Vaccine-associated complications: a comparative multicenter evaluation among dental practitioners and dental students—which candidate vaccine is more safe in SARS COV II, Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV(Sinopharm)?

Background The rapidly developed vaccines against the severe acute respiratory syndrome coronavirus 2 carry a risk of provoking side effects. This study aimed to evaluate current vaccination non-serious/serious side effects. Methods A multicenter electronic questionnaire via an online platform was conducted over a 1-week period among vaccinated dental staff and dental students inquiring whether they experienced vaccine-related side-effects after vaccine administration. Results A total of 1205 respondents with a mean age of 39 (SD: 12) were retained for the analyses. The following vaccines were reported; Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV (Sinopharm). The majority of respondents received ChAdOx1 nCoV-19 (51.1%) and Gam-COVID-Vac (37.6%). The symptoms most frequently reported after vaccination were fatigue (79%), local pain in the injection site (77.4%), malaise (73%), and body pain (71.1%). Enrollees reported more onset of reactions on 0–12 h (44.1%) and 12–24 h (29.0%) after vaccine administration (p value <0.001). In 75.7%, the side effects last for up to 3 days. Merely 5.5% of cases reported the presence of side effects after the first week. Individuals with a history of SARSCoV-2 and other infections (MERS, influenza, and EBV) were more likely to report a number of unserious systemic side effects. Conclusion The commonly reported adverse events were in line with similar studies. We have concerns with the frequency of serious adverse effects. This work necessitates the need for further clinical assessments with larger sample sizes.

Hallux rigidus: clinical examination, radiology, and classification

The severity of hallux rigidus depends on the degree of joint involvement, from local pain to stress fractures of other bones of the foot due to hyper-support. Radiology is mandatory to have an accurate diagnosis and gives us a parameter of joint injury. We use the Coughlin and Shurnas classification as the gold standard for treatment. Level of Evidence IV.

Experience of patients with herpetic ganglioneuritis observation in the neurological hospital

Objective — to evaluate the clinical, laboratory and functional parameters of patients with herpetic trigeminal ganglioneuritis in the neurological department. Methods and subjects. The case anamnesis of 43 patients (26 (60.5 %) female and 17 (39.5 %) male) with a diagnosis of herpetic trigeminal ganglioneuritis were retrospectively analyzed: clinical presentation, data on general blood and urine tests, biochemical blood tests, electrocardiography, ultrasound examination of the main arteries of the brain, organs of the abdominal cavity and small pelvis, rheoencephalography. Results. Out of 43 hospitalized patients, 31 (72.1 %) had lesion of the first branch (64.5 % of women and 35.5 % of men), 9 (20.9 %) had lesion of the second branch, and 3 (7.0 %) ) — III branch of the trigeminal nerve. Patients older than 46 years predominated (86.0 %). In general, right‑sided lesion was observed in 22 cases (51.2 %), left‑sided — in 21 (48.8 %) cases. In women, right‑sided lesions prevailed (16 patients — 61.5 %), while in men — left‑sided lesions (11 patients — 64.7 %). The main complaint, in addition to rashes, was local pain, which was mainly of a burning character (24 patients — 55.8 %) with simultaneous itching (15 patients — 34.9 %). Severe pain was observed in 23 (53.5 %), moderate in 14 (32.6 %) and mild in 6 cases (13.9 %). Hyperesthesia accompanied pain in 28 (65.1 %) cases, while only 6 (14.0 %) patients demonstrated hypoesthesia. In the case of involvement of the I branch, herpetic kerato‑uveitis was registered in 9 (29.0 %) cases. Edema of the periocular region was observed in 17 patients (54.8 %). In the case of elderly patients, intellectual and mind functions decrease (45 %), positive subcortical reflexes (46.5 %), and moderate coordination disorders (34.9 %) were observed. Among the general and functional analyses carried out, attention was drawn to an increase ESR (39.5 %), as well as metabolic changes in the myocardium on the ECG (65.1 %). In the case of older age group, comorbidities were dominated by bychronic cerebrovascular accident (45 %), arterial hypertension (40.0 %), type 2 diabetes mellitus (25.0 %), and osteochondrosis (20.0 %). Conclusions. In the case of herpetic lesions, clinical observations confirm the predominant lesion of the I branch of the trigeminal nerve, more marked predominance of elderly women with right‑sided symptoms in the pathological process was observed. Beside the background of typical rashes, severe baking local pain, accompanied by itching and hyperesthesia, dominates in the clinical picture. Despite sometimes delayed hospitalization due to attempts at outpatient or self‑treatment, a general blood analysis often reveals markers of inflammation. The complexity and variability of complaints, as well as examination results, can be mainly explained by the elderly age of patients.

Reactogenicity of BNT162b2 mRNA COVID-19 Vaccine in a Young Working Age Population: A Survey among Medical School Residents, within a Mass Vaccination Campaign, in a Regional Reference Teaching Hospital in Italy

Vaccinations are a key prevention measure in fighting the COVID-19 pandemic. The BNT162b2 mRNA vaccine (BioNTech/Pfizer), the first to receive authorization, was widely used in the mass vaccination campaign in Italy. Healthcare workers were identified as a priority group for vaccination, but few studies have assessed its reactogenicity among the young working age population. An online survey was conducted to investigate the adverse reactions occurring in the 7 days following the first and second vaccination doses amongst resident doctors of the University of Genoa, employed at the IRCCS Ospedale Policlinico San Martino of Genoa, between 11 January and 16 March 2021. A total of 512 resident physicians were invited to participate in the study (female = 53.2%; mean age = 28.9 years), of whom 296 (female = 53.4%, mean age = 28.9 years) and 275 (female = 55.3%, mean age = 29.1 years) completed the survey after their first and second vaccination doses, respectively. In the 7 days following the first dose, most common adverse reactions were local pain (96.3%), fatigue (42.6%), headache (33.8%), arthromyalgia (28.0%), and 5.1% reported fever, while following the second dose, participants reported local pain (93.5%), fatigue (74.9%), headache (57.5%), arthromyalgia (58.2%), and fever (30.9%), with a higher prevalence among females. Systemic (but not local) reactions increased following the second vaccination, reaching severe intensity in 9.8% of participants and causing three or more events of moderate intensity in 23.7% of participants. Adverse reactions preventing regular daily activities could cause absenteeism among workers. These results can be useful to inform populations of young individuals, set expectations, and improve adherence to vaccination campaigns.

Clinical features and treatment of spinal metastatic pheochromocytoma and paraganglioma: a single institutional experience with 18 patients

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors, which can potentially metastasize to the spine. Clinical researches and treatment guideline on this entity are lacking. This study described the clinical features and treatment outcomes of metastatic PPGLs on the spine. We reviewed 18 patients with spinal PPGLs who were consecutively treated in our spinal center. The cohort included ten cases of pheochromocytomas and eight paragangliomas. The local pain and neurological deficits were the two most common symptoms. One third of the spinal PPGLs were diagnosed as functional tumors. The surgical strategies for the cohort included percutaneous vertebroplasty, neurological decompression and partial tumor resection with or without internal fixation, and total en-bloc resection. The postoperative courses were uneventful except one patient developed heart failure. The adjuvant therapies were implemented in six patients with 131I-MIBG, five with radiotherapy, two with chemotherapy and one with target therapy. The median survival period was 39 months. The patients’ Karnofsky performance scores were positively correlated with the overall survival (p < 0.05).Therefore, surgery is indicated for intractable local pain and neurological impairment in the patients with spinal PPGLs, while a holistic set of adjuvant therapies shall be incorporated for a better tumor control.

Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study

Background: Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. Method: In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. Results: We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. Conclusion: In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

Parameters of robotic mechanotherapy BIODEX SYSTEM 3 PRO Dual Position Back Ext / Flex with biofeedback in the treatment by patients with osteochondrosis of the lumbar spine

Aim. To assess the dynamics of pain syndrome in patients with osteochondrosis of the lumbar spine using the method of mechanotherapy using the BIODEX SYSTEM 3 PRO Dual Position Back Ext / Flex apparatus with biofeedback. Materials and Methods. The analysis of the treatment of 27 patients with chronic and acute lumbodynia in the subacute stage was carried out. On the robotic complex BIODEX SYSTEM 3 PRO Dual Position Back Ext / Flex with biological feedback, the average value of the maximum torque was determined: 60 (Nm) for the flexors of the trunk, 155.5 (Nm) for the extensors of the trunk and 215.5 (Nm) for the muscles of the trunk (sum of the flexors and extensors of the trunk). Results. The main result of the work was to determine the safe torque at the time of the treatment procedure. For the flexor muscles of the trunk, the average values ranged from 40-90 Nm, for the extensor muscles of the trunk – from 50 to 300 Nm. Conclusions. Complex rehabilitation in patients with osteochondrosis of the lumbar spine using the robotic complex BIODEX SYSTEM 3 PRO Dual Position Back Ext / Flex with biofeedback allows to relieve local pain syndrome.

Calvarial lesions: overview of imaging features and neurosurgical management

Calvarial lesions are rare and can present as a variety of different diseases. The lesions can be palpable on the skin and cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. This research aims to present an overview of typical imaging features as well as neurosurgical management. We examined the charts of patients who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra-, and postoperative data were analyzed with morphological and histological findings and compared with each other. Pain, swelling, cosmetically disturbing, and neurological deficits were the main complaints. Seventy-seven lesions were limited to the bone, while another 56 lesions showed an infiltrating growth in the adjacent tissue. Depending on the clinical signs and suspected diagnosis, a biopsy, a partial removal, or a complete resection was performed. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19), and osteomas (n=16) were the most common lesions. Fibrous dysplasia (n=6) and intraosseous hemangioma (n=9) were less common; other lesions were present only in isolated cases. Imaging features may suggest the lesion to be benign or malignant, but the diagnosis can be only confirmed by histological examination. The surgical strategy depends on the complaints, location of the lesion, and suspected diagnosis. Adjuvant treatment should be initiated according to the histological findings.

Outcomes of surgical treatment for pituitary metastasis

We analyzed the outcomes of surgical treatment for pituitary metastasis (PM) based on 35 observations. We registered the best estimates of resection radicalism in patients with minor PM, its inconsiderable spread ascending and descending from the diaphragm of the sella turcica, slightly bleeding metastasis, and no invading to the cavernous sinus. Positive changes in the PM patients’ quality of life are chiefly associated with regressed visual impairment, local pain syndrome, and, to a lesser degree, oculomotor disorders. No post-operative regress or intensifying of hormonal impairments, such as diabetes insipidus and hypopituitarism, were seen. The age of patients, the time interval between the cancer diagnosis and the PM occurrence, control of the underlying disease, size of the tumour are the factors determining the life expectancy in PM patients.