SARS-CoV-2 infection in patients with inflammatory bowel disease: comparison between the first and second pandemic waves

In Italy, the incidence of SARS-CoV-2 infection peaked in April and November 2020, defining two pandemic waves of coronavirus disease 2019 (COVID-19). This study compared the characteristics and outcomes of patients with inflammatory bowel disease (IBD) and SARS-CoV-2 infections between pandemic waves.MethodsObservational longitudinal study of IBD patients with SARS-CoV-2 infection. Patients with established diagnoses of IBD and of SARS-CoV-2 infection were consecutively enrolled in two periods: (i) first wave, from 1 March 2020 to 31 May 2020; and (ii) second wave, from 15 September to 15 December 2020.ResultsWe enrolled 937 IBD patients (219 in the first wave, 718 in the second wave). Patients of the first wave were older (mean & PLUSMN; SD: 46.3 & PLUSMN; 16.2 vs. 44.1 & PLUSMN; 15.4 years, p = 0.06), more likely to have ulcerative colitis (58.0% vs. 44.4%, p < 0.001) and comorbidities (48.9% vs. 38.9%; p < 0.01), and more frequently residing in Northern Italy (73.1% vs. 46.0%, p < 0.001) than patients of the second wave. There were no significant differences between pandemic waves in sex (male: 54.3% vs. 53.3%, p = 0.82) or frequency of active IBD (44.3% vs. 39.0%, p = 0.18). The rates of negative outcomes were significantly higher in the first than second wave: pneumonia (27.8% vs. 11.7%, p < 0.001), hospital admission (27.4% vs. 9.7%, p < 0.001), ventilatory support (11.9% vs. 5.4%, p < 0.003) and death (5.5% vs. 1.8%, p < 0.007).ConclusionBetween the first and second SARS-CoV-2 pandemic waves, demographic, clinical and geographical features of IBD patients were different as were the symptoms and outcomes of infection. These differences are likely due to the different epidemiological situations and diagnostic possibilities between the two waves

Multiple myeloma - oral radiological evidences

Objective: The aim of this article is to summarize the main radiological evidences induced by multiple myeloma at the jaws level. Materials and Methods: The analysis examines the main case reports and reviews on the matter. All relevant publications were searched through the PubMed search engine, using the following keywords: "Multiple Myeloma" and "Radiological evidences", "Maxilla", "Jaw", "TMJ". The purpose of our review is to highlight how oral radiological investigation is extremely useful in detecting any bone alterations associated with cases of multiple myeloma. In addition, we investigate the sites of the jaws where direct bone alteration is more frequently, and we perform a differential diagnosis with other focal alterations of the jaws or those that are the result of certain drug therapies (bisphosphonates). Our research stresses the concept that early diagnosis of multiple myeloma at the jaws level may prevent unnecessary and inadequate treatments. Results: From the evaluation of our research, it is evident that osteolytic lesions are one of the fundamental signs of multiple myeloma, especially in areas undergoing intense hematopoietic activity. Among the radiological techniques used for diagnosis, the most sensitive one appears to be the three-dimensional technique, such as CT or Cone Beam, whereas two-dimensional radiographs (orthopantomography) appear to be exhaustive only when the lesion is very extensive. Conclusions: It is evident that the dentist figure plays not only a supportive role, but also a fundamental part in the diagnostic process, as lesions that may anticipate a systemic manifestation are often encountered at the oral level.Sin financiaciónNo data 2020UE

A meta-analysis and trial sequential analysis comparing nonoperative versus operative management for uncomplicated appendicitis: a focus on randomized controlled trial

Background The aim of this study is to provide a meta-analysis of randomized controlled trials (RCT) comparing conservative and surgical treatment in a population of adults with uncomplicated acute appendicitis. Methods A systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL. We have exclusively incorporated randomized controlled trials (RCTs). Studies involving participants with complicated appendicitis or children were excluded. The variables considered are as follows: treatment complications, complication-free treatment success at index admission and at 1 year follow-up, length of hospital stay (LOS), quality of life (QoL) and costs. Results Eight RCTs involving 3213 participants (1615 antibiotics/1598 appendectomy) were included. There was no significant difference between the two treatments in terms of complication rates (RR = 0.66; 95% CI 0.61—1.04, P = 0.07, I2 = 69%). Antibiotics had a reduced treatment efficacy compared with appendectomy (RR = 0.80; 95% CI 0.71 to 0.90, p &lt; 0.00001, I2 = 87%) and at 1 year was successful in 540 out of 837 (64.6%, RR = 0.69, 95% confidence interval 0.61 to 0.77, p &lt; 0.00001, I2 = 81%) participants. There was no difference in LOS (mean difference − 0.58 days 95% confidence interval − 1.59 to 0.43, p = 0.26, I2 = 99%). The trial sequential analysis has revealed that, concerning the three primary outcomes, it is improbable that forthcoming RCTs will significantly alter the existing body of evidence. Conclusions As further large-scale trials have been conducted, antibiotic therapy proved to be safe, less expensive, but also less effective than surgical treatment. In order to ensure well-informed decisions, further research is needed to explore patient preferences and quality of life outcomes

Sanzioni "individuali" del Consiglio di sicurezzae garanzie processuali fondamentali

Parte I - Consiglio di sicurezza e terrorismo internazionale; Parte II - L'attuazione delle sanzioni del Consiglio di sicurezza nella prospettiva della Convenzione europea dei diritti dell'uomo e del Diritto dell'Unione europea; Parte III - L'attuazione delle sanzioni del Consiglio di sicurezza nell'ordinamento italiano

Undiagnosed prediabetes is highly prevalent in primary infertile men - results from a cross-sectional study

Objective To study the prevalence and the risk associated with prediabetes (PreDM) in primary infertile men. Patients and methods Data from 744 infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every man. Semen analysis was based on 2010 World Health Organization (WHO) reference criteria. PreDM was defined according to the clinical criteria detailed by the American Diabetes Association (Diabetes Care 2014; 37 (Suppl. 1): S81). Descriptive statistics and logistic regression analyses tested the association between PreDM status, hormonal milieu and seminal parameters. The predictive accuracy of all variables was evaluated using the area under the curve, and the clinical net benefit estimated by decision curve analysis (DCA). Results Of the 744 men, PreDM was found in 114 (15.4%). Men with PreDM (+PreDM) were older, had higher CCI scores, lower total testosterone and sex hormone-binding globulin but higher follicle-stimulating hormone (FSH) and 17 beta-oestradiol values compared to those without PreDM (-PreDM) (all P &lt;= 0.04). Higher sperm DNA fragmentation index (DFI; P = 0.014) and idiopathic non-obstructive azoospermia (iNOA; P &lt; 0.001) were found more frequently in +PreDM men. At multivariable logistic regression analysis, older age, FSH and iNOA (all P &lt;= 0.04) were significantly associated with +PreDM status. DCA demonstrated a clinical net benefit in discriminating men at higher risk of a +PreDM status. Conclusions About 15% of primary infertile men had criteria suggestive of undiagnosed PreDM. A PreDM status was associated with a greater risk of hypogonadism, higher DFI values and iNOA status. Age, FSH values and iNOA status could be considered as useful parameters to recognise men with PreDM and implement early preventive interventions in those men at risk of the consequences from poor glycaemic control

Open Abdomen in Obese Patients: Pay Attention! New Evidences from IROA, the International Register of Open Abdomen

Background: Open abdomen is the cornerstone of damage control strategies in acute care and trauma surgery. The role of BMI has not been well investigated. The aim of the study was to assess the role of BMI in determining outcomes after open abdomen. Methods: This is an analysis of patients recorded into the International Register of Open Abdomen; patients were classified in two groups according to BMI using a cutoff of 30&nbsp;kg/m2. The primary outcome was in-hospital mortality; secondary outcomes were primary fascia closure rate, length of treatment, complication rate, entero-atmospheric fistula rate and length of ICU stay. Results: A total of 591 patients were enrolled from 57 centers, and obese patients were 127 (21.5%). There was no difference in mortality between the two groups; complications developed during the open treatment were higher in obese patients (63.8% vs. 53.4%, p = 0.038) while post-closure complications rate was similar. Obese patients had a significantly longer duration of the open treatment (9.1 ± 11.5&nbsp;days vs. 6.3 ± 7.5&nbsp;days; p = 0,002) and lower primary fascia closure rate (75.5% vs. 89.5%; p &lt; 0,001). No differences in fistula rate were found. There was a linear correlation between the duration of open abdomen and the BMI (Pearson’s linear correlation coefficient = 0,201; p &lt; 0,001). Conclusions: Open abdomen in obese patients seems to be safe as in non-obese patients with similar mortality; however, in obese patients the length of open abdomen is significantly higher with higher complication rate, longer ICU length of stay and lower primary fascia closure rate. Trial registration number: ClinicalTrials.gov, Identifier: NCT02382770

Long-term outcome of chronic myeloid leukemia patients treated frontline with imatinib

For almost 10 years imatinib has been the therapeutic standard of chronic myeloid leukemia. The introduction of other tyrosine kinase inhibitors (TKIs) raised a debate on treatment optimization. The debate is still heated: some studies have protocol restrictions or limited follow-up; in other studies, some relevant data are missing. The aim of this report is to provide a comprehensive, long-term, intention-to-treat, analysis of 559 newly diagnosed, chronic-phase, patients treated frontline with imatinib. With a minimum follow-up of 66 months, 65% of patients were still on imatinib, 19% were on alternative treatment, 12% died and 4% were lost to follow-up. The prognostic value of BCR-ABL1 ratio at 3 months (≤10% in 81% of patients) was confirmed. The prognostic value of complete cytogenetic response and major molecular response at 1 year was confirmed. The 6-year overall survival was 89%, but as 50% of deaths occurred in remission, the 6-year cumulative incidence of leukemia-related death was 5%. The long-term outcome of first-line imatinib was excellent, also because of second-line treatment with other TKIs, but all responses and outcomes were inferior in high-risk patients, suggesting that to optimize treatment results, a specific risk-adapted treatment is needed for such patients

The clinicopathologicspectrum of hypertrophiccardiomyopathy. The experience of the italian heart transplant program

Hypertrophic cardiomyopathy (HCM) is an idiopathic cardiac disease which is predominantly genetic in origin and transmitted as an autosomally dominant trait [1, 2]. The mutated genes code for altered contractile myofibrillar proteins, leading to deformed myocytes and histological evidence of extensive myocell disorganization, namely the disarray typical of hypertrophie cardiomyopathy (HCM). In the natural history of HCM endstage heart failure is relatively infrequent and associated with a pattern of left ventricular systolic impairment with cavity dilatation, which occurrs in about 10% of patients [3, 4], with a yearly incidence of 1.5% [5]. End-stage disease may coexist with premature sudden death in family members carrying the same genetic abnormality [6]. This pattern is characterized by a particularly poor prognosis, so that heart transplantation has been advocated in this subgroup of patients