[Neonatal group B Streptococcus infection: an integrated approach (of clinical pathologists, gynecologists, midwives, pediatricians-neonatologists) of the functional area of Cuneo (Italy)]. / Infezione neonatale da Streptococco B: un approccio multidisciplinare integrato (di laboratoristi, ginecologi, ostetriche e pediatri-neonatologi) del Quadrante di Cuneo.

The frequency of early-onset neonatal sepsis without prophylaxis is 1-5/1.000 live births. Since year '70 the most frequent causative microorganism is the group B Streptococcus (S. agalactiae, GBS), followed by Escherichia coli. The mortality rate is now reduced to 4% due to the improvement of neonatal intensive care. In the USA, the incidence of GBS early-onset neonatal sepsis has been markedly reduced by the application of the guidelines released by the Centers for Disease Control (CDC). This strategy, however, is not effective on occurrence of late-onset neonatal group B streptococcal disease. In Italy, the application of CDC guidelines is not customary, and different, often complex, protocols of obstetrical-neonatological integrated approach are applied. The frequency of infectious risk has made the GBS a paramount problem for the neonatologist, even for the legal responsibility issues resulting from the multiplicity of possible options. To reach the best level of protection of the newborn against early-onset GBS infection, the working group of providers of prenatal, obstetric, and neonatal care of the functional area of Cuneo issued an integrated protocol, in order to perform the GBS screening with the optimal culture method suggested by CDC guidelines in the highest possible number of pregnant women, and to standardize the obstetrical and neonatal management.

[Application of new therapeutic approaches in the prevention of osteoporosis in women]. / Applicazione dei nuovi approcci terapeutici nella prevenzione dell'osteoporosi nella donna.

The prevention of female osteoporosis is based on: a) promoting the achievement of optimal bone mass at the time of menopause; b) minimizing subsequent rarefaction especially in fast bone losers. Both these objectives can be partly attained by appropriate behaviour (balanced diet with adequate calcium intake, physical exercise) but often with additional preventive treatment that is undoubtedly easier to undertake since the introduction of new therapeutic approaches like the use of transdermal estradiol (TDE) and the salmon calcitonin (CT) nasal spray. Certain situations, chronic hypo-estrogenism (amenorrhea caused by primary ovarian deficit and primary or secondary hypothalamic hypogonadotropinemia) should be rectified by replacement estrogen-progestin treatment before the onset of menopause. Protracted treatment of this kind can also be used beneficially in patients identified as at risk of osteoporosis during the climacteric and where it is advisable to minimise the hepatocellular action of the estrogens TDE will be the treatment of choice. In both phases the CT spray can be used preventively wherever there are contraindications to the use of the estrogens and a real risk of osteoporosis.