Therapy with different dose regimens of rituximab in patients with active moderate-to-severe Graves' Orbitopathy

Background: Immunosuppressive therapy of Graves’ orbitopathy (GO) is indicated during the active phase of disease. Intravenous steroids (IVGC) are effective in about 70% of patients, although unresponsiveness or relapse are observed. In previous studies, rituximab (RTX) has been shown to be effective in inactivating moderate-to-severe GO when used early in the disease, but its optimal dosage has never been studied in randomized clinical trials. Aim of this study was to compare the efficacy and safety of different doses of RTX, based on a post-hoc analysis of two open label studies and one prospective trial randomized to IVGC. Methods: of 40 patients (35 women, 5 men), with active moderate-to-severe GO treated with RTX, 14 received a single dose of 100 mg (Group 1), 15 a single dose of 500 mg (Group 2) and 11 two 1000 mg doses, administered one week apart (Group 3). Thyroid function, TSH-receptor antibodies (TRAb) and peripheral CD19+ cells were measured. Primary endpoint was disease inactivation, measured as a decrease of the Clinical Activity Score (CAS) of at least two points. Secondary endpoints were improvement of proptosis, diplopia, quality of life and safety. Results: Baseline CAS decreased significantly in all groups (P<0.0001), independently of GO duration or whether patients had newly occurring or relapsing GO after IVGC. Proptosis did not significantly change. There was an inverse correlation between the Gorman score for diplopia and RTX dose (P<0.01). The appearance score of the GO-QoL improved in Group 1 (P=0.015), and the visual function score, in Group 2 (P=0.04). A reduction of serum TRAb was observed in Group 1 (P=0.002) and Group 2 (P<0.0002), but not in Group 3. CD19+ cell decreased in all groups (P<0.01), independently of the dose. Conclusions: We studied the optimal dosage of RTX in the treatment of active moderate-to-severe GO. In this analysis, we considered the efficacy of RTX in inactivating GO, in changing its natural course, its effect on disease severity and on the patients’ quality of life. Based on our clinical findings, and balancing the cost of therapy, a single 500 mg dose regimen is suggested in the majority of patients

Long-acting bronchodilators improve Health Related Quality of Life in patients with COPD

Summary Background Long-acting bronchodilators are first-line treatment for chronic obstructive pulmonary disease (COPD), and their efficacy on lung function and clinical parameters is recognized. Objective To explore the available evidence about the effects of long acting bronchodilators on Health Related Quality of Life (HRQoL) and Health Status (HS) in clinical research. Methods Randomized controlled trials published till December 2012 evaluating HRQoL/HS in COPD by means of validated questionnaires were analysed. Results Fifty-one trials on Long acting β 2 agonist (LABA) and Long acting Anticholinergic (LAMA) met the inclusion criteria. A total of 37,225 moderate-severe COPD patients testing 6 drugs, 12 different devices and 22 different dosages, with a study duration ranging from 4 weeks to 4 years were studied. A statistical significant HRQoL/HS improvement was reached in 93% of the studies. Nevertheless, the Minimal Important Difference (MID) was reached in 70,6% of the studies considering the difference between baseline and end of the study, and in 50% when comparing active treatment and placebo. Conclusions The data coming from the review support the efficacy of long acting bronchodilators in improving HRQoL/HS of COPD patients. Further research evaluating HRQoL/HS as primary outcome and according to guidelines on Patient Reported Outcomes is needed

Musculoskeletal tissue injuries and tissue regeneration

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How the Italian nursing student deal the pandemic COVID-19 condition

Background and Aim of the work: Since December 2019, a new infectious disease known as Coro-navirus disease (Covid-19) has rapidly spread globally until it has been declared a pandemic by the World Health Organization. At the same time, if we consider the University context, there is little attention paid during basic nursing education to emergency response, and faculty members report feeling poorly prepared to teach students about this topic. The present study aims to investigate how the Covid-19 pandemic condi-tion influenced the psychological well-being of the Italian nursing students. Methods: An online questionnaire was administered to Italian nursing students which contains two parts: a demographic section and the assessment to the psychological well-being nursing student with the Impact of Event Scale-Revised and the Patient Health Questionnaire-9. Results: Given the emergency health situation from Covid-19, our initial concern was to find a large number of students with difficulties in mentally processing this situation even with problems such as depression, as their future profession is heavily involved in the management of this pandemic. Fortunately our results have denied our initial hypothesis since both the impact management levels of the event, assessed with the IES-R scale, and the depression levels, assessed with the PHQ-9 recorded values ​that were almost normal. Conclusions: Nursing students are better able to face the situation since they find themselves in the role of spectators and not in the role of actors in the care of patients with Covid-19. If the training ameliorates psychological well being, therefore, it is necessary to provide and preserve nurses expertise to encourage teaching in nursing degree courses on maxi emergencies to prepare future nurses to face them adequately. (www.actabiomedica.it). © 2020, Mattioli 1885. All rights reserved

High intensity laser therapy in the treatment of tendinopathy: a brief narrative review and update of current literature

INTRODUCTIONː Tendinopathy is a pathology characterized by an inflammatory and a degenerative component; therefore, conservative treatment will need to manage both components. Among these therapies, laser therapy is indicated. In the last ten years, there has been an emerging interest in applying high intensity laser therapy in the management of this clinical picture. EVIDENCE ACQUISITIONː The clinical studies published so far in the application of high intensity laser therapy in different pathological models of tendinopathy, from shoulder impingement syndrome, to epicondylitis, from plantar fasciitis to Achilles tendinopathy, have so far highlighted the therapeutic efficacy of this methodical. The possibility emerges of modulating the choice of wavelengths, in order to modulate the treatment in relation to the expected biological effects. Studies demonstrate the safety of the treatment and the possibility of increasing the energy administered, in absolute safety, to obtain better tissue biostimulation effects. The protocols should be integrated with a rehabilitation part, to obtain a better functional recovery of the district. EVIDENCE SYNTHESISː Subsequent studies and systemic reviews will make it possible to verify the most suitable protocols for each pathological district and in relation to the more inflammatory or more degenerative phase of the tendinopathy. CONCLUSIONSː High-energy laser treatment is a valid therapeutic option in patients suffering from tendinopathy, resulting in improvement of pain, functional recovery and good compliance

Temperature Controlled High Energy Adjustable Multi-Mode Emission Laser Therapy in the Treatment of the Chronic Low Back Pain

Temperature controlled high energy adjustable multi-mode emission laser therapy (THEAL) is a new physiotherapy method recently introduced in the treatment of musculoskeletal disorders. The first published clinical trials show an excellent clinical response in the treatment oflow back pain (LBP). In view of various protocol modulation modes, we wanted to verify the effect of a protocol that provided contextual administration of different wavelengths. We administered to twenty patients a treatment that consisted of ten sessions of Temperature controlled High Energy Adjustable multi-mode emission Laser therapy (THEAL) (iLux XP/ Ixyon, Mectronic Medicale, Italy), with the simultaneous delivery of 650nm, 810nm and 1064nm wavelengths. The patients have been monitored during different follow-ups(FUs)to check the remission of pain, using Visual Analog Scale (VAS) for pain, Roland Score for functional recovery with and OswestryScore for regression of disability. Already at the end of the treatment after 10 days, and at subsequent FUs time at 1, 2, 4 and 12 months, a significant improvement was noticed for all these scores. These clinical results are consistent with the expected biological effects for each wavelengththat we have administered. The 810nm has a strong affinity for modulating no receptive pain, 650nm wavelengths have a marked anti-inflammatory effect and 1064nm has a decontracting action on muscles. The possibility to use a High Energy Laser with adaptive modulating emission and thermal control of biological tissue (THEAL) allows an optimized energy delivery with good local compliance. The concomitant administration of these wavelengths would therefore enable action on the various pathogenic noxa: radicular pain, local inflammation and reactive muscle response

Extracorporeal shock wave therapy on muscle tissue: the effects on healty athletes

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Epidemiology of injuries in water board sports: Trauma versus overuse injury

BACKGROUND: Surfing is an increasingly popular sport in the world, but it is not sufficiently investigated in terms of epidemiology of injuries and possible prevention strategies. Moreover, there are different surfing disciplines, with specific characteristics and therefore different potential risks of injury. The aim of this study was to look at the injuries of recreational surfers in an italian cohort, distinguishing between trauma and overuse lesions and putting in evidence any difference between specific water board sports. MeThodS: The design is that of a retrospective observational study. an online survey was distributed to a group of italian surfers that are members of a surfing association. The survey comprised: demographic data, surfing information such as number of sessions per year and years of experience, and surfing injuries story. The sample size consisted of 126 recreational surfers who practiced four different types of surfing: surf, kitesurf, windsurf and stand-up paddle. RESULTS: The incidence of trauma was significantly higher than the incidence of overuse lesions in all four water board sports evaluated (e.g. in surf, 81% for trauma vs. 27% for overuse, with a difference of 55%

Short term efficacy of capacitive-resistive diathermy therapy in patients with low back pain: a prospective randomized controlled trial

To compare the effectiveness of Doctor Tecar TherapyTM with that of laser therapy in the management of low back pain (LBP), a total of 60 patients with LBP were enrolled. The participants were randomly divided into two groups: a Tecar group (experimental group, 30 subjects), and a laser group (control group, 30 subjects). All the subjects received 10 sessions of therapy: one each day from Monday to Friday and the same again the following week. All the subjects were evaluated for pain (VAS) and disability (Roland and Morris score and Oswestry score) at baseline (T0), and 2 weeks (T1), 1 month (T2) and 2 months (T3) after the end of treatment. The pain and disability presented a trend to improvement over time in both groups. This improvement was statistically significant at all follow-ups (FUs) in the Tecar group but only at T1 for the Laser group (p less than 0.01). Comparing the two methods, there emerged a significant difference in favour of the Tecar group at T2 and T3 (p less than 0.01). The results show that Tecar therapy determined significant improvement already by the end of the treatment. Moreover, at the first and second month FUs, the Tecar therapy showed statistically better results than laser therapy