Neoadjuvant Treatment for a cT4cN+ HER2+ Breast Cancer: Case Report of a Therapeutic Success.

BACKGROUND: HER2 positive disease accounts for 15-20% of early breast cancer. Achieving a pathological complete response after neoadjuvant chemotherapy (NACT) improves prognosis and decreases risk of recurrence. CASE REPORT: Our case report aimed to highlight an emblematic clinical success and benefit of NACT with the addition of pertuzumab to the standard trastuzumab/taxane/anthracycline combination in a patient with a 9 cm breast neoplasm and extensive lymph node involvement (>4 pathological lymph nodes). CONCLUSION: Achieving a complete pathological response with NACT, should be the main goal, especially in patients with triple negative and HER2 positive breast cancer.

Clinical nutrition and the role of hospital pharmacist in the management of covid patient.

The nutritional status of everyone represents a fundamental element to maintain a good health and it can be related to infectious agents in some disorders. Prevention, diagnosis and treatment of malnutrition should be included in the management of SARS-CoV-2 patients in order to improve both short- and long-term prognosis. In Covid patients the choice of route of administration for nutrition is closely related to respiratory autonomy. In subjects who are not mechanically ventilated or with non-invasive ventilation (NIV), spontaneous oral feeding is strongly indicated, while considering the patient's comorbidity, chewing ability and swallowing. If this is not possible or if it is not possible to meet the appropriate nutritional needs, it is necessary to resort to artificial nutrition (enteral or parenteral). Enteral nutrition (EN) is preferred to parenteral nutrition (PN) because it allows to maintain the trophism of the gastrointestinal tract, involving a lower risk of infectious complications and it is easier to manage. PN is usually used in patients in whom NE is not feasible, insufficient or contraindicated, or in patients with invasive total mechanical ventilation. Based on these considerations, it would be necessary to develop a targeted nutritional pathway in order to support the management of Covid patients. In the nutritional management of these patients, the role of the hospital pharmacists is fundamental. They collaborate with clinicians, nutritionist, dieticians and speech therapists to choose the most appropriate nutrition, based on the clinical characteristics of the patient and on the availability of nutritional formulations in the therapeutic guide.

Real-Life Analysis with Erenumab: First Target Therapy in the Episodic and Chronic Migraine's Prophylaxis.

BACKGROUND: to research retrospectively the efficacy of Erenumab's treatment, thus allowing to describe a summary more in line with the reality observed every day in clinical practice, relative to a sample of patients widely heterogeneous. The study aims to confirm the efficacy of Erenumab, in terms of reduction of migraine days per month, from baseline to month 12 of treatment. Additional objectives included a reduction in the number of days of symptomatic drug use and change from baseline in the Migraine Disability Assessment Score Questionnaire (MIDAS); Methods: the analysis included all patients treated for 12 months with Erenumab during the year 2019-2020. The population analyzed consists of twenty-six patients from the Neurology outpatient clinic in Fossombrone. Several quantitative and qualitative variables were recorded by reading the medical records of the patients. The MIDAS was administered to patients to assess the disability related to migraine; Results: at the end of treatment, a statistically significant reduction in the mean number of monthly migraine days, acute medication use per month, and MIDAS questionnaire score was observed; Conclusions: as a preventive treatment of episodic and chronic migraine, our analysis data confirm the efficacy of Erenumab for the prevention of the migraine. The success is achieved in 96% of cases.

Severe hypocholesterolaemia is often neglected in haematological malignancies.

AIM OF THE STUDY: It is generally believed that high levels of cholesterol (hypercholesterolaemia) are life-threatening, while low levels seem to be positive. Unfortunately this assumption is far from true, and can be indicative of an underlying serious medical condition in most of the cases (i.e. cancer). However, the biological role of severe hypocholesterolaemia is poorly understood. Here, the possible biological process is being investigated. Cholesterol plays a key role in cell proliferation, hence it has been suggested that low cholesterol levels are probably linked to the high cellular cholesterol demands from neoplastic cells. SUMMARY OF THE METHODS: We used serum and isolated T-lymphocytes from patients with acute lymphoblast leukaemia and human lymphoblast cell line to test this hypothesis. RESULTS: We found that patients with low serum cholesterol levels have instead high levels of cholesterol in lymphocytes. These data were supported with in vitro studies. In fact we have demonstrated that low cholesterol level in the culture medium was related to the neoplastic cellular growth, suggesting a greater use by lymphoma cells for their proliferation. Therefore by inhibiting cholesterol synthesis by mevastatin, in vitro, we showed that cholesterol levels did not change significantly in culture medium and the cellular growth was inhibited. CONCLUDING STATEMENT: Following these preliminary results, blood cholesterol levels could be potentially considered a good biological marker to follow up the neoplastic process.