Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Il laser a diodi in chirurgia orale

Le finalità e gli scopi di ogni procedura chirurgica sono quelli di poter eliminare la lesione definita patologica, comportando minori danni possibili ai tessuti limitrofi e creando le premesse affinché si abbia localmente un processo di guarigione senza complicanze a breve, medio e lungo termine. Questi principi sono validi anche nel vasto campo delle applicazioni dei raggi laser. Il mercato propone numerose apparecchiature laser, che presentano particolari specificità insite alle caratteristiche delle onde elettromagnetiche prodotte. Queste particolari specificità non sono solo messe in relazione alle caratteristiche del taglio dei tessuti, ai tempi di lavoro, alla profondità delle ferite chirurgiche o alle metodiche di esecuzione, ma sono rivolte alla specificità di assorbimento delle onde laser di ogni singola componente tissutale. Il laser a diodi in particolare si rivela efficace per alcune caratteristiche fondamentali: • completa sterilità della fonte energetica con conseguente decontaminazione e sterilizzazione dei tessuti trattati; • minor aumento della temperatura sul bersaglio trattato in confronto ai parametri simili di trattamento con altri tipi di laser; • minima necessità di utilizzazione dell’anestetico locale; • perfetto controllo dell’emostasi, dovuto all’ottima affinità verso l’emoglobina, che lo rendono adatto a qualsiasi intervento di piccola chirurgia orale; • minima indispensabilità dell’applicazione di punti di sutura; • minimo danno al tessuto circostante l’area di trattamento. Si può considerare quindi il laser non solo un dispositivo tecnologicamente avanzato che permette di trattare chirurgicamente lesioni organiche con grande facilità, ma una metodica terapeutica selettiva che consente di identificare componenti organici e tissutali da poter colpire con assoluta precisione.The finality and scope of each surgery procedure is the capacity to delete the wound , defined as pathological , providing less eventual damages to neighbouring tissues and creating the conditions for a local recovery process in short medium and long term. Those statements are valid also in the wide field of laser rays’ applications. The market offers many kind of laser equipments which are provided with specific particularities highlighted in the electromagnetic waves features. These peculiarities are connected not only to the tissue’s cut characteristics, to the working time and to the wounds deepness or to the execution modalities. They are oriented towards the absorption potentials of the laser waves in each tissue’s component. In particular diode lasers are particularly effective for some fundamental features: • complete sterility of the power source with a consequent decontamination and sterilization of the treated tissues; • less temperature increasing on the mark compared to similar treatments with other kind of lasers; • minimal need of local anaesthetic; • perfect control on haemostasis owed to the optimal affinity with the haemoglobin that see it fit to any surgical oral intervention; • minimal need of stitches; • minimal damage of neighbouring tissues. Therefore we can consider the diode laser not only an high tech device that allow to treat organic wounds with ease, but a selective therapeutic method that permit to identify organic components and tissues to treat with absolute accuracy

Il laser a diodi in chirurgia orale

Le finalità e gli scopi di ogni procedura chirurgica sono quelli di poter eliminare la lesione definita patologica, comportando minori danni possibili ai tessuti limitrofi e creando le premesse affinché si abbia localmente un processo di guarigione senza complicanze a breve, medio e lungo termine. Questi principi sono validi anche nel vasto campo delle applicazioni dei raggi laser. Il mercato propone numerose apparecchiature laser, che presentano particolari specificità insite alle caratteristiche delle onde elettromagnetiche prodotte. Queste particolari specificità non sono solo messe in relazione alle caratteristiche del taglio dei tessuti, ai tempi di lavoro, alla profondità delle ferite chirurgiche o alle metodiche di esecuzione, ma sono rivolte alla specificità di assorbimento delle onde laser di ogni singola componente tissutale. Il laser a diodi in particolare si rivela efficace per alcune caratteristiche fondamentali: • completa sterilità della fonte energetica con conseguente decontaminazione e sterilizzazione dei tessuti trattati; • minor aumento della temperatura sul bersaglio trattato in confronto ai parametri simili di trattamento con altri tipi di laser; • minima necessità di utilizzazione dell’anestetico locale; • perfetto controllo dell’emostasi, dovuto all’ottima affinità verso l’emoglobina, che lo rendono adatto a qualsiasi intervento di piccola chirurgia orale; • minima indispensabilità dell’applicazione di punti di sutura; • minimo danno al tessuto circostante l’area di trattamento. Si può considerare quindi il laser non solo un dispositivo tecnologicamente avanzato che permette di trattare chirurgicamente lesioni organiche con grande facilità, ma una metodica terapeutica selettiva che consente di identificare componenti organici e tissutali da poter colpire con assoluta precisione.The finality and scope of each surgery procedure is the capacity to delete the wound , defined as pathological , providing less eventual damages to neighbouring tissues and creating the conditions for a local recovery process in short medium and long term. Those statements are valid also in the wide field of laser rays’ applications. The market offers many kind of laser equipments which are provided with specific particularities highlighted in the electromagnetic waves features. These peculiarities are connected not only to the tissue’s cut characteristics, to the working time and to the wounds deepness or to the execution modalities. They are oriented towards the absorption potentials of the laser waves in each tissue’s component. In particular diode lasers are particularly effective for some fundamental features: • complete sterility of the power source with a consequent decontamination and sterilization of the treated tissues; • less temperature increasing on the mark compared to similar treatments with other kind of lasers; • minimal need of local anaesthetic; • perfect control on haemostasis owed to the optimal affinity with the haemoglobin that see it fit to any surgical oral intervention; • minimal need of stitches; • minimal damage of neighbouring tissues. Therefore we can consider the diode laser not only an high tech device that allow to treat organic wounds with ease, but a selective therapeutic method that permit to identify organic components and tissues to treat with absolute accuracy

MIH: epidemiologic clinic study in paediatric patient

The Molar Incisor Hypomineralization (MIH) is a qualitative and quantitative defect of the enamel structure of the first permanent molars, which may vary from 1 to 4 with involvement of maxillary and jaw permanent incisors. Aim: Aim of this study is that to evaluate, among 1500 paediatric patients chosen at random aged between 0 and 14 years, afferent by the Paediatric Dentistry of the Azienda Ospedialiera Policlinico Tor Vergata of Rome from 1996 to 2011, the incidents and the prevalence of the MIH distribution, and furthermore to ascertain the possible relationship with the data described in the literature. Results and discussion: From the sample of 1500 paediatric patients, the number of those affections from MIH has turned out to be pairs to 110 (7.3%) aged between 4 and 15 years, and an average age equal to 9.7. The incidence of the hypoplastic defects is greater in the elements of the permanents series in which the functional class mainly interested is that of the first molars, with a percentage of 39.8%. Regarding the elements of the deciduous series affections from hypoplasia, they turn out to be in all in number of 20 represented in 80% of the cases from the seconds molars while in the remaining 20% of the cases the items involved are the central incisors. About the percentage of elements involved in the MIH: the molars, involved with a frequency of 56%, turn out to be more hit regarding incisors (44%). As reported in the literature, it can be asserted that the MIH can hit in equal measure both the male sex that feminine one. Conclusions: MIH represents a condition quite frequent in the paediatric population. In managing this anomaly takes an essential role in the early diagnosis and in the differential one. The study done underlined the importance of a correct application of the therapeutic protocol which, starting from a careful diagnosis and articulating themselves in the execution of preventive treatments and in severe cases restorative and prosthetic, has the aim to certify the functionality and the aesthetic of the dental elements affected by MIH

Atypical deglutition: diagnosis and interceptive treatment: clinical study

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentitio

Analysis of clinical efficacy of interceptive treatment of Class II division 2 malocclusion in a pair of twins through the use of two modified removable appliances

The interceptive therapeutic approach of a functional type is indicated for the treatment of Class II Division 2 mandibular retrusion with deep bite, where improvement is required not only in occlusal relationships but also in skeletal and aesthetic parameters. Purpose: The aim of this study is to assess, in two identical twins suffering from the same malocclusion, the effectiveness and clinical stability of functional interceptive Class II division 2 treatment during puberty by mandibular retro-positioning associated with deep bite, and to compare skeletal changes and dental and dental-alveolar changes induced by the application of two different modified removable appliances: Clark’s Twin block and Bergersen’s Occlus-o-guide. Results: The results show that both devices allowed for circumvention of the pre-functional therapy phase aimed at correcting the upper labial segment, and for the conversion of the Class II division 1 incisor relationship, they were able to promote significant and obvious clinical effects. Conclusions: The study shows that Class II Division 2 functional type interceptive treatment of mandibular retrusion with deep bite conducted in the puberal phase through clinical use of modified Bergersen’s Occlus-o-guide® allowed for simultaneous resolution of the skeletal, dental-alveolar and dental problems in one step, while that using modified Clark’s Twin-block still requires a second phase of treatment necessary to resolve the alignment, levelling, inter-cuspidation of the arches, optimization of the dental overjet and overbite parameters and to the stabilization of the basal Class I

Oral lesions in paediatric patients with graft-versus-host disease

This work aims at assessing and describing the most frequent clinical manifestations of the Graft-versus-Host Disease (GvHD) in the oral and maxillofacial region in paediatric patients affected by neoplastic or non neoplastic haematologic disorders undergo specific hematopoietic stem cell transplantation (HSCT) protocols, with a view to detecting the potential pathological modifications which are recognised as the cause of a possible altered harmonious development of the child. Thirty-eight paediatric patients aged between 3 and 13 who underwent hematopoietic stem cell transplantation for neoplastic or non neoplastic haematological disorders were assessed on the basis of their medical history and accurate clinical and instrumental exams, in order to make a correct diagnosis, preliminarily assess oral conditions, detect possible oral pathological manifestations and evaluate their incidence both locally and in terms of clinical severity, as well as to mitigate associated symptoms. This was done to prevent and eliminate any oral interference in the systemic treatment protocol. In line with the data presented in the Literature, clinical GvHD manifestations seem to mainly involve the oral and maxillofacial region from an early phase also in paediatric patients. As a consequence, a timely diagnosis and a multidisciplinary treatment programme are essential to get to an early detection of the oral signs of potential systemic complications, to improve the quality of life of these young patients, as well as to prevent any potential alterations of dentoskeletal development and growth in the child