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BACKGROUND AND AIMS West Africa has among the highest levels of maternal and neonatal mortality and morbidity globally, including amongst conflict-affected populations. Many lives could be saved and much human suffering averted with effective implementation of low-cost, high impact interventions. METHODS UNHCR implemented a three-year Bill and Melinda Gates Foundation-funded project to reduce neonatal and maternal mortality and morbidity among 772,000 refugees in Cameroon, Chad and Niger. A mixed-method assessment identified needs and priorities. Action plans and a monitoring/supportive supervision tool were developed to track progress. Clinical training on leading causes of neonatal and maternal mortality were adapted using a low-dose, high-frequency approach. Health facilities were rehabilitated, equipped and supported with medicines and commodities, and job aids developed to enhance quality of care. Clinical activities linked with strong community outreach included home visits by community health workers during pregnancy and the first postnatal week. RESULTS A 25% reduction in neonatal mortality rate was achieved with 33,530 births (from 19.0 in Q4 2018 to 11.9/1,000 live births in 2021, p=0.02). Uptake of kangaroo mother care reached nearly 100% among newborns < 2,000g. This, and improved clinical skills and availability of essential supplies, contributed to a decrease in neonatal mortality rates among low birth weight (LBW) newborns. Weighted case fatality rate for newborns with complications, and LBW newborns below 2000g decreased from 11.8% to 6.3%, and 31.5% to 12.3% respectively, from 2019 to 2021. CONCLUSIONS The combination of low-dose high-frequency trainings, health facility strengthening and community outreach activities improved neonatal outcomes and contributed towards sustainability. Future interventions among refugee populations should address persisting socio-cultural issues, including gender-related factors, affecting health access.

Gynecological tumors, including endometrial, cervical and ovarian cancer, have increased in incidence over time. The widespread introduction of screening programs and advances in diagnostic imaging methods has lead to a progressive increase in gynecological cancer detection. Accurate diagnosis and proper monitoring of disease remain the primary target for a successful treatment. In the last years, knowledge about cancer biomarkers has considerably increased providing great opportunities for improving cancer detection and treatment. In addition, in the last few years there has been an important development of imaging techniques. Nowadays, a multimodal approach including the evaluation of serum tumor biomarkers combined with imaging techniques, seems to be the best strategy for assessing tumor presence, spread, recurrence, and/or the response to treatment in female cancer patients In this review we provide an overview of the application of biomarkers combined with novel imaging methods and highlight their roles in female cancer diagnosis and follow-up.

Vitamin D may have prognostic value in hypertension patients and, in addition to conventional biomarkers, could be a valuable tool for disease management. The aim of this study was to assess the association of vitamin D status in patients with essential hypertension and to evaluate its prognostic utility. Forty-eight consecutive patients (40 Caucasian and 8 Asian) aged between 30 and 80 years (mean 61.5, range 34-84 years), were enrolled in the study. The main exclusion criteria were age less than 18 years, kidney failure, onco-hematologic disease, hypo-hyperparathyroidism, osteoporosis, treatment with bisphosphonate or 25(OH) vitamin D supplementation. Of the 48 patients included in the study, hyperlipidemia was described in 28, diabetes type 2 in 8, and ischemic heart disease in 14. Serum electrolytes, calcium, sodium, and potassium concentrations were within normal range. Low 25(OH) vitamin D levels inversely correlated with essential hypertension values (p less than 0.001) were considered extremely significant. The determination of 25(OH) vitamin D levels in patients with essential hypertension could improve the research for possible underlying conditions, which should be managed meticulously according to current guidelines.

Vitamin D may have prognostic value in cardiovascular disease (CVD) patients and, in addition to conventional biomarkers, could be a valuable tool for disease management. The aim of this study was to assess the association of vitamin D status in patients with acute coronary syndrome (ACS) and to evaluate its prognostic utility. The levels of 25(OH) vitamin D were correlated with troponin T hs. Forty-eight consecutive outpatients (40 Caucasian and 8 Asian) aged between 40 and 70 years (mean 61.5, range 43-77 years) were enrolled in the study. All patients were admitted to the Emergency Department with chest pain and suspected ACS. The main exclusion criteria were age18 years, kidney failure, onco-haematological disease, hypo-hyperparathyroidism, hypo/hyperthyroidism, osteoporosis, treatment with bisphosphonate or 25(OH) vitamin D supplementation. Of the 48 subjects included in the study, thoracic pain symptoms were described in 12 patients with unstable angina (UA) and in 6 patients with ST elevation myocardial infarction (STEMI) and in 30 patients with non-ST-elevation myocardial infarction (NSTEMI). Low 25(OH) vitamin D levels correlated with the presence of ACS (p0.02) and inversely correlated with Troponin T hs (TnT hs) levels (p0.03). The determination of 25(OH) vitamin D levels in combination with TnT hs could improve the research for possible underlying conditions, and these should be managed meticulously according to current guidelines.

118° Congresso Nazionale- Società Italiana di Medicina Interna Introduction: cardiovascular diseases represent the leading cause of mortality and morbidity bot in men and woman, and include both heart and blood vessels conditions. The aims of this study was to determine the levels of PCT in acute coronary syndrome. Materials and Methods: Between November 2015 and March 2016, 48 consecutive patients, aged 40 and 70 years were enrolled in the study. Results: among the 48 patients included in the study, chest pain was described in 25% patients with unstable angina, 12,5% patients with St elevation myocardial infarction and 62,5% with no ST elevation myocardial infarction. Conclusion: Studies on the use markers in ACS diagnosis, an inflammatory process indicate usability; but some other studies emphasize its insufficiency in diagnosis and se it only as predictor of heart patients survival.

methods for the large-scale analysis of genetic variation in Plasmodium falciparum by deep sequencing of parasite DNA obtained from the blood of patients with malaria, either directly or after short-term culture. Analysis of 86,158 exonic single nucleotide polymorphisms that passed genotyping quality control in 227 samples from Africa, Asia and Oceania provides genomewide estimates of allele frequency distribution, population structure and linkage disequilibrium. By comparing the genetic diversity of individual infections with that of the local parasite population, we derive a metric of within-host diversity that is related to the level of inbreeding in the population. An open-access web application has been established for the exploration of regional differences in allele frequency and of highly differentiated loci in the P. falciparum genome. The genetic diversity and evolutionary plasticity of P. falciparum are major obstacles for malaria elimination. New forms of resistance against antimalarial drugs are continually emerging 1,2 , and new forms of antigenic variation are a critical point of vulnerability for future malaria vaccines. Effective tools are needed to detect evolutionary changes in the parasite population and to monitor the spread of genetic variants that affect malaria control. Here we describe the use of deep sequencing to analyse P. falciparum diversity, using blood samples from patients with malaria. The P. falciparum genome has several unusual features that greatly complicate sequence analysis, such as extreme AT bias, large tracts of nonunique sequence and several large families of intensely polymorphic genes 3 . Our aim was therefore not to determine the entire genome sequence of individual field samples—which would be prohibitively expensive with current technologies—but to define an initial set of single nucleotide polymorphisms (SNPs) distributed across the P. falciparum genome, whose genotype can be ascertained with confidence in parasitized blood samples by deep sequencing. An additional complication in the analysis of P. falciparum genome variation is that the billions of haploid parasites that infect a single individual can be a complex mixture of genetic types. Previous studies 4–8 have largely focused on laboratory-adapted parasite clones, but the within-host diversity of natural infections is of fundamental biological interest. Parasites in the blood replicate asexually, but when they are taken up in the blood meal of an Anopheles mosquito they undergo sexual mating. If the parasites in the blood are of diverse genetic types, this process of sexual mating can generate novel recombinant forms. Deep sequencing provides new ways of investigating within-host diversity and the role of sexual recombination in parasite evolution.

Glanzmann’s thrombasthenia (GT) is a rare bleeding syndrome characterized by deficiency or defect of platelet aggregation complex. The pathogenesis of endometriosis is controversial but the strongest evidence leans towards retrograde menstruation. GT probably predisposes to endometriosis. The management of women affected by this disease can be difficult due to the risk of bleeding complications, especially during surgical treatment. We describe the cases of three sisters affected by endometriosis and GT, referred to our Department, who received different therapeutic management.

Aim of the present study was to assess the diagnostic value of unenhanced biparametric magnetic resonance imaging (Bp-MRI) as adjunct to CA125 and human epididymis protein 4 (HE4) in the characterization of large ovarian masses.Bp-MRI and dynamic contrast-enhanced (DCE) imaging of 53 patients with large ovarian masses were retrospectively analyzed and compared to histological diagnosis. The results of Bp-MRI and DCE were assessed by two readers in consensus for each technique individually compared to each other and then with HE4 and CA125.Sensitivity, specificity, negative predictive values and positive predictive values for Bp-MRI and DCE were 92.3%, 91.4%, 94.1%, 88.9% and 84.6%, 94.3%, 89.2%, 91.7%, respectively. Both Bp-MRI and DCE were significant predictors of outcome. Among biomarkers, HE4 was significant. Considering the area under receiver operating characteristic curve the model including Bp-MRI and HE4 was not significantly different from the model including DCE and HE4.Bp-MRI in addition to HE4, especially in women of pre-menopausal age, could improve the characterization of large ovarian masses.

Neoplasms of the ovary present an increasing challenge to the physician. Neoplastic ovarian cysts can resemble endometriomas in ultrasound imaging and need to be carefully considered in the differential diagnosis. We report the case of a woman with a strong family history of hereditary breast and ovarian cancer, who presented with a pelvic mass. The young girl refused oncogenetic counseling and genetic testing, even though she had a 50% a priori probability of being a BRCA1 mutation carrier. Pelvic magnetic resonance imaging (MRI) and a comparative analysis of the serum concentration of HE-4 and CA125 biomarkers provided accuracy and sensitivity in the diagnosis of a benign ovarian pathology. Based on this experience, we propose that the sensitivity of a screening program based on a HE4 and CA125 assay and MRI in high risk patients with mutations in the BRCA1 and BRCA2 genes may be considered a useful pre-operative tool for the differential diagnosis of pelvic masses.

A terpyridine-functionalized perylene bisimide chromophore (TPBI) has been used as a building block in the stepwise, layer-by-layer fabrication of self-assembled Fe-TPBI multilayers on gold, with the assembled supramolecular chains oriented approximately perpendicular to the gold surface. Time-resolved spectroscopy measurements seem to indicate that the energy absorbed by the multilayer is promptly dissipated to the gold surface by ultrafast processes.