Integrated Physiotherapeutic Intervention for Rehabilitation of a Patient With Intellectual Disabilities: A Case Report.

Intellectual disabilities (ID) encompass a broad spectrum of neurodevelopmental disorders marked by impairments in cognitive functioning and adaptive behavior. Accessing and benefiting from rehabilitation services pose significant challenges for individuals within this population. In this case study, the rehabilitation journey of a 44-year-old man with ID, emphasizes the tailored approach to his rehabilitation program. The primary objectives of the program were to augment the patient's functional capabilities, foster independence, and enhance his overall quality of life. The case highlights the significance of personalized, comprehensive rehabilitation strategies intricately tailored to address the distinct requirements of individuals with ID. The case study delineates a comprehensive rehabilitation regimen integrating physical therapy to address the multifaceted needs of individuals with varying degrees of disability. This inclusive approach represents a paradigm shift toward a multidisciplinary (physiotherapy along with general medical care, special education, vocational training, and community-based interventions) person-centered model of care. Through addressing the varied needs of individuals with ID, the rehabilitation plan endeavors to empower them to lead enriching, self-directed lives within their communities, thereby unlocking their complete potential. This case study stands as evidence of the profound impact of customized rehabilitation interventions in cultivating inclusivity and optimizing the well-being of individuals with ID.

Myocardial Strain Imaging Using Feature Tracking Method of Cardiac MRI: Our Initial Experience of This Novel Parameter as an Additional Diagnostic Tool.

Background Left ventricular ejection fraction (LVEF) is used as quantitative parameter to evaluate myocardial function. However, interobserver variation, limited reproducibility, and dependence on pre-load and after-load reduces its accuracy. The fall in LVEF occurs very late, when myocardial dysfunction is already advanced. Myocardial strain measurements (especially global longitudinal strain) is a new parameter to detect myocardial dysfunction before derangements in LVEF. The aim of this article is to share our experience of this novel diagnostic tool. Methods Feature tracking method of strain assessment is performed using routine long and short axis cine images of cardiac MRI (CMR). Dedicated post-processing CMR software can perform off-line analysis and provide results in form of color-coded maps, percentage values as well as strain over time curve for each myocardial segments. Results Global longitudinal strain (GLS) is more sensitive than LVEF and can identify sub-clinical left ventricular (LV) dysfunction in various cardiomyopathies. It is also an important prognostic marker in serial assessment of heart failure patients. Regional differences in strain parameters can provide clues in hypertrophic cardiomyopathy as well as amyloidosis. GLS is recommended as routine measurement in patients undergoing chemotherapy to detect LV dysfunction prior to fall in LVEF. Strain imaging can be applied to guide placement of the LV pacing lead in patients receiving cardiac resynchronization therapy. More clinical data is needed to evaluate its role in ischemic heart disease. Conclusion Strain imaging can identify LV dysfunction earlier than conventional methods and this opens a new perspective in risk stratification and therapeutic decision-making of various cardiac pathologies.

Can smart nutrient applications optimize the plant's hidden half to improve drought resistance?

Global agriculture is challenged with achieving sustainable food security while the climate changes and the threat of drought increases. Much of the research attention has focused on above-ground plant responses with an aim to improve drought resistance. The hidden half, that is, the root system belowground, is receiving increasing attention as the interface of the plant with the soil. Because roots are a sensing organ for nutrients and moisture, we speculate that crop root system traits can be managed using smart nutrient application in order to increase drought resistance. Roots are known to be influenced both by their underlying genetics and also by responses to the environment, termed root plasticity. Though very little is known about the combined effect of water and nutrients on root plasticity, we explore the possibilities of root system manipulation by nutrient application. We compare the effects of different water or nutrient levels on root plasticity and its genetic regulation, with a focus on how this may affect drought resistance. We propose four primary mechanisms through which smart nutrient management can optimize root traits for drought resistance: (1) overall plant vigor, (2) increased root allocation, (3) influence specific root traits, and (4) use smart placement and timing to encourage deep rooting. In the longer term, we envision that beneficial root traits, including plasticity, could be bred into efficient varieties and combined with advanced precision management of water and nutrients to achieve agricultural sustainability.

Sinuclean Nebules treatment in children suffering from otitis media with effusion.

OBJECTIVE: Otitis media with effusion (OME) is an ear disorder defined by the presence of fluid in the middle ear without signs or symptoms of acute infection. The current randomized, double-blind, controlled study aimed to evaluate whether Sinuclean Nebules treatment, administered by nasal douche (Rinowash), could induce ear healing better than isotonic saline in children with OME. METHODS: The study was randomized, double-blind, and controlled. Group A (30 children) was treated with Sinuclean Nebules 45 and Group B (31 children) was treated with isotonic saline; both compounds were administered by nasal nebulization with Rinowash nasal douche twice/day in the morning and in the evening for 10 days, followed by a one-week suspension, and after by a second course as the first. Tympanogram and audiometry were performed at baseline and after treatment. RESULTS: Considering the global evaluation of the treatment: in Group A, 28 (93.3%) patients had complete resolution and 2 (6.7%) had partial resolution; in Group B, all patients had failure of treatment. There was a significant difference between groups (p < 0.0001). CONCLUSION: The current randomized-controlled study demonstrated that Sinuclean Nebules was effective and in the treatment of children with OME.

Florid cement-osseous dysplasia of maxilla and mandible: a rare clinical case

Cemento-osseous dysplasia is a group of disorders known to originate from periodontal ligament tissues. Florid cemento-osseous dysplasia clearly appears to be a form of bone and/or cementoid tissues restricted to jaw bones. This lesion is usually asymptomatic and is incidentally detected during routine radiographic examination. The diagnosis is made by clinical and radiographic examinations, and biopsy is not necessary. The patient must manifest the typical changes in atleast two quadrants. An asymptomatic individual requires only a periodic follow-up to ensure that there is no change in the disease behavior. Surgical management is indicated only for a progressive lesion that produces orofacial disfigurement. This paper presents a rare case of a 60-year-oldfemale who was clinically and radiographically diagnosed as having florid cemento-osseous dysplasia in the maxilla and mandible. Discussion is presented with emphasis on clinical and radiographic manifestations.

Results and complications of the Baha system (bone-anchored hearing aid).

The aim of this work is to reexamine our experience with the treatment of conductive and mixed hearing loss using the Baha system. The system was implanted in 47 patients (16 adults and 31 children under the age of 14), bilaterally in two cases. The causes of hypoacusis were bilateral congenital aural atresia (31 patients), bilateral chronic otitis media or outcomes of middle-ear surgery (Gillett et al. in J laryngol Otol 120:537-542, 2006), and otosclerosis (Pazzaglia et al. in Acta Orthop Scand 54:574-579, 1983). The following parameters were assessed: mean preoperative air- and bone-conduction thresholds for the frequencies of 500, 1,000, 2,000 and 4,000 Hz; mean postoperative threshold with the Baha; hearing improvement calculated by subtracting the postoperative threshold with the Baha from the preoperative threshold for air conduction in the better ear; speech audiometry test; improvement in the quality of life, calculated using the Glasgow Benefit Inventory for the adult patients and the Glasgow Children's Benefit Inventory for paediatric patients; frequency and type of surgical complications. Follow-up ranged from 6 to 38 months. The audiological results were satisfactory, with air-bone gap closure in 85.1% of cases. In terms of quality of life, assessment using the Glasgow Benefit Inventory showed a clear-cut improvement in health for all the 45 patients that answered to the questionnaires in our study. Out of the 49 operations that were performed, complications were reported in 3 cases (6.1%): 2 cases of skin regrowth around the titanium screw and one in which the abutment was not osseointegrated. The data from this study show that the Baha system offers a high percentage of success, which can significantly improve the patient's quality of life, and a low rate of complications.

Prevention of surgery in children with adenoidal hypertrophy treated with intranasal flunisolide: a 12-month follow-up.

Adenoidal hypertrophy (AH) represents one of the most frequent indications for surgery in children. Recently, treatment with intranasal corticosteroids has been suggested to decrease the size of AH. The aim of the study is to evaluate the long-term effect of intranasal flunisolide on AH during a 12-month follow-up. One hundred seventy-eight children with a grade III or IV AH at baseline endoscopic examination were enrolled in this randomised and controlled study. Children were treated with intranasal flunisolide or isotonic saline solution for 8 weeks. Subsequent assessment, including history and fiberoptic endoscopy, was made at 8 weeks, and 6 and 12 months after treatment suspension. Flunisolide treatment was initially associated with significant (p<0.01) reduction of the degree of AH. However, during follow-up all but one of the non-allergic children relapsed, whereas most allergic children maintained AH size reduction (p<0.05). No clinically important adverse events were reported. In conclusion, this preliminary study demonstrates that an 8-week treatment with intranasal flunisolide is significantly associated with reduction of AH, however, the adenoidectomy avoidance was warranted only for allergic children.

Ear, nose and throat manifestation of viral systemic infections in pediatric patients.

OBJECTIVE/METHODS: An exhaustive review of literature was performed to investigate available data and evidences regarding pediatric otolaryngologic manifestations of viral systemic infections. RESULTS/CONCLUSIONS: Modern otolaryngologists should be familiar with viral systemic infections since many have head and neck manifestations. Cooperation between otolaryngologist, paediatrician and virologist can be considered and excellent tool in diagnosis and treatment of these diseases in particular when complications occur.

Adeno-tonsillar surgery in Italy.

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

[The treatment of acute recurrent pharyngotonsillitis]. / Il trattamento delle flogosi acute ricorrenti faringo-tonsillari.

AIM OF THE STUDY: In paediatric patients, recurrent febrile pharyngo-tonsillitis is usually due to chronic inflammation of the tonsils and/or adenoids: these episodes are often associated with other clinical manifestations (respiratory obstruction of naso-pharyngeal origin; auricular inflammation, especially effusive otitis media and acute otitis media; streptococcal beta-haemolytic Group A (SBEGA) infection, causing a distant disorder of varying severity and which may, therefore, give rise to serious pathological conditions). A retrospective multicentric investigation has, therefore, been carried out in order not only to further elaborate findings emerging from earlier studies, performed in other countries, in which random methods were used, but also to focus on: 1. the possible association of these clinical manifestations with recurrent febrile pharyngo-tonsillar inflammation in relation to frequency of the condition; 2. results obtained with adenoidectomy or with adeno-tonsillectomy, referring to the overall clinical outcome of the pathological condition, bearing in mind data emerging from the control groups, submitted to strict follow-up, associated with any medical treatment deemed necessary. MATERIAL AND METHODS: The study population comprised 692 patients (394 male, 298 female), age range 2-11 years and with a minimum follow-up of 2 years. Considering the clinical manifestations emerging from the case history, the following two investigations were carried out: 1. the first, on 501 patients, all previously submitted to adeno-tonsillectomy in whom the recurrent febrile pharyngo-tonsillar inflammation had occurred, respectively > 4 or < or = 4 episodes during the last 12 months; 2. the second, on 455 patients in whom recurrent febrile pharyngo-tonsillar inflammation, in the 12 months prior to the beginning of the study, had been < or = 4 episodes: in 264 cases, adeno-tonsillectomy was carried out; in 144, adenoidectomy; 47 children were studied as controls and, therefore, submitted to watchful waiting. The results obtained were statistically analysed by chi2 and Fisher test: a "p" value of < 0.05 was considered statistically significant. RESULTS: The first investigation showed that all symptomatological manifestations considered were resolved following adeno-tonsillectomy, in a significantly high percentage of cases (recurrent febrile pharyngo-tonsillar in flammation: 91.8%; naso-pharyngeal respiratory obstruction: 92.2%; pathological ASO titre: 69.8%; distant disorders probably due to SBEGA: 76%; effusive otitis media: 76%; acute recurrent otitis media: 87.5%). The most interesting clinical findings obtained can be summarized as follows: naso-pharyngeal respiratory obstruction is a frequent finding; the incidence is statistically higher in cases in which recurrent febrile pharyngo-tonsillar inflammation is less frequent (p < 0.05): in these patients, this is an important pathological manifestation indicating the need for surgery; the higher incidence is associated with at significant finding of pathological auricular processes; the percentages of recovery for naso-pharyngeal respiratory obstruction are statistically greater in the group of patients in whom the recurrent febrile pharyngo-tonsillar inflammation is more frequent: an identical result is found in patients with the effusive form of otitis media and in those with recurrent acute otitis media; a pathological ASO titre is more frequently found, the difference being statistically significant (p < 0.05), in the group of patients with more frequent recurrent febrile pharyngo-tonsillar inflammation, albeit this factor does not affect the percentage of recovery; also the favourable evolution and recovery of clinical distant manifestations, related to streptococcal beta-haemolytic Group A infection, are correlated with the return to normal of the ASO titre. The second investigation demonstrated the efficacy of surgical treatment, adeno-tonsillectomy and adenoidectomy, in all the clinical manifestations studied, the possibility of achieving resolution of recurrent febrile pharyngo-tonsillar inflammation even in the control subjects submitted to medical treatment, but also the lack of success, in the latter, as far as concerns naso-pharygeal respiratory obstruction, the pathological ASO titre and the inflammatory auricular processes. CONCLUSIONS: The present investigations confirm previous observations emerging from randomized clinical studies, regarding the possibility to achieve valid prevention of recurrent febrile pharyngo-tonsillar inflammation, also in a large percentage of control patients submitted to watchful waiting; these investigations, however, also demonstrated that, in the control group, the percentage of subjects in whom recovery of other symptoms was achieved was very low compared to that in the groups submitted to surgery. In other words, clearly emerges as far as concerns the overall symptomatological picture of the patients, the efficacy of the surgical treatment, but also the lack of success of the medical treatments in all clinical manifestations associated with recurrent febrile inflammations. Therefore, it is necessary to select and advise the most suitable treatment strategy, not in relation to the Guidelines elaborated on the basis of results emerging from statistical research, that, due to the intrinsic methodology limits cannot be applied to all cases in an acritical fashion, but in relationship to the specific clinical picture of each individual patient.

[Acute recurrent pharyngotonsillitis and otitis media]. / Le flogosi faringo-tonsillari acute ricorrenti e le manifestazioni infiammatorie auricolari.

BACKGROUND: In the more recent randomized clinical studies, the surgical procedures adopted (adenoidectomy and adeno-tonsillectomy) for the treatment of the effusive and the acute recurrent forms of otitis media have generally shown a relatively modest and not persistent efficacy. It should be pointed out, however, that the cases studied displayed no clinical elements suggesting the existence of any aetio-pathogenic relationship between the auricular inflammation and a possible pathological disorder localized in the tonsils and/or adenoids. AIM OF THE STUDY: The present investigation aimed to establish: a) the frequency with which the two forms of tympanic inflammation, under study, were detected in children with recurrent febrile pharyngo-tonsillar inflammation, also considering the possible presence of naso-pharyngeal respiratory obstruction and the severity of these two pathological manifestations; b) in relationship to these parameters, what might be the outcome with respect to the pathological auricular processes following surgical treatment of the pharyngeal disorder (adeno-tonsillectomy or adenoidectomy) vs. watchful waiting, c) the possible advantages offered by ventilation tube, inserted during surgical treatment, in the prevention of the two forms of otitis media studied. MATERIAL AND METHODS: This retrospective multi-centre investigation involved 678 subjects (388 male, 290 female), age range 2 - 11 years: all subjects were followed-up for a minimum period of 2 years. Patients in this study population were submitted to 3 groups of investigations: a) in the first (487 children submitted to adeno-tonsillectomy), the study population was subdivided into 2 groups according to the frequency of the complaints of febrile pharyngo-tonsillar inflammation reported during the previous 12 months (> 4 or < or = 4); b) in the second (443 children with recurrent febrile pharyngo-tonsillar inflammation during the previous 12 months < or = 4), three groups of cases were compared; in the 1st (252 cases), patients were submitted to adeno-tonsillectomy; in the 2nd (144 subjects), adenoidectomy was carried out; in the 3rd (47 cases), the watchful waiting approach was adopted; c) in the third (193 cases, with both pathological auricular manifestations), patients were submitted to adeno-tonsillectomy (119 cases) or to adenoidectomy 74 cases); during surgery, ventilation tube was applied bilaterally in 61 cases, while 132 patients formed the control group. The results obtained were statistically analysed by chi2 and Fisher test: a "p" value of < 0.05 was considered statistically significant. RESULTS: The first investigation showed: a) the incidence of cases with auricular disorders was greater in the group presenting recurrent febrile pharyngo-tonsillar inflammation < or = 4 (effusive otitis media: p < 0.05); in this group, the presence of cases with naso-pharyngeal respiratory obstruction was statistically greater (p < 0.05); b) the number of cases in which the pathological auricular process was resolved following adeno-tonsillectomy, appeared high (effusive otitis media: 136/179 = 76%; acute recurrent otitis media: 189/216 = 87.5%), not unlike the percentage of patients with positive results on recurrent febrile pharyngo-tonsillar inflammation and on naso-pharyngeal respiratory obstruction (91.6% and 92.4%, respectively); c) the percentages of recovery, for auricular disorders, were significantly higher in the group presenting more frequent recurrent febrile pharyngo-tonsillar inflammation, i.e. > 4 (p < 0.05); in this group, also the incidence of cases, in which the naso-pharyngeal respiratory obstruction was resolved, was greater. The second investigation demonstrated, in the groups in which surgical treatment was carried out, compared to controls: a) a significantly greater percentage of cases achieving recovery, for both parameters (p < 0.05); as far as concerns the effusive form of otitis media, a total of 72 (67.3%) subjects were cured following adeno-tonsillectomy; 67 (81.7%), following adenoidectomy; in acute recurrent otitis media, the subjects achieving recovery were; for adeno-tonsillectomy, 97 (82.2%); for adenoidectomy; 85 (81.7%); b) in the subjects in whom, following surgical treatment, the inflammatory auricular disorder was resolved, it was generally found that recovery had been achieved not only for the recurrent febrile pharyngo-tonsillar inflammation but also for the naso-pharyngeal respiratory obstruction; c) in the controls, the results appeared to be significantly less satisfactory (< 0.001); together with the lack of success in the watchful waiting approach, as far as concerns auricular disorders, we found, likewise, a significant lack of efficacy (p < 0.001) of this treatment in the management of naso-pharyngeal respiratory obstruction (5/35 cases cured: 14.3%). The third investigation showed that the application of the ventilation tube during adeno-tonsillectomy or adenoidectomy did not lead to any improvement in the results; indeed, the percent recovery of the pathological tympanic processes was significantly greater (p < 0.05) in those subjects in whom transtympanic drainage had not been adopted. CONCLUSIONS: The results of these investigations reveal a clear relationship between the naso-pharyngeal respiratory obstruction and the pathological auricular processes in subjects with episodes of recurrent febrile pharyngo-tonsillar inflammation. These results also demonstrate that adeno-tonsillectomy and/or adenoidectomy are able to resolve the auricular inflammatory manifestations in a very large percentage of cases. These data are apparently in contrast with those described in recent reports related to randomised investigations. In effect, the two groups of investigations had different aims: the studies carried out according to a randomised approach were performed on study populations in which the findings of pathological auricular manifestations were not linked by the demonstration of a correlation with possible adenoid or adeno-tonsillar inflammation; the present study, on the other hand, was performed on patients in whom the auricular disorder was part of the clinical picture of recurrent febrile pharyngo-tonsillar inflammation. Therefore we believe that each of these study methods has precise possibilities, but also limitations; thus, one should not exclude the other, but rather be integrated.

Repair of pulmonary artery sling by reimplantation without cardiopulmonary bypass.

A 20-month-old girl successfully underwent repair of pulmonary artery sling through a median sternotomy by division of the left pulmonary artery and its reimplantation into the main pulmonary artery without cardiopulmonary bypass or tracheal reconstruction. The patient is doing well on 18 months follow-up with unobstructed pulmonary blood flow and dramatic reduction of tracheal stenosis. Simple repair of pulmonary artery sling is feasible with good results in selected cases without tracheomalacia.

Recovery of nickel oxide from spent catalyst.

This study investigates the possibility of recovering nickel from the spent catalyst (NiO/Al2O3) resulting from the steam reforming process to produce water gas (H2/H2O) in many industries. In the extraction process, nickel is recovered as sulfate using sulfuric acid as a solvent. The considered parameters affecting nickel recovery were acid concentration, temperature and time of digestion solid:liquid ratio, particle size and stirring rate. Nickel was to be directly recovered as a sulfate salt by direct crystallization method. The conversion was 99% at 50% sulfuric acid concentration, solid: liquid ratio (1:12) by weight, particle size less than 500 micron for more than 5 h and 800 rpm at 100 degrees C.

Sublingual allergen-specific immunotherapy in allergic rhinitis and related pathologies: Efficacy in a paediatric population.

The aim of this study was to demonstrate the efficacy and safety of the sublingual-swallow allergen-specific immunotherapy (SLIT) in a paediatric population suffering from allergic rhinitis and related pathologies. From March 1994 through March 2000, at our ENT Department 4000 children (1800 male and 2200 female), aged 3 to14 years, were examined for recurrent nasal obstruction and nasal polyps. 2400 (60%) of them were allergic and underwent the following investigations: Impedance test, Pure tone audiometry, rhinomanometry, Prick test, RAST, nasal provocation test and paranasal sinus TC without contrast media. Of the allergic group we admitted 288 patients(12%) to a 3 yr SLIT, meeting the following criteria: children aged 5 years or more, mono-sensitised to one allergen and with family cooperation support. After three years of SLIT, we observed complete symptom remission and a marked improvement in instrumental examinations in 80% of these children. The improvement was poor in 8% of patients, while in 12% of the subjects no changes in symptoms and instrumental results were detected. These results are in agreement with previously published studies and confirm that SLIT can be a valid tool for treating allergic upper respiratory tract diseases in children.

[Acute epiglottitis in children: current criteria for the diagnosis and treatment]. / Epiglottite acuta in età infantile: attuali criteri di diagnosi e trattamento.

Acute epiglottitis is still a potentially lethal pathology, particularly in early childhood. The present study involves seven cases of acute epiglottitis in children under 4 years of age. The authors describe the diagnostic and therapeutic protocols used in these pediatric patients placing particular emphasis on the use of endoscopy and the need for prompt hospitalization in an intensive care unit to best integrate the diagnostic approach with therapeutic treatment.