Ospedale Garibaldi

Whippet is considered quite a healthy breed. Nonetheless, the perception of some veterinary neurologists is that the occurrence of neurological diseases, especially cervical disc disease (CDD), is frequent in this breed. This study aimed to get information about the prevalence of the most common disorders and conditions affecting the Italian Whippet population, particularly investigating the prevalence of CDD and the perception of the problem by owners and breeders. Owners and breeders included in the Italian Sighthound Club register were invited to answer anonymously an online questionnaire. Descriptive statistics were used for breeder/owner and dog characteristics, and statistical association with the development of CDD were explored. Over 280 Whippets, the overall prevalence of CDD was 7.2% and 29% in Whippets older than 9years. Whippets older than 9years were overrepresented in the CDD group (P<0.0001; O.R. 0.07; 95% CI: 0.02-0.22) compared with the CDD group. These findings confirm the hypothesis that CDD may be a challenging and more prevalent than expected disorder in this breed and health screening programs could be recommended to breeders and owners to assess cervical spine conformation, especially before sporting activity or breeding.

The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.

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.

Differentiated thyroid carcinoma (DTC) has an excellent prognosis, but recurrence remains a clinical concern, especially in intermediate-risk patients. Current stratification systems focus primarily on tumor characteristics, overlooking the host's biological capacity to counteract tumor progression. To investigate this aspect, we assessed systemic inflammatory and nutritional status using hematological indices. The study aimed to evaluate the prognostic value of these markers in predicting recurrence risk in patients with intermediate-risk DTC. We retrospectively analyzed consecutive patients with intermediate-risk DTC who met the following criteria: (1) were classified as intermediate risk according to ATA guidelines; (2) showed an excellent or indeterminate response 12 months after initial treatment; and (3) had at least three consecutive years of follow-up at our center after thyroidectomy. Nine hematological indices were calculated from blood samples collected on the day of RAI administration. Statistical analyses included ROC curve analysis, logistic regression, and Kaplan-Meier analysis. A total of 282 patients were included, with a median follow-up of 91 months. Among the indices tested, the monocyte-to-lymphocyte ratio (MLR) predicted recurrence better than the others. A cut-off of 0.188 yielded 82.9% sensitivity and 54.7% specificity (AUC: 0.70). In multivariate analysis, high MLR (OR = 4.94, p < 0.001), tumor size, vascular invasion, and lymph node metastases were independently associated with recurrence. Cox regression confirmed MLR as an independent predictor of shorter recurrence-free survival (HR = 3.01, p < 0.001). Nutritional indices showed no prognostic value. Pre-RAI MLR may serve as a simple marker to refine recurrence risk stratification and personalize follow-up in intermediate-risk DTC.

Modern oncology faces the need to integrate high-level evidence, non-pharmacological interventions into care pathways. Among these, structured physical exercise is shifting from a simple "virtuous recommendation" to a treatment that concretely influences clinical outcomes. The phase III CHALLENGE trial, conducted on 889 patients with stage II-III colon cancer, demonstrated a 6.4% absolute increase in 5-year disease-free survival (DFS) (HR 0.72) and a 37% reduction in overall mortality (HR 0.63). Observational evidence further confirms benefits in breast, prostate, and lung cancers. This review summarizes the literature, analyzes barriers and implementation strategies (tele-exercise, dedicated professionals, hub-and-spoke models), and assesses psychological and economic impacts.

The management of chronic lymphocytic leukemia (CLL) in older patients requires careful balancing of therapeutic efficacy with the risks of treatment intolerance. Frailty assessment is increasingly recognized as a critical determinant of clinical outcomes, but its specific role in guiding therapy with second-generation Bruton tyrosine kinase inhibitors remains poorly defined. We conducted a prospective, multicenter investigation of 326 consecutive CLL patients aged 65years or older who received zanubrutinib across 52 Italian centers, aiming to evaluate whether the Clinical Frailty Scale (CFS) could predict treatment discontinuation in real-world practice. The cohort was characterized by advanced age (median 78.1years, range 65.1-94.5), with over half of the patients presenting with Binet stage C disease. Two-thirds were treated in the frontline setting, while the remainder received zanubrutinib as salvage therapy. After a median follow-up of 8 months, 48 patients (14.7%) discontinued treatment, most commonly due to toxicity or disease progression. Receiver operating characteristic curve analysis identified a CFS of 3 as the optimal threshold for predicting discontinuation, with an area under the curve of 0.65 (95% CI 0.56-0.73, p<0.001). At 12months, the discontinuation rate was significantly higher among patients with a CFS >3 (29.2%) compared with those with a CFS ≤3 (8.8%) (p<0.001); among conventional prognostic variables, only relapsed/refractory disease demonstrated an independent association with TTD. These findings highlight the CFS as a simple yet powerful clinical tool that provides incremental prognostic information beyond standard disease-related factors. Incorporating frailty assessment into treatment planning may enhance patient selection and optimize therapeutic strategies for elderly CLL patients in daily practice.