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  • Author: Francesco Salvatore x
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Abstract

In the area of the Medical Sciences, the chronological age has always been, and still is, an indicator by which we try to understand the health status of an individual. However, besides considering people born with an already expressed disease, each human genome has sequence alterations called predisposing mutations; carriers of such genetic alterations have an increased risk of contracting diseases during their life. In addition, the exposome, i.e. the totality of environmental noxae (“hits”) to which our body is exposed throughout life (through ingestion, breathing, body surface hits, and psychosociological stress agents, etc.) contributes to increase gradually but inexorably the frailty of an organism, and this process is usually referred to as “physiological ageing”. This position paper proposes that we invert our visual angle and view the passage-of-time not as the cause of diseases, but consider the genome alterations present at birth and the noxae received during our life as the real major causes of ageing. The Biomedical Sciences are now increasingly unraveling the etiopathogenesis of most chronic degenerative diseases; thus, it will be possible to monitor and treat those that most contribute to the increased frailty of each person, which is now referred to with the misnomer “physiological ageing”. These concepts are not banal; indeed, they imply that we must try to avoid the causes of alterations that result later in chronic degenerative diseases. Thus, we should shift our attention from the cure to the prevention of alterations/diseases also to improve both the length and quality of our life. Moreover, this approach involves real personalized or individualized medicine, thus conferring a more direct benefit to each of us by finalizing either the cure or the monitoring of diseases.

Abstract

We report the diagnostic evaluation, management, and intermediate-term outcomes of a rare variant of bladder cancer and concomitant Abdominal Aortic Aneurysm. A 62 year old male with gross haematuria and Abdominal Aortic Aneurysm was admitted to our hospital. Cystoscopy revealed a large bulky mass occupying the posterior bladder wall. The tumor was transurethrally resected and its histology showed a Sarcomatoid Carcinoma of the urinary bladder. Due to the aggressive behavior of the tumor and the risk of aneurysm rupture, concomitant endovascular exclusion of Aneurysm, total cystectomy with urinary diversion was performed. 12 months after radical surgery the patient was alive without any local recurrence, distant metastasis, and thrombosis of iliac axis. To our knowledge this study is the first report to describe data on the diagnostic evaluation, Management, and intermediate-term outcomes in Sarcomatoid carcinoma and Concomitant Abdominal Aortic Aneurysm. Multi-institutional collaboration is important to perform clinical trials of adequate sample size to design more effective treatments for these aggressive cancers in the presence of Concomitant Abdominal Aortic Aneurysm.

Abstract

Background:

Cannabis has been used since ancient times to relieve neuropathic pain, to lower intraocular pressure, to increase appetite and finally to decrease nausea and vomiting. The combination of the psychoactive cannabis alkaloid Δ9-tetrahydrocannabinol (THC) with the non-psychotropic alkaloids cannabidiol (CBD) and cannabinol (CBN) demonstrated a higher activity than THC alone. The Italian National Institute of Health sought to establish conditions and indications on how to correctly use nationally produced cannabis to guarantee therapeutic continuity in individuals treated with medical cannabis.

Methods:

The evaluation of cannabinoids concentration and stability in standardized preparations of cannabis tea and cannabis oil was conducted using an easy and fast ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) assay.

Results:

Extraction efficiency of oil was significantly higher than that of water with respect to the different cannabinoids. This was especially observed in the case of the pharmacologically active THC, CBD and their acidic precursors. Fifteen minutes boiling was sufficient to achieve the highest concentrations of cannabinoids in the cannabis tea solutions. At ambient temperature, a significant THC and CBD decrease to 50% or less of the initial concentration was observed over 3 and 7 days, respectively. When refrigerated at 4 °C, similar decreasing profiles were observed for the two compounds. The cannabinoids profile in cannabis oil obtained after pre-heating the flowering tops at 145 °C for 30 min in a static oven resulted in a complete decarboxylation of cannabinoid acids CBDA and THCA-A. Nevertheless, it was apparent that heat not only decarboxylated acidic compounds, but also significantly increased the final concentrations of cannabinoids in oil. The stability of cannabinoids in oil samples was higher than that in tea samples since the maximum decrease (72% of initial concentration) was observed in THC coming from unheated flowering tops at ambient temperature. In the case of the other cannabinoids, at ambient and refrigerated temperatures, 80%–85% of the initial concentrations were measured up to 14 days after oil preparation.

Conclusions:

As the first and most important aim of the different cannabis preparations is to guarantee therapeutic continuity in treated individuals, a strictly standardized preparation protocol is necessary to assure the availability of a homogeneous product of defined stability.

Abstract

Introduction: The majority of existing research regarding cochlear-implanted patients focuses on acoustic perception and language skills in children and adolescents, or on the postoperative quality of life in adults.

Purpose: We hypothesized that a patient’s psychological reaction to a cochlear implant (CI) may be influenced by the temperament of the implanted subject. This case study aims to assess whether temperament plays a role in the adaptation to CIs and if certain temperamental and character traits may be risk or protective factors for surgery and rehabilitation outcomes.

Method: We evaluated a 21-year-old male patient presenting a history of traumatic hearing loss. The Temperament and Character Inventory (TCI) was employed to obtain a psychological evaluation.

Results: The findings suggest a connection between the scores obtained on the TCI questionnaire and the patient’s behavior toward the CI. The effects of the operation may be mediated by some temperamental and character traits.

Conclusion: In the field of clinical psychology and hearing rehabilitation, psychological evaluation may contribute a more profound understanding of the personality dynamics that influence the patient’s reaction toward traumatic hearing loss, compliance, and CI surgery outcomes.

Abstract

Background: Procalcitonin (PCT) is currently the most studied infection biomarker and its blood levels seem to mirror the severity of illness and outcome. PCT is widely used together with other biomarkers, such as white blood cells (WBC) count and C reactive protein (CRP), in order to guide antibiotic therapy. This study aimed to verify the diagnostic and prognostic power of WBC, CRP and PCT in patients with suspected infection in emergency department (ED).

Methods: A total of 513 patients presenting to the ED with signs/symptoms of local infections or sepsis were enrolled. APACHEII score and in-hospital death were recorded. Patients were subdivided into quartiles by age, and the biomarkers were measured at baseline. Receiver operating characteristics (ROC) curves for evaluating diagnostic and prognostic role of PCT, CRP and WBC were calculated for each variable alone and combined.

Results: When compared each other for PCT, CRP, and WBC there was no significant difference between the four subgroups. A direct correlation between PCT and WBC was found in the II, III, and IV quartiles (the highest correlation, r=0.34, p<0.0003). PCT alone or when combined with WBC showed the best diagnostic and prognostic power at ROC analysis.

Conclusions: Our data demonstrate that WBC, but more CRP and PCT are reliable diagnostic and prognostic biomarkers, when considered in combination and with severity clinical score. PCT confirms its stronger usefulness as a diagnostic marker of sepsis. A multi-diagnostic tools approach is fundamental to perform a correct and rapid diagnosis of infection and sepsis in ED.