30 research outputs found
Prevenzione dell’esposizione all’infezione tubercolare tra gli operatori di un Policlinico Universitario
No full textIntroduzione: Eliminare la tubercolosi (TB) è una priorità globale e gli obiettivi da
raggiungere sono delineati nella Strategia “End TB” dell’Organizzazione Mondiale
della Sanità (OMS). Per perseguire l’obiettivo di eliminare la TB come problema
di salute pubblica entro il 2030, lOMS ha promosso in questi anni strategie di
sorveglianza e controllo che sottolineano l’importanza di una diagnosi tempestiva,
di un trattamento farmacologico standardizzato ed un sistema di sorveglianza
con flussi informativi stabili. Per rendere la TB a bassa incidenza come è avvenuto
nei paesi occidentali, tra cui l’Italia, o addirittura eliminarla, sarebbero necessari
alti livelli di ricchezza, bassi livelli di disuguaglianza di reddito e programmi/
servizi efficaci contro la tubercolosi in grado di soddisfare le esigenze delle
persone che non ne hanno beneficiato e sono ancora a rischio. Lo scopo del
nostro studio è descrivere il fenomeno nella popolazione degli operatori sanitari
del Policlinico “Santa Maria alle Scotte”, Siena. Materiali e Metodi: Lo studio si è
svolto tra dicembre 2022 e gennaio 2023 presso UOC di Medicina del Lavoro del
Policlinico Santa Maria alle Scotte. Attraverso il generatore di applicativi clinici
Argos (versione 3.50) è stato ricercato il numero di test di Mantoux effettuati
nel biennio 2021/2022; da questo totale è stato estrapolato il numero di soggetti
risultati negativi e il numero di positivi. Successivamente è stato ricercato il
numero di Quantiferon test richiesti e, tramite le cartelle cliniche, abbiamo
ottenuto il numero TB latenti seguite e avviate a terapia farmacologica eradicante
presso il reparto di Medicina del Lavoro nei due anni esaminati. Risultati: Nel
biennio 2021/2022 sono stati eseguiti 2484 test di Mantoux, di cui 2418 hanno
dato esito negativo (97,34%) mentre 66 sono risultati positivi (2,66%), questi ultimi
stratificati per lo stato di nascita hanno evidenziato che quasi il 50% (30) dei
positivi erano nati all’estero. A fronte del numero di positivi sono stati richiesti in
tutto 56 Quantiferon test e in conclusione, nel periodo preso in esame, sono state
identificate e trattate 10 TB latenti. Conclusioni: Come sottolineato dalla circolare
del Ministero della Salute del 23/8/2011, in soggetti immunocompetenti il 10%
113
POPULATION MEDICINE | Abstract Book
delle TB latenti possono evolvere in tubercolosi attive e nella metà dei casi questo
avviene nei primi 2-5 anni dall’infezione. Diviene quindi fondamentale continuare
ad applicare al meglio i sistemi di sorveglianza sanitaria e di prevenzione, al fine di
ridurre al minimo il rischio di riattivazione e il possibile sviluppo di focolai infettivi
Applicazione della Tecnologia AAV-CRISPR / Cas9 come Terapia genica su neuroni differenziati da iPSC derivanti da pazienti con mutazioni in MECP2,FOXG1,CDKL5,IQSEC2, e PCDH19
No full textAutoinflammatory disorders and patients with isolated serosal involvement
No full textInternational audienc
Suitability of electroencephalography in brain death determination: a monocentric, 10-year retrospective, observational investigation of 428 cases
No full textBackground We aimed to verify the usefulness of electroencephalographic (EEG) activity recording (that is mandatory
according to the Italian law), in addition to two clinical evaluations spaced 6 h, among the procedures of brain death determination (BDD) in adult individuals. Methods The study is a monocentric, retrospective analysis of all BDDs performed in the last 10 years at Policlinico Le Scotte in Siena (Italy). Results Of the 428 cases revised (mean age 67.6 ± 15.03 years; range 24–92 years), 225 were males and 203 females. In total, 212 out of 428 patients (49.5%) were donors. None of the BDD procedures were interrupted due to the reappearance of EEG activity (neither for clinical reasons) at any sampling time, with the exception of one case that was considered a false negative at critical reinspection of the EEG. In 6/428 cases (1.4%), a cardiac arrest occurred during the 6 h between the first and second evaluation, thus missing the opportunity to take organs from these patients because the BDD procedure was not completed.
Conclusions Once the initial clinical examination before convening the BDD Commission has ascertained the absence of brainstem reflexes and of spontaneous breathing, and these clinical findings are supported by a flat EEG recording, the repetition of a 30-min EEG twice over a 6 h period seems not to add additional useful information to clinical findings. Current data, if confirmed in other centers and possibly in prospective studies, may help to promote a scientific and bioethical debate in Italy, as well as in other countries where the EEG is still mandatory, for eventually pdating the procedures of BDD. © 2022, The Author(s)
Management of asthma in the elderly patient
No full textAndrea S Melani Fisiopatologia e Riabilitazione Respiratoria, Dipartimento Vasi, Cuore e Torace, Policlinico Le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy Abstract: A significant number of older asthmatics, more often than in previous ages, have poorly controlled asthma, leading to increased morbidity and mortality. On the other hand, current guidelines suggest that most asthmatics can obtain achievement and maintenance of disease control and do not include sections specific to the management of asthma in the elderly so that it is more evident the contrast between poor control of asthma in the elderly and the lack of specific guidance from guidelines on asthma management in older asthmatics. Inhaled corticosteroids are the cornerstone for older asthmatics, eventually with add-on inhaled long-acting beta-agonists; inhaled short acting beta-agonists can be used as rescue medications. Triggers exacerbating asthma are similar for all ages, but inhaled viruses and drug interactions have greater clinical significance in the elderly. Older asthmatics have an increased likelihood of comorbidities and polypharmacy, with possible worsening of asthma control and reduced treatment adherence. Physicians and older asthmatics probably either do not perceive or accept a poor asthma control. We conclude that specific instruments addressed to evaluate asthma control in the elderly with concomitant comorbidities and measurements for improving self-management and adherence could assure better disease control in older asthmatics. Keywords: asthma, beta2-agonists, inhaled corticosteroids, asthma control, elderl
Our Experience Managing Difficult Accidental Chainsaw Trauma
No full textBackground: Chainsaw and circular-saw injuries represent a rare condition within the maxillofacial region. The purpose of this clinical report is to describe the injuries and the clinical and surgical management of these rare traumas.Methods: In this clinical report, 11 patients presenting themselves to the emergency room in the hospital "Policlinico Le Scotte," Siena, from March 2016 to September 2017 with severe chainsaw and circular-saw injuries, were included. All of the patients underwent general anesthesia and surgical treatment. This study describes 3 of the 11 patients with saw injuries.Results: No complications occurred during surgeries and a good primary closure of the wound margins were achieved in all patients. However, after surgery, the authors experienced some complications in 2 patients: the 1st one displayed chewing problems due to extensive local edema; the 2nd one developed a total loss of vision in his left eye, even though there was no damage inflected to the eye ball during the trauma or surgery.Conclusion: All the patients were followed during the 1st year after surgery. The authors evaluated the patients at 3 months, 6 months, and after 1 year, and none of them developed complications or alterations related to the trauma. However, 1 patient is still experiencing loss of vision and he is under constant specialized follow-up
Correlation of microsatellite instability at multiple loci with long-term survival in advanced gastric carcinoma
No full textHYPOTHESIS:
Microsatellite instability (MSI) correlates with clinicopathologic characteristics and long-term prognosis in patients having gastric carcinoma.
DESIGN:
Analysis of prospectively collected data and biologic material.
SETTING:
Tertiary University Hospital, Policlinico "Le Scotte," Siena, Italy.
PATIENTS:
Two hundred fifty patients with gastric carcinoma.
MAIN OUTCOME MEASURES:
Five mononucleotide repeats (BAT-26, BAT-25, NR-24, NR-21, and NR-27) were analyzed in these patients.
RESULTS:
An MSI phenotype was identified in 63 patients (25.2%) and correlated with specific clinicopathologic characteristics. Favorable prognosis was confirmed for patients with an MSI phenotype in univariate (P < .001) and multivariate (P = .05) analyses. Significant differences in clinicopathologic characteristics and long-term prognoses were observed among patients with microsatellite-stable tumors, tumors having instability at 2 to 4 markers, and tumors having instability at all 5 markers (MSI/5). The MSI/5 phenotype was associated with older age (P < .001), female sex (P = .001), antral tumor location (P = .04), intestinal histotype (P = .003), and less infiltration of the serosa (P = .006); lymph node involvement was rare (P < .001) and was limited to few (median, 3) metastatic lymph nodes (P = .001). Long-term survival of patients with the MSI/5 phenotype is favorable and was confirmed in multivariate analysis (relative risk vs patients with stable tumors, 0.32; 95% confidence interval, 0.16-0.63; P = .002).
CONCLUSIONS:
Compared with stable tumors, MSI tumors have distinct clinicopathologic features and are associated with a better prognosis. Patients with the MSI/5 phenotype have a very good prognosis
Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations
No full textAesthetic Plast Surg. 2001 May-Jun;25(3):170-4.
Carbon dioxide therapy in the treatment of localized adiposities: clinical study and histopathological correlations.
Brandi C, D'Aniello C, Grimaldi L, Bosi B, Dei I, Lattarulo P, Alessandrini C.
Source
Unità Operativa di Chirurgia Plastica, Università digli Studi di Siena, Policlinico Le Scotte, Italy. [email protected]
Abstract
The authors report their experience using carbon dioxide (CO2) therapy for the treatment of 48 female patients presenting adipose accumulations, located on the thighs, knees, and/or abdomen; a Carbomed Programmable Automatic Carbon Dioxide Therapy apparatus was used. In light of the effects of CO2 on the microcirculation recently described in the literature, we expected this gas, which we administered subcutaneously, to positively affect the physiological oxidative lipolytic process. The aim of our study was to evaluate the effect of this therapy on localized adiposities. As such, we describe the method we used and report the results observed in the areas treated (in terms of reduction in maximum circumference) as well as side effects. Furthermore, we assessed the effect of subcutaneous administration of CO2 on the microcirculation by showing changes in the Laser Doppler signal and in the concentration of transcutaneous oxygen tension (tcPO2). Pre- and posttreatment biopsies of tissues were performed in seven patients in order to study the changes induced by the use of CO2 on both adipose and connective tissues. All data obtained were statistically analyzed; values of P < 0.05 were considered significan
Effetto della LDL-aferesi sulla compliance arteriosa di pazienti con ipercolesterolemia familiare
No full textBazedoxifene for the prevention of postmenopausal osteoporosis
No full textLuigi Gennari, Daniela Merlotti, Vincenzo De Paola, Giuseppe Martini, Ranuccio NutiDepartment of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Policlinico Le Scotte 53100-Siena, ItalyAbstract: Bazedoxifene acetate is a novel, chemically distinct selective estrogen receptor modulator (SERM) that has been specifically developed after a stringent preclinical screening in order to obtain favorable effects on the skeleton and lipid metabolism with the additional improvement of a neutral effect on hot flushes and without stimulating the uterus or the breast. In both preclinical and clinical studies this SERM was shown to maintain BMD, prevent fractures, and reduce total cholesterol. Moreover, bazedoxifene also showed an improved uterine profile and demonstrated estrogen antagonistic activity on the endometrium. Importantly, this latter capacity has led to the development of a novel class of menopausal therapy called tissue selective estrogen complex (TSEC), in which bazedoxifene is combined with conjugated estrogen. The rationale for selecting bazedoxifene as the SERM in this TSEC combination is that it may offset estrogen stimulation of endometrial and breast tissue, without the necessity of using a progestin in women with an intact uterus, without aggravating menopausal vasomotor symptoms, but with an additive effect on bone. Preliminary data from phase 3 clinical trials appear to confirm this hypothesis, showing a greater effect of bazedoxifene on BMD with respect to raloxifene, coupled with efficacy on menopausal vasomotor symptoms not achieved by SERM alone. These properties and the safety profile of this combination, if confirmed long-term in ongoing phase 3 trials, might significantly affect the way women and physicians approach menopause and its related disorders.Keywords: bazedoxifene, SERM, estrogen, postmenopausal osteoporosis, treatmen
