Clinical Management Issues
type: channel
description: eISSN 2283-3137 Clinical Management Issues published mainly case reports and articles on clinical management of a disease in all the fields of medicine and was published by SEEd Medical Publishers. Clinical Management Issues is available and indexed in: Crossref DOAJ EMCare Emerging Sources Citation Index (ESCI) Web of Science OpenAIRE SHERPA/RoMEO CINHAL Embase Clinical Management Issues was an open access journal. The aim was to provide clinical content of the highest quality, authority and accessibility. The aim of the published case reports was to expand medical knowledge, allowing a better explanation of the practical application of a clinical guideline, or including an up-to-date review of medical knowledge in that field, or helping doctors to make better decisions in a “grey area”, or explaining how to manage a disease with an integrated approach between different specialists involved. Clinical Management Issues also published unusual case reports (i.e. unusual side effects or adverse interactions involving medications, unexpected or unusual presentations of a disease, etc.), articles on clinical management of a disease, case series, editorials, and brief reports. Content was subject to peer-review and was editorially independent. This journal provided immediate open access to all of its articles (both HTML and PDF versions) on the principle that making research freely available to the public supported a greater global exchange of knowledge. Authors were asked to state any professional and financial situations that might be perceived as causing a conflict of interest with respect to integrity of content. Submitted articles should follow the author guidelines.
publisher: SEEd
language: en
publication name: Clinical Management Issues
issn: 2283-3137
copyright: Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution Non-Commercial 4.0 Licence that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)
items: Acknowledgement to Reviewers (2021-2023)
items: Editorial Staff Disclosure (2021-2023)
items: Pulmonary Complications in a Patient with Common Variable Hypogammaglobulinemia
items: [Clinical and psychodynamic aspects of the therapeutic work with the anorexic personality]
items: [Fever of Unknown Origin in a Patient Administered With Bacillus Calmette-Guérin (BCG) to Treat Urothelial Vesical Carcinoma in Situ]
items: Candida guilliermondii Peritonitis During Peritoneal Dialysis. Case Report and Literature Review
items: Operative Management of Cecal Volvulus Herniating Through the Foramen of Winslow
items: Baclofen-Induced Coma Reversible by Dialysis in a Patient Affected by Acute Kidney Injury
items: [La diagnosi psicopatologica nel lavoro psicologico-psichiatrico]
items: Telemedicine: Current Status and Future Perspectives
items: Iatrogenic Hypoglycemia Induced by Valproic Acid in an Adult Patient
items: Risk of Colorectal Cancer in Inflammatory Bowel Disease: Prevention and Monitoring Strategies According With Risk Factors
items: Familial Gullo’s Syndrome: a clinical case report
items: [A rare case of sepsis from Citrobacter koseri in adults]
items: Editorial Staff Disclosure (2020)
items: Acknowledgement to Reviewers (January 2020 - December 2020)
items: Treatment With Efmoroctocog Alfa (Elocta®) in Hemophilia: A Case Series
items: Cerebral Embolism Beyond Atrial Fibrillation: Interatrial Block
items: La struttura di personalità delle figure sanitarie nel lavoro psicologico-psichiatrico
items: The Imprecision of “Precision Medicine” in Pancreatic Adenocarcinoma
items: A Rare Case Report on Plummer-Vinson Syndrome with a Complication of Oral Cancer in a South-Asian Woman
items: Myeloid Sarcoma Involving Kidneys: From Diagnosis to Treatment. Case Report and Literature Review
items: Adult ADHD
items: Cognitive-Behavioral and Pharmacological Treatments for Insomnia: A Combined Approach
items: Hypercalcemia and Nephrogenic Diabetes Insipidus: Rare and Life-Threatening Effects of Lithium Intoxication
items: Coronavirus Disease 2019 (COVID-19): A Brief Report
items: Editorial Staff Disclosure (2019)
items: Acknowledgement to Reviewers (January 2019 - December 2019)
items: Listeria monocytogenes Brain Abscess Mimicking Ischemic Stroke in an Immunocompromised Patient: A Case Report
items: The Role of Carbon Dioxide Laser Therapy in Penile Kaposi’s Sarcoma: A Case Series of Three HIV-Negative HHV-8-Positive Patients

Acknowledgement to Reviewers (2021-2023)
type: item
subject: Acknowledgements to reviewers
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2023
date: 2023-12-21
publication date: 2023-12-21
doi: 10.7175/cmi.v17i1.1555

Editorial Staff Disclosure (2021-2023)
type: item
subject: Editorial Staff Disclosure
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2023
date: 2023-12-21
publication date: 2023-12-21
doi: 10.7175/cmi.v17i1.1556

Pulmonary Complications in a Patient with Common Variable Hypogammaglobulinemia
type: item
description: Common variable immunodeficiency (CVID) is a rare disorder characterized by primary antibody deficiency leading to hypogammaglobulinemia and increased risk of infections. Pulmonary hypertension (PH) is an unusual complication of CVID and may be associated with chronic hypoxemic respiratory failure. We described the case of a 47-year-old female patient hospitalized with worsening dyspnea, which had emerged about 10 days before and was associated with productive cough. 26 years before, she was diagnosed with common variable hypogammaglobulinemia, that was treated with intravenous immunoglobulin infusions for at least 20 years. She had suffered from recurrent secondary infections of the respiratory tract with inveterate bronchiectasis, pulmonary hypertension, and chronic respiratory failure. This case suggests that Internal Medicine wards, due to their global vision of the patient, are well suited to manage subjects with serious, complex, and genetically determined pathologies.
subject: Case report
  topic: section
subject: Common variable hypogammaglobulinemia
  topic: keywords
subject: respiratory failure
  topic: keywords
subject: pulmonary hypertension
  topic: keywords
subject: Immunology
  topic: disciplines
creator: Paolo Ghiringhelli
creator: Fabrizio Foieni
creator: Girolamo Sala
creator: Alessandro Diana
creator: Beatrice Valvo
creator: Mariella Ciola
creator: Michele Zaza
creator: Roberto Bertolini
creator: Cinzia Simoni
creator: Lorenzo Bellintani
creator: Andrea Agostinelli
creator: Federica Macchi
creator: Sara Limbiati
creator: Michela Provisione
rights: Copyright (c) 2023
date: 2023-01-31
publication date: 2023-01-31
doi: 10.7175/cmi.v17i1.1521

[Clinical and psychodynamic aspects of the therapeutic work with the anorexic personality]
type: item
description: A psychodynamic profile at the origin of anorexia was described. In order to provide reliability to the considerations presented, the work made use of a sample of anorexic and depressed patients compared with controls, to whom a series of statistically processed personality tests were administered. This methodology brought to light that anorexic profile originated in childhood (adverse attitudes enacted by the personality of parental figures), interpreted by the child as a refusal of her own (fat) corporeity and the tendency to process information, express emotions and affections, react and act accordingly. These traits characterize the nascent personality and become apparent in adolescence (disesteem, insecurity, immaturity, social isolation, and sexual issues). Therefore, clinical work on the personality and anorexic behavior should aim at understanding the meanings attributed to the food and the body to initiate a correction and change. Such an intervention would tend to facilitate a gradual change in the original feeling and thinking of these dimensions in anorexia.
subject: Clinical management
  topic: section
subject: Anorexia
  topic: keywords
subject: Psychodynamics
  topic: keywords
subject: Alexithymia
  topic: keywords
subject: Childhood
  topic: keywords
subject: Adolescence
  topic: keywords
subject: Hyperprotectiveness
  topic: keywords
subject: Psychology
  topic: disciplines
creator: Roberto Infrasca
rights: Copyright (c) 2023
date: 2023-06-21
publication date: 2023-06-21
doi: 10.7175/cmi.v17i1.1541

[Fever of Unknown Origin in a Patient Administered With Bacillus Calmette-Guérin (BCG) to Treat Urothelial Vesical Carcinoma in Situ]
type: item
description: Koch’s Bacillus bovis (Mycobacterium bovis) was made avirulent by special culture conditions, i.e., 230 passages on medium containing potatoes treated with bile salts. It has been used mainly to prevent tuberculosis. The vaccine was named after the bacteriologist Albert Calmette and the veterinarian Camille Guérin, i.e., Bacillus Calmette-Guérin (BCG). These researchers worked at the Pasteur Institute in Lille and launched the vaccine in 1921. Recently, BCG was used also for its non-specific immunostimulant action. Intravesical administration of BCG is an adjunctive therapy for the treatment of bladder cancer, which does not invade the muscle wall. We will discuss the clinical case of a patient who had fever of unknown origin for about 2 months and was resistant to treatment with multiple lines of antibiotics.
subject: Case report
  topic: section
subject: BCG
  topic: keywords
subject: Urothelial Carcinoma
  topic: keywords
subject: Fever
  topic: keywords
subject: Mycobacterium bovis
  topic: keywords
subject: Internal Medicine
  topic: disciplines
subject: Urology
  topic: disciplines
creator: Paolo Ghiringhelli
creator: Federica Macchi
creator: Mariella Ciola
creator: Girolamo Sala
creator: Beatrice Valvo
creator: Andrea Agostinelli
creator: Lorenzo Bellintani
creator: Gaetano Emanuele Rizzo
creator: Michela Provisione
creator: Michela Zaza
creator: Alessandro Diana
creator: Maurizio Ferrarese
rights: Copyright (c) 2023
date: 2023-07-19
publication date: 2023-07-19
doi: 10.7175/cmi.v17i1.1543

Candida guilliermondii Peritonitis During Peritoneal Dialysis. Case Report and Literature Review
type: item
description: Peritonitis is the most frequent complication of peritoneal dialysis (PD) and 3–6% of episodes have fungal origin. Candida guilliermondii is an uncommon species of Candida with invasive behavior in patients affected by severe underlying disorders or using indwelling vascular devices. Here we report the case of an 84-year-old woman undergoing outpatient PD for 4 years who had fever, chills, and diffuse increasing abdominal pain. After empiric antimicrobial therapy, based on teicoplanin in the dialytic circuit plus oral ciprofloxacin plus fluconazole, the patient was hospitalized. Afterwards, the culture from the peritoneal fluid showed the presence of C. guilliermondii. PD-related fungal peritonitis is an infrequent event, but the morbidity and mortality rates are significant. In this scenario, appropriate prevention strategies including antifungal prophylaxis during antibiotic treated bacterial peritonitis should be evaluated.
subject: Case report
  topic: section
subject: Candida guilliermondii
  topic: keywords
subject: Nephrology
  topic: keywords
subject: Peritoneal Dialysis
  topic: keywords
subject: Peritonitis
  topic: keywords
subject: Infectious Diseases
  topic: disciplines
creator: Antonio Mastroianni
creator: Valeria Vangeli
creator: Maria Vittoria Mauro
creator: Francesca Greco
creator: Filippo Urso
creator: Roberto Manfredi
creator: Sonia Greco
rights: Copyright (c) 2023
date: 2023-05-25
publication date: 2023-05-25
doi: 10.7175/cmi.v17i1.1537

Operative Management of Cecal Volvulus Herniating Through the Foramen of Winslow
type: item
description: Cecal volvulus is a surgical emergency which is associated with the risk for bowel ischemia and perforation. Occasionally, volvulus can be caused by an internal hernia. We report the case of a 73-year-old woman with no prior surgical history who had abrupt onset abdominal pain, distension, bilious emesis, and obstipation. Computed tomographic imaging showed a twisted, dilated cecum within the lesser sac with the base of the volvulus at the foramen of Winslow and mass effect against a decompressed stomach. In the operating room, the patient underwent exploratory laparotomy, reduction of the cecal volvulus through the lesser sac, and right hemicolectomy with primary ileocolic anastomosis. Given the substantial morbidity and mortality risk if a closed loop obstruction is left untreated, it is of paramount importance to consider internal hernias as a potential cause to allow an early diagnosis and an urgent surgical treatment.
subject: Case report
  topic: section
subject: Cecal Volvulus
  topic: keywords
subject: Internal Hernia
  topic: keywords
subject: Foramen of Winslow
  topic: keywords
subject: General surgery
  topic: disciplines
creator: Ava Yap
creator: Jonathan Freise
creator: Beverly Bolinger
creator: Ahmed Alkoraishi
rights: Copyright (c) 2022
date: 2022-04-29
publication date: 2022-04-29
doi: 10.7175/cmi.v16i1.1514

Baclofen-Induced Coma Reversible by Dialysis in a Patient Affected by Acute Kidney Injury
type: item
description: Baclofen is commonly used to treat muscular spasticity and other conditions such as pain, alcohol withdrawal, and myoclonus. It is contraindicated in chronic kidney disease. As it is eliminated predominantly by the kidneys, acute kidney injury can lead to acute baclofen overdose with central nervous system affection due to drug accumulation. Currently, there is no consensus about the treatment of baclofen intoxication. A 67-year-old woman was admitted with altered mental status and vomiting. Initially, she was unresponsive/lethargic and kept the intermittent ability of nonverbal communication gradually sliding into a comatose state with apneas. Initial neurologic and radiologic examinations ruled out a structural lesion of the central nervous system. Laboratory data showed acute kidney injury and suspected urinary tract infection with extremely high inflammation parameters. The patient had a history of multiple sclerosis and received daily oral baclofen. Baclofen-induced coma secondary to baclofen overdose caused by renal insufficiency was suspected and renal dialysis started within 24 hours. Cystoscopy and implantation of a ureteric stent were necessary because of obstructive nephropathy. During hemodialysis, the patient’s mental status steadily improved. The patient woke up and was oriented and cooperative. Both clinical and laboratory data were widely normalized within days. Diagnosis of baclofen overdose can be challenging, but adequate supportive therapy, including hemodialysis, should be considered to reduce the length of comatose state and the risk of aspiration pneumonia.
subject: Case report
  topic: section
subject: Coma
  topic: keywords
subject: Baclofen
  topic: keywords
subject: Acute Kidney Injury
  topic: keywords
subject: Dialysis
  topic: keywords
subject: Emergency medicine
  topic: disciplines
subject: Neurology
  topic: disciplines
subject: Toxicology
  topic: disciplines
subject: Nephrology
  topic: disciplines
creator: Oliver Malle
creator: Tadeja Urbanic Purkart
creator: Karin Amrein
rights: Copyright (c) 2022
date: 2022-06-09
publication date: 2022-06-09
doi: 10.7175/cmi.v16i1.1518

[La diagnosi psicopatologica nel lavoro psicologico-psichiatrico]
type: item
description: The psychopathological diagnosis, which is crucial in the psychological-psychiatric work, is performed through tests and interviews aimed at evaluating the cognitive processes and the patients’ behavior. Feeling-thinking-communicating-acting process is particularly important, as it characterizes patients’ evolutionary phases and allows to move closer to the diagnosis. In this study, three patients with different psychological-psychiatric pathologies are described. For each case, verbal and non-verbal communication and psycho-emotional and cognitive sequence are analyzed. After this description, psychodiagnostic test results are discussed in order to highlight signs and symptoms of considered subjects. The described method allows to “explore” psychodynamic spaces hidden by psychic defenses that prevent a clear understanding of the psychic functioning and the operative plot at the intra- and inter-personal level of the subject.
subject: Case series
  topic: section
subject: Language
  topic: keywords
subject: Evolutionary sequence
  topic: keywords
subject: Psychology
  topic: keywords
subject: Psychopathological diagnosis
  topic: keywords
subject: Psychology
  topic: disciplines
creator: Roberto Infrasca
rights: Copyright (c) 2022
date: 2022-07-05
publication date: 2022-07-05
doi: 10.7175/cmi.v16i1.1526

Telemedicine: Current Status and Future Perspectives
type: item
subject: Editorial
  topic: section
subject: Telemedicine
  topic: keywords
subject: Telehealth
  topic: keywords
subject: Healthcare
  topic: keywords
subject: Internal Medicine
  topic: disciplines
subject: Pain Management
  topic: disciplines
subject: Geriatrics
  topic: disciplines
creator: Andrea Tinnirello
rights: Copyright (c) 2021
date: 2021-07-30
publication date: 2021-07-30
doi: 10.7175/cmi.v15i1.1511

Iatrogenic Hypoglycemia Induced by Valproic Acid in an Adult Patient
type: item
description: Literature on antiepileptic induced iatrogenic hypoglycemia is scanty. Due to its broad spectrum of activity and mechanisms of action, valproic acid (VPA), a fatty acid, is the most widely prescribed epilepsy treatment worldwide. Herein, we describe an adult epileptic patient, where persistent, otherwise unexplained hypoglycemia, was most likely induced by VPA, as suggested by the VPA time course and glucose blood levels. Indeed, no further hypoglycemic episodes occurred after VPA discontinuation and the diagnostic work-up ruled out other possible causes of hypoglycemia. This case supports the hypothesis that VPA may induce hypoglycemia, due to still not well-defined metabolic mechanisms of action. Moreover, it emphasizes the fact that an iatrogenic pathogenesis should be considered if an apparently unexplained hypoglycemia occurs in a patient on chronic therapy with antiepileptics, even at a therapeutical dosage.
subject: Case report
  topic: section
subject: hypoglycemia
  topic: keywords
subject: valproic acid (VPA)
  topic: keywords
subject: epilepsy
  topic: keywords
subject: side effects
  topic: keywords
subject: diabetes mellitus
  topic: keywords
subject: Jatrogenic effects
  topic: keywords
subject: seizure
  topic: keywords
creator: Eugenia Rota
creator: Paola Varese
creator: Luciano Arena
creator: Lorenzo Celli
creator: Irene Pappalardo
creator: Nicola Morelli
rights: Copyright (c) 2021
date: 2021-04-23
publication date: 2021-04-23
doi: 10.7175/cmi.v15i1.1487

Risk of Colorectal Cancer in Inflammatory Bowel Disease: Prevention and Monitoring Strategies According With Risk Factors
type: item
description: Colorectal cancer (CRC) is slightly increased in inflammatory bowel disease (IBD) patients, with roughly a 2.5-fold increase compared to the general population. Clinical features associated to CRC risks are extent and severity of colonic involvement, disease duration, concomitant primary sclerosing cholangitis (PSC) and/or familial history of CRC in first-degree relatives. Colonic Crohn’s disease (CD) and ulcerative colitis (UC) share similar risks when similar colonic extent is affected. Risk stratification affects outcomes and surveillance programs. Newer endoscopic techniques substantially ameliorated diagnostic performance of endoscopy, and nowadays the standard for CRC surveillance in IBD patients is high-definition endoscopy, with dye-spray or virtual colonoscopy, oriented at targeted (+ random) colonic biopsies. Visible dysplastic lesions should be considered for endoscopic resection, while invisible dysplasia is still a mandatory proctocolectomy indication. Newer endoscopic interventional techniques (endoscopic mucosa resection, EMR, and endoscopic submucosal dissection, ESD) are appropriate therapeutic techniques to be delivered, but long-term risks of cancer should be balanced towards proctocolectomy.
subject: Clinical management
  topic: section
subject: Inflammatory Bowel Disease
  topic: keywords
subject: Cancer
  topic: keywords
subject: Surveillance
  topic: keywords
subject: Endoscopic Techniques
  topic: keywords
subject: Gastroenterology
  topic: disciplines
subject: Oncology
  topic: disciplines
creator: Enrica Giuffrida
creator: Michela Mangia
creator: Alessandro Lavagna
creator: Enrico Morello
creator: Maurizio Cosimato
creator: Rodolfo Rocca
creator: Marco Daperno
rights: Copyright (c) 2021
date: 2021-02-05
publication date: 2021-02-05
doi: 10.7175/cmi.v15i1.1464

Familial Gullo’s Syndrome: a clinical case report
type: item
description: This case report describes a male patient born in 1953 presenting an occasional increase in serum amylase and lipase forty years ago. The monitoring of enzymes was accompanied by radiological investigations, which did not reveal pancreatic pathology. In his family, including 10 siblings, half were carriers of this isolated anomaly; multiple cysts in pancreas, kidneys, and liver were present in some family members, in addition to a pancreatic neoplasia in a sister who did not carry the enzymatic abnormality. Our patient developed colon adenocarcinoma at the age of 67. Here we examine the characteristics of non-pathological chronic pancreatic hyperenzymemia defined as such by the main Italian pioneer Professor Gullo.
subject: Case report
  topic: section
subject: Hyperamylasemia
  topic: keywords
subject: Hyperlipasemia
  topic: keywords
subject: Familial Pancreatic Hyperenzimemia
  topic: keywords
subject: Gullo’s Syndrome
  topic: keywords
subject: Magnetic Resonance Cholangiopancreatography Imaging
  topic: keywords
subject: Endocrinology
  topic: disciplines
subject: Internal medicine
  topic: disciplines
creator: Mauro Turrin
creator: Lucia Fornasiero
rights: Copyright (c) 2021
date: 2021-03-30
publication date: 2021-03-30
doi: 10.7175/cmi.v15i1.1493

[A rare case of sepsis from Citrobacter koseri in adults]
type: item
description: We describe the case of a 53-year-old man, recently diagnosed with decompensated type II diabetes mellitus, admitted to our Department for fever, asthenia, and detection of multiple lung abscesses and pulmonary embolism at chest tomography. His clinical history revealed just a recent orthopedic surgery of osteosynthesis on the left wrist with normal clinical and instrumental post-surgical evolution. Empirical antibiotic therapy with piperacillin/tazobactam and clindamycin was initiated. During hospital stay, swelling and functional impotence in the right knee occurred. They were investigated by arthrocentesis and magnetic resonance, and diagnosed as septic arthritis. Blood culture performed at admission tested positive for Citrobacter koseri on several samples where meropenem was added according to antibiogram. On the other hand, the cultures of bronchoaspirate, pulmonary fine needle aspiration, and arthrocentesis were negative. Antibiotic therapy was administered up to two weeks after discharge and radiological and physical features progressively improved.
subject: Case report
  topic: section
subject: Citrobacter koseri
  topic: keywords
subject: Septic arthritis
  topic: keywords
subject: Fever
  topic: keywords
subject: Internal medicine
  topic: disciplines
subject: Infectious diseases
  topic: disciplines
creator: Matteo Pistoia
creator: Mariella Ciola
creator: Girolamo Sala
creator: Fabrizio Foieni
creator: Andrea Agostinelli
creator: Beatrice Valvo
creator: Lorenzo Bellintani
creator: Paolo Ghiringhelli
rights: Copyright (c) 2021
date: 2021-06-30
publication date: 2021-06-30
doi: 10.7175/cmi.v15i1.1501

Editorial Staff Disclosure (2020)
type: item
subject: Editorial Staff Disclosure
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2020
date: 2020-12-23
publication date: 2020-12-23
doi: 10.7175/cmi.v14i1.1492

Acknowledgement to Reviewers (January 2020 - December 2020)
type: item
subject: Acknowledgements to reviewers
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2020
date: 2020-12-23
publication date: 2020-12-23
doi: 10.7175/cmi.v14i1.1491

Treatment With Efmoroctocog Alfa (Elocta®) in Hemophilia: A Case Series
type: item
description: Hemophilia A is a rare X-linked disease that occurs as a result of a defect in the FVIII-encoding gene. The reduction or absence of plasma FVIII compromises the coagulation cascade, resulting in frequent bleeds, especially in joints or soft tissues. Currently, replacement therapy with coagulation factor concentrates is the gold standard for the treatment of FVIII deficiency. Herein, we report a case series of five hemophilia A patients treated with an extended half-life recombinant human coagulation factor, FVIII-Fc fusion protein (efmoroctocog alfa). The prophylactic regimen for each patient was individualized based on their pharmacokinetic profile. Compared to previous prophylactic treatments, most patients received a reduced weekly dose of concentrate, all underwent a reduced frequency of administration, the annualized bleeding rates (ABR) and hemophilia joint health scores (HJHS) were stable or improved. The half-life of efmoroctocog alfa and the 72-hour trough levels were higher than those observed in the A-LONG Phase III trial. In conclusion, all patients reported clinical improvements and general subjective wellbeing in the absence of significant safety concerns after switching to efmoroctocog alfa.
subject: Case series
  topic: section
subject: Hemophilia A
  topic: keywords
subject: FVIIIFc
  topic: keywords
subject: Efmoroctocog alfa
  topic: keywords
subject: Bleeding
  topic: keywords
subject: Extended Half-Life
  topic: keywords
subject: Recombinant Factor VIII
  topic: keywords
subject: Hematology
  topic: disciplines
subject: Rare Diseases
  topic: disciplines
creator: Ezio Zanon
creator: Alberto Tosetto
creator: Paolo Radossi
creator: Samantha Pasca
creator: Elisa Bonetti
creator: Simone Cesaro
creator: Anna Chiara Giuffrida
rights: Copyright (c) 2020
date: 2020-10-28
publication date: 2020-10-28
doi: 10.7175/cmi.v14i1.1484

Cerebral Embolism Beyond Atrial Fibrillation: Interatrial Block
type: item
description: This paper is devoted to conditions that imply a risk for cerebral embolism beyond atrial fibrillation (AF). We focus on advanced interatrial block (IAB) and its relationship with stroke in elderly patients with no documented arrhythmias. Advanced IAB is manifested in the surface electrocardiogram (ECG) as a P-wave duration >120 ms plus biphasic morphology (positive and negative deflection) in leads II, III, and aVF. Several data suggest that AF is not necessarily the leading cause of stroke, but rather a risk factor. In fact, a high stroke risk has been described even in the absence of AF in patients with high CHA2DS2VASc-score (Congestive Heart failure, hypertension, Age ≥75 years [doubled], Diabetes, Stroke [doubled], Vascular disease, Age 65-74 years, Sex category [female sex]). Moreover, excessive atrial ectopy and short atrial runs also increase stroke risk. Some of the previously mentioned stroke risk factors in patients without documented arrhythmias might be combined to determine thrombotic risk. That risk is particularly high in elderly patients with advanced IAB, structural heart disease, CHA2DS2-VASc score ≥3, and frequent ambient atrial arrhythmias. Systematic screening for advanced IAB in elderly patients can be performed with a simple surface ECG. Advanced IAB is a risk marker of stroke.
subject: Clinical management
  topic: section
subject: Stroke
  topic: keywords
subject: Anticoagulation
  topic: keywords
subject: Atrial Fibrillation
  topic: keywords
subject: Risk Factor
  topic: keywords
subject: ECG
  topic: keywords
subject: Interatrial Block
  topic: keywords
subject: Geriatrics
  topic: disciplines
subject: Cardiology
  topic: disciplines
creator: Helena Martínez-Sellés
creator: Ana Ayesta
creator: Manuel Martínez-Sellés
rights: Copyright (c) 2020
date: 2020-10-08
publication date: 2020-10-08
doi: 10.7175/cmi.v14i1.1462

La struttura di personalità delle figure sanitarie nel lavoro psicologico-psichiatrico
type: item
subject: Editorial
  topic: section
subject: Psychiatry
  topic: disciplines
subject: Psychology
  topic: disciplines
creator: Roberto Infrasca
rights: Copyright (c) 2020
date: 2020-07-15
publication date: 2020-07-15
doi: 10.7175/cmi.v14i1.1477

The Imprecision of “Precision Medicine” in Pancreatic Adenocarcinoma
type: item
subject: Editorial
  topic: section
subject: Oncology
  topic: disciplines
creator: Stefano Cascinu
rights: Copyright (c) 2020
date: 2020-03-23
publication date: 2020-03-23
doi: 10.7175/cmi.v14i1.1463

A Rare Case Report on Plummer-Vinson Syndrome with a Complication of Oral Cancer in a South-Asian Woman
type: item
description: Plummer-Vinson syndrome (PVS), also called "Paterson-Brown-Kelly syndrome“, is a rare medical syndrome generally affecting middle-aged women. Iron deficiency anemia is the prime etiological factor and other probable factors include malnutrition, genetic predisposition, or autoimmune processes characterized by three distinctive features: iron deficiency anemia, dysphagia, and esophageal web. The dysphagia is generally painless and intermittent or progressive over years, restricted to solids, and associated with weight loss. The exact pathogenesis of PVS is still indistinguishable, but it is interconnected with iron deficiency anemia. Plummer-Vinson syndrome, if left untreated, carries an increased risk of developing squamous cell carcinoma of the upper alimentary tract. In this case report, a 40-year-old female patient presented long-standing dysphagia for months, which progressively developed to postcricoid squamous cell carcinoma by the time she approached to medical treatment. Diagnosis was confirmed through laboratory tests, showing iron deficiency anemia and whole-body positron emission tomography-computed tomography (PET-CT) presenting squamous cell carcinoma in postcricoid region (hypopharynx).
subject: Case report
  topic: section
subject: Paterson-Brown-Kelly Syndrome
  topic: keywords
subject: Plummer-Vinson Syndrome
  topic: keywords
subject: Iron Deficiency Anemia
  topic: keywords
subject: Dysphagia
  topic: keywords
subject: Squamous Cell Carcinoma
  topic: keywords
subject: Postcricoid Region
  topic: keywords
subject: Gastroenterology
  topic: disciplines
subject: Oncology
  topic: disciplines
subject: General medicine
  topic: disciplines
creator: Ayisha Ayisha
creator: Sheema Masood Ali
rights: Copyright (c) 2020
date: 2020-01-30
publication date: 2020-01-30
doi: 10.7175/cmi.v14i1.1448

Myeloid Sarcoma Involving Kidneys: From Diagnosis to Treatment. Case Report and Literature Review
type: item
description: Myeloid sarcomas (MS) are rare extramedullary hematological tumors which generally occur during the natural course of acute myeloid leukemia or chronic myeloid leukemia. Rarely, their onset precedes peripheral blood and bone marrow manifestations of disease. Common sites of involvement are skin, bone, soft tissue, lymph nodes, reproductive or digestive organs, and central nervous system. Herein, we report the case of a 72-year-old man affected by JAK2 V617F mutated myeloproliferative neoplasm who developed MS involving collecting system of both kidneys. MS and MS-related obstructive nephropathy were the first signs of the acute evolution of a known chronic hematological malignancy, preceding by some weeks the onset of leukocytosis.
subject: Case report
  topic: section
subject: Sarcoma
  topic: keywords
subject: Acute Myeloid Leukemia
  topic: keywords
subject: Kidney
  topic: keywords
subject: Hematology
  topic: disciplines
creator: Francesca Guidotti
creator: Angelo Gardellini
creator: Maddalena Feltri
creator: Michelle Zancanella
creator: Vittoria Saccà
creator: Luciana Ambrosiani
creator: Mauro Turrini
rights: Copyright (c) 2020
date: 2020-09-15
publication date: 2020-09-15
doi: 10.7175/cmi.v14i1.1460

Adult ADHD
type: item
subject: Editorial
  topic: section
subject: Psychiatry
  topic: disciplines
creator: Agnese Raponi
creator: Giancarlo Giupponi
creator: Andreas Conca
rights: Copyright (c) 2020
date: 2020-02-25
publication date: 2020-02-25
doi: 10.7175/cmi.v14i1.1459

Cognitive-Behavioral and Pharmacological Treatments for Insomnia: A Combined Approach
type: item
description: Insomnia is the most prevalent sleep disorder (10-40%). It is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep and that results in some form of daytime impairment. Among the typical symptoms, there are fatigue, decreased mood or irritability, general malaise, and cognitive impairment. According to the International Classification of Sleep Disorders 3rd edition, ICSD-3, it has been defined as chronic (lasting more than three months) or short-term insomnia (less than three months). In clinical practice, the usual therapeutic approach is pharmacological (benzodiazepines, z drugs, slow wave sleep enhancers), even if the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the European Sleep Research Society (ESRS) guidelines suggest that the first clinical choice should be non-pharmacological (cognitive behavioral therapy). A combined (non-pharmacological and pharmacological)approach could be considered in poor responders to manage drug dependence and to increase compliance to treatment and patients’ quality of life.
subject: Clinical management
  topic: section
subject: Sleep
  topic: keywords
subject: Insomnia
  topic: keywords
subject: Pharmacological Treatment
  topic: keywords
subject: Non-pharmacological treatment
  topic: keywords
subject: CBT-I
  topic: keywords
subject: Neuroscience
  topic: disciplines
subject: Sleep Disorders
  topic: disciplines
creator: Alessandro Cicolin
creator: Alessandra Giordano
rights: Copyright (c) 2020
date: 2020-07-30
publication date: 2020-07-30
doi: 10.7175/cmi.v14i1.1474

Hypercalcemia and Nephrogenic Diabetes Insipidus: Rare and Life-Threatening Effects of Lithium Intoxication
type: item
description: Lithium is the most effective therapy for bipolar and schizoaffective disorders. Despite its efficacy, lithium has a narrow therapeutic index and adverse effects are frequent. Lithium intoxication (LI) generally affects brain, but less frequently can affect kidneys, thyroid, and parathyroid. Here, we report the case of a patient with lithium neurotoxic effects complicated by parathyroid and renal adverse effects. The patient was a 52-year-old woman treated with lithium, who was recently diagnosed with hypercalcemia and hyperparathyroidism. She was admitted for severe agitation, confusion, and diffuse tremor. Despite serum lithium and calcium normalization, laboratory tests revealed a life-threatening hypernatremia caused by nephrogenic diabetes insipidus (NDI). Hemodialysis was started, but after the first treatment the patient died for cardiac arrest. Neurological symptoms of LI may occur even if the dosage is close to the normal therapeutic range. Hypercalcemia and NDI are rare, but should be promptly diagnosed and treated. In case of poor clinical outcome, hemodialysis should be performed independently of lithium serum level.
subject: Case report
  topic: section
subject: Lithium Toxicity
  topic: keywords
subject: Hypercalcemia
  topic: keywords
subject: Nephrogenic Diabetes Insipidus
  topic: keywords
subject: Hypernatremia
  topic: keywords
subject: Neurology
  topic: disciplines
subject: Psychiatry
  topic: disciplines
subject: Internal Medicine
  topic: disciplines
subject: Nephrology
  topic: disciplines
subject: General medicine.
  topic: disciplines
creator: Arturo de Falco
creator: Maria Lieto
creator: Valentina Scarano
creator: Daniele Spitaleri
creator: Vincenzo Palma
rights: Copyright (c) 2020
date: 2020-09-30
publication date: 2020-09-30
doi: 10.7175/cmi.v14i1.1461

Coronavirus Disease 2019 (COVID-19): A Brief Report
type: item
description: Severe acute respiratory syndrome (“SARS-CoV-2”, previously provisionally named “2019 novel coronavirus” or “2019-nCoV”) disease (COVID-19) in China, at the end of 2019, resulted in a large global outbreak. Among patients with pneumonia caused by SARS-CoV-2, fever is the most common symptom, followed by dry cough. Bilateral lung involvement with ground-glass opacities (GGOs) is the most common finding from computed tomography (CT) images of the chest. At present, there are no specific antiviral drugs against SARS-CoV-2 infection for potential therapy of humans. Current treatments are mainly focused on symptomatic and respiratory support in patients with COVID-19. Preventive measures are the current strategy to limit the spread of cases. The present report summarizes the point of the situation about this global emergency.
subject: Brief report
  topic: section
subject: SARS-CoV-2
  topic: keywords
subject: Coronavirus
  topic: keywords
subject: Pandemic
  topic: keywords
subject: Pneumonia
  topic: keywords
subject: Respiratory Support
  topic: keywords
subject: Infectivology
  topic: disciplines
subject: Pneumology
  topic: disciplines
subject: Emergency
  topic: disciplines
creator: Domenico Lorenzo Urso
rights: Copyright (c) 2020
date: 2020-04-03
publication date: 2020-04-03
doi: 10.7175/cmi.v14i1.1467

Editorial Staff Disclosure (2019)
type: item
subject: Editorial Staff Disclosure
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2019
date: 2019-12-19
publication date: 2019-12-19
doi: 10.7175/cmi.v13i1.1456

Acknowledgement to Reviewers (January 2019 - December 2019)
type: item
subject: Acknowledgements to reviewers
  topic: section
creator: Laura Fascio Pecetto
rights: Copyright (c) 2019
date: 2019-12-19
publication date: 2019-12-19
doi: 10.7175/cmi.v13i1.1455

Listeria monocytogenes Brain Abscess Mimicking Ischemic Stroke in an Immunocompromised Patient: A Case Report
type: item
description: Listeria monocytogenes (L. monocytogenes) is a Gram-positive bacillus that infects immunocompromised persons, neonates, pregnant women and, occasionally, previously healthy individuals. L. monocytogenes brain abscesses are particularly rare. We present a 62-year-old female on corticosteroid treatment due to a recent diagnosis of autoimmune hepatitis, who suddenly developed right hemiparesis mimicking a stroke. A brain computerized tomography (CT) scan revealed a brain abscess and the blood cultures drawn yielded L. monocytogenes. A conservative treatment without surgical intervention was selected. The patient was commenced on intravenous ampicillin and gentamicin and showed remarkable improvement. She was successfully discharged on oral amoxicillin with probenecid. Since the subsequent magnetic resonance imaging (MRI) study and CT scans exhibited reduction in the size of the abscess, the antimicrobial treatment was discontinued after a three-month period. The patient underwent regular follow-up visits with no signs of relapse.
subject: Case report
  topic: section
subject: Listeria
  topic: keywords
subject: Listeria monocytogenes
  topic: keywords
subject: Brain abscess
  topic: keywords
subject: Stroke
  topic: keywords
subject: Immunosuppression
  topic: keywords
subject: Internal medicine
  topic: disciplines
subject: Infectious Diseases
  topic: disciplines
creator: Angeliki Tsifi
creator: Stavroula Panagiota Lontou
creator: Maria Triantafyllou
creator: Sevastianos Chatzidavid
creator: Dimitrios Theodoridis
creator: Marina Skouloudi
creator: Marina Mantzourani
rights: Copyright (c) 2019 The Authors
date: 2019-05-21
publication date: 2019-05-21
doi: 10.7175/cmi.v13i1.1420

The Role of Carbon Dioxide Laser Therapy in Penile Kaposi’s Sarcoma: A Case Series of Three HIV-Negative HHV-8-Positive Patients
type: item
description: Kaposi’s sarcoma (KS) is a rare tumor of vascular origin. It is quite common in HIV patients. It is rarely located on the glans penis, especially in HIV-negative patients (just some tens in the literature). Owing to the rarity of the disease, both the real impact on survival and the most suitable therapy are not known. However, in this 3-patient case series, carbon dioxide laser therapy was effective both for local control and survival. In fact, two late relapses but no disease-related death were recorded. Probably, KS in HIV-negative patients is a slowly progressive disease, not so aggressive as in HIV-positive patients. Laser therapy is easy, fast, and cheap, and may treat the disease radically. If these data are confirmed by further studies, in the foreseeable future, laser therapy may become the gold standard for treating HIV-negative patients affected by penile KS.
subject: Case series
  topic: section
subject: Penile Neoplasms
  topic: keywords
subject: Laser Therapy
  topic: keywords
subject: Sarcoma
  topic: keywords
subject: Kaposi
  topic: keywords
subject: Herpesvirus 8
  topic: keywords
subject: Human
  topic: keywords
subject: Infection
  topic: keywords
subject: Urology
  topic: disciplines
subject: Oncology
  topic: disciplines
subject: Infectious Diseases
  topic: disciplines
creator: Tullio Torelli
creator: Biagio Paolini
creator: Mario Achille Catanzaro
creator: Nicola Nicolai
creator: Maurizio Colecchia
creator: Davide Biasoni
creator: Alberto Macchi
creator: Silvia Stagni
creator: Antonio Tesone
creator: Roberto Salvioni
rights: Copyright (c) 2019 The Authors
date: 2019-03-01
publication date: 2019-03-01
doi: 10.7175/cmi.v13i1.1403