Recenti progressi in medicina最新文献

The triple-negative breast carcinoma (TNBC), despite representing a minority of all breast carcinoma cases, poses a significant problem due to its biological aggressiveness and the resulting unfavorable prognosis for affected patients. Until recently, the only therapeutic strategy available was chemotherapy. However, new therapeutic approaches have recently led to an improvement in the natural history of this disease. Among these, the monoclonal antibody-drug conjugate sacituzumab govitecan has been shown to double the survival of the patients under examination. The use of this drug is associated with non-negligible side effects, the management of which must be careful and prompt, especially in the case of elderly patients, who are inherently at higher risk of toxicity related to anticancer therapies but should not be denied the possibility of new and effective treatments. This study will describe the clinical case of an elderly patient with advanced TNBC.

Actinic keratosis (AK) is a common cutaneous keratinocyte dysplasia characterized by the abnormal proliferation of atypical epidermal keratinocytes; an area that presents photoinduced subclinical changes, similar to those found in AKs, on the periphery of clinically visible AKs is defined as a field of cancerization. Its treatment, rather than a treatment aimed at the single lesion, is more recommended as it manages the subclinical damage and prevents the onset of a possible squamous cell carcinoma. Among the field therapies, tirbanibulin has recently been introduced with an innovative mechanism of action that determines cellular apoptosis and consequently a poor local inflammatory reaction. We present the case of an 82-year-old patient, known for previous removals of squamous cell carcinomas at the vertex and currently suffering from a large field of cancerization in the nose and scalp, to whom we proposed a sequential treatment with three cycles of tirbanibulin in contiguous areas. The treatment was well tolerated and allowed complete clearance to be obtained on the nose and > 95% on the scalp, with a reduction of the Actinic Keratosis Area and Severity Index (AKASI) from 9.4 to 1.4.

Modern military strategies, armaments and technologies imply that every war today has a deleterious impact on all determinants of health, with direct and indirect effects that cause physical, mental and social suffering of the exposed population, that extends far beyond the duration of the conflict. The promotion of peace and the prevention of war is therefore clearly one of the professional tasks of health professionals, at least as much as the prevention of other public health risks. Nevertheless, peace promotion and anti-war activities are struggling to take off and spread in the health sector. The article examines two possible factors that stand as obstacles between the realisation of the evil of war, shared by all, and the actual commitment to disarmament and peace, practised by a few. The first of these obstacles is the divergence of views on the methods to choose to prevent conflict. Nonviolence and disarmament or military deterrence? The hypothesis discussed is that the deterrence theory still enjoys a certain credibility even in the medical scientific world although it is far from being an evidence-based strategy. The second obstacle examined is the fear of professionals and their associations of being accused of 'playing politics'. Since war is always a public health catastrophe, when health professionals oppose war, they are only doing their job. However, it is undoubtedly true that preventing war also involves political choices, but this is the case in every other area of public health, which without the use of political and regulatory instruments could not fulfil its task. Lastly, a concrete example of an intervention to promote peace is presented, promoted by several Italian scientific societies in the health field who have succeeded in drawing up a joint declaration in favour of peace and against war, open for subscription also by other scientific societies, journals, associations and foundations in the health sector.

The recent guidelines issued by the European Society of Hypertension reaffirmed that the degree of control of hypertension remains suboptimal worldwide. In order to increase the proportion of well-controlled patients, in addition to nonpharmacological measures, it is necessary to improve the implementation of drug therapy in the clinical practice as much as possible. Initial therapy should almost always be based on the combination, free or fixed, between ACE inhibitor drugs, or direct angiotensin II inhibitors ('sartans') and diuretics (thiazide or thiazide-like) or calcium channel blockers at the maximum recommended and well-tolerated dose. The combination of the thiazide-like diuretic indapamide with the ACE inhibitor delapril has shown, based on numerous clinical trials and meta-analyses, very good results in terms of antihypertensive efficacy, tolerability, and prevention or regression of organ damage. Indapamide is a thiazide-like diuretic also endowed with direct vasodilator effect and long duration of action. A meta-analysis of 19 randomized clinical trials demonstrated a greater reduction in the incidence of cardiac events, stroke and heart failure with thiazide-like diuretics than with thiazide diuretics. Delapril is a non-sulfhydryl ACE-inhibitor with high affinity for converting enzyme at the cardiac, pulmonary, and peripheral vascular levels. Being strongly lipophilic, delapril inhibits the ACE enzyme at the tissue level more potently than other ACE inhibitors. A peculiar feature of delapril is its weak bradykinin-enhancing effect due to its higher affinity for the C site than the N site of ACE, resulting in a lower incidence of cough and angioneurotic edema compared with other ACE inhibitors. In some meta-analyses, the pressor reduction was statistically, greater with the delapril-indapamide combination than with combinations between hydrochlorothiazide and ACE inhibitors. The combination consists of divisible tablets containing 30 mg delapril and 2.5 mg indapamide, and its pharmacological and clinical properties are not affected by simultaneous food intake. The antihypertensive efficacy of the combination, as well as its components, persists for the entire 24 hours. The recent alarming reports on the incidence of skin cancer during treatment with hydrochlorothiazide should also be a guide in clinical practice toward the preferential choice of a thiazide-like diuretic such as chlorthalidone or indapamide to replace hydrochlorothiazide.

The authors question whether having an innate talent or possessing acquired professional skills is more important for "living as a physician." The article emphasizes a combination of personal traits, such as compassion, emotional intelligence, and teamwork skills, which are highly significant and complement technical competencies. The authors highlight the importance of being able to make quick decisions and provide emotional support in critical situations, especially in emergency medicine. Furthermore, it is crucial that a group of professionals has a variety of talents, as this can be the basis for more inclusive care. Patience, cited by Roger Federer in a speech at Dartmouth University, is an essential quality for healthcare professionals during years when the healthcare system is experiencing a profound funding crisis. Finally, it is essential for a physician to be adaptable and committed to continuous cultural growth in an evolving healthcare environment.

A 72-year-old man presented with actinic keratosis (AK) of the scalp confirmed by line-field confocal optical coherence tomography (LC-OCT) a novel non-invasive skin imaging technique. Patient was treated with Tirbanibulin 1% ointment once a day for 5 consecutive days and, after 8 days from baseline, mild erythema and desquamation was observed on the treated area, associated with mild pruritus. At the same time-point, L'LC-OCT revealed the presence of intraepidermal "targeted-like" cells, corresponding to apoptotic keratinocytes. After 2 months, clinical and instrumental examination showed the almost total disappearance of the AK. At the same time-point, a strong improvement of photoaging was noted at the level of the treated area. At 1-year follow-up, no relapse and/or new AK were observed. In conclusion, the reported case is emblematic of the short and long-term efficacy and safety of tirbanibulin in the treatment of AK, as already reported in the literature, as well as of the usefulness of non-invasive imaging technique such as LC-OCT in the therapeutic monitoring.