Suicidio medicalmente assistito ed eutanasia in Italia: tra giurisprudenza, iniziativa popolare e responsabilità clinicaG. Antonucci Legge n. 219/2017: consenso informato, disposizioni anticipate di trattamento e pianificazione condivisa delle cureP. Moscatelli, M. Caiti Violenza contro gli operatori sanitari: da emergenza silenziosa a priorità collettivaM. Di Nitto, L. Del Bene, M. Zanini, G. Catania, L. Sasso, A. Bagnasco Il ruolo della medicina interna nel percorso clinico-assistenziale delle persone detenuteV.O. Palmieri Telemedicina e intelligenza artificiale: profili e criticità giuridiche del loro impiego nella sanitàC. Rabbito

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 (<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 <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.

Lung cancer includes all malignant diseases in the lungs, both primary malignancies and metastases. Globally, there are approximately 2.2 million new lung cancer cases each year, with 1.8 million deaths recorded in 2020. In Indonesia, lung cancer is the leading cause of cancer-related deaths, accounting for 30,843 cases (13.2%), with 34,873 new cases (8.8%). The prognosis of lung cancer patients is generally poor due to late-stage diagnosis and the absence of non-invasive early detection methods. Chronic inflammation plays a crucial role in lung cancer progression, as inflammatory and tumor cells release cytokines and chemokines that influence cancer development. Transforming growth factor β1 (TGF-β1) has been identified as a potential biomarker for lung cancer prognosis. This analytical observational study employs a retrospective cohort design. TGF-β1 levels in bronchial washing fluid from non-small cell lung cancer (NSCLC) patients diagnosed at Dr. Wahidin Sudirohusodo Hospital, Makassar, were analyzed. Patients were followed for 1 year to assess disease progression and survival. Samples collected from June 2022 to May 2023 were stored at -80°C before analysis at the Hasanuddin University Medical Research Unit. TGF-β1 levels in bronchial washing showed a cut-off value of 1638.22 pg/mL with 62.1% sensitivity and 95.5% specificity, indicating its potential as a prognostic biomarker. Higher TGF-β1 levels correlated with advanced disease stages and shorter survival rates. Increased TGF-β1 levels in NSCLC patients are associated with poor prognosis and reduced survival. Thus, TGF-β1 serves as a valuable prognostic biomarker in NSCLC.

Premises and Purpose of the study: This study explores the impact of SGLT2 inhibitors and GLP-1 receptor agonists on type 2 diabetes mellitus with peripheral artery disease (PAD) patients undergoing percutaneous distal revascularization (PTA). The research aims to assess the short-term effects of these drugs on some clinical parameters and on metabolic balance in this patient population.Materials and Methods: At ‘SS. Annunziata’ Hospital (Taranto),33 patients with T2DM complicated by PAD undergoing PTA were studied. Divided into SGLT2-i and/or GLP1-RA-treated (11) and other kind of treatment (22), clinical parameters (Leriche-Fontaine stage, recurrence of stenosis and the risk of amputation) were assessed at pre-operative (T0) and 6 months post-surgery(T1). Also, blood-chemical parameters (A1C, lipid profile, renal function, CRP) were examined. Results: Significant reductions in A1C, CRP, uric acid and triglyceride values were observed regardless of drug treatment. Further categorization, revealed that at T0 the untreated group had a higher CRP value, higher insulin and lower metformin intake, while the treated group had higher triglyceride values. At T1, the treated group showed better renal function, reduced Leriche-Fontaine stage and fewer amputations than the untreated group. The two-way ANOVA showed a positive impact of treatment with the new drugs on renal function.Conclusions: This study shows SGLT2-i and/or GLP1-1-RA benefits in T2DM patients with PAD: reduced systemic inflammation, improved blood circulation, fewer stenotic recurrences, lower amputation risk.

Background and Purpose: Obtaining peripheral venous access is often difficult and can cause delays in patient management, prolonging hospital stays, especially in patients with DIVA (Difficult Intra-Venous Access). In these cases, selecting the correct device is crucial for achieving effective results and preserving the venous network.Materials and Methods: A search was conducted for the device that best met the needs of patients in Medicine, and a long cannula was identified. The nursing group was subsequently trained with theoretical lessons, practical sessions on simulators, and on-site shadowing for patient implants. Data on the implants were collected to assess the suitability of the device.Results: 89 long cannulas were placed. 26 cannulas remained in place for over 10 days, up to a maximum of 26. 74 patients had the device until their discharge. Only 4 cannulas were removed due to complications. The placement of this device has led to a reduction in the placement of midline catheters and PICC lines.Conclusions: The device proved to be safe and stable, ensuring the presence of a long-lasting access that prevented interruptions and delays in therapy administration. The trained nursing team developed expertise in ultrasound, stimulating motivation and professional growth. Additionally, he involved the rest of the staff in the process of vascular access management according to good practices.

Background: Internal Medicine deals with complex cases, frequently with nonspecific presentation, and Fever of Unknown Origin is one of the hardest challenges.Clinical case: A 56-year-old woman came to the ER for persistent hyperpirexia unresponsive to two lines of antibiotics, associated with right inguinal painful lymph node. In her medical history, a psoriatic arthritis treated with methotrexate and adalimumab, and NDD thrombocytopenia. Suspecting an infectious disease, she was investigated for common and opportunistic pathogens, zoonosis and STDs, without significant findings. A gynecological evaluation ruled out PID, transthoracic echocardiogram excluded vegetations, and total body CT confirmed inguinal lymphadenopathy and splenomegaly: only the hypotheses of lymphomatous disease or rare causes remained open. The patient underwent excisional lymph node biopsy, showing subsequent clinical improvement. Although the evolution seemed to lead to a diagnosis of Castleman’s disease, the histological examination was diagnostic for follicular T Helper lymphoma with angioimmunoblastic phenotype. Therefore, the patient was treated with chemotherapy following the CHOEP regimen. A follow-up CT performed after two months showed stable splenic disease, without captating lymph nodes. The patient continued through the oncohematological pathway aimed at marrow transplantation.Conclusions: Angioimmunoblastic T cell lymphomas typically present with nonspecific symptoms; deductive reasoning can help to reach an early diagnosis, thus increasing the possibility of a favourable clinical evolution.

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i), are increasingly used not only in diabetes but also for heart failure. The literature shows several case reports of acute pancreatitis (AP) attributed to SGLT2-i, especially with coadministration of dipeptidyl peptidase 4 inhibitor (DPP-4i), glucagon-like peptide 1 analog (GLP-1RA), ACE i, and statins.Case report: A 59-year-old male with a history of dilated cardiomyopathy and post cholecystectomy status arrived at the emergency room with a 2 day history of epigastric pain. He denied alcohol intake. On physical examination, temperature 38°C, blood pressure 90/60 mmHg, pulse 98/min, and respiratory rate 18/min, saturating 96% on room air. His abdomen was diffusely tender to palpation. Initial labs were notable for a leukocyte count of 0.8×109/L, calcium 8.8 mg/dL, lipase 2378 U/L, and triglyceride of 48 mg/dL. HbA1c and IgG4 was normal. Infectious causes are excluded. Drugs history was positive for valsartan/sacubitril, in association with a dapagliflozin, started 6 months before. While waiting for diagnostic tests, SGLT2-i was promptly discontinued. It was started on conservative treatment with parenteral fluid and pain management. Computer tomography scan, magnetic resonance imaging and echoendoscopy showed AP, without biliary ductal dilatation or choledocholithiasis and no pancreas divisum. Conclusions: Physicians should consider SGLT2-i a possible cause of pancreatitis having ruled out any other etiologies. Patients should be informed about the symptoms of AP and advised to discontinue SGLT2-i.

Premises and Purpose of the study: HDV is a RNA virus that uses HBsAg as own viral envelope and is estimated to infect about 15-20 million persons worldwide. Bulevirtide (BLV) is a novel therapy for chronic HDV infection that binds the NCTP receptor and blockes the entry of HDV in hepatocytes. The aim of this study is to evaluate the effectiveness of BLV in the real field of clinical practice.Materials and Methods: From June 2023 to December 2023 10 patients with HBV-HDV chronic hepatitis were enrolled. All patients received Bulevirtide 2 mg/day subcutaneously in the center of the Emergency and Highly Contagious Unit, Cotugno Hospital, Naples. All patients were Italian natives resident in Campania region. Blood specimens were collected for HDV-RNA, AST, ALT, PLT, globulins at baseline and after 6 months of BLV treatment.Results: 8 patients were males and 2 patients were female, mean age was 57 (range 51-67). 9 patients were cirrhotics and 5 of them showed clinically significative portal hypertension. All patients showed elevated ALT levels and serum HDV-RNA detectable at baseline, with high levels of viremia (>10000 cp/ml) in 8 of them. At 6 months of BLV treatment, HDVRNA was below low limit of detection in 8 patients and below low limit of quantification in the other 2. All patients except one showed a prompt early decline within the normal values of ALT, while all presented a delayed strong progressive decrease of serum HDV-RNA.Conclusions: Bulevirtide in our experience was highly effective as antiviral both in reducing liver necroinflammation and the viral load too.

Background: Miller Fisher-Bickerstaff Syndrome is an acute idiopathic polyneuritis characterized by the sudden onset of ataxia, ophthalmoplegia, areflexia, alterations of consciousness. It is more common in males, with an average onset age of 44 years. In 80-90% of patients antibodies against GT1a and GQ1b are present. Case report: A 55-year-old woman presented to the emergency room with fever, shaking chills, and abdominal pain. Abdominal CT revealed right pyelonephritis. During the hospitalization there was a sudden ideomotor slowdown, slurred speech, and persistent headache. She also exhibited a tendency to drowsiness and profound asthenia. Neurological examination revealed dysarthria, hypophonia, mild bilateral ptosis, diplopia on lateral gaze, easy fatigability of neck muscles and MingazziniI-II, with weak knee reflexes and absent Achilles reflexes. The search for anti-GT1a and GQ1b antibodies was negative. Electromyography indicated acute polyneuro-radiculopathy with predominant involvement of the upper limbs and facial region, with sign of possible involvement of the brainstem. Intravenous immunoglobulin (Igev) therapy was administered for 5 days, followed by a fast recovery. Conclusions: Miller Fisher syndrome is a rare form of Guillain-Barré syndrome, often triggered by an infection, typically respiratory, present in approximately 72% of cases, with an average latency of 10 days. Spontaneous complete recovery is usually achieved within 2-3 months of onset. Usually at 6 months no residual disabilities are observed.

Background and Purpose of the study: People affected by COVID-19 have been exposed to abnormal clotting and endothelial dysfunction, which may result in thromboembolic events. The purpose of this study was to test whether the oral anticoagulant therapy OAT (both DOACs and VKAs) may impact on the medium-term mortality in a cohort of SARS-CoV2 patients.Materials and Methods: 1238 patients hospitalized for COVID-19 at our hospital from March 17, 2020, to June 15, 2021, were analyzed; 247 survivors and 247 deceased within 90 days from hospitalization were matched 1:1 based on age, sex and ICU admission within 3 days. Conditional logistic regression was used to estimate associations by means of Odds Ratio with 95% confidence interval.Results: The group of survivors was comparable to the group of deceased patients for age (76±10 years), gender (141 men and 106 women in each group) and hospitalization in ICU (25 per group). Compared to patients living at 90 days, those with a fatal event achieved more frequently heart failure, HF (10.5% vs. 23.1%; p <0.001), atrial fibrillation, AF (13.4% vs. 22.3%; p=0.009), as well as respiratory disease or COPD, and renal failure. Subjects in OAT were 60 (24.3%) in the group of survivors and 69 (27.9%) in the group of deceased patients.Conclusions: While HF and AF, characterized by a pro-thrombotic state that frequently complicate one another, are among the comorbidities mainly associated to medium-term mortality of COVID-19 patients, no statistically significant link was detected between the examined clinical parameters and OAT.