This case report illustrates a patient with Heparin-Induced Thrombocytopenia (HIT) who was successfully treated with Apixaban. HIT is an adverse drug reaction induced by treatment with heparin. The optimal anticoagulation strategy remains uncertain. This case presents a patient who developed massive pulmonary embolisms post total knee replacement, she was then treated with low-molecular-weight heparin (LMWH), which lead to bleeding and a critically platelet count drop, indicating serious HIT 2 syndrome. By discontinuation of LMWH and switch to Apixaban in a modified dose regime, we managed to stop the life-threatening complications of LMWH. The platelet count recovered, and the patient survived.

By means of the formidable emergence of medical technology, the future role of the traditional clinician is called into question, because of the risk of becoming just a technician of operating devices, and progressively moving away from patients as individuals.

We present a case of a woman with progressive parkinsonistic features, and a previous history of breast cancer with no recurrence since 20 years.

Intravenous Urography (IVU) has been used in emergency departments for the evaluation of patients with acute renal and urinary tract colic. A non-contrast computed tomography (NCCT) is rapidly becoming the preferred imaging modality for the evaluation of patients with suspected renal colic. The purpose of this work is to investigate whether NCCT can replace IVU as the primary modality for the evaluation of patients with acute renal colic in radiology departments at four hospitals from the perspective of comprehensive diagnosis of both techniques. The methods employed in this study monitor and review the radiological investigation records of 520 patients with acute renal calculi who visited four hospitals between April 2016 and March 2017 and analyse the use of IVU and NCCT. Patients have been adopted based on their radiological examinations records for renal colic in four hospitals. NCCT showed a more comprehensive diagnosis and a short study time, whereas IVU indicated a lower radiation dose and better cost-effectiveness. An intravenous urogram (IVU) showed 81% sensitivity and 89% specificity, while non-contrast computed tomography (NCCT) had sensitivity and specificity of 95% and 97%, respectively. In conclusion, NCCT is highly sensitive and specific for renal and ureteral calculi but the challenges it faces are that CT examination generates higher radiation doses compared to examination by IVU, even when using a low radiation dose CT protocol

Purpose: Diabetes is an increasing and relevant public health problem due to the increasing prevalence and incidence. Despite the recommendations, a large proportion of patients do not achieve the desired level of glycemic control even after starting basal insulin. In the past years new therapeutic options have been made available, providing an alternative to insulin treatment initiation after the failure of oral therapy; for these reason, we performed an economic evaluation to estimate the impact on the Italian National Health Service (INHS) expenditure of treating with exenatide once weekly those patients for whom basal insulin would be the treatment of choice.

Patients and Methods: A budget impact model based on Italian data (drug market composition, healthcare resource use and costs) was developed as indicated by international guidelines.

Results: Hypothesizing a greater uptake of exenatide once weekly versus basal insulin’s, even considering the high cost of exenatide once weekly, the model estimates a relevant saving for INHS expenditure due to the reduction in use and related costs for consumables, outpatients and hospitalization. The reduction in healthcare expenditure is estimated at national level in €5.8 million the first year, €15.5 million the second year and €27.3 million the third.

Conclusions: The increased use of exenatide once weekly as a possible effective and safe treatment option in patient’s candidate to basal insulin, by reducing healthcare resource use as ospitalizations, outpatients and consumables, could be associated with a reduction in total healthcare expenditure in Italy.