Delayed hypersensitivity to new oral anticoagulants. Demonstration of cross reactivity for the drug category and definition of non-irritant concentrations for patch tests.

Summary: The current therapy with direct trombin inhibitors (DTI) is indicated for the prevention of stroke in non-valvular atrial fibrillation. Side effects are reported, particularly skin hypersensitivity, for this whole category of drugs as well as for other modern antiplatelet and anticoagulant drugs. For their clinical features, these reactions appear as delayed T-cell mediated drug hypersensitivity, but at present there are no diagnostic methods of investigation. We reported a case of delayed skin reaction to edoxaban and we found the non-irritant concentration for patch test in the whole category of drugs. The patch test resulted positive for edoxaban. A successive challenge with alternative DTIs and/or a switch to warfarin is proposed as alternative therapy.

Management of a clinical and surgical centre in rural Cambodia (2006-2011).

The activities of the Bambino Gesù Paediatric Clinical and Surgical Centre Takeo in Cambodia started in May 2006, after the signature of a formal agreement between the Royal Government of Cambodia and the hospital. The paediatric centre is currently composed of an out-patients section with diagnostic ultrasound facilities and an obstetrics and gynaecology section, 3 consulting rooms, 20 beds for clinical activities, 13 beds for surgery, 7 beds for the paediatric intensive care unit, 2 dressing rooms, 1 out-patients sterile section, a library for off- and on-line consultation, a playroom and laundry facilities, and an administration office. For the last five years its activity has neen steadily on the increase, and the local population are beginning to look on the Centre as a full-scale local and regional referral hospital. From the 190 cases handled in 2006, the Centre increased to 669 surgical procedures in 2010 and 341 in the first four months of 2011, with good prospects of exceeding 1000 operations before the end of 2012. Takeo Centre also developed a Mobile Clinic Project to assist children directly in rural areas lacking health facilities. Today the Centre is a new reality in Cambodia's healthcare system.