Direct-acting antivirals and visceral leishmaniasis: A case report

Background: Visceral leishmaniasis is a vector-borne parasitic disease caused by protozoa belonging to the genus Leishmania. The clinical presentation of visceral leishmaniasis strictly depends on the host immunocompetency, whereas depressive conditions of the immune system impair the capability to resolve the infection and allow reactivation from sites of latency of the parasite. Case presentation: We describe a case of visceral leishmaniasis (VL) that occurred in a patient with chronic hepatitis C treated with direct-acting antiviral drugs (DAA). The hypothesized mechanism is the alteration of protective inflammation mechanisms secondary to DAA therapy. Downregulation of type II and III IFNs, their receptors, which accompany HCV clearance achieved during treatment with sofosbuvir and ribavirin might have a negative impact on a risk for reactivation of a previous Leishmania infection. We know indeed that IFN-\u3b3 is important to enhance killing mechanisms in macrophages, which are the primary target cells of Leishmania. Conclusion: Since VL is endemic in Sicily as well as in other countries of the Mediterranean basin, physicians should be aware of the possible unmasking of cryptic Leishmania infection by DAAs

Unified covariant treatment of hyperfine splitting for heavy and light mesons

This paper aims at proving the fundamental role of a relativistic formulation for quarkonia models. We present a completely covariant description of a two-quark system interacting by the Cornell potential with a Breit term describing the hyperfine splitting. Using an appropriate procedure to calculate the Breit correction, we find heavy meson masses in excellent agreement with experimental data. Moreover, also when applied to light quarks and even taking average values of the running coupling constant, we prove that covariance properties and hyperfine splitting are sufficient to explain the light mesons spectrum and to give a very good agreement with the data.Comment: 4 page

Stressed caregivers. An observational study in a rehabilitation care home in western Sicily

Introduction: Caregiver is the person who takes care of the patient from the practical point of view, helping him in managing the disease and carrying out daily activities, but also supporting him on an emotional level. Caregiver burnout is a state of physical, emotional, and mental exhaustion that may be accompanied by a change in attitude from positive and caring to negative and unconcerned. The aim of the study was to understand what factors were associated with having panic attacks or crying crises in the caregivers of our study population. Materials and methods: The study design is observational. An anonymous questionnaire was administered to caregivers of the patients of a hospital for the intensive post-acute rehabilitation from April 2016 to December 2018. The statistical significance level chosen for the entire analysis was 0.05. The covariates to be included were selected using a stepwise backward selection process, with a univariate p-value <0.25 as the main criterion. Results are expressed as adjusted Odds Ratio (aOR) with 95% Confidence Intervals (CI). Results: The sample consists of 302 caregivers (60.93% was females and 39.07% was males). The mean age of the sample is 53.42 years old (SD ± 12.19). The multivariable logistic regression model shows that the risk to have panic or crying crisis is significantly associated with the following indipendent variables: female gender (aOR 27.06); living with the patient (aOR 4.38); had claimed that the problems related to the illness of their family member is a source of stress (aOR 23.54), smoking cigarettes (aOR 14.68); had claimed that taking care of their client affected their personal financial statement/career (aOR 5.95), having free time (aOR 7.68). Conclusions: In our study we found a greater probability of having panic attacks or crying crises in female subjects, smokers, who think they have sacrificed their careers to take care of the person they follow from a welfare point of view. Certainly in the light of what has emerged it is necessary to dedicate and pay close attention to the psychological and social aspects of the caregiver

A proposal for an evidence-based model of the screening for the colorectal carcinoma in an Italian setting

Introduction. The aim of this paper is to improve the feasibility perception of policymakers, health care workers and target population about the cost-effectiveness of the implementation of colorectal screening as Public Health strategy. Methods. Retrospective study by application of a three-step model designed for a local setting in Sicily (Palermo and its Province) in order to distribute Fecal Occult Blood Tests (FOBTs), offer colonoscopy and surgery, by district allocation of pharmacies, public digestive endoscopic centres and oncologic and general surgery units. Mean adherence to consolidated colorectal screening programs in Italy was applied in order to evaluate the feasibility of an operative model in our area. Results. Applying the model to the target population (269,368 individuals of both sexes), it can be expected a mean percentage of 79% delivered invitation and a mean participation rate of 46.3% accounting for a total of 213,070 invited individuals and 98,651 participating in the first round of the program. Furthermore, considering the national mean of 6% positive FOBT, 82% of colonscopy adhesion and 7% CRC detection rate, it can be scheduled a burden for health care structures involved in the program accounting for 49,325 FOBTs, 2,338 colonscopies and 141 surgeries for each year. Discussion. This work demonstrates the feasibility of a colorectal screening project in our area, showing a sustainable impact for local health care involved structures. Furthermore, this program may be spread as an applicative model to other areas, adapting the project to the needs of the local setting in which the colorectal screening will be organized

Potential impact of a nonavalent HPV vaccine on HPV related low-and high-grade cervical intraepithelial lesions: A referral hospital-based study in Sicily

While bivalent and quadrivalent HPV vaccines have been used for about 10 years, a nonavalent vaccine against HPV types 6/11/16/18/31/33/45/52 and 58 has been recently approved by FDA and EMA and is now commercially available. The objective of our study was to evaluate the potential impact of the nonavalent vaccine on HPV infection and related low- and high-grade squamous intraepithelial lesions (LSIL, HSIL), compared to the impact of the quadrivalent vaccine, in a female population living in Sicily (Italy). Low estimates of HPV vaccine impact were calculated as prevalence of HPV 6/11/16/18/31/33/45/52 and 58 genotypes, alone or in association, but excluding presence of other HPV types; high estimates were calculated as prevalence of HPV 6/11/16/18/31/33/45/52 and 58 genotypes alone or in association, in the presence of other HPV types. The nonavalent HPV vaccine showed increased impact, compared to the quadrivalent vaccine. Estimates of potential impact varied from 30.9% (low estimate) to 53.3% (high estimate) for LSIL, and from 56.9% to 81,0% for HSIL. The proportion of additional cases potentially prevented by the nonavalent vaccine was 14.4%\u201323.8% for LSIL, and 19.0%\u201332.8% for HSIL. The benefit of the nonavalent vaccine compared to the quadrivalent vaccine was more than 80% for both low and high impact estimates for LSIL and more than 50% for both low and high impact estimates for HSIL. The present study confirms that the switch from a first generation HPV vaccines to a nonavalent vaccine would increase the prevention of cervical HSIL in up to 90% of cases

Immunotherapy for recurrent ovarian cancer: a further piece of the puzzle or a striking strategy?

Introduction: Treatment of ovarian cancer has been long standardized with the inclusion of surgery and chemotherapy based on platinum and taxanes, this strategy reaching high remission rates. However, when this treatment fails, further options are available with little benefit. Since ovarian cancer has specific immunologic features, actually immunotherapy is under evalua- 15 tion to overcome treatment failure in patients experiencing recurrence. Areas covered: Immunogenicity of ovarian cancer and its relationship with clinical outcomes is briefly reviewed. The kinds of immunotherapeutic strategies are summarized. The clinical trials investigating immunotherapy in recurrent ovarian cancer patients are reported. 20 Expert opinion: The results of these clinical trials about immunotherapy are interesting, but little clinical benefit has been achieved until now. For this reason, we could conclude that immunotherapy is quite different from other treatment options and it could change the global approach for recurrent ovarian cancer treatment. However, to date only fragmentary findings are 25 available to define the real role of immunotherapy in this setting