medicine | MY SPECIAL DOCTOR

Cannabis as medicine for neurological and psychiatric diseases

26 February 20246 January 2024 by pcarrieri

Commonly referred to as a “mild drug” because of its sweetened effects on the central nervous system; in fact, it is a real drug that has long been used not only for “recreational” purposes, but also for medical and religious purposes. We are talking about cannabis (or hemp), an angiosperm plant native to Afghanistan that is widely cultivated in Asia, Europe and Africa. Cannabis comes in various forms, including “hash,” the resinous part, and “marijuana,” consisting of the dried and shredded leaves and stems of the plant.

History

The use of cannabis as medicine dates back at least 2,500 years and was described in the first treatise on pharmacology written in China. In Europe, the widespread use of cannabis is mainly related to its use in textiles, but in the 17th and 18th centuries it was also used in medicine as an analgesic and sedative. Numerous famous writers and poets made use of it, including Verlaine, Rimbaud, Mallarmé, Dumas, Baudelaire, Balzac, Hugo, and Shakespeare. In Italy, it was Raffaele Valieri, a physician at the Incurabili Hospital in Naples, who introduced the properties of cannabis in the medical field. Since 2015, the cultivation of cannabis plants for use in the preparation of medicines has been legalized in our country. However, cannabis is still not considered a true therapy, but a supportive treatment to standard ones when the latter have not produced the desired effects or have resulted in non-tolerable side effects.

Use in medicine

Cannabis is currently the most widely used drug in the world due to both the sharp increase in volutary use and medical use, especially for the treatment of neurological and psychiatric diseases, such as amyotrophic lateral sclerosis, multiple sclerosis, Alzheimer’s, Parkinson’s, epilepsy, bipolar disorder, and schizophrenia.
Let’s take Parkinson’s disease. Very recent scientific studies (2014 and 2015) of patients treated with cannabis extracts have shown significant improvements in the main symptoms of the disease, such as tremor, rigidity and slowness of movement, but also in non-motor disorders, such as alterations in sleep-wake rhythm and pain.
Regarding its use in pain, cannabis is capable of improving mood and quality of life in HIV-infected individuals. In addition, in cancer patients, cannabis can combat chemotherapy-induced anorexia, nausea, and vomiting, as well as chronic pain,insomnia, and mood depression.

The negative aspects

Having ascertained its medicinal qualities, cannabis is still a drug and, as such, it causes negative, serious and lasting effects especially in young people, particularly those who began taking cannabis in their teens.
Addiction, respiratory disorders, memory deficits, reduced attention and concentration, behavioral disorders, and accentuation of depressive, anxious, or psychotic disorders are among the most frequent adverse events.
Despite the difficulties in the therapeutic use of cannabis, numerous studies on its medical use continue to be conducted around the world. However, often the conclusions of such research do not seem appropriate or properly applicable in the public health field. Indeed, studies conducted often lack data to support a favorable risk-benefit ratio. Hence the difficulties in drafting appropriate regulations or procedures for the use of cannabis in the medical field.

By Pietro Biagio Carrieri, Andrea Di Cesare, Massimo Persia

The approach to pain in the child

25 February 20246 January 2024 by psalari

How should we react when our little one complains of some kind of physical pain? The wise and recommended thing to do is to consult your pediatrician before giving your little one any kind of medicine. First, the pediatrician needs to acquire some information to understand the type and extent of the pain, and it is therefore good for parents (if the child is not yet able to express himself) to prepare to respond. He himself will recommend the most appropriate medications for each situation and type of pain.

The use of drugs

The drug of first choice in mild-to-moderate pain without inflammation, such as In the case of teething, growing pains and migraines, it is acetaminophen administered orally, which pmay be administered from day one due to the excellent relationship in terms of effectiveness and safety. Paracetamol acts within 30 minutes or so, and its analgesic effect lingers for 4-6 hours. Il paracetamol can also be employed even on an empty stomach, to a dosage higher than that indicated for fever, as directed by the pediatrician, but always In relation to the child’s weight e without exceeding over the course of one day the threshold of 60 mg/Kg In children younger than 3 months of age e di 80 mg/Kg In larger ones. Rectal administration of the drug is to be left
always as an alternative, for example in case thechild is unable to take anything by mouth because of vomiting. For pain associated with inflammation after the third month of life and over 5.6 kg in weight, the ibuprofen, to be administered on a full stomach, based on weight and with an interval of at least 6-8 hours (as opposed to 4-6 hours for acetaminophen) and without exceeding the maximum dosage of 30 mg/Kg in a day.

In any case, it should be remembered that i treatment of pain, in order for it to be effective, must take place according to a fixed schedule and not on an as-needed basis

. Finally, if the pain is associated with local manifestations, such as discharge from the ear or redness or swelling after a fall, or if it should increase in intensity, it is always advisable to consult the pediatrician.

Among all disorders, pain is the one that most undermines the child’s physical and psychological integrity and in addition distresses and worries his or her family members, with a significant impact on quality of life and care. For this reason, it should not be underestimated, nor should it be trivialized: even in cases where there are reasons to suspect that a child may be feigning sickness, for example as an excuse for shirking a school commitment, it is always advisable to proceed with the appropriate checks rather than risk not caring or treating him or her roughly.

Melanoma: everything you need to know about this disease

25 February 20246 January 2024 by Dr. Nazzaro

melanoma is a malignant tumor that originates from melanocytes, cells that contain the pigment, called melanin, responsible for skin coloration. It can develop in the skin all over the body, but in rare cases it can arise in the mucous membranes, such as the mouth, genitals, and ocular conjunctiva. The incidence of this cancer continues to rise. It is one of the most frequent cancers, with an incidence ranging from 55 per 100,000 population in Australia to 0.4 per 100,000 in Japan. In Italy the incidence is about 6-13 cases per 100,000 subjects.

It is one of the major cancers that arises at a young age and currently in Italy constitutes the third most frequent cancer in both sexes under the age of 49 as more than 50% of melanoma cases are diagnosed by the age of 60, in contrast to other cancers that mainly affect the elderly population. The most affected site is the trunk in men and the lower limbs in women.

The risk factors

Risk factors for melanoma are divided into personal and environmental. As for the former, it plays a moto important role the family history in fact even though inheritance depends on multiple genes, patients with family members with melanoma have an increased risk of developing melanoma, just as it has been reported that individuals with melanoma have a ninefold increased risk of developing a second melanoma. An additional personal risk factor has been described in individuals with phototypes I and II (light eyes and hair, very fair skin), with numerous freckles and frequent sunburn.

As for environmental risks, on the other hand, the most important risk factor is certainly cumulative sun exposure, as well as exposure to artificial UV rays (tanning lamps). Other factors are:

Intense and intermittent sun exposure
Previous sunburns
Exposure to artificial UV radiation, especially if aged <35 years old

Therapeutic strategies

Early stage melanoma is treated surgically. The dermatologist or surgeon will excise the suspicious lesion and, after histologic confirmation of melanoma, margin enlargement surgery will follow. The aim is to ensure a margin of healthy skin around the malignant lesion so as to reduce the risk of local recurrence.

In more advanced stages, however, the oncologist will take charge of the patient and discuss with him or her the treatment strategy to be adopted, most often chemotherapy, explaining any side effects. Chemotherapy is a systemic treatment, that is, it acts on any cancer cells that may be present. Treatment involves the administration of one or more anticancer drugs. Intake is either oral or intravenous, which enters the bloodstream carrying it throughout the body. Chemotherapy can be given in an outpatient setting, at your primary care physician’s office, or at home. This of course depends on the patient’s health condition and prescribed therapy. Chemotherapy is usually chosen as therapy when the melanoma has metastasized.

NEW SMA CURE: First drug to treat spinal muscular atrophy approved in Italy

25 February 20246 January 2024 by Redazione My Special Doctor

Approved in Italy Nusinersen for the treatment of patients with SMA, a rare genetic neuromuscular disease that predominantly affects children and is the leading genetic cause of infant mortality. Data from clinical trials have shown significant results in terms of increased survival in children with the disease and achievement of important developmental motor milestones, such as head control, sitting, crawling and walking. Italy an example of excellence in the world for accelerated time to approval and access to the new therapy.

What is SMA
Spinal muscular atrophy (SMA) is characterized by the loss of motor neurons in the spinal cord and brainstem, resulting in severe and progressive muscle weakness and atrophy. Individuals with the most severe Type of SMA may eventually go into paralysis and have difficulty maintaining vital functions, such as breathing and swallowing.

Due to the loss or defect in the SMN1 gene, people with SMA do not produce sufficient amounts of SMN protein, which is critical for motor neuron survival. The severity of SMA correlates with the amount of SMN protein. Individuals with Type 1 SMA, the most severe form, produce very low amounts of SMN protein and do not achieve the ability to sit without aids or live beyond two years without respiratory support. Individuals with Type 2 and Type 3 SMA produce a higher amount of SMN protein and have less severe forms of SMA, but still capable of changing life expectancy and quality of life.

Approval
Nusinersen constitutes the first treatment for this disease approved in Italy; the drug was reviewed under the Italian Medicines Agency’s accelerated approval pathway, aimed at speeding up access to drugs that treat serious or life-threatening diseases and generally address unmet clinical needs.

The approval of nusinersen is largely based on the results of two multicenter, controlled registrational studies, including the final data from the ENDEAR study (for childhood-onset SMA) and the interim data from the CHERISH study (for late-onset SMA), which demonstrated clinically and statistically significant efficacy and favorable benefit-risk profile of nusinersen. The approval was further supported by data from the open-label NURTURE study, obtained in pre-symptomatic individuals genetically diagnosed with SMA and with the possibility of developing SMA Type 1, 2, or 3.

Nusinersen is administered intrathecally, that is, via a lumbar puncture directly into the cerebrospinal fluid (CSF) around the spinal cord, the site of motor neuron degeneration caused by insufficient levels of SMN protein in SMA patients.

Acne: what it is and how to fight it

25 February 20246 January 2024 by psalari

The term acne comes from the Greek word acmé or acné, meaning foam or summit. It is one of the most common skin diseases in the juvenile population; in fact, it is present in about 95%. The frequency is much higher certainly among adolescents, but acne can persist or appear in adulthood as well.

Types of acne

It typically makes its onset on the face, back, chest, and shoulders and affects both sexes in almost similar percentages. It typically manifests as closed and open comedones, so-called blackheads, papules, or whiteheads, pustules, better known as pimples, nodules i.e., furuncles, cysts, and unfortunately can also result in scarring in some cases. There are many causes of acne: increased activity of sebaceous glands, thickening of the wall of follicular ostium, bacterial colonization, in pjoint by Propionibacterium Acnes, and inflammation. In addition, various factors contribute to its occurrence such as family predisposition, stress, and smoking.

Especially in adolescence, it is important to be able to frame the degree of acne early, that is, whether it is mild, moderate, or severe, or, depending on the type of lesion, it can be classified into comedonic, papulo-pustular, nodular, and, in severe cases, conglobate. This avoids the development of scarring. In fact, this condition is often underestimated, which can therefore lead to psychological distress on the part of young patients and delay the benefits of treatment. It is known from studies conducted on patients’ quality of life that the acne-prone adolescent often suffers from low self-esteem, embarrassment, shyness, and in extreme cases even depression, emotional turmoil, shame about one’s appearance, resulting in difficulty relating to the opposite sex and a decline in school performance.

Therapies

Regarding treatment, the European Guidelines, published in 2012 recommend which drugs, topical and systemic, to use according to the degree of acne. Topical retinoids, derived from vitamin A, are the first choice in comedonic acne. An important role is also played by benzoylperoxide a keratolytic agent with antibacterial action but not inducing antibiotic resistance, which is recommended in acne vulgaris and comedo- or papulo-pustular-predominant forms.

The use of topical antibiotics is useful in inflammatory forms, but is limited by resistance, which unfortunately is increasing in Europe. therefore, as far as acne is concerned, their local use in combination with other topical drugs is advisable, avoiding the concomitant administration of oral antibiotics and limiting the use of the latter to periods not exceeding three months, discontinuing them if there is no improvement. Remembering to fixed combinations of topical preparations offers the possibility of acting more specifically on the mechanisms that cause acne, also increasing adherence to therapy, making the application of only one product sufficient.

Questions about lesser-known practical aspects of vaccination

25 February 20246 January 2024 by psalari

Here are some examples that report very common questions among parents about vaccination for their children.

Giorgia
My son is 13 years old and has his vaccination booster on June 1: is it the case
Have him do the papilloma virus one as well? (I would keep it, heh)
– Yes, if the center allows it

Donatella
I was wondering, since there is some misinformation about it, if there are any
special contraindications for children prone to allergies, and in case, for
what types of allergies you need to proceed with caution!
– Only severe allergy sufferers require special precautions (for example, with the vaccines containing traces of gelatin), which more often than not result in.
In protected site vaccination. A small minority of children do not
can also be vaccinated in a protected environment and benefits from the
ground protection.

Flavia
I would like to get information about the new meningitis vaccine and whether those who have done
The unique one more than 10 years ago should do it again.
– The latest vaccine released on meningitis covers meningococcal B and is now included in vaccinations to be given to newborns. For comprehensive protection coverage against serogroups A, C, W135 and Y is also appropriate

Vittorio
What does a doctor respond to when faced with side effects that I read about a
Lombardy region circular addressed to doctors “child paralysis ”
“brain damage “? What is the rate of this collateral damage?
In the circular as the last collateral damage was … death of the child …. but
I don’t want to believe it.
– Vaccines, like drugs, can give rise to side effects even
serious and unforeseeable. The incidence data are the result of reports
from the local area and can be found at www.epicentro.it. They must
be read with caution, however (for example, for a combination vaccine the
individual components are included among the undesirable effects). It is always
appropriate to consult with your pediatrician and be clear that the logic
of vaccinations is that of cost-effectiveness, just as
an insurance policy involves, yes, a cost, but it offers enormous advantages in
case of need.

Simona
I would like to know more about the papilloma virus vaccine, if there is a
casuistry and at what age to do it, and whether we should inform ourselves or whether like other vaccines
we are contacted by the ASL.
– Not all ASLs routinely send the summons, which, moreover, could
also not to be received in case of postal mismatch. Instead, it is appropriate that the parents, with the vaccination calendar in hand, directly request
information to the area vaccination center. Regarding HPV in the
www.epicentro.it finds a wealth of authoritative information.

Federica

My daughter has to do it in a year, and honestly if it was also for adults I would do it too
– HPV exposure follows a behavioral risk profile. Nothing
would prohibit vaccination (privately) at any age, but it makes sense to
protect individuals who are not yet sexually active.

Victory
For the Lombardy region, so far papilloma virus vaccination is
provided for girls between the ages of 11 and 12 (notice home by letter).
Although it has now been extended to males in all regions of Italy with the
new Vaccine Plan, the vaccination centers in Milan that I contacted did not
they carry out. It needs to be done privately. Where and at what price I have not yet understood.
– The vaccination plan takes a few months to be applied to
regime. Vaccines can also be given privately, in some
Co-payment cases where not yet available or outside the
stipulated age limits.

Alessandra
A boy and his family are against vaccines because they argue that a vaccine
caused type 1 diabetes in his older brother. Thank you
– Type 1 diabetes recognizes a clear familiarity and is believed to be triggered by
A nonspecific viral infection. There is no evidence that vaccines can
trigger it, regardless of the fact that if a child is genetically
predisposed, with the frequency of the community runs a high risk not
Otherwise avoidable.

Jordan
I would be interested to know what vaccines are recommended for adults today
(hepatitis?) and which recalls (tetanus shot?).
– For adults, vaccines should be remembered in case of travel/stay in areas
endemic (for example, there is an ongoing hepatitis A epidemic in Apulia), the
dTPa to be recalled every 10 years (or during pregnancy), and the vaccine against
pneumonia and zoster after age 64.

Health: shock waves against erectile dysfunction

25 February 20246 January 2024 by MinnieLuongo

Treating impotence even without drugs. News that will make many men happy: truly promising results are coming from the first study of the Italian Society of Andrology (SIA) regarding the treatment of the much-feared erectile dysfunction, which for many males is still-though wrongly I– a taboo. Although we need to tread lightly for the time being, preliminary results speak for themselves: 70 percent of patients “recovered” from impotence through the use of low-intensity shock waves. Therefore, we are facing a new treatment option for those who complain of mild to moderate erectile dysfunction, estimated to be one-third of the more than three million patients in our country. The treatment causes no side effects, is noninvasive, and is quick and painless. The Italian multicenter study, coordinated by the SIA, was conducted on about 100 patients and is still ongoing, with positive results for that 70 percent of patients, who stopped using drugs (so-called love pills) to return to spontaneous sexuality, while in the most severe patients the response to oral therapy improved in 40% of cases.

The survey

The survey, launched a year ago, involved patients aged 18 to 65 years with organically based erectile dysfunction being treated at hospital or university centers in Florence, Naples, Trento, Bari, and Trieste. This is the first study coordinated by a Scientific Society conducted on shock wave therapy for erectile dysfunction, with the aim of independently evaluating possible outcomes and the most appropriate indications. Patients underwent an average of six shock wave sessions with 3,000 low-voltage shots; then the effect was evaluated with a penile echocolordoppler and sexual activity questionnaires. “The six-month follow-up data are very promising,” explains Alessandro Palmieri, SIA president and study coordinator. In men with mild to moderate erectile dysfunction, therapy is successful and provides marked improvement in 70% of cases. Success in this case means possible cure: erectile dysfunction drugs have revolutionized sexual habits but remain “on-demand” cures, unable except in rare cases to restore erectile function. Shock waves, on the other hand, are able to reestablish the erection mechanism, allowing a return to natural sexuality without the need for relationship programming. However, this is still an emerging technique, and research is tasked with investigating the mechanisms of action of the method. This requires data from multicenter studies to define the long-term effects of treatment.”

A technology born in Israel

The method was developed in Israel a few years ago and is a physical therapy already used in other body districts, for example, for the treatment of kidney stones or as analgesic therapy. “Shock waves are high-energy acoustic waves,” explains Nicola Mondaini, SIA advisor. “They are applied to the penis through specific devices in sessions that last about 10 minutes, to be repeated for a total of six treatments in total. Physical therapy is thus brought exactly where it is needed and works by stimulating penile circulation, through the gradual growth of new blood vessels ( neo-angiogenesis), restoring spontaneous erection to the patient because circulation in the penis returns to normal and can provide an efficient erection.

Celiac disease: characteristics and numbers in Italy

25 February 20246 January 2024 by psalari

Celiac disease: What it is

Celiac disease is one of the most common hereditary diseases of pediatric age but fortunately also one of the treatable conditions: in fact, the remedy is to eliminate all foods containing gluten (bread, pasta, cookies, rusks, cakes, and even some medications). Gluten comprises a family of plant proteins, the polyamines, contained in wheat (gliadins), barley (hordeins), rye (secalins) and, still controversially, oats (avenins). Such proteins have little nutritional value-that is, they are not essential to the body-and gluten gives flour, once mixed with water, the ability to form a compact and elastic dough, which is among other things an essential prerequisite to breadmaking.

The numbers

A large survey had already estimated in 1994 a prevalence of people with celiac disease at a 1:200 ratio, which in fact is even higher today (1:100-1:150). On the other hand, celiac disease until the 1990s was misrecognized, but the advent of increasingly simple, rapid, and widespread laboratory techniques has enabled the recognition of more cases and thus a significant improvement in diagnostic possibilities.

It is currently believed that there are at least 100 individuals with celiac disease in a population sample of 100 thousand individuals. A number, therefore, that certainly does not justify the characterization as a rare disease, considering also the fact that there are 35,000 certified celiacs and every year new diagnoses increase by 10 percent, amounting to 5,000 cases of which 2,800 are in newborns. The intake of gluten, suggested in children as young as 6 months of age, basically activates an immune response that leads to flattening of the intestinal villi, resulting in generalized malabsorption and stunting of growth, which is the most striking sign (although some cases, which escaped initial diagnosis, are recognized in later life ages).

The consequences and risks

Numerous gastroenterological diseases, each burdened with a different clinical impact, such as irritable bowel syndrome, recurrent aphthous stomatitis, and hypertransaminemia (i.e., increased transaminases, enzymes produced by the liver, assayed in the blood) may be associated with celiac disease with different prevalence.

From celiac disease, with the unavoidable support of the physician, should be distinguished from the wheat allergy, which mainly affects the skin and respiratory tract, and the “gluten sensitivity“, which is always caused by ingestion of this food, but does not affect patients with celiac disease or allergy to wheat (in Italy, it is estimated that it could affect between 5 and 10 percent of the population). The latter causes clinical symptoms similar to those of irritable bowel syndrome (abdominal pain, bloating, and so on) and nonspecific extraintestinal manifestations (eczema, itching, headache), which usually arise within a short distance of gluten intake and just as quickly regress following an exclusion diet.

Maculopathy: causes, diagnosis and treatment

25 February 20246 January 2024 by Redazione My Special Doctor

Maculopathy is a disease that affects the retina, to be exact its most important part for vision that is the central part, called the macula. This important region of the eye can go through a variety of different processes; but most frequently the macular region is affected by aging processes in the retina and neighboring tissues, which is why it is commonly referred to as Macular Degeneration (DM). DM is bilateral in most cases and generally has a progressive course.

Maculopathy, which usually appears beginning in the sixth decade of life, constitutes one of the most frequent causes of legal blindness in the Western world. In fact, the condition affects 18-20% of the elderly population, with prevalence for the female sex. In industrialized countries it is the leading cause of irreversible loss of central vision after age 55, causing 41 percent of cases of legal blindness according to WHO.

The causes

The causes of maculopathy have not yet been fully proven, but several risk factors have been identified: age over 50, cigarette smoking habit, alcohol abuse, sedentary lifestyle, obesity, high blood pressure, and diet low in antioxidants. A genetic origin is also documented, as familiarity also appears to be a major risk factor, especially if first-degree relatives are affected.

With aging processes, the blood and nutrient supply is reduced, that is, the delicate mechanisms that oversee the nutrition of worn retinal cells are altered. This results in an accumulation of “waste” below the macula of both eyes that alters the function of the cells deputed to vision. The disturbances and decline in visual acuity are a function of the subsequent disappearance (atrophy) of these cells.

Therapy

In the therapy of neovascular-type age-related macular degeneration, i.e., the UMIDA form, the goal is to counteract the formation-or induce the regression-of new vessels and the subsequent reduction of edema and hemorrhage in the macular area. In particular, there are two treatments that have demonstrated real effectiveness:

Intravitreal injections with anti-VEGF drugs: this therapy takes advantage of the action of drugs that, when injected inside the eyeball, and exactly into the vitreous (that gelatinous substance that fills the eye cavities), interact with the neovascularization process. They are named anti-angiogenic drugs, that is, drugs that inhibit the formation of the abnormal neovases responsible for macular degeneration by binding and promoting the elimination of tissue growth factors that are released into the vitreous by damaged or suffering retinal cells.
Laser therapy: laser therapy in neovascular macular degeneration uses laser energy directed toward the retinal lesion (neovessus), which causes regression or destruction of the neovessus itself.

Rapid timing in diagnosis and administration of therapy are critical in this condition. InWHO ‘s recommendations to put in place strategies to stop what some are calling an epidemic, it is stressed that the most industrialized countries, whose life expectancy has now exceeded 80 years, are at greatest risk. Macular degeneration predominantly affects the elderly population. And Italy becomes a high-risk country. “That’s why it is indispensable,” argues Lucio Buratto, scientific director of the Ambrosian Ophthalmic Center, “a widespread information action because, as from the demographic survey I had carried out, it transpires that only 10 percent of respondents know what maculopathy is and what serious consequences it entails.

Functional gastrointestinal disorders

25 February 20246 January 2024 by psalari

Medicine, accustomed as it is to conventions and classifications, distinguishes diseases into organic and functional. The former are those associated with actual damage: this is the case, for example, with gastroenteritis caused by infection by a bacterium or virus, which settles in the intestines giving rise to diarrhea. Functional diseases, on the other hand, despite the occurrence of sometimes even intense symptoms, are characterized by the absence of injuries documentable: diarrhea, to refer to the situation just hypothesized (but an entirely similar consideration applies to the diametrically opposite condition, constipation), is triggered or maintained by factors that are not clearly identifiable or quantifiable, such as a particular emotional state.

Gastrointestinal functional disorders

What then are functional gastrointestinal disorders? They can be defined as a set of recurrent or chronic, age-varying symptoms that are independent of an underlying disease. In the first 2 years of life they may be physiological, that is, an expression of normal development, such as infant regurgitation, or, later, they may result from abnormal behavioral responses to internal or external stimuli, such as functional constipation caused by painful defecation.

Thus, at the basis of functional gastrointestinal disorders we find physiological, psychological and sociocultural factors capable of amplifying the perception of symptoms, which are experienced as severe, disabling and burdened with major repercussions on daily activities. Examples of functional disorders, in addition to those mentioned above, include colic, cyclic vomiting syndrome, and dyschezia (pain at the time of stool emission) in early childhood, abdominal migraine, functional dyspepsia, and irritable bowel syndrome in preschool, school, and adolescent ages.

Diagnosis and treatment

Two other elements need to be highlighted: first, there are no diagnostic indicators. In other words, there are no laboratory tests or benchmarks to be able to make the diagnosis, which is therefore based on as objective a set of symptoms as possible. Secondly, the care cannot be limited to medication but requires an approach that takes into account genetic and environmental factors (family influences, emotionally important events, infections, and so on), which may influence the child’s psychosocial development and cause him or her to be more susceptible to stress or bowel dysfunction (altered motility, altered immune system or visceral hypersensitivity). If, for example, a child suffers from functional diarrhea, treatment will have to contemplate the use not so much of medication but of dietary and especially behavioral measures, both for the child and his or her family members.

In the current view, in short, every intestinal disorder deserves to be transcoded not under the trivial label of a pretext contrived by the child to avoid a challenging test, but in the logic of a more complex effect resulting from the interaction between the organic sphere and the environment.

Informed consent: a right of every patient

25 February 20246 January 2024 by avettori

Informed consent, understood as the obligation to inform the patient, is the acceptance by a patient of medical treatment, care, therapy proposed to him or her by a physician. It thus represents the patient’s right to choose, accept, or in some cases refuse a specific treatment to which physicians would like to subject him or her. This is an inalienable right, which is also enshrined in the constitution.

A key element for consent to be legitimate is clear and adequate information about the entire treatment process to which the patient should undergo.

Clear and detailed information

The physician has the bbligation to illustrate in every detail the treatment he or she intends to propose to the patient, making clear what, if any, risks or dangers may be encountered. The patient needs to be aware of what the diagnosis is, the proposed treatment, the benefits, the risks, and even the dangers of not taking action. Only in cases where the patient receives clear, detailed information from the physician that is understandable to him or her can consent be considered valid and legitimate. Indeed, if a situation arises in which the patient is not fully aware of what he or she is (or is not) consenting to, the consent is to be considered null and void.

The document

In compliance with clear regulations that protect both parties, there is an official document that the patient is required to sign to authorize doctors to proceed with treatment. Such a document is written both for the protection of the patient, who can have an even clearer view of the procedure (or therapy) to which he or she is to undergo, and for the physician, who can prove, in the case of complications of any kind, that the patient was perfectly agreeable to continuing with the health care service. Despite this, the patient always has the option of reconsidering and no longer accepting treatment, thus availing himself of the so-called“right not to treat,” even if it might endanger his health.

The questions to be asked

Before undergoing any kind of therapy, it is good for every patient to ask very important and precise questions to their doctor, such as:

Is the surgery that I will have to undergo necessary ?
Are there therapeutic alternatives ?
What are the most frequent complications and risks ?
Can the same surgery be done using minimally invasive surgical techniques ?
Should I experience pain after surgery, will appropriate pain relief therapies be used ?
After how long will I be able to return to my living habits ?
Are there any particular prescriptions that I will have to follow on nutrition and treatments ?

In any case, the key element is clarity, but the patient’s trust in his or her doctor is also no less important.

Tattoo ink makes its way into the body through the bloodstream

25 February 20246 January 2024 by clemente.ferrara

Do you have a tattoo or are you thinking of getting one ? Before deciding of engraving an indelible phrase on your skin, or marking it with a symbol that refers to something important to you (whether it is the first tattoo or the last in a long series) you should pay close attention to the professionalism of the centers you go to and the attention they pay to the materials with which they will engrave your skin. Not only are perfectly sterilized needles and instruments sufficient, but also of great importance is the quality of the colors that will be injected under your skin. Let’s find out why.

The pigments that travel in the blood

Following a study published, in the journal Scientific Reports, carried out by a team of scholars led by Ines Schreiver, of the German Federal Institute for Risk Assessment (Bfr), the presence of the following was noted for the first time. color pigments in the blood of tattooed individuals, which travel through the channels of veins and arteries into our bodies. These are tiny particles, a millionth of a millimeter in diameter, that through the blood manage to reach various areas of our body, including the lymph nodes, organs of fundamental importance to our immune system.

Unfortunately, the possible consequences of such “contamination,” as a result of which chronic swelling of the lymph nodes has been noted, are not yet clear, but numerous studies are being planned to try to identify any adverse effects these pigments may have on the body. To be able to detect the presence of the color in blood vessels, the research team used the X-ray fluorescence technique to examine skin and lymph node samples taken from some tattooed subjects.

Hazardous inks

As mentioned above, it is of paramount importance to pay attention to the type of tattoo inks used. Many of these in fact, in addition to containing organic pigments, consist of numerous other (often toxic) substances such as preservatives and contaminants such as nickel, chromium, manganese and titanium dioxide. In fact, very often the danger lies precisely in the chemical composition of the ink, as also highlighted by the words of Hiram Castillo, of the European Synchrotron Light Center Esfr in Grenoble (who took part in the research): “When someone wants to get a tattoo they are very careful to go to centers that use sterile needles. However, no one checks the chemical composition of the colors, you should do that, and now we show why.”

The necessary precautions

Whenever you decide to get a tattoo, some very important questions need to be asked before you decide to proceed. Let’s look at some of them:

Who is the tattoo artist? It is very important to make sure that the person who will tattoo your skin has the skills to do so. Then verify that he has all the necessary licenses and permits to practice his profession.
Is the equipment used suitable ? Also pay close attention to the tools in the study. Are they all in good condition? Are they sterilized ? Most importantly, as for the disposable ones, make sure they are removed from the package in front of your eyes so you can be sure they are new and clean.
Am I really convinced that I want to get a tattoo ? Have I carefully chosen which part of the body to tattoo ? A tattoo is an indelible mark that will remain on your skin forever (unless you decide to remove it with long, expensive and painful laser treatments). Be 100 percent aware of your choice, have in mind why you want to get a tattoo and, most importantly, think carefully about the area of the body you intend to tattoo, because later second-guessing can cause you quite a few problems.

All these steps are more than necessary to avoid running into the most common tattoo-related problems. These include allergic reactions (which can lead to even very serious consequences), infectious diseases ( in case the tools are not properly cleaned and sterilized), skin infections, and scarring, caused perhaps by the tattoo artist’s inexperience or mistake.

Mind you, any scaremongering would be totally senseless and inappropriate, there is, however, a need to urge greater care in choosing carefully the specialized centers to which to turn for a tattoo, asking for precise elucidation on the chemical composition and quality of the inks used, as well as making sure of the professionalism of the tattoo artist and the safety of the tools he uses.

Antarctica is born: the EU agreement against antibiotic misuse

24 February 20246 January 2024 by clemente.ferrara

It all happened during“European Antibiotic Day,” organized by the European Centre for Disease Prevention and Control. Europe’s two most impotant scientific societies Escmid and Esicm have agreed to enter into an agreement called Antarctica (Antimicrobial resistance critical care), designed to combat antimicrobial resistance in intensive care units. In a nutshell, this is a stipulation that aims to significantly reduce the abuse of antibiotics and promote their much more rational and controlled use.

Data in hand

In fact, according to the latest estimates, up to 50 percent of antibiotics are administered too easily and excessively or inappropriately in hospitals in the European Union. In fact, according to surveys, the use of antibiotics to treat multidrug-resistant infections in Europe even doubled between 2010 and 2014. Italy specifically, is one of the states where there is very high consumption (27.8 doses per thousand inhabitants per day).

Such abuse will lead to very serious consequences if not stopped in time. In fact, if we continue at this rate, it is estimated that by 2050“superbugs” (i.e., those viruses that have developed strong resistance to even the strongest antibiotics) will become the world’s most prevalent cause of death, even more so than cancer. Suffice it to say that at present, in Europe, there are four million infections with antibiotic-resistant germs each year with 25 thousand deaths (world estimates instead record a rate of 700 thousand deaths from this cause).

Italian health care poverty

As if that were not enough, there is a further increase in health poverty in Italy. In fact, more and more people, due to the growing economic crisis and rising unemployment (especially youth unemployment), no longer have the ability to purchase medications for their health and are increasingly turning to health care centers. This is stated in the report “Donate to Cure.”, compiled by the Banco Farmaceutico Foundation and Bfr Research, according to which in 2017 the demand for medicines by the aforementioned institutions (about 1722) grew by 9.7 percent, with the number of people assisted exceeding 580,000 (with a growth rate of 4 percent), registering higher numbers especially among young people under 18 years of age.

In the words of Mario Melazzini, general manager AIFA: “Of even greater concern is the gap that has been created between the average level of spending, which stands at about 695 euros a year, and that of the indigent, who have about 106 euros, 17 less than in 2016.” And again, “We must never forget that behind the numbers and statistics are people, and there are inequalities in access to medicines, problems with treatment adherence, poor information, and a general worsening of health conditions.”

Colds: causes, symptoms and treatment

24 February 20246 January 2024 by Redazione My Special Doctor

A cold is an acute respiratory infection of viral origin that primarily affects the nose and throat and may be accompanied by coughing. Once affected by the viruses, the nasal mucous membranes become inflamed, swell, and begin to produce mucus, usually fluid and clear, more or less abundant. Although they can be very bothersome, these manifestations should not be resisted because they are an expression of the attack that the immune system is making on the cold virus and, in fact, help to heal.

A cold is a harmless seasonal ailment that usually heals on its own within 3-7 days. It is very common among children, who may experience it repeatedly especially in the fall and winter months (reaching up to 7-10 episodes per year), but it also routinely affects adults (on average 2-3 times per year).

Disorders and symptoms

Characteristic symptoms of a cold include a dripping (rhinorrhea) and flushed nose, feeling stuffy and difficulty breathing through the nostrils, sneezing, sore throat, coughing, mild headache (especially in the middle of the forehead), sometimes a few lines of fever and modest general malaise.

In infants and younger children, recurrent colds can facilitate the onset of otitis, sinusitis, and more or less intense inflammation of the upper airways (pharyngitis, laryngitis, tracheitis, tonsillitis): all diseases that need to be managed with the help of the pediatrician and may sometimes require the use of antibiotics (always to be taken only on prescription).

Causes

Causing colds are more than 200 types of viruses, mainly belonging to the rhinovirus and coronavirus classes, which are respiratorily transmitted and can infect humans at any time of the year.

Coronaviruses tend to multiply and cause colds especially from early fall to early spring, when the immune defenses of the respiratory system are reduced due to cold weather, temperature changes, smog and other unfavorable environmental factors.

Rhinoviruses spread best when the weather is milder (spring and summer), causing annoying “unseasonable” symptoms, which should not be confused with those of “allergic rhinitis.” The manifestations in the two cases are quite similar, but while rhinovirus colds last for a few days, the symptoms of allergic rhinitis tend to persist as long as allergens to which one is sensitive are present in the air.

To date, there is no vaccine to prevent colds. To reduce the risk of contracting it, some practical steps can be taken such as: wash your hands often, with soap and water or antiseptic gels; avoid touching your nose, mouth and eyes with hands that are not perfectly clean; avoid crowded enclosed places; stay away from people with cold symptoms; do not smoke; use disposable paper towels and throw them in the garbage immediately after blowing your nose or sneezing; ventilate the rooms in which you stay frequently, but without exposing yourself to air blasts or temperature changes; support your immune system by getting enough rest, exercising regularly, avoiding stress, eating healthy foods and taking adequate amounts of vitamins, zinc and minerals.

Diagnosis

Diagnosis of a cold is extremely simple and related to the finding of characteristic symptoms. Whether it affects a child or an adult, the common cold does not involve discomfort that requires medical attention. However, when the disorder is very intense and/or associated with coughing, when it affects a child in the early years of life or a frail elderly person, and when it persists for several days or recurs frequently, it is reasonable to undergo a medical examination to receive an accurate diagnosis and targeted treatment recommendations.

How to treat

Even a fairly intense cold gets better within a few days without special treatment. However, when the symptoms bother you a lot or prevent you from sleeping and concentrating, you can try to relieve them by resorting to decongestant nasal sprays, which relieve the inflammation of the mucous membrane of the nose, providing quick, if partial and temporary, relief.

Decongestant nasal sprays are contraindicated in children and in those with hypertension, glaucoma, diabetes, thyroid disorders, and during pregnancy and lactation. Even adults without these conditions, however, should try to use nasal sprays as little as possible so as not to risk prolonging the discomfort too long. The advice is to apply them no more than 3-4 times a day (1-2 sprays per nostril) and for up to 4-5 days.

Effective and harmless alternatives for clearing the noses of children and adults include nasal washes with sterile saline, aerosol, and suffumigation. Absolutely forbidden, on the other hand, is the use of antibiotics: against viruses, antibiotics are completely useless and their incorrect intake promotes the development of resistant bacteria that are increasingly difficult to fight.

Art also positively influences health

24 February 20246 January 2024 by MinnieLuongo

At St. Joseph’s Hospital Di Milano, life and art come to light thanks to “Curarsi ad Arte,” an exhibition itinerary of care and culture now in its second edition. At the Maternal-Infantile Department of the facility for the past few days it has been possible to admire a series of paintings made by students of the Brera Academy on the theme of light. According to the “cultural welfare” paradigm, art and culture improve patients’ quality of life by reducing hospitalization, inpatient and medicalization costs: It is no coincidence that one of the objectives of the 2018 European Year of Cultural Heritage is to highlight the contribution of culture to the well-being of EU citizens.

The initiative

In the presence of Lombardy Region Welfare Councillor Giulio Gallera, the exhibition “Curarsi ad arte – La luce” was inauguratedprecisely on Dec. 13, the day that celebrates St. Lucy, considered the patron saint of eyesight. Launched in 2016 thanks to the collaboration between the well-known Milanese hospital and the prestigious Art Institute, the project was born as an original experiment of “diffuse museum” within places deputed to care and, after the success of the first edition, is back again this year with a specific focus on light. Exactly in the corridors of the Maternal-Infantile Department, where new lives are being “brought to light,” works created by Brera students are in fact on display.
The virtuous partnership between Art and Medicine thus continues., which, on the one hand, allows young artists to exhibit and make themselves known; on the other hand, it creates an unprecedented possibility of cultural fruition, taking art outside its classical “temples” and bringing it closer to a particular audience: that of the users and health workers who populate the corridors of a large Italian hospital every day. In addition, there is a growing body of evidence confirming that art and beauty can exert a beneficial effect on patients, aiding the healing process and, at the same time, reducing anxiety and depression.

Health benefits of culture

“Today there are studies that show the effect of culture on quality of life and psychological well-being, but also its effectiveness in a wide variety of clinical areas”-confirms Pier Luigi Sacco, professor of Economics of Culture at IULM University in Milan. The idea of a possible“cultural welfare” paradigm is spreading” which, with appropriately declined interventions, is able to produce an improvement in the conditions of the people being cared for, at the same time reducing the costs of hospitalization, hospitalization and medicalization, and freeing up resources that can be used, among other purposes, to cover these same interventions, which would then in fact be self-financing. In order to achieve such a result, new pilot experiences are needed, no longer as has happened so far on a small scale, but with significantly larger numbers.”
Unlike 2016, for this year’s edition, students were given a theme to develop: light. “On our part, it therefore seemed logical and natural to offer the St. Joseph’s Maternal and Child Wards as an exhibition space”- concludes Daniele Schwarz, chief executive officer and general manager of the MultiMedica Group -.This department, in recent years, has been able to regain a leading role in Milan’s birth rate, reaching a quota close to 1,500 annual deliveries. Not only that, it has contributed to St. Joseph’s Hospital obtaining the recognition of the two Pink Stamps of the National Observatory on Women’s Health (ONDA). Results also made possible thanks to numerous upgrades and modernizations: from the new delivery block with a tub for water births, to the activation of a second-level neonatal intensive care unit, to name but a few examples.”

The exhibited works were created by: Flavia Albu, Marta Galbusera, Raffaele Greco, Maddalena Lusso, Anna Mangone, Michele Oppizzi. The selection was made by the Scientific Committee composed of: Franco Marrocco, Director, Brera Academy of Fine Arts; Daniele Schwarz, CEO, MultiMedica Group; Giuseppe Bonini, Dean, Department of Visual Arts, Brera Academy of Fine Arts; Roberto Casiraghi, Lecturer, Department of Visual Arts, Brera Academy of Fine Arts; Alessandra Chiarello, Director of Marketing and Communications, MultiMedica Group; Sergio Harari, President of Peripato Association; Alberto Mugnaini, Curator and art critic; Pierluigi Sacco, Professor of Economics of Culture, IULM/Special Advisor to the European Commissioner for Culture/Visiting Scholar, Harvard University; Carmen Sommese, Corporate Health Director, MultiMedica Group

Spontaneous chronic urticaria

24 February 20246 January 2024 by psalari

Pomphi, itching (often nocturnal) and swelling of certain parts of the body, sometimes disfiguring, with no known cause and disappearing only to recur suddenly and unpredictably. These are the symptoms of the chronic spontaneous urticaria, a particular form of urticaria unrelated to allergic factors that mainly affects individuals between the ages of 20 and 40 years (women twice as frequently), though it can appear at any time of life, and lasts on average for 3-4 years but sometimes even for decades. Although it affects 1 percent of the population, it is underestimated in both frequency and impact, leading to repercussions on school and work performance, social relationships, and psychological well-being.

This problem negatively affects quality of life to a greater extent than patients with even more serious skin problems, such as psoriasis. The presence of autoimmune diseases, especially thyroid disease, such as Hashimoto’s thyroiditis present in 10% of cases, celiac disease, and type 1 diabetes appears to correlate with an increased risk of chronic spontaneous urticaria. For the reasons explained above, it is easy to see why recognition of the disease is often delayed.

Diagnosis and treatment

The diagnostic pathway first proceeds with the search for any pathology associated with urticaria. Second step is to try to avoid factors that can aggravate urticaria, such as stress and especially the use of nonsteroidal anti-inflammatory drugs capable of inducing a flare-up or aggravation of urticaria in 20-30% of patients. The pharmacological approach involves the use of second-generation antihistamines at standard dosage, which can be doubled or quadrupled if symptoms persist after 2-4 weeks of therapy.

As a next step, omalizumab, a biologic drug that can improve symptoms in many cases and probably change the course of the disease, is used. If necessary, the fourth line of treatment relies on immunosuppressants, such as cyclosporine A, and the fifth on montelukast, an antileukotrienic. Unlike other chronic diseases, there is still no national patient registry and an organized network of services, and there are still numerous interregional disparities and limits to the Health Service’s coverage of treatment with antihistamines (in fact, they are reimbursed only at the standard dosage) and omalizumab, which is provided in the treatment plan for only 6 months.

Transient ischemic attacks

24 February 20246 January 2024 by pcarrieri

Transient ischemic attack, or transient ischemia, (TIA) is defined as an episode of neurological deficit caused by focal cerebral ischemia with complete recovery within 24 hours. On average, the duration of a TIA is about 10 minutes.

The cause of TIAs is usually atherothrombotic in nature and is due, in particular, to the presence of platelet microemboli or fibrin-platelet material from atheromasic plaques. This material can temporarily interrupt blood flow within an artery. The resumption of blood circulation and, consequently, the disappearance of the neurological deficit may be due to the Rapid dissolution of emboli. It is also possible that functional recovery is due to the rapid establishment of a
anastomotic compensation circle.
.

In the case of TIA affecting the
vertebro-basilar system
mechanisms may be invoked hemodynamic type such as abrupt head movements, which in subjects with cervical spondylarthrosis result in a momentary reduction in cerebral blood flow by compression on the vertebral arteries.

The numbers

The annual incidence of TIAs is around
120 cases per 100,000 population
, but hard data do not exist because such manifestations are not often reported to the physician or do not always prompt the subject to go to the
emergency room
. Episodes of TIA may instead be reported to the physician during the course of the medical history after cerebral ischemia. The TIA is in fact a risk factor important short-term risk factor for ischemic stroke. The possibility of an ischemic stroke after a TIA is estimated to be approximately between 3-10% after two days, around 5% after 7 days and between 9 and 17% after 3 months.

Also in the case of TIAs, symptomatology is related to the arterial district affected and can be distinguished, depending on whether the
carotid territory
or the
vertebrobasilar
.

Symptoms

Major complaints include loss of strength in a limb or a right or left hemilateral, difficulty speaking (aphasia, dysarthria), dizziness, drop-attack (sudden fall to the ground due to failure of the lower limbs with preservation of consciousness), short-term memory impairment (Transient global amnesia).

It is necessary to be
great care
in advancing the
suspicion of TIA
, because the symptomatology reported by the patient could be confused with other conditions such as syncopal episodes, seizures partial, migraine with hemiplegia

I would like to emphasize again that TIA is a
neurological deficit without loss of consciousness:
therefore the affected person remembers the episode very well and is able to report it in great detail, as opposed to during epileptic seizure.

On the other hand, one cannot confuse a TIA with a cerebral stroke, even of modest magnitude, because in the case of a stroke the neurological deficits are of more than 24 hours’ duration: moreover, an ischemic brain lesion can be evidenced on CT (Computed Tomography) or MRI (Magnetic Resonance Imaging) brain.

Parkinson’s disease: Symptoms, causes and treatment

24 February 20246 January 2024 by pcarrieri

Parkinson’s disease is a chronic progressive disease; it was first described by James Parkinson in 1817. After dementias, it is the most common neurodegenerative disease.

EPIDEMIOLOGY

The condition is equally prevalent worldwide; the average age of onset is between
55 and 60 years of age
and affects
1-2% of the entire population over 65 years of age; 5% of those affected are under 40 years of age.

In Italy there are about
220 thousand people affected.

ETIOPATHOGENESIS

Various risk factors for Parkinson’s disease have been identified, including age, family history, male gender, environmental exposure to herbicides, pesticides, metals (manganese, iron), well water, residence rural, mental and physical trauma, emotional stresses.

A protective factor, on the other hand, is cigarette smoking.
.

The cause of the disease is unknown, but it is probably the result of an interaction between environmental toxins, genetic susceptibility, and senescence.
Mitochondrial dysfunction and oxidative stress
are now considered among the main mechanisms underlying the disease.

In a .small percentage
of the cases a genetic cause
. Major mutations include those affecting genes coding for
alpha-synuclein
and for
parkin
.

The
pathogenesis
is related to the
degeneration of most of the dopaminergic neurons in the black substance
(nerve structure located at the level of the midbrain). This results in the reduced production of
dopamine
, a key neurotransmitter in the
regulation of movement
. Symptoms of the disease become apparent
When more than 70 percent
of dopaminergic neurons were lost.

The main alterations involve the
black substance
which appears paler than normal; within it there is a reduction in the number of neurons and in surviving neurons inclusions of a substance called
alpha-synuclein:
are the so-called
Lewy bodies
, which are not specific to Parkinson’s disease, as they can also be found in
Lewy body dementia
and in
Alzheimer’s dementia.

SYMPTOMATOLOGY

The onset is sneaky
with tremor in one hand
, but also often with
joint pain, depression of mood, easy fatigability.

The cardinal symptoms are
resting tremor
, the
slowness of movement
, also called bradykinesia,

and the
rigidity
. To these symptoms must be added postural instability. PD is a
asymmetric pathology
in that, especially in the early stages, it affects one half of the body more than the other .

Let us go on to illustrate the basic symptoms.

The resting tremor, present in about 70% of cases, has a frequency of 4-6 shocks per second and at onset affects only one hand and, in particular, the first three fingers, giving the impression of “count coins“; tremor is accentuated under conditions of emotional tension, fatigue, o When the subject feels observed, while it is absent during sleep.

The
rigidity
is characterized by an
increased muscle tone
with
constant resistance
to mobilization. There may be the so-called
cogwheel phenomenon
, in that the presence of resistance to passive mobilization is alternated with
sudden failures
, brings to mind the
clicks of a gear
.

The
slowness of movement
(bradykinesia) is the third cardinal sign of the disease, also accompanied by reduced motility. During the march, the subject with PD gives the impression of having the
upper limbs attached to the body
without the characteristic
pendular movements
.

Also observed are
difficulties such as using a knife or fork, buttoning up or
unbuttoning, shave. The writing becomes trembling and uncertain and you shrinks (microgra phy), the facial expressions is reduced (amimia) (Figure 8). The subject, over time, assumes a prone posture with
Head flexed forward and knees and elbows flexed
.

Postural instability
is the difficulty in maintaining upright station in response to external thrusts; it can be the cause of disastrous falls and is present in about 40% of cases.

NON-MOTOR SYMPTOMS

Autonomic nervous system involvement is characterized by the presence of
orthostatic hypotension, constipation, sialorrhea, seborrhea, increased sweating
At the level of the head and neck. Urinary disorders may be present such as urinary urgency
and increased
urinary frequencyI.

The
cognitive impairment, usually moderate, is present in up to 60 percent of cases; there may be impairment of attention, concentration and memory and slowness in performing executive tasks. Unfortunately in some cases until the
in 20%
may be present a
frank dementia
subcortical type

The
depression of mood tone
is often present but under-diagnosed and under-treated. I sleep-wake rhythm disorders are very common being able to affect up to 90% of people with PD. They can consist of
excessive daytime sleepiness
or in
difficulty in initiating or maintaining sleep
, or in
poor sleep quality with frequent awakenings
and reductions in stages III and IV sleep and REM sleep.

DIAGNOSIS

It is mainly based on the recognition of the three main signs
, resting tremor, rigidity and bradykinesia with unilateral onset, and the response to L-DOPA.

CT or MRI scans of the brain are normal or at most can demonstrate the presence of some degree of brain atrophy, which is otherwise highly variable.

The following can be used to assess presynaptic dopaminergic pathways
the SPET-DaT SCAN, which s
erve to show alteration of dopaminergic pathways, but is not always superior to clinical diagnosis.

To assess the degree of disability, the use of Rating Scales is useful. The most widely used are the UPDRS and the Hoehn and Yahr Scale.

THERAPY

Initially there is a good drug response; later, as the disease worsens, the response to drugs worsens and fluctuations appear especially in the area of motor symptoms. These include the on-off phenomenon, sudden lack of response to medication with no relation to the timing of intake; wearing-off, predictable reappearance of parkinsonian symptoms after a number of years due to the shorter duration of response to medication; and freezing of gait or simply freezing, sudden motor blockage that occurs at the onset of walking, or in crossing narrow passages, or in changes of walking direction; in the latter case, the subject reports having his or her feet as if glued to the floor.

MEDICINE: characteristics and symptoms of diabetes

24 February 20246 January 2024 by MinnieLuongo

Diabetes-which, for accuracy, should be referred to as “diabetes mellitus”-is a complex disease in which there is an increase in blood glucose levels due to a deficit in the amount and, often, in the biological effectiveness ofinsulin, the hormone that controls blood glucose and is produced by the pancreas. It is a very common condition: about 3 million people in Italy have been diagnosed with diabetes, and, in addition, it is estimated that another 1.5 million have the disease without knowing it. Internationally recognized, the new classification of diabetes drawn up in 1997 divides diabetes into three main types:

Type 1 diabetes mellitus = Includes almost all immune-mediated forms of diabetes; here the underlying cause is a malfunction of the immune system, which, recognizing “pancreatic beta cells “of the so-called islets of Langerhans as foreign, attacks and destroys them.
Type 2 diabetes mellitus = This includes all forms of diabetes, due to a deficit in insulin secretion, by the pancreatic beta cells of the islets of Langerhans, and a resistance of the body tissues to the action of insulin (insulin resistance).
Gestational diabetes = As it was in the old classification, this includes forms of diabetes secondary to the state of pregnancy. Generally, it is a transient phenomenon.

Disorders and symptoms of diabetes

In the vast majority of cases, the disease gives no discomfort. If these are present they are intense thirst (polydipsia), need to urinate often with copious urine (polyuria), and fatigue (asthenia). In type 1 diabetes there is often weight loss, and the onset of the disease can be abrupt with noticeable malaise, drowsiness, and acetone odor on the breath. In contrast, in type 2 diabetes the diagnosis is often made in a person who is basically well at laboratory tests (check up) or during investigations or hospitalization for another disease (casual diagnosis).

Risk factors

In type 1 diabetes:

First-degree relatives (parents, siblings) with type 1 diabetes;
Autoimmune diseases (such as thyroiditis, rheumatoid arthritis, celiac disease, vitiligo);
Autoimmune diseases among first-degree relatives

In type 2 diabetes these are the main ones:

First-degree relatives with type 2 diabetes;
Suboptimal blood glucose or HbA1c;
Previous gestational diabetes;
Excess body weight;ssedentariness;
Overfeeding;
Smoking;
Hypertension;
Low HDL cholesterol;
Elevated triglycerides;
Advanced age.

Care

The treatment program should include periodic medical visits from one’s general practitioner and diabetes specialist, according to an individually agreed protocol that takes into account the patient’s clinical characteristics. The treatment program should include periodic screening and staging for any chronic complications of the disease, with certain tests repeated at preestablished intervals.

INFLUENZA: maximum peak coming up

24 February 20246 January 2024 by clemente.ferrara

More than 7 million Italians have been bedridden in recent weeks because of infuenza, which seems to be very aggressive indeed this year. As always, those most affected are the elderly, children, and all patients suffering from chronic conditions. The most common symptoms are fever, cough, and a general sense of exhaustion that affects the entire body, forcing sick people to take forced rest under the covers. This wave of the disease has not yet reached its peak (due next week), but its numbers have already surpassed those recorded last year.

According to Caterina Rizzo, an epidemiologist at the National Institute of Health, “This season is having a greater impact. We have the highest numbers in the last five seasons. Higher prevalence, but severe cases are in line with previous seasons. However, we are approaching the peak: in the last week of December there were 11 cases per 1,000 population, already in the last week we had 13.5. We think that the highest peak ever recorded was 15 cases per thousand, in the 2004-2005 season. So we are already at a high level.”

The most serious cases

Although the numbers of the most serious cases sian0 in line with those of past years, there was, unfortunately, no shortage of deaths. Since the beginning of surveillance (roughly around September 2017) there have been about 140 more serious cases reported, with as many as 30 deaths of individuals over the age of 25. Among the most serious cases, moreover, three involved expectant mothers, who, however, fortunately managed to recover without compromising the health of their babies. Of the 140 patients in serious condition, all were admitted to an intensive care unit and/or subintensive care unit, and 79 were intubated.

As mentioned earlier, those most at risk are undoubtedly children and individuals over 65, for whom the vaccine is recommended, although we are almost out of maximum time as the vaccine needs about two weeks to offer ideal protection.

How to treat yourself

To resist the flu attack, it is essential to put in place an important prevention and treatment effort. In the words of Claudio Mastroianni, Simit secretary, “It is essential to stay at rest and warm, drink, use anti-inflammatories and antipyretics. Antibiotics only in cases of bacterial complications since this is a viral form that can be treated with symptomatic therapy.” There is no need to go to the hospital immediately, but if the high fever continues for more than three days, a doctor should be contacted.

Family physicians and chronic diseases: not all drugs are prescribable

24 February 20246 January 2024 by Redazione My Special Doctor

Family doctor, general practitioner, primary care physician, general practitioner, general physician, or even, in institutional settings, general practitioner. Whatever you want to call him, this doctor is known to all Italians because he is the doctor to whom every citizen turns at the first symptom of discomfort. But perhaps not everyone knows that the family doctor cannot prescribe a number of medications, including those for diabetes. A limitation that physicians and specialists themselves, as well as patient associations, do not find justified and therefore call for its abolition.

Within our national health service, the primary care physician is the first-level health officer, that is, the one who provides the first level of care on the ground. Having issued the diagnosis, the general practitioner can prescribe drugs with a special prescription or indicate specialist medical visits through a so-called referral. However, he cannot prescribe innovative drugs, namely new generation antidiabetics, anticoagulants, and chronic obstructive pulmonary disease (COPD) drugs. Under current regulations in Italy, in fact, the prescription of entire classes of drugs is entrusted exclusively to medical specialists as part of the compilation of the “treatment plan.”

The rationale behind these prescribing restrictions is purely economic: these are drugs with costs on average higher than others available for the same conditions. A difference that GPs object to because, according to them, the choice of drugs should be based on shared criteria of prescriptive appropriateness, and not instead reserved only for certain categories of professionals.

As for the effects on citizens, according to primary care physicians, limiting prescriptions hinders patients’ right to access medication and risks compromising the effectiveness of treatment. Physicians, therefore, clamor to be able to prescribe the drugs they deem most appropriate, particularly antidiabetic drugs, some of which are real therapeutic advances for blood glucose control, or new anticoagulants that improve therapeutic adherence, or COPD drug combinations.

Immediate prescribing, therefore, ensures direct benefits to patients, who would not go to crowded specialist facilities. Expanding expertise would also enable family physicians to gain new professionalism and new scientific knowledge with respect to innovative drugs.

by Paola Mantovano

Sore throat: how to recognize if it is strep throat

23 February 20246 January 2024 by psalari

Sore throat from Virus or Streptococcus?

Sore throat is among the most common symptoms in children and adults. In most cases, it is a trivial viral infection of the upper respiratory tract, and does not need treatment. If, on the other hand, the sore throat is caused by streptococcus bacteria, antibiotic treatment becomes necessary.

The inflammation may involve the pharynx (pharyngitis) or even the tonsils (pharyngotonsillitis), causing pain. The tonsils may appear increased in volume, reddened, and covered with a whitish material (exudate). These are the so-called “plates”, caused by the immune system’s reaction to the infection. However, their presence on the tonsils does not mean that the infection is bacterial, that is, caused by streptococcus, but can instead be viral in origin, as in the case of mononucleosis. Typically, when pharyngitis and pharyngotonsillitis are caused by viruses, they are accompanied by other typical signs of viral diseases, such as colds, conjunctivitis, hoarseness, or diarrhea.

Source: AdnKronos Health

The antibiotic, therefore, should be taken only if plaques are a result of the presence of streptococcus, which should be ascertained by resorting to pharyngeal swabbing, which is a swab that is taken by vigorously rubbing a cotton swab on the oropharynx and the surface of both tonsils, avoiding touching other parts of the oral cavity or contaminating it with saliva.

Streptococcus is a spherical (coconut) bacterium of which there are several types, many of which do not cause diseases. In some cases, however, they can cause pharyngotonsillitis, otitis, meningitis, pneumonia, infection generalized and endocaritis (infections of the internal cavities or valves of the heart). Also scarlet fever, the rheumatic disease and an inflammation of the kidney (glomerulonephritis) are attributable to streptococcus.

Source: AdnKronos Health

Today, streptococcal infections are no longer scary, but complications should not be underestimated, especially since the misuse of inappropriate antibiotic therapies has produced “resistances” that are weakening the effectiveness of law enforcement. Antibiotic therapy of streptococcal pharyngitis should begin within 9 days of the onset of sore throat, but not before swabbing, the microbiological examination of the pharyngeal cavity. Therapy can shorten and alleviate frequent sore throats, but is mainly aimed at preventing complications.

Physical and cognitive activity protect women’s brains

18 February 20246 January 2024 by rosanna.feroldi

Any physical and cognitiveactivity performed by women around age 40-55 can protect intellectual function in later life years, reducing the risk of developing cognitive decline and dementia of various types and levels of severity. Had you already been told this? Most likely, yes, because there have been many studies in this area conducted in recent decades.

The added value inherent in the results of the research conducted at the University of Gothenburg (Sweden) is the particularly long observation period (follow-up was as long as 44 years) and the clarification of the protective effects of physical and cognitive activity against vascular dementia and Alzheimer’s disease, respectively.

The study, recently published in the peer-reviewed journal Neurology, involved 800 women with a mean age at enrollment of 44 years (in the range of 38-54 years), selected from the general population. For all participants, intellectual, artistic, manual, social, religious and sports activities habitually performed were recorded at the beginning of the evaluation, and periodic monitoring of cognitive performance was, therefore, initiated from 1968 to 2012.

During follow-up, 194 women were diagnosed with dementia, 102 with Alzheimer’s disease, 27 with vascular dementia, 41 with mixed dementia, and 81 with dementia associated with cerebrovascular disease. All diagnoses were made based on the criteria provided in the reporting period, taking into account the outcomes of neuropsychiatric interviews, visits and examinations, data collected in medical records and patient registries.

Analysis of available information showed that, in general, women who remain intellectually active between the ages of 40 and 55 have a reduced risk of developing a form of dementia by about one-third (-34%). The protection was found to be particularly pronounced against Alzheimer’s disease, the occurrence of which would be practically halved (-46%) compared to women who were less inclined to read, study, listen to music, take classes, attend museums, go to the theater or movies.

Even more favorable has been shown to be the impact o fexercise, particularly against mixed dementia and cerebrovascular disease-related forms. In fact, the risk of developing the former was found to be 57 percent lower among the more physically active women, while the risk of developing dementia related to cerebrovascular disease was found to be 53 percent lower.

The magnitude of these preventive effects is surprising, to say the least, when one considers that, at present, medical has very few weapons (moreover, of very limited effectiveness) to protect against these neurodegenerative diseases, and that the outcomes cited were obtained after excluding major confounding factors such as educational level, socioeconomic status, presence of hypertension, diabetes or cardiovascular disease, body weight, smoking, stress and depression.

Of course, more confirmation is needed before we can come to any firm conclusions, but in the meantime, it’s worth banishing all laziness and trying to keep as intellectually and physically active as possible, shall we?

Source

Najar J et al. Cognitive and physical activity and dementia. A 44-year longitudinal population study of women. Neurology 2019;92:e1322-e1330. doi:10.1212/WNL.0000000000007021 (https://n.neurology.org/content/92/12/e1322.long)

Gastro-oesophageal reflux

16 January 20246 January 2024 by Maria Chiara Villa

Gastro-oesophageal reflux

Here are the main indications to counteract this disorder

Recent studies show that gastroesophageal reflux in Italy affects about 20-25% of the population. The main causes of the onset of reflux are precisely poor eating habits and incorrect lifestyles and being overweight. Gastroesophageal reflux occurs when gastric contents back up into the esophageal lumen. Symptoms vary, but the most common is burning.

The main directions for addressing this issue are:
1. Reduce the quantity of meals by increasing their frequency (eat little but often).
2. Follow a low-fat diet, also paying attention to the consumption of sweets and sugary drinks.
3. Be careful not to take food that is too hot or too cold.
4. Beware of consuming foods that can increase stomach acidity such as: coffee, tea, milk, citrus fruits, tomato and chocolate.
5. Take time to eat, eating slowly helps reduce symptoms. The meal should be consumed in no less than 25 minutes.
6. If you are overweight or obese, it is recommended that you try to gradually lose weight through an individualized nutritional plan based on each person’s work and family preferences and nutritional needs, while practicing physical activity.
7. Encourage good hydration by taking in at least 1.5 liters of water daily, including in the form of soups, herbal teas, and prefer the consumption of foods such as fruits and vegetables in addition to whole foods.

Finally, it is good to avoid lying down immediately after eating, but waiting 1-2 hours. If you smoke, it is good, of course, to try to quit.

NUTRITION AND DIET	NATURE, SPORTS, PLACES	CULTIVATING HEALTH	MENOPAUSE	MOM IN SHAPE
TRADITIONAL CHINESE MEDICINE	HEART SURGERY	MEDICINES AND MEDICAL DEVICES	PARENTING	THE CULTURE OF HEALTH
HEALTH UTILITIES	GENERAL MEDICINE	NATURAL MEDICINE, THERMAL	MIND AND BRAIN	NEUROVEGETATIVE DYSTONIA
WAYS OF BEING	HEALTH AND SOCIETY	HEALTHCARE AND PATIENTS	SEXUALITY	OLDER AGE
CANCERS	EMERGENCIES

NUTRITION AND DIET	NATURE, SPORTS, PLACES
CULTIVATING HEALTH	MENOPAUSE
MOM IN SHAPE	TRADITIONAL CHINESE MEDICINE
HEART SURGERY	MEDICINES AND MEDICAL DEVICES
PARENTING	THE CULTURE OF HEALTH
HEALTH UTILITIES	GENERAL MEDICINE
NATURAL MEDICINE, THERMAL	MIND AND BRAIN
NEUROVEGETATIVE DYSTONIA	WAYS OF BEING
HEALTH AND SOCIETY	HEALTHCARE AND PATIENTS
SEXUALITY	OLDER AGE
CANCERS	EMERGENCIES

DIGESTIVE SYSTEM	RESPIRATORY SYSTEM	UROGENITAL SYSTEM	HEART AND CIRCULATION	SKIN
INFECTIOUS DISEASES	EYES	EARS, NOSE, AND THROAT	BONES AND LIGAMENTS	ENDOCRINE SYSTEM
NERVOUS SYSTEM

DIGESTIVE SYSTEM	RESPIRATORY SYSTEM
UROGENITAL SYSTEM	HEART AND CIRCULATION
SKIN	INFECTIOUS DISEASES
EYES	EARS, NOSE, AND THROAT
BONES AND LIGAMENTS	ENDOCRINE SYSTEM
NERVOUS SYSTEM

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