Mobile Screening Units for the Early Detection of Breast Cancer and Cardiovascular Disease: A Pilot Telemedicine Study in Southern Italy.

Introduction: Telemedicine is the use of Information and Communication Technologies (ICT) to improve patient outcomes by increasing access to care, medical information and services. The aim of this pilot study was to evaluate and support the implementation of screening and early detection programs in the prevention of breast cancer and cardiovascular diseases with the establishment of a remote diagnosis through the use of ICT in mobile units. Materials and Methods: A total of 430 individuals were recruited in an area of Southern Italy. Particularly, 321 women were recruited to undergo breast cancer screening in accordance with Italian guidelines. Likewise, cardiovascular screening interested 109 subjects. A self-contained mobile unit with connectivity was provided to offer breast and cardiovascular screenings. To maximize the benefit, we have evaluated the return of investment. Results: The telemedicine screening program allowed the detection of early pathologies. In breast cancer screening, 40.8% of cases were negative to lesions, 34.9% were positive to benign lesions, and 3.1% presented suspicious malignant lesions; these lesions were further checked by histological analyses, which showed a positive response in 70% of cases. The cardiovascular screening concerned 109 participants based on age and other risk factors. We observed a significant difference among risk factors in patients with cardiac disease (p < 0.001); particularly, hypertension was significantly the most present risk factor (51.4%, p < 0.05), followed by smoking (28.4%, p < 0.05). A cardiovascular pathology was detected in 40.4% of enrolled subjects. A 3.3:1 return on investment was calculated. Conclusion: Our findings demonstrate that telemedicine may represent a promising approach to deliver several health services, such as screening programs, with users who cannot utilize services in their locations. The use of telemedicine on diagnostic campers greatly reduces the costs of screening for breast cancer and major cardiovascular diseases within the Southern Italian Health Service. We believe that public investment can have a further significant return on investment by implementing the principles of precision medicine.

[Hepatitis-associated aplastic anemia: description of a new case]. / Epatite acuta associata ad anemia aplastica: descrizione di un caso.

Hepatitis-associated aplastic anemia is an only recently recognised syndrome. We present a case whereby a month after an episode of fever, a 17-year-old boy was recovered with liver enzyme elevation and circulating platelet reduction. All the acute viral hepatitis markers were negative. After bone marrow aspiration a severe aplastic anemia was diagnosed and all the findings were consistent with hepatitis-associated aplastic anemia. The disorder was initially treated with glucocorticoids and platelet transfusion, obtaining the normalization of the liver enzymes but worsening of the aplastic anemia. An HLA-identical related marrow donor was not found. The patient responded to immunosuppressive treatment but died of multi-organ failure due to severe sepsis.