Ospedale Santa Maria Goretti

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.

Azacitidine (AZA) combined with venetoclax (VEN) as an outpatient treatment of unfit patients with acute myeloid leukemia (AML) has been infrequently investigated. We report on 65 elderly AML patients: 35 patients received AZA + VEN as first-line and 30 after progression on prior treatment with AZA (R/R group). Thirty-eight patients were treated as outpatients, while 27 were hospitalized. The overall survival (OS) and event-free survival (EFS) were calculated, and predictive factors were assessed using Cox regression models. Inpatients were slightly younger, with a median age of 72 versus 74 years in outpatients (p = 0.015). Median WBC was higher in inpatients (median 7.3 × 109/L vs. 2.9 × 109/L, p = 0.020). Median marrow blast count was 43% in inpatients versus 25.5% in outpatients (p = 0.042). Treatment setting emerged as a key predictive factor for infection development during Cycle 1 in both univariate (p = 0.016) and multivariate analysis (p = 0.043), in the overall cohort. Inpatients had a significantly higher infection rate (81.4%) versus outpatients (44.7%, p = 0.004). In R/R group, 1-year EFS was 68% for outpatients versus 38% for inpatients (p = 0.009). One-year OS was 77% in outpatients versus 38% in inpatients (p = 0.052). In most instances, outpatient administration of Cycle 1 of AZA + VEN should be preferred as a beneficial option.

Since the beginning of the percutaneous coronary intervention (PCI) era, periprocedural myocardial infarction (PMI) has been recognized as a potential source of impaired outcomes in patients undergoing revascularization. Subsequently, several different definitions of PMI have been provided, coming from trial research groups or international consensus. Despite these efforts, the debate over the prognostic value or PMI in terms of mortality risk, as well as its role in defining composite ischemic endpoints in clinical investigations, has been extremely active. Currently, three international definitions of PMI are available: the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the definition by the Society for Cardiovascular Angiography and Interventions (SCAI). These definitions differ significantly in terms of sensitivity and prognostic relevance, which has led to heterogeneous findings in clinical studies investigating this topic. Thus, this review aims to provide an overview of the main features of these definitions, their association with the risk of mortality, and how different definitions can influence the results of major investigations in the research setting.

There's more beauty in truth, even

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ABSTRACT Background Aims of this study were to evaluate the serum level of autoantibodies against G-protein-coupled receptors for Angiotensin II type 1 (anti-AT1R) and endothelin receptor type A (anti-ETAR) in systemic sclerosis (SSc) patients and healthy controls (HC) and to evaluate the associations of these antibodies with microvascular complication of SSc, such as digital ulcers (DUs), subclinical renal vasculopathy and early pulmonary vasculopathy. Research design and methods Sixty-four SSc patients and 20 HC were tested for anti-AT1R and anti-ETAR. Results SSc patients had higher anti-AT1R [7.78 ng/ml (IQR 6.14;12.16) vs 3.25 ng/ml (IQR 2.60;4.70), p < 0.001] and anti-ETAR [0.16 OD (IQR 0.14;0.17) vs 0.10 OD (IQR 0.10;0.12), p < 0.001] than HC. SSc patients with DUs had higher anti-AT1R [10.79 ng/ml (IQR 7.32;14.15) vs 6.76 ng/ml (IQR 5.88;7.88), p < 0.001] and anti-ETAR [0.16 OD (IQR 0.15;0.18) vs 0.15 OD (IQR 0.13;0.16), p < 0.01] than SSc patients without DUs. We found a positive correlation between renal resistive index (RRI) and anti-AT1R (r = 0.357, p < 0.01) or anti-ETAR (r = 0.442, p < 0.001) and a negative correlation between tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure (TAPSE/sPAP) and anti-AT1R (r = −0.436, p < 0.001) or anti-ETAR (r = −0.334, p < 0.01). Conclusions Anti-AT1R and anti-ETAR may play a pathogenic role in endothelial dysfunction.

Bruton tyrosine kinase (BTK) plays a pivotal role in B-cell receptor signaling, making it a key therapeutic target in hematologic malignancies. Bruton tyrosine kinase inhibitors (BTKIs) have revolutionized the treatment landscape, improving survival outcomes in conditions such as chronic lymphocytic leukemia and mantle cell lymphoma. However, despite their clinical efficacy, BTKIs—particularly first-generation agents such as ibrutinib—are associated with significant cardiovascular toxicity, including atrial fibrillation, hypertension, bleeding, and, in rare cases, ventricular arrhythmias and heart failure. This narrative review explores the evolving landscape of BTKI-related cardiovascular toxicity, from first-generation drugs to next-generation agents that have improved safety profiles. We summarize current evidence on the incidence, mechanisms, and risk factors of BTKI-induced cardiovascular events and highlight potential predictive tools and mitigation strategies. Given the increasing use of these agents, a comprehensive understanding of their cardiovascular impact is essential for optimizing treatment selection and patient outcomes. Future research should focus on refining risk stratification models and developing cardioprotective strategies to ensure the long-term safety of BTKI therapy.

La educación inclusiva es una oportunidad para transformar vidas, esta no solo se aborda desde la educación básica y media la educación superior debe estar a la vanguarda de estos procesos en este trabajo analiza la labor de un docente de la universidad de Córdoba. Abordando su perspectiva y punto de vista sobre la educación inclusiva en sus años de experiencia laboral en el rol docente en educación superior, para ello se adoptó un enfoque cualitativo, empleando el método biográfico, el cual se centra en el estudio detallado de la vida y las experiencias de un individuo, se establecieron tres categorías principales para su interpretación; la primera centrada en las necesidades de formación docente, la segunda en el respeto y empatía como base para la formación y la tercera en la educación inclusiva un escenario para demostrar la idoneidad del docente como resultados más relevantes se destaca que existe una marcada necesidad de formación docente frente a la diversidad que a diario llega a las aulas de clase , por otro lado ser docente implica tener un compromiso social enmarcado desde una empatía y que esta debe ser transferida a sus estudiantes para que el aula sea mas incluyente , finalmente se destaca que es la educación inclusiva la que muestra la verdadera idoneidad del docente , el que es buen docente lo demuestra en un escenario donde debe fomentar la inclusión

Maxillary antral mucoceles are rare complications of chronic inflammation of the sinus mucosa due to infection or trauma that leads to an obstructed sinus outflow, such as allergic fungal rhinosinusitis. Treatment of choice of AFRS is medical therapy associated with functional endonasal endoscopic surgery; surgical evacuation (preferentially using endoscopic approach) of mucocele is resolutive in most cases. We think that in cases of giant maxillary mucocele Caldwell Luc approach should be avoided even in case of facial soft tissues (including the orbit) or pterygomaxillary fossa involvement, since endoscopic approach can provide adequate surgical field reducing complication rate and sequaelae.