Azienda Unità Sanitaria Locale Rimini

The third stage of labour occurs between the birth of the foetus and the expulsion of the placenta. A major complication during this stage is postpartum hemorrhage, which poses a significant concern for maternal health. To mitigate this risk, active management strategies have emerged, raising concerns about the safety of physiological management following a physiological birth. Midwives play a vital role in ensuring a safe third stage of labour by minimizing medical intervention and preventing postpartum hemorrhage. This scoping review aims to map the evidence on midwifery practices that support a physiological third stage of labour. We conducted a scoping review using the Joanna Briggs Institute methodology. We retrieved articles from PUBMED, PsycINFO (via EBSCO), CINAHL (via EBSCO), LILACS, SCOPUS, ClinicalTrials.gov, Open Science Framework, ProQuest Dissertations and Theses, Cochrane Library, and JBI. The search yielded 2190 articles, with 1779 remaining after duplicates were removed. Screening identified 80 articles for review; 63 were excluded, resulting in 17 articles defining key findings. Two articles contributed to a theoretical framework for a physiological approach. Ten articles further discussed how midwives provide care during this stage to maintain normalcy. Three articles debated the safety of expectant management for low-risk women, while three studies also suggested new risk factors for postpartum hemorrhage. Midwifery care during the physiological third stage of labour must balance safety and trust in the woman's body. More research is needed to assess expectant management in home births and midwifery-led units, with a focus on individual needs and the long-term impacts of a physiological approach.

Tirbanibulin, a topical treatment for actinic keratosis (AK) with a novel antiproliferative mechanism of action, has demonstrated efficacy and a favorable tolerability profile in clinical trials and real-life studies. An insight into best-practice use of tirbanibulin in different clinical presentations of AK would be useful. The aim of this article was to deliver advice, via expert consensus, on the optimal use of tirbanibulin in the real-life management of AK. A panel of 11 dermatologists with expertise in the treatment of AK convened to develop consensus statements about key aspects of tirbanibulin treatment in AK patients based on selected literature data and on their own clinical experience. Two areas were examined and discussed: clinical assessment/diagnostic procedures and key aspects of tirbanibulin therapy. A total of 19 statements concerning clinical evaluation of AK patients, routine and advanced diagnostic instruments, patient selection, treatment modalities, and key messages for patient communication were drafted and voted on. Tirbanibulin should be considered as a first-line option for most patients with AK owing to its proven efficacy, good local and systemic tolerability, and a short treatment regimen of five days. All these factors encourage patient acceptability and treatment compliance. The favorable safety profile and tolerability of tirbanibulin also enable flexible therapeutic schedules, including repeated treatment cycles, if needed.

Background: In May 2023, Romagna, Italy, faced a devastating flood resulting in 16 fatalities, forced displacement of 26,000 citizens, and significant economic losses. Due to potential water contamination, implementing public health strategies became imperative for the Local Health Authority to mitigate the health consequences, analyze the flood’s impact on the local population’s health, and detect early anomalies requiring timely public health interventions. Methods: Between June and July 2023, general practitioners who were part of the RespiVirNet surveillance network completed weekly structured forms. These forms collected data on individuals exposed or not to floodwaters and clinical syndromes. Rates per 1000 resident population aged > 14 were stratified by district, week of observation, and symptomatology. Missing data were addressed by imputation using second-order autoregressive modeling. Results: An incidence of 3.52 syndromes potentially related to flood water exposure per 1000 individuals (95% CI 2.82–4.35) was estimated. Ravenna, the city most affected by the flood, recorded the highest rate (6.05 per 1000, 95% CI 4.59–7.82). Incidence decreased in the weeks post-event. Anxiety, or trauma and stress symptoms, exhibited higher rates among the exposed, diminishing over weeks. The incidence for the non-exposed (12.76 per 1000, 95% CI 10.55–15.29) showed no significant territorial differences compared to the exposed ones. Conclusions: Syndromic surveillance provided timely information on the flood’s health impact, revealing a higher incidence of individual syndromes among the non-exposed. This study contributes to guiding the implementation of future public health preparedness and response strategies for populations facing similar natural disasters.

The most common adverse events following laparoscopic sleeve gastrectomy are leaks in the staple line, which occur in up to 2% of cases [1]. Apart from surgical repair, various endoscopic treatment options have been explored such as placement of self-expandable metal stents (SEMSs) [2]. Recently, endoscopic vacuum therapy (EVT) has become a valid alternative owing to a clinical success rate of up to 95%, shorter treatment duration, and lower mortality rate [3]. However, intraluminal EVT in the upper gastrointestinal tract prevents early enteral nutrition. The VACStent (Micro-Tech Europe, Dusseldorf, Germany) is a new treatment option that overcomes the drawbacks of endoluminal EVT and combines EVT with the advantages of covered stenting.

Generally infrequent, multiple sclerosis (MS) with late onset (LOMS) is characterized by an onset over the age of 50 and a mainly progressive course, while relapsing-remitting (RR) forms are less frequently observed and explored. This study aimed to characterize a large cohort of MS patients with RRMS at onset to assess the baseline factors related to the worst disability trajectories and explore the role of LOMS. The data were extracted from the Italian MS Register (IMSR). Disability trajectories, defined using at least two and up to twenty expanded disability status scale (EDSS) assessments annually performed, were implemented using group-based trajectory models (GBTMs) to identify different groups with the same trajectories over time. MS profiles were explored using multinomial logistic regression. A total of 16,159 RR patients [1012 (6.26%) presented with LOMS] were analyzed. The GBTM identified four disability trajectories. The group with the most severe EDSS trend included 12.3% of the patients with a mean EDSS score > 4, which increased over time and exceeded 6 score. The group with medium severity EDSS trend comprised 21.9% of the patients and showed a change in EDSS > 3 scores over time. The largest group with 50.8% of patients reported a constant EDSS of 2 score. Finally, the benign group comprised 14.9% of the patients with a low and constant EDSS of 1 score over time. The probability of being in the worst groups increased if the patient was male; had LOMS or experienced brainstem, spinal, or supratentorial symptoms. Four MS severity profiles among RRMS patients in the IMSR have been reported, with LOMS being associated with a rapid worsening of EDSS scores. These findings have important implications for recognizing and managing how older age, aging, and age-related factors interact with MS and its evolution.

ABSTRACTIgA nephropathy (IgAN) is a progressive form of kidney disease defined by glomerular deposition of IgA. We performed a genome-wide association study involving 10,146 kidney biopsy-diagnosed IgAN cases and 28,751 matched controls across 17 international cohorts. We defined 30 independent genome-wide significant risk loci jointly explaining 11% of disease risk. A total of 16 loci were novel, including TNFSF4, REL, CD28, CXCL8/PF4V1, LY86, LYN, ANXA3, TNFSF8/15, REEP3, ZMIZ1, RELA, ETS1, IGH, IRF8, TNFRSF13B and FCAR. The SNP-based heritability of IgAN was estimated at 23%. We observed a positive genetic correlation between IgAN and total serum IgA levels, allergy, tonsillectomy, and several infections, and a negative correlation with inflammatory bowel disease. All significant non-HLA loci shared with serum IgA levels had a concordant effect on the risk of IgAN. Moreover, IgAN loci were globally enriched in gene orthologs causing abnormal IgA levels when genetically manipulated in mice. The explained heritability was enriched in the regulatory elements of cells from the immune and hematopoietic systems and intestinal mucosa, providing support for the pathogenic role of extra-renal tissues. The polygenic risk of IgAN was associated with early disease onset, increased lifetime risk of kidney failure, as well as hematuria and several other traits in a phenome-wide association study of 590,515 individuals. In the comprehensive functional annotation analysis of candidate causal genes across genome-wide significant loci, we observed the convergence of biological candidates on a common set of inflammatory signaling pathways and cytokine ligand-receptor pairs, prioritizing potential new drug targets.