Il trattamento riabilitativo integrato alla terapia farmacologica con anticorpo anti RANK-L

abstract pubblicato su atti congressual

Synergistic Effect of Physical Therapy Plus Pharmacological Therapy with Eperisone in Tension-Type Cervicalgia

Background. This study assessed the effect of eperisone + physical therapy compared with physical therapy alone on the alleviation of pain and disability experienced by patients with tension-type cervicalgia. Methods. Patients with tension-type cervicalgia were randomized to eperisone + physical therapy (Group A) or physical therapy alone (Group B). Patients were assessed at baseline (T0), after 4-weeks’ treatment (T1), and at 2 months’ follow-up (T2). Outcome measures included the Numerical Rating Scale, the Italian version of the Neck Pain and Disability Scale, the Short Form-McGill Pain Questionnaire, and the Italian version of the Neck Disability Index. Results. Ninety-eight patients (50 patients in Group A and 48 patients in Group B) completed the study. Pain and disability scores for all outcome measures were significantly lower at both T1 and T2 for patients in Group A compared with Group B (all p<0.001). A small, improvement between T1 and T2 was observed in Group A patients but not in Group B patients, and significantly more Group B than Group A patients were worse at 2 months’ follow-up (all p<0.001). Conclusions. Eperisone in synergy with physical therapy can be a valuable tool in the therapeutic management of patients suffering from tension-type cervicalgia

Association between the donor to recipient ICG-PDR variation rate and the functional recovery of the graft after orthotopic liver transplantation: A case series

Background: Despite current advances in liver transplant surgery, post-operative early allograft dysfunction still complicates the patient prognosis and graft survival. The transition from the donor has not been yet fully understood, and no study quantifies if and how the liver function changes through its transfer to the recipient. The indocyanine green dye plasma disappearance rate (ICG-PDR) is a simple validated tool of liver function assessment. The variation rate between the donor and recipient ICG-PDR still needs to be investigated. Materials and methods: Single-center retrospective study. ICG-PDR determinations were performed before graft retrieval (T1) and 24 hours after transplant (T2). The ICG-PDR relative variation rate between T1 and T2 was calculated to assess the graft function and suffering/recovering. Matched data were compared with the MEAF model of graft dysfunction. Objective: To investigate whether the variation rate between the donor ICG-PDR value and the recipient ICG-PDR measurement on first postoperative day (POD1) can be associated with the MEAF score. Results: 36 ICG-PDR measurements between 18 donors and 18 graft recipients were performed. The mean donor ICG-PDR was 22.64 (SD 6.35), and the mean receiver's ICG-PDR on 1st POD was 17.68 (SD 6.60), with a mean MEAF value of 4.51 (SD 1.23). Pearson's test stressed a good, linear inverse correlation between the ICG-PDR relative variation and the MEAF values, correlation coefficient -0.580 (p = 0.012). Conclusion: The direct correlation between the donor to recipient ICG-PDR variation rate and MEAF was found. Measurements at T1 and T2 showed an up- or downtrend of the graft performance that reflect the MEAF values

Risk factors for acquisition of hepatitis C virus infection: a case series and potential implications for disease surveillance

BACKGROUND: Transmission of hepatitis C vims (HCV) is strongly associated with use of contaminated blood products and injection drugs. Other "non-parental" modes of transmission including sexual activity have been increasingly recognized. We examined risk factors for acquiring HCV in patients who were referred to two tertiary care centers and enrolled in an antiviral therapy protocol. METHODS: Interviews of 148 patients were conducted apart from their physician evaluation using a structured questionnaire covering demographics and risk factors for HCV acquisition. RESULTS: Risk factors (blood products, injection/intranasal drugs, razor blades/ toothbrushes, body/ear piercing, occupational exposure, sexual activity) were identified in 141 (95.3%) of participants; 23 (15.5%) had one (most frequently blood or drug exposure), 41 (27.7%) had two, and 84 (53.4%) had more than two risk factors. No patient reported sexual activity as a sole risk factor. Body piercing accounted for a high number of exposures in women. Men were more likely to have exposure to street drugs but less exposure to blood products than women. Blood product exposure was less common in younger than older HCV patients. CONCLUSION: One and often multiple risk factors could be identified in nearly all HCV-infected patients seen in a referral practice. None named sexual transmission as the sole risk factor. The development of a more complete profile of factors contributing to transmission of HCV infection may assist in clinical and preventive efforts. The recognition of the potential presence of multiple risk factors may have important implications in the approach to HCV surveillance, and particularly the use of hierarchical algorithms in the study of risk factors

Sustained seizure freedom with adjunctive brivaracetam in patients with focal onset seizures

The maintenance of seizure control over time is a clinical priority in patients with epilepsy. The aim of this study was to assess the sustained seizure frequency reduction with adjunctive brivaracetam (BRV) in real-world practice. Patients with focal epilepsy prescribed add-on BRV were identified. Study outcomes included sustained seizure freedom and sustained seizure response, defined as a 100% and a ≥50% reduction in baseline seizure frequency that continued without interruption and without BRV withdrawal through the 12-month follow-up. Nine hundred ninety-four patients with a median age of 45 (interquartile range = 32–56) years were included. During the 1-year study period, sustained seizure freedom was achieved by 142 (14.3%) patients, of whom 72 (50.7%) were seizure-free from Day 1 of BRV treatment. Sustained seizure freedom was maintained for ≥6, ≥9, and 12 months by 14.3%, 11.9%, and 7.2% of patients from the study cohort. Sustained seizure response was reached by 383 (38.5%) patients; 236 of 383 (61.6%) achieved sustained ≥50% reduction in seizure frequency by Day 1, 94 of 383 (24.5%) by Month 4, and 53 of 383 (13.8%) by Month 7 up to Month 12. Adjunctive BRV was associated with sustained seizure frequency reduction from the first day of treatment in a subset of patients with uncontrolled focal epilepsy

Adjunctive Brivaracetam in Focal Epilepsy: Real-World Evidence from the BRIVAracetam add-on First Italian netwoRk STudy (BRIVAFIRST)

Background: In randomized controlled trials, add-on brivaracetam (BRV) reduced seizure frequency in patients with drug-resistant focal epilepsy. Studies performed in a naturalistic setting are a useful complement to characterize the drug profile. Objective: This multicentre study assessed the effectiveness and tolerability of adjunctive BRV in a large population of patients with focal epilepsy in the context of real-world clinical practice. Methods: The BRIVAFIRST (BRIVAracetam add-on First Italian netwoRk STudy) was a retrospective, multicentre study including adult patients prescribed adjunctive BRV. Patients with focal epilepsy and 12-month follow-up were considered. Main outcomes included the rates of seizure‐freedom, seizure response (≥ 50% reduction in baseline seizure frequency), and treatment discontinuation. The incidence of adverse events (AEs) was also considered. Analyses by levetiracetam (LEV) status and concomitant use of strong enzyme-inducing antiseizure medications (EiASMs) and sodium channel blockers (SCBs) were performed. Results: A total of 1029 patients with a median age of 45 years (33–56) was included. At 12 months, 169 (16.4%) patients were seizure-free and 383 (37.2%) were seizure responders. The rate of seizure freedom was 22.3% in LEV-naive patients, 7.1% in patients with prior LEV use and discontinuation due to insufficient efficacy, and 31.2% in patients with prior LEV use and discontinuation due to AEs (p < 0.001); the corresponding values for ≥ 50% seizure frequency reduction were 47.9%, 29.7%, and 42.8% (p < 0.001). There were no statistically significant differences in seizure freedom and seizure response rates by use of strong EiASMs. The rates of seizure freedom (20.0% vs. 16.6%; p = 0.341) and seizure response (39.7% vs. 26.9%; p = 0.006) were higher in patients receiving SCBs than those not receiving SCBs; 265 (25.8%) patients discontinued BRV. AEs were reported by 30.1% of patients, and were less common in patients treated with BRV and concomitant SCBs than those not treated with SCBs (28.9% vs. 39.8%; p = 0.017). Conclusion: The BRIVAFIRST provided real-world evidence on the effectiveness of BRV in patients with focal epilepsy irrespective of LEV history and concomitant ASMs, and suggested favourable therapeutic combinations

CASE REPORT: FRATTURE VERTEBRALI DA FRAGILIT\uc0 E BPCO

Le fratture vertebrali rappresentano una rilevante complicanza nella BPCO sia per il dolore cronico che per il peggioramento della funzione polmonare; la prevalenza varia dal 24 al 63% ed il tasso di nuove fratture vertebrali \ue8 del 20% nel primo anno, per tale motivo \ue8 fondamentale la prevenzione primaria e la diagnosi precoce. Si descrive il caso di L.M., sesso femminile, 60 anni fumatrice da 45 anni (20 sigarette/die) affetta da BPCO e depression

VALUTAZIONE DELLA COMPLIANCE E DELLA PERSISTENZA NELLA TERAPIA DELL\u2019OSTEOPOROSI CON ALENDRONATO: NOSTRA ESPERIENZA

Tra le molteplici patologie cronico-degenerative, l\u2019osteoporosi \ue8 una di quelle a maggiore impatto sanitario, economico e sociale. Si tratta di una malattia sistemica dello scheletro, caratterizzata dalla progressiva diminuzione della massa ossea e dal deterioramento della microarchitettura, processo che comporta un\u2019aumentato rischio di frattura. Il corretto trattamento prevede l\u2019aderenza terapeutica, definita come combinazione di compliance (rispetto delle indicazioni nell\u2019assunzione del farmaco, valutata mediante il Medication Possession Ratio cio\ue8 il numero cumulativo di giorni di copertura farmacologica) e di persistenza (proseguimento del trattamento per tutta la durata prescritta). I bisfosfonati rappresentano indubbiamente la classe di farmaci pi\uf9 ampiamente utilizzata, con un profilo di efficacia e sicurezza ben studiato e documentato. Scopo principale degli studi finora condotti \ue8 stato quello di identificare la migliore formulazione farmacologica da utilizzare al fine di migliorare l\u2019aderenza terapeutica. L\u2019alendronato \ue8 stata la prima molecola ad essere registrata con azione anti-fratturativa ed \ue8 ancora oggi il farmaco pi\uf9 prescritto. Studi internazionali dimostrano come circa il 50-60% dei pazienti interrompe il trattamento entro un anno. Una maggiore percentuale di adesione alla terapia potrebbe essere legata alla recente formulazione solubile sia per la semplicit\ue0 nella somministrazione che per la possibile riduzione di eventi avversi, specie gastrolesivi

IL TRATTAMENTO RIABILITATIVO DELLA LOMBALGIA CRONICA CON BACK SCHOOL: NOSTRA ESPERIENZA

low back pain rappresenta un problema di grande rilevanza pubblica e sanitaria nei paesi occidentali. \uc8 una patologia bio-psicosociale in quanto al fenomeno biologico di base si sovrappongono elementi psicologici e sociali che contribuiscono al mantenimento del dolore cronico. La Back School nasce con lo scopo di educare i soggetti affetti da lombalgia, ad un uso corretto del rachide attraverso un programma di lavoro personalizzato, che comprende: rieducazione respiratoria e posturale, mobilizzazione, decompressione, stabilizzazione e potenziamento muscolare. L\u2019approccio cognitivo comportamentale di tale tecnica prevede che il dolore e la disabilit\ue0 non siano determinati solo da condizioni anatomiche ma anche da fattori psicologici e sociali. L\u2019obiettivo che si prefigge, \ue8 di ridurre il sintomo dolore e di rimuovere la causa che lo provoca; essa unisce i contributi della medicina, della chinesiterapia, dell\u2019ergonomia, della psicologia e dell\u2019educazione alla salute. Il nostro studio ha lo scopo di evidenziare l\u2019efficacia di un programma di esercizi secondo la Back School in associazione al Laser Co2 in lombalgia cronica

Riabilitazione dell'atleta nella sindrome di Sinding-Larsen-Johansson

la malattia di Sinding-Larsen-Johansson \ue8 una tendinopatia inserzionale prossimale del tendine rotuleo. Si manifesta pi\uf9 frequentemente nella popolazione sportiva di et\ue0 compresa tra i 14 e 20 anni. Gli sport pi\uf9 interessati sono la pallacanestro, la pallavolo e l'atletica leggera, sport in cui l'apparato estensore del ginocchio ed in particolare il tendine rotuleo, \ue8 sottoposto a grandi sollecitazioni. Da marzo 2010 a gennaio 2013, presso la nostra U.O.C. di Riabilitazione dell'A.O.U.P. Paolo Giaccone, sono stati reclutati 3 atleti agonisti (2 pallavolisti ed 1 cestista) di et\ue0 compresa tra i 18 ed i 20 anni. Il protocollo riabilitativo consisteva in 10 sedute a cadenza giornaliera di laser Nd:YAG e di rieducazione funzionale del ginocchio. la nostra esperienza conferma la validit\ue0 del trattamento riabilitativo combinato consentendo una marcata riduzione della sintomatologia algica ed il recupero della limitazione funzionale con un veloce ritorno all'attivit\ue0 agonista