Duloxetine in the treatment of depression: an overview

Depression is a disorder that can be classified in the categories of non-organic psychiatric disorders and mood disorders. Mood tone is an important psychic function involved in the adaptation to both our internal and external world. It is flexible, that is, it goes up when we are in positive and favorable conditions, but it goes down when we are in negative and unpleasant states. We can define depression as a condition when mood tone loses its flexibility, it goes down and it's no longer influenced by favorable external events. In fact, depression is characterized by changes in the way how the affected individual thinks, feels and acts. Even if this change occurs gradually, a depressed subject is not the same as before. For example, a brilliant student could be persuaded to be not able to finish his studies; an affectionate mother could start to neglect her sons; an enterprising worker could lose every interest for his activity. Moreover, a depressed person doesn't care of his aspect or of himself. The surviving instinct could leave place to the desire to stop his own life. The most evident characteristic of depression in the adulthood is a sad mood, a gloomy solitary and apathetic attitude. A depressed subject could cry also with no apparent reason, he could have difficulty falling asleep or he could wake up very early in the morning and no longer returns to sleep. Or, instead, he could sleep more than usually and he could feel tired persistently. He could lose appetite and weight, or, in some cases, he could eat much more than usually and he could gain weight. Typically, a depressed person feels himself in a extremely negative way, he could think to be hopeless and helpless and he often condemns himself for small guilty. A depressed subject is pessimistic about himself and his own future; he loses interest in all what happens around him and he gets no satisfaction from the activities that before were pleasant. Some persons can be depressed also if they don't show evident signs of depression, but they complain for physical symptoms or they abuse of alcohol or other substances. It has been estimated that in the industrialized Western world one to six persons has a depressive episode at least once during his life; at present, the incidence of depression in the general population is around 5% with clear cut prevalence in the female sex. This leads to high social costs: behind the short-term inability, we have to consider also the long term inability (it has been estimated that, in 2020, depression will represent the second most frequent cause of permanent inability) as well as the suicide risk, the proved major susceptibility of depressed subjects to various non-psychiatric pathologies and the increased rate of premature deaths of depressed individuals as compared to the general population. The present work not only evaluates the drugs used for the treatment of depression, but it focuses also on those studies that investigated the efficacy of a second generation drug: Duloxetine that has a higher selectivity of action and a better tolerability profile as compared to first generation medications. These characteristics make Duloxetine the most effective therapeutic choice to improve both psychological and somatic symptoms of depression in order to get higher rates of symptomatic remission on depressive episodes.     

Malignant pleural effusion

Malignant pleural effusion is a frequent condition with important prognostic repercussions on duration and quality of life. The neoplasms that more frequently determine pleural effusion are lung and breast cancer and pleural mesothelioma. Lymphomas, tumours of the genitourinary tract and gastrointestinal tract as a group account for a further 25%. Surgical treatment has palliative purposes and finalized to reduction symptoms and to improve quality of life. More frequent clinical presentation is a massive pleural efusion associated to dyspnoea and cough. Pleural aspiration is the first choice treatment but the recurrence rate equals to 100% within 1 month. Repeated pleural aspirations are indicated in those patients that have lower expectation of life. The recurrence risk can be reduced with chemical pleurodesis that allows the adhesion between pleural surfaces. Pleurodesis can be realized by the instillation of several substances by the tube of drainage (slurry) or during thoracoscopy (poudrage). Video Assisted Thoracoscopy (VATS) is a safe and well tolerated technique, a complication rate is lower than 0.5%, VATS can be used to obtain diagnosis and to treat patients with malignant pleural effusion and better expectation of life.     

Celiac disease associated with systemic sclerosis

Systemic scleroderma (SS) affects the connective tissue, with involvement of multiple organs. Digestive system involvement occurs in 50% of patients. SS is frequently associated with other autoimmune diseases. Celiac disease (CD) is an autoimmune disorder that affects the digestive system and is trigged by gluten intake. These two diseases share some HLA antigens. We describe the case of a woman with a diagnosis of SS who presented with weight loss. CD was diagnosed. Because the literature on this topic is scarce, this case is compared with a prior review and some similarities were found. Diagnosis of CD in patients with SS may be difficult but is essential to achieve optimal treatment response in patients with poor quality of life.     

Hodgkin Lymphoma and Nephrotic Syndrome in Childhood

An association between nephrotic syndrome and extrarenal neoplasia was described for the first time in 1922. Since then a large number of cases have been published, few of them describing the link between Hodgkin disease (HD) and nephrotic syndrome (NS). It shows that the incidence of nephrotic syndrome in Hodgkin lymphoma is less than 1%. Till date, to the best of author’s knowledge, there are about 50 pediatric cases published, no one among Italian children. In the present paper, the authors report 2 cases observed in their department in the 7 yrs period.     

Treatment-free remission in chronic myeloid leukemia patients treated front-line with nilotinib: 10-year follow-up of the GIMEMA CML 0307 study

We report the final analysis, with a 10-year follow-up, of the phase II study GIMEMA CML 0307 ({"type":"clinical-trial","attrs":{"text":"NCT 00481052","term_id":"NCT00481052"}}NCT 00481052), which enrolled 73 adult patients (median age 51 years; range, 18-83) with newly diagnosed chronic-phase chronic myeloid leukemia to investigate the efficacy and the toxicity of front-line treatment with nilotinib. The initial dose was 400 mg twice daily; the dose was reduced to 300 mg twice daily as soon as this dose was approved and registered. The 10-year overall survival and progression-free survival were 94.5%. At the last contact, 36 (49.3%) patients were continuing nilotinib (22 patients at 300 mg twice daily, 14 at lower doses), 18 (24.7%) patients were in treatment-free remission, 14 (19.2%) were receiving other tyrosine-kinase inhibitors and four (5.5%) patients have died. The rates of major and deep molecular responses by 10 years were 96% and 83%, respectively. The median times to major and deep molecular response were 6 and 18 months, respectively. After a median duration of nilotinib treatment of 88 months, 24 (32.9%) patients discontinued nilotinib while in stable deep molecular response. In these patients, the 2-year estimated treatment-free survival was 72.6%. The overall treatment-free remission rate, calculated on all enrolled patients, was 24.7% (18/73 patients). Seventeen patients (23.3%), at a median age of 69 years, had at least one arterial obstructive event. In conclusion, the use of nilotinib front-line in chronic phase chronic myeloid leukemia can induce a stable treatment-free remission in a relevant number of patients, although cardiovascular toxicity remains of concern.