This review summarized different studies reporting the presence of autoantibodies reacting against cells of the pituitary (APAs) and/or hypothalamus (AHAs). Both APAs and AHAs have been revealed through immunofluorescence using different kinds of substrates. Autoantibodies against gonadotropic cells were mainly found in patients affected by cryptorchidism and hypogonadotropic hypogonadism while those against prolactin cells were found in different kinds of patients, the majority without pituitary abnormalities. APAs to growth hormone (GH) cells have been associated with GH deficiency while those against the adrenocorticotropic cells have distinguished central Cushing’s disease patients at risk of incomplete cure after surgical adenoma removal. AHAs to vasopressin cells have identified patients at risk of developing diabetes insipidus. APAs have been also found together with AHAs in patients affected by idiopathic hypopituitarism, but both were also present in different kinds of patients without abnormalities of the hypothalamic–pituitary axis. Despite some data being promising, the clinical use of pituitary and hypothalamus autoantibodies is still limited by the low diagnostic sensitivity, irreproducibility of the results, and the absence of autoantigen/s able to discriminate the autoimmune reaction involving the pituitary or the hypothalamus from the other autoimmune states.

Background: Left main (LM) coronary atresia (LMCA) is a rare coronary anomaly where the LM is congenitally absent and a variable clinical spectrum can follow. The diagnosis of LMCA is generally made in youth because of the development of symptoms, but very rarely in adulthood. In symptomatic patients, surgical revascularization is recommended, whereas, in asymptomatic patients with LMCA and without inducible myocardial ischaemia, preventive surgical treatment is controversial. Case summary: A 58-year-old male patient with aortic ectasia detected during an echocardiogram performed to evaluate a hypertension-related preclinical cardiac damage and, due to this finding, an echocardiographic follow-up was suggested. Three years later, he was admitted to undergo coronary angiography (CA) after the computed tomography finding of a suspected occlusion of the LM with collateral circulation from right coronary artery (RCA) to left anterior descending and circumflex arteries. CA confirmed an LMCA and the RCA provided blood supply to the left coronary artery through collaterals whose calibre was similar to that of the target left-sided vessels. No obstructive coronary artery disease was detected. In order to detect potential myocardial ischaemia, a technetium-tetrofosmin cardiac single-photon emission computed tomography during maximal exercise-stress test was performed and it did not show a perfusion defect. Medical management with scheduled follow-up visits was deemed to be the best therapeutic option. Discussion: LMCA is a rare anomaly where LM is absent and the RCA provides collateral circulation for left coronary artery. In asymptomatic patients, preventive surgical treatment is controversial.

Context In autoimmune polyendocrinopathy-candidiasis–ectodermal dystrophy (APECED), autoantibodies (AutoAbs) labeling brain neurons were reported, conversely, brain magnetic resonance imaging (MRI) alterations associated to these AutoAbs were never reported. Objectives To describe brain alterations in APECED and to correlate them with AutoAbs against glutamic acid decarboxylase (GAD)-, tyrosine hydroxylase (TH)-, and 5-tryptophan hydroxylase (5-HT)- neurons. Design and participants Fourteen Sardinian APECED patients and age-matched control subjects were recruited for MRI analysis and blood sampling to detect AutoAbs to GAD-, TH-, and 5-HT- neurons using rat brain sections. The majority of patients (n=12) were investigated for AutoAbs a decade ago and 7/12 were positive for AutoAbs to GAD and TH neurons. Main outcomes APECED patients had smaller cerebellum and gray matter volumes, with a ventricular enlargement and a total liquor increase, compared to controls (p<0.01). In 11/14 patients, brain abnormalities were associated with AutoAbs to GAD and/or TH neurons (titer 1:100–15000), that had persisted for 10 years in 7/11 patients. AutoAbs to 5-HT neurons were revealed in all patients with AutoAbs to TH neurons. A decrease in whole brain and cerebellum volumes (p=0.028) was associated with AutoAbs to GAD neurons while a liquor increase with AutoAbs to GAD- and TH/5-HT neurons (p<0.05). HLA alleles did not appear to be involved in neuronal autoimmunity. Conclusions For the first time, brain alterations together with neuronal AutoAbs were observed in 78.6% Sardinian APECED patients, suggesting a brain autoimmune reaction. Prolonged clinical follow-up must be conducted for the possible appearance of clinical neurological consequences.

Background The aim of this study was to evaluate the prevalence and clinical significance of Anti-neuronal antibodies (AnAb) in a cohort of neuropsychiatric (NP) Systemic Lupus Erythematosus (SLE) patients. Methods Overall, 28 SLE patients (age 45.6 ± 14.4 years) with inflammatory neuropsychiatric syndromes, classified according to existing criteria (1, 2) were enrolled and serum samples were collected before starting treatment for the specific NP event; 41 consecutive SLE patients (44.2 ± 14.2 years) without NP involvement, 22 Multiple Sclerosis patients (37.9 ± 11.0 years) and 82 healthy subjects (44.8 ± 15.0 years) served as controls. Search for AnAb was performed by tissue-based immunohistochemistry assays (IHC) on male Sprague Dawley rat’s brain sections and confirmed by cell-based immunocytochemistry assays on SH-SY5Y (human neuroblastoma) cell cultures. The association between serum positivity for AnAb by IHC and a large panel of data (demographic, serologic, SLEDAI, conventional brain MRI, treatment) was investigated by univariate analysis. Multivariate models were fitted with covariates with p<0.05 to identify factors independently associated with serum positivity for AnAb; p<0.05 were considered statistically significant. Results AnAb were detected in 23 (82.1%) NPSLE patients and in 16 (39.0%) SLE patients without NP involvement resulting in 82% specificity (95%CI 71%-90%) and 61% sensitivity (95%CI 48%-72%) in differentiating NPSLE from SLE without NP involvement. None of the sera from MS patients (0%) and healthy subjects (0%) showed AnAb. Serum AnAb by IHC were independently associated with NPSLE (p<0.01) and higher SLEDAI (p<0.01). No association with specific NPSLE syndrome and brain conventional MRI abnormalities was identified. Conclusion AnAb are significantly more frequent in patients with NPSLE than SLE. Further studies are needed to identify the unknown neuronal antigens targeted by AnAb in SLE patients.

Background and Importance Penitentiary institute contain a population of prisoners or interned who, from the moment they enter the prison, they bring with them their personal experience of discomfort that results in the concentration in a single environment of physical, mental and behavioural diseases. The direct consequence is the use of a large number of drugs. The activities of the hospital pharmacy include the distribution of drugs to the penitentiary institute. Aim and Objectives The objective of the study was to analyse the use of drugs in the prison population strongly influenced by the contingent situation and which has a high demand for health needs. Material and Methods A study was conducted to examine data of drugs required from the penitentiary institute in terms of quantity expressed in dosage units and costs from the data consumption of hospital medicines in the three-year period 2019–2021. Results The total cost of medicine consumption in the penitentiary institution considered is €103522.9 in 2019, €81.484.31 in 2020, down by 21.2% compared to the previous year and €86.525.72 in 2021 (Δ% 21–20 = +5.8). Analysing the first level of Anatomical Therapeutic Chemical (ATC) classification system, the highest consumption value is related to drugs for the nervous system (N), followed by those active on alimentary tract and metabolism (A) and cardiovascular drugs (C). By analysing costs, the highest value is observed for the category of drugs for the nervous system, 68% in 2019–2020 of the total cost and 61% in 2021. Drugs active on alimentary tract and metabolism represent the 7% in 2019–2020 and 11% in 2021 respectively. The therapeutic category with the highest consumption are psycholeptics, antiepileptics and drugs for disorders related to acid secretion. Among the substances with the greatest cost are clonazepam and aripiprazole in 2019–2020, while in 2021 is promazine. Valproic acid and quietapine are the most used substances in the three-year period. Conclusion and Relevance The data described the use of drugs in a penitentiary institute emphasised the high pharmacological burden consequence of many pathologies in this population. In fact, psychotropic drugs are the most commonly used substances. This data is related to the presence of neuro-psychiatric disorders in prisoners. Conflict of Interest No conflict of interest