Ospedale Versilia

Hemoptysis is a potentially life-threatening symptom that often prompts emergency department (ED) evaluation and hospitalization. Reliable prognostic tools to guide clinical decision-making and optimize resource use are currently lacking. To prospectively validate the Florence Hemoptysis Assessment Score (FLHASc) in patients presenting with hemoptysis to the ED, and to eventually derive and validate an improved version of the score (FLHASc2). We analyzed data from the POPEIHE study (NCT06067997), a multicenter prospective cohort of 546 consecutive adult patients presenting with hemoptysis to 9 Italian EDs. The primary outcome was a composite of in-hospital death, need for ventilatory support, intensive care unit (ICU) admission, blood transfusion, or invasive hemostatic procedures. We evaluated the prognostic performance of the original FLHASc, then derived a new model (FLHASc2) using multivariate logistic regression in a randomly selected derivation cohort (n=321) and validated it in the remaining cohort (n=225). A simplified version of the score was also tested. The original FLHASc demonstrated moderate discriminatory ability (AUC 0.71; 95% CI: 0.65-0.76) and suboptimal calibration. The FLHASc2 showed improved performance (AUC 0.79, 95% CI: 0.73-0.87 in derivation and 0.81, 95% CI: 0.73-0.88, in validation cohorts; Brier score<0.10 in both). The simplified FLHASc2 (sFLHASc2), assigning one point per variable, maintained comparable accuracy (AUC 0.80, 95% CI: 0.72-0.87) and identified 47.8% of patients as low risk (2.7% event rate). When combined with a negative chest X-ray, the observed event rate in this subgroup dropped to 0.87%, with a negative predictive value of 99.1% (CI 95%, 96.5-100%). The FLHASc2 and its simplified version are accurate prognostic tools for identifying hemoptysis patients at low risk of short-term adverse outcomes. Use of the sFLHASc2 combined with chest X-ray may allow safe ED discharge in nearly half of cases. A prospective management trial is warranted to confirm its clinical impact. NCT06067997.

Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of autoimmune diseases characterised by skeletal muscle inflammation and frequently by involvement of other organs, in particular lung and skin, but also joints, heart and gastrointestinal tract. Although they are rare diseases, the literature on IIMs has been growing rapidly and many studies have been published in order to clarify pathogenesis and to better define diagnosis, clinical manifestations (muscular and extramuscular) and treatment.The purpose of this review article is to summarise the most relevant contributions published over the last year on this topic.

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions. Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation “Train the Trainers” course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites. Results: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas. Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.

Abstract Introduction Anthracyclines and human epidermal growth factor receptor 2 (HER-2) inhibitors are cornerstone therapies for breast cancer but are associated with significant cardiotoxicity. While sodium–glucose cotransporter 2 (SGLT2) inhibitors such as dapagliflozin have demonstrated cardio–renal protective effects during anthracycline treatment, their efficacy in preventing cardiotoxicity from sequential anthracycline and HER-2 blockade remains poorly understood. This study investigates the cardioprotective role of dapagliflozin in a preclinical model of chemotherapy-induced cardiotoxicity. Methods Female C57Bl/6 mice were divided into four groups and treated for 10 days as follows: (1) a normal control group receiving saline (sham); (2) a model control group receiving doxorubicin (2.17 mg/kg/day for 5 days) followed by HER-2-blocking monoclonal antibody (2.25 mg/kg/day for 5 days); (3) a dapagliflozin-only group (10 mg/kg/day via oral gavage); and (4) a treatment group receiving the combination of doxorubicin, HER-2 inhibitor, and dapagliflozin. Cardiac function was assessed using echocardiography (VEVO 2100), analyzing IVS; d-D (mm), LVID; d-D (mm), LVPW; d-D (mm), LV Mass (mg), LVID; s-D (mm), EF (%) (Ejection Fraction), FS (%) (Fractional Shortening), Radial Strain (Pk%) and Longitudinal Strain (Pk%). Biomarkers of myocardial injury and inflammation (NLRP3, MyD88, CXCR4, H-FABP, troponin-T, and cytokines) were quantified via ELISA and immunohistochemistry. Circulating markers such as mitofusin-2, cardiac myosin light chain, malondialdehyde (MDA), and 4-hydroxy-2-nonenal (4-HNE) were also measured. Results Dapagliflozin significantly preserved the ejection fraction and reduced both radial and longitudinal strain impairment in mice treated with the doxorubicin–HER-2 inhibitor combination (p &amp;lt; 0.001). Levels of myocardial NLRP3, MyD88, CXCR4, H-FABP, interleukin-1β, and troponin-T were significantly lower in the dapagliflozin-treated group compared to the chemotherapy-only group. Serum markers of oxidative stress and cardiac injury, including mitofusin-2, MDA, 4-HNE, BNP, and high-sensitivity C-reactive protein (hs-CRP), were also reduced by dapagliflozin treatment. Conclusion Our findings demonstrate that dapagliflozin effectively mitigates early cardiac dysfunction and injury in a preclinical model of sequential doxorubicin and HER-2 inhibitor therapy.

Cardiac amyloidosis (CA) involves the deposition of misfolded proteins in the heart, most commonly light-chains (AL) or transthyretin (ATTR). Advancements in non-invasive diagnostics have challenged the classification of CA as a rare disease. The Cardiac Amyloidosis RegistRY (CARRY) provides updated insights into CA's epidemiology, diagnosis, and clinical features. CARRY is a prospective, multicenter study across 20 hospitals in Tuscany and Umbria. All patients aged ≥18years with suspected CA were enrolled between January and December 2022. Baseline demographic, clinical, laboratory, and imaging data were collected, including all tests required to confirm or rule out CA diagnosis. Among 553 patients with complete data (median age 79years [interquartile range, IQR, 74-84], 70% male), 87% reported mild dyspnea, 32% had a history of heart failure, and one-third reported carpal tunnel syndrome. Elevated cardiac biomarkers were prevalent, with a median NT-proBNP of 1015ng/L (IQR 275-3198). Most patients exhibited a heart failure with preserved ejection fraction phenotype. No significant differences in clinical features were found between patients from university (referral centers) and non-university hospitals, though referral centers more often reported patients with hematologic disorders. Echocardiographic signs of overt CA were more frequent in non-university centers. The CARRY registry highlights the clinical characteristics of patients with suspected CA, revealing that despite educational efforts, suspicion remains biased towards older patients with advanced disease. Increased awareness and earlier diagnosis, particularly with available disease-modifying therapies, are critical for improving outcomes.

Abstract The article aims to examine the language of the Statutes of Sassari through a comparison between the two versions in which the text is preserved, namely Latin and Sardinian Logudorese. The rare occurrence of such an ancient bilingual statute (late 13th century) offers an opportunity to observe how the language of law has, on the one hand, remained firmly rooted in Latin, and on the other, developed a degree of autonomy in the vernacular, with forms that, in some cases, are still of current use in specialized legal terminology.

Abstract Background Little is known about the relationship between thyroid diseases (TDs) and Idiopathic inflammatory myopathies (IIMs). This study aimed at evaluating the prevalence of TDs in a monocentric cohort of patients with IIMs, exploring possible correlations with clinical phenotype, organ involvement, comorbidities and quality of life (QoL). Methods We retrospectively analysed medical records of patients with IIM according to the EULAR/ACR 2017 criteria, collecting data about demography, IIM subset, disease duration, autoantibody profile, organ involvement and comorbidities. Besides, we registered the occurrence of Hashimoto Thyroiditis (HT), Multinodular goitre (MNG), Grave’s Disease (GD) and Thyroid papillary cancer (TPC). In addition, some different patient reported outcomes were administered, to collect data on QoL. Results A total of 191 patients were enrolled: 125 (65.4%) were female, with a mean age of 66.6±13.5 years and a mean disease duration of 9.8±7.4 years; 111 (58.1%) had dermatomyositis (DM), 50 (26.2%) polymyositis (PM), 11 (5.8%) clinically amyopathic DM or inclusion body myositis, 6 (3.1%) immune-mediated necrotizing myopathy and 2 (1%) juvenile DM. Ninety-nine patients (51.8%) had a TD; 53/191 (27.7%) had MNG, 42/191 (22%) had HT and 3/191 (1.6%) GD. One patient (0.5%) had a TPC. The presence of a TD was associated with oesophagus’ involvement and with a higher risk of osteoporosis and fragility fractures (p≤0.01). Moreover, patients with TDs tended to accumulate a greater number of comorbidities (p&lt;0.001) and showed higher values of cumulative dose of glucocorticoids (p=0.032). Finally, considering patients’ QoL, the presence of a TD was associated with lower values of the SF-36 bodily pain domain (p=0.006). Conclusions More than half of our IIMs patients had a TD, with a higher prevalence of both MNG and HT. Our results partially fill a lack of knowledge about the relationship between TDs and IIMs, stressing the opportunity of regularly screening patients for thyroid function.

IntroductionWhole blood cells and derived indices can be used as a read-out of the inflammatory pathogenic processes in many human diseases, including psoriasis. Indeed, systemic treatments with special regard to anti-IL-23 agents could exert anti-inflammatory and disease modifying effects; however, there is still a lack of conclusive data.ObjectivesWe aimed to assess the therapeutic effect of risankizumab on whole blood cells and inflammatory indices in psoriatic patients.MethodsWe performed a prospective multicenter observational study on adult patients with moderate-to-severe psoriasis who underwent risankizumab therapy for at least 52 weeks. Blood cell count, CRP, and ESR were prospectively recorded for each patient included in the study, at routine visits up to week 52. The ratio between peripheral cells, namely NLR, PLR, MLR, SII, and PIV, were calculated and compared at time 0 and at weeks 12, 24, and 52 of treatment. At different timepoints, modulation of laboratory values and derived indices and their correlation with disease severity and response to treatment were analyzed. Subanalysis of very early responders and late responders was performed as well.ResultsWe observed a progressive reduction in inflammatory indices such as CRP, ESR, NLR, and SII during treatment, with prominent modification involving SIRI as well, in patients who had a very early and almost complete response to risankizumab. Reduction in neutrophils and MPV, a transient increase in eosinophils at week 12, and a progressive increase in peripheral basophils were associated with therapeutic response.ConclusionRisankizumab promotes a progressive anti-inflammatory effect, more prominent in patients with a faster response in the early phases of treatment.