We use ϵ-aminocaproic acid or tranexamic acid swish and swallow to help control oral bleeding, topical thrombin, collagen, and fibrin glue to manage dental extractions, and progestational agents to manage menorrhagia. All others can be treated as outpatients. Oggi risponderemo a una domanda che molti dei nostri lettori ci pongono frequentemente ovvero: Come faccio ad inserirmi nelle graduatorie? Diplomati ITP in GAE: pronuncia Storica del Tribunale di Torino #AssetScuola What is more contentious and requires individualization and considerable judgment is the wisdom of treating patients with platelet counts between 20 000 and 50 000 × 109/L. Therapy of adult ITP before splenectomy. Idiopathic thrombocytopenic purpura in adults: current issues for pathogenesis, diagnosis and management. Our experience is consistent with the reported incidence of relapse of 15% to 25% within 10 years.7,25 In general, responses cannot be predicted through routinely available measures.48 However, we have found that patients totally refractory to multiple prior treatments appear to fare less well, as do the elderly,50 patients with secondary forms of ITP,51 and perhaps those with an hepatic platelet sequestration pattern,25,52 although we have no direct experience on the latter. An alternative is to use cyclophosphamide either intravenously (2 or 3 courses of 500-1000 mg/m2 at 3-4-week intervals)67 or orally (1-2 mg/kg daily adjusted to avoid severe neutropenia). I ricorsi per essere inseriti in II fascia G.I. Long-term follow-up study of 168 patients with immune thrombocytopenic purpura. Fabris F, Tassan T, Ramon R, et al. A sancirlo sono state le storiche pronunce giudiziarie 9234/17, 6443/17 e 4879/18 del Tar Lazio, che contro ogni pronostico ha ufficialmente riconosciuto […] Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by auto-immune thrombocytopenia. We do not use danazol, cyclophosphamide, anti-CD20, vinca alkaloids, and other potentially teratogenic therapy (with the possible exception of azathioprine for which a registry exists for renal transplant recipients83 ). Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. Various combinations of chemotherapeutic agents have been used successfully in small numbers of heavily pretreated patients.69 In one study, the long-term outcome of 12 patients (follow-up 35-150 months) included 5 complete and 1 partial remission.70 Therapy should be stopped if there is no response after 2 courses and the literature is based on treating responders with at least 3 or more courses even if the platelet count has normalized. Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. Graduatorie provinciali 2020: disposizioni per docenti inseriti nelle graduatorie ad esaurimento e per gli Insegnanti Tecnico Pratici. If a response occurs, therapy should be continued at full doses for at least 12 months and then discontinued gradually. Combination immunotherapy for patients with refractory ITP or Evan's syndrome (ES) [abstract]. Ideally, maternal platelet counts should be maintained above 20 000 × 109/L throughout pregnancy and above 50 000 × 109/L near term to minimize the need for platelet transfusions in the event an emergency cesarean section is required,2,3,79 but a higher platelet count may be required for epidural anesthesia. Splenectomy remains the single best option to convert a patient with ITP into a “nonpatient,” that is, one who is unlikely to need frequent monitoring or intervention, and it minimizes interference with a normal lifestyle. ITP remains a diagnosis of exclusion. The timing of the procedure depends on disease severity, responsiveness and side effects of therapy, risk of trauma and of the procedure, and patient and doctor preference. Per quanti di loro hanno intrapreso le vie giudiziali per entrare in II fascia e nelle GAE si prospettano nuovi sviluppi sulla base di alcune pronunce del TAR. (4) We recommend splenectomy for those clearly requiring therapy beyond 12 months to maintain a hemostatic platelet count and sooner in select individuals intolerant of therapy, with active lifestyles or comorbid risk factors that make higher platelet counts desirable. Idiopathic thrombocytopenic purpura, neonatal alloimmune thrombocytopenia, and post-transfusion purpura. Fiduciosi delle recenti pronunce favorevoli ottenute, CORSO DIGITALE PER COLLABORATORE SCOLASTICO (ATA), BOOM DI CONVOCAZIONI COME ASSISTENTE TECNICO. (1) The goal of therapy in this population is to maintain a hemostatic platelet count while minimizing drug-induced toxicity; select patients may require somewhat higher platelet counts because of comorbid risk factors as discussed in “Treatment of chronic ITP.” (2) Our preference is to use anti-CD20 if not used previously and we consider reuse if a response was seen prior to splenectomy. Response to treatment, especially intravenous immune globulin (IVIG) or intravenous anti-D (IV anti-D), even if transient, is the single best diagnostic test. Sono un ITP con ricorso per l’inserimento in GaE in attesa di risposta; posso iscrivermi? ITP requisiti di accesso GPS Portiejle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Un’altro ostacolo, questa volta riguarda gli ITP che chiedevano l’ingresso in GaE? ITP: Quali sono i diplomi e le classi di concorso dell’insegnante tecnico pratico30 Settembre 2019 Concorso ITP 2020: bando, come partecipare, prove, cosa studiare29 Aprile 2020 Come diventare ITP: mansioni, requisiti, diplomi, classi di concorso e stipendio18 Novembre 2019 Newland A, Caulier MT, Schipperus MR, et al. Doan CA, Bouroncle BA, Wiseman BK. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. I Diplomati ITP devono essere Inseriti in GAE, a sancirlo sono state le storiche pronunce giudiziarie 9234/17 e 6443/17 del Tar Lazio. Stessa sorte per gli ITP e altre categorie di docenti.Sono ormai centinaia i rigetti dei tribunali per l’inserimento in GAE , ma nonostante ciò si continuano a proporre ricorsi senza senso , solo per spillare soldi ai propri associati. Although we think that a platelet count of 50 000 × 109/L is generally sufficient for epidural anesthesia, we find practice patterns are set by obstetricians and anestheologists.3,86 Criteria for heparin prophylaxis after cesarean section have been reviewed.3 ITP is not a contraindication to breast-feeding. Therapy of adult ITP following splenectomy. A retrospective, 11-year analysis of obstetrical patients with idiopathic thrombocytopenic purpura. Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor. Cines DB, McMillan R. Management of adult idiopathic thrombocytopenic purpura. Solo pochi giorni fa si è avuto il pronunciamento del Tar del Lazio sulla questione degli ITP in seconda fascia: ecco cosa è stato deciso. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Si tratta di un vero e … Non sono un legale, ma non mi è parso di capire in queste "storiche pronunce giudiziare" che gli ITP abbiano diritto ad essere inseriti in GAE. DOMANDA GAE DIPLOMA ITP 2 DATA _____ FIRMA _____ e che il Ministero dell’Istruzione, dell’Università e della Ricerca provveda ad attivare le apposite funzioni della piattaforma telematica “Istanze on line” anche per il/la sottoscritto/a al fine di ITP requisiti di accesso GPS. Sono . Il legale sottolinea il fatto che il docente ITP in questione potrà partecipare al prossimo ed imminente piano delle assunzioni a seguito del proprio inserimento nelle GAE. Initial management of immune thrombocytopenic purpura in adults: a randomized controlled trial comparing intermittent anti-D with routine care. ricorso inserimento in gae 2019 itp. In the largest series to date, 25% to 30% of patients showed responses lasting longer than 1 year.47 Alternatives, including anti-CD20 (rituximab) or danazol are discussed (see “First-line therapy” and “Second-line therapy,” respectively). We generally choose danazol and either azathioprine or mycophenolate mofetil. However, long-term effects of the procedure on the incidence of occlusive cerebrovascular disease remain under study. Dubbi dei lettori. po indicates orally; prn, as needed; and q, every. Approximately 4% of ITP neonates are born with severe thrombocytopenia (platelet counts < 20 000 × 109/L), but importantly few have platelet counts that are less than 5000 × 109/L unless alloantibodies are also present.87 The severity of neonatal thrombocytopenia is often most marked 1 to 3 days after birth. McCrae KR, Samuels P, Schreiber AD. Cooper N, Heddle NM, Haas M, et al. These assays lack sufficient sensitivity to exclude a diagnosis of ITP18-20 and interlaboratory reproducibility is inadequate.21. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis (RE9960). Cines DB, Blanchette V. Idiopathic thrombocytopenic purpura. There is limited experience with chemotherapy for neoplastic diseases in pregnant women that may be helpful in managing the truly exceptional case (for reviews, see Koren et al84 and Weisz et al85 ). Cortelazzo S, Finazzi G, Buelli M, Molteni A, Viero P, Barbui T. High risk of severe bleeding in aged patients with chronic idiopathic thrombocytopenic purpura. Per maggiori informazioni consultare i seguenti allegati: Sentenza. Figure 1 shows our treatment algorithm for initial management. Proton pump inhibitors should be given when corticosteroids are used for more than a few weeks. Il suo ambito principale d’azione è rappresentato dagli Istituti Tecnici e Professionali, dove le ore di laboratorio ricoprono buona parte del progetto formativo degli alunni. Calverley DC, Jones GW, Kelton JG. The patient should be informed that no antenatal maternal measurements reliably predict the neonatal platelet count, nor does the maternal response to treatment guarantee a favorable neonatal outcome; conversely, women requiring considerable therapy to manage their platelet count should not assume their neonate has an inordinate risk of bleeding. Docenti ITP in seconda fascia dopo sentenze negative. I diplomati ITP hanno diritto a restare nelle graduatorie ad esaurimento (GAE) nelle rispettive province, anche ai fini della stipula dei contratti di lavoro a tempo indeterminato o determinato (Sentenza 707 del 26 agosto 2020). However, it is also important to point out that precipitous falls are seen on occasion and demand more intensive therapy with its attendant complications. (3) Thrombocytopenia recurs in most adults as corticosteroids are tapered. A sancirlo sono state le storiche pronunce giudiziarie 9234/17, 6443/17 e 4879/18 del Tar Lazio, che contro ogni pronostico ha ufficialmente riconosciuto il Diritto dei Diplomati ITP ad entrare in GAE. Warner MN, Moore JC, Warkentin TE, Santos AV, Kelton JG. Il mancato invio di tutta la documentazione determina l’impossibilità di procedere al ricorso e lo studio legale è sollevato da qualsiasi responsabilità in caso di mancato invio della documentazione nei termini richiesti. Antiphospholipid antibodies and antiphospholipid syndrome in patients presenting with immune thrombocytopenic purpura: a prospective cohort study. N400/2017 *** Dopo la recente e storica vittoria presso il Tribunale del Lavoro, che ha inserito nelle GAE i docenti abilitati ITP vengono riaperti i termini … Maloisel F, Andres E, Zimmer J, et al. We also initiate general measures to reduce the risk of bleeding, including cessation of drugs that impair platelet function, control of blood pressure, measures to minimize trauma, and measures to reduce mucosal bleeding, such as ϵ-aminocaproic acid (100 mg/kg loading dose up to a maximum of 5 g given intravenously over 30-60 minutes followed by up to 5 g every 6 hours intravenously or orally [maximum dose = 24 g/day]) and, on occasion, desmopressin acetate (DDAVP; 0.3 μg/kg). I Diplomati ITP devono essere Inseriti in GAE, a sancirlo sono state le storiche pronunce giudiziarie 9234/17 e 6443/17 del Tar Lazio. (2) We generally initiate therapy with prednisone and add either IV anti-D (in Rh+, direct antiglobulin-negative patients) or IVIG as needed for persistent severe thrombocytopenia with the goal of attaining a platelet count of greater than 30 000 × 109/L and cessation of bleeding. Shashaty GG, Rath CE. VEDI ANCHE: Concorso ITP 2020 - Bando, requisiti, come partecipare, cosa studiare In quali scuole e quali materie possono insegnare gli ITP. A prospective study of protein-specific assays used to investigate idiopathic thrombocytopenic purpura. IV anti-D and platelet transfusions may be given as needed; repeated or continuous platelet transfusions may be required in urgent situations; all 3 modalities given prior to transfusions may help preserve their longevity in the circulation. Gli ITP inseriti tramite ricorso, che fine faranno? Nessuno sarà mai inserito in GAE né in II fascia. doi: https://doi.org/10.1182/blood-2004-12-4598, Our goal is to set forth our opinion of the best approach to managing adults with primary idiopathic (autoimmune) thrombocytopenic purpura (ITP), with emphasis on the word “opinion.” The paucity of evidence-based medicine on this topic has been noted.1 Both the American Society of Hematology2 and the British Committee for Standards in Haematology General Haematology Task Force3 have issued “practice guidelines.” These, in large part, proved to be compendia of opinions from panels of experienced physicians who concurred on some matters but not on others. Diz-Kucukkaya R, Hacihanefioglu A, Yenerel M, et al. The long-term effect of treatment on immune surveillance is unknown. Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. Blood 2005; 106 (7): 2244–2251. Most patients achieve this goal, although it may take years25,26 and therapy can be toxic17 if not used judiciously.25,26 There are no randomized trials to support the effectiveness of any specific approach.58 We concur with several of the recommendations of the British Haematology Task Force3 concerning platelet counts for minor surgery (> 50 000 × 109/L) and most major surgery (> 80 000 × 109/L); higher counts are advisable for cardiac bypass surgery, neurosurgery, and complex orthopedic or plastic surgery. Clonality and cytogenetics are assessed as part of the bone marrow evaluation. Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE… The goal of therapy in this setting is to attain a hemostatic platelet count rather than to achieve cure, while minimizing drug-induced toxicity (Figure 2). The mode of delivery is based almost entirely on obstetric considerations.3,76 Postpartum bleeding is uncommon after vaginal delivery, even in women with severe thrombocytopenia.75,80 Blood loss during cesarean section varies inversely with platelet counts. Gli ITP vanno considerati come dei docenti a tutti gli effetti, al pari degli insegnanti laureati, e sono riconosciuti giuridicamente ed economicamente docenti sulla base del DLgs 1277/48 pubblicato sulla GU 6/11/1948 n.259. ricorso per ottenere equiparazione stipendiale docenti sostegno ii grado diplomati. GPS per gli itp ITP. Alkylating agents should be avoided or minimized (total dose of cyclophosphamide < 2000 mg/m2) in younger adults and those wishing to have children, whereas other medications may adversely affect comorbid conditions (eg, corticosteroids and bone density or danazol and prostate disease). Zhang L, Li H, Zhao H, Ji L, Yang R. Hepatitis C virus-related adult chronic idiopathic thrombocytopenic purpura: experience from a single Chinese center. Le tesi sostenute dal Sindacato Asset Scuola hanno centrato ancora una volta nel segno. If the decision is made to treat, the next step depends in part on the urgency of the situation. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. In the absence of symptoms or treatment, we monitor platelet counts at least monthly through the first 2 trimesters, biweekly in the third, weekly as term approaches and more often, if indicated. Baumann MA, Menitove JE, Aster RH, Anderson T. Urgent treatment of idiopathic thrombocytopenic purpura with single-dose gammaglobulin infusion followed by platelet transfusion. Per gli ITP infatti non è richiesta solo l’abilitazione, ma anche l’iscrizione nelle graduatorie (GaE o II fascia di istituto) entro il 31 maggio 2017 (data di entrata in vigore del d.lgs. Common toxicities of IV anti-D include fever/chill reactions, which can be ameliorated by pretreatment with corticosteroids, and extravascular hemolysis; intravascular hemolysis and disseminated intravascular coordination are rare33,91 and the risk is lessened by avoiding treatment in those with a positive direct antiglobulin test unless attributable to prior IVIG or IV anti-D therapy. Until recently, experience from numerous centers over more than a half-century indicated that the typical adult with ITP is a woman, generally between 18 and 40 years of age.6 Gender disparity largely disappears among the elderly.6,7 Two recent publications have questioned this perception. Miur, Consiglio di Stato e Tar del Lazio La vicenda dei diplomati magistrali agita ancora gli animi, e solo pochi giorni fa si è arrivati a un primo risultato per un altro gruppo di docenti, gli Insegnanti Tecnico Pratici. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. I ricorrenti riceveranno nei prossimi giorni copia della decisione, e le relative istruzioni per l’inserimento. Leung AYH, Chim CS, Kwong YL, Lie AKW, Au WY, Liang R. Clinicopathologic and prognostic features chronic idiopathic thrombocytopenic purpura in adult Chinese patients: an analysis of 220 cases. Failure to respond to prednisone, IV anti-D, and/or IVIG should prompt the diagnosis to be reconsidered and a bone marrow evaluation, including cytogenetics and flow cytometry, to be performed. Con ordinanza cautelare, il TAR Lazio ha accolto il ricorso proposto dallo Studio Legale Marone disponendo l’inserimento dei docenti con Diploma ITP nelle Graduatorie ad Esaurimento. Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura: report of seven patients and a meta-analysis. Fiduciosi delle recenti pronunce favorevoli ottenute, invitiamo coloro i quali non avessero ancora aderito a non perdere quest’ultima straordinaria occasione. Management of adult patients with persistent idiopathic thrombocytopenic purpura following splenectomy. The response to cyclophosphamide or azathioprine in patients who did or did not respond to the other agent is unknown. Huhn RD, Fogarty PF, Nakamura R, et al. Elderly patients are more likely to have severe bleeding and to suffer debilitating side effects of therapy.90 It is our practice to look for an accessory spleen with magnetic resonance imaging or another sensitive scanning method (eg, heat-damaged red cells) if the response to splenectomy was durable.49. Una nota del Miur inviata ai Dirigenti Scolastici, di Prato e Pistoia, chiarisce che p otrà permanere con riserva solo chi ha già ricevuto un provvedimento giurisdizionale favorevole . We only perform bone marrow examinations as a matter of routine in otherwise typical patients if they are over 60 years of age when the incidence of MDS becomes significant, in those who do not show a robust response (> 50 000 × 109/L) to treatment, and often prior to splenectomy if not previously performed. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Supplenze; Supplenze scuola 2020/21 e graduatorie provinciali: indicazioni per ITP e docenti inseriti in Gae. Berchtold P, Muller D, Beardsley D, et al. We cite published evidence where we find it compelling and reproducible, but much of what follows rests on our mutual experience treating patients, both on- and off-study, rather than an encyclopedic, heavily referenced review.
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