bluuebunny/crossref_metadata_2025 huggingface dataset:
La formación del profesorado universitario en competencias lifelong learning a partir de las demandas de empleadores y egresados
Authors: Jato Seijas Elisa , Cajide Val José , Muñoz Cadavid María A. , García Antelo Beatriz
Published: June 2016

La presente investigación pretende conocer las demandas de formación del mercado laboral en términos de competencias para el aprendizaje a lo largo de la vida a través de la importancia que egresados y empleadores les conceden y traducirlas en recomendaciones y propuestas de formación para el profesorado universitario. En una primera fase, a partir de los elementos conceptuales que determinan dichas competencias, se establecieron y delimitaron aquellas que se vinculan con la empleabilidad. En una segunda fase se realizó un estudio empírico en el que se elaboraron dos cuestionarios que se aplicaron a dos muestras, una de egresados y otra de empleadores de diferentes comunidades autónomas y sectores productivos. Se realizaron análisis descriptivos y comparativos y los resultados fueron sometidos a un grupo de discusión de expertos. Entre las competencias más valoradas destacan la “competencia digital” y “aprender a aprender”.

 
Racionalidad instrumental y prácticas de gestión en jefes técnicos de liceos de la Araucanía
Authors: Mansilla Sepúlveda Juan , Beltrán Véliz Juan Carlos
Published: June 2016

El objetivo del estudio fue develar la racionalidad que subyace a las prácticas de gestión de los Jefes de Unidad Técnico Pedagógica en liceos situados en contextos de vulnerabilidad social en la Araucanía. Los instrumentos de recogida de in formación fueron entrevistas semiestructuradas y lectura de textos escritos. Los sujetos de estudio fueron 24 jefes técnicos y 28 profesores/as de cada uno de los centros. Se planteó un método cualitativo descriptivo con un diseño de caso instrumental, en base a la teoría fundamentada construccionista y el método comparativo constante. Los resultados develan la inexistencia de la consideración de criterios epistemológicos respecto de las funciones generales que deben cumplir. Además, las prácticas de los jefes técnicos se orientan desde una “racionalidad instrumental” anclada en la conducción basada en el control y en el poder que le otorga el cargo.

 
Diagnóstico de la competencia matemática de los alumnos más capaces
Authors: García Perales Ramón , Jiménez Fernández Carmen
Published: June 2016

El presente estudio analiza los resultados obtenidos por 102 alumnos de quinto curso de educación primaria con alta capacidad matemática, diagnosticada ésta mediante la Batería de Evaluación de la Competencia Matemática y mediante los siguientes criterios: rendimiento matemático del alumno, interés del alumno por las Matemáticas a juicio del profesor y según el propio alumno, aptitud matemática medida por los tests Series Numéricas y Problemas Numéricos, repetición o no de curso y si está o no diagnosticado como alumno con alta capacidad, además de considerar las variables moduladoras sexo de los alumnos y tipo de centro en el que han estudiado. Concluye que excepto el juicio estimativo de los tutores sobre la existencia o no de aptitud matemática en los alumnos, los restantes criterios son eficaces y confluyentes. Como era de esperar hay algunas diferencias entre los alumnos situados en los dos niveles superiores de la batería, a favor del más alto.

 
Inteligencia emocional percibida, disposición al optimismo-pesimismo, satisfacción vital y personalidad de docentes en su formación inicial
Authors: Cazalla-Luna Nerea , Molero David
Published: June 2016

El presente estudio analiza la inteligencia emocional percibida, el optimismo-pesimismo disposicional, las satisfacción vital y la personalidad en docentes durante su formación inicial y la capacidad de predicción de estas variables de la satisfacción de los mismos. Participaron 355 estudiantes de la Universidad de Jaén (España) que contestaron a las escalas TMMS-24, LOT-R, SWLS y NEO-FFI en su versión española. Existen diferencias significativas en función del género en optimismo y pesimismo, en el factor de la personalidad amabilidad; en función de la edad en pesimismo, satisfacción vital y algunos factores de la personalidad (neuroticismo y responsabilidad). Los resultados apuntan que los futuros docentes con mayor responsabilidad, optimismo y extraversión tendrán mayores niveles de satisfacción vital. Las variables consideradas en el estudio de regresión para predecir la satisfacción vital explican un 49.2% de la varianza.

 
Percepción del alumnado sobre la utilidad de las actividades de aprendizaje para desarrollar competencias
Authors: Rubio Hurtado María José , Ruiz Bueno Antoni , Martínez-Olmo Francesc
Published: June 2016

El estudio trata sobre las actividades de aprendizaje que se realizan en las asignaturas de carácter metodológico con el objetivo de conocer la utilidad percibida por el alumnado para el desarrollo competencial. La investigación es cuantitativa descriptiva, por encuesta con cuestionario, administrado a 121 estudiantes de Pedagogía de la Universidad de Barcelona que estaban finalizando el grado en el momento de la aplicación. Los resultados muestran que la mayoría de las actividades son valoradas positivamente, no existe relación entre los indicadores de caracterización muestral y la percepción de utilidad, si bien se han encontrado diferencias de opinión en algunas asignaturas en relación a ciertas variables. Además se han obtenido diferentes perfiles de alumnado. Como conclusiones se destaca que para que las actividades tengan utilidad para el alumnado tienen que facilitar la superación de la asignatura, comportar simulación o aplicación de contenidos e implicar la interacción y discusión entre estudiantes. Finalmente se ofrecen orientaciones para planificar actividades que fomenten el desarrollo de las competencias metodológicas.

 
Autorregulación del aprendizaje en una clase de la Universidad: un enfoque de infusión curricular
Authors: Da Fonseca Rosário Pedro S. L. , Fuentes Sonia , Beuchat Marianne , Ramaciotti Antonietta
Published: June 2016

Este trabajo presenta y analiza la eficacia de un programa de promoción de procesos y estrategias de aprendizaje en la universidad con un formato de infusión curricular. El programa “Cartas de Gervasio”, se organiza en torno de cartas escritas por un alumno de primer año de universidad sobre sus reflexiones, dificultades y éxitos vividos en esta nueva etapa de su vida académica. El programa persigue equipar a los alumnos universitarios con las herramientas estratégicas que les permitan funcionar, de una forma más competente y autónoma, al abordar sus procesos de aprendizaje. Los datos obtenidos indican que los estudiantes que participan en el programa de intervención en la modalidad de infusión curricular mejoran significativamente en cuanto al dominio de conocimiento declarativo respecto de las estrategias de aprendizaje y de su utilización. En resultado, la complejidad estructural de los productos académicos fue incrementada.
Expectativas de futuro laboral del universitario de hoy: un estudio internacional
Authors: González Lorente Cristina , Martínez Clares Pilar
Published: June 2016

Ante las elevadas tasas de desempleo juvenil crece la preocupación y el interés por alcanzar un mejor ajuste entre las competencias profesionales y los requerimientos del mercado de trabajo. La educación tiene un compromiso, el bienestar de la sociedad, y como tal, el proceso de inserción socio-laboral se convierte en una parte esencial de la misma. Este trabajo desde una perspectiva internacional, la Universidad de Murcia y de la Universidad Católica de Córdoba (Argentina), trata de analizar cuáles son los factores que pueden influir en las percepciones y creencias del mercado laboral, desde la visión del estudiante de último curso de grado y las posibilidades factibles de acceder al mismo una vez finalizada la formación inicial, a través de un estudio no experimental, exploratorio y transversal, tipo encuesta. Los resultados son útiles para avanzar en el desarrollo, mejora y funcionalidad de la Educación Superior.

 
Language learning strategy use by spanish efl students: the effect of proficiency level, gender, and motivation
Authors: Risueño Martínez Jesús J. , Vázquez Pérez María Luisa , Hidalgo Navarrete José , De la Blanca de la Paz Soledad
Published: June 2016

El propósito de este estudio es investigar el uso de las estrategias de aprendizaje de la lengua extranjera por parte de estudiantes de inglés con distintos niveles de competencia. Además, intenta explorar la relación que ptstros participantes (N=206) hacen un uso moderado de esas estrategias, siendo las más utilizadas las metacognitivas y las afectivas. El nivel de competencia sólo tuvo un impacto significativo en la categoría de estrategias cognitivas entre los estudiantes del nivel más alto y los de los niveles básicos. No se encontraron diferencias significativas entre las mujeres y los hombres en el uso de las estrategias. Sin embargo, el factor motivacional sí arrojó diferencias significativas.
¿Quo vadis, evaluación? Reflexiones pedagógicas en torno a un tema tan manido como relevante
Authors: Pérez Juste Ramón
Published: June 2016

 

En este artículo se presentan una serie de reflexiones sobre la evaluación desde perspectivas radicalmente pedagógicas en las que el autor pretende analizar las implicaciones que una determinada concepción de la misma, concretada en unos principios básicos, representan para un buen hacer al servicio de la calidad de la educación. El autor defiende un enfoque unitario, armónico y coherente de la evaluación del aprendizaje y de la enseñanza, de los programas y de los centros educativos, extensible a otras manifestaciones como pueden ser los currículos universitarios y los sistemas educativos, aunque estos últimos tengan otro tipo de implicaciones que aquí no corresponde abordar.
An annoying persistent cough
Authors: Cipollini Francesco
Published: June 2016

Chronic cough is a stressful condition and can lead to extensive investigations. We report a case of a 48-year-old woman who had suffered from persistent chronic cough for more than 3 months. She had been treated with cough suppressant. However, her cough was not alleviated by these treatments, and the patient was referred to our hospital. She did not exhibit typical gastroesophageal reflux disease (GERD) symptoms heartburn and regurgitation. Esophagoscopy did not disclose reflux esophagitis. The patient was treated with a proton-pump inhibitor, which markedly alleviated her cough. Chronic cough due to GERD was diagnosed. Although the diagnosis of chronic cough due to GERD is not easy when traditionally symptoms are not present, our case report underscores the importance of this association to the differential diagnosis of chronic cough. In these cases a relatively simple test as high dose proton pump-inhibitors trial may be useful to confirm GERD related cough.
A case of acute respiratory failure in a young man
Authors: Di Stefano Fabio
Published: June 2016

A 40 years old man presents with a few hours history of progressive dyspnea. He was suffering from almost a week of low grade fever. The night before the onset of dyspnea he had high fever (39,5°C), polyuria and dysuria. His blood pressure is 115/65 mmHg and his oxygen saturation while breathing ambient air is 81%. Chest auscultation reveals rales bilaterally. A chest radiography shows bilateral pulmonary infiltrates consistent with pulmonary edema. How should this patient be evaluated to establish the cause of the acute pulmonary edema and to determine appropriate therapy?
Sincope: clinic risk determination and therapeutic management
Authors: Mecca Fabio , Favaro Enrica , Marengo Claudio
Published: June 2016

Syncope is a frequent symptom characterizing a wide group of pathologies with very different prognosis. By this reason, it is necessary a careful risk stratification for a better patient management. For this aim medical history and physical examination are fundamental. Diagnostic exams complete and confirm diagnostic suspiciousness formulated by medical history and examination, but rarely give elements for unexpected diagnosis. Correct identification of pathological mechanism of syncope and determination of associated clinical risk allow the best patient management avoiding dangerous discharge but also, in relation to increasingly limited resources, inappropriate hospitalizations.
Jealousy delirium associated with memory deficits
Authors: Zanetti Orazio , Tommasoni Angela , Lussignoli Giulia
Published: June 2016

Alzheimer’s disease is a progressive and fatal neurodegenerative disorder manifested by cognitive and memory deterioration, progressive impairment of activities of daily living, and a variety of neuropsychiatric symptoms and behavioural disturbances. A correct and early diagnosis not only allows prompt treatment but can also give the person with Alzheimer’s and his family more time to arm themselves with knowledge about this type of dementia and the best way to live with the disease. The role of Family Physician is very important in early diagnosis: dementia may be suspected if memory deficits are exhibited during the medical history and physical examination. Information from the patient’s family members, friends and caregivers may also point to signs of dementia. We report a case of a 75-years-old man who was suffering from cognitive deficits and behavioural problems: the first disease symptom was a strong feeling of jealousy towards his wife.
An “inexplicable” problem of habitual abortion
Authors: Gallone Gabriella
Published: June 2016

Thyroid autoimmunity (TAI) appears to be a determining factor in pregnancy loss. Many studies have confirmed this association, not only in hypo- and hyperthyroid women but also in euthyroid ones. The main risk associated with TAI is the occurrence of maternal hypothyroidism, with its potential deleterious effects for both the mother and fetus. We report a case of a 35-years-old woman with a history of habitual abortion. After diagnosis of TAI with normal thyroid function and treatment with levothyroxine, the patient became pregnant. After a normal pregnancy without problems, she gave birth of normal fetus at 39’ weeks gestation.
A case of metabolic syndrome, positive antinuclear antibodies and cirrhosis.
Authors: Grasso Alessandro
Published: June 2016

Metabolic syndrome is a common clinical condition often associated with hepatic steatosis and sometimes with mild transaminases and gamma-glutamyl transpeptidase increase. We report a case of a 45-years-old female, with mild increase of ALT, who was followed-up in our Department. A liver biopsy was then performed when an atorvastatin-induced ALT flare, as well as a positive antinuclear antibody appearance, occurred. A picture of steatohepatitis with sever fibrosis and cirrhosis was found. A caloric restriction with physical activity as well as the use of metformin were recommended. In the following 6 years the patient develops a decompensated cirrhosis and was referred to a Transplant Unit. This case suggests that non alcoholic steatohepatitis and cirrhosis can develop in patients with metabolic syndrome, especially when other cofactors of liver damage, as alcohol, may be superimposed. In non alcoholic steatohepatitis liver biopsy is mandatory to stage the disease. Moreover it is always recommended when different causes may concur to liver damage in the same patient.
An excluded diagnosis
Authors: Ghiringhelli Paolo , Aspesi Mariagrazia
Published: June 2016

We describe a 50-years-old patient with septic fever of unidentifiable source, following resection for rectal adenocarcinoma. He has been in treatment for sepsi two months before. Blood coltures, an accurate amanestic analysis and a transesophageal echocardiography were the major tools for the diagnosis of this disease. After the diagnosis of infective endocarditis had been excluded, antibiotic treatment (with teicoplanin and rifampicine) was given for the presence of Staphylococcus epidermidis. The previous pacemaker system was removed and a DDD pacemaker was implanted.
Cryoglobulinemic glomerulonephritis: an extrahepatic manifestation of hepatitis C virus (HCV) infection
Authors: Garini Giovanni , Iannuzzella Francesco
Published: June 2016

A 66-year-old woman was admitted to our Department for evaluation of a nephrotic syndrome. Physical examination revealed ankle edema, palpable purpura of the legs and hypertension. There was no hepatosplenomegaly. The main laboratory findings were haemoglobin 11.4 g/dl, serum creatinine 1.4 mg/dl, proteinuria 3.5 g/day with reduced serum albumin (3.1 g/dl), rheumatoid factor (RF) activity 125 IU/ml, and serum C4 levels 2.3 mg/dl. Cryocrit was 24%, with type II (IgG-IgM-κ) cryoglobulins. The patient was positive for HCV antibodies and serum HCV RNA; the genotype was 1b. A percutaneous renal biopsy showed a cryoglobulinemic membranoproliferative glomerulonephritis with moderate histologic severity. The primary goal in patients with mild-to-moderate disease is viral clearance, so combination therapy with interferon-α (3 MU thrice weekly) and ribavirin (800 mg/day) was started. Twelve weeks later, serum HCV RNA had disappeared, a result that was confirmed at the end of antiviral therapy in week 48, and during the post-treatment follow-up. Proteinuria returned to the normal range, cryoglobulins decreased to undetectable levels and serum C4 levels normalized. RF activity decreased, but remained above normal. The message provided by this illustrative case is that antiviral therapy represents the first-line treatment for HCV-related cryoglobulinemic patients with mild-to-moderate kidney involvement, because it provides the best chance of viral clearance and subsequent disease improvement.
A case of familial hypercholesterolemia
Authors: Zaninelli Augusto
Published: June 2016

We report a case of a 50-year-old woman with familial hypercholesterolemia (FH). Patients with FH have an increased incidence of atherosclerotic cardiovascular disease (CVD). Lifestyle measures, including fat-modified diets, and pharmacotherapy, particularly with statins, can substantially decrease the risk of CVD. FH fulfils all the WHO criteria for disease screening: to avoid cardiovascular events, screening is one of the most important features, but regrettably this is not practiced regularly at present. Healthcare systems must implement well-organized screening strategies, supported by an efficient disease management program. These initiatives will require optimization of primary care, because general practitioners are in first line in the overall prevention of CVD.
A case report of anterior vaginal prolapse: the use of tension-free sling
Authors: Ceresoli Andrea
Published: June 2016

Occult incontinence occurring after surgery for anterior vaginal wall prolapse may be a stressful unmasked condition which may lead to a second surgical approach. For this reason extremely careful selection of patients should be done prior surgery which should treat in the same time either the prolapse and the asymptomatic urethral hypermobility or the intrinsic sphincteric deficency. We report the case of a 59-year-old female presented with symptoms of pelvic prolapse; she denied stress urinary incontinence (SUI). The patient was referred to our institution where videourodynamics were performed, revealing a grade IIb cystocele (POP-Q), a QTip test of 50° and a negative Valsalva leak-point pressure test. She had no history of prior anti-incontinence surgeries. Pelvic examination identified no SUI, with or without reduction of the prolapse. Anterior colporrhaphy with transobturatory sub-urethrovesical placement of a new composite polypropylene tension-free sling was performed. Her prolapse symptoms resolved, with no new-onset of SUI. At 2 year follow-up she had complete resolution of prolapse and denied SUI or de novo detrusor instability urgency.
Lovastatin: a new “ancient” molecule for hypercholesterolaemia/dyslipidaemia treatment
Authors: Imperiale Gianlorenzo , Marengo Claudio
Published: June 2016

Lovastatin is the first HMGCoA-reductase inhibitor used for the control of hypercholesterolaemia (USA, 1987). In Italy, it’s been authorized for the therapy of hypercholesterolaemia/dyslipidaemia since end 2005. Several studies, conducted both in primary and in secondary cardiovascular prevention, underline the favourable profile in reducing the risk for ischaemic events and their complications. This molecule has the capability to reduce plasmatic atherogenic lipids levels enough to induce clinical benefits. The safety and tolerability of lovastatin are proved even for high dosages, as well as for long term use. Pharmacoeconomic evaluations have shown the value of its choice, in particular for patients who need lipid-lowering treatment but don’t satisfy eligibility criteria for reimbursement by the Italian National Health Service, as outlined by AIFA in 2005.
Criteria and instruments of appropriateness in primary care
Authors: Pizzini Andrea
Published: June 2016

The World Health Organization describes three particular features to assess the appropriateness of most medical services provided by clinicians during typical primary care visits: equity, efficacy and effectiveness. But many others aspects are involved and primary care physicians provide a wide range of services, most of which have not been studied sufficiently to develop explicit criteria for appropriateness. This articles describes meaning and characteristics of appropriateness in primary care and underlines the most important difficulties met by general practitioners, from the so called “disease mongering” to the application of the results of trials into the real clinical practice.
Family doctors and clinical trials
Authors: Brasesco Pierclaudio
Published: June 2016

There is a growing awareness that research in primary care is needed to provide excellent clinical and population-based care, to develop effective health systems and policies, and to educate future primary care professionals and researchers. The relevance of research undertaken in primary care is unquestionable: the results of researches conducted in other settings has limited relevance because primary care encounters health problems rarely managed in other sectors of health care (i.e. low probability of major acute disease and high prevalence of comorbidity). From legislative aspects to limits and difficulties of application, the article underlines the importance of research in primary care in the Italian context, where this kind of activity is almost absent. An example, concerning the Genova ASL 3, is reported to suggest strategies to promote and improve research as an integral component of family doctors skills.
Integrated management of cardiovascular risk
Authors: Cosentino Eugenio Roberto , Rinaldi Elisa Rebecca , Borghi Claudio
Published: June 2016

Cardiovascular disease (CVD) is a leading cause of mortality and is responsible for one-third of all global deaths. Regrettably, surveys of physician’s clinical practice patterns indicate that the recommendations made in the guidelines are sometimes not implemented and the predefined goals of therapy for patients with cardiovascular diseases are not achieved. CVD prevention and management can only be improved through an integrated approach that addresses overall cardiovascular risk and that involve general practitioners as well as specialists.
Follow-up of ischemic cardiopathy, an essential moment in the communication between in-patient and out-patient setting: problems and opportunities
Authors: Paolini Italo
Published: June 2016

It is known that the transition from the inpatient to the outpatient setting is a critical time. Evidence suggests that contact between patients and providers (i.e., physicians, nurse practitioners, and physician assistants) during this interval may be crucial for appropriate treatment modifications and recognition of errors in treatment. Ambulatory follow-up provides opportunities for clinical assessment, patient education, and medication review, which may in turn improve outcomes. However, little is known about the appropriate timing and type of follow-up that is necessary following hospitalization for AMI. In Italian System of Heath contact between general pratictioner and specialists, after dicharge, is critical moment for management of chronic pharmacological and non pharmacological therapy. If professional approaches are not integrated can reduce patients compliance and effectiveness of therapies themselves. Good management of chronic cardiovascular disease requires attention to stenghtening the continuity of information and management of patients.
Imaging and screening in lung cancer
Authors: Giaj Levra Matteo , Longo Marina , Capelletto Enrica , Rapetti Simonetta Grazia , Novello Silvia
Published: June 2016

Lung cancer is the main cause of death for neoplasia in the world. Hence it’s growing the necessity to investigate screening tests to detect tumoral lesions at the early stages: several trials have been performed to establish the best method, target and frequence of the screening to offer. CT, X-ray, PET, sputum citology and CAD software are here analyzed, together with the associated statistics and bias.
Role of high dose octreotide LAR for the treatment of GEP-NETs
Authors: Franchi Giulia M. , Cappelletti Chiara , Villa Valentina V. , Bosi Emanuele , Manzoni Marco F.
Published: June 2016

Neuroendocrine Tumours (NETs) are a heterogeneous group of rare neoplasms that account for 0,5% of all malignancies. The increased incidence observed in the last few decades may be accounted for by increased awareness, improved diagnostic tools and a revision in the definition. The main primary sites are the gastro-entero-pancreatic (GEP) tract (62-67%), and the lung (22-27%). In patients with GEP-NETs, the strongest predictor of 5-years survival is the staging. An adequate clinical management of GEP-NETs should be multidisciplinary and should aim at assuring a good quality of life. Somatostatin (sst) analogues are widely used in these tumours, which often express sst receptors, since they are demonstrated to reduce clinical symptoms and tumour growth. Herein we explore the usefulness of doubling octreotide LAR dose in selected patients after escaping from symptoms control and/or tumour stabilization in course of treatment with standard dose.
Beta-blockers in chronic heart failure in elderly patient
Authors: De Bernardi Alberto
Published: June 2016

Chronic heart failure (CHF) is a common and disabling condition with morbidity and mortality that increase dramatically with advancing age. There are evidences, from both randomized trials and observational studies, that suggest that beta-blockers are effective and well tolerated in elderly as well as in young patients. Nonetheless in clinical practice they are substantially underutilized in elderly patients. The article underlines peculiarities of chronic heart failure treatment with beta-blockers in elderly patients, with a review of the most important published trials.
Aromatase inhibitors in the treatment of deep endometriosis
Authors: Ferrero Simone , Camerini Giovanni , Remorgida Valentino
Published: June 2016

Recent case reports and pilot studies suggested that aromatase inhibitors might be effective in treating pain symptoms related to the presence of endometriosis. We present the case of a 32-year-old woman who suffered dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia caused by rectovaginal endometriosis. Pain symptoms recurred after treatment with the oral contraceptive pill; the patient refused surgery. Therefore a double-drug regimen including letrozole (2.5 mg/day) and norethisterone acetate (2.5 mg/day) was offered to the patient. The scheduled length of treatment was six months. This double-drug regimen determined a quick and significant improvement in all pain symptoms. During treatment, the patient complained mild arthralgia. After the interruption of treatment, pain symptoms quickly recurred and at 6-month follow-up their intensity was similar to baseline values. Operative laparoscopy was performed, the presence of rectovaginal endometriosis was confirmed and all visible endometriotic lesions were excised. Aromatase inhibitors might be offered when pain symptoms caused by endometriosis persist during the administration of other hormonal therapies and the patient refuses surgery. However, women must be informed that these drugs determine only a temporary relief of pain symptoms and might cause adverse effects (such as arthralgia).
Acute coronary syndrome: analysis of two case reports
Authors: Mascellanti Marco
Published: June 2016

The patients presenting acute coronary syndrome without ST segment elevation can have a short and long-term risk of death or recurrent ischemic events. Therefore, the evaluation of risk is an essential step in the management of such patients. We report two cases – a 86-year-old male, and a 46-year-old one – with acute coronary syndrome with non-ST-segment elevation, showing the importance of risk assessment to determine management strategy. Two risk profile scores were used: TIMI score and GRACE score. Routine use of validated risk score may facilitate more appropriate tailoring of intensive therapies, but the clinical reasoning of the physician is essential to take right decisions.
Pegylated interferon, ribavirin, and frequent supportive therapy with growth factors. Which pathogenesis for a severe psoriasis complicating the treatment of chronic HCV hepatitis?
Authors: Manfredi Roberto
Published: June 2016

One of the most effective treatments for HCV and HBV infection is the combination of pegylated IFN-alpha and ribavirin. However, both IFN-alpha and ribavirin can induce hematologic toxicity, which can compromise treatment adherence and dose maintenance and could, therefore, influence outcomes. Hematopoietic growth factors (e.g. filgrastim) can provide significant benefits in the treatment of this toxicity, but they can also exacerbate cutaneous psoriasis. We report a case of a 54-year-old woman with chronic, progressive hepatitis C, treated with long-term pegylated interferon plus ribavirin, associated with multiple cycles of filgrastim for a severe, recurring granulocytopenia. The patient developed an extensive and severe psoriasis, which improved only after specific treatment with cyclosporin. The case highlights the importance of treatment adherence and dose maintenance to obtain a sustained virologic response, and underlines the difficulties of the management of this disease when side effects, such as hematologic toxicity and psoriasis, are present.
Treatment of vaginal infections: effectiveness of the association of metronidazole and clotrimazole
Authors: Ferrero Simone
Published: June 2016

The normal vagina of women of reproductive age is colonised by lactobacilli that produce lactic acid, hydrogen peroxide and bacteriocins; these substances contribute to lowering the vaginal pH. A low vaginal pH creates an environment hostile to the growth of other microrganisms. When the number of lactobacilli is decreased, the resulting increase in the pH may favour vaginal infections. The three most common vaginal infections are bacterial vaginosis, trichomoniasis, and vaginal candidosis. There are multiple clinical and laboratory tests for diagnosing vaginal infections; the most commonly used methods for diagnosing bacterial vaginosis are the Amsel’s criteria and the Nugent’s Gram stain scale. Infections caused by Candida and Trichomonas vaginalis can be diagnosed by microscopic examination of vaginal secretions. Clotrimazole and metronidazole, especially when administered topically, are highly effective in treating vaginal infections.
Quetiapine: recent developments in preclinical research
Authors: Orsetti Marco , Di Brisco Fabio , Mauro Massimo , Dallorto Dario , Ghi Piera
Published: June 2016

Quetiapine (QTP) is an atypical antipsychotic labelled for the treatment of patients with schizophrenia, bipolar mania and bipolar depression. Nevertheless, QTP has been tried across multiple diagnosis categories and seems to be used, among other atypical antipsychotics, in clinical practice for an expanding range of disorders such as major depression, substance abuse disorders, anxiety disorders, and borderline personality disorders. The present review focuses on papers which investigated the molecular mechanism(s) of QTP antidepressant effect. In particular, preclinical studies performed by coupling the chronic mild stress, an animal model of human depression with Affymetrix microarray technology, revealed that chronic QTP administration prevented the stress-induced up- or down-regulation of 42 genes involved in the central nervous system development or having a crucial role for viability of neural cells, like regulation of signal transduction, inorganic ion transport, membrane organisation, and neurite morphogenesis. Among these, Ptgs2, Hes5, Plcb1, Senp2, Gad1, and Marcks are presumably the effectors of the QTP clinical efficacy.
A severe infective endocarditis successfully treated with linezolid
Authors: Minafra Graziano Antonio , Cibelli Donatella Concetta , Pipino Maria , Dargenio Vincenzo , Ventrella Francesco
Published: June 2016

Despite significant improvements in surgical and medical therapy, prosthetic valve endocarditis (PVE) is a diagnostic and therapeutic challenge and is often associated with a severe prognosis. We report a case of a 59-year-old woman, with  PVE and bacterial endocarditis (Streptococcus bovis) successfully treated with linezolid. Linezolid is a bacteriostatic oxazolidinone antibiotic that has been proven to be effective for the treatment of patients with pneumonia, skin and soft tissue infections, and infections due to Gram-positive cocci. Linezolid is not yet recognised as a standard therapy for infective endocarditis, but its use becomes a necessity when infection is due to multidrug-resistant microorganisms.
Long lasting octreotide LAR therapy in large cell neuroendocrine carcinoma (LCNEC) of the lung
Authors: Butera Alfredo
Published: June 2016

In this article we report a case of a patient with large cell neuroendocrine carcinoma (LCNEC) of the lung. Patients with LCNEC usually have poor prognosis and the benefit of adjuvant chemotherapy for these patients has not been fully established. This case suggests that octreotide LAR, a somatostatine analogue (SSA), can be useful in the treatment of neuroendocrine carcinoma also as maintenance therapy in association with chemotherapy. Further studies, regarding individual tumour biological behaviour and SSAs optimal dosage, could be useful to optimise treatment and to add new insights into the mechanisms of action and the role of SSAs in the therapy of NETs.
Virological and immunological stabilisation in AIDS-presenter, regardless antiretroviral therapy
Authors: Manfredi Roberto
Published: June 2016

Aim of our report is to present and discuss a paradigmatic case report of a patient followed for HIV infection for over twenty years, who, despite the initial diagnosis of AIDS presenter (due to the diagnosis of three episodes of cryptococcal meningo-encephalities, and one episode of pneumocystosis), showed a little or a complete lack of compliance to all the therapeutic regimens, including antiretrovirals, and primary and secondary antimicrobial chemoprophylaxis. Despite the non-compliance during the last three years of follow-up (from poor adherence to voluntary and complete discontinuation of all the therapies) an unexpected clinical-laboratory stabilisation was observed, with progressive increase of CD4+ T-lymphocyte count (range 410 to 825 cells/µl), and HIV viraemia under control (range 5,970-24,000 HIV-RNA copies/ml). This case report arises a number of open questions, concerning the anomalous course of the illness in this patient and the management of non-compliance.
A case of beta-thalassaemia major resistant to standard treatment
Authors: Masera Nicoletta , Decimi Valentina , Tavecchia Luisa , Capra Marietta , Cazzaniga Giovanni , Biondi Andrea , Masera Giuseppe
Published: June 2016

We report the case of a 22-year-old woman from Albania, with thalassaemia major, in severe clinical condition who could no longer be transfused due to the occurrence of severe, acute, post-transfusional reactions. After 10 years of treatment, she failed to respond to hydroxyurea. When she received thalidomide, haemoglobin levels increased from 3.7 g/dl to 9 g/dl. Since then, at 22 months of follow-up, the therapy is still effective and well tolerated. The case gives the opportunity to describe the clinical use of thalidomide, and its potential in the management of beta-thalassaemia.
Efficacy of risedronate in a post-menopausal woman affected by osteoporosis and inflammatory bowel disease
Authors: Palomba Stefano , Rocca Morena , Falbo Angela
Published: June 2016

Post-menopausal osteoporosis is a skeletal disease that can be asymptomatic and is sometimes underdiagnosed and undertreated. Post-menopausal osteoporosis can be associated with fractures and consequent impaired quality of life and increase of health care costs. Bisphosphonates are a therapeutic choice, because they proved to be effective in preventing bone loss. The current case report shows the efficacy of six-month risedronate administration in a post-menopausal woman affected by osteoporosis and inflammatory bowel disease in reducing biochemical bone turnover markers and increasing bone mineral density.
Neurologic complications in oncology
Authors: Pace Andrea , Di Lorenzo Cherubino , Guariglia Lara , Zaratti Massimo
Published: June 2016

Neurologic side effects related to cancer therapy are a common problem in oncology practice. These complications can negatively affect the management of the patient, because they can inhibit treatment and diminish quality of life. Therefore specific skills are required to recognise symptoms and clinical manifestations. This review focuses on the most common neurologic complications to improve physician’s familiarity in determining the aetiology of these symptoms.
Nilotinib therapy in an imatinib intolerant chronic myeloid leukemia patient with pulmonary severe hypertension
Authors: Annunziata Mario
Published: June 2016

Imatinib mesylate is a tyrosine kinase inhibitor that has significant efficacy in the treatment of chronic myelogenous leukemia. In general, hematologic and extrahematologic side effects of imatinib therapy are mild to moderate, with the large majority of patients tolerating prolonged periods of therapy. However, a minority of patients are completely intolerant of therapy, while others are able to remain on therapy despite significant side effects. Here, we describe a chronic phase CML patient with pulmonary arterial hypertension, mechanical hearth valve, who experienced extrahematologic adverse event (persistent grade III cutaneous rash, despite two discontinuations of imatinib and using of steroid). Necessitating switch to one of new tyrosine kinase inhibitors, nilotinib, has resulted in complete cytogenetic response and major molecular response, after 3 and 6 months, respectively. No cross-intolerance with imatinib was observed during nilotinib therapy. Besides, this clinical case suggests that warfarin and nilotinib can be used concurrently without the risk of increased anticoagulant effect.
Use of rosuvastatin to treat protease inhibitor-associated hypercholesterolaemia in a HIV-infected patient at high risk of cardiovascular diseases
Authors: Calza Leonardo
Published: June 2016

Rosuvastatin represents one of the latest inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase introduced in clinical practice for the treatment of hypercholesterolaemia. In comparative trials, across dose ranges this statin reduced low-density lipoprotein (LDL) cholesterol and total cholesterol significantly more than atorvastatin, simvastatin, and pravastatin, and triglycerides significantly more than simvastatin and pravastatin. In healthy subjects with normal LDL cholesterol and elevated C-reactive protein, rosuvastatin treatment produced a significant decrease in the incidence of cardiovascular events.Its chemical and pharmacokinetic properties suggest a very limited penetration in extrahepatic tissues with a lower risk of muscle toxicity and metabolically mediated drug-drug interactions, suggesting a low risk of pharmacokinetic interactions with antiretroviral drugs in patients with HIV infection. We describe a case of protease inhibitor-associated hypercholesterolaemia in a male HIV-infected patient with high cardiovascular risk. Treatment with rosuvastatin leaded to a significant reduction in total and LDL cholesterol levels, with a good tolerability profile after 15 months of follow-up.
Osteoporosis in men: a case report
Authors: Dominguez Ligia J. , Miraglia Simona , Barbagallo Mario
Published: June 2016

Osteoporosis in men is frequently not considered, underdiagnosed and often undertreated. In contrast with osteoporosis occurring in women, the genesis is frequently secondary (30-60%) with a complex diagnostic approach. A careful anamnesis and physical examination associated with laboratory and instrumental evaluation are necessary for an accurate diagnosis. The clinical case presented concerns a 70-year-old man with negative family history for osteoporosis and a personal history of depression, HBV carrier, and chronic obstructive pulmonary disease (COPD) in a heavy ex-smoker with history of alcoholism. The comprehensive geriatric evaluation allowed us to diagnose a multifactorially secondary osteoporosis associated to osteomalacia probably generated by the combination of alcohol abuse with consequent severe malnutrition, heavy smoking and COPD, physical inactivity and rapid weight loss.
Hyperammonemia of unknown origin
Authors: Molino Francesca
Published: June 2016

Idiopathic portal hypertension is a benign long-standing non-cirrhotic portal hypertension with no typical laboratory findings and absence of stigmata of chronic liver disease. The disease is diagnosed by the presence of evidence of portal hypertension with preserved liver function and absence of extrahepatic portal vein obstruction. We report the case of a 71-year-old woman who was admitted in hospital with encephalopathy and hyperammonemia. Liver biochemical tests excluded cirrhosis but revealed pancytopenia; preliminary abdomen ultrasound was normal. Ultrasound doppler and abdomen computed tomography of portal vein revealed patent portal vein with impaired portal intrahepatic perfusion and portal-systemic shunts.
Dysthyroidism and heart failure: from clinical case to pathophysiology
Authors: Giordanetti Stefano
Published: June 2016

Dysthyroidism affects cardiovascular function in many ways and can cause heart failure. The physiopathological mechanisms underlying the development of heart failure involve both direct intranuclear transcriptional effects of thyroid hormones and specific haemodynamic consequences of vascular modifications induced by dysthyroidism. Phospholamban regulatory action on diastolic ventricular function appears to play a pivotal role in mediating both direct T3 action and adrenal effects on myocardial contractility, possibly explaining the way dysthyroidism mimics sympathoadrenergic alterations on cardiovascular function. Therapeutical approach to cardiovascular disorders in dysthyroidism should focus on both thyroid hormones dysregulation and sympathoadrenergic activity, to attempt a reversal of the associated derangements.
Diaphragmatic flutter in a patient with a pacemaker
Authors: Bussolino Carlo , Massarelli Laura , Saracco Valter
Published: June 2016

Diaphragmatic flutter is a rarely reported disorder characterized by an abnormal diaphragmatic activity, which may be associated with respiratory symptoms (respiratory myoclonus). We describe a case of a 65-year-old patient with abnormal abdominal movements and no other symptoms. These movements resulted from rapid involuntary contractions of the diaphragm. Emotional tension and anxiety were the most common precipitating factors, the etiology was unclear and several pharmacologic agents have shown to be ineffective until the flutter was suppressed with high dose of clonazepam.
The Lombardia Stroke Unit Registry: a year experience
Authors: Micieli Giuseppe , Cavallini Anna , Duè Michela , Tartara Elena
Published: June 2016

Stroke is the third cause of death and the first long-term disability cause in industrialised countries. It is therefore an important problem, not only from a clinical point of view, but also because of the high costs involved in its management. The results of clinical trials, reviews and meta-analysis highlight the importance of the Stroke Unit in the correct and adequate management of the patient with stroke. This article describes the Lombardia Stroke Unit and the related Stroke Registry. In 2010 this Registry includes 27 Centres and recruits patients with acute stroke or transient ischaemic attacks (TIAs). The Registry aims at measuring performance parameters, identifying guidelines, non-compliance causes, and analysing care processes.
Endothelial pathophysiology, glycosaminoglycans and glycocalyx
Authors: Masotti Luca
Published: June 2016

The endothelial glycocalyx can be described as a network of membrane-bound proteoglycans and glycoproteins, covering the luminal surface of endothelial cells. Over the past decades, structural properties and functions of glycocalyx have been increasingly examined, underlining its role in many physiological processes. This article provides the basis on composition and functions of the endothelial glycocalyx. The Author also describes the so called “endothelial dysfunction” and how it can lead to the development of pathological inflammatory processes and consequent vascular diseases.
Nilotinib efficacy in a patient resistant to imatinib
Authors: Luciano Luigia
Published: June 2016

Imatinib, a BCR-ABL inhibitor, is the standard of care for the first-line treatment of patients with chronic-phase CML. Despite the optimal results, some patients develop resistance to imatinib. For these patients, the second-generation tyrosine kinase inhibitors represent effective therapeutic options. Here, we describe a report about a young patient with CML developing resistance to imatinib due to BCR-ABL kinase domain mutations. After six months of treatment with imatinib 400 mg daily, the patient had complete cytogenic response, while at 12 months he had a sub-optimal molecular response, that is a “warning” according to the European LeukemiaNet guidelines (both 2006 and 2009). At 29 months, persisting the sub-optimal molecular response, we decided to increase the imatinib dose up to 800 mg daily. Even after the dose escalation, the patient couldn’t achieve a major molecular response. Therefore we subjected him to a mutation screening, that highlighted L248V mutation. After switching to nilotinib the patient has resulted in complete cytogenic response and major molecular response.
Use of nilotinib in the diabetic patient
Authors: Tomaselli Carmen
Published: June 2016

A 42-year-old man, diabetic patient, after CML Ph+ diagnosis started a treatment with imatinib reaching both CHR and CCyR within 6 months. Because of two episodes of vitreous haemorrhage the treatment was discontinued for four months with the lost of the CCyR and the maintenance of the CHR. The patient begun second line therapy with nilotinib, another TK inhibitor, recovering CCyR after 3 months and MMolR after 12 months, and keeping them up after 18 months of treatment. Nilotinib related side effects were transient rash and first degree arthromyalgia that occurred during the first month of therapy. In this case nilotinib therapy has shown to be safe and effective also for diabetic patients with intolerance to imatinib.