Ospedale A. Perrino

Patients with transfusion-dependent thalassemia (TDT) require lifelong blood transfusions; data on the psychosocial and economic impact on patients and their caregivers remain limited. The study aims to address this gap by describing the burden of TDT on pediatric, young, and adult patients, as well as their caregivers, within real-world settings in Italy. This is a cross-sectional, descriptive study conducted between May and December 2021. TDT patients and their caregivers from Italian sites were invited to complete an online survey with the Ratip and Modell questionnaire (1996) and another bespoke questionnaire. All subjects signed an online informed consent before responding to the questionnaires. Seventy-nine subjects completed the survey: 59 patients (43 adults and 16 children) and 20 caregivers (the majority of adult patients were aged 41-50 years). The age at diagnosis differed between adults and pediatric patients, being earlier in the latter (0-2 months in 43.8%). Nearly half of patients received more than one transfusion/month. More than half of the patients experienced blood shortages, particularly during the summer. School absenteeism was reported as a major issue. TDT continues to impose a significant burden, negatively impacting daily life, work, education, and social interactions. The availability of blood resources remains a critical issue, particularly in high-prevalence regions. The study highlights the need for ongoing research, innovative approaches, and enhanced support to ensure improved well-being for TDT patients and their caregivers.

The COVID-19 pandemic showed few weak points in health-system resilience and highlighted the need to strengthen surveillance capacities. In Italy, the Federation of Health Trusts (FIASO) established the Sentinel Hospital Network (SHNet) to monitor COVID-19 hospitalizations and support operational decision-making. A multicentre ecological study was conducted across 21 hospitals (November 2021-March 2023), collecting weekly data on admissions, vaccination status, and classification of cases as for or with COVID-19. Trends were compared with national surveillance from the Istituto Superiore di Sanità (ISS). SHNet recorded 48,117 admissions in 2022. Basically vaccination reduced the severe disease, with an 87% decrease in ICU admissions for COVID-19. Hospitalizations with COVID-19 showed limited variation. Strong correlation with ISS trends confirmed SHNet reliability. SHNet provided timely, clinically detailed data complementing national surveillance and improved understanding of hospital burden. Sentinel surveillance represents a preacious tool for preparedness, enabling rapid response, resource optimization, and resilience in future health emergencies.

Identifying chronic myeloid leukaemia (CML) patients at risk of therapeutic switch remains debated. We analysed the cumulative risk of treatment change in the CML Italian network prospective cohort based on first-line tyrosine kinase inhibitors and patient characteristics. Sub-hazard ratios (sHRs) were estimated using Fine and Gray multivariable models. Among 1662 patients, initial treatment consisted of imatinib for 840 (50.5%), nilotinib for 490 (29.5%) and dasatinib for 332 (20.0%). Subsequently, 492 patients (29.6%) required second-line therapy, with 232 (47.1%) switching due to resistance and 176 (35.8%) due to intolerance. At 2 years, the risk of resistance was 18.3% for imatinib, 8.4% for dasatinib (sHR = 0.32; 95% confidence interval 0.21-0.49) and 6.8% for nilotinib (0.29; 0.19-0.42). The risk of switching increased in intermediate (1.95; 1.40-2.72) and high Eutos long term survival (ELTS) risk (3.19; 2.10-4.83) but was reduced with older age (0.97 per year; p < 0.0001). Intolerance at 2 years was 8.5% for imatinib, 12.4% for dasatinib (2.55; 1.73-3.75) and 5.2% for nilotinib (1.04; 0.65-1.65). Switching to a third-line therapy at 3 years was 8% for imatinib, 5% for dasatinib and 4% for nilotinib. The results showed that the time to first treatment switch for resistance is shorter for younger patients, for imatinib and for intermediate/high ELTS risks. The risk of switching for intolerance is higher for patients initially treated with dasatinib.

Introduction. Physician-patient communication is a pivotal element in the management of chronic kidney disease (CKD), yet it is sometimes reduced to a mere transmission of information. Ineffective communication undermines therapeutic adherence, delays clinical decision-making, and negatively impacts patients' quality of life. Methods. We conducted a panoramic review of the literature, with a specific focus on nephrology context, examining how various aspects (communication barriers, patient expectations, use of multimedia tools, digital self-monitoring) affect clinical outcomes and can transform from critical issues into resources for improving the therapeutic alliance and adherence. Results. Evidence shows that: (1) physician-patient communication, expectations, and genuine understanding directly influence clinical outcomes; (2) digital tools such as educational/storytelling videos, online platforms, institutional social media channels, and dedicated apps improve health literacy and patient engagement; (3) self-monitoring and smart devices can help strengthen awareness and foster the doctor-patient relationship, even remotely; (4) therapeutic adherence can be significantly improved through empathetic and shared care relationships, including through digital media, countering misinformation and mistrust. Conclusions. Innovating communication in nephrology requires moving beyond the traditional information-delivery model, embracing narrative and digital approaches, and recognizing communication as a fully-fledged therapeutic intervention.

Conventional ultrasound (US) has long been central to hepatocellular carcinoma (HCC) surveillance in cirrhotic patients, due to its low cost, wide availability, non-invasiveness, and adequate sensitivity for detecting small nodules. However, its specificity in distinguishing HCC from other lesions is limited. Contrast-enhanced ultrasound (CEUS) has significantly improved the characterization of nodules first identified on conventional US. Yet, when CEUS is performed using sulfur hexafluoride (SonoVue)-the only contrast agent available in Western countries-assessment remains restricted to a single nodule per examination, and enhanced CT or MRI is still required for full characterization and staging. In clinical settings, such as hepatology, internal medicine, infectious diseases, and surgery, CEUS offers the advantage of immediate availability, enabling rapid characterization of suspicious nodules in cirrhotic livers and facilitating timely therapeutic decisions. Although the introduction of direct-acting antivirals (DAAs) has substantially reduced HCV-related HCC, HCC incidence is increasingly driven by metabolic dysfunction-associated steatohepatitis (MASH). Evidence on surveillance strategies for MASH patients remains limited, and current EASL guidelines recommend monitoring only patients with >F2 fibrosis. Additionally, the effectiveness of US in obese or diabetic/obese populations is under ongoing investigation; abbreviated non-contrast MRI has been proposed as an alternative surveillance tool, but its adoption would entail significant economic implications for healthcare systems. HCC arising from MASH-sometimes even without cirrhosis-exhibits different sonographic and pathological features. Instead of small, hypoechoic nodules, typically seen in HCV-related cirrhosis, clinicians increasingly encounter larger or multiple lesions, often accompanied by macrovascular invasion, limiting access to curative treatments. Furthermore, typical CEUS LI-RADS patterns are less frequently observed. This review summarizes the evolving US findings in the era of MASH-related HCC and underscores the continued importance of US as the primary imaging tool in routine clinical practice.

ABSTRACT BACKGROUND Serum uric acid (SUA) has been associated with cardiovascular (CV) and all-cause mortality; however, its interpretation is influenced by renal function. The serum uric acid to creatinine ratio (SUA/sCr) has been proposed as a refined marker, integrating urate burden with renal excretory capacity. Evidence from real-world populations with preserved renal function remains limited. METHODS A retrospective observational analysis was performed using administrative and laboratory databases from nine Italian healthcare entities, covering more than 7.6 million individuals. Eligible subjects were 18–95 years old, with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m², serum creatinine (sCr) ≤1.8 mg/dL, and no prior urate-lowering therapy. The index date was defined as the first SUA measurement between January 2017 and March 2022. A total of 739,950 participants were stratified into quintiles of SUA/sCr ratio. Outcomes were two-year all-cause mortality and CV events, including ischemic heart disease, heart failure, cerebrovascular disease, and coronary revascularization. RESULTS All-cause mortality exhibited a U-shaped distribution, with the lowest risk in mid-quintiles and the highest in extreme quintiles (6.2% in quintile 1, 7.0% in quintile 5). Cardiovascular events showed a progressive increase, from 9.9% in quintile 1 to 11.6% in quintile 5. Sex-stratified analyses indicated higher absolute risks in men, whereas women demonstrated steeper relative increases across higher quintiles. In individuals with hyperuricemia, mortality and CV events rose consistently with increasing SUA/sCr values. CONCLUSIONS The SUA/sCr ratio is an independent predictor of short-term mortality and cardiovascular events in individuals with preserved renal function. Its incorporation into routine risk stratification may support earlier identification of high-risk patients, particularly those with elevated SUA. CLINICAL PERSPECTIVE What Is New? In this large, real-world study of nearly 740,000 adults with preserved renal function, the serum uric acid to serum creatinine (SUA/sCr) ratio emerged as a strong, independent predictor of two-year all-cause and cardiovascular mortality. The prognostic value of SUA/sCr was particularly evident in patients with hyperuricemia, where higher quintiles were associated with progressively increased risk of death and cardiovascular events. What Are the Clinical Implications? The SUA/sCr ratio, based on two inexpensive and widely available laboratory parameters, provides a practical tool for early cardiovascular risk stratification in patients without overt kidney disease.

Acute coronary syndrome (ACS) requires comprehensive post-discharge management to improve outcomes and prevent recurrence. This study evaluates the effectiveness of a structured, multidisciplinary Diagnostic-Therapeutic Care Pathway implemented in the Local Health Unit of Brindisi n.1 compared to traditional outpatient management by general practitioners (GPs). A retrospective analysis was conducted on 200 patients discharged after ACS: 100 were managed through a structured post-ACS clinic (network group), and 100 were followed on demand by GPs (control group). Clinical variables, therapeutic adherence, and risk factor control were assessed over 12 months. The network group showed superior clinical outcomes. Low-density lipoprotein cholesterol targets (&lt;55 mg/dL) were reached by 87% of network patients vs. 34% of controls. Blood pressure was controlled in 98% of the network group vs. 88% in controls. Glycemic control (hemoglobin A1c &lt;6.5%) was achieved in 78% of diabetic patients in the network vs. 64% in controls. All network patients received dual antiplatelet therapy, compared to 56% in the control group. Smoking prevalence was lower in the network group (11% current smokers) vs. controls (31%). Despite a higher mean body mass index (28.5 vs. 27.8), the network group demonstrated better overall metabolic control. The integrated care model significantly improved adherence to evidence-based therapies and achievement of cardiovascular risk targets. These results support structured follow-up pathways as a superior strategy in secondary prevention of ACS, promoting continuity of care, patient education, and therapeutic optimization. Widespread implementation of similar models could enhance long-term cardiovascular outcomes and reduce healthcare burden.

Background: High social support is easily assessed and associated with a healthier lifestyle, including vaccination adherence. Similarly, immunization is a widely available public health statistic associated with healthier behaviors. However, the link between the hepatitis immunization status and social support needs to be explored. Methods: We assessed the association between levels of social support and hepatitis immunization status using the National Health and Nutrition Examination Survey (NHANES), a cross-sectional multidisciplinary database publicly available for researchers. With 2005–2006 data, 2997 participants were included. Statistical analyses were conducted using STATA18.5v software, including the odds ratio of both univariable logistic regression and multivariable logistic regression. After adjusting for clinically relevant confounders, two distinct models were designed: 1) full immunization, and 2) incomplete immunization. Results: Multivariable analysis revealed significantly greater odds of high social support for participants fully or partially immunized against both hepatitis A and B: 3.15 (95% CI 1.03–9.66,p=0.04) and 3.35 (95% CI 1.15–9.75,p=0.03), respectively. Conclusion: Our findings show an association between vaccination and social support in both adjusted models. Individuals not vaccinated at all may behave differently from those willing to be, at least partially, immunized. It seems that a similar behavior that may lead to vaccination may also lead to increased social support. Therefore, our study suggests that hepatitis vaccination could perhaps be a surrogate marker for public-health-related outcomes.

IntroductionLymphomas encompass a heterogeneous group of B- and T-cell malignancies necessitating a complex and precise management. With the aim to define standardized diagnostic and therapeutic pathways across multiple hematology centers in Italy, the “Right Path 4 Lymphomas” project was designed as a multidisciplinary expert platform designed to establish consensus-driven diagnostic and therapeutic pathways.MethodsUsing a two-phase methodology – the Nominal Group Technique followed by a Delphi process – experts systematically evaluated and prioritized key diagnostic and therapeutic topics for five major lymphoma subtypes: classical Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and peripheral T-cell lymphomas.ResultsThe Delphi process achieved a high level of consensus on 264 of 270 statements (97.8%), reinforcing the importance of multidisciplinary collaboration in shaping evidence-based recommendations. Key areas of agreement included histopathologic and molecular diagnostic standards, risk-adapted treatment approaches integrating novel immunotherapies, and structured follow-up strategies. However, areas of debate remained over the clinical utility of minimal residual disease monitoring, optimal sequencing of immunotherapies, and the potential of CAR-T therapy versus bispecific antibodies.DiscussionThis project highlights the need for a structured, consensus-driven approach to lymphoma care that aligns with evolving international guidelines while addressing the distinct regulatory and healthcare landscape in Italy. The findings provide a valuable framework for clinicians and policymakers to optimize lymphoma management, balancing innovation with the allocation of resources and clinical feasibility.

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