Biological Therapy and Risk of Malignancies: A Literature Review

Data from literature show that the overall risk of cancer does not as a result from treatment with these drugs. The only cancer for which various authors have reported an increased risk, in some cases, are skin cancers, different from melanoma and melanoma. Recent results of large observational studies and meta-analyzes indicate the absence of an increased risk of lymphoma related to therapy with anti-TNF-α. It has been reported, by some authors, that there is a possible increased risk of lung cancer, especially in patients with chronic obstructive pulmonary disease. There is limited information in literature about the effects of biologics in patients with a history of cancer. Most of the guidelines indicate that treatment with biologics can be considered with caution and only in patients free of cancer since at least 5 years. Some studies report a lower oncological risk with etanercept compared to monoclonal antibodies, especially in the case of lymphoma. However, this data has not been confirmed in other studies, and has been associated with a limited period of time after starting therapy. Information about the latest biological therapies is still poor. Therefore, there is not sufficient evidence for a preferential use of certain drugs rather than others

Clinical hints to diagnosis of attenuated forms of Mucopolysaccharidoses

The mucopolysaccharidoses (MPS) are clinically similar but also heterogeneous in terms of major or minor involvement of different organs/systems, burden of disease, and rate of progression. The attenuated forms of MPS, due to their less severe presentations, are more difficult to diagnose and often receive a significantly delayed diagnosis. On the other hand, the diagnosis is very important since the attenuated forms may benefit from earlier treatments. The aim of this paper is to describe the natural history and the clinical signs useful to arise a suspicion of an attenuated form of MPS. MPS patients usually show a cluster of signs and symptoms, one of which may be the trigger for an evaluation by a specialist. Individuals with attenuated MPS are mostly cognitively normal, and dysmorphisms of the facies may be mild or absent. The most frequently involved organs/systems are the osteoarticular system, heart, and eyes. These patients may also have hepatosplenomegaly, hearing loss, and respiratory problems. When they are referred to a specialist (rheumatologist, cardiologist, ophthalmologist, surgeon, orthopedist, etc.) for their main complaint, the other signs and symptoms are likely to be missed in the medical history. To avoid missing data and to save time, we propose a semistructured medical history form to be filled in by the patients or their caregivers while waiting for evaluation by a specialist

Non-Hodgkin Lymphoma in Psoriatic Arthritis Treated with Sequential, Multiple Anti-TNF-α Agents: A Case Report

Data obtained by large observational studies and meta-analysis indicate the absence of an increased risk of lymphoma related to therapy with anti-TNF-α, but there is limited information in literature about the safety of sequential, multiple biological agents therapy for a time longer than three years. We hereby present a case of psoriatic arthritis developing non-Hodgkin lymphoma after a six-year history of poorly effective therapy with different anti-TNF-α

Beyond cat scratch disease: a case report of bartonella infection mimicking vasculitic disorder

Cat scratch disease (CSD) is a bacterial disease caused by Bartonella henselae and it is mainly characterized by self-limiting lymphadenopathy in the draining site of a cat scratch or bite. We report a patient with history of fever, swelling lymph nodes, vasculitic-like skin lesions, and positivity of Bartonella serology initially considered as expression of a disimmune disease

Early Occupational Therapy Intervention: Patients’ Occupational Needs

The occupational therapy management involves the assessment of the individual’s specific needs. This kind of assessment facilitates the therapeutic relationship and boosts the person’s motivation, as he or she feels valued and heard. Early-stage collection of information about meaningful activities for the individual helps them project themselves outside the context of illness. Collecting occupational need at an early stage, permits “Engagement”, which means participating in activities even without actually doing them. An occupational therapy model called “Personal Environment Occupation Model” suggests that already at an early stage we should make the environment and occupations meaningful to the person in order to maximise the patient’s performance. An observational study on stroke patients shows how people have personal occupational needs beyond simple self-care, including productive life and leisure time, already in the subacute phase. A further study is underway to demonstrate the effectiveness of early occupational therapy intervention, including complex patients regardless of diagnosis and taking into account their need for care and disability in order to promote their participation and maximise their autonomy

Sanitary costs of osteoarthritis

Muscoloskeletal disorders are the first cause of disability and the second cause of permanent disablement in Italy. Osteoarthritis is the most frequent rheumatic disease and affects about 4 million Italians. In spite of that, data concerning social costs are lacking. On account of this lack we measured sanitary costs of 314 patients suffering from osteoarthritis. A retrospective, prevalence-based multicentric study was performed using a bottom-up approach. The study period was 12 months and referred to 1999. Eight percent of patients didn't take any drug for the treatment of osteoarthritis; NSAIDs were prescribed to 86.9% of patients, analgesics to 29.9%, chondroprotective drugs to 7.6%, and gastroprotective drugs to 36.9%. Total sanitary costs came to 455 euro / patient / year: 122 euro were spent on diagnostics, 293 euro on therapy and 40 euro on management of drug-related gastropathy. Since the costs of anti-inflammatory drugs came to 30 euro we calculated iatrogenic cost factor of 2.3. Moreover, the study supplied interesting informations about prescriptive habits, which differ in Italy from international guidelines for the medical treatment of OA, about patient management, because of hospitalization, which by itself absorbs 1/3 of resources, and about physiotherapy, which costs twice as much as pharmacological therapy. At last, data analysis gave the cue for suggestions on changing patients' managemen

Dactilitis and oligoarthritis after BCG immunotherapy in a patient affected by bladder cancer

The treatment of bladder cancer with Bacillus of Calmette-Guerin (BCG) immunotherapy can induce the appearance of a reactive disorder. The Authors describe a 55-year-old male patient with bladder cancer treated with endovesical instillation of BCG immunotherapy, followed after the fifth application by asymmetric oligoarthritis and dactilitis. The observed positivity of both HLA-B27 and HLA-B51 antigens reinforces the hypothesis of a reactive form, possibly through "molecular mimicry" mechanism. The discontinuation of BCG instillation along which a therapeutic attempt with NSAD failed to improve the rheumatic manifestation, which completely remitted after a four-month course of oral steroids. No relapses of joint and tendon involvement was observed during the following five-month period. The clinico-pathogenetic implications suggested by this case are discussed

Diffuse post-traumatic calcification of the anterior longitudinal ligamentum of cervical and dorsal spine

Among the different conditions causing inflammation and calcification/ossification of the soft tissues of the spinal cord, single or recurrent traumatic events are included. Within the international literature, the involvement of the posterior longitudinal ligament, following spinal cord injuries is frequently reported, especially in the elders. The Authors describe here an uncommon calcification/ossification of the anterior longitudinal ligament occurred after a double traumatic event in a young man, followed clinically and radiologically for a long-term period. On the basis of clinical, laboratory and radiological findings, the differential diagnosis with other possible aetiologies, especially DISH (Diffuse idiopathic skeletal hyperostosis) and ankylosing spondylitis, is discussed

Exploring mobile network data for tourism statistics: the collaboration between Istat and Vodafone Business Italia

The paper describes the collaboration between Istat and Vodafone Business Italia to innovate and enhance tourism statistics. The common goal is to evaluate the potential uses of mobile phone data in current surveys and to investigate new outputs for official statistics, such as visiting routes and means of transport. The analysis concerned inbound tourism (foreigners in Italy), domestic tourism (Italians in Italy), and outbound tourism (Italians abroad). The work presents analyses and results for the Province of Rimini and the Municipality of Roma, referred to August 2019/2020 and April 2020, and a trial of the use of the “Welcome SMS” for the estimate of the residents in Italy who travel to foreign countries. Phone data required specific treatments to meet the definitions of official statistics. Some aspects related to the location and definition of overnight stays will require further investigation