Management of severe epistaxis during pregnancy: a case report and review of the literature

Epistaxis is a common problem during pregnancy. Few cases of severe epistaxis, not associated with nasal lesions or clotting disorders, were described in the literature. We reported a case of severe epistaxis in a pregnant patient, exploring all the different possible management options

PARP inhibition: a promising therapeutic target in ovarian cancer

Ovarian cancer is burdened by the highest mortality rate among gynecological cancers. Gold standard is represented by the association of platinum-taxane -based chemotherapy and radical surgery. Despite several adjustments occurred in cytotoxic drug in last decades, most patients continue to relapse, and no significant enhancement has been reached in the overall survival. The development of drug resistance and the recurrence of disease have prompted the investigations of other targets that can be used in the treatment of ovarian cancers. Among such targets, polyadenosine diphosphate-ribose polymerase (PARP) represents a novel way to target specific patways involved in tumor growth. PARP accelerates the reaction of the polyADP-ribosylation of proteins implicated in DNA repair. PARP inhibitors have shown activity in cancers with BRCA mutations, with other deficient DNA repair genes or signaling pathways that modulate DNA repair, or in association with DNA damaging agents not involved in DNA repair dysfunction. A number of inhibitors for PARP has been developed, and such drugs are under investigation in clinical trials to identify their impact in the treatment of ovarian cancers. This review aims to summarize the recent researches and clinical progress on PARP inhibitors as novel target agents in ovarian cancer

Does lung ultrasound have a role in the clinical management of pregnant women with SARS COV2 infection?

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patient

Increased FGF23 serum level is associated with unstable carotid plaque in type 2 diabetic subjects with internal carotid stenosis.

BACKGROUND: The object of this study was to investigate the potential role of FGF23 on plaque stability in type 2 diabetic patients with internal carotid artery stenosis. METHODS: In this retrospective observational study, we analyzed FGF23 serum level in 361 type 2 diabetic patients with internal carotid artery stenosis undergoing carotid endarterectomy and in 598 diabetic controls without carotid atherosclerosis. RESULTS: We found that FGF23 median serum levels was significantly higher in patients than in diabetic controls [67.7 (59.5-77.8) pg/mL and 43.89 (37.5-50.4), P < 0.001] and was significantly and independently associated with unstable plaque in patients with internal carotid artery stenosis [OR, 5,71 (95% CI, 2.09-15.29]. CONCLUSIONS: We have found, for the first time, that FGF23 could be associated with unstable plaque in type 2 diabetic patients with internal carotid artery stenosis

A comparative LCA of three WWTPs in a tourist area: Effects of seasonal loading rate variations

: Although the wastewater treatment is a fundamental utility for the protection of human health and the environment, non-evident drawbacks are associated with it. Wastewater treatment plants (WWTPs) located in tourist areas generally suffer from the seasonal increase in wastewater flow-rate and associated pollution loads. In this study, a Life Cycle Assessment (LCA) of three medium-size urban WWTPs, located in a tourist area in central Italy, was carried out. The study compared the environmental impacts generated by 1 m3 of treated wastewater in low season (LS) and high season (HS). All the material and energy flows involved in the operational phase of wastewater treatment were considered within the system boundaries, including the disposal or recovery treatment of the waste streams generated by the WWTPs, namely screenings, waste from grit removal and wastewater sludge. The analysis was conducted using almost only real data from full-scale plants. In each WWTP, the environmental impacts produced in HS were higher than those generated in LS; therefore, the environmental impacts increased as the loading rate increased. Furthermore, a correlation between WWTP size and environmental performance was observed. Indeed, in 8 out of 11 environmental indicators, the percentage increase in pollutant emissions due to wastewater treatment in HS decreased as the WWTP size increased. Results revealed that larger WWTPs suffered less from seasonal loading rate variations, showing greater flexibility. The existence of a scale factor suggests that the centralization of WWTPs in tourist areas can be an option to enable better treatment performance in terms of environmental impacts. A sensitivity analysis was performed, increasing N2O emission factors from wastewater treatment in LS: considering a 75 % increase, the outcomes found in default LCA were not confirmed. Future research should investigate the operational factors and biological mechanisms that most affect wastewater treatment when significant seasonal variations are present

Biochemical Hydrogen Potential Tests Using Different Inocula

Four inocula collected from different operating facilities were tested in their hydrogenic performances by means of two biochemical hydrogen potential test set-ups using sucrose and food waste as substrates, with the aim of evaluating the influence of inoculum media in batch fermentative assays. The selected inocula were: activated sludge collected from the aerobic unit of a municipal wastewater treatment plant, digested sludge from an anaerobic reactor treating organic waste and cattle manure, digested sludge from an anaerobic reactor treating agroindustrial residues, and digested sludge from an anaerobic reactor of a municipal wastewater treatment plant. Test results, in terms of specific hydrogen production, hydrogen conversion efficiency, and volatile solids removal efficiency, were significantly dependent on the type of inoculum. Statistical analysis showed different results, indicating that findings were due to the different inocula used in the tests. In particular, assays performed with activated sludge showed the highest performances for both substrates and both experimental set-ups

Biochemical methane potential tests of different autoclaved and microwaved lignocellulosic organic fractions of municipal solid waste

The aim of this research was to enhance the anaerobic biodegradability and methane production of two synthetic Organic Fractions of Municipal Solid Waste with different lignocellulosic contents by assessing microwave and autoclave pre-treatments. Biochemical Methane Potential assays were performed for 21 days. Changes in the soluble fractions of the organic matter (measured by soluble chemical oxygen demand, carbohydrates and proteins), the first order hydrolysis constant kh and the cumulated methane production at 21 days were used to evaluate the efficiency of microwaving and autoclaving pretreatments on substrates solubilization and anaerobic digestion. Microwave treatment led to a methane production increase of 8.5% for both the tested organic fractions while autoclave treatment had an increase ranging from 1.0% to 4.4%. Results showed an increase of the soluble fraction after pre-treatments for both the synthetic organic fractions. Soluble chemical oxygen demand observed significant increases for pretreated substrates (up to 219.8%). In this regard, the mediocre results of methane’s production led to the conclusion that autoclaving and microwaving resulted in the hydrolysis of a significant fraction of non-biodegradable organic substances recalcitrant to anaerobic digestion

[Deep venous thrombosis in pregnancy: diagnostic difficulties and therapeutic indications. Discussion of a clinical case].

Pregnancy is a risk factor for deep and superficial venous thrombosis because of hemodynamic changes and modifications of the coagulation and fibrinolitic systems. In case of a patient suffering from a congenital or acquired thrombophilia, risk of severe and recurrent thrombosis becomes much higher, with the possibility of a life threatening complication as pulmonary embolism. Recently a number of congenital thombophilic syndromes have been described, in particular congenital hereditary deficit of coagulation inhibitors. Among the acquired pathologies, the antiphospholipid syndrome has been recently object of studies. Diagnostic and therapeutic options are still controversial. The authors present a case of recurrent deep vein thrombosis in pregnancy treated with positioning of a caval filter for the prophylaxis of pulmonary embolism. Diagnostic difficulties are discussed, as the patient presented with low levels of the coagulation inhibitor protein S, and also circulating antibodies anticardiolipin

Chirurgia vaginale nel carcinoma della portio

The Authors show the evolution of the indications and vaginal surgery techniques for treatment of the cervical cancer describing their actual conservative technique: the radical trachelectomy with lymphadenectomy