Adult Still's disease and Tako-Tsubo syndrome

Here we describe the case of a 68-year-old Italian female who was admitted in our hospital for the occurrence of arthralgia, abdominal pain and general discomfort. The clinical picture was complicated by recurrent febrile episodes up to 40°C associated with skin rush and cardio-respiratory failure with ECG ischemic alteration, TnT-hs troponin elevation and an ipo-akinetic alteration of the apex at the echocardiogram examination. After an intensive workup, the diagnosis of an adult Still's disease was formulated according to the classification criteria. Moreover, the patient underwent coronarographic study and cardiac MR that, collectively, supported the diagnosis of Tako-Tsubo syndrome. The patient was treated with steroid obtaining the remission of the disease. Myocardial injury with adult Still's disease was been rarely reported. In our case we observed for the first time, to our knowledge, a case of adult Still's disease complicated by a Tako-Tsubo syndrome

Intensity of medical care in internal medicine: impact on outcomes from a trend analysis over six years

In large acute medical wards treating heterogenous and complex patients intensity of patient care should be graduated according to clinical severity. We conducted a retrospective observational study on all unselected admissions (8838) to the internal medicine ward of the Santa Chiara Hospital of Trento from 2012 to 2017. During 2012 and 2013, a standard organizational model (SMC) was in place, while an organizational model for intensity of medical care (IMC) was introduced in 2014. In SMC, patient admission was performed according to bed availability only. In IMC, patients were allocated to three different ward settings (high, medium and post-acute care) based on the stratification of clinical instability. The National Early Warning Score (NEWS) was used for the stratification, together with the clinical judgment. The implementation of the IMC model led to a decrease of mortality and urgent transfers for clinical deterioration to Intensive Care Unit and to an increase of admissions from Intensive Care Unit and from regional spoke hospitals. Redesigning delivery processes based on IMC can play a pivotal role in improving patient outcomes and bed management

Colchicine for children with pericarditis: systematic review of clinical studies

OBJECTIVE: To review the evidence for the efficacy and safety of colchicine in children with pericarditis. DESIGN: Systematic review. SEARCH STRATEGY: The following databases were searched for studies about colchicine in children with pericarditis (June 2015): Cochrane Central, Medline, EMBASE and LILACS. ELIGIBILITY CRITERIA: All observational and experimental studies on humans with any length of follow-up and no limitations on language or publication status were included. The outcomes studied were recurrences of pericarditis and adverse events. DATA EXTRACTION: Two authors extracted data and assessed quality of included studies using the Cochrane risk of bias tool for non-randomised trials. RESULTS: Two case series and nine case reports reported the use of colchicine in a total of 86 children with pericarditis. Five articles including 74 paediatric patients were in favour of colchicine in preventing further pericarditis recurrences. Six studies including 12 patients showed that colchicine did not prevent recurrences of pericarditis. LIMITATIONS: No randomised controlled trials (RCTs) were found. CONCLUSIONS: Although colchicine is an established treatment for pericarditis in adults, it is not routinely used in children. There is not enough evidence to support or discourage the use of colchicine in children with pericarditis. Further research in the form of large double-blind RCTs is needed to establish the efficacy of colchicine in children with pericarditis

Endothelial Cells' Activation and Apoptosis Induced by a Subset of Antibodies against Human Cytomegalovirus: Relevance to the Pathogenesis of Atherosclerosis

Human cytomegalovirus (hCMV) is involved in the pathogenesis of atherosclerosis. We have previously shown in patients with atherosclerosis that antibodies directed against the hCMV-derived proteins US28 and UL122 are able to induce endothelial cell damage and apoptosis of non-stressed endothelial cells through cross-rection with normally expressed surface molecules. Our aim was to dissect the molecular basis of such interaction and to investigate mechanisms linking innate immunity to atherosclerosis.We analysed the gene expression profiles in endothelial cells stimulated with antibodies affinity-purified against either the UL122 or the US28 peptides using the microarray technology. Microarray results were validated by quantitative PCR and by detection of proteins in the medium. Supernatant of endothelial cells incubated with antibodies was analysed also for the presence of Heat Shock Protein (HSP)60 and was used to assess stimulation of Toll-Like Receptor-4 (TLR4). Antibodies against UL122 and US28 induced the expression of genes encoding for adhesion molecules, chemokines, growth factors and molecules involved in the apoptotis process together with other genes known to be involved in the initiation and progression of the atherosclerotic process. HSP60 was released in the medium of cells incubated with anti-US28 antibodies and was able to engage TLR4.Antibodies directed against hCMV modulate the expression of genes coding for molecules involved in activation and apoptosis of endothelial cells, processes known to play a pivotal role in the pathogenesis of atherosclerosis. Moreover, endothelial cells exposed to such antibodies express HSP60 on the cell surface and release HSP60 in the medium able to activate TLR4. These data confirm that antibodies directed against hCMV-derived proteins US28 and UL122 purified from patients with coronary artery disease induce endothelial cell damage and support the hypothesis that hCMV infection may play a crucial role in mediating the atherosclerotic process

Stockholm’s Engine of Change: Cyclists Remaking Themselves and Their City

Today we are experiencing an urbanization process at a speed never acknowledged before. With mobilityaccounting for a considered share of the environmental impact of these expanding urban ecosystems, the bicycleassumes an increasing fundamental role in the framework of sustainable development. However, despite gainingrecognition as valuable sustainable transportation alternative, it is still marginalized within a current car-centeredsociety. Collective action around cycling has therefore started to mobilize in order to defend cyclists’ interestsand needs. Yet, there is still limited research on its role on affecting urban development, as well as on its impacton the people who engage in such action. This thesis aims to fill this research gap by focusing on how collective action around cycling has shaped city andpersons. First of all, the collective action framework has been delineated by building on different authorscontributions: in this thesis, collective action has then been defined as an action of the collectivity for thecollectivity through the efforts of both single individuals and organized groups. Three sub-questions haveconsequently been investigated: how collective action changed its own practitioners, transforming theircapabilities and self-perceptions; how collective action has been shaped itself by cyclists group identity; and howsuch action has impacted the development of the city of Stockholm, taken as case study. The methods appliedinclude a literature review to provide relevant background, followed by a qualitative research based on semi-structured interviews. The informants involved were selected based on their engagement in the collective actionof the Stockholm scene, taken as case study due to its rather rapid process and quest in becoming a more bikeablecity. By analyzing their experiences and answers, the study results provide a new perspective on the impact ofcollective action, focusing in particular on the way group identification can strengthen and direct this engagementand on how the latter has contributed to a more personal development of its practitioners. The results build up on and also confirm previous findings in relation to dynamics typical of collective action andgroup identity, applying a more case-related perspective. In regard to its practitioners, collective action has beenfound to have an impact by enhancing a feeling of empowerment, freedom and community, affecting also non-practitioners and benefiting the society as a whole. Group identification resulted to play a significant role inshaping the different kinds of engagement, for example by focusing on contrasting the car hegemony within theurban system; however, consistent differences were found between high and low identifiers. For what concernsthe urban development of Stockholm, collective action has been found to have shaped the city in regards toinfrastructure, policies and organization, thanks to a growing network and political engagement of different actorsand organizations. The deriving increased awareness and recognition represent a core starting point for theachievement of future goals

SCHNITZLER'S SYNDROME TREATED SUCCESSFULLY WITH INTRAVENOUS PULSE CYCLOPHOSPHAMIDE

none5nonePETERLANA D; A. PUCCETTI; TINAZZI E; SIMEONI S; LUNARDI CPeterlana, D; Puccetti, Antonio; Tinazzi, E; Simeoni, S; Lunardi, C

Stroke-like manifestations in a patient with Listeria monocytogenes abscess and Horton’s arteritis

Brain abscesses due to Listeria monocytogenes are rare and are a clinical challenge. We report the case of a 72-year old female patient under immunosuppressive treatment for Horton’s arteritis who was admitted with an initial diagnosis of ischemic stroke. Further workup revealed listerial abscesses as the cause of her neurological symptoms. She was treated with ampicillin plus gentamicin with an excellent outcome. In spite of the rarity of this entity, immunosuppresive drugs are the most important predisposing factors. These drugs are widely used and consequently there is an increased number of subjects at risk of listerial brain abscesses

Adult Still’s disease and Tako-Tsubo syndrome

Here we describe the case of a 68-year-old Italian female who was admitted in our hospital for the occurrence of arthralgia, abdominal pain and general discomfort. The clinical picture was complicated by recurrent febrile episodes up to 40°C associated with skin rush and cardio-respiratory failure with ECG ischemic alteration, TnT-hs troponin elevation and an ipo-akinetic alteration of the apex at the echocardiogram examination. After an intensive workup, the diagnosis of an adult Still’s disease was formulated according to the classification criteria. Moreover, the patient underwent coronarographic study and cardiac MR that, collectively, supported the diagnosis of Tako-Tsubo syndrome. The patient was treated with steroid obtaining the remission of the disease. Myocardial injury with adult Still’s disease was been rarely reported. In our case we observed for the first time, to our knowledge, a case of adult Still’s disease complicated by a Tako-Tsubo syndrome