EFFETTI AVVERSI NEI PAZIENTI IN TERAPIA CON GH IN UN CENTRO PEDIATRICO: DATI REAL LIFE

OBIETTIVI Abbiamo analizzato la nostra casistica di pazienti in trattamento con GH: 145 pz (86M; 59F), età : 4-17 anni, al fine di valutare efficacia della terapia, eventuali eventi avversi, endocrinopatie insorte dopo l’inizio della terapia (tiroidite autoimmune; insufficienza surrenalica, etc) e/o iperglicemia o franco DM. METODI La casistica esaminata comprende: 6 pz con SHOX-D; 28 pz SGA; 5 con S. di Turner; 4 in terapia con GH per indicazioni diverse, previste dalla nota 39 (IRC, S. di Prader Willi). RISULTATI 3 pz (2 pz con S. di Turner; 1 pz con GHD) hanno manifestato, durante la terapia, tiroidite autoimmune e sono in terapia con L-tiroxina. 1 pz ha una diagnosi di iperinsulinismo congenito ed è in terapia con diazossido; la terapia con GH è stata ben tollerata e non ha richiesto aggiustamenti posologici, né alterazioni del profilo glicemico, consentendo- peraltro - un miglioramento della velocità di crescita staturale. 1 pz ha presentato iperglicemia, non presente prima della terapia con GH; ha mantenuto dosi minime efficaci di GH, raggiungendo il target staturale genetico, non avendo mai avuto necessità di terapia farmacologica per l’iperglicemia. 5 pz, con GHD idiopatico hanno presentato cefalea, non tuttavia tale da richiedere la sospensione della terapia. La valutazione con RMN, oculistica, NPI sono risultate nella norma. Dopo un iniziale wash out terapeutico di una settimana, la terapia è stata ripresa a giorni alterni e poi quotidianamente, mantenendo una buona tollerabilità. 2 pz hanno presentato artralgie agli arti inferiori, non etichettabili come “dolori di crescita”. La riduzione della dose ha consentito una progressione del trattamento senza ulteriori effetti collaterali. In 2 pz, durante il follow up semestrale in corso di terapia con GH (1 pz con SHOX-D; 1 pz con GHD) si è slatentizzata una malattia celiaca, con iniziale riduzione della velocità di crescita, ripresa dopo dieta senza glutine, senza altre patologie associate. CONCLUSIONI La terapia con GH, nella nostra casistica, ha mostrato un buon profilo di sicurezza, una buona tollerabilità, anche in rari casi ove manifestazioni transitorie hanno consentito- tramite un adeguamento posologico- di ottenere un guadagno staturale adeguato al target genetico

Aspergillus ibericus : a new species of section Nigri isolated from grapes

As part of a study on the ochratoxin producing mycoflora of grapes, several Aspergillus strains were isolated and tested for their ochratoxin A (OTA) producing abilities. Aspergillus strains of the section Nigri, which did not produce detectable amounts of OTA but which had a similar morphology to A. carbonarius, were isolated from wine grapes and/or dried vine fruit in Portugal and Spain. These strains, however, have characters that allow morphological distinction from the other species in the section, particularly the conidia size (5–7µm), which allows separation of the species from the two most common biseriate species in section Nigri: A. carbonarius (7–9 µm) and A. niger and its aggregate species (3–5 µm). The strains are described here as belonging to a new species, named A. ibericus. The validation of this new taxon is supported further by analysis of the ITS-5.8S rDNA and calmodulin gene sequences and by analysis of the amplified fragment length polymorphism (AFLP) patterns, which were consistent in separating these strains from other species in the section. A. ibericus strains do not produce OTA therefore they are interesting for biotechnological exploration because many metabolites with commercial value are produced by other species in the section.Fundação para a Ciência e a Tecnologia (FCT

The Dark Side of Activated Phosphoinositide 3-Kinase-δ Syndrome 2: A Story Rewritten through FDG-PET

Background: Activated phosphoinositide 3-kinase-δ syndrome 2 (APDS2) is characterized by lymphoproliferation and increased risk of malignancy. FDG-PET/CT may represent a helpful diagnostic tool for differentiating these clinical features and correctly diagnosing inborn errors of immunity (IEI). Case report: We present the case of a female patient diagnosed with Hodgkin’s lymphoma at 19 years of age, although atypical imaging aspects emerged: baseline FDG-PET/CT revealed several hot lymph nodes with a symmetrical distribution, and increased tracer uptake in spleen, axial, and appendicular bone marrow. Imaging repeated after chemotherapy and autologous stem cell transplantation showed persistent increased FDG uptake at multiple supradiaphragmatic nodes and in bone marrow. After the diagnosis of APDS2 and rapamycin treatment, FDG-PET/CT confirmed complete metabolic normalization of all sites. Conclusions: In the IEI scenario, FDG-PET/CT plays an effective role in differentiating malignant proliferation and immune dysregulation phenotypes. Atypical patterns at FDG-PET/CT should be interpreted as a red flag for the need of an early immunological evaluation

Liver hemangioma and vascular liver diseases in patients with systemic lupus erythematosus

AIM: To investigate whether systemic lupus erythematosus (SLE) is associated with benign focal liver lesions and vascular liver diseases, since these have been occasionally reported in SLE patients

Characterization of Dextran Produced by the Food-Related Strain Weissella cibaria C43-11 and of the Relevant Dextransucrase Gene

A metabolic feature of lactic acid bacteria (LAB) is the production of exopolysaccharides (EPSs), which have technological and functional properties of interest to the food sector. The present study focused on the characterization of the Weissella cibaria strain C43-11, a high EPS producer in the presence of sucrose, in comparison with a low-producing strain (C2-32), and on possible genetic regulatory elements responsible for the modulation of dextransucrase (dsr) genes expression. NMR analysis of the polymeric material produced by the C43-11 strain indicated the presence of dextran consisting mainly of a linear scaffold formed by α-(1–6) glycosidic linkages and a smaller amounts of branches derived from α-(1–2), α-(1–3), and α-(1–4) linkages. Molecular analysis of the dsr genes and the putative transcriptional promoters of the two strains showed differences in their regulatory regions. Such variations may have a role in the modulation of dsr expression levels in the presence of sucrose. The strong upregulation of the dsr gene in the C43-11 strain resulted in a high accumulation of EPS. This is the first report showing differences in the regulatory elements of the dsr gene in W. cibaria and indicates a new perspective of investigation to identify the regulatory mechanism of EPS production

World Hypertension Day 2021 in Italy: Results of a Nationwide Survey

Hypertension is the biggest contributor to the global burden of cardiovascular diseases and related death, but the rates of hypertension awareness, treatment, and control remain largely perfectible

Evaluation of persistence and adherence to teriparatide treatment in patients affected by severe osteoporosis (PATT): a multicenter observational real life study

Introduction. Osteoporosis is a chronic condition leading to an increased risk of developing fractures, with high morbidity and mortality in aging population. Efficacy of anti-osteoporotic treatment is based on drug potency but also on compliance and persistence to treatment regimen, which is very low, as already described for other diseases. Teriparatide (TPTD) is the first anabolic agent developed for the treatment of osteoporosis. Since it appears that persistence to Teriparatide declines over time, aim of this pilot multicenter observational study was to evaluate persistence and adherence to TPTD (20 μg daily injection regimen for 18 months) treatment (PATT) in patients affected by severe osteoporosis in an every day clinical practice. Methods. Patients affected by severe osteoporosis were selected among those who referred to 5 different specialized centers for osteoporosis in North, Center and South of Italy. A sample of 475 women with severe postmenopausal osteoporosis treated with TPTD in accordance to the Italian osteoporosis guidelines was included. At the beginning of TPTD treatment patients were instructed on the use of the device by the referring specialist of the center, a resident fellow or a nurse. Bone biochemical markers were evaluated the same morning and after 1, 3, 6, 12 and 18 months. Patients were visited at time 0 and after 6, 12 and 18 months for clinical follow up. Results. The results included observations of 441/475 patients (98% women) who completed the 18 months treatment; mean age for women was 73±8 and for men 65±9. After 6 months of TPTD treatment persistence was of 89,79%, 87,75% after 12 months and 86,85% after 18 months. Adherence was of 100% at 6,12 and 18 months. Total dropouts were 13,15% (71/441), which was usually higher within the first 6 months of TPTD treatment. Most common adverse events (arthralgies 2,7%, dizziness 1,8%, migraine 1,8%, depression 1,6%, hypertension 1,1%) were reported in 62/441 patients (14%) of patients, but were not reason for stopping treatment. Conclusions. The persistence and adherence to TPTD treatment obtained in this multicenter observational real life study was very high as compared to studies performed by others. These encouraging results suggest that different key factors such quality of information, frequency of visits, motivations given to patients, opportunity to call the doctor might play a pivotal role in the high persistence and adherence to TPTD treatment obtained in our study and need to be carefully considered before prescribing chronic anti-osteoporotic therap

Effectiveness of Golimumab as Second Anti-TNFα Drug in Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Axial Spondyloarthritis in Italy: GO-BEYOND, a Prospective Real-World Observational Study

In this prospective observational study, data were collected from 34 rheumatology clinics in Italy in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) who started golimumab (GLM) as a second anti-TNF alpha drug. The primary objective was to evaluate the effectiveness of GLM after 6 months. Changes in quality of life using the EQ-5D-5L were also assessed. A total of 194 patients aged 53.2 +/- 12 years started GLM as a second anti-TNF drug: 39 (20.1%) with RA, 91 (46.9%) with PsA and 64 (32.9%) with axSpA. After 6 months of GLM treatment, 68% of RA patients achieved low disease activity (LDA; DAS28-CRP <= 3.2), 31.9% of PsA patients achieved minimal disease activity and 32.5% of axSpA patients achieved LDA (ASDAS-CRP < 2.1). Good/moderate EULAR response was achieved in 61.9% and 73.8% of patients with RA and PsA, respectively, and 16% of axSpA patients achieved a 50% improvement in BASDAI. Across all indications, improvements in disease activity measures and EQ-5D-5L domains were observed over 6 months. The main reasons for GLM interruption were lack/loss of efficacy (7.2%) or adverse events (2%). This study confirms the effectiveness of GLM as a second-line anti-TNF for the treatment of RA, PsA and axSpA in a real-world setting in Italy