[Rheumatology in the Italian literary fiction: "La Longobarda" by Giorgio Conconi (1999)]

In the literary fiction "La Longobarda" by Giorgio Conconi (1999) the protagonist Linda narrates her life, when about fifty she falls ill because of arthritis, thus looking prematurely older and suffering from severe disturbances of body image. This fiction represents an uncommon case of contemporary literature dealing with rheumatological topics. In the present note, it has shown how literature can contribute in several ways to achievement in the human dimension of medicine, by teaching physician concrete and powerful lessons about the lives of sick people

The Institute for the History of Rheumatology, an offspring of the Italian Society of Rheumatology, is born in Venice.

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Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Rheumatology in the Italian literary fiction: “La Longobarda” by Giorgio Conconi (1999)

In the literary fiction "La Longobarda" by Giorgio Conconi (1999) the protagonist Linda narrates her life, when about fifty she falls ill because of arthritis, thus looking prematurely older and suffering from severe disturbances of body image. This fiction represents an uncommon case of contemporary literature dealing with rheumatological topics. In the present note, it has shown how literature can contribute in several ways to achievement in the human dimension of medicine, by teaching physician concrete and powerful lessons about the lives of sick people

The discovery of "sale amarissimo antifebbrile" ("bitter febrifugal saline") by Bartolommeo Rigatelli, i.e. the origins of pharmacoeconomics

When considering the history of salycilates, it has to be underlined that a number of Italian scientists made significant contributions on such a topic. Among these, two pharmacists, Bartolommeo Rigatelli in Verona and Francesco Fontana in Lazise, carried out the first extraction of the active component of willow bark in 1824. Rigatelli named the drug "sale amarissimo antifebbrile" ("bitter febrifugal saline"). In his report some references of pharmacoeconomics are sketched out, thus indicating the attention that the Austrian government on the North Italian districts gave to the management policy. In fact, Rigatelli carried out an economic account of the use of salicin extracts as an antipyretic agent instead of the chincona bark which had been imported from South America at that time and was very expensive. This historical report gives rise to outline a brief history of pharmacoeconomics

Quelques notes sur Cesare Bertagnini, pionnier de la pharmacocinétique

Cesare Bertagnini was a student of Raffaele Piria. He took orally various acids (nitrobenzoic, camphoric and salicylic) and dosed these compounds and metabolites in his own urines. He acted as a precursor of pharmacokinetics.Cesare Bertagnini est un élève de Raffaele Piria qui, ayant absorbé de l’acide nitrobenzoïque, de l’acide camphorique et de l’acide salicylique, dosa ces composés et leurs métabolites dans les urines, se montrant un précurseur de la pharmacocinétique.Pasero Giampiero, Marson Piero. Quelques notes sur Cesare Bertagnini, pionnier de la pharmacocinétique. In: Revue d'histoire de la pharmacie, 96e année, N. 361, 2009. pp. 37-40

The Italian contributions to the history of salicylates

It is well-known that the modern history of salicylates began in 1899 when the compound acetylsalicylic acid was registered and introduced commercially as “aspirin” by the Bayer Company of Germany. As a matter of fact, however, remedies made from willow bark had been used to treat fever and rheumatic complaints at least since 1763, when Edward Stone described their efficacy against malarian fever. A number of Italian scientists made significant contributions during the long period of research leading up to the synthesis of acetylsalicylic acid and its widespread use in rheumatic diseases. In this paper we will review the contributions of some of these researchers, beginning with Bartolomeo Rigatelli, who in 1824 used a willow bark extract as a therapeutic agent, denominating it “salino amarissimo antifebbrile” (very bitter antipyretic salt). In the same year, Francesco Fontana described this natural compound, giving it the name “salicina” (salicin). Two other Italian chemists added considerably to current knowledge of the salicylates: Raffaele Piria in 1838, while working as a research fellow in Paris, extracted the chemical compound salicylic acid, and Cesare Bertagnini in 1855 published a detailed description of the classic adverse event associated with salicylate overdoses – tinnitus – which he studied by deliberately ingesting excessive doses himself. Bertagnini and above all Piria also played conspicuous roles in the history of Italy during the period of the Italian Risorgimento, participating as volunteers in the crucial battle of Curtatone and Montanara during the first Italian War of Independence

The role of plasma exchange in the management of autoimmune disorders

Therapeutic plasma exchange (TPE) has been mainly used in the treatment of autoimmune diseases. The main mechanisms of action of TPE include the removal of circulating autoantibodies, immune complexes, complement components, cytokines and adhesion molecules, along with sensitization of antibody-producing cells to immunosuppressant agents. TPE is useful in autoimmune haematological, renal, rheumatic and neurological diseases, and is recommended for acute disorders, together with relapsed or worsened chronic diseases that are often unresponsive to conventional treatments. The American Society for Apheresis and the British Society of Haematology have published guidelines on the clinical use of apheresis procedures, indicating the different levels of efficacy of TPE. Based on the evidence from current literature and our personal experience, this review discusses the indications and the suggested regimens for TPE in autoimmune haematological and non-haematological disorders