Use of deferoxamine (DFO) in transfusion-dependent β-thalassemia during pregnancy: A retrospective study.

Objective: To report cases of use of chelation therapy during pregnancy which resulted in favorable outcomes for the babies. Materials and methods: In this retrospective cohort study, we described the evolution and outcome of 9 pregnancies in Italian thalassemic women who received deferoxamine (DFO) inadvertently during early pregnancy. Results: The use of deferoxamine during first trimester did not lead to adverse effects on the fetus or cause major complications for the gestation, although an increase in iron burden was observed after suspending chelation therapy. Conclusion: In our experience, iron-chelation therapy might be administrated in pregnancy where the benefits to the mother outweigh the potential risks to the baby. Keywords: Deferoxamine, Iron chelation therapy, Magnetic resonance T2*, Pregnancy, Thalassemi

The nucleus and coma of 67P/Churyumov-Gerasimenko: highlights of the Rosetta-VIRTIS results

This paper will describe the major results obtained so far during the prelanding and initial escort phases (July 2014–February 2015) by the VIRTIS (Visible, Infrared and Thermal Imaging Spectrometer) dual channel spectrometer onboard Rosetta. The scientific goals of the VIRTIS instrument are related to the study of the nucleus surface composition and of its temperature and to the study of the gaseous and dust components of the coma. These are achieved by studying the reflected and emitted radiance of the comet in the spectral range 0.25-5.0 μm with a Mapping Spectrometer (VIRTIS-M) and a High Resolution Spectrometer (VIRTIS-H). The nucleus observations were performed with spatial resolution varying from the initial 500m down to 2.5m and have generated compositional maps of the illuminated areas. The nucleus integrated normal albedo has been calculated as 0.060 ± 0.003 at 0.55 μm, and reflectance spectra display distinct gradients in the VIS and IR regions (5-25 and 1.5-5 % kÅ-1 respectively). These results suggest a surface made of an association of carbon bearing species and opaque minerals such as sulfides. In addition a broad absorption feature in the 2.9-3.6μm range has been observed; this band is present across the entire illuminated surface and, its shape and width are compatible with absorptions due to non-volatile organic macromolecular materials, complex mixture of various types of C-H and/or O-H chemical groups. Ice rich regions of very limited extent, have also been observed. The surface temperature has been measured since the first distant observations of the nucleus in thermal emission. The highest surface temperature seen so far is 220K, which is an indication of a surface structure largely covered by a porous crust, mainly devoid of water ice. Water vapour and carbon dioxide molecules have been observed in the coma and their variability, as a function of altitude and geographic location has been studied. The molecules display an anti-correlated behaviour in their spatial distribution, which could suggest either intrinsic differences in the nucleus composition or insolation induced variability, which most probably will imply seasonal changes

Expression of IL-23/Th17-related cytokines in basal cell carcinoma and in the response to medical treatments

Several immune-related markers have been implicated in basal cell carcinoma (BCC) pathogenesis. The BCC inflammatory infiltrate is dominated by Th2 cytokines, suggesting a specific state of immunosuppression. In contrast, regressing BCC are characterized by a Th1 immune response with IFN-γ promoting a tumor suppressive activity. IL-23/Th17-related cytokines, as interleukin (IL)-17, IL-23 and IL-22, play a significant role in cutaneous inflammatory diseases, but their involvement in skin carcinogenesis is controversial and is poorly investigated in BCC. In this study we investigated the expression of IFN-γ, IL-17, IL-23 and IL-22 cytokines in BCC at the protein and mRNA level and their modulation during imiquimod (IMQ) treatment or photodynamic therapy (PDT). IFN-γ, IL-17, IL-23 and IL-22 levels were evaluated by immunohistochemistry and quantitative Real Time PCR in 41 histopatho-logically-proven BCCs (28 superficial and 13 nodular) from 39 patients. All BCC samples were analyzed at baseline and 19 of 41 also during medical treatment (9 with IMQ 5% cream and 10 with MAL-PDT). Association between cytokines expression and clinico-pathological variables was evaluated. Higher levels of IFN-γ, IL-17, IL-23 and IL-22 were found in BCCs, mainly in the peritumoral infiltrate, compared to normal skin, with the expression being correlated to the severity of the inflammatory infiltrate. IFN-γ production was higher in superficial BCCs compared to nodular BCCs, while IL-17 was increased in nodular BCCs. A significant correlation was found between IFN-γ and IL-17 expression with both cytokines expressed by CD4+ and CD8+ T-cells. An increase of all cytokines occurred during the inflammatory phase induced by IMQ and at the early time point of PDT treatment, with significant evidence for IFN-γ, IL-23, and IL-22. Our results confirm the role of IFN-γ and support the involvement of IL-23/Th17-related cytokines in BCC pathogenesis and in the inflammatory response during IMQ and MAL-PDT treatments

Diagnosis & management of imported malaria in pregnant women in non-endemic countries

Malaria in pregnancy is an important cause of maternal and foetal morbidity and is a potentially life-threatening infection. With ever-growing global exchanges, imported malaria in pregnancy is becoming an issue of concern in non-endemic countries where women, because of low immunity, have higher risk of severe diseases and death. Malaria in pregnancy is a dangerous condition which can be associated with important consequences for both mother and child such as stillbirth, low birth weight, maternal anaemia. In non-endemic-countries it is more frequent in its severe form which can lead to maternal death if not treated adequately. Specific anti-malarial interventions such as the use of repellents and insecticide treated bed nets in addition to chemoprophylaxis should be used by pregnant women if they are travelling to endemic areas. In cases of confirmed infection, specific treatment regimens vary according to gestational age and the presence of complications. Malaria should be considered a global health problem, increasingly involving western countries. Clinicians all over the world need to be prepared for this emerging disease both in terms of prevention and therapy

INDAGINI E RILIEVI NEI SINISTRI STRADALI. Gli errori più frequenti, come riconoscerli, come evitarli. Manuale ad uso di organi di polizia, legali e periti. Con Cd-Rom contenente normativa, giurisprudenza e formulario.

L’opera è una guida teorico – pratica che affronta in modo or- ganico tutti gli elementi salienti della tematica della rilevazione dei sinistri stradali, con particolare attenzione alla parte dell’in- dagine, la più critica di questa complessa attività. Dopo un momento prodromico di analisi, concernente il pri- mo sopralluogo sul teatro del sinistro e l’individuazione degli elementi chiave per l’indagine, viene trattata in modo molto approfondito la fase di ricerca ed acquisizione delle prove sulla scena del sinistro stradale, passando poi alle vere e proprie attività di polizia giudiziaria necessarie alla ricostruzione della dinamica dell’incidente stradale. Vengono quindi analizzate le ipotesi di reato presenti nel codi- ce della strada e collegate al sinistro, per poi successivamente affrontare anche il complesso problema dei possibili profili di responsabilità degli enti proprietari della strada. Infine, viene de- dicato un approfondimento specifico agli accorgimenti psicolo- gici da adottare nell’escussione delle persone informate sui fatti. L’opera è modulare e i vari argomenti sono trattati da autori di diverse provenienze culturali e professionali, con apporti che provengono dal mondo della polizia locale, dal mondo universi- tario, dal mondo legale; ogni autore ha dunque una professio- nalità specifica nel settore trattato, così da fornire agli organi di polizia stradale, ma anche agli avvocati ed ai periti assicurativi, un quadro esauriente della materia, anche con riferimento ad aspetti molto spesso tralasciati dalla dottrina

Safety and Efficacy of Triple Therapeutic Targets with Rivaroxaban after Acute Myocardial Infarction Complicated by Left Ventricular Thrombi in a Case of Nonvalvular Atrial Fibrillation

We present the complex case of a high-risk patient with nonvalvular atrial fibrillation, who experienced a non-ST elevation myocardial infarction complicated by left ventricular (LV) thrombi and underwent percutaneous coronary intervention with drug-eluting stent implantation. The patient was initially treated with short-term triple therapy including aspirin, clopidogrel, and rivaroxaban 15 mg/die. Following aspirin dropping one month after discharge, the patient continued on dual therapy with clopidogrel and rivaroxaban, and a clinical and imaging follow-up at 6 and 12 months confirmed the LV thrombi resolution, with no thromboembolic episodes and a good safety profile

Sequential treatment with calcitriol and methyl aminolevulinate-daylight photodynamic therapy for patients with multiple actinic keratoses of the upper extremities

Topical photodynamic therapy (PDT) is a widely used and effective treatment for actinic keratoses (AKs). However, cure rates are significantly reduced for AKs on acral sites. We compared the sequential regimen of topical calcitriol and methyl aminolevulinate (MAL) daylight-PDT (CAL-DL-PDT) versus placebo and MAL-DL-PDT (P-DL-PDT) on acral AKs in an intra-individual, randomized trial

Long-term efficacy and safety of daylight photodynamic therapy with methyl amninolevulinate for actinic keratosis of the face and scalp

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Metformin reduces maternal weight gain in obese pregnant women: a systematic review and meta‐analysis of two randomized controlled trials

Obese pregnant women are likely to face several gestational and neonatal complications. Metformin is an effective oral antihyperglycaemic agent that is considered to be effective during pregnancy. The aim of our study was to evaluate the effect of metformin on obstetric and perinatal outcomes in obese pregnant women. Electronic databases were searched (MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, OVID, and Cochrane Library). The selection criteria included only randomized clinical trials (RCTs) of obese pregnant women randomized to a daily metformin regimen or to a placebo condition. The type of participants included women with a body mass index (BMI) ≥ 30 kg/m2 who did not have diabetes mellitus, any other disease, or a contraindication to metformin use. The summary measures were reported as relative risk (RR) with 95% confidence intervals (CIs). The primary outcome was the effect on maternal weight gain (MWG). Two double-blind RCTs, including 849 obese pregnant women, were included in the meta-analysis: 428 (50.4%) were randomized to the metformin group, and 421 (49.6%) were randomized to the placebo group. The use of metformin was significantly associated with lower MWG. Metformin was also associated with a significantly lower incidence of preeclampsia (PE) and admission to the neonatal intensive care unit (NICU). Metformin could be considered a useful drug for the treatment of obese, nondiabetic pregnant women because it can significantly decrease weight gain in pregnant women and improve perinatal outcomes by reducing the incidence of PE and NICU admission. However, women should be aware of the uncertainties concerning the long-term effects of metformin transplacental passage on metabolic outcomes

Real-life efficacy and safety of ingenol mebutate for the treatment of actinic keratosis of the face and scalp: A single arm retrospective study

BACKGROUND: The efficacy and safety of ingenol mebutate versus placebo have been proven in four randomized controlled trials (RCTs), although there is a lack of real-life studies corroborating such promises in routine clinical practices. In our study, we sought to describe real-life effectiveness, safety and regimen adherence among patients with multiple AKs on the face treated with ingenol mebutate and evaluate correlates of clinical outcomes in this population. METHODS: We reviewed the clinical charts of adult patients with multiple ( 653) AK grade I and II of the face and scalp, treated with ingenol mebutate from April 2014 to April 2015. All subjects received the medication according to ingenol mebutate standard of care. RESULTS: We enrolled 88 patients during the study period and carried out 122 treatment cycles. The unadjusted lesion clearance rate per treated field was 81.3% and the average local skin reactions score at day 4 was 6.0\u2009\ub1\u20092.8 (range: 0-18). CONCLUSIONS: We observed an excellent rate (>99%) of adherence to ingenol mebutate. This was mirrored by the fact that our clinical outcomes broadly confirmed results obtained in RTCs. Our study showed that the efficacy and safety of ingenol mebutate observed in RCTs can be reliably translated in real-world practice