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Monastero di Lanzo, Italy

Torlone E.,Science Medicina Interna | Vitacolonna E.,University of Chieti Pescara
Giornale Italiano di Diabetologia e Metabolismo | Year: 2013

Optimal metabolic control is the goal in pregnancies complicated by diabetes. Studies of the glucose metabolism in physiological pregnancy indicate that the concept of "normality" in pregnancy is definitely different from what is "normal" outside pregnancy. Knowledge of the pathophysiology of the carbohydrate metabolism in pregnancy and changes in the glycemic profile and the patients' characteristics should guide the choice of insulin therapy and mode of delivery. Prospective trials with the insulin analogs aspart and detemir showed that in the preconceptional period these reduced the risk of nocturnal hypoglycemia and improved glycemic profiles. Although insulin analogs did not appear to show any particular superiority over human insulin the women enrolled from preconception had better outcomes. Meta-analysis on insulin lispro and on glargine showed no worsening of fetal malformations compared with human insulin. Even today, unfortunately, the objectives of the Saint Vincent's Declaration for pregnancy have not been fully achieved. Insulin analogs should be favored as early as possible in preconception counseling to stabilize metabolic control better and obtain more favorable maternal and fetal outcomes. Despite the paucity of clinical trials in pregnancy, some experts still consider the insulin pump (CSII) the first choice in the treatment of type 1 diabetes and it can be an effective tool in highly selected pregnant women. Women using an insulin pump during pregnancy maintain better glycemic control in the postpartum period too. In addition their metabolic control improves faster, they have a lower insulin requirement and fewer episodes of hypoglycemia, with better metabolic control at term. This therapy must take account of the overall burden, indications to treatment and selection of patients by an experienced team. Continuous glucose monitoring (CGM) can be useful in carefully selected pregnant women. Integrated CSII-CGM systems are attracting increasing attention, above all from the perspective of "closing the loop".

Buosi R.,SCDU Oncologia Medica | Borra G.,SCDU Oncologia Medica | Alabiso O.,SCDU Oncologia Medica | Galetto A.,SCDU Oncologia Medica | And 2 more authors.
Italian Journal of Medicine | Year: 2013

Venous thromboembolism (VTE) is the leading cause of mortality and morbidity in patients with cancer. The estimated risk of VTE in cancer patients is 0.5% per year and 0.04% per month. In small cell lung cancer and non-small cell lung cancer (NSCLC) the cumulative incidence is 3% per year and it seems to be associated with advanced stage and histotype. We performed a retrospective analysis on data from all NSCLC treated at the Oncology Day Hospital in Novara, Italy, northern Italy, to assess the incidence of thromboembolic events in patients undergoing systemic cancer treatments. All patients diagnosed with NSCLC who were treated at the Oncology Day Hospital in Novara from January 2008 to May 2011 have been assessed. Many variables related to VTE were analyzed: age, gender, different NSCLC histotype, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index, stage of disease, treatment and chemotherapy regimen, development of a VTE event and its temporal correlation with chemotherapy, central venous catheter presence, use of erythropoietin, use of low molecular weight heparin at baseline, use of acetyl salicylic acid. A total of 355 patients were evaluated, 307 of whom were considered to be eligible for analysis. Median age was 68 years. Histology was as follows: 7% not otherwise specified, 60% adenocarcinoma, 31% squamous cell carcinoma and 2% large cell carcinoma. Thirty-six cases of deep vein thrombosis (DVT) have been reported (incidence 12%). Thirty-one DVT were recorded in patients who were candidates for or undergoing chemotherapy: 14 during treatment, 7 at the end of chemotherapy, and 10 before treatment. The incidence was significantly higher for patients treated with cisplatin (CDDP), both during chemotherapy and after chemotherapy. A correlation with disease stage was documented: 26.5% of total VTE occurred in locally advanced and metastatic stages (IIIB and IV); 18.8% in stage IIIA (N2). A significant correlation between non-squamous histology was also highlighted (P=0.015) and ECOG 0-1 (P=0.010). According to the high incidence of VTE in patients with NSCLC, especially adenocarcinoma, and the correlation highlighted in this study with ECOG performance status 0-1 and CDDP-based treatment, we believe that outpatients undergoing chemotherapy for advanced stage (IIIB-IV) lung cancer should receive thromboembolic prophylaxis at least for the duration of chemotherapy. It is, therefore, essential to propose a thrombo-prophylaxis clinical trial that recruits only lung cancer patients to evaluate the benefit of prophylaxis in this population and to assess the real risk of bleeding during antithrombotic treatment. ©Copyright R. Buosi et al., 2013 Licensee PAGEPress.

Rondoni F.,Casa di Riposo Andrea Rossi | Simonelli G.,Casa di Riposo Andrea Rossi | Lunghi P.M.,Casa di Riposo Andrea Rossi | Rossetti F.,Science Medicina Interna | Bondi L.,AUSL n. 2 dellUmbria
Italian Journal of Medicine | Year: 2013

Protein-energy malnutrition (PEM) is a common finding in hospitalized or institutionalized elderly people. In the literature, PEM is not mentioned as being related to individual ability of the patient to feed him or herself correctly. This study analyzed the 56 patients of a nursing home divided into two groups: self-sufficient and non self-sufficient regarding feeding. Levels of serum albumin, transferrin, prealbumin and hemoglobin (Hb) were examined and compared to body mass index (BMI) calculated with bioelectrical impedance analysis. Fifty-three percent of patients were self-sufficient, while 47% were not self-sufficient for feeding of which 83.3% were women and 16.7% men. Levels below the average range were 49.1% for lymphocyte count, 52.9% for serum albumin, 13.7% for serum transferrin and 52.9% for serum prealbumin. No significant differences were found in terms of patient age, while the mean values of the parameters examined in the two groups, self-sufficient and not, were lower in the patients who were not self-sufficient, even if statistical significance was not reached. Serum albumin was in inverse proportion to age (P<0.05) and 46.1% of individuals with low levels of transferrin also showed low levels of Hb. Anemia was in direct proportion (P<0.05) to age. Measurement of BMI showed values below 22.5 (cut off for risk for malnutrition) in 33.4% of the subjects examined. Of the three hematochemical parameters, analysis of a possible relationship with BMI showed only a significant and directly proportional correlation with prealbumin (P<0.05%). These data should be considered in the context of an epidemiological research study carried out in a conditioned and limited environment, where PEM, detected using hematochemical parameters, amounted to 50% of the patients, whereas BMI identified only approximately one-third of patients at risk of malnutrition. There were no statistically significant differences between men and women. Mean values of the surrogate hematochemical parameters were lower in patients non-self-sufficient for feeding, but the comparison does not reach significance due to the small sample size. ©Copyright F. Rondoni et al., 2013.

Ventrella F.,Presidio | Mastroianni F.,Science Geriatria | Errico M.,Science Medicina Interna
Italian Journal of Medicine | Year: 2015

In recent decades, in the medical field, criteria and methods of decision-making have radically changed, going from an environment dominated by opinions and knowledge transmitted from experts to a context of evidence-based medicine, that finds its practical realization in the drafting of guidelines (GL). However, GL have a poor implementation in the real world for several factors. In the field of chronic obstructive pulmonary disease (COPD), there are already many GL, international, national, regional and by specific scientific societies. This multiplicity, while it responds to the legitimate needs to respect the diversity of interpretation of the available scientific data, on the other hand, however, can be an element of confusion for physicians. In this varied scenery we have tried to create some new tools, easy and quick to use, in order to improve the local application of existing GL on COPD, by planning a limited number of pathways in the management of acute exacerbation of COPD, which focus on the fundamental diagnostic and therapeutic aspects, as a tool to improve appropriateness in Internal Medicine Departments. These pathways, reported on individual sheets, which can be distributed to medical personnel of wards/units involved in the care of patients with COPD (First Aid, Internal Medicine, Geriatrics, Pulmonology, Intensive Respiratory Care Unit, Resuscitation), are useful to support the physician in the decision-making process and help you to resolve any disputes. ©Copyright F. Ventrella et al., 2015.

Novelli M.,Science Medicina Interna | Pilato A.,Science di Medicina Interna dellOspedale ex Mauriziano di Lanzo Torinese | Bertello P.,Science Medicina Interna
Recenti Progressi in Medicina | Year: 2011

Acute cytomegalovirus infection (CMV) may be responsible of venous thromboembolism, especially in immunocompromised patients. In addition, an association between CMV infection and thrombotic events in immunocompetent hosts has been sporadically reported.We present a case of a previously healthy woman with venous thromboembolic event during acute CMV infection and the presence of anti-cardiolipin IgM antibodies.

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