Autofluorescence Image-Guided Endoscopy in the Management of Upper Aerodigestive Tract Tumors

At this juncture, autofluorescence and narrow-band imaging have resurfaced in the medicine arena in parallel with current technology advancement. The emergence of newly developed optical instrumentation in addition to the discovery of new fluorescence biomolecules have contributed to a refined management of diseases and tumors, especially in the management of upper aerodigestive tract tumors. The advancement in multispectral imaging and micro-endoscopy has also escalated the trends further in the setting of the management of this tumor, in order to gain not only the best treatment outcomes but also facilitate early tumor diagnosis. This includes the usage of autofluorescence endoscopy for screening, diagnosis and treatment of this tumor. This is crucial, as microtumoral deposit at the periphery of the gross tumor can be only assessed via an enhanced endoscopy and even more precisely with autofluorescence endoscopic techniques. Overall, with this new technique, optimum management can be achieved for these patients. Hence, the treatment outcomes can be improved and patients are able to attain better prognosis and survival

Oxidative stress neuroinflammation and cellular stress response in sensorineural hearing loss: novel nutritional therapeutical approaches

This study is intended to validate the hypothesis that changes in the redox state of glutathione, the major endogenous antioxidant, associated with the abnormal expression and activity of cytoprotective vitagenes, which in normal conditions are expressed only at low level may represent a critical factor, involved in the physiopathological changes associated to degenerative damage occurring in cochlear diseases. Moreover modulation of stress responsive vitagenes by nutritional antioxidants can be an effective therapeutic strategy to minimize consequences of oxidative stress associated to the pathogenesis and course of sensorineural hearing loss. One therapeutic approach can be antioxidant substances, as cisteina and superoxide dismutase supplementation to burst vitagenes and confer neuroprotection. The damage caused in the inner ear by oxidative stress can induce apoptosis and necrosis of both the hair cells as neurons of the spiral ganglion. Reactive oxygen species (ROS) and free radicals are formed not only as by-products of various metabolic pathways but also for exposure to ototoxic substances such as aminoglycosides and cisplatin, for hypoxia/ischemia and to exposure to noise. Although the mechanism of production of ROS within the cochlea has not yet been precisely identified, it is conceivable that mitochondrial dysfunction and consequent burst in oxidative stress are major causative factors. Consistent with this notion, it is known that the base of the cochlea is more vulnerable to oxidative damage resulted from exposure to ototoxic substances than the apical portions. The difference in survival between the basal outer hair cells and the apical ones appear to be due to a significantly lower level of glutathione in the basal outer hair cells than the apical, a phenomenon that makes it easier basal cells vulnerable to damage from free radicals. © Mattioli 188

Impact of COVID-19 pandemic on Italian Otolaryngology Units: a nationwide study

Objective: The aim of this study was to provide an accurate picture of the changes which have occurred during the COVID-19 pandemic, and the contributions given by Italian Otolaryngology Units. Methods: A 29-item questionnaire was completed and returned by 154 Otorhinolaryngology Units across Italy that investigated geographic distribution, the main changes which occurred in workload management and in clinical and surgical activities and screening procedures for COVID-19 in healthcare personnel and patients. Results: Nearly half of the Otolaryngology Units that responded to the questionnaire were merged with other units, while 22% were converted into COVID-19 units or temporarily closed. A reduction of 8.55% in the number of team members was reported, and about 50% of the units applied uniform work shifts for all staff. Elective activities were uniformly stopped or delayed, passing from 30,295 (pre-COVID data) to 5,684 (COVID data) weekly procedures, with a mean decrease of 81.24% (p < 0.001). Conclusions: Most of the elective otolaryngology activities were suspended during the pandemic; the only procedures were for oncology and emergency patients. Italian Otolaryngologists have demonstrated a high availability to collaborate with non-surgical colleagues

Therapeutical innovations and medical responsibility: What's new in oto-laryngology

On one hand the incessant and constant technological and instrumental progress in the medical fieldhas allowed to increase knowledge and to reach new objectives. On the other hand, however, it has also raised the risk linked to professional responsibility, regarding informed consent and law 24/2017 of the Italian Republic, better known as Gelli Bianco. In this work an analysis of relevant literature will be presented, followed by a study on the role of new devices on responsibility profiles in otolaryngology. According to the analysis of the Italian law and considering the weaknesses ofthe above mentioned guidelines, pending legal administrative clarifications, we believe an operational protocol can be proposed in case of application of therapeutical innovations, especially about experimental introductions. Consequently, in our opinion, the risk of incrimination persists in case of use of innovative procedures in the absence of a formal shared opinion expressed in guidelines or in good practices, which still need a satisfactory definition

Adaptive psychological structure in childhood hearing impairment: audiological correlations

La presente ricerca affronta i problemi clinici e sociali che riguardano lo sviluppo linguistico e cognitivo nei bambini sordi. Attualmente, lo sviluppo della Teoria della mente rappresenta un importante campo di ricerca nello studio della sordità. Questi studi internazionali hanno evidenziato nei bambini sordi una significativa alterazione nello sviluppo della Teoria della Mente, soprattutto in caso di perdita congenita o preverbale delludito. In particolare, la ricerca si concentra sulle competenze dei bambini sordi nel riconoscere emozioni e desideri, attraverso metodi sia cognitivi che percettivi, per la valutazione delle capacità psico-cognitiva attraverso una serie di domande composte da alcuni test adeguati, da somministrare ai pazienti con perdita uditiva. Lesperimento è stato condotto su un gruppo composto da 10 bambini (5 maschi e 5 femmine), di età compresa tra 4 e 9 anni e tra 54 e 108 mesi), affetti da perdita uditiva congenita bilaterale (da grave a cofosi), o da perdita uditiva preverbale sviluppata sia in bambini che attendono lultimo anno prima di frequentare la scuola elementare, sia in quelli che frequentano il quarto anno di scuola elementare. I criteri di selezione sono stati basati su: valutazione audiologica, somministrazione di test neuropsicologici al fine di valutare, in generale, le capacità cognitive e percettive e osservazioni cliniche effettuate, al fine di valutare la psicopatologia del campione, attraverso dei test che valutano più facilmente lo sviluppo sia della percettività visiva (Coloured Progressive Matrices), sia della rappresentazione grafica (Test di disegno sulla figura umana e il Test di disegno sulla famiglia). Lo strumento di misurazione cognitiva è stato il Deaf Children Series, test strutturato da noi, che consiste in un esame dello stato mentale (MSE), capace di valutare: il livello di capacità cognitiva (conoscenza-correlato), lumore e modelli di discorso e di pensiero di un paziente al momento della valutazione. I bambini sordi mostrano sul lato percettivo una sensibilità ridotta alle espressioni di tristezza. Nel test possiamo osservare un meccanismo di difesa psicodinamico per quanto riguarda la prestazione percettiva. Al contrario, per quanto riguarda i bambini normoudenti, la paura è lemozione più difficile da identificare. I bambini sordi sembrano essere maggiormente predisposti al riconoscimento di emozioni visive. Inoltre, i bambini sordi presentano notevoli capacità di problem solving, capacità di riconoscimento emotivo, probabilmente a causa del loro problema

New onset of loss of smell or taste in household contacts of home-isolated SARS-CoV-2-positive subjects

Purpose: To estimate the prevalence of smell or taste impairment in household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. Methods: Cross-sectional study based on ad hoc questions. Results: Of 214 mildly symptomatic COVID-19 patients managed at home under self-isolation, 179 reported to have at least one household contact, with the total number of no study participants contacts being 296. Among 175 household contacts not tested for SARS-CoV-2 infection, 67 (38.3%) had SARS-CoV-2 compatible symptoms, 39 (22.3%) had loss of smell or taste with 7 (4.0%) having loss of smell or taste in the absence of other symptoms. The prevalence of smell or taste impairment was 1.5% in patients tested negative compared to 63.0% of those tested positive for SARS-CoV-2 (p < 0.001). Conclusion: Smell or taste impairment are quite common in not-tested household contacts of mildly symptomatic home-isolated SARS-CoV-2-positive patients. This should be taken into account when estimating the burden of loss of sense of smell and taste during COVID-19 pandemic, and further highlights the value of loss of sense of smell and taste as a marker of infection

The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors - within health systems and at a national level - along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve publichealth. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity - not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers