Gestione della sepsi e dello shock settico, confronto internazionale a Bologna [Cardio]

Si è tenuto a Bologna il DEC-Day & BEYOND: FACING NEW CHALLENGES, un evento scientifico di rilievo internazionale promosso da AOP Health, dedicato alla gestione avanzata del paziente critico con sepsi e shock settico. Due giornate intense, ricche di contributi multidisciplinari, che hanno visto la partecipazione di clinici e ricercatori impegnati ad affrontare le sfide emergenti in area critica, alla luce delle più recenti evidenze e strategie terapeutiche.

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Ruxolitinib crema nella vitiligine: efficacia reale oltre i dati clinici. #ICD2025 [Dermatologia]

A un anno dall’introduzione di ruxolitinib crema, primo trattamento topico specifico per la vitiligine non segmentale, si apre un nuovo capitolo nella gestione clinica della malattia. In occasione dell’incontro scientifico Sharing Real Practice in Vitiligo: Beyond Clinical Data, svoltosi durante il XIV International Congress of Dermatology, sono state condivise esperienze, casi clinici e dati real-world, confrontando l’efficacia terapeutica osservata nella pratica quotidiana con i risultati degli studi di fase 3. 

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Neurofibromatosi di tipo 1, Progetto SENSE. Video Reportage di PharmaStar [Malattie Rare]

Il progetto SENSE (esperienza Sensoriale nella gestione e trattamento del Neurofibroma pleSsiformE), realizzato grazie al contributo non condizionante di Alexion, nasce dalla volontà di proporre un approccio più profondo, umano e multidisciplinare a una delle sfide più delicate nell’ambito delle malattie rare pediatriche: accompagnare i bambini con neurofibromatosi di tipo 1 (NF1) nella complessa gestione del neurofibroma plessiforme (PN).

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Vasculiti ANCA-associate, conferme per avacopan da studi di real life #EULAR2025 [Ortopedia e Reumatologia]

Nel corso del congresso EULAR, sono stati presentati nuovi dati che suffragano l’impiego di avacopan nel trattamento di due vasculiti ANCA-associate (la granulomatosi con poliangioite e la poliangioite microscopica – GPA ed MPA). Il primo (AVAC-EUR), uno studio osservazionale multicentrico retrospettivo europeo, ha mostrato come la continuazione del trattamento con il farmaco si accompagni ad una riduzione delle ospedalizzazioni e dei tassi di infezione rispetto al quanto osservato con l’ìnterruzione del trattamento entro un anno. Il secondo, uno studio prospettico multicentrico italiano di real life, ha dimostrato l’efficacia precoce e duratura, la sicurezza e i miglioramenti nei punteggi della qualità di vita associati al trattamento con avacopan nella gestione delle vasculiti sopra indicate. in una coorte di pazienti italiani.

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Tumori: l'immunoterapia pre-intervento rivoluziona le cure. Convegno a Napoli [Oncologia-Ematologia]

Dal melanoma al tumore del polmone, dal cancro al seno triplo negativo a quello del colon-retto e della vescica: sono sempre più numerosi i tumori per cui la somministrazione dell’immunoterapia neoadiuvante, cioè del trattamento prima dell’intervento chirurgico, mostra evidenze di maggiore efficacia. Questa nuova evoluzione dell’immunoterapia è al centro della seconda edizione di “I.N.N.O.VA.T.E. – International Neoadjuvant Immunotherapy Across Cancers”, al via oggi, e fino a domani, a Napoli.

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Theory-based chatbot for promoting colorectal cancer screening in a community setting in Hong Kong: study protocol of a randomised controlled trial

Background
Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer mortality worldwide. Despite the organised CRC screening programme, the uptake rate of the population-based CRC screening was still low. Thus, we will conduct a randomised controlled trial in a community setting to evaluate the effectiveness of a theory-based chatbot in promoting CRC screening uptake.

Methods and analysis
A total of 500 eligible participants will be randomly assigned to a WhatsApp Messenger-initiated chatbot outreach group or a standard text reminder group at a ratio of 1:1. The intervention group will deliver Chinese culturally tailored education texts and videos developed based on the Health Belief Model and the Trans-Theoretical Model. The control group will deliver a standard text reminder of information about the Hong Kong organised CRC screening programme. In addition to the baseline assessment and postintervention assessment, all subjects will be followed up for 3 months and 6 months, respectively. The primary outcome will be the CRC screening uptake rate at the 3 month and 6 month follow-up. The secondary outcomes will be the intention to undergo CRC screening uptake, time interval to participate in and complete screening after recruitment, and reasons for not participating in screening at the 3 month and 6 month follow-up. Quantitative data will be analysed using Student’s t-test, Pearson’s 2 test or Fisher’s exact test. Qualitative data will be analysed by thematic analysis.

Ethics and dissemination
Ethical approval of this trial was granted by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (2022.614). Written informed consent will be obtained from study participants before enrolment. The findings will be disseminated through peer-reviewed journals.

Trial registration number
The study was registered on clinicaltrials.gov (NCT06192862).

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Eczema cronico delle mani, perché è necessario parlare di epidemiologia? [Dermatologia]

L’eczema cronico delle mani rappresenta una sfida significativa sia clinica che sociale, e la sua gestione non può prescindere da una solida conoscenza epidemiologica. Affrontare l’argomento dal punto di vista epidemiologico è fondamentale per molteplici ragioni, che vanno ben oltre la semplice descrizione clinica. E’ stato questo il tema della relazione della Dott.ssa Emanuela Martina, Specialista in Dermatologia e Venereologia, SOD Clinica di Dermatologia, AOU delle Marche, Ancona, in occasione della Special Edition del congresso SIDeMaST-ADOI che si è svolto in parallelo alla prima giornata del XIV International Congress of Dermatology.

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Presentato in Senato il Position Paper sui PDTA per amiloidosi da transtiretina  [Cardio]

Un paziente con amiloidosi cardiaca da transtiretina (ATTR) oggi in Italia può ricevere diagnosi e cure molto diverse a seconda della Regione in cui vive. Eppure, questa malattia rara, spesso sottovalutata e diagnosticata troppo tardi, necessita di un percorso di cura rapido, personalizzato e multidisciplinare.
Per rispondere a questa sfida, Bistoncini Partners ha realizzato, con il contributo non condizionante di Pfizer, il Position Paper: “L’importanza dei PDTA personalizzati per la gestione del paziente con Amiloidosi da Transtiretina”, che viene oggi presentato nel corso di una conferenza stampa promossa dalla Senatrice Elena Murelli

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Cancro della prostata non metastatico ormono-sensibile, Aifa approva  la rimborsabilità di enzalutamide. Cambia il paradigma di cura [Italia]

L’Agenzia Italiana del Farmaco (Aifa) ha riconosciuto la rimborsabilità di un’ulteriore indicazione terapeutica per enzalutamide, sulla base dei risultati dello studio di Fase 3 EMBARK. Con questa autorizzazione enzalutamide diventa il primo ed unico inibitore del segnale del recettore degli androgeni che ha ottenuto la rimborsabilità per il trattamento di uomini adulti con cancro della prostata non metastatico ormono-sensibile (nmHSPC) con recidiva biochimica (BCR) ad alto rischio non idonei alla radioterapia di salvataggio

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Gestione dell'infezione da HIV: importanza dell'ottimizzazione della terapia [Infettivologia]

La gestione dell’infezione da HIV ha fatto enormi progressi, portando oggi la maggior parte delle persone con HIV in trattamento a raggiungere e mantenere una viremia non rilevabile. Tuttavia, l’efficacia della terapia antiretrovirale (ART) non è più il solo parametro da considerare: l’ottimizzazione della terapia è diventata fondamentale per garantire che il trattamento sia ben tollerato, sostenibile e adattato alle esigenze individuali, migliorando così l’aderenza e la qualità di vita del soggetto, in una prospettiva di successo a lungo termine.

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Understanding Predictors of Lifelong Initiation and Follow-up Treatment for adolescents and youth living with HIV (UPLIFT): an integrated prospective cohort in Eastern Cape, South Africa

Purpose
Adolescents living with HIV (ALHIV) are a priority population for achieving global HIV prevention and treatment targets but experience poorer outcomes than adults. Long-term follow-up is essential to understand their transition into adulthood. By linking self-reported survey data with routine laboratory records, we established a social science clinical cohort of ALHIV South Africa’s Eastern Cape to explore factors shaping their long-term health and well-being.

Participants
Eligible participants were adolescents who were part of a three-wave quantitative cohort of ALHIV and not living with HIV (2014–2018) and had consented (adolescent and caregiver) to having their self-reported interviews linked with routine health records (n=1563). Adolescents were recruited into the existing three-wave cohort through clinic and community-based methods (97% enrolment, >90% retention over three waves). Between 2019 and 2022, we abstracted laboratory test records from the National Health Laboratory Services database for all eligible participants, with matching based on demographic variables. Individuals with at least one HIV-related record form our ‘lifelong social science cohort’, a total of 956 ALHIV (852 of 1107 ALHIV and 104 of 456 HIV-uninfected).

Findings to date
A total of 32 886 laboratory test records from 2004 to 2023 were matched through three rounds of data extraction, using iteratively refined record-linking searches. Most records were viral load (8864) and CD4 count (6801) results, with a median of 10 (IQR: 7–14) and 8 (IQR: 5–11) tests per matched adolescent, respectively. Overall, 956 of 1563 adolescents (61%) were successfully linked to laboratory data, including 852 of 1107 (77%) ALHIV. Analysis of the matched cohort survey-laboratory data provided several insights. Self-reported antiretroviral therapy adherence was strongly associated with viral suppression, even after adjusting for covariates. The strongest predictors of suppression were not reporting missed doses in the past 3 days, past week and not missing clinic appointments in the past year. Among adolescent girls and young women living with HIV, access to safe and affordable facilities, and kind and respectful staff were associated with a higher likelihood of multiple improved HIV-related outcomes, including viral suppression. Exposure to sexual and intimate partner violence predicted worse viral load outcomes among adolescents.

Future plans
This integrated prospective cohort provides an opportunity to characterise long-term HIV treatment outcomes among ALHIV in Africa. We will investigate how individual, familial, community and healthcare experiences in childhood, and adolescence shape these outcomes. Since the COVID-19 pandemic happened during the period of matched data, we will also investigate the potential effect of the COVID-19 pandemic on adolescent HIV treatment outcomes, with potential subgroup analyses for individuals with available COVID-19-related results.

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ProVag: the effect of oral probiotics on the vaginal microbiota composition in women receiving medical assisted reproduction in a Dutch fertility clinic – protocol of a randomised, placebo-controlled, double-blind study

Introduction
Differences in the profile of the vaginal microbiota (VMB) have been associated with pregnancy rates after medical assisted reproduction (MAR) such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Monitoring the VMB profile of IVF patients creates an opportunity to identify the best window for IVF treatment and embryo transfer. The ReceptIVFity test is a predictive test that assesses the chances of becoming pregnant in women undergoing IVF treatment based on the VMB composition. A VMB profile dominated by beneficial strains, most notably Lactobacillus species, is associated with increased pregnancy chances. However, to date, limited evidence is available on the effect of active modification strategies to facilitate the modulation of the VMB profile to help restore a VMB dominated by Lactobacillus species.

Methods and analysis
This is a randomised, placebo-controlled, double-blind intervention study. The study will involve 1:1 randomisation to one of the two arms: oral probiotic or placebo. Vaginal and rectal swabs will be collected at intake and 4, 6 and 8 weeks after the start of the treatment. Our objective is to determine if oral probiotic treatment improves the VMB profile of IVF patients from a low to a medium/high ReceptIVFity score, compared with placebo treatment. Secondary outcomes are: the potential of the bacterial strains in the oral probiotic to be detected in the vaginal tract and/or in the gut, and if the treatment leads to an increased ongoing pregnancy rate after IVF.

Ethics and dissemination
Ethical approval was obtained by the local medical ethical review committee at the Maastricht University Medical Centre. Findings from this study will be published in a peer-reviewed scientific journal and presented at one or more scientific conferences.

Trial registration number
CCMO NL81210.068.22, registered 25 September 2023.

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Assessing the experimental EuroQol toddler and infant populations (EQ-TIPS) descriptive system: a protocol integrating discrete choice experiment (DCE) surveys in instrument development

Introduction
The experimental EuroQol Toddler and Infant Populations (EQ-TIPS) instrument is currently under development as a health-related quality of life (HRQoL) measure for toddlers and infants aged 0–36 months. Using this protocol, researchers can conduct surveys with discrete choice experiments (DCEs) that examine the key properties of HRQoL instruments, specifically whether severity aligns with preferences across each attribute and the extent to which attributes influence choices. To demonstrate this protocol, we will conduct two waves of DCE surveys using different choice tasks and a common scenario (a 1-month health episode for a 1-year-old child).

Methods and analysis
In the first wave (a general population sample of 400 Australian adults; 14 kaizen tasks each), respondents will view a single EQ-TIPS-five-level (v3.0) profile for each task and be asked to make a series of choices that sequentially alleviate the child’s health problems. Using this exploratory evidence, we will assess whether EQ-TIPS severity aligns with preferences and the extent to which each attribute level influences choices (ie, main effects). In the second wave (1000 Australian adults; 28 paired comparisons), respondents will see two EQ-TIPS profiles for each task and be asked to choose between them. Using this confirmatory evidence, we will compare the main effects and their uncertainty by wave. For each DCE, we will estimate a main-effects conditional logit model and test for differences in effects using cluster bootstrap techniques. As sensitivity analyses, we will evaluate the effects of task sequence, attribute order and sample size on uncertainty in each wave.

Ethics and dissemination
The independent review board at Includovate evaluated the application for ethical clearance and approved the study on 19 February 2025. To disseminate our findings, we will prepare multiple manuscripts for publication in peer-reviewed journals and present highlights at scientific meetings, such as the EuroQol Plenary Meeting and the International Academy of Health Preference Research.

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