microRNAs and Inflammatory Immune Response in SARS-CoV-2 Infection: A Narrative Review

The current SARS-CoV-2 pandemic has emerged as an international challenge with strong medical and socioeconomic impact. The spectrum of clinical manifestations of SARS-CoV-2 is wide, covering asymptomatic or mild cases up to severe and life-threatening complications. Critical courses of SARS-CoV-2 infection are thought to be driven by the so-called “cytokine storm”, derived from an excessive immune response that induces the release of proinflammatory cytokines and chemokines. In recent years, non-coding RNAs (ncRNAs) emerged as potential diagnostic and therapeutic biomarkers in both inflammatory and infectious diseases. Therefore, the identification of SARS-CoV-2 miRNAs and host miRNAs is an important research topic, investigating the host–virus crosstalk in COVID-19 infection, trying to answer the pressing question of whether miRNA-based therapeutics can be employed to tackle SARS-CoV-2 complications. In this review, we aimed to directly address ncRNA role in SARS-CoV-2-immune system crosstalk upon COVID-19 infection, particularly focusing on inflammatory pathways and cytokine storm syndromes

in keeping with the spirit of the albertine statute constitutionalisation of the national unification

This chapter deals with the difficult process of constitutionalisation which characterised Italian Unification. Constitutionalisation is a long-term phenomenon which had the purpose of giving constitutional forms to the Nation. The promulgation of the Albertine Statute is more the start than the arrival of this phenomenon. The focus of this investigation is, therefore, to study the Constitution through its evolution paying particular attention to the process of legal integration within the structures of the Albertine Statute and to the amendment mechanisms of the constitutional text. The preamble of the Albertine Statute speaks of «perpetual and irrevocable fundamental law». The word «perpetual» meant the prohibition of revoking constitutional concession, while the word «irrevocable» was intended as a pact between the Sovereign and the Nation. Over the years, very few were the changes to the letter of the Albertine Statute. The interpretation and the practice represented the most important mechanisms of constitutional change (implicit constitutional changes). A primary role was acknowledged to non-written norms. In this perspective, it may well be said that the Italian Constitution consisted in something more than the written text and dwelt in the spirit and not in the letter of the Albertine Statute

Adult-onset still’s disease: Novel biomarkers of specific subsets, disease activity, and relapsing forms

Adult-onset Still’s disease (AOSD) is a systemic inflammatory disease of unknown etiology. Recent studies have demonstrated that the hallmark of AOSD is a cytokine storm, which is characterized by the excessive production of interleukin (IL)-1, IL-6, IL-18, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ), suggesting how pro-inflammatory cytokines play an important role in the pathogenesis of this disease. Actually, a certain proportion of patients (around 17–32%) with severe clinical symptoms achieves only partial remission or is resistant to both first-line corticosteroids and second-line DMARDs. These patients are defined as refractory AOSD patients, requiring higher dosage glucocorticoids, longer treatment duration, or the simultaneous introduction of immunosuppressive drugs, further leading to AOSD relapses. In this narrative review, we will analyze the latest literature data to unravel potential pathogenetic factors associated with specific patterns of AOSD disease or relapses in order to identify biomarkers that may guide clinical decisions, eventually leading to new therapeutic options

Reply to: “Herpes zoster seven days after SARS-CoV-2 vaccination in a patient with ankylosing spondylitis under adalimumab” by Josef Finsterer

Several guidelines suggest investigating the incidence and prevalence of vaccine-preventable infections in adult patients with autoimmune or inflammatory diseases; consequently, the effect and safe-ty issues of vaccination are under careful examination. Moreover, immunosup-pression and immunodeficiency were con-traindications for the previously available vaccine in the past years, thus live zoster vaccine was originally recommended for immunocompetent adults aged ≥50 years, leading to an unmet need for vaccination against HZ in immunocompromised adults. Considering all these efforts and the current pandemic challenge, we be-lieve that now more than ever we are asked to quickly detect potential adverse events, even extremely rare and mild ones, and to face them, in order to support the robust pharmacovigilance campaign for SARS-CoV2 vaccination

Herpes zoster infection following mRNA COVID-19 vaccine in a patient with ankylosing spondylitis

none4noSince the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic outbreak, vaccines gained a growing role. Possible vaccine-related side effects range from minor local events to more prominent systemic manifestations up to anaphylactic reactions. A heterogeneous spectrum of cutaneous reactions has been reported, ranging from local injection site reactions to urticarial and morbilliform eruptions, pernio/chilblains and zoster flares. Here, we describe a case of varicella zoster virus reactivation following mRNA coronavirus 2019 vaccine and discuss the available literature upon the topic published so far.openMaranini B.; Ciancio G.; Cultrera R.; Govoni M.Maranini, B.; Ciancio, G.; Cultrera, R.; Govoni, M

The Role of Ultrasound in Temporomandibular Joint Disorders: An Update and Future Perspectives

Temporomandibular joint (TMJ) disorder is the second most common chronic pain condition affecting the general population after back pain. It encompasses a complex set of conditions, manifesting with jaw pain and limitation in mouth opening, influencing chewing, eating, speaking, and facial expression. TMJ dysfunction could be related to mechanical abnormalities or underlying inflammatory arthropathies, such as rheumatoid arthritis (RA) or juvenile idiopathic arthritis (JIA). TMJ exhibits a complex anatomy, and thus a thorough investigation is required to detect the TMJ abnormalities. Importantly, TMJ involvement can be completely asymptomatic during the early stages of the disease, showing no clinically detectable signs, exposing patients to delayed diagnosis, and progressive irreversible condylar damage. For the prevention of JIA complications, early diagnosis is therefore essential. Currently, magnetic resonance imaging (MRI) is described in the literature as the gold standard method to evaluate TMJ. However, it is a high-cost procedure, not available in all centers, and requires a long time for image acquisition, which could represent a problem notably in the pediatric population. It also suffers restricted usage in patients with claustrophobia. Ultrasonography (US) has emerged in recent years as an alternative diagnostic method, as it is less expensive, not invasive, and does not demand special facilities. In this narrative review, we will investigate the power of US in TMJ disorders based on the most relevant literature data, from an early screening of TMJ changes to differential diagnosis and monitoring. We then propose a potential algorithm to optimize the management of TMJ pathology, questioning what would be the role of ultrasonographic study

Erythema nodosum after COVID-19 vaccine

: The current coronavirus disease 2019 (COVID-19) pandemic is a global challenge with strong medical and socioeconomic implications. Hopes have been placed in the development of various vaccines. As the vaccination campaign is in progress, adverse effects need to be monitored closely. Possible side effects range from minor events to more serious manifestations. In this article, we describe two cases of erythema nodosum (EN) after COVID-19 vaccination in two previously healthy female patients of 59 and 51 years, respectively. Most of the usual etiologies of EN were excluded by laboratory testing. EN was successfully treated with corticosteroids. Remarkably, in the first case, a relapse occurred 48 hours after the second dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. In this case series, we describe two unusual occurrences of EN after vaccination with an mRNA COVID-19 vaccine and a viral vector vaccine, respectively, and we discuss the available related literature

Temporomandibular joint involvement in psoriatic arthritis: a prospective clinical and ultrasonographic study

OBJECTIVES: To evaluate the prevalence of temporomandibular disorders (TMD) in a monocentric cohort of patients affected by psoriatic arthritis (PsA), and to investigate the accuracy of temporomandibular joint (TMJ) ultrasound (US) compared with clinical evaluation and clinimetric composite index in assessing TMJ involvement. METHODS: We conducted a prospective cohort study of patients diagnosed with PsA who underwent at least one TMJ US examination and maxillofacial surgeon's evaluation between 2018 and 2021. The rheumatology physician's interpretation of each TMJ US exam (presence/absence of TMD) was compared with psoriatic arthritis disease activity indexes and maxillofacial surgeon's clinical judgement (presence/absence of TMD signs and/or symptoms). RESULTS: 142 psoriatic arthritis patients were included. 111 patients were totally asymptomatic for TMD, but 58.5% of them already showed TMJ US changes; moreover, 103 patients passed the maxillofacial surgeon's examination in the absence of any relevant findings but again, of these, 55.3% already presented US signs of TMD. Univariate analysis of subgroups with and without TMJ synovitis and with and without active power Doppler signal showed a significant prevalence of peripheral enthesitic involvement in patients affected by TMD (95.7% vs. 4.3%, p=0.001; and 72.2% vs. 27.3%, p=0.007, respectively). Multivariate regression analysis confirmed the results (p=0.01 and p=0.013, respectively). CONCLUSIONS: Peripheral enthesitic involvement may represent a potential risk factor for the development of TMJ synovitis in PsA patients. Since TMD often develops asymptomatically, TMJ US may detect early signs of TMD, ensuring precocious and adequate management

Extranodal localization of non-Hodgkin’s lymphoma in systemic sclerosis: A diagnostic challenge and review of the literature

Background: Systemic sclerosis is associated with an increased incidence of malignancies, in particular solid neoplasms. Hematological cancers have been also observed in autoimmune diseases, though rarely present with lung involvement. The latter may be misdiagnosed in systemic sclerosis patients, due to the frequent concomitant interstitial lung disease.Case description: Here, we present the case of a 63-year-old man affected by systemic sclerosis presenting with an atypical lung imaging and splenomegaly, who was diagnosed with splenic marginal zone lymphoma, thus raising the suspicion of lung secondarism. We discuss the diagnostic challenge of differential diagnosis in interstitial lung presentation and briefly review the available literature on this topic.Conclusion: Several reports have demonstrated an increased risk of malignancy in patients with systemic sclerosis. Still, the lack of concretely defined guidelines for systemic sclerosis, along with systemic sclerosis multifaceted organ involvement at presentation, may challenge diagnosis and management. Here, we remark the importance of clinical work-up and a multidisciplinary approach in systemic sclerosis, to early detect and treat concomitant hematological malignancies, especially during the first years of the disease

O ensino como ferramenta de transforma\ue7\ue3o social e promo\ue7\ue3o da sa\ufade: a experiencia do Centros de Estudos e Pesquisa em Sa\ufade Internacional e Intercultural (CSI) da Universidade de Bologna

O Centro de Estudos e Pesquisa em Sa\ufade Internacional e Intercultural (CSI) da Universidade de Bolonha \ue9 um centro acad\ueamico criado em 2006 por um pequeno grupo de ativistas da \ue1rea de sa\ufade, insatisfeitos com a falta de compromisso social na pr\ue1tica e no ensino da medicina. O objetivo era reafirmar a sa\ufade como direito humano fundamental e ben\ue9fico da comunidade, abordar as rela\ue7\uf5es de poder entre a profiss\ue3o m\ue9dica e a comunidade como fator de risco para a sa\ufade e adotar pr\ue1ticas de trabalho para enfrent\ue1-las. De forma auto-reflexiva, o CSI come\ue7ou a desenvolver pr\ue1ticas que fossem abertamente contra-hegem\uf4nicas abrindo um espa\ue7o de trabalho acad\ueamico participativo, horizontal, sem hierarquias, gerenciado com a m\ue9todo da unanimidade, aberto a professores, estudantes, profissionais da sa\ufade e a todos que compartilham as finalidades. Como centro universit\ue1rio, o CSI pretende utilizar a pesquisa e o ensino como ferramenta de transforma\ue7\ue3o social e de promo\ue7\ue3o da sa\ufade atrav\ue9s de diferentes a\ue7\uf5es: desenvolver pesquisas e atividades did\ue1ticas auto-reflexivas quanto \ue0s rela\ue7\uf5es de poder, com abordagem de sa\ufade global, tentando conectar os problemas locais com o contexto global, enfatizando a necessidade de uma abordagem transdisciplinar e participativa; promover a transforma\ue7\ue3o dos curriculuns promovendo perspectivas multi-profissionais, participativas, capazes de modificar o saber, saber fazer e saber ser dos estudantes; facilitar o contato de estudantes e profissionais com o trabalho participativo e com metodologias quali-quantitativas, com a complexidade cotidiana na vida das pessoas, enquadrando os processos sa\ufade-doen\ue7a na estrutura das determinantes sociais e das desigualdades em sa\ufade; fortalecer a conex\ue3o entre academia e sociedade construindo parcerias em particular com a por\ue7\ue3o mais fr\ue1gil da comunidade a partir dos problemas percebidos; Hoje o centro conta mais de 30 volunt\ue1rios e bolsistas de diferentes \ue1reas, prop\uf5e mais de 150hs de did\ue1tica participativa e multiprofissional, pesquisas desenvolvidas com a comunidade e colabora\ue7\uf5es com redes de promo\ue7\ue3o da sa\ufade nacionais e internacionais. Os principais problemas encontrados s\ue3o relativos \ue0 atitude conservadora da academia frente as mudan\ue7as; a dificuldade dos profissionais em abordar o tema das rela\ue7\uf5es de poder e de se identificar como fator de risco potencial para a sa\ufade; a dificuldade dos m\ue9dicos em aceitar abordagens multi-metodol\uf3gicas e trabalhar em equipes multidisciplinares