Rare splenic complications and specific serology: decisive diagnostic tools in two cases of visceral leishmaniasis

Introduction: Visceral leishmaniasis (VL) is a major endemic vector-borne disease in Southern Europe. We present two cases of VL, both characterized by splenic complications. Methods and results: Case 1: A 47-year-old female presented with effort angina, hepatosplenomegaly and pancytopenia. The clinical course was complicated by splenic infarction. Although bone marrow biopsy failed to show amastigotes, diagnosis was performed by a fast agglutinating screening test (FAST) and confirmed by a direct agglutinating test (DAT). The patient was treated successfully with AmBisome. Case 2: A 22-year-old male who had undergone a splenectomy to treat splenic rupture related to a minor trauma four months earlier presented with fever, nocturnal sweats and weight loss. The lack of pancytopenia was due to the absence of the spleen. The first biopsy did not identify parasites, but because the FAST had been positive, another bone marrow biopsy was performed, which demonstrated leishmaniasis. This patient was treated with the same schedule of AmBisome infusion. Discussion: 1) The clinical presentation of VL can be atypical, 2) splenic complications can characterize this disease, and 3) specific serology may be an important tool to reach a diagnosis

The Waste Land. Il Politecnico alla Bovisa nel parco industriale dei Gasometri.

A partire dalla consapevolezza della storia del Politecnico, che dal 1974 vede l’area di Bovisa come luogo deputato alla ricerca e alla formazione, il progetto affronta la complessità dell’intervento riorganizzandolo secondo alcuni temi, fortemente integrati attraverso il disegno di un’architettura (alla scala urbana). Due sono gli aspetti principali: a) la necessità del consolidamento e ampliamento del Politecnico nell’area dei gasometri, con l’integrazione dello Science Park; b) l’opportunità di realizzare un grande parco urbano, attrezzato e connesso al campus recuperato nella “waste land” dell’area dei gasometri. Strettamente connessi a questi due temi, conseguono gli altri nodi funzionali: c) il recupero, restauro e riutilizzo del patrimonio dismesso del complesso industriale delle officine del gas, persistente oggi come frammento ancora ben strutturato di una città-fabbrica; d) l’integrazione tra l’ampliamento futuro e il già attuato Politecnico Lambruschini-La Masa, che necessita di un consolidamento, con interventi sugli spazi pubblici urbani per una maggiore abitabilità pedonale e facilitazione alla vita del campus esistente; e) l’organizzazione di un parco lineare residenziale di completamento al campus, con servizi integrati, facilitazioni all’accessibilità con un nuovo assetto architettonico della stazione FNM Bovisa e il nuovo complesso commerciale. f) la riorganizzazione della viabilità locale e dei trasporti pubblici per una compatibilità tra scala urbana e nuove funzioni insediate, con conseguente decongestione del traffico di quartiere. Ipotesi fondata con la verifica della sostenibilità alla scala urbana dei traffici generati dall’insieme delle delle nuove funzioni insediate, svolta mediante simulazioni modellistiche capaci di restituire le criticità locali e quelle riverberate nell’intorno territoriale circostante il quartiere Bovisa

Factors Enhancing Treatment of Hepatitis C Virus-Infected Italian People Who Use Drugs: The CLEO-GRECAS Experience

We assessed the performance of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected people who use drugs (PWUDs) in terms of sustained virological response (SVR) and adherence rates in comparison to a location-matched cohort of non-PWUD HCV patients

Factors Enhancing Treatment of Hepatitis C Virus–Infected Italian People Who Use Drugs: The CLEO-GRECAS Experience

We assessed the performance of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected people who use drugs (PWUDs) in terms of sustained virological response (SVR) and adherence rates in comparison to a location-matched cohort of non-PWUD HCV patients

Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial

Background Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue.Methods We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (>= 200 mg/day) and furosemide (>= 25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008-000625-19, and ClinicalTrials. gov, number NCT01288794.Findings From April 2, 2011, to May 27, 2015, 440 patients were randomly assigned and 431 were included in the modified intention-to-treat analysis. 38 of 218 patients died in the SMT plus HA group and 46 of 213 in the SMT group. Overall 18-month survival was significantly higher in the SMT plus HA than in the SMT group (Kaplan-Meier estimates 77% vs 66%; p=0.028), resulting in a 38% reduction in the mortality hazard ratio (0.62 [95% CI 0.40-0.95]). 46 (22%) patients in the SMT group and 49 (22%) in the SMT plus HA group had grade 3-4 non-liver related adverse events.Interpretation In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis. (C) 2018 Elsevier Ltd. All rights reserved