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Environmental sustainability in ophthalmology

Vittorio Capuano — Wed, 21 Feb 2024 00:00:00 +0000

Fournier’s gangrene wounds successfully healed with High pbserum enzymes: a case report

Eugenia Paris, Jorge López-Berroa — Mon, 26 Feb 2024 00:00:00 +0000

Fournier’s gangrene is an aggressive form of infective necrotizing fasciitis in the perianal and genital area. In this article we discuss the case of a 75-year-old male patient diagnosed with Fournier’s gangrene with the entire perianal region affected. Surgical washings were performed and debridement with multiple flaps were required for reconstruction. Complications in the suture wounds, cavities, and a seroma were observed after 5 weeks, and they were treated with dressings. Treatment with High pbserum recombinant enzymes was initiated after 3 weeks, to accelerate the closure of the wounds. The granulation tissue was irrigated by drip irrigation once every 3 weeks, ensuring good tissue impregnation. We observed that the epithelialization of the affected areas was achieved after the first week, and in 1 month, most of the wounds healed properly without signs of infection. High pbserum is an enzyme cocktail, composed of higher collagenase concentration, lipase, and liase. This study shows how High pbserum improves and accelerates wound healing in a patient with Fournier’s gangrene. Further investigations are needed to conclude treatment recommendations.

A case of exaggerated placental site treated with hysteroscopy

Thu, 11 Jan 2024 00:00:00 +0000

Exaggerated placental site (EPS) is a benign lesion that can occur in association with term pregnancy, ectopic pregnancy, molar pregnancy, intrauterine fetal death or miscarriage. The characteristics of EPS are described in several case reports and have been reported after major surgery such as hysterectomy. We describe the hysteroscopic characteristic of EPS associated with a spontaneous miscarriage. Hysteroscopic inspection of the uterine cavity revealed copious tissue with increased vascularization without signs of invasion. No cleavage was visualized between material and myometrium could be established during the resection procedure. 40 days after hysteroscopy the patient became pregnant. The pregnancy proceeded without complications and during the cesarean section no residual placenta-related abnormal site appearance was noted on inspection of the uterine wall. The hysteroscopic treatment could be considered feasible to preserve future fertility in young women in cases of suspect non-malignant trophoblastic disease.

Vitreoretinal interface disorders

Marco Pastore, Antonio Gemito, Daniele Tognetto — Fri, 12 Apr 2024 00:00:00 +0000

This article is designed to bridge the knowledge gap for Doctors, shedding light on retinal pathologies that have long dwelled in the shadows of ultra-specialization. It delves into the identification and management of atypical conditions affecting the vitreomacular interface, encompassing disorders like vitreomacular traction, epiretinal membrane, full thickness macular holes and lamellar holes. Optical coherence tomography emerges as a crucial diagnostic tool, significantly enhancing our capacity to recognize abnormalities at the vitreoretinal junction, offering clinical insights unattainable through conventional ophthalmic methods. While vitrectomy remains the predominant choice for treating these conditions, alternative approaches are being explored.

Follow-up of breast cancer: why is it necessary to start a Consensus in 2024?

Fri, 23 Feb 2024 00:00:00 +0000

In Italy, breast cancer is the most frequently diagnosed cancer in women, with 55,900 new cases in 2023 (over 90% in the early stages). Due to the screening, early diagnosis and adjuvant treatment, these patients have a 5-years survival rate of 87% after the diagnosis.

There are 834,154 women in Italy with a previous diagnosis of breast cancer: most of these women require a follow-up.

The AIOM, ESMO and ASCO Guidelines recommend for early breast cancer (EBC) a clinical follow-up with only physical examination (and eliciting of symptoms) and an annual X-ray mammography, on the basis of the results of two randomized trials published in 1994 that showed no benefit in overall survival with intensive follow-up.

However, an Italian survey reported the application by 80% of oncologists of an intensive follow-up based on the individual patient’s risk of recurrence. In fact, the oncologists believe that an early diagnosis of locoregional or distant recurrence may allow an early start of very effective therapies.

In this lack of up-to-date scientific data, many questions about follow-up remain unanswered and the few ongoing studies will provide results in several years.

Non-compliance with guideline recommendations leads to increased costs for the healthcare system. Furthermore, management varies widely from centre to centre with regard to guideline recommendations, resulting in inequalities between patients. For these reasons, the follow-up of breast cancer should be reconsidered.

In the absence of recent scientific evidence, a multidisciplinary group of breast cancer experts has initiated a Consensus on the follow-up of EBC according to the mini-Delphi methodology. The project will be completed by the end of 2024.

After 100 years of life, is there an insulin crisis? The problem of insulin costs and the opportunity of biosimilar insulins

Domenico Cucinotta, Annalisa Giandalia, Giuseppina T. Russo — Thu, 09 Feb 2023 00:00:00 +0000

Considering other pharmacological approaches, also in the field of insulin therapy, the use of biosimilar drugs instead of originators could help to reduce the worldwide increasing costs of its related disease, that is, diabetes mellitus (DM), and the subsequent risk of insulin underutilization. Available evidences clearly demonstrate that biosimilar efficacy and safety are superimposable to those of the originator insulin with lower expenditure; despite this, however, their underutilization persists both in Eastern and in Western countries. Specific, regional activities are needed in order to improve biosimilar insulin use and to contribute to a substantial reduction of the costs of DM.

Economic evaluation of two therapeutic sequences in the first-line treatment of moderate to severe active ulcerative rectocolitis in Italy

Sat, 02 Mar 2024 00:00:00 +0000

Background: Vedolizumab (VDZ) and infliximab are used to treat moderate to severe ulcerative colitis (UC). The choice of the drug to use at first-line is often based on a combination of clinical and economic factors. The cost of treatment pathway is rarely considered. Therefore, this cost-consequence analysis (CCA) investigated the overall costs of treatment pathway for vedolizumab followed by infliximab (VDZ → IFX) compared to infliximab followed by vedolizumab (IFX → VDZ).

Methods: We used a published cost-consequence model (CCM), based on a targeted literature search reporting the time-on-treatment data for vedolizumab or infliximab in UC in first and second-line of treatment. CCM time horizon was defined by the length of treatment sequences. Considering the Italian hospital perspective, the CCA evaluated the biologic drugs acquisition costs, drug administration costs, hospitalization costs, switch costs, colectomy costs and third-line treatment costs. Third-line options included colectomy, tofacitinib, ustekinumab or dose escalation of second-line biologic.

Results: Over the 5.2-year time horizon (duration of the longer VDZ → IFX pathway), the mean cost per patient of VDZ → IFX pathway was slightly lower than the mean cost per patient of IFX → VDZ pathway (€ 86,339 vs 89,636). The CCM predicted that using VDZ as first-line treatment delayed the time to costly third-line therapies compared to first-line using IFX (VDZ-first-line median time-on-treatment 3.6-years and IFX-second-line 1.6-years; IFX-first-line 1.4-years and VDZ-second-line 2.3-years and third-line 1.5-years).

Conclusion: The CCA showed that a biologic treatment pathway that begins with first-line vedolizumab is not more expensive than one beginning with first-line infliximab and delayed the time to costly third-line.