Minerva medica
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The patients undergoing major orthopedic surgery, which includes total hip replacement (THR), total knee replacement (TKR), and hip fracture surgery (HFS), represent a group that has a particularly high risk for venous thromboembolism (VTE), and routine thromboprophylaxis has been standard of care for >20 years. The following article summarizes data derived from numerous randomized clinical trials of thromboprophylaxis following THR, TKR, and HFS; areas of orthopedic surgery for which there are much less data, including knee arthroscopy and isolated lower extremity injuries, are also reviewed.
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Cervical cancer is the second most common female cancer with 500000 new cases and 290000 deaths occurring worldwide per annum. Organized cervical screening programs have reduced the incidence and mortality of cervical cancer. However, in developing countries scarce resources, poverty, lack of infrastructure and disenfranchisement of women have been major hurdles in the effective implementation of routine screening programmes. ⋯ The development and implementation of a prophylactic HPV vaccine will have a major impact on preventing this global disease. However, long-term surveillance of the HPV vaccination program will be required to confirm the expected reduction in cervical cancer incidence. This article reviews the role of HPV in the development of cancer and the burden of HPV related cancers; types and pharmacokinetics of HPV vaccines; challenges and issues in implementing vaccination programmes; screening in the developing and developed countries and screening options in the post-vaccination era.
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Solid organ and hematopoietic stem cell transplant recipients are uniquely predisposed to develop clinical illness, often with increased severity, due to a variety of common and opportunistic viruses. Patients may acquire viral infections from the donor (donor-derived infections), from reactivation of endogenous latent virus, or from the community. Herpes viruses, most notably cytomegalovirus and Epstein Barr virus, are the most common among opportunistic viral pathogens that cause infection after solid organ and hematopoietic stem cell transplantation. ⋯ Treatment for viruses with proven effective antiviral drug therapies should be complemented by reduction in the degree of immunosuppression. For others with no proven antiviral drugs for therapy, reduction in the degree of immunosuppression remains as the sole effective strategy for management. Prevention of viral infections is therefore of utmost importance, and this may be accomplished through vaccination, antiviral strategies, and aggressive infection control measures.
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Ovarian cancer, the most aggressive gynecologic cancer, is the foremost cause of death from gynecologic malignancies in the developed world. Over 90% of ovarian cancers arise from the surface epithelium, which are classified as epithelial ovarian cancer (EOC). EOCs can be categorized as serous, mucinous, endometrioid, clear cell, and transitional cell types. ⋯ The presence of regulatory T cells, the inhibition of natural killer cytotoxic responses, the accumulation of myeloid suppressor cells in the tumor, deficiencies on interferon signaling, the secretion of cytokines that enhance tumor growth (i.e., IL-6, IL-10, CSF-1, TGF-b, TNF), and the expression of surface molecules (i.e., HLA-G, B7-H1, B7-H4, CD40, CD80) that have a role on immune suppression, are discussed in detail. The aim of this review is to provide insight of the evidence that supports the role of immunodeficiency in the progression of ovarian cancer and future directions for ovarian cancer therapies. It also discusses the genetic alterations in the subtypes of ovarian cancers.
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The epidemiology of lower respiratory tract (LRT) viral infections in adults is probably underestimated and the high frequency of multiple viral infections complicates the evaluation of the possible role of the single viruses. The aim of this study was to investigate the clinical epidemiology and impact of respiratory viral pathogens, in particular of those singularly detected, in bronchoalveolar lavage (BAL) specimens from hospitalized adult patients. ⋯ The use of a comprehensive diagnostic panel for respiratory viral infections may be useful to clarify the epidemiology and clinical impact of viral pathogens in hospitalized adult patients. The occurrence of multiple infections is a common finding and results should be interpreted taking into account the clinical context as well as viral load and the biological characteristics of each virus.