Efficacy of a Non-addictive Nasal Irrigation Based on Sea Salt Enriched with Natural Enzymes among Patients with Sinusitis: An In Vivo, Randomized, Controlled Trial

BACKGROUND: Chronic rhinosinusitis (CRS) is a common condition that is defined as inflammation of the nose and paranasal sinuses. Nasal irrigation plays an important role in the treatment of CRS. Evidence from basic research favors hypertonic saline over isotonic saline for mucociliary clearance, but evidence from clinical studies is controversial. AIM: This study aims to investigate the hypothesis that the use of daily nasal irrigation based on sea salt, enriched with natural enzymes and lysozyme, may be useful in patients with CRS. PATIENT AND METHODS: Patients (30 men and 30 women) 18–55 years old (mean age 41 ± 3 y.o.), with two episodes of acute sinusitis or one episode of chronic sinusitis per year for 2 consecutive years, were enrolled stratified by sex and age and randomly divided into two groups supplementation: Group A (test) and Group B (control/placebo). Moreover, an exit questionnaire was asked to Group A subjects to report whether their sinus-related quality of life has gotten worse, stayed the same, or improved (scale from 0 to ±100%). RESULTS: The result showed that in the test group (A) from T0 to T1, a reduction of 17.65% for the symptoms related headache and/or facial pressure and a reduction of the 18.18%, for the symptoms relates to congestion and/or nasal discharge. On the other hand, the control group (B) shown less difference between T0 and T1. CONCLUSIONS: This study strengthens the argument that the tested formulation is a safe, well-tolerated, long-term therapy that patients with chronic sinonasal complaints can and will use at home with minimal training and follow-up

Gastrointestinal symptoms and motility disorders in patients with systemic scleroderma

<p>Abstract</p> <p>Background</p> <p>Studies on gastrointestinal symptoms, dysfunctions, and neurological disorders in systemic scleroderma are lacking so far.</p> <p>Methods</p> <p>Thirty-eight scleroderma patients (34 limited, 4 diffuse), 60 healthy controls and 68 dyspeptic controls were scored for upper and lower gastrointestinal symptoms (dyspepsia, bowel habits), gastric and gallbladder emptying to liquid meal (functional ultrasonography) and small bowel transit (H₂-breath test). Autonomic nerve function was assessed by cardiovascular tests.</p> <p>Results</p> <p>The score for dyspepsia (mainly gastric fullness) was greater in scleroderma patients than healthy controls, but lower than dyspeptic controls who had multiple symptoms, instead. Scleroderma patients with dyspepsia had a longer disease duration. Fasting antral area and postprandial antral dilatation were smaller in scleroderma patients than dyspeptic and healthy controls. Gastric emptying was delayed in both scleroderma patients (particularly in those with abnormal dyspeptic score) and dyspeptic controls, who also showed a larger residual area. Despite gallbladder fasting and postprandial volumes were comparable across the three groups, gallbladder refilling appeared delayed in dyspeptic controls and mainly dependent on delayed gastric emptying in scleroderma. Small intestinal transit was also delayed in 74% of scleroderma and 66% of dyspeptic controls. Bowel habits were similar among the three groups. Autonomic neuropathy was not associated with dyspepsia, gastric and gallbladder motility and small intestinal transit.</p> <p>Conclusion</p> <p>In scleroderma patients dyspepsia (mainly gastric fullness), restricted distension of the gastric antrum and diffuse gastrointestinal dysmotility are frequent features. These defects are independent from the occurrence of autonomic neuropathy.</p

From Bench to Bedside in Precision Medicine: Diabetes Mellitus and Peri-Implantitis Clinical Indices with a Short-Term Follow-Up: A Systematic Review and Meta-Analysis

Background and objective: Diabetes mellitus (DM) refers to a group of metabolic disorders characterized by hyperglycemia resulting from impaired secretion or action of insulin. The high levels of glucose in the blood can negatively affect the healing processes through alterations in vascularization, bone remodeling, and with increased susceptibility to infections. Diabetes mellitus is therefore a risk factor not only for many systemic diseases, but also for localized problems such as peri-implantitis. The objective of this systematic review was to identify a clear relationship between peri-implant inflammation indices and glycemic levels, through the investigation of prospective studies that report data on a short-term follow-up period. Our hypothesis was that peri-implant inflammatory indices may already present themselves in a statistically significant way as altered in patients with DM compared to patients without DM. Materials and methods: This review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Results: More than 992 records were identified in the PubMed, Scopus, and Cochrane Central Register of Controlled Trial electronic databases and only seven studies were included in the meta-analysis. The results of the meta-analysis report worse outcomes in patients with DM, even in the short period of six months, for peri-implatitis inflammation indices, such as Marginal bone loss (standardized (Std). mean difference (MD) 12 months 0.81 [0.45, 1.17].82 [0.53, 3.10]), Bleeding on probing (Std. MD 12 months 2.84 [1.34, 4.34].44 [1.41, 5.50]), Probing depth (Std. MD 12 months 1.14 [0.60, 1.68].24 [0.66, 3.83]), and the plaque index (Std. MD 12 months 2.83 [0.09, 5.57]). Conclusion: The literature linking glycaemic control to peri-implant disease is highly heterogeneous due to lack of consistency of the definition of peri-implantitis and its clinical indicators among studies. Therefore, interpretation of finding and relevance to clinical practice should be considered on individual bases. In the era of personalized medicine, the clinician should utilize individualized information from translational researches and analyze all risk factors to provide the patient with evidence-based treatment options

Presentation of Graves' orbitopathy within European Group On Graves' Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)

Background: Graves' orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves' Orbitopathy (EUGOGO) tertiary referral centres and initial management over time. Methods: Prospective observational multicentre study. All new referrals with diagnosis of GO within September-December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012. Results: Besides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p&lt;0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0-350) vs 6 (0-552) months; p&lt;0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p&lt;0.001) or selenium (22.3% vs 3.0%; p&lt;0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p&lt;0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027). Conclusion: GO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment

Spatial and temporal distribution of mercury in the recent sediments of the Adriatic Sea

Several sources of anthropogenic mercury (Hg), which date back to the sixteenth century, have been identified in the Adriatic Sea making this basin one of the most contaminated marine areas with regard to duration and amount of metal accumulated. Taking into account 2 complementary datasets, the distribution of total Hg was investigated in surface sediments (0.003-16.940 \u3bcg g-1; avg. 0.715\ub11.929 \u3bcg g-1; median 0.102 \u3bcg g-1, n=162) and in 7 short cores collected from the Po River delta to the Strait of Otranto (0.002-0.963 \u3bcg g-1; avg. 0.171\ub10.226 \u3bcg g-1; median 0.077 \u3bcg g-1, n=189). The objectives of our research were to integrate the two datasets in a distribution map to identify anomalies and potential sources at basin scale, and to reconstruct the recent history of sediment contamination. Results show that the coastal sediments of the northern sector are particularly enriched in Hg compared to the area extending from the Po delta to the Otranto Strait. This is due to the presence of multiple sources of contamination, the main one identifiable in the Gulf of Trieste at the north-easternmost side of the basin. Even now the Isonzo River supplies significant quantities of Hg to the sea, mainly in mineral form (cinnabar) as a result of mining activity that was operating at Idrija (Slovenia) for 500 years (Covelli et al., 2001). The nearby Marano and Grado Lagoon is another prominent area of metal accumulation by sources which include but are not restricted to mining (Acquavita et al., 2012). Part of Hg contamination is also associated with the past activity of a chlor-alkali plant whose effluents were deliberately discharged into the lagoon system. The \u201cindustrial\u201d Hg was dispersed in this environment mixing with Hg from Idrija mine. Similarly, other sources can be recognised in the Venice Lagoon (the Porto Marghera industrial site) and Po River drainage basin. As we proceed southwards along the Italian coast, the concentrations of Hg decrease showing a significant negative gradient with increasing distances from the emission sources. The sedimentary profiles of Hg show decreasing trends in concentration and flux over the last 20-30 years indicating the beginning of a \u201crecovery\u201d period. The only exception is the core collected offshore Otranto, which still shows a weak increasing trend probably due to a delay in transferring the contamination signal of Hg coming from the northern sector of the basin

[The treatment of recurrent uveitis with TNF-alpha inhibitors].

Objective. Uveitis is a severe manifestation of rheumatic diseases since it can lead to visual impairment and even blindness. Ocular involvement is frequently a clinical challenge because its occurrence often requires changes of the therapeutic strategy. There are growing evidence that tumor necrosis factor α (TNFα) inhibitors may be an effective treatment of refractory uveitis. Purpose of this study was to evaluate the efficacy and safety of TNFα blocking agents in patients with seronegative spondylo-arthropathies (SNSA) and Behcet disease (BD) associated relapsing uveitis. Methods. Five consecutive patients with chronic or relapsing uveitis were prospectively studied. Two patients with SNSA had recurrent anterior uveitis and three patients had BD associated uveitis (one anterior, two posterior uveitis). All of the patients were taking systemic and topical corticosteroids and three of them were also treated with DMARDS (methotrexate, cyclosporine, sulphasalazine) without clinical benefit. Four patients received infliximab, an anti- TNFα monoclonal antibody, at a dosage of 5 mg/kg body weight and one patient was treated with etanercept, a TNFα receptor p75-Fc fusion protein, at a dosage of 25 mg twice weekly. Results. Both infliximab and etanercept induced a marked improvement in uveitis and none relapse was observed throughout all the study. Systemic corticosteroids were progressively tapered and stopped in all patients. Also methotrexate and sulphasalazine were discontinued, while cyclosporine dose has been reduced by 30% until now. No side effects were observed. Conclusions. Therapy with TNFα blockers, infliximab and etanercept, was effective and safe in the treatment of rheumatic disease associated uveitis. A complete remission was achieved even in patients with severe steroid resistant uveitis. Further controlled studies on larger number of patients are needed to better define the different forms of ocular involvement that can benefit from the therapy with TNFα inhibitors

An Ancient Science to Improve Today’s Clinical Practice: Oral Surgery Meets Human Anatomy

Human body dissection was a ubiquitous practice in the past, to better understand anatomy and to develop medicine. Today, its role could still be important to answer everyday clinical queries and help surgeons. The example of the possible lack of anesthesia during symphysis surgeries can emphasize the usefulness of dissection. The mandibular symphysis usually receives innervation from inferior alveolar nerve terminations, but, in some rare cases, a particular anastomosis involves the lingual nerve and the nerve to the mylohyoid. The anatomical knowledge resulting from body dissections could help oral surgeons to understand the reason why the patient could feel pain during the surgery, and ensure performance of the right lingual nerve block to obtain complete anesthesia. This clinical situation shows the educational role of an ancient, yet still valid, practice, human dissection, and the importance of anatomical studies to improve surgical skills, to provide better treatment for the patient

Refractory knee giant cell tumor of the synovial membrane treated with intra-articular injection of Infliximab: A case series and review of the literature

Giant cell tumor (GCT) of the synovial membrane, also known as pigmented villonodular synovitis, causes a progressive, relapsing and destructive arthropathy affecting one or more synovial joints. Systemic therapy can be combined to intra-articular treatments, including surgical synoviectomy, especially when monoarticular. Despite that, the synovial membrane commonly grows again with clinical relapse. Here, we report three case of patients diagnosed with GCT of the knee who had an early relapse of the disease even after surgical synoviectomy. All of them underwent intra-articular therapy with infliximab and subsequent synoviectomy to eradicate residual tissue. A complete remission of CGT was achieved without relapse occurring during the follow-up. These preliminary data need to be confirmed by further clinical trials; however, intra-articular therapy with infliximab might be deemed a potential option to treat CGT of a single joint