Antithrombotic secondary prophylaxis with low dose of apixaban or rivaroxaban in the onco-hematologic patients: comparison with non-neoplastic patients

Management of cancer-associated thrombosis (CAT) is usually performed employing low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs). Low-intensity DOACs are the mainstay for extended duration therapy for VTE in non-oncologic patients. The aim of our study was to evaluate the efficacy and the safety of low doses of apixaban or rivaroxaban as secondary prophylaxis in patients affected by hematological malignancies with follow-up > 12 months. We report an observational, retrospective, single-center study that evaluated consecutive patients referred to our center between January 2016 and January 2023. The DOACs were administered at full dose during the acute phase of VTE and then at low dose for the extended phase. We included 154 patients: 53 patients affected by hematological malignancies compared to 101 non-neoplastic patients. During full-dose treatment, no thrombotic recurrences were observed in the two groups. During low-dose therapy, 2 (1.9%) thrombotic events (tAE) were observed in the control group. During full-dose treatment, the rate of bleeding events (bAE) was 9/154 (5.8%): 6/53 (11%) in hematological patients and 3/101 (2.9%) in non-hematological patients (p = 0.0003). During low-dose therapy, 4/154 (2.6%) bAE were observed: 3/53 (5.5%) in the hematologic group and 1 (1%) in the control group (p = 0.07). We found encouraging data on the safety and efficacy of low doses of DOACs as secondary prophylaxis in the onco-hematologic setting; no thrombotic complications were observed, and the incidence of hemorrhagic events was low.

Low-dose apixaban or rivaroxaban as secondary prophylaxis of upper extremity deep vein thrombosis

Upper extremity deep vein thrombosis (UEDVT) may occur without inciting factor or may be secondary to malignancy, surgery, trauma, central venous catheter or related to thoracic outlet syndrome (TOS). International guidelines recommend anticoagulant treatment for at least three months, in particular the use of vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs). No data on extended anticoagulant therapy and reduced dose of DOACs have been reported in patients affected by UEDVT with persistent thrombotic risk (active cancer, major congenital thrombophilia) or without affected vein recanalization. In our retrospective observational study, including 43 patients, we treated secondary UEDVT with DOACs. In the acute phase of thrombosis (median time of 4 months), we used therapeutic dose of DOACs; the 32 patients with permanent thrombotic risk factors or without recanalization of the UEDVT were shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily). During therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis; no thromboembolic events were observed during treatment with low-dose DOACs. During full-dose treatment, 3 patients presented minor hemorrhagic complications; no hemorrhagic events were observed during DOACs at low dose. We think our preliminary data could support the indication to extend the anticoagulation with dose reduction of DOACs in patients affected by UEDVT and no-transient thrombotic risk. These data should be confirmed in randomized controlled prospective study.

Estimating bacteria diversity in different organs of nine species of mosquito by next generation sequencing

BACKGROUND

Symbiosis in insects is accumulating significant amount of studies: the description of a wide array of mutualistic associations across the evolutionary history of insects suggests that resident microbiota acts as a driving force by affecting several aspects of hosts biology. Among arthropods, mosquito midgut microbiota has been largely investigated, providing crucial insights on the role and implications of host-symbiont relationships. However, limited amount of studies addressed their efforts on the investigation of microbiota colonizing salivary glands and reproductive tracts, crucial organs for pathogen invasion and vertical transmission of symbiotic microorganisms. Using 16S rRNA gene sequencing-based approach, we analysed the microbiota of gut, salivary glands and reproductive tracts of several mosquito species, representing some of the main vectors of diseases, aiming at describing the dynamics of bacterial communities within the individual.

RESULTS

We identified a shared core microbiota between different mosquito species, although interesting inter- and intra-species differences were detected. Additionally, our results showed deep divergences between genera, underlining microbiota specificity and adaptation to their host.

CONCLUSIONS

The comprehensive landscape of the bacterial microbiota components may ultimately provide crucial insights and novel targets for possible application of symbionts in innovative strategies for the control of vector borne diseases, globally named Symbiotic Control (SC), and suggesting that the holobiont of different mosquito species may significantly vary. Moreover, mosquito species are characterized by distinctive microbiota in different organs, likely reflecting different functions and/or adaptation processes.

Efficacy of Dutasteride, Alfuzosin or both on Quality of Life in Patients with Prostatic Hyperplasia and BOO. A Two-Year Spontaneous, Observational, Self-Controlled Study

Three homogeneous groups of patients suffering from benign prostatic hypertrophy (BPH) were evaluated by means of a two-year observational study, in order to assess and compare their Quality of Life (QoL) under the following different medical treatments. Group 1: alfuzosin alone, Group 2: alfuzosin and dutasteride, Group 3: dutasteride alone. QoL was evaluated by validated indexes, such as the IPSS and the QoL-Vas.

Although different in entity and timing, as expected, all the three groups showed an improvement. The best and quickest results were detected in the drug association of Group 2. Significant decrease in volume was detected in the dutasteride groups (2 and 3) but not in group 1 (alfuzosin alone), where a quick relief of LUTS was detected, due to its well-known alphalytic action. Our results suggest that dutasteride alone does not result in a rapid decrease in LUTS, whereas it can help to manage the reduction of the prostate volume. A combination therapy seems therefore to be recommended to obtain LUTS relief both in the short and long term results.

Incidence of Prostate Cancer in Sicily: Results of a Multicenter Case-Findings Protocol

OBJECTIVE

To establish the incidence of prostate cancer (PCa) in Sicily in patients who entered an early detection protocol.

METHODS

From February 2002 to February 2004, 16,298 subjects aged 40-75 entered the protocol. Patients with suspicious DRE, PSA>10 ng/ml, PSA<or=2.5 ng/ml, from 2.6 to 4 ng/ml or from 4.1 to 10 ng/ml with F/T PSA of <or=15%, <or=20% and <or=25% respectively underwent needle biopsy according to an extensive protocol.

RESULTS

3266 patients were eligible for biopsy; PSA was <or=4 in 12.7% and <or=10 ng/ml in 63.9% of patients. A PCa was found in 1171 cases (36.9%) with a relationship between PCa incidence and PSA and age respectively (chi2-test, p<0.0001); 51.8% of patients with PCa had a PSA<10 and 8.8% a PSA<4 ng/ml; 49% were clinically staged as T1c. The estimated odds ratios for each age group showed increased risk for PCa in the fourth decade with PSA between 2.6 and 4 ng/ml (12.5 times higher) and in the fifth decade with PSA between 4.1 and 10 ng/ml (6.2 times higher).

CONCLUSIONS

Age and serum PSA levels are the major risk factors for PCa. On their basis it is possible to modulate the most suitable timing for early diagnosis in individual patients.

Incidence of bladder cancer in areas “at risk”

– Cancer of the bladder is closely correlated to life style and exposure to environmental and occupational chemical substances. This study, based on data taken from the tumour register of the Province of Ragusa for the period 1988–1992, has shown that bladder cancer is higher in terms of incidence and mortality than the national average. Epidemiological data would seem to back up the suspicion that there is a link between bladder cancer and phytopharmaceuticals, which could act as “initiator” and/or “promoter” agents according to the “carcinogenesis in two stages” theory. Further research will also be carried out with specific toxicological studies.

[Treatment of urinary tract infections with macro-crystalline nitrofurantoin]

Therapy of urinary tract infections with nitrofurantoin macro-crystals. The aim of this study is to evaluate the therapeutic effectiveness of two dosages of nitrofurantoin macro-crystals. Between January 1993 and February 1994, 101 patients (54 male and 47 female), either suffering from urinary tract infections or on whom internal examination had been carried out, were treated with nitrofurantoin macro-crystals. There were divided into two groups: A, a posology of 100 mg 3 times daily for 7 days and B, a posology of 100 mg 4 times daily for 7 days. A urine culture was carried out on all patients before and after treatment. E. Coli was found in 60.5% of cases, Streptococcus Faecalis in 12.7% and Staphylococcus aureus in 5.6%. Infection was eliminated in 85.3% of patients in group A and 93.9% in group B. The dysuric symptomatology was cured in 84.6% of patients in group A, and 89% in group B. The statistic elaboration of the results with X2 and p tests did not reveal any difference between the two groups examined.

Hypothermic prostatic resection

A simple method of markedly reducing blood loss during T.U.R. is reported. Cooling of the irrigant solution to 2 degrees C by placing the glycine in a domestic refrigerator reduces the operative blood loss 6-fold.