Il paziente con cardiopatia congenita

Il capitolo rivolge l'attenzione alle patologie del distretto oro-cefalico del paziente pediatrico affetto da cardiopatia congenita, offrendo indicazioni di diagnosi e terapia sulla base dell'esperienza clinica e delle evidenze presenti in letteratura

Due casi di ipomagnesemia familiare, ipercalciuria e nefrocalcinosi caratteristiche odontostomatologiche

L\u2019ipomagnesemia familiare con ipercalciuria e nefrocalcinosi (FHHNC) \ue8 una sindrome molto rara, descritta per la prima volta da Praha nel 1995. Si presenta con nefrocalcinosi (patognomonica), poliuria, polidispsia, alterazioni oculari, infezioni renali ricorrenti, nefrolitiasi. La sindrome \ue8 stata codificata geneticamente nel 1999 come disordine autosomico recessivo connesso ad una mutazione del gene paracellina-1, che codifica per una proteina coinvolta nel riassorbimento tubulare del magnesio e del calcio. La rarit\ue0 della sindrome giustifica le poche e non sempre concordanti descrizioni presenti in letteratura e l\u2019assenza di dati relativi alle caratteristiche odontostomatologiche. Due sorelle di razza cinese, una di 18 ed una di 15 anni, affette dalla sindrome in esame sono state inviate in consulenza al Servizio di Assistenza odontoiatrica per Disabili del Dipartimento di Scienze odontostomatologiche dal Reparto di Pediatria del Policlinico S.Orsola-Malpighi. La situazione odontoiatrica delle due sorelle \ue8 caratterizzata da anomalie della struttura dentale del tipo amelogenesi e dentinogenesi imperfetta e da parodontopatia profonda, in sono prevalenti le anomalie della struttura dentale, nell\u2019altra un grave quadro di gengivite marginale e di parodontopatia profonda. Sono necessarie ulteriori indagini per stabilire una connessione tra il disordine metabolico di base e le patologie dentali e parodontali rilevate in queste pazienti

Autotrapianto in paziente autistico: follow up a quattro anni

L’autotrapianto dentale è una metodica in genere utilizzata per sostituire elementi perduti a causa di trauma o per correggere agenesia ed ectopie. Viene presentato un caso clinico in cui è stato compiuto un autotrapianto di un terzo molare per sostituire un primo molare fortemente compromesso a causa di patologia cariosa, in un ragazzo affetto da autismo. La scarsa collaborazione e quindi l’impossibilità di compiere un trattamento tradizionale con ricostruzione protesica dell’elemento, hanno portato a questa scelta terapeutica. Vengono descritte le fasi dell’intervento e il caso seguito per quattro anni, durante i quali si registra il mantenimento della vitalità pulpare pur avendo, l’elemento autotrapiantato, l’apice maturo. Il caso descritto dimostra come questo tipo di intervento possa rappresentare una alternativa terapeutica per sostituire elementi dentali perduti in giovani adulti scarsamente collaboranti affetti da disabilità e dimostra inoltre come la vitalità dell’elemento possa essere mantenuta anche quando l’apice è completamente formato al momento dell’impiant

Novel therapeutic approaches based on the pathological role of gut dysbiosis on the link between nonalcoholic fatty liver disease and insulin resistance

The growing global epidemic of obesity and type 2 diabetes mellitus has determined an increased prevalence of NAFLD (non-alcoholic fatty liver disease), making it the most common chronic liver disease in the Western world and a leading cause of liver transplantation. In the last few years, a rising number of studies conducted both on animal and human models have shown the existence of a close association between insulin resistance (IR), dysbiosis, and steatosis. However, all the mechanisms that lead to impaired permeability, inflammation, and fibrosis have not been fully clarified. Recently, new possible treatment modalities have received much attention. To reach the review purpose, a broad-ranging literature search on multidisciplinary research databases was performed using the following terms alone or in combination: “NAFLD”, “gut dysbiosis”, “insulin resistance”, “inflammation”, “probiotics”, “Chinese herbs”. The use of probiotics, prebiotics, symbiotics, postbiotics, fecal microbiota transplant (FMT), Chinese herbal medicine, antibiotics, diet (polyphenols and fasting diets), and minor therapies such as carbon nanoparticles, the MCJ protein, water rich in molecular hydrogen, seems to be able to improve the phenotypic pattern in NAFLD patients. In this review, we provide an overview of how IR and dysbiosis contribute to the development and progression of NAFLD, as well as the therapeutic strategies currently in use

Polypharmacy in older people: lessons from 10\ua0years of experience with the REPOSI\ua0register

As a consequence of population aging, we have witnessed in internal medicine hospital wards a progressive shift from a population of in-patients relatively young and mainly affected by a single ailment to one of ever older and more and more complex patients with multiple chronic diseases, followed as out-patients by many different specialists with poor integration and\ua0inevitably treated with multiple medications. Polypharmacy (defined as the chronic intake of five or more drugs) is associated with increased risks of drug\u2013drug interactions and related adverse effects, prescription and intake errors, poor compliance, re-hospitalization and mortality. With this background, the Italian Society of Internal Medicine chose to start in 2008 a prospective register called REPOSI (REgistro POliterapie SIMI, Societ\ue0 Italiana di Medicina Interna) in internal medicine and geriatric hospital wards. The country wide register is an ongoing observatory on multimorbidity and polypharmacy in the oldest old, with the goal to improve prescription appropriateness and, thus to avoid potentially inappropriate medications. The main findings of the register, that has accrued so far, 7005 older patients throughout a 10\ua0year period, are summarized herewith, with special emphasis on the main patterns of poor prescription appropriateness and related risks of adverse events

Mortality rate and risk factors for gastrointestinal bleeding in elderly patients

Background: Gastrointestinal bleeding (GIB) is burdened by high mortality rate that increases with aging. Elderly patients may be exposed to multiple risk factors for GIB. We aimed at defining the impact of GIB in elderly patients. Methods: Since 2008, samples of elderly patients (age 65 65 years) with multimorbidity admitted to 101 internal medicine wards across Italy have been prospectively enrolled and followed-up (REPOSI registry). Diagnoses of GIB, length of stay (LOS), mortality rate, and possible risk factors, including drugs, index of comorbidity (Cumulative Illness Rating Scale [CIRS]), polypharmacy, and chronic diseases were assessed. Adjusted multivariate logistic regression models were computed. Results: 3872 patients were included (mean age 79 \ub1 7.5 years, F:M ratio 1.1:1). GIB was reported in 120 patients (mean age 79.6 \ub1 7.3 years, F:M 0.9:1), with a crude prevalence of 3.1%. Upper GIB occurred in 72 patients (mean age 79.3 \ub1 7.6 years, F:M 0.8:1), lower GIB in 51 patients (mean age 79.4 \ub1 7.1 years, F:M 0.9:1), and both upper/lower GIB in 3 patients. Hemorrhagic gastritis/duodenitis and colonic diverticular disease were the most common causes. The LOS of patients with GIB was 11.7 \ub1 8.1 days, with a 3.3% in-hospital and a 9.4% 3-month mortality rates. Liver cirrhosis (OR 5.64; CI 2.51\u201312.65), non-ASA antiplatelet agents (OR 2.70; CI 1.23\u20135.90), and CIRS index of comorbidity >3 (OR 2.41; CI 1.16\u20134.98) were associated with GIB (p < 0.05). Conclusions: A high index of comorbidity is associated with high odds of GIB in elderly patients. The use of non-ASA antiplatelet agents should be discussed in patients with multimorbidity