The patient with rhinitis in the pharmacy. A cross-sectional study in real life

In the practical management of allergic rhinitis (AR), pharmacists are usually the first-line contact, also because some medications are available as over the counter. Therefore, pharmacists may represent an important resource, in mediating the interaction between patients and physicians. We evaluated the clinical/demographic characteristics of patients with respiratory allergies who consulted their pharmacists as first-line contact. A patient-oriented questionnaire was developed by a scientific committee including pharmacists, GPs, allergists, pulmonologists and ENT specialists

Solitary biceps muscle metastasis from neuroendocrine breast tumor.

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The role of teicoplanin in the treatment of SARS-CoV-2 infection: a retrospective study in critically ill COVID-19 patients (Tei-COVID Study)

Teicoplanin has a potential antiviral activity expressed against SARS-CoV-2 and was suggested as a complementary option to treat COVID-19 patients. In this multicentric, retrospective, observational research the aim was to evaluate the impact of teicoplanin on the course of COVID-19 in critically ill patients

Prognostic factors in merkel cell carcinoma: A retrospective single-center study in 90 patients

Abstract Merkel Cell Carcinoma (MCC) is a rare but highly aggressive neuroendocrine neoplasm of the skin. This study aimed at describing characteristics, treatment, and prognosis of a series of consecutive cases of MCC patients, in order to contribute to the investigation of this rare malignancy and provide better patient care. This is a retrospective cohort study including all 90 patients diagnosed and/or treated for MCC between 1991 and 2018 at the Veneto Institute of Oncology in Padua (Italy). Patient and tumor characteristics, treatment, and immunohistochemical data were extracted from a prospectively collected local database. There were 68 primary (76%) and 22 non-primary (15 occult primary, three metastatic, four recurrence) tumors (24%). CK20 expression was associated with reduced overall (HR 2.92, 95% CI 1.04-8.16) and disease-specific (HR 4.62, 95% CI 1.31-16.28) survival. Immunomodulatory regimens for treatment of other comorbidities were associated with reduced disease-specific ((HR 2.15, 95% CI 1.06-4.36) and recurrence-free (HR 3.08, 95% CI 1.44-6.57) survival. latrogenic immunomodulation resulted as the main factor associated with impaired prognosis. Lack of CK20 expression was associated with better survival

A Therapeutic and Diagnostic Multidisciplinary Pathway for Merkel Cell Carcinoma Patients

Merkel Cell Carcinoma (MCC) is a highly aggressive neuroendocrine neoplasm of the skin. Due to its rarity, the management of MCC is not standardized across centers. In this article, we present the experience of the Veneto region in the North-East of Italy, where a committee of skin cancer experts has proposed a clinical pathway for the diagnosis and treatment of MCC. Putting together the evidence available in the international literature, we outlined the best approach to the management of patients affected with this malignancy step- by- step for each possible clinical situation. Crucial in this pathway is the role of the multidisciplinary team to deal with the lack of robust information on each aspect of the management of this disease

Treatment with human, recombinant FSH improves sperm DNA fragmentation in idiopathic infertile men depending on the FSH receptor polymorphism p.N680S: A pharmacogenetic study

Study question: Does the spermDNAfragmentation index (DFI) improve depending on the FSH receptor (FSHR) genotype as assessed by the nonsynonymous polymorphisms rs6166 (p.N680S) after 3 months of recombinant FSH treatment in men with idiopathic infertility? summary answer: FSH treatment significantly improves sperm DFI only in idiopathic infertile men with the p.N680S homozygous N FSHR. what is known already: FSH, fundamental for spermatogenesis, is empirically used to treat male idiopathic infertility and several studies suggest that DFI could be a candidate predictor of response to FSH treatment, in terms of probability to conceive. Furthermore, it is known that the FSHR single nucleotide polymorphism (SNP) rs6166 (p.N680S) influences ovarian response in women and testicular volume in men. study design, size and duration: Amulticenter, longitudinal, prospective, open-label, two-arm clinical trial was performed. Subjects enrolled were idiopathic infertile men who received 150 IU recombinant human FSH s.c. every other day for 12 weeks and were followed-up for a further 12 weeks after FSH withdrawal. Patients were evaluated at baseline, at the end of treatment and at the end of follow-up. participants/materials, setting, methods: Eighty-nine men with idiopathic infertility carrier of the FSHR p.N680S homozygousNor S genotype, FSH 64 8 IU/l and DFI >15%,were enrolled. A total of 66 patients had DFI analysis completed on at least two visits. DFI was evaluated in one laboratory by TUNEL/PI (propidium iodide) assay coupled to flow cytometry, resolving two different fractions of sperm, namely the 'brighter' and 'dimmer' sperm DFI fractions. main results and the roleof chance: Thirty-eightmen(57.6%)were carriers of the p.N680S homozygousNand 28 (42.4%) of the homozygous S FSHR. Sperm concentration/number was highly heterogeneous and both groups included men ranging from severe oligozoospermia to normozoospermia. Total DFI was significantly lower at the end of the study in homozygous carriers of the p.N680SNversus p.N680S S allele (P = 0.008). Total DFI decreased significantly from baseline to the end of the study (P = 0.021) only in carriers of the p.N680S homozygous N polymorphism, and this decrease involved the sperm population containing vital sperm (i.e. brighter sperm) (P = 0.008). The dimmer sperm DFI fraction, including only nonvital sperm, was significantly larger in p.N680S S homozygous patients than in homozygous N men (P = 0.018). Total DFIwas inversely related to total sperm number (P = 0.020) and progressive sperm motility (P = 0.014).Whenpatients were further stratified according to sperm concentration (normoozospermic versus oligozoospermic) or -211G>T polymorphism in the FSHB gene (rs10835638) (homozygous Gversus others), the significant improvement of sperm DFI in FSHR p.N680S homozygousNmen was independent of sperm concentration and associated with the homozygous FSHB -211G>T homozygous G genotype. limitations, reasons for caution: The statistical power of the study is 86.9% with alpha error 0.05. This is the first pharmacogenetic study suggesting that FSH treatment induces a significant improvement of total DFI in men carriers of the p.N680S homozygousNFSHR; however, the results need to be confirmed in larger studies using a personalized FSH dosage and treatment duration. wider implications of the findings: The evaluation of sperm DFI as a surrogate marker of sperm quality, and of the FSHR SNP rs6166 (p.N680S), might be useful to predict the response to FSH treatment in men with idiopathic infertility. study funding/competing interest(s): The study was supported by an unrestricted grant to M.S. and H.M.B. from Merck Serono that provided the drug used in the study. MS received additional grants from Merck Serono and IBSA as well as honoraria from Merck Serono. The remaining authors declare that no conflicts of interest are present. trial registration number: EudraCT number 2010-020240-35

Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Smolynyy monastyr

View of complex, with cathedral at center; Smolny Convent of the Resurrection (Voskresensky), located on the bank of the River Neva, consists of a Cathedral (sobor) and a complex of buildings surrounding it, originally intended for a convent. Construction on the complex was begun as a Russian Orthodox monastery for nuns. It was built to house Elizabeth, the daughter of Peter the Great, after she was disallowed from succession to the throne and opted instead to become a nun. In 1741, Elizabeth accepted the offer of the Russian throne. When Catherine II assumed the throne in 1762, she ended funding. The cathedral was only finished in 1835 by Vasily Stasov with the addition of a neoclassical interior to suit the changed architectural tastes of the day. Source: Wikipedia; http://en.wikipedia.org/wiki/Main_Page (accessed 7/21/2009

Zimni dvorets

South elevation, showing the central bay above the entry to the court; The official seat of the government of Russia from 1712 to 1917, it is sited on the left bank of the River Neva, east of the Admiralty, and is now part of the Hermitage Museum. There have been four successive palaces on the site, the first two of wood and destroyed by fire. Bartolomeo Carlo Rastrelli and Bartolomeo Francesco Rastrelli built the new, stone, Third Winter Palace (1732-1736) for Empress Anne (reigned 1730-1740). Anne’s palace was demolished and its foundations used as the base for the west wing of the new (fourth) palace. In 1754 Bartolomeo Francesco Rastrelli began building the Fourth Winter Palace for Empress Elizabeth (reigned 1741-1761), also in stone. Rastrelli, who was assisted by Yury Fel’ten, finished the present, Fourth Winter Palace in 1762. Four massive three-storey ranges linked by broad galleries surround a courtyard. Each façade is individual, but the principal ones are on the north and south. In the northern part, facing the Neva, are the staterooms and the ceremonial staircase, originally called the Posol’skaya or Ambassadorial Staircase. The south side faces the square and the city; a three-arched gateway leads into the courtyard. The interior was rebuilt after a fire in 1837 with some efforts at restoration and the rest as new decoration. Source: Grove Art Online; http://www.oxfordartonline.com/ (accessed 6/16/2009

Zimni dvorets

East wall of the court, detail showing window; The official seat of the government of Russia from 1712 to 1917, it is sited on the left bank of the River Neva, east of the Admiralty, and is now part of the Hermitage Museum. There have been four successive palaces on the site, the first two of wood and destroyed by fire. Bartolomeo Carlo Rastrelli and Bartolomeo Francesco Rastrelli built the new, stone, Third Winter Palace (1732-1736) for Empress Anne (reigned 1730-1740). Anne’s palace was demolished and its foundations used as the base for the west wing of the new (fourth) palace. In 1754 Bartolomeo Francesco Rastrelli began building the Fourth Winter Palace for Empress Elizabeth (reigned 1741-1761), also in stone. Rastrelli, who was assisted by Yury Fel’ten, finished the present, Fourth Winter Palace in 1762. Four massive three-storey ranges linked by broad galleries surround a courtyard. Each façade is individual, but the principal ones are on the north and south. In the northern part, facing the Neva, are the staterooms and the ceremonial staircase, originally called the Posol’skaya or Ambassadorial Staircase. The south side faces the square and the city; a three-arched gateway leads into the courtyard. The interior was rebuilt after a fire in 1837 with some efforts at restoration and the rest as new decoration. Source: Grove Art Online; http://www.oxfordartonline.com/ (accessed 6/16/2009