A regional-based newborn hearing screening program: the Emilia-Romagna model after ten years of legislation.

Background: Hearing loss, occurring in 1-3/1,000 newborns in the well-babies population, is one of the most common congenital diseases, and hearing screening at birth still represents the only means for its early detection. Since 2011 the Emilia Romagna Regional Health Agency has recommended Newborn Hearing Screening for all babies at its birth points and for newborns moving to the region. The aims of this study are to analyze the results of this regional-based Newborn Hearing Screening program and to discuss the impact of the legislative endorsement on the organization. Material and methods: This is an observational retrospective chart study. The recordings of well-babies and babies at Neonatal Intensive Care Units were collected during the period from January 1st 2015 to December 31st 2020. The following data were included: Newborn Hearing Screening coverage, percentage of refer at otoacoustic emissions, prevalence and entity of hearing loss, unilateral/bilateral rate, presence of audiological risk factors. Results: More than 99% of a total of 198,396 newborns underwent the Newborn Hearing Screening test during the period January 1st 2015 to December 31st 2020, with a coverage ranging between 99.6% and 99.9%. Overall, the percentage of confirmed hearing loss cases was about 17-30 % of refer cases, 745 children received a diagnosis of hearing loss (prevalence 3.7/1,000). Considering profound hearing loss cases, these represent 13% of bilateral hearing loss. Conclusion: A regional-based Newborn Hearing Screening program is valuable and cost-effective. In our experience, the centralization of the data system and of the data control is crucial in order to implement its efficiency and effectiveness. Healthcare policies, tracking systems and public awareness are decisive for a successful programme implementation.

Optimización de la seguridad del paciente durante el servicio de dispensación de medicamentos con formas farmacéuticas tipo parche transdérmico / Optimising patient safety during the dispensing service of medicines with transdermal patch-type dosage forms

INTRODUCCIÓN: la frecuencia de los errores que se producen por una incorrecta administración de los medicamentos en el domicilio de los pacientes oscila entre el 19 y el 59 %, dependiendo del estudio. Hasta en un 26 % delos casos los pacientes sufren daños. Los tipos de errores más frecuentes en el domicilio de los pacientes son la toma del medicamento a una dosis incorrecta o con un intervalo incorrecto, confusiones entre los medicamentos por falta de información o debido a la similitud en la apariencia de los nombres o los envases, duplicidades terapéuticas, omisiones y falta de adherencia, así como en el manejo de dispositivos de preparación y o administración, situación que no se escapa a la administración de parches transdérmicos tal y como indican los resultados del Instituto para el Uso Seguro del Medicamento en España.OBJETIVOS: analizar, desde el punto de vista de la seguridad del paciente, la seguridad clínica del servicio de dispensación de aquellos medicamentos cuya forma farmacéutica es un parche transdérmico. Establecer una lista de verificación PRELIMINAR que debe de considerar el farmacéutico en su protocolo de dispensación para optimizar la gestión terapéutica del paciente usuario de parches transdérmicos.MÉTODOS: reunión de varios farmacéuticos comunitarios en plataforma ZOOM para valorar los riesgos asociados a la dispensación de formas farmacéuticas tales como parches transdérmicos, comprimidos bucodispersables y formas de liberación modificada. Creación de documento compartido en la plataforma Google Drive donde poder hacer una lluvia de ideas. Creación de un decálogo y un checklist que sirva para evitar potenciales errores de medicación asociados a la dispensación de medicamentos cuya forma farmacéutica sea un parche transdérmico. (AU)

Optimización de la seguridad del paciente durante el servicio de dispensación de medicamentos con formas farmacéuticas tipo comprimido bucodispersable / Optimising patient safety during the dispensing service of orodispersible tablet type medicines

INTRODUCCIÓN: la frecuencia de los errores que se producen por una incorrecta administración de los medicamentos en el domicilio de los pacientes oscila entre el 19 y el 59 %, dependiendo del estudio. Hasta en un 26 % delos casos los pacientes sufren daños. Los tipos de errores más frecuentes en el domicilio de los pacientes son la toma del medicamento a una dosis incorrecta o con un intervalo incorrecto, confusiones entre los medicamentos por falta de información o debido a la similitud en la apariencia de los nombres o los envases, duplicidades terapéuticas, omisiones y falta de adherencia, así como en el manejo de dispositivos de preparación y o administración, situación que no se escapa a la administración de comprimidos bucodispersables, tal y como indican los resultados del Instituto para el Uso Seguro del Medicamento en España.OBJETIVOS: analizar, desde el punto de vista de la seguridad del paciente, la seguridad clínica del servicio de dispensación de aquellos medicamentos cuya forma farmacéutica es un comprimido bucodispersable. Establecer una lista de verificación preliminar que debe de considerar el farmacéutico en su protocolo de dispensación para optimizar la gestión terapéutica del paciente usuario de comprimidos bucodispersables.MÉTODO: reunión de varios farmacéuticos comunitarios en plataforma ZOOM para valorar los riesgos asociados ala dispensación de formas farmacéuticas tales como parches transdérmicos, comprimidos bucodispersables y formas de liberación modificada. Creación de documento compartido en la plataforma Google Drive donde poder hacer una lluvia de ideas. Creación de un decálogo y un checklist que sirva para evitar potenciales errores de medicación asociados a la dispensación de medicamentos cuya forma farmacéutica sea un comprimido bucodispersable. (AU)

Optimización de la seguridad del paciente durante el servicio de dispensación de medicamentos con formas farmacéuticas de liberación modificada FLM / Optimisation of patient safety during the dispensing service of medicines with modified release dosage forms FLM

INTRODUCCIÓN: la frecuencia de los errores que se producen por una incorrecta administración de los medicamentos en el domicilio de los pacientes oscila entre el 19 y el 59 %, dependiendo del estudio. Hasta en un 26 % delos casos los pacientes sufren daños. Los tipos de errores más frecuentes en el domicilio de los pacientes son la toma del medicamento a una dosis incorrecta o con un intervalo incorrecto, confusiones entre los medicamentos por falta de información o debido a la similitud en la apariencia de los nombres o los envases, duplicidades terapéuticas, omisiones y falta de adherencia, así como en el manejo de dispositivos de preparación y o administración, situación que no se escapa a la administración deformas farmacéuticas de liberación modificada (FLM), tal y como indican los resultados del Instituto para el Uso Seguro del Medicamento en España.OBJETIVOS: analizar, desde el punto de vista de la seguridad del paciente, la seguridad clínica del servicio de dispensación de aquellos medicamentos cuya forma farmacéutica es una FLM. Establecer una lista de verificación preliminar que debe de considerar el farmacéutico en su protocolo de dispensación para optimizar la gestión terapéutica del paciente usuario de FLM.MÉTODOS: Reunión de varios farmacéuticos comunitarios en plataforma ZOOM para valorar los riesgos asociados a la dispensación de formas farmacéuticas tales como parches transdérmicos, comprimidos bucodispersables y formas de liberación modificada. Creación de documento compartido en la plataforma Google Drive donde poder hacer una lluvia de ideas. Creación de un decálogo y un checklist que sirva para evitar potenciales errores de medicación asociados a la dispensación de medicamentos cuya forma farmacéutica sea una FLM. (AU)

Proyecto el farmacéutico que necesitas. Carpa de salud 19 abril 2022. L@s farmacéutic@s con la Palma / The pharmacist you need project. Health tent 19 April 2022. Pharmacists with La Palma

INTRODUCCIÓN: la erupción del Volcán de Cumbre Vieja en La Palma. "Este desastre natural ha acarreado a lo largo de tres meses de actividad la muerte de una persona, el desplazamiento de más de 7.000 en una comunidad de algo más de 80.000 residentes, la desaparición de más de 1.200 edificaciones que incluyen viviendas, empresas, colegios, iglesias y hasta cementerios, más de 1.000 hectáreas de terreno de cultivo y la destrucción o deterioro de infraestructuras vitales como carreteras, conducciones eléctricas e hidrológicas. El día a día se ha acompañado de terremotos cotidianos, el rugido y el tremor volcánico, la emisión por el cráter de gases tóxicos, cenizas y piroclastos y el progreso arrasador de la lava incandescente a través de distintas coladas. Evidentemente, esta situación de indefensión y sufrimiento puede originar consecuencias en la salud mental de los afectados, especialmente aquellos más vulnerables como personas con patologías previas, escaso apoyo social o que han sufrido un daño más significativo, tal como se ha visto en otras catástrofes, con la previsible aparición, más o menos diferida, de trastornos como el estrés postraumático, la ansiedad, la depresión o el aumento en el consumo de alcohol y sustancias”.OBJETIVOS: poner de manifiesto, a través de la presencia de los farmacéuticos comunitarios (FC) de Canarias y la acción profesional en las áreas de salud de la carpa, el compromiso de la Sociedad Española de Farmacia Clínica, Familiar y Comunitaria (SEFAC) con la población afectada en la Isla de La Palma con motivo de la erupción del Volcán de Cumbre Vieja del pasado 19 de septiembre de 2021. Ofrecer servicios de educación sanitaria sobre los trastornos de salud derivados de la erupción más prevalentes detectados en las farmacias comunitarias de la isla a través de la labor humanística de escucha, apoyo y motivación del FC como profesional sanitario. (AU)

Implementación del Servicio SIFAC durante el episodio de calima prolongado en la Pandemia del COVID 19 / Implementation of the SIFAC Service during the prolonged haze episode in COVID Pandemic 19

JUSTIFICACIÓN: los problemas asociados a la calima y el impacto del polvo sahariano son un potencial peligro para la salud, y se manifiestan la mayoría en síntomas menores respiratorios y oftalmológicos tales como congestión nasal, tos, ojo rojo y ojo seco. Aunque la duración habitual es de 3 a 5 días, en las Islas Canarias ocurrió un episodio del 27 de enero de al 12 de febrero de 2022. Valor en la práctica habitual del Servicio definido y protocolizado por Foro de Atención Farmacéutica en farmacia comunitaria, siendo necesario: reducir la inseguridad del paciente en el autocuidado y la automedicación, en el caso de los síntomas menores realizar actuación o intervención: dispensación del medicamento solicitado que no precise prescripción, asegurando que es utilizado correctamente. Indicación de tratamiento farmacológico que no precise prescripción, para ese síntoma menor. Indicación de medidas higiénico-dietéticas, educación sanitaria y/o recomendaciones sanitarias. La derivación al centro de salud de manera adecuada y consensuada, potenciando la comunicación con otros profesionales sanitarios implicados en la atención a ese paciente.MATERIAL Y MÉTODOS: reunión de los tres farmacéuticos comunitarios en plataforma ZOOM para coordinar la recopilación de datos en el SIF de los siguientes síntomas menores: congestión nasal, tos, ojo rojo y ojo seco. Creación de documento compartido en la plataforma Google Drive donde poder registrar la información. Entrevista con el paciente: PASITAMAE. Registro del servicio en Programa Digital de SEFAC, que permite la evaluación simultanea del paciente con ayuda de los protocolos consensuados. Entrega del Informe para el paciente de la actuación farmacéutica y/o entrega del informe de derivación al médico. Cuantificar los datos de las tres farmacias comunitarias en función de resolución del síntoma menor y/o derivación al médico de Atención primaria o al Servicio de Urgencias. (AU)

Adherencia y Seguridad del paciente: el peligro del triturador de comprimidos / Adherence and Patient Safety: the danger of the tablet crusher

PRESENTACIÓN DEL CASO/ANTECEDENTES: cuidador de un paciente de 85 años acude a la farmacia comunitaria con fecha de enero de 2022, para adquirir un triturador de comprimidos. El farmacéutico le pregunta para qué lo va a utilizar. El cuidador le explica que el paciente posee una demencia grabe. Cuando se le administra la medicación, la mastica y se produce a veces lesiones en la cavidad bucal. Ha decidido triturar toda la medicación para disolverla en agua y que el paciente la ingiera sin autolesionarse.EVALUACIÓN: se le pide el plan de tratamiento para confirmar si su medicación se puede partir/y o triturar. Se le pregunta si ha empeorado en alguna patología o han variado los valores de tensión arterial, glucemia y colesterolemia, y si está más agresivo o si padece insomnio. Se le solicita también la última analítica realizada, que fue hace un mes. Ésta refleja un aumento de hiperglucemia e hipercolesterolemia. Afirma que la tensión arterial ha aumentado y está descontrolada, que está más inquieto y no duerme bien. Se pregunta si le ha comentado la situación a su Médico de Atención Primaria y comenta que no. El cuidador comenta que era normal el deterioro del paciente, por el cambio tan grande producido por la pandemia del COVID 19 en su entorno familiar.INTERVENCIÓN: el farmacéutico revisa el plan de tratamiento y de 11 medicamentos para su tratamiento crónico, 1 de ellos inyectable y otro colirio, 7 de ellos no se puede ni ranurar, ni triturar. Se envía carta de derivación al médico, y alternativas de medicamentos con formas farmacéuticas para los 7 tratamientos que si se pueden triturar.RESULTADO/SEGUIMIENTO: el M.A.P. valora positivamente el informe y cambia la medicación. También pide analítica dos semanas después del cambio. (AU)

Sustainable plant polyesters as substrates for optical gas sensors.

The fast and non-invasive detection of odors and volatile organic compounds (VOCs) by gas sensors and electronic noses is a growing field of interest, mostly due to a large scope of potential applications. Additional drivers for the expansion of the field include the development of alternative and sustainable sensing materials. The discovery that isolated cross-linked polymeric structures of suberin spontaneously self-assemble as a film inspired us to develop new sensing composite materials consisting of suberin and a liquid crystal (LC). Due to their stimuli-responsive and optically active nature, liquid crystals are interesting probes in gas sensing. Herein, we report the isolation and the chemical characterization of two suberin types (from cork and from potato peels) resorting to analyses of gas chromatography-mass spectrometry (GC-MS), solution nuclear magnetic resonance (NMR), and X-ray photoelectron spectroscopy (XPS). The collected data highlighted their compositional and structural differences. Cork suberin showed a higher proportion of longer aliphatic constituents and is more esterified than potato suberin. Accordingly, when casted it formed films with larger surface irregularities and a higher C/O ratio. When either type of suberin was combined with the liquid crystal 5CB, the ensuing hybrid materials showed distinctive morphological and sensing properties towards a set of 12 VOCs (comprising heptane, hexane, chloroform, toluene, dichlormethane, diethylether, ethyl acetate, acetonitrile, acetone, ethanol, methanol, and acetic acid). The optical responses generated by the materials are reversible and reproducible, showing stability for 3 weeks. The individual VOC-sensing responses of the two hybrid materials are discussed taking as basis the chemistry of each suberin type. A support vector machines (SVM) algorithm based on the features of the optical responses was implemented to assess the VOC identification ability of the materials, revealing that the two distinct suberin-based sensors complement each other, since they selectively identify distinct VOCs or VOC groups. It is expected that such new environmentally-friendly gas sensing materials derived from natural diversity can be combined in arrays to enlarge selectivity and sensing capacity.

Mast cell tumours in dogs less than 12 months of age: a multi-institutional retrospective study.

OBJECTIVES: To describe the clinicopathological and genetic characteristics of mast cell tumours in dogs less than 12 months old. MATERIALS AND METHODS: Retrospective review of dogs aged less than 12 months when diagnosed with mast cell tumours at three referral hospitals in the UK. RESULTS: Sixteen pure-bred dogs were included, of which 11 were female. The median age at first presentation and diagnosis were 7.6 and 9 months, respectively. In 13 dogs the mast cell tumours were cutaneous and in three they were subcutaneous. Four cutaneous mast cell tumours were described as high-grade (Patnaik or Kiupel) and nine were Patnaik grade II; three had mitotic index of >5 in 10 high-power fields. Of the three subcutaneous tumours, two had an infiltrative growth pattern and one had mitotic index of 10 per 10 high-power fields. Of 10 tested dogs, seven had c-kit mutations in exon 11 and Ki-67 score was above the cut-off value in nine. Four of 12 cases showed evidence of metastasis in the regional lymph nodes. After varying treatment protocols, all patients were alive and disease free at a median of 1115 days after diagnosis. CLINICAL SIGNIFICANCE: The prognosis of mast cell tumours in dogs less than a year old appears better than the adult counterparts, even without extensive treatment.

Tumour-to-tumour metastasis: breast carcinoma to an olfactory neuroblastoma.

Tumour-to-tumour metastasis is a rare phenomenon. It occurs when a primary tumour is a recipient of a separate tumour within the same individual. We present a case of a 66-year-old woman with known breast cancer who presented with one-sided nasal symptoms. Examination and imaging revealed a unilateral polyp arising from the skull base. She underwent endoscopic polypectomy with the histology demonstrating tumour-to-tumour metastasis from a breast carcinoma to an olfactory neuroblastoma, a rare sinonasal tumour. Clinicians should be cautious of distant metastases in any patient presenting with head and neck symptoms and a known primary tumour. This is the first documented case of this type.

RHBDD2 overexpression promotes a chemoresistant and invasive phenotype to rectal cancer tumors via modulating UPR and focal adhesion genes.

The current standard of care for locally advanced rectal cancer (RC) is neoadjuvant radio-chemotherapy (NRC) with 5-fluorouracil (5Fu) as the main drug, followed by surgery and adjuvant chemotherapy. While a group of patients will achieve a pathological complete response, a significant percentage will not respond to the treatment. The Unfolding Protein Response (UPR) pathway is generally activated in tumors and results in resistance to radio-chemotherapy. We previously showed that RHBDD2 gene is overexpressed in the advanced stages of colorectal cancer (CRC) and that it could modulate the UPR pathway. Moreover, RHBDD2 expression is induced by 5Fu. In this study, we demonstrate that the overexpression of RHBDD2 in CACO2 cell line confers resistance to 5Fu, favors cell migration, adhesion and proliferation and has a profound impact on the expression of both, the UPR genes BiP, PERK and CHOP, and on the cell adhesion genes FAK and PXN. We also determined that RHBDD2 binds to BiP protein, the master UPR regulator. Finally, we confirmed that a high expression of RHBDD2 in RC tumors after NRC treatment is associated with the development of local or distant metastases. The collected evidence positions RHBDD2 as a promising prognostic biomarker to predict the response to neoadjuvant therapy in patients with RC.

Direct costs of glaucoma: Relationship between cost and severity of the disease.

OBJECTIVES: To estimate the direct medical costs associated with the management of patients with primary open-angle glaucoma and to compare the costs of patients according to the degree of severity. METHODS: A longitudinal retrospective study was carried out using all patients with primary open-angle glaucoma that recorded follow-up from May 2010 to June 2013 at the Hospital Privado de Córdoba. We estimated the cost of the disease from the perspectives of the institution, with a bottom-up approach. RESULTS: The three-year follow-up after treatment of 104 patients revealed that the average cost of care for a patient with primary open-angle glaucoma was US$2746 ± 1560. The first year of treatment was significantly more expensive than subsequent ones (US$1100-$810-$827). Cost was related to the degree of severity of glaucoma; patients in "Stage 0" had significantly lower costs than those in other groups (Kruskal-Wallis test, p < 0.01). This was a consequence of lower costs associated with medication and a lower percentage of patients undergoing surgery. DISCUSSION: The direct medical costs of a patient with primary open-angle glaucoma vary according to the severity of their disease and the year of treatment. We found that costs increased with disease severity, but decreased over time.

Triamcinolone acetonide-loaded lipid nanocapsules for ophthalmic applications.

Triamcinolone acetonide (TA) is an effective drug widely (off-label) used in the treatment of several ocular diseases involving inflammation and angiogenic processes. However, the use of TA ocular presents some limitations mainly related to its excipient composition, as in the case of benzyl alcohol. Thus, the aim of this work was to obtain an alternative TA formulation based on lipid nanocapsules (LNCs). Triamcinolone acetonide-loaded lipid nanocapsules (TA-LNCs) were obtained by the phase inversion temperature process without the use of irritating excipients, by combining lipids and surfactants generally recognized as safe. Pre-formulation studies were carried out to evaluate the TA solubility in different co-surfactants and to optimize the lipid core composition in order to enhance the drug loading and encapsulation rate in the LNCs. A stable final TA-LNC formulation was obtained with a mean particle size (MPS) of below 50 nm, a narrow size distribution (PDI < 0.2), a negative zeta potential (ZP) and a high encapsulation efficiency (%EE > 98%). In vitro cellular viability assays revealed that blank LNCs and TA-LNCs at 0.1 µg/mL did not affect the viability of the human corneal epithelial (HCE) cells. TA-LNCs showed a high anti-inflammatory activity below the toxicity level, with a reduction of 30% in interleukin (IL)-6 secretion observed in an in vitro model using the same cell line. More importantly, the TA-LNCs revealed a therapeutic efficacy in the endotoxin-induced uveitis (EIU) rabbit model with a significant attenuation of clinical signs of an inflammatory response. These findings make the TA-LNCs a safer and more efficient alternative for the treatment of eye disorders.

Hypogammaglobulinemia: a diagnosis that must not be overlooked.

Humoral immunological defects are frequent and important causes of hypogammaglobulinemia, leading to recurrent infections, autoimmunity, allergies, and neoplasias. Usually, its onset occurs in childhood or during the second and third decades of life; however, the diagnosis is made, on average, 6 to 7 years afterwards. As a consequence, antibody defects can lead to sequelae. Here we describe the clinical-laboratory characteristics, treatment, and prognoses of patients with hypogammaglobulinemia. An observational, cross-sectional, and retrospective study of patients attending the recently established outpatient group of Clinical Immunology between 2013 and 2018 was carried out. Patients with IgG levels below 2 standard deviations from the mean values for the age and/or impaired antibody response were included. Eight patients (3 F and 5 M; median age=41 years (16-65), average symptom onset at 25 years (1-59), and time to diagnosis of 10 years were included. The main infections were: sinusitis in 7/8, pneumonia in 6/8, otitis in 2/8, tonsillitis and diarrhea in 2/8, and diarrhea in 2/8 patients. Hypothyroidism was identified in 4/8 (50%) patients. Rhinitis was found in 7/8 (87.5%) and asthma in 3/8 (37.5%) patients. The tomographic findings were consolidations, atelectasis, emphysema, ground glass opacity, budding tree, bronchial thickening, and bronchiectasis. Immunoglobulin reposition was used between 466 and 600 mg/kg monthly (514.3 mg·kg-1·dose-1). Prophylactic antibiotic therapy was included in 7/8 (87.5%) patients. Airway manifestations prevailed in patients with hypogammaglobulinemia. There is a need for educational work to reduce the time of diagnosis and initiation of treatment, avoiding sequelae.

Hypogammaglobulinemia: a diagnosis that must not be overlooked

Humoral immunological defects are frequent and important causes of hypogammaglobulinemia, leading to recurrent infections, autoimmunity, allergies, and neoplasias. Usually, its onset occurs in childhood or during the second and third decades of life; however, the diagnosis is made, on average, 6 to 7 years afterwards. As a consequence, antibody defects can lead to sequelae. Here we describe the clinical-laboratory characteristics, treatment, and prognoses of patients with hypogammaglobulinemia. An observational, cross-sectional, and retrospective study of patients attending the recently established outpatient group of Clinical Immunology between 2013 and 2018 was carried out. Patients with IgG levels below 2 standard deviations from the mean values for the age and/or impaired antibody response were included. Eight patients (3 F and 5 M; median age=41 years (16-65), average symptom onset at 25 years (1-59), and time to diagnosis of 10 years were included. The main infections were: sinusitis in 7/8, pneumonia in 6/8, otitis in 2/8, tonsillitis and diarrhea in 2/8, and diarrhea in 2/8 patients. Hypothyroidism was identified in 4/8 (50%) patients. Rhinitis was found in 7/8 (87.5%) and asthma in 3/8 (37.5%) patients. The tomographic findings were consolidations, atelectasis, emphysema, ground glass opacity, budding tree, bronchial thickening, and bronchiectasis. Immunoglobulin reposition was used between 466 and 600 mg/kg monthly (514.3 mg·kg-1·dose-1). Prophylactic antibiotic therapy was included in 7/8 (87.5%) patients. Airway manifestations prevailed in patients with hypogammaglobulinemia. There is a need for educational work to reduce the time of diagnosis and initiation of treatment, avoiding sequelae.

Hereditary angioedema with C1 inhibitor (C1-INH) deficit: the strength of recognition (51 cases).

Hereditary angioedema (HAE) is a rare autosomal dominant disease due to C1 esterase inhibitor deficiency (C1-INH). The disease is characterized by subcutaneous and submucosal edema in the absence of urticaria due to the accumulation of bradykinin. This descriptive study aimed to evaluate the clinical characteristics of patients with a confirmed diagnosis of HAE referred to our Outpatient Clinic between December 2009 and November 2017. Fifty-one patients (38 F, 13 M) with a mean age of 32 years (range: 7-70 y) were included. Family history of HAE was reported in 70% (36/51) of the cases; 33/46 patients became symptomatic by 18 years of age. The median time between onset of symptoms and diagnosis was 13 years (3 mo-50 y). The most frequent triggering factors for attacks were stress (74.4%), trauma (56.4%), and hormonal variations (56%). The main symptoms were subcutaneous edema in 93.5% (43/46) of patients, gastrointestinal symptoms in 84.8% (39/46), and obstruction in the upper airways in 34.8% (16/46). Hospitalization occurred in 65.2%, of whom 13.3% had to be transferred to the Intensive Care Unit. Prophylactic treatment was instituted in 87% (40/46) of patients, and 56.5% (26/46) required additional treatment to control attacks. Owing to our data collection over a period of 8 years, a significant number of patients were identified by this HAE reference center. Despite early recognition and prophylactic treatment, a high percentage of patients were hospitalized. HAE is still diagnosed late, reinforcing the need for more reference centers specialized in diagnosis and educational projects for health professionals.

Emerging and re-emerging infectious disease in otorhinolaryngology.

SUMMARY: Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

The reactivation time in the treatment of AMD: a forgotten key parameter?

OBJECTIVE: Summarize and compare the available evidence on the reactivation times in patients with age-related macular degeneration treated with Ranibizumab (RNB). METHOD: Systematic review of studies that reported the reactivation time of patients (direct method) or the number of injections received in a certain period of follow-up (indirect method). RESULTS: Only 18 of 89 selected studies reported the average reactivation time of patients in a manifest form, without the need of any calculation. The average calculated, weighted reactivation time was 101.8 days with the direct method and 99.8 days in the indirect method (84 studies included). With both methods, it was found that the average reactivation time of the RCTs was between 2 and 3 weeks less than the average time identified in the observational studies. These differences are also reflected in the clinical results, there being a correlation between the number of doses received and the change in BCVA. The analysis of 11 comparative studies showed a difference in reactivation times between patients treated with RNB or Bevacizumab (BVZ). CONCLUSION: There are few direct studies of reactivation time, but calculation from the PRN dose number turns out to be a good approximation for retrospective study of the variable. The use of the PRN, with criteria not based on optical coherence tomography scans, delays the application of doses between 2 or 3 weeks, and patients suffer loss of clinical benefits. RNB enables patients to receive less injections than BVZ throughout treatment.