIZUMZB VS RANIBIZUMAB. ASPETTI BIOETICI E MEDICO-LEGALI DOPO LO STUDIO CATT

Il trattamento della degenerazione maculare senile è attualmente oggetto di ampio dibattito. Anche se l’uso del Ranibizumab (Lucentis®) è stato autorizzato ed approvato, infatti, molti oculisti in Italia e in tutto il mondo prescrivono il Bevacizumab (Ava- stin®), che è, invece, autorizzato per il trattamento di alcuni tumori metastatici, ma non per delle patologie oculari. L’uso off-label di Bevacizumab sembra produrre risultati comparabili, come illustrato dalle linee-guida di società scientifiche di tutto il mondo e dal Gruppo di Ricerca CATT, a fronte di un costo notevolmente inferiore rispetto al trattamento con Ranibizumab. In questo contesto è bene ricordare che la pratica medica è, senza dubbio, basata sulla valutazione delle prove scientifiche e, di conseguenza, il processo di autorizzazione all’uso dei farmaci gioca un ruolo fondamentale. Il dibattito Lucentis®-Aventis® svela una tipica controversia nella pratica clinica tra la devozione alla mera evidenza scientifica ed il peso che alcuni altri elementi (ad esempio la sensibilità ed il rapporto costo-efficacia) rivestono nelle decisioni mediche. Secondo la prima teoria, l’uso off-label dei farmaci sarebbe scoraggiato in favore dei farmaci autorizzati. Questo approccio avrebbe l’effetto collaterale di limitare drastica- mente l’accesso universalistico ai servizi sanitari. Viceversa, la seconda teoria presta il fianco a critiche fondate sulla difficoltà di bilanciare il ruolo che l’empatia, il rapporto costo-efficacia ed altri criteri dovrebbero svolgere nella giustizia distributiva. Data la necessità di dimostrare l’equivalenza dell’effetto terapeutico, le aziende farmaceutiche non sempre hanno mostrato particolare attenzione al contesto sociale ed economico, soprattutto a causa della perdita di profitto derivante dalla messa in commercio di trattamenti più economici. Inoltre, in assenza di un chiaro indirizzo circa l’uso senza licenza oppure off-label dei farmaci da parte delle autorità competenti, sarebbe legitti- mo mettere in dubbio l’atteggiamento universalistico dal momento che quest’ultimo è palesemente limitato dall’efficacia. In entrambe le ipotesi, comunque, vi è il rischio di sussumere prove scientifiche per la massimizzazione del profitto (medicina basata sul reddito), dato che l’evidenza scienti- fica di per sé considerata potrebbe anche condizionare negativamente guadagni imme- diati e futuri delle aziende farmaceutiche, senza alcun rispetto della salute del singolo e della collettività. In tale contesto, prendere posizione tra le ipotesi di cui sopra sembra dipendere dal singolo professionista, determinando così disuguaglianze ingiuste. Inoltre, non vi è, ad oggi, protezione giuridica per i medici che agiscono secondo scienza e coscienza. Infatti, in presenza di prove scientifiche incomplete, l’uso off-label potrebbe essere valutato come non diligente. Anche in quest’ottica, ad oggi, secondo gli autori l’uso del Ranibizumab deve ritenersi pressoché obbligatorio rispetto al Bevacizumab

Isolated foveal hypoplasia

Abstract Purpose To describe a patient with isolated foveal hypoplasia. Methods A 55-year-old man with the clinical suspicion of foveal hypoplasia was given a complete ophthalmological examination, including optical coherence tomography (OCT), fluorescein angiography (FA) and fundus-related perimetry (FRP). Mutation screening for oculocutaneous albinism and aniridia was also performed, but the results were negative for both. Results Following a complete ophthalmological examination and genetic studies, we were able to confirm the clinical suspicion of isolated foveal hypoplasia in this otherwise healthy patient. Conclusions With this report we want to highlight the roles of OCT, FA and FRP in the diagnosis of such a singular condition as isolated foveal hypoplasia. Keywords Fluorescein angiography Fundus-related perimetry Foveal hypoplasia Optical coherence tomography Oculocutaneous albinis