Improved Survival and Quality of Life Through an Integrative, Multidisciplinary Oncological Approach: Pathophysiological Analysis of Four Clinical Cancer Cases and Review of the Literature.

Objectives: According to the National Cancer Institute, the integrative medicine (IM) approach to medical care combines standard medicine with complementary and alternative medicine practices that have proved safe and effective. Methods: We describe the clinical cases of four patients with malignant pleural mesothelioma (MPM), diffuse malignant peritoneal mesothelioma (DMPM), intrahepatic cholangiocarcinoma, and breast cancer (BC) who received supportive treatment (ST) according to an IM approach after the failure of standard cancer treatments or the appearance of serious adverse events caused by antiblastic chemotherapy. The critical role of complementary drugs in reducing the side effects of cancer treatments and normalizing the white cell count is especially apparent in the case of the patient with metastatic BC, who experienced prolonged neutropenia. Results: The IM approach was well-tolerated and had no adverse side effects. It improved the quality of life (QoL) of all patients and in two cases extended overall survival. Conclusion: The extended clinical and instrumental response to IM of the patients with malignant mesothelioma and the improved health-related QoL and good tolerance of the ST demonstrated in all cases support the value of this approach in patients whose cancer therapies have failed but who show a good performance status. Our data require confirmation in a well-designed prospective clinical trial.

Long-term clinical impact of a virtual model of care in cystic fibrosis

Background: Health professionals have explored and tested the use of digital technologies provide in managing chronic respiratory diseases remotely during the COVID-19 pandemic. Further investigation into whether these new approaches to care delivery provide an opportunity to improve cystic fibrosis (CF) management is needed. The aim of this study was to assess the long-term clinical impact of use of e-health as part of a virtual model of care in CF. Method(s): The NuvoAir Home platform consists of a smartphone application, Bluetooth spirometer, and clinician portal. Patients were trained to use the platform and asked to perform home spirometry monthly. Data on pulmonary function and pulmonary exacerbations were collected at baseline and after 12 months. A surveywas emailed to evaluate patients' experience using the technology. Result(s): A cohort of 43 people with CFwere recruited (26 female;mean age 31.6 +/- 6.8;16 homozygous for delta F508;FEV1 48.4 +/- 16.3% predicted). Sustained improvement in forced expiratory volume in 1 second (FEV1) expressed as absolute and percentage predicted was seen through 12 months (mean absolute change 100 mL, p = 0.02;mean percentage predicted change 3.8%, p = 0.005). We found significant improvement in forced vital capacity expressed as absolute value (mean change 230 mL, p = 0.006) and percentage predicted (mean change 6.2%, p = 0.002). The average of number of exacerbations per person 1 year before use of digital technology was 0.84, vs 0.09 1 year after ( p < 0.001). Ninety percent of patients reported that they understood their CF better after starting the virtual care service. No changes in medical treatmentwere reported during that time. Conclusion(s): Use of digital technologies in the management of adults with CF improved lung function and decreased pulmonary exacerbations. People with CF readily accepted using a virtual model of care and improved their understanding of their medical condition. Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Effectiveness and safety of a new helmet CPAP configuration allowing tidal volume monitoring in patients with COVID-19.

BACKGROUND: High generated tidal volumes (Vt) have been correlated with higher risk of self-induced lung injury and worse clinical outcome. This study aimed to evaluate the effectiveness and safety of a new helmet continuous positive airway pressure delivered (h-CPAP) configuration allowing Vt monitoring in patients affected by COVID-19. METHODS: This prospective observational study was performed in the respiratory intermediate care unit of University Hospital in Turin, Italy, between March 24th, and June 15th, 2020. Included patients were treated with CPAP via a single-limb intentional leak configuration by a turbine-driven ventilator, provided with a dedicated patch. Effectiveness and safety of the configuration and healthcare workers safety were the outcomes of the study. MAIN FINDINGS: Thirty-five patients were included in this study. Median age was 67 years (IQR 57-76 years), and 30 patients (85.7%) were men. Median value of overall leaks (intentional plus unintentional) was 68 L/min (IQR 63-75). Reliability of Vt measurements was 100%. An out of scale of Vt (above 50% compared to the previous values) was never recorded. Six patients (17.1%) needed more than two helmet replacements, due to leak test >10 l/min. Arm oedema and skin breakdowns were reported in sixteen (45.7%) and seven (20%) patients respectively. Among the 63 healthcare workers involved in the care of COVID-19 patients during the study only one was positive at RT-PCR nasopharyngeal swab testing. CONCLUSIONS: The use of h-CPAP for treating COVID-19 in this configuration allowed for reliable Vt monitoring. Further studies evaluating this configuration in larger patients' cohorts are needed.

Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review.

BACKGROUND: Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety. METHODS: MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020. RESULTS: We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group, 15 single-arm). To date, no randomized trials have been published. We retrieved no studies at low risk of bias. Forty-five ongoing studies were retrieved from trial registries. CONCLUSIONS: There is insufficient evidence regarding the clinical efficacy and safety of tocilizumab in patients with COVID-19. Its use should be considered experimental, requiring ethical approval and clinical trial oversight.

[Standard procedures in dialysis during the Covid-19 epidemic]

Scope: The aim of this document has been to define standard procedures for dealing with dialysis patients once the first cases of novel Coronavirus 2019-nCoV (Covid-19) were confirmed among the Italian population. Applicability: These procedures, that refer exclusively to the hospital's dialysis rooms, are currently implemented at the ASST Santi Paolo e Carlo in Milan and two smaller centers in the Milan area. Description: We describe the preemptive measures adopted by the staff at our dialysis unit since 24/02/2020, in order to slow down the transmission of Covid-19. They have allowed us to adopt a uniform approach towards all patients, streamlining the way we identify and deal with suspected, likely and confirmed Coronavirus infections. To start with, all patients coming to the hospital for their dialytic session have been treated as potentially infectious and everybody has been following closely the standard protocols regarding personal protective equipment (PPE).