Recenti progressi in medicina最新文献

The debate over medical residents' commitment highlights the evolution of the healthcare profession. Moving beyond the rhetoric of "vocation" or initiatory suffering, a new professionalism is emerging. This must integrate scientific expertise with Medical Humanities, be supported by legal and organizational safeguards, and foster a therapeutic relationship built on trust and collaboration among colleagues.

Introduction: Globalization and increasing migration flows have profoundly reshaped demographic and health landscapes in Europe. Physicians are now required to integrate not only biomedical expertise but also cultural competence and knowledge of global disease patterns. Tropical Medicine (TropMed) and Migration Medicine (MigMed) represent two complementary domains bridging infectious disease expertise with social and intercultural dimensions of care. Despite their relevance, several studies highlight significant educational gaps in these fields across Europe.

Methods: We conducted an exploratory, observational study at the University of Udine (Italy) using a self-administered online questionnaire (EUSurvey platform) to assess awareness, knowledge, and educational exposure to TropMed and MigMed among medical students and residents. The survey was open from April to June 2024 and addressed 1,406 eligible participants. Only descriptive statistics were applied given the small and self-selected sample.

Results: A total of 48 participants completed the questionnaire (response rate: 3.4%). Awareness of MigMed was limited, with one quarter of respondents unfamiliar with the term, while TropMed was better known. Knowledge of infectious diseases linked to migration varied: tuberculosis and sexually transmitted infections were relatively well known, whereas diseases such as Chagas or Dengue were rarely identified. Educational exposure was scarce: only one third had attended vaccination courses, fewer than 20% had participated in training on migration health, and less than 10% had engaged with activities organized by the Italian Society of Migration Medicine (SIMM). Despite these gaps, a notable minority expressed career aspirations in international or NGO settings.

Conclusions: Although limited by an extremely low response rate, this study highlights a critical educational gap in TropMed and MigMed among future physicians. The lack of engagement itself is a meaningful finding, reflecting limited awareness and interest in topics of growing public health importance. These results call for urgent curricular reforms in Italian medical education, integrating global health, intercultural competence, and equity-oriented training as core components to prepare physicians for a healthcare system increasingly shaped by migration and cultural diversity.

Informed consent is today an essential element of clinical practice, grounded in the principle of patient self-determination. Its evolution, from the traditional paternalistic model to the recognition of the patient's right to make conscious choices, has been marked by key historical and legal milestones such as the Nuremberg trials, the Tuskegee Study, and, in Italy, the landmark "Massimo" ruling of 1990, later consolidated by Law 219/2017. In General Practice, consent takes on specific features: often implicit, dynamic, and closely linked to the doctor-patient relationship, it goes beyond the mere signing of a form and unfolds throughout the entire care process. Information plays a central role and must be tailored, clear, and proportionate to the patient's level of understanding, while avoiding the pitfalls of excessive "defensive information." In this perspective, informed consent becomes a tool for sharing therapeutic goals and building a decision-making alliance, thereby redefining the very aims of medicine.

Brexucabtagene autoleucel (brexu-cel), a CD19-directed chimeric antigen receptor (CAR) T-cell therapy, is a promising and available salvage option for relapsed/refractory philadelphia-positive B-Cell Acute Lymphoblastic Leukemia patients, potentially effective even after several previous lines of therapy and a previous allogeneic stem cell transplant (HSCT). This reported clinical case allowed us to highlight different relevant factors for the optimal, complex and multidisciplinary management of this subgroup of patients: bridging therapy selection, the need of reevaluating CD19 expression, disease burden as an outcome predictor and the role of HSCT as a further therapeutic consolidation.

Introduction: Relapsed or refractory B-cell acute lymphoblastic leukemia (R/R B-ALL) represents a complex clinical scenario, and the advent of immunotherapy has radically changed the therapeutic options available for these patients. The introduction of CAR-T cell therapy for patients over 25 years old offers a new treatment opportunity, with high remission rates and durable responses.

Clinical case: A 67-year-old female patient with multiple comorbidities was diagnosed with Philadelphia-negative B-ALL and treated with induction therapy according to the GIMEMA LAL1913 protocol plus rituximab with dose reductions due to age, achieving a complete MRD-negative complete remission (CR). During the sixth month of maintenance therapy, a relapse was diagnosed. The patient was then referred for brexu-cel treatment, following bridging therapy with inotuzumab which led to the achievement of MRD-positive remission. Brexu-cel therapy was complicated by grade 1 CRS, grade 1 ICANS, and an episode of atrial fibrillation, but ultimately led to a complete MRD-negative CR. The patient remains in complete MRD-negative remission over one year after therapy, without the need for further treatment.

Conclusion: Brexu-cel represents an effective treatment option for patients with R/R B-ALL. In patients with comorbidities and significant transplant-related risks, prolonged remissions can be maintained even without additional consolidation therapies. Optimization of bridging therapy, monitoring, and toxicity management is essential.

In recent years, proximity of care has taken on a fundamental role in oncological management, improving the humanization and accessibility of treatments. The model of decentralizing oncological care from hospitals to local areas has been supported by national and international healthcare policies, such as the National Cancer Plan 2023-2027 and Ministerial Decree No. 77/2022. The aim of this work is to assess the impact of a hospital-territory integration pathway started by the G. Mazzini Hospital in Teramo, considering both the quality of the services offered and the economic implications for the National Health Service. The integration was achieved through the creation of a territorial oncology center, which provides care through a team of professionals working under the "migrant unit" model. This model focuses on chronic patients and long-term survivors, reducing waiting times and improving access to services. It has alleviated hospital overcrowding, improved organizational efficiency, treatment quality, and the psychological well-being of patients, which was measured using specific quality of life (QoL) questionnaires and financial toxicity assessments. From 1st January 2024 until 31 December 2024 the center managed approximately 3,000 visits, easing the hospital workload by rationalizing space and human resources, and improving access to treatments. An analysis of financial toxicity showed improved cost management, with a significant reduction in the cost per service, dropping from 30 euros in 2021 to about 17 euros in 2024 (-43%). The reorganization also helped reduce hospitalizations by optimizing care settings. Patient satisfaction was high, both in terms of service quality and stress reduction, thanks to a less crowded and more welcoming environment. Decentralization reduced the burden on hospital departments, improved efficiency and patient satisfaction, and lowered costs. The experience suggests that this model could be implemented and scaled in other regional healthcare systems to further enhance overall efficiency.

CAR-T cell therapy revolutioned the therapeutic landscape of the relapsed/refractory B-cell acute lymphoblastic leukemia (ALL-R/R), improving relapse-free survival and overall survival of patients. Optimal management of late complications, such as hematological toxicity as well as allogeneic transplantation role in the therapeutic sequence, are specific topics currently being debated. We report a case of a young woman with ALL-B R/R extramedullary relapsed after a first allogeneic transplant and second-line immunotherapy, successfully treated with brexu-cel obtaining a complete remission status confirmed after one year. We adopted a conservative strategy choosing to delay the option of a second allogeneic transplantation to manage a prologed severe hematological toxicity and to consolidate the remission obtained.