Agenzia Sanitaria Regionale Abruzzo

Treatment-resistant depression (TRD) is a common phenomenon and a considerable clinical challenge; recently, esketamine in conjunction with an oral antidepressant (AD) has emerged as a potential treatment for TRD. Several studies have shown the efficacy of esketamine in improving depressive symptoms. This prospective study aims to explore the long-term effects of esketamine therapy on subjective quality of life (QoL) and general status of adults with TRD. The study was an observational, prospective and multicenter study comprising a total of 18 TRD patients treated with Esketamine-Nasal Spray ESK-NS. Anamnestic data and psychometric assessments were collected at baseline (T0) and at follow-ups at 1 month (T1), 3 months (T2), and 6 months (T3). Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF), Sheehan Disability Scale (SDS), and Personal and Social Performance Scale (PSP) showed a statistically significant amelioration in QoL and functioning for all 3 scales, with progressive improvements at 1, 3, and 6 months. Montgomery-Asberg Depression Rating Scale (MADRS) scores decreased from a baseline score of 39.2 to 28.7 on T1, 20.9 on T2, and 15.9 on T3, respectively. Correlation analyses showed statistical significance between changes at 6 months between MADRS and QLES and between MADRS and SDS, but not between MADRS and PSP. Significant improvement in QoL was observed among patients with TRD treated with ESK-NS; ESK-NS in combination with an oral AD appears to offer meaningful benefit as a treatment option for patients with TRD who generally have substantial QoL and functioning limitations as a result of their depressive illness.

Abstract Background Pre-eclampsia (PE) is the leading cause of adverse cardiovascular (CV) outcomes during and after pregnancy. Thromboxane (TX)-dependent platelet activation plays a key role in PE pathogenesis. Urinary 11-dehydro-TXB2, a major TX metabolite (TXM), is reduced by at least 75% by low-dose aspirin (ASA) treatment and predicts the occurrence of CV events and mortality in individuals with and without CV disease on ASA. Low-dose ASA showed to prevent PE, even though an interindividual variability in ASA responsiveness exists. Purpose Our aims were to identify platelet and circulating biomarkers and clinical predictors of PE in patients at high risk for PE. Methods We enrolled 24 women with pregnancy at high risk for PE and 11 women with physiological pregnancy in an ongoing study. At first visit and every trimester, women underwent clinical evaluation, CV imaging, blood and urine sampling for biochemical markers of platelet activation. Based on the slope of sTXB2 between 10 and 24 hours after ASA intake, which indicates the recovery rate of COX-1 activity, women at risk for PE were stratified into tertiles. Results At baseline, the two groups did not differ in parameters except for higher glucose and cholesterol levels, lower PAPP-A and PLGF in pregnancies with high PE risk. TXM and circulating P-selectin were not different between groups at baseline, while, as expected, were significantly reduced during ASA treatment compared to healthy women, consistent with the predominant platelet source of TXM. Higher levels of TXM during the II trimester characterized women at high PE risk with serumTXB2 slope in the third vs. I tertile. Six patients at high PE risk experienced childbirth with PE. Compared to high PE risk women who did not develop events (no PE), women who developed PE were more hypertensive (p=0.01), had higher basal body weight (p=0.056), family history of coronary artery disease (p=0.031), lymphocyte count, C-reactive protein (CRP) [I, p=0.028 and III trimester, p=0.042)], higher percentage of immature platelets, higher urinary TXM (p=0.020) and a higher percentage of platelet P-selectin (p=0.072) in the II trimester. Interestingly, patients who developed PE had a suboptimal, lower than 75% TXM percent inhibition (p=0.058) during II trimester of pregnancy (Fig B). Women with TXM<75% have an odds ratio 2.40 (95% CI: 0.30 to 19.04; P = 0.41) of developing PE. Finally, TXM during II trimester, adjusted for baseline values, predicted the development of PE despite ASA, among at-risk patients (p=0.035) (Fig A). Conclusions Residual, TX-dependent platelet activation is associated with a shorter duration of ASA effect over the 24-hour dosing interval and may predict the occurrence of PE, despite prophylaxis with low dose ASA. Studies with a larger sample size are needed to validate the role of urinary TXM as a circulating biomarker predicting suboptimal response to ASA and PE occurrence in pregnant women at high risk for PE.Figure 1, Panel A and B

Healthcare workers, particularly those in training, face significant exposure to biological risks, including needlestick and sharps injuries, which remain a critical occupational hazard. This study examines the incidence and nature of such injuries among young healthcare trainees at the University of Campania “L.Vanvitelli,” with the aim of providing useful information for designing an effective preventive program. From 2014 to 2023, a study population of 14,908 health students was subject to health surveillance, of which 141 workers suffered an occupational injury. Needlestick injuries were most common (67.4%). Surgical residents were the most affected subgroup (24.8%). Injuries occurred more frequently after the first year of training (74.5%). Multivariate logistic regression showed significantly higher odds of injury for nursing students (OR = 8.673; 95% CI: 3.196–35.634) and residents (OR = 50.726; 95% CI: 17.789–214.279) compared to medical students. The findings underscore the urgent need for enhanced risk management strategies, targeted education programs, and stricter adherence to safety regulations to protect this vulnerable population.

Background: Periodontitis is associated with increased oxidative stress, which may impair treatment outcomes. Ozone therapy has shown promise in reducing oxidative stress and improving periodontal health. This study examined the impact of adjunctive gaseous ozone administration on salivary oxidative stress markers in patients with periodontitis stages II–IV and grades A–C undergoing non-surgical periodontal treatment (NSPT). Methods: Ninety patients with periodontitis were randomly allocated to either the test group (NSPT with gaseous ozone administration) or the control group (NSPT alone) using computer-generated randomization. The OzoneDTA system was used to deliver ozone at 2100 ppm for 60 s per site once weekly for 4 weeks. Clinical periodontal parameters (probing depth [PD], clinical attachment level [CAL], plaque index [PI], gingival index [GI]) and salivary oxidative stress markers (malondialdehyde [MDA], total antioxidant capacity [TAC], superoxide dismutase [SOD]) were assessed by blinded examiners at baseline, 3, and 6 months post-treatment. Results: Mixed ANOVA revealed significant three-way interactions between time, treatment, and stage or grade for clinical and biochemical measures (p < 0.001). The test group exhibited significant improvements in TAC (mean difference: 0.45 ± 0.12 mmol/L, p = 0.002), MDA (−0.38 ± 0.09 nmol/mL, p = 0.001), and SOD (65 ± 18 U/mL, p < 0.001) compared with the control group, with more pronounced effects in stages III and IV. Large effect sizes (Cohen’s d > 0.8) were observed for the test group between baseline and 6 months for all markers. Conclusions: Gaseous ozone administration as an adjunct to NSPT can effectively improve clinical periodontal parameters and salivary oxidative stress markers, particularly in stages III and IV periodontitis. The enhanced outcomes may be attributed to ozone’s antimicrobial and immunomodulatory properties, which synergistically reduce oxidative stress and promote periodontal healing.