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BACKGROUND: Adolescent idiopathic scoliosis screening still needs a considerable implementation, particularly throughout a school-based assessment protocol. OBJECTIVE: This study aims to evaluate the effectiveness of clinical examinations currently in use for the diagnosis of adolescent idiopathic scoliosis, through a survey carried out in secondary schools to standardize a screening protocol that could be generalized. METHODS: In their classrooms, the adolescents underwent an idiopathic scoliosis screening through three examinations: Adam’s test, axial trunk rotation (ATR) and plumb line. In case of single positivity to one of the three examinations, a column X-ray examination was recommended. RESULTS: The sensitivity and diagnostic specificity of Adam’s test or ATR were 56.3% and 92.7%, respectively. The positivity to at least one between ATR or plumb line showed that sensitivity was higher than specificity: 91.3% versus 80.8%; the positivity to at least one between Adams’s test or plumb line showed a sensitivity of 95.2% and a specificity of 81.5%. Finally, the positivity to all three examinations showed an increase in specificity (99.7%). CONCLUSIONS: Taken together, our findings show that this school-based screening protocol had a very high specificity in early diagnosis of adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) has an incidence of 2–3% in the general population and a multifactorial etiology. The present study aims to analyze modifiable risk factors and their interactions in the development of AIS in order to increase knowledge about the disease and to prevent the evolution of AIS in young students with tailored public health strategies. A cross-sectional study was conducted over two consecutive school years among students attending 11 first-grade secondary schools in the province of Palermo, Italy. A self-administered questionnaire that investigated socio-demographical, physical and anamnestic characteristics and habits, focusing on possible risk factors associated with idiopathic scoliosis, was administered. In addition, a clinical evaluation was performed with Adams’ test and Bunnel’s inclinometer. Suspected AIS cases were associated with the practice of high-risk sports (p < 0.05), weekly physical activity lasting ≥3 h (p < 0.05), lower back pain (p < 0.001), posture disorders (p < 0.01) and having had no contact with a physician (p < 0.01). Practice of high-risk sports (adj OR = 1.83; CI 95% 1.11–4.76) and suffering of posture disorders (adj OR = 1.67; CI 95% 1.12–3.60) showed a significant association with a confirmed diagnosis of AIS (Cobb angle ≥ 10° at X-ray). The risk factors associated with AIS are still unclear. Therefore, it is crucial to identify early modifiable and multiple risk factors to prevent the evolution of scoliosis in school-age children.

Background Fracture of the proximal femur is the most feared complication of osteoporosis. Given the numerous physiological functions that magnesium performs in our body, in the literature there is a correlation between osteoporosis and low serum levels of magnesium. Aim Evaluate the incidence of hypomagnesemia in patients with lateral fragility fracture of the proximal femur, the possible correlation between serum magnesium levels and fractures, and the effectiveness of supplementing Sucrosomial® magnesium associated with therapeutic exercise on the outcome of these patients. Methods We divided the study into two parts. In the first part, we assessed the preoperative incidence of hypomagnesemia in patients using a blood test. In the second part, patients with hypomagnesemia were divided, in the post-operative period, into two groups, who received, respectively, only therapeutic exercise or oral supplementation with sucrosomial magnesium associated with therapeutic exercise. Results Half of the patients with fragility femoral fracture had hypomagnesemia, with a higher incidence of the subclinical form. From the comparison between the two groups, the T1 treatment group showed a significant improvement in blood levels of magnesium (2.11 ± 0.15 vs. 1.94 ± 0.11; p p p p Conclusions More attention would be needed in the diagnosis and correction of subclinical hypomagnesemia and not just the simple and clinically evident one, including hypomagnesemia among the modifiable risk factors for osteoporosis.

Background: Local treatments such as ultraviolet-A (UVA) phototherapy, topical calcitriol, injection of autologous fat grafting, Platelet-Rich Plasma (PRP), hyaluronic acid (HA) and local ultrasound (US) treatment are considered alternative approaches for skin involvement in Systemic sclerosis (SSc).The aim of our study was to evaluate the efficacy of PRP injection and lipofilling or local ultrasound in the treatment of SSc-related digital ulcers (DUs). Methods: We enrolled 28 patients with SSc. At baseline time (T0), all patients were treated with Iloprost intravenous infusions. Then, six patients (group 1) received a first inoculation of PRP, after 15 days a second inoculation of PRP and after 15 days a third of lipofilling. Other six patients (group 2) received the three consecutive injections associated with a maintenance therapy with additional injections of PRP every 30 days for 12 months. Six patients continued only the Iloprost therapy (controls). Ten patients (group 3) underwent medical sessions with ultrasound treatment for 10 days. Clinical evaluation was assessed at baseline, after 3 and 12 months of treatment for all patients.Results: In our study have shown an improvement in cutaneous and microvascular level, in quality of life, in mobility of extremities of upper limbs and a reduction of administration of Iloprost after PRP-Lipofilling and US treatment.Conclusions: Our findings suggest that PRP, coupled with lipofilling, and ultrasound treatment in SSc patients, can be considered additional procedures in the management of DUs.

This study aims to evaluate the effectiveness of clinical tests currently in use for the diagnosis of JIS, through a survey, carried out in secondary schools in the province of Palermo, in order to standardize a school screening protocol that could be extended to the whole regional territory. The adolescents underwent a specialist physiatric examination in their classrooms; moreover three screening tests have been administred: Adams test, Bunnel Inclinometer and Plumb line test. In case of single positivity to one of the three tests, the adolescent underwent to radiography of the whole column. Then we examined the sensitivity and diagnostic specificity of the Adams or inclinometer test, respectively: 56.3% and 92.7%. On the other hand, the positivity to at least one between inclinometer or plumb line sensitivity was higher than the specificity: 91.3% versus 80.8%. The same happened for the positivity to at least one test between Adams index or plumb line test, which showed a sensitivity of 95.2% compared to a specificity of 81.5%. Finally, taking into consideration patients with triple test positivity, a clear increase in specificity compared to sensitivity was demonstrated, reaching 99.7% Performing a single test cannot be considered a sufficient tool aiming to detect potential scoliotic subjects. To conclude, an effective screening program can reduce health care expenditure related to specialist medical examinations as well as unnecessary instrumental exams such as X-rays.

BACKGROUND: Aromatase inhibitors (AIs) might have a detrimental impact on bone health in breast cancer (BC) women. Denosumab has been shown to reduce the risk of fractures, but the appropriate time for starting is yet to be clearly defined. OBJECTIVE: To evaluate the effects of early treatment with Denosumab (⩽ 12 months after starting AIs) compared to a delayed treatment in BC women. METHODS: In this retrospective case-control study, we included medical records of BC post-menopausal women, treated with AIs therapy; they were divided as: study group (starting Denosumab ⩽ 12 months after AIs) and control group (> 12 months). At the baseline (T0) and at 18 months (T1), we evaluated the lumbar spine (LS) Tscore and femoral neck (FN) Tscore. Furthermore, at T1 we assessed the incident fragility fractures. RESULTS: Fifty-nine BC survivors (mean age: 61.5 ± 11.5 years) were included: 28 with Early Denosumab and 31 with Late Denosumab. At T1, the study group did not show any incident hip or vertebral fragility fracture, whereas the Late Denosumab group showed 2 incident hip fractures (6.5%) and 4 (12.9%) vertebral fragility fractures. Early Denosumab showed a significant positive effect on both LS (p= 0.044) and FN (p= 0.024) Tscore variations. CONCLUSION: Taken together, our findings suggest that an early start of Denosumab might be considered for the osteoporosis management in BC women undergoing AIs.

Currently, the elderly population (>65 years old) is in very growth. In fact, in Italy old age index (number of elderly per 100 persons under the age of 14 years) is estimated to be 157,7 and is projected to increase to 257,9 in the year 20651,2. The increase of the elderly population determines the increase of the age-dependent diseases including also impairment of the vestibular function, this problem is defined "presbiastasia". Patient suffering from this condition exhibit disturbances of static and dynamic postural control with far less frequent cases of relapsing objective rotatory vertigo. Occasionally, they also report a feeling of insecurity in new or unknown environments, increasing the risk of falls. These balance disorders significantly affect patients’ private and social life, as they interfere with a large number of daily activities, as transfer into bed, ambulation, car transfers, eating, using of telephone. The number of patients with this disease is expected to increase with the rise in the number of elderly population and this has important implications on the national health system's resources. Thus, the rehabilitation of these balance disorders presents serious difficulties. This explains the great number of techniques, with or without the use of equipment, which have so far been proposed. Some authors suggested to apply actual protocols, more or less modifiable according to patient characteristics; others recommended individual exercises or special equipment-aided techniques. In these cases, vestibular rehabilitation allows to stimulate the equilibrium system by preventing and slowing down the effects of aging, through the use of "adaptive, substitutive and custom" strategies.