Acta Bio Medica Atenei Parmensis <p>Expression of the Society of Medicine and Natural Sciences of Parma and Centre on Health System's Organization, Quality and Sustainability, Parma. Acta Bio Medica is now one of the few Italian generals reviewed publications on major international databases. Divided into sections on research, case studies and updated monograph, is a training tool for broad spectrum close to the most recent advances of modern medical science.</p> en-US (Editor Acta) (Valeria Ceci) Fri, 30 Mar 2018 00:00:00 +0000 OJS 60 Diabetic ketoacidosis as the onset of type 1 diabetes in children <p>Not available</p> Lombardo Fortunato, Giuseppina Salzano ##submission.copyrightStatement## Mon, 26 Mar 2018 00:00:00 +0000 Smartphone APPlications in the clinical care and management of Rheumatic Diseases <p><em>Background:</em> Rheumatic diseases (RDs) are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Smartphones technology have the potential to become an important tool that rheumatologist can employ in the clinical care management of RD. <em>Methods:</em> Research of the published literature on the principle electronic databases available as Ovid MEDLINE, Health Technology Assessment Database, Embase, and PsycINFO was conducted, and the studies evaluated eligible were reviewed. <em>Results:</em> Our search produced 120 results from which 47 eligible articles were identified reporting studies of smartphone apps for patients with RD. All examined feasibility and five assessed the efficacy of a smartphone intervention for clinical care management. <em>Conclusions:</em> It has been demonstrated a strong evidence for the feasibility of using smartphone to enhance care of patients with RD.&nbsp; Based on the available literature and our personal experiences, we consider useful the development of some mobile phone apps, to simplify and assist the rheumatologist during his clinical practice. Still remains limited data on the efficacy of such interventions.</p> <p>&nbsp;</p> Fausto Salaffi, Sonia Farah, Marco Di Carlo ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 The ethics of organizational change in healthcare <p>The article addresses the increasingly important issue of organizational ethics in healthcare. Assuming that the governance of organizational change consists of a seriousness of continuous choices and of objectives to be determined and achieved, a possible definition of this new discipline is then deepened, and its fields of application are identified.</p><p>In the discussion therefore emerge the close link between ethical choice in organization and legality, passing through transparency and prevention of corruptive phenomena. After a focus on the strategic role played by the Medical Doctor of the healthcare management team, in conclusion, the need arises to support a strengthened supervisory and evaluation system and a culture of the ethical organizational choice of health managers, a rooting of the sense of identity and belonging to the healthcare organization and its mission by Professionals. Also governing this last aspect is the new challenge for the management of public healthcare enterprises.</p> Antonio Ferrari, Pietro Manotti, Antonio Balestrino, Massimo Fabi ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Aspirin for thromboprophylaxis in major orthopedic surgery: old drug, new tricks? <p>Major orthopedic surgery, mainly entailing hip fracture surgery, hip and knee arthroplasty, is associated with significant morbidity and mortality, which are especially attributable to the high risk of postoperative VTE. Such a considerable risk is mainly due to a procoagulant state sustained by several important mechanisms, including massive release of procoagulants from tissue and bone damage, blood vessel injury, reduced venous emptying, perioperative immobilization and cement polymerization, among others. The risk of VTE during and after major orthopedic surgery approximates 50-80% in patients with no thromboprophylaxis, and persists for up 3 to 6 months after surgery. The anticoagulant or antithrombotic armamentarium entails several anticoagulants such as heparin, coumarins, fondaparinux, and the recently developed DOACs inhibiting either activated factor Xa (i.e., rivaroxaban, apixaban, edoxaban) or thrombin (i.e., dabigatran), as well as aspirin, i.e., the oldest antiplatelet drug to be ever discovered and used in clinical practice. The current guidelines are not in complete agreement regarding the choice of the ideal thromboprophylaxis, since some consider aspirin, and some discourage it. Recent evidence seems to support the use of aspirin in selected situations and in selected protocols. Therefore, we believe that consideration should be made about increasing the use of this old but still effective drug for perioperative prophylaxis of VTE, especially in patients for whom the administration of DOACs may be challenging.</p> <p>&nbsp;</p> Giuseppeli Lippi, Gianfranco Cervellin ##submission.copyrightStatement## Tue, 27 Feb 2018 00:00:00 +0000 Self-determination, healthcare treatment and minors in Italian clinical practice: ethical, psychological, juridical and medical-legal profiles <p><em>Background and aim:</em> The social role of the minor, as indeed that of the physician, has changed markedly. This transformation has given rise to new patterns and responsibilities in the management of healthcare procedures that involve minors. <em>Discussion:</em> According to international legislation, in the clinical setting, as in other areas of social life, minors have the right to be heard and to have their opinions taken into consideration as an increasingly determining factor, in accordance with their age and degree of maturity and discernment. The authors describe the right to information and the decision-making process when the patient is a minor and underline the role of the parties involved (physicians, parents, under-age patient, judge) in various circumstances. Specifically, the paper analyzes the ethical and legal issues relating to the entitlement to&nbsp; decisions concerning the medical treatment of children and assesses the importance that Italian law attaches to the will of minors in the healthcare choices that affect them. <em>Conclusions:</em> Healthcare workers&nbsp; are called upon to face new challenges in order to ensure that healthcare services are able to safeguard the interests of minors while, at the same time, respecting their will. How to evaluate children’s competence to consent and how to balance the autonomy of parents and minors are crucial questions which the law courts in the various countries are increasingly being asked to address. These issues require close collaboration among various figures (parents, doctors, psychologists, judges) and imply the ethical need to undergo continuous training.&nbsp;</p> <p>&nbsp;</p> Rosagemma Ciliberti, Linda Alfano, Ilaria Baldelli, Francesco De Stefano, Alessandro Bonsignore ##submission.copyrightStatement## Wed, 28 Feb 2018 00:00:00 +0000 Intramuscular oxygen-ozone therapy in the treatment of low back pain <p><em>Background and aim of the work:</em> Intramuscular paravertebral injections of ozone are minimally invasive, safe and efficacy in reducing pain and disability. The aim of this paper is to present the early results of paravertebral lumbar ozone injections in the treatment of low back pain. <em>Methods:</em> Between February 2011 and December 2015, a total of 109 patients underwent intramuscular paravertebral lumbar injections of ozone due to low back pain. Of them, 42 interrupted the treatment at a medium of 5.4 injections and were lost to follow-up. Of the 67 remaining patients, only 24 answered to our questionnaire. Local and radiating pain was assessed using a 10-cm horizontal Visual Analogue Scale. Perceived functional status and disability were evaluated using the Oswestry Disability Index, administered before treatment and one month after the last injection. <em>Results:</em> Visual Analogue Scale reduction was demonstrated in 23 out of 29 cycles (79%) of ozone therapy. Regarding disability evaluation, Oswestry Disability Index score reduction was assessed in all except one. No complications were recorded. Our results are similar to the other reports: 79% of patients had VAS reduction of 2.3 points and all except one patient reported ODI reduction (average reduction of 9%). <em>Conclusions:</em> Lumbar paravertebral oxygen-ozone injections are minimally invasive, safe, cheaper and effective in relieving pain as well as disability. This technique is easy to perform, it doesn’t need computed-tomography or anesthesiologist support. We suggest its application in low back pain as first choice to replace intradiscal computed-tomography-guided infiltrations and to avoid or delay surgery.</p> <p>&nbsp;</p> Alessio Biazzo, Andrea Saverio Corriero, Norberto Confalonieri ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 A pilot study on sperm DNA damage in β-thalassemia major: is there a role for antioxidants? <p>Excess iron deposition in patients with beta thalassemia major (BTM) causes excess free radical formation, damages the hypothalamic pituitary testicular axis and production of sperms with DNA defects. As antioxidants were reported to improve fertility in healthy males; their effectiveness to improve sperm DNA defects in adult males with BTM was studied. Twenty fully pubertal BTM patients were included consecutively, all had semen analysis; 10 were found to be azoospermic, so further analysis for sperms and DNA defects was conducted on the remaining 10 participants. Semen was analyzed for antioxidants in seminal plasma and sperms for defects including the DNA fragmentation index, sperm deformity index, teratozospermia index and acrosomal index. Participants were then given L-carnitine and N-acetylcysteine for 6 months. All semen parameters were reassessed after treatment. The sperm deformity index and teratozospermia index increased significantly after treatment from 1.90±0.33 to 2.46±0.61 and from 1.59±0.22 to 1.86±0.28 respectively. So, apparently antioxidants accentuated sperm deformities in men with BTM. Therefore, the results of this study are not in favour with the use of antioxidants in BTM patients for improving potential fertility. Larger studies, however, are needed to confirm these preliminary results.&nbsp;</p> <p>&nbsp;</p> Heba Elsedfy, Vincenzo De Sanctis, Alaa Youssef Ahmed, Noha Refaat Mohamed, Mohamed Arafa, Mohsen Saleh Elalfy ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 The frequency of hypothyroidism and its relationship with HCV positivity in patients with thalassemia major in southern Iran <p><em>Introduction:</em> Hypothyroidism is one the most complication due to iron overload in patients with β-thalassemia major (TM). On the other hand these patients are prone to Hepatitis C virus (HCV) infection that can cause&nbsp; thyroid dysfunction by itself or as the side effect of treatment with interferon (INF) or IFN plus ribavirin. The aim of this study is to evaluate the association of hypothyroidism with HCV positivity and serum ferritin levels in patients with TM. <em>Methods:</em> In this cross-sectional study, 201 randomly selected patients with TM who were registered at the Thalassemia Clinic of a tertiary hospital in Shiraz, southern Iran were investigated. Thyroid function tests and serologic screening assays for HCV seropositivity (HCV Ab and HCV-RNA) were conducted for all patients.<em> Results:</em> Frequency of hypothyroidism was 22.9% including 19.9% subclinical hypothyroidism, 2% primary overt hypothyroidism and 1% central hypothyroidism. Eighty six patients (42.8%) were HCV Ab positive and 60 patients (29.9%) were HCV RNA positive. No significant relationship was found between hypothyroidism and HCV positivity or receiving IFN-α (P&gt;0.05). Hypothyroidism showed a borderline significant association with high serum ferritin levels in TM patients (P=0.055). <em>Conclusion: </em>Our results showed no significant association between hypothyroidism and HCV infection in TM patients. It seems that the main mechanism of hypothyroidism in our patients is iron overload; however, for better evaluation a larger multicenter study is recommended.&nbsp; Also due to the importance of consequences of HCV infection, more careful pre-transfusional screening of blood should be considered in TM patients.</p> <p>&nbsp;</p> Sezaneh Haghpanah, Shohreh Jelodari, Hammdollah Karamifar, Forough Saki, Rahil Rahimi, Vincenzo De Sanctis, Javad Dehbozorgian, Mehran Karimi ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 One-year experience in carotid endarterectomy combining general anaesthesia with preserved consciousness and sequential carotid cross-clamping <p><em>Background and aim of the work:</em> We report 1-year single-centre experience in carotid endarterectomy (CEA) combining general anaesthesia with preserved consciousness (GAPC) and standardized carotid sequential cross-clamping, for our protocol effectiveness evaluation in reduction of perioperative stroke, death or cardiologic complications. <em>Methods:</em> We considered all patients who underwent CEA in 2016. All patients underwent superficial cervical plexus block and GAPC with Remifentanil. The surgical technique consisted of common carotid artery (CCA) cross-clamping, carotid bifurcation isolation, external (ECA) and internal carotid artery (ICA) cross-clamping. After CCA cross-clamping, we performed a neurological tolerance test (NTT); this allowed selective shunting only for positive NTT. Primary end-points were: transient ischemic attack (TIA)/stroke, myocardial infarction, death in perioperative period. Secondary end-points were: carotid shunting, peripheral cranial nerves injuries (PCNI), GAPC intolerance, other complications, reintervention in perioperative period, length of hospital stay. <em>Results:</em> 104 consecutive patients underwent CEA with this protocol in the considered period. Twenty-seven (25.9%) patients were symptomatic. Mean clamping time was 48±13.5 minutes. Five cases (4.8%) requested internal carotid artery shunting. No TIA/stroke, myocardial infarction or death were recorded in the perioperative period. PCNI were observed in 19 cases (18.2%) in the immediate post-operative period; 16 of them (84.2%) showed complete or partial resolution at discharge. Only one patient (0.9%) showed GAPC intolerance. No other complication occurred. Three patients (2.9%) underwent reintervention for neck haematoma drainage. Mean hospital stay were 3±0.9 days. <em>Conclusions:</em> GAPC associated with sequential carotid cross-clamping appeared to be safe and effective in prevention of major neurological and cardiologic complications during CEA.</p> <p>&nbsp;</p> Alessandro Ucci, Rita Maria D'Ospina, Mara Fanelli, Giulia Rossi, Federica Persi, Franca Bridelli, Michela Tosi, Claudio Bianchini Massoni, Paolo Perini, Bilal Nabulsi, Alessandro de Troia, Tiziano Tecchio, Matteo Azzarone, Antonio Freyrie ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Diabetic ketoacidosis at the onset of Type 1 diabetes in young children Is it time to launch a tailored campaign for DKA prevention in children <5 years? <p><em>Aim:</em> To analyze clinical characteristics associated with the occurrence of diabetic ketoacidosis (DKA) at the onset of type 1 diabetes (T1D) in children aged &lt;5 years in order to identify early signs or symptoms useful to prevent DKA appearance. <em>Methods:</em> Data of patients&nbsp; with newly diagnosed TID aged &lt;5 years (Group 1) and 6-10 years old&nbsp; (Group 2) coming from the province of Parma were collected in the period 2012-2016. <em>Results:</em> Mild/moderate ketoacidosis at diabetes diagnosis occurred more frequently in Group 1 than in Group 2 patients (p&lt;0.0015). Severe DKA incidence was higher in children below 5 (21.8%) than in those over 5 years of age (3.75%; p=0.021). Latent period before overt T1D diagnosis was longer in Group 1 than in Group 2 patients (p=0.0081). During this latent period similar indicators were recorded among parents of children &lt;3 years old: frequent use of disposable baby diapers (87%), wet baby diapers because of a large amount of urine (86%), body weight loss (79%).&nbsp; In children aged 3-4 years reported symptoms consisted of polyuria (89%), polydipsia (79%), fatigue (72%). In Group 2 patients predominant signs concern unusual episodes of&nbsp; enuresis. <em>Conclusion</em>s<em>: </em>We believe that it is time to launch a DKA prevention campaign tailored for children under 5 years old and focused just on the above-mentioned three warning signs. Information program must involves pediatricians, pediatric nurses, new moms and nursery school teachers.&nbsp;</p> <p>&nbsp;</p> Brunella Iovane, Antonina Marta Cangelosi, Ilaria Bonaccini, Dora Di Mauro, Chiara Scarabello, Arianna Panigari, Alessandra Tiri, Carla Mastrorilli, Valentina Fainardi, Icilio Dodi, Maurizio Vanelli ##submission.copyrightStatement## Mon, 08 Jan 2018 00:00:00 +0000 Comparison between self-gripping, semi re-absorbable meshes with polyethylene meshes in Lichtenstein, tension-free hernia repair: preliminary results from a single center <p>Even tough inguinal hernia repair is among the commonest operations in general surgery, the choice for an optimal approach continues to be a controversial topic. Because of the low recurrence rates and low prevalence of complications, tension-free mesh augmented operation has become the standard technique in inguinal hernia surgery, significantly reducing hernia recurrence rates. On the contrary, prevalence of chronic postoperative groin pain (CPGI) i.e. pain beyond a three month-postoperative period still remains significant: as rates of CPGI may range between 15% and 53%, surgical approaches aimed to avoid chronic post-hernioplasty pain have been extensively debated, and the avoidance of CPGI has become one of the primary endpoints of surgical research on inguinal hernia repair). Recently, a sound base of evidence suggested that the entrapment of peripheral nervous fibers innervating part of the structures in the inguinal canal and stemming from ilioinguinal (Th12), iliohypogastric (L1) nerves as well as from the genital branch of the genito-femoral nerve (L1, L2), may eventually elicit CPGI (1-10). Consequently, innovative fixation modalities (e.g. self-gripping meshes, glue fixation, absorbable sutures), and new material types (e.g. large-pored meshes) with self-adhesive sticking or mechanical characteristics, have been developed in order to avoid penetrating fixings such as sutures, clips and tacks. However, some uncertainties still remain about the pros and cons of such meshes in terms of chronic pain, as new, innovative mesh apparently does not significantly reduce the rate of CPGI. Parietex ProGrip® (Medtronics<sup>TM</sup>) is a bicomponent mesh comprising of monofilament polyester and a semi re-absorbable polylactic acid gripping system that allows sutureless fixation of prosthetic mesh to the posterior inguinal wall. As ProGrip® does not requires additional fixation, inguinal canal may be closed within minutes after adequate groin dissection, ultimately shortening operating time. In other words, ProGrip® has the potential for significant savings, in terms of surgical and post-operating costs as well (10). The aim of our study is therefore to compare the results of the same technique with two different mesh materials (ProGrip® mesh vs. polyethylene mesh), in terms of operative time, post-operative pain, complications, and recurrence rates.</p> <p>&nbsp;</p> Luigi Percalli, Renato Pricolo, Luigi Passalia, Matteo Riccò ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Multidimensional approach usefulness in early Alzheimer’s disease: Advances in clinical practice <p><em>Background and aim:</em> Improving quality of life of patients with early Alzheimer’s Disease (AD) is a primary concern of health professionals involved in dementia treatment. The aim of this study is to reveal associations among psychiatric symptoms and wellbeing aspects, dysfunctional lifestyles and stress-related behaviors, illness perception, personality traits, and life quality satisfaction, in order to offer a comprehensive evaluation of psychological and behavioral aspects characterizing patients with early AD. <em>Methods:</em> This is a cross-sectional study in which all the outpatients included were evaluated at the Dementia Clinic in Parma (Italy). 21 patients with probable AD were assessed by an overall cognitive screening (Milan Overall Dementia Assessment), the evaluation of personal and instrumental autonomy (Activities of Daily Living and Instrumental Activities of Daily Living), and of dementia severity (Clinical Dementia Rating Scale). After the neurocognitive assessment, a wide battery of clinical and psychological measures (Symptom Questionnaire, Pisa Stress Questionnaire, Illness Behavior Questionnaire, Sixteen Personality Factor Questionnaire and Satisfaction Profile) was administered to the patients. Spearman’s rho correlations between clinical and psychological measures were performed. <em>Results: </em>A tendency to deny anxiety, depressive and somatic symptoms might be present in patients with early AD. They also present with hypochondriasis, resulting in higher level of anxiety and depression. Reduced liveliness and self-reliance as personality traits may influence the intensity of such symptoms. <em>Conclusions:</em> A comprehensive assessment including psychological and clinical measures should be routinely integrated in clinical practice for the evaluation of patients with early AD.&nbsp;</p> <p>&nbsp;</p> Carlo Pruneti, Augusto Innocenti, Davide Maria Cammisuli ##submission.copyrightStatement## Mon, 05 Mar 2018 00:00:00 +0000 The economic crisis and lifestyle changes: a survey on frequency of use of medications and of preventive and specialistic medical care, in the Marche Region (Italy) <p><em>Background and aim: </em>In the words of one observer, one of the many effects of the economic downturn has been a “health system shock” marked by reductions in the availability of healthcare resources and increases in the demand for health services. The financial situation influences negatively the low-income family groups, particularly those who normally use the government provided primary prevention services. The goal of this study was to assess the impact of the global recession on the use of medicines and medical investigation recession in different areas of the Marche Region. <em>Methods:</em> An anonymous questionnaire prepared by the National Institute of Statistics, modified and validated by the University of Camerino, has been distributed to junior highschool students of Central Italy to provide a statistically representative sample of families. The questionnaire has been administered in 2016-2017. <em>Results:</em> This article examines the results about healthcare habits, specifically, regarding medicines and medical examinations. Data obtained emphasize a reduction in the use of nonsteroidal anti-inflammatory drugs (NSAIDs). The parents category showed the higher change in medicines use (72.9%). Comparing the data of the Fabriano area with that of the Civitanova Marche area, Fabriano reported a greater reduction in the frequency of taking medicine. Concerning the medical examinations, half of the respondents (62.5%), indicated that they and their family members have regular medical check-up. <em>Conclusions: </em>Respondents who admitted that the economic crisis had reduced their quality of life indicated that the parents were the ones who had experienced the greatest change. This is confirmed by the information on the reduced frequency of medicine use, which affected the parents more than the children, whom they sought to protect and safeguard the most. This reduction was most marked in the Fabriano area. In contrast, in the Civitanova Marche area, with different socioeconomic characteristics, an increase in the use of all the categories of medicines was reported. Concerning visits the situation in the Marche Region appears encouraging.</p> <p>&nbsp;</p> Iolanda Grappasonni, Stefania Scuri, Elisabetta Tanzi, Lenka Kracmarova, Fabio Petrelli ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Survey about the potential effects of economic downturn on alcohol consumption, smoking and quality of life in a sample of Central Italy population <p><em>Background and aim of the work:</em> Negative health effects have been associated with the changes in lifestyles in relation with the low income of population. Consequently, in our study we investigated the frequency changes of alcohol and smoke consumption, physical activity, and quality of life in families of Marche Region in Central Italy. <em>Methods:</em> In the period 2016-2017, an anonymous questionnaire has been distributed to junior highschool students of Camerino, Fabriano, and Civitanova Marche of Marche Region. The Manchester Short Assessment of Quality of Life (MANSA), was used to assess subjective quality of life. <em>Results:</em> Data obtained in this research were used to analyze lifestyle changes, specifically those involving alcohol consumption, smoking, and physical activity, and to assess perceived general quality of life. In all categories of population, an increase of frequency in alcohol consumption was observed. On the contrary, for the tobacco smoke we observed a reduction in particular in the parents category. The MANSA mean value was 4.5 with a Standard Deviation of 1.3. <em>Conclusions:</em> As underlighted, also, by results of the MANSA test we can hypothesize a reduction in the family income produces a change of lifestyles.</p> <p>&nbsp;</p> Fabio Petrelli, Iolanda Grappasonni, Annalisa Peroni, Lenka Kracmarova, Stefania Scuri ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Vascular Parkinsonism sensitive to Rotigotine therapy is found in aged patients: a clinical case description <p>Previous and recent papers have pointed out several discussions about the so called ‘Vascular Parkinsonism’ (VP), particularly about some distinctive characteristics with respect to the Idiopathic Parkinson Disease (IPD); differences commonly described are&nbsp; sudden onset of extrapyramidal symptoms after a stroke, main involvement of lower limbs in diffuse brain microinfarcts (lower body parkinsonism), low, short in time or absent response to classic IPD therapy in all kinds of vascular brain pathologies. But few published studies have also emphasized some relationship linking brain morphological signs of vascular damage in elder patients suffering from diagnosed IPD, both ‘normally’ responding to classic Levodopa therapy or not.&nbsp;</p> <p>&nbsp;</p> Flora Zarola ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Role of Transesophageal 3D Echocardiography in Adult Cor Triatriatum Diagnosis <p>Cor triatriatum is a very rare congenital abnormality, symptomatic during childhood;the non restrictive form is usually diagnosed as an incidental finding. We report the case of a 88 years old man referred to our hospital for elective endovascular repair of an aortic aneurysm; transthoracic cardiac bidimensional echocardiography showed an abnormal mass into the left atrium and a the diagnosis of cor triatriatum was fully made by a three dimensional transesophageal echocardiography. 3D echocardiography is an excellent noninvasive method that provides a rapid bedside diagnosis , without having to use ionizing radiation.</p> <p>&nbsp;</p> Walter Serra, Giorgio Bennati, Andrea Biagi ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Hypochlorite accident during wndodontic therapy with nerve damage – A case report <p>Endodontic therapy is a routinely practised clinical procedure with few reported complications but, as a bleaching agent, inadvertent spillage of sodium hypochlorite beyond the root canal system may result in extensive soft tissue or nerve damage, and even airway compromise. Although very rare, complications arising from hypochlorite extrusion beyond the root apex are described. NaOCl causes oxidation of protein and lipid membrane and causes necrosis, hemolysis and dermal ulcerations (2-4). Neurological complication are very rare. Paraesthesia and anaesthesia may affect the mental, inferior dental and infra-orbital branches of the trigeminal nerve and normal sensation may take many months to&nbsp; completely resolve (6, 7). Nerve damage (the buccal branch) was described in 2005 by Witton et al. (8) and patients exhibited a loss of the naso-labial groove and a down turning of the angle of the mouth and the motor function was regained after several months. We present a case in which the extrusion of NaOCl solution during endodontic therapy led to important destructive effects on soft tissues and nerves. The arisen medico legal issues are discussed.&nbsp;</p> <p>&nbsp;</p> Silvia Perotti, Paola Bin, Rossana Cecchi ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Percutaneous treatment of traumatic talus extrusion: a case report. <p><em>Background and aim of work:</em> Total traumatic extrusion of talus with interruption of all ligaments (missing talus) is a very rare injury. We represent the case of a 44-years-old male who reported total extrusion of talus and Lisfranc dislocation after a motorbike accident. This rare injury has a wide choice of treatment but usually there is not a successful functional restore. <em>Methods:</em> We decided to treat the patient with an immediate reimplantation of extruded talus using 3 Kirschner wires and antibiotic therapy. We performed a temporary fixation of talus with calcaneus, tibia and scaphoid. <em>Results:</em> Usually, this kind of injuries are treated with a tibiocalcaneal arthrodesis and show common complications such as avascular necrosis and infection. Against our expectations we managed to treat successfully our patient. <em>Conclusions:</em> After 5 years of follow up the patient reported good clinical outcomes without performing arthrodesis and recording major complications.&nbsp;</p> <p>&nbsp;</p> Davide Calabrò, Giuseppe Meliadò, Michele Biasi, Gaetano Topa, Francesco Campo, Federico Fusini ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 A rare case of gint lipomatous hypertrophy of the atrial septum <p>Benign lipomatous lesion of the heart includes&nbsp; an heterogeneous group of entities including neoplastic, congenital and reparative phenomena. Among these lipomas and lipomatous hypertrophy of the atrial septum ( LHIS) represent the most common lesion. Patients suffering from LHIS are often asymptomatic, however atrial fibrillation, congestive heart failure and supraventricular tachycardia are typical findings. Here we present a rare case of LHIS symptomatic&nbsp; for asthenia and dyspnea.</p> <p>&nbsp;</p> Davide Carino, Andrea Agostinelli, Matteo Ricci, Giorgio Romano, Francesco Nicolini, Tiziano Gherli ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Endocrinopathies in celiac disease: When the endocrinologist sees what is invisible to the gastroenterologist <p>Celiac disease (CD) is a systemic, immune mediated and genetically determined small intestinal disorder characterized by intolerance to dietary gluten that generally presents with gastrointestinal symptoms in young children and extra-intestinal manifestations. Furthermore, there is close association between CD and endocrine diseases, including diabetes, autoimmune thyroid diseases, growth and pubertal disorders, etc. probably due to the presence of a common genetic predisposition. The present review aims to highlight and give more insight to the endocrine changes in CD, especially when there are few or no gastrointestinal symptoms and to emphasize on screening opportunities in some endocrine diseases.&nbsp;</p> <p>&nbsp;</p> Dooa Khater ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Current treatment of hypoparathyroidism: Theory versus reality waiting guidelines for children and adolescents <p>The diagnosis of hypoparathyroidism(HPT)is readily made in the presence of hypocalcemia with markedly reduced or absent parathormone (PTH) levels. Currently available treatments for HPT include high dose vitamin D (ergocalciferol, D2 and cholecalciferol, D3) or, the active metabolite dihydroxy vitamin D (calcitriol), in addition to calcium supplements.This regimen, if not well monitored, can lead to hypercalciuria, as PTH deficiency impairs renal calcium reabsorption. Thus the goal of treatment, is to maintain serum calcium at the low end of the normal range. Undertreatment can cause symptomatic hypocalcemia, while overtreatment hypercalciuria, which may lead to nephrolithiasis, nephrocalcinosis, and renal insufficiency. At present, there is no consensus on the management of HPT in children and adolescents and only few studies are available on the long term outcome of patients with recombinant HPT treatment. The purpose of this article is to review, in a comprehensive manner, the major aspects of HPT management in children and adolescents waiting for authoritative guidelines for the treatment of HPT in this group of patients. Further research, addressing specific questions for this population are urgently needed to improve long-term safety of patients. Educational interventions are also needed for professionals, parents and patients to enable them to improve knowledge, quality of life and effective management care at home.</p> <p>&nbsp;</p> Salvatore Di Maio, Ashraf T Soliman, Vincenzo De Sanctis, Christos C Kattamis ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000 Thyroid Disorders in Subjects with Down Syndrome: An Update <p>Down syndrome (DS) is the commonest chromosomal disorder among live born infants. DS is associated with increased risk of endocrine abnormalities particularly thyroid gland disorders. The spectrum of thyroid dysfunction in patients with DS include congenital hypothyroidism, subclinical hypothyroidism, acquired hypothyroidism (autoimmune - non autoimmune), and hyperthyroidism. This review will focus on the characteristics of the different presentations of thyroid abnormalities in DS, screening and management recommendations.</p> <p>&nbsp;</p> Nermine H Amr ##submission.copyrightStatement## Tue, 27 Mar 2018 00:00:00 +0000