New treatment strategies for HIV-positive cancer patients undergoing anticancer medical treatment: update of the literature.

The introduction of highly active antiretroviral therapy (ART) has deeply modified the outcome of HIV patients by improving their overall survival and ameliorating their quality of life (QoL). The prolongation of these patients' survival has led to an increased risk of highly diffused non-infectious diseases, e.g., cardiovascular diseases, endocrine disease, neurological diseases, and cancer. The management of antiretroviral therapy and anticancer agents (AC) can be challenging, due to the possible drug-drug interactions (DDI) between AC and ART. For this reason, a multidisciplinary approach is always preferred as demonstrated by the GICAT (Italian Cooperation Group on AIDS and Tumors). This review aims to analyze the current scientific data regarding the possible effects of ART on the management of HIV-positive cancer patients and to evaluate the possible DDIs that must be taken into consideration when co-administrating ART and AC. A collaboration between all the involved professional figures, particularly infectious disease specialists and oncologists, represents the key to the correct managing of these patients in order to guarantee the best oncological outcome possible.

Adapted physical activity for breast cancer patients: shared considerations with two Olympic and world Italian sports champions.

Breast cancer is a growing global public health concern. Thanks to the recent treatments progress, the survival rate of BC patients has significantly improved (88% of 5-year survival rate) and the number of cancer survivors has also increased. Notwithstanding these brilliant results, many BC patients have long-term side effects as pain, oedema, limited mobility, cancer related fatigue, etc. as a consequence of surgical, radiotherapy and medical treatments. For example, posture appears to be frequently altered after mastectomy, due to the impairment of the mobility of the arm caused by surgical scars. All these aspects negatively affect the health-related Quality of Life (QoL) of BC patients. Recent several randomized clinical trials have shown benefits of regular and appropriate physical activity (PA) during and after BC treatment, particularly in terms of benefits for health, reducing fatigue, improving strength levels, QoL and physical function. In this context, two types of sports have demonstrated their affinity and efficacy as treatment support during and after treatments for BC patients: fencing and rowing. Here we report considerations shared with two sport champions: the fencing Olympic gold medal Daniele Garozzo and the rowing World Champion Giovanni Ficarra, with the aim to find the adapted PA for BC patients.

Penile cancer: prognostic and predictive factors in clinical decision-making.

Penile cancer (PC) is a typical tumor of non-industrialized countries. The incidence is 20-30 times higher in Africa and South America, considering the elevated prevalence of sexually transmitted diseases. Histologically, PC includes squamous cell carcinoma (SCPC), the most frequent, and nonsquamous carcinoma (NSCPC). Early diagnosis is the goal, whereas later diagnosis relates to poor functional outcomes and worse prognosis. The 5-year survival rate is 85% for patients with histologically regional negative lymph nodes, compared to 29%-40% for those with histologically regional positive lymph nodes. To date no new drugs are approved, and there are few new data about molecular mechanisms underlying tumorigenesis. The SCPC remains a rare tumor and the current therapeutic algorithm is based principally on retrospective analysis and less on prospective trials. In this review article, biomarkers of prognosis and efficacy of current treatments are summarized with a focus on those that have the potential to affect treatment decision-making in SCPC.

Efficacy of non-invasive mechanical ventilation in the general ward in patients with chronic obstructive pulmonary disease admitted for hypercapnic acute respiratory failure and pH < 7.35: a feasibility pilot study.

AIM: To date non-invasive (NIV) mechanical ventilation use is not recommended in chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) and pH < 7.30 outside a 'protected environment'. We assessed NIV efficacy and feasibility in improving arterial blood gases (ABG) and in-hospital outcome in patients with ARF and severe respiratory acidosis (RA) admitted to an experienced rural medical ward. METHODS: This paper is a prospective pilot cohort study conducted in the General Medicine Ward of Budrio's District Hospital. Two hundred and seventy-two patients with ARF were admitted to our Department, 112, meeting predefined inclusion criteria (pH < 7.35, PaCO2 > 45 mmHg). Patients were divided according to the severity of acidosis into: group A (pH < 7.26), group B (7.26 ≤ pH < 7.30) and group C (7.30 ≤ pH < 7.35). ABG were assessed at admission, at 2-6 h, 24 h, 48 h and at discharge. RESULTS: Group A included 55 patients (24 men, mean age: 80.8 ± 8.3 years), group B 31 (12 men, mean age: 80.3 ± 9.4 years) and group C 26 (15 men, mean age: 78.6 ± 9.9 years). ABG improved within the first hours in 92/112 (82%) patients, who were all successfully discharged. Eighteen percent (20/112) of the patients died during the hospital stay, no significant difference emerged in mortality rate (MR) within the groups (23%, 16% and 8%, for groups A, B and C, respectively) and between patients with or without pneumonia: 8/29 (27%) versus 12/83 (14%). On multivariable analysis, only age and Glasgow Coma Scale had an impact on the clinical outcome. CONCLUSION: In a non-'highly protected' environment such as an experienced medical ward of a rural hospital, NIV is effective not only in patients with mild, but also with severe forms of RA. MR did not vary according to the level of initial pH.

Evolution of the rheumatoid factor over time.

With purpose to verify the epidemiological value of the Rheumatoid Factor's variations over time, we studied: 421 RA at first hospitalization (from 1976 to 1985; Group A); 348 consecutive RA with follow-up at 0, 6, 12, 24, and 48 months (Group B); 750 subjects, chosen at random from a healthy population, before and after 48 months (Group C). Five agglutination tests were used: three latex tests with human (2) and rabbit (1) IgGs; one red cells test on slide, and one in tube. The results were: uneven variations in positive results in all tests (Group A); the maximum confirmation of the basic profile are provide in short-term follow-up; in subsequent follow-ups, with the exclusion of the case of all the negative tests, the remaining profiles have a decreasing confirmation rate (Group B); the positive frequency is different in all the tests; this trend is sustained at follow-up (4 years later) in spite of the overall increase of positive results (Group C). Serum-positive RA, according to all or many tests, tend to reduce the number of positive results; healthy subjects (with few positive tests) tend to increase the number of positive results over time. RA with all the negative tests have a reasonably constant profile.

[Rheumatoid serology: insufficient using a single test]. / Sierologia reumatoide: insufficiente un solo test.

The rheumatoid factor research restricted to only a test finds evident limitation not only in clinical field, but also on epidemiological investigations. The problem may find a solution by contemporary employment of a tests pool both in epidemiology and in the different physiopathological conditions present in rheumatology. Such kind of proposal has been verified on rheumatic diseases (rheumatoid arthritis classic or probable, polyarthritic syndrome, polyarthritis, spondylitis, psoriatic arthritis) and not rheumatic ones and in control group population (2901 subjects controlled). The results obtained emphasize the eventual presence of rheumatoid factor in the control group population, usually documented by the isolate positivity of three or more tests is preponderant for the same occurrence. By the statistical analysis applied to the conditions with equivalent number in the positive tests, is resulted that the possibility to discriminate the population, apparently health from the sick one is realized in a significative way of the positive tests, and starting from the positivity of two or more tests at least. It can be concluded confirming the already historical datum that the rheumatoid factor research with a test only has a limited orientation power to the diagnosis purpose.