Ecografía prostática transrectal en cáncer de próstata: correlación con tacto rectal y antígeno prostático específico como optimizadores en la selección de pacientes para biopsia prostática

El Cáncer de Prostata ha adquirido una gran importancia en los últimos años, debido al incremeneto de la tasa de mortalidad. El diagnóstico precoz del cáncer prostático asienta sobre el Tacto Rectal (TR), el Antígeno Prostático Específico e suero (APE) y el examen con Ecografía Transrectal (ETR), seguido de la Biopsia Transrectal (BTR). Es conocido el problema de decidir a qué pacientes indicar biopsia en base a parámetros específicos, teniendo en cuenta la morbilidad del procedimiento y sabiendo que sólo un 40 de las biopsias transrectales arrojan resultados positivos. La ecografía transrectal ha aportado elementos para identificar pacientes candidatos a efectuar una biopsia, con más probabilidad de encontrar cáncer: lesión hipoecogénica, alteración del borde glandular, modificación del plano graso perioprostático, y/o un cambio en la vascularización del parenquima.Fil: Marangoni, Alberto Antonio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Ecografía prostática transrectal en cáncer de próstata: correlación con tacto rectal y antígeno prostático específico como optimizadores en la selección de pacientes para biopsia prostática

El Cáncer de Prostata ha adquirido una gran importancia en los últimos años, debido al incremeneto de la tasa de mortalidad. El diagnóstico precoz del cáncer prostático asienta sobre el Tacto Rectal (TR), el Antígeno Prostático Específico e suero (APE) y el examen con Ecografía Transrectal (ETR), seguido de la Biopsia Transrectal (BTR). Es conocido el problema de decidir a qué pacientes indicar biopsia en base a parámetros específicos, teniendo en cuenta la morbilidad del procedimiento y sabiendo que sólo un 40 de las biopsias transrectales arrojan resultados positivos. La ecografía transrectal ha aportado elementos para identificar pacientes candidatos a efectuar una biopsia, con más probabilidad de encontrar cáncer: lesión hipoecogénica, alteración del borde glandular, modificación del plano graso perioprostático, y/o un cambio en la vascularización del parenquima.Fil: Marangoni, Alberto Antonio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin

Optimizing Patient Care: A Systematic Review of Multidisciplinary Approaches for SLE Management

Systemic lupus erythematosus (SLE) is characterized by multisystemic clinical manifestations ranging from a relatively mild involvement to potentially life-threatening complications. Due to this complexity, a multidisciplinary (MD) approach is the best strategy for optimizing patients' care. The main aim of this systematic literature review (SLR) was to scrutinize the published data regarding the MD approach for the management of SLE patients. The secondary objective was to evaluate the outcomes of the MD approach in SLE patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. We performed an SLR to retrieve articles available in English or Italian listed in PubMed, Embase, Cinahl, and Cochrane Library concerning the MD approach used in observational studies and clinical trials. Four independent reviewers performed the study selection and data collection. Of 5451 abstracts evaluated, 19 studies were included in the SLR. The MD approach was most frequently described in the context of SLE pregnancy, reported in 10 papers. MD teams were composed of a rheumatologist, except for one cohort study; a gynecologist; a psychologist; a nurse; and other health professionals. MD approaches had a positive impact on pregnancy-related complications and disease flares and improved SLE psychological impact. Although international recommendations advise an MD approach for managing SLE, our review highlighted the paucity of data supporting this strategy, with most of the available evidence on the management of SLE during pregnancy

Italian natural history museums on the verge of collapse?

The Italian natural history museums are facing a critical situation, due to the progressive loss of scientific relevance, decreasing economic investments, and scarcity of personnel. This is extremely alarming, especially for ensuring the long-term preservation of the precious collections they host. Moreover, a commitment in fieldwork to increase scientific collections and concurrent taxonomic research are rarely considered priorities, while most of the activities are addressed to public events with political payoffs, such as exhibits, didactic meetings, expositions, and talks. This is possibly due to the absence of a national museum that would have better steered research activities and overall concepts for collection management. We here propose that Italian natural history museums collaborate to instate a “metamuseum”, by establishing a reciprocal interaction network aimed at sharing budgetary and technical resources, which would assure better coordination of common long-term goals and scientific activities

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Disease-Modifying Therapies and Coronavirus Disease 2019 Severity in Multiple Sclerosis

Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS). Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results. Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses. Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists

COVID-19 Severity in Multiple Sclerosis: Putting Data Into Context

Background and objectives: It is unclear how multiple sclerosis (MS) affects the severity of COVID-19. The aim of this study is to compare COVID-19-related outcomes collected in an Italian cohort of patients with MS with the outcomes expected in the age- and sex-matched Italian population. Methods: Hospitalization, intensive care unit (ICU) admission, and death after COVID-19 diagnosis of 1,362 patients with MS were compared with the age- and sex-matched Italian population in a retrospective observational case-cohort study with population-based control. The observed vs the expected events were compared in the whole MS cohort and in different subgroups (higher risk: Expanded Disability Status Scale [EDSS] score > 3 or at least 1 comorbidity, lower risk: EDSS score ≤ 3 and no comorbidities) by the χ2 test, and the risk excess was quantified by risk ratios (RRs). Results: The risk of severe events was about twice the risk in the age- and sex-matched Italian population: RR = 2.12 for hospitalization (p < 0.001), RR = 2.19 for ICU admission (p < 0.001), and RR = 2.43 for death (p < 0.001). The excess of risk was confined to the higher-risk group (n = 553). In lower-risk patients (n = 809), the rate of events was close to that of the Italian age- and sex-matched population (RR = 1.12 for hospitalization, RR = 1.52 for ICU admission, and RR = 1.19 for death). In the lower-risk group, an increased hospitalization risk was detected in patients on anti-CD20 (RR = 3.03, p = 0.005), whereas a decrease was detected in patients on interferon (0 observed vs 4 expected events, p = 0.04). Discussion: Overall, the MS cohort had a risk of severe events that is twice the risk than the age- and sex-matched Italian population. This excess of risk is mainly explained by the EDSS score and comorbidities, whereas a residual increase of hospitalization risk was observed in patients on anti-CD20 therapies and a decrease in people on interferon

DMTs and Covid-19 severity in MS: a pooled analysis from Italy and France

We evaluated the effect of DMTs on Covid-19 severity in patients with MS, with a pooled-analysis of two large cohorts from Italy and France. The association of baseline characteristics and DMTs with Covid-19 severity was assessed by multivariate ordinal-logistic models and pooled by a fixed-effect meta-analysis. 1066 patients with MS from Italy and 721 from France were included. In the multivariate model, anti-CD20 therapies were significantly associated (OR = 2.05, 95%CI = 1.39–3.02, p < 0.001) with Covid-19 severity, whereas interferon indicated a decreased risk (OR = 0.42, 95%CI = 0.18–0.99, p = 0.047). This pooled-analysis confirms an increased risk of severe Covid-19 in patients on anti-CD20 therapies and supports the protective role of interferon

En tiempos del COVID-19: pandemia e infodemia

En el mes de mayo de 2009, la Organización Mundial de la Salud (OMS) modificó la definición de “pandemia”, definiéndola como “la propagación mundial de una nueva enfermedad”. Antes se definía como “enfermedad por un agente infeccioso, simultánea en diferentes países, con una mortalidad significativa en relación con la proporción de población infectada” A su vez, recientemente, la OMS advirtió sobre la “infodemia,” un neologismo también conocido como fake news, práctica que consiste en difundir noticias falsas sobre cualquier situación (aplicable hoy a la pandemia) y que tiene como riesgo provocar el pánico en las sociedades. Debido a la aparición del COVID-19, la infodemia ha invadido el ámbito científico, biológico y médico con una súbita profusión de información acelerada. La mayoría de las veces esta no es corroborada con el rigor científico requerido para una publicación cientifica, sea porque no han cumplido con el ciclo de tiempo para obtener datos sustentables y rigurosamente analizados, sea que no contaron con previa revisión de pares o ambas. Es necesario reconocer que se trata de una situación de emergencia que condujo a una reacción desesperada por transmitir datos que pudieran dar origen a consejos de tratamientos y conductas. Consejos que posibilitaran, a su vez, evitar la catastrófica evolución y el penoso número de seres humanos fallecidos que se fueron sucediendo en los últimos ocho meses, aproximadamente, en todo el mundo.Fil: Marangoni, Alberto Antonio. Universidad Católica de Córdoba. Facultad de Ciencias de la Salud; Argentin