Unit SYSTEMIC PATHOLOGY V

BLOOD DISEASES - MOD. 1

Code	GP004821
CFU	2
Teacher	Vincenzo Maria Perriello
Teachers	Vincenzo Maria Perriello
Hours	25 ore - Vincenzo Maria Perriello
Learning activities	Caratterizzante
Area	Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica
Academic discipline	MED/15
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Anemias: - Erythropoiesis and general aspects of anemia - Classifications of anemia: a. etiopathogenetics; b. size/morphological - Morphological alterations of the red blood cells. Peripheral venous blood smear - Iron deficiency anemias - Megaloblastic anemias and other macrocytic anemias - Anemia of chronic disorders - Hemolytic anemias Hereditary hemolytic disorders Hemolytic disorders from extraglobular causes - Thalassemias - Differential diagnosis of anemic syndromes. Discussion of clinical cases and diagnostic process. Topics of general hematological interest: - Numerical alterations of blood elements: a. differential diagnosis of erythrocytosis and primary and secondary platelet disease b. Chronic myeloproliferative syndromes (Polycythemia Vera, Essential Thrombocythemia, Idiopathic Myelofibrosis, Chronic Myelogenous Leukemia) - Lymphadenomegaly: Differential diagnosis - Non-Hodgkin lymphomas (general classification, clinical and diagnosis) - Follicular lymphoma - Mantle cell lymphoma - Marginal lymphoma - Large B-cell lymphoma - Primary lymphoma of the mediastinum - Non-Hodgkin T lymphomas (general information) - Hodgkin's lymphoma
Reference texts	Harrison's - Principles of Internal Medicine
Educational objectives	The learning outcomes are compliant with the provisions in the didactic published at: http: //www.med.unipg.it/ccl (http://www.med.unipg.it/ccl). In detail, the general objective of education is to provide students with the foundation to address the study of blood diseases (either malignant or not).
Prerequisites	In order to understand and know how to tackle the course, students must have the basic understanding on: - Physiology of blood, features and functions of the elements of blood (leukocytes, erythrocytes and platelets) - Anatomy, organization and functions of the lymphatic system - Cellular and humoral immunity - Structure of the bone marrow and hematopoiesis - The blood count - Principles of Serum protein electrophoresis - The monoclonal antibodies
Teaching methods	Face to face lessons. Clinical cases discussion.
Learning verification modality	EXAMINATION METHODS: Oral examination of approximately 15-20 minutes divided into 2 questions, the first relating to a topic of non-oncohaematological pathology (clinical case starting from the interpretation of a blood count test) and 1 relating to a topic of oncohaematological pathology. A further question on the minimum essential knowledge may be asked in the event of an unsatisfactory answer to the 2 previous questions. VERIFICATION OF CLINICAL SKILLS: interpretation of a blood count and possible differential diagnoses to set the diagnostic process. VERIFICATION OF THE SKILLS ACQUIRED DURING THE INTERNSHIP: ability to communicate and discuss about clinical and laboratory diagnostic paths when faced with a specific clinical case. METHOD OF ALLOCATION OF THE FINAL MARK: arithmetic mean of the marks obtained in the two questions.
Extended program	Anemias: - Erythropoiesis and general aspects of anemia - Classifications of anemia: a. etiopathogenetics; b. size/morphological - Morphological alterations of the red blood cells. Peripheral venous blood smear - Iron deficiency anemias - Megaloblastic anemias and other macrocytic anemias - Anemia of chronic disorders - Hemolytic anemias Hereditary hemolytic disorders Hemolytic disorders from extraglobular causes - Thalassemias - Differential diagnosis of anemic syndromes. Discussion of clinical cases and diagnostic process. Topics of general hematological interest: - Numerical alterations of blood elements: a. differential diagnosis of erythrocytosis and primary and secondary platelet disease b. Chronic myeloproliferative syndromes (Polycythemia Vera, Essential Thrombocythemia, Idiopathic Myelofibrosis, Chronic Myelogenous Leukemia) - Lymphadenomegaly: Differential diagnosis - Non-Hodgkin lymphomas (general classification, clinical and diagnosis) - Follicular lymphoma - Mantle cell lymphoma - Marginal lymphoma - Large B-cell lymphoma - Primary lymphoma of the mediastinum - Non-Hodgkin T lymphomas (general information) - Hodgkin's lymphoma

BLOOD DISEASES - MOD. 2

Code	GP004822
CFU	1
Teacher	Enrico Tiacci
Teachers	Enrico Tiacci
Hours	12.5 ore - Enrico Tiacci
Learning activities	Caratterizzante
Area	Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica
Academic discipline	MED/15
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Acquired hemolytic anemias: - Classification - Autoimmune hemolytic anemias - Drug-induced hemolytic anemias - Paroxystic nocturnal hemoglobinuria Thrombocytopenias: - Classification - Pseudo thrombocytopenia - Immune thombocytopenia - Gestational trombocitopenias - Thrombotic thrombocytopenic purpura Discussion of clinical cases of anemia and thrombocytopenia, and related diagnostic work-up Myelodysplasias: - Classification - Genetic lesions - Pathophysiology - Clinical picture - Therapy Myeloid and lymphoid acute leukemias: - Classification - Genetic lesions - Pathophysiology - Clinical picture - Therapy
Reference texts	Harrison's - Principles of Internal Medicine
Educational objectives	The learning outcomes are compliant with the provisions in the didactic published at: http: //www.med.unipg.it/ccl (http://www.med.unipg.it/ccl). In detail, the general objective of education is to provide students with the foundation to address the study of blood diseases (either malignant or not).
Prerequisites	In order to understand and know how to tackle the course, students must have the basic understanding on: - Physiology of blood, features and functions of the elements of blood (leukocytes, erythrocytes and platelets) - Anatomy, organization and functions of the lymphatic system - Cellular and humoral immunity - Structure of the bone marrow and hematopoiesis - The blood count - Principles of Serum protein electrophoresis - The monoclonal antibodies
Teaching methods	Face to face lessons. Clinical cases discussion.
Other information
Learning verification modality	EXAMINATION METHODS: Oral examination (jointly with that of Module 1) of approximately 15-20 minutes divided into 2 questions, the first relating to a topic of non-oncohaematological pathology (clinical case starting from the interpretation of a blood count test) and 1 relating to a topic of oncohaematological pathology. A further question on the minimum essential knowledge may be asked in the event of an unsatisfactory answer to the 2 previous questions. VERIFICATION OF CLINICAL SKILLS: interpretation of a blood count and possible differential diagnoses to set the diagnostic process. VERIFICATION OF THE SKILLS ACQUIRED DURING THE INTERNSHIP: ability to communicate and discuss about clinical and laboratory diagnostic paths when faced with a specific clinical case. METHOD OF ALLOCATION OF THE FINAL MARK: arithmetic mean of the marks obtained in the two questions.
Extended program	Acquired hemolytic anemias: - Classification - Autoimmune hemolytic anemias - Drug-induced hemolytic anemias - Paroxystic nocturnal hemoglobinuria Thrombocytopenias: - Classification - Pseudo thrombocytopenia - Immune thombocytopenia - Gestational trombocitopenias - Thrombotic thrombocytopenic purpura Discussion of clinical cases of anemia and thrombocytopenia, and related diagnostic work-up Myelodysplasias: - Classification - Genetic lesions - Pathophysiology - Clinical picture - Therapy Myeloid and lymphoid acute leukemias: - Classification - Genetic lesions - Pathophysiology - Clinical picture - Therapy
Obiettivi Agenda 2030 per lo sviluppo sostenibile

DISEASES OF THE IMMUNE SYSTEM

Code	GP005900
CFU	2
Teacher	Antonella Mancusi
Teachers	Antonella Mancusi
Hours	25 ore - Antonella Mancusi
Learning activities	Caratterizzante
Area	Medicina delle attività motorie e del benessere
Academic discipline	MED/09
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Pathogenesis, clinical signs and diagnosis of the main diseases of the immune system: primary and secondary immunodeficiencies; autoimmune diseases; rejection, graft-versus-host disease and infections after allogeneic hematopoietic stem cell transplantation; hypersensitivity reactions and allergy; clinical immunology of vaccines.
Reference texts	HARRISON "Principles of Internal Medicine"
Educational objectives	Knowledge of pathogenesis and immunological mechanisms, clinical signs and diagnosis of the main diseases of the immune system.
Prerequisites	For the purpose of learning, the student should have good knowledge of anatomy and physiopathology and good skill in general physical examination of the patient.
Teaching methods	Classroom-taught lessons.
Learning verification modality	EXAM: Oral examination consisting of 3 questions about pathogenesis, clinical signs and diagnosis of diseases of the immune system. EVALUATION OF CLINICAL EXPERTISE: 1 question about diagnosis and differential diagnosis of disorders of the immune system. EVALUATION OF INTERNSHIP: Description of a diagnostic technique for the evaluation of an immunocompromised patient. EXAM GRADE: mean of grades obtained in the disciplines included in the course.
Extended program	IMMUNODEFICIENCY DISEASES: pathogenesis of susceptibility to infections and diagnosis; primary immunodeficiency diseases (severe combined immunodeficiency diseases; antibody immunodeficiency; complement deficiencies; phagocytic cell defects); secondary immunodeficiency diseases (AIDS, immunosuppressive and cytostatic drugs; splenectomy; hematologic and solid malignancies). HEMATOPOIETIC STEM CELL TRANSPLANTATION: Immunobiology; transplant donor selection; engraftment and rejection; Graft-versus-host disease e Graft-versus-tumor effect; infections. INNOVATIVE APPROACHES OF IMMUNOTHERAPY: Checkpoint inhibitors; CAR-T cells. HYPERSENSITIVITY DISEASES: Hypersensitivity reactions (type I, II, III, IV); associated diseases: urticaria, angioedema, food allergies, asthma, anaphylactic shock. PATHOGENESIS AND CLINICAL SIGNS OF ORGAN-SPECIFIC AUTOIMMUNE DISEASES: Hashimoto's thyroiditis; Multiple sclerosis; Autoimmune cytopenia; Aplastic anemia; Celiac disease. PATHOGENESIS AND CLINICAL SIGNS OF SMALL-VESSEL VASCULITIS: ANCA-associated vasculitis; IgA vasculitis (Schönlein-Henoch); Cryoglobulinaemic vasculitis. CLINICAL IMMUNOLOGY OF VACCINES: Immune response to vaccines; associated clinical signs.

MOLECULAR MEDICINE

Code	GP004823
CFU	1
Teacher	Roberta La Starza
Teachers	Roberta La Starza
Hours	12.5 ore - Roberta La Starza
Learning activities	Caratterizzante
Area	Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica
Academic discipline	MED/15
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Technological approaches for genome study: cytogenetics, molecular cytogenetics, microarrays, NGS, WET. Leukemic and cancer stem cells, multistep process of oncogenesis; mechanisms of deregulation of oncogenes, oncosuppressors, repair genes and check-point genes. Hematopietic clonality and pathogenesis of leukemias. Pathogenesis models of congenital and acquired bone marrow failures. Patterns of pathogenesis of acute leukemias. Function of tyrosine kinases. Models of pathogenesis of lymphoproliferative disorders. Models of pathogenesis of myeloma. Patterns of pathogenesis of solid tumors (central nervous system).
Reference texts	The material will be provided by professor
Educational objectives	The course aims to cover the basics of understanding the bio-molecular aspects of medicine: mechanisms of gene deregulation, role/function of oncogenes and oncosuppressors, cell cycle, DNA repair mechanisms, germinal or acquired alterations, clonal hematopoiesis, preneoplastic clonality
Prerequisites	none
Teaching methods	Frontal lessons Seminars
Learning verification modality	written exam with 15 multiple choice questions; duration 20 minutes VOTE: Arithmetic mean of grades in individual modules
Extended program	Technological approaches for genome study: conventional cytogenetics, fluorescence in situ hybridization (interphase, metaphase, on tissue), multi-FISH, arrays on DNA and RNA, NGS targets. Characteristics of leukemic and cancer stem cell Study of the multistep process of oncogenesis, mechanisms of alteration of oncogenes, oncosuppressors, repair genes and check-point genes. Oncogenes and oncosuppressors: role and type of deregulation Patterns of pathogenesis of congenital and acquired bone marrow failure. Patterns of pathogenesis of Acute and chronic Leukemias. Function and involvement of tyrosine kinases in human neoplasms. Pathogenesis models of Multiplo Myeloma and Lymphomas. Patterns of pathogenesis of solid tumors (central nervous system).
Obiettivi Agenda 2030 per lo sviluppo sostenibile	3 -Health and welfare

REUMATHOLOGY

Code	GP005901
CFU	2
Teacher	Carlo Perricone
Teachers	Carlo Perricone
Hours	25 ore - Carlo Perricone
Learning activities	Caratterizzante
Area	Clinica delle specialità medico-chirurgiche
Academic discipline	MED/16
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Classification, epidemiology and pathogenesis of rheumatic disease. Clinical features of most common acute and chronic osteoarticular disease, inflammatory and not, of extra-articular rheumatism, of systemic autoimmune disease and of systemic vasculitides.
Reference texts	Reumatologia. Per studenti e medici di medicina generale a cura di UNIREUMA. IDELSON GNOCCHI IV Ed. 2022. HARRISON et al. Principles of Internal Medicine XX Ed. McGraw Hill Ed. Malattie Autoimmuni Sistemiche di Roberto Perricone, SEU
Educational objectives	At the end of the study course students are expected to recognize and define the peculiar features of most common chronic articular conditions, both inflammatory and degenerative, extra-articular rheumatic diseases, systemic autoimmune diseases, and systemic vasculitis, from an etiologic, pathogenic and, most importantly, clinical point of view. In addition, the students are asked to prove the ability to recognize and interpret the specific laboratory tests for the aforementioned conditions and the most common instrumental procedures employed in rheumatology clinics. The students’ diagnostic approach based on signs and symptoms will also be evaluated.
Prerequisites	In order to start Rheumatology lessons, the student should have good knowledge of anatomy and physiopathology and good skill in general physical examination of the patient.
Teaching methods	The Course includes 25 hours with 14 theoretical hours and 11 hours of practical skills and practical training or seminars.
Other information	Overarching objectives are recognition, the main therapeutic guidelines and indications for the professional contribution of the specialist in the most frequent rheumatological diseases.
Learning verification modality	METHOD OF CONDUCTING THE EXAM: The exam will be carried out through an oral test, lasting on average approximately 15-25 minutes. It will include at least one question relating to the recognition of epidemiological, pathogenetic, clinical, laboratory, radiological, histopathological aspects, and notes on therapy on pathologies of the study program and a question that can allow the evaluation of theoretical and practical knowledge, as well as reasoning and of communication. The student must demonstrate that they are able to apply the acquired knowledge independently in clinical practice. A further question on the minimum necessary knowledge may be asked in the case of an unsatisfactory answer to the 2 previous questions. TESTING OF CLINICAL SKILLS: differential diagnosis of a clinical case, interpretation of a laboratory report or an imaging test VERIFICATION OF THE SKILLS ACQUIRED DURING THE INTERNSHIP: description of the rheumatological diagnostic process METHOD FOR ALLOCATION OF THE FINAL MARK: arithmetic mean of the marks obtained in the individual disciplines The exam will be evaluated according to the following criteria: Not suitable: significant deficiencies and/or inaccuracy in knowledge and understanding of the topics; limited analysis and synthesis skills, frequent generalizations. 18-20: sufficient knowledge and understanding of the topics with possible imperfections; Sufficient analytical, synthesis and independent judgment skills. 21-23: Knowledge and understanding of routine topics; Correct analysis and synthesis skills with coherent logical argumentation. 24-26: Fair knowledge and understanding of the topics; good analytical and synthesis skills with rigorously expressed arguments. 27-29: Complete knowledge and understanding of the topics; remarkable analytical and synthesis skills. Good independent judgement. 30-30L: Excellent level of knowledge and understanding of the topics. Remarkable analytical and synthesis skills and independent judgement. Arguments expressed in an original way. For information on support services for students with disabilities and/or DSA visit the page http://www.unipg.it/disabilita-e-dsa
Extended program	1. Definition, classification and epidemiology of rheumatic diseases 2. The musculoskeletal system: anatomic and functional elements 3. Etiopathogenic mechanisms of rheumatic diseases 4. Signs and symptoms of rheumatic diseases 5. Laboratory and imaging diagnosis and synovial fluid analysis 6. Inflammatory joint diseases a) Rheumatoid arthritis and other related joint diseases b) Spondylarthritis i. Ankylosing Spondylitis ii. Reactive arthritis iii. Psoriatic arthritis iv. Enteropathic arthritis c. Polymyalgia rheumatica 7. Connective tissue diseases a) Systemic lupus erythematosus b) Antiphospholipid syndrome c) Systemic sclerosis d) Polymyositis/Dermatomyositis/ Inflammatory myopathies/Anti-synthetase syndrome e) Sjögren's syndrome f) Overlap syndromes, included mixed connective tissue disease g) Undifferentiated connective tissue diseases (UCTD) 8. Primary systemic vasculitides a) Large size-arteries: Takayasu arteritis, Horton arteritis b) Medium-size arteries: polyarteritis nodosa c) Medium and small-size vessels ANCA-associated (micropolyangiitis, granulomatosis with polyangiitis - Wegener's granulomatosis; eosinophilic granulomatosis with polyangiitis - Churg-Strauss syndrome) 9. Small-size vessels a) Behçet's disease b) cryoglobulinemia c) IgA vasculitis - Schönlein-Henoch purpura 10. Septic and post-infective arthritis (rheumatic fever) 11. Microcrystal arthropaties (Gout, Calcium pyrophosphate dihydrate and hydroxyapatite deposition disorders) 12. Osteoarthritis 13. Localized and generalized extra-articular rheumatic diseases and fibromyalgia 14. Neurovascular and neurologic syndrome a) Raynaud 's phenomenon b) Carpal tunnel syndrome 15. Autoinflammatory disorders a. Monogenic autoinflammatory diseases b. Adult onset Still’s disease 16. Miscellaneous disorders associated with rheumatologic manifestations a. Sarcoidosis b. IgG4-related disease

PROFESSIONALISING TRAINING IN BLOOD DISEASES

Code	GP004824
CFU	1
Teacher	Angelo Genua
Teachers	Angelo Genua
Hours	25 ore - Angelo Genua
Learning activities	Altro
Area	Tirocini formativi e di orientamento
Academic discipline	MED/15
Type of study-unit	Obbligatorio (Required)

PROFESSIONALISING TRAINING IN DISEASES OF THE IMMUNE SYSTEM

Code	GP005902
CFU	1
Teacher	Antonella Mancusi
Teachers	Antonella Mancusi
Hours	25 ore - Antonella Mancusi
Learning activities	Altro
Area	Tirocini formativi e di orientamento
Academic discipline	MED/09
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Laboratory practice on evaluation of lymphocyte subpopulations by flow cytometry for the diagnosis of immunodeficiency diseases and monitoring immune reconstitution in patients after hematopoietic allogeneic stem cell transplantation or infusion of CAR-T cells. Clinical practice with the specialist in the allogeneic bone marrow transplant section that provides an overview of infectious complications caused by a state of immunodeficiency.
Reference texts	HARRISON " Principles of Internal Medicine
Educational objectives	Knowledge of clinical signs and diagnosis of the main diseases of the Immune System.
Prerequisites	For the purpose of learning, the student should have good knowledge of anatomy and physiopathology and good skill in general physical examination of the patient.
Teaching methods	Laboratory and clinical practice.
Learning verification modality	For the professionalizing internship, there is no a specific exam, but learning evaluation is part of the final oral exam.
Extended program	Laboratory practice: 1) evaluation of lymphocyte subpopulations by flow cytometry; 2) evaluation of lymphocyte subpopulations for the diagnosis of immunodeficiency diseases; 3) evaluation of lymphocyte subpopulations for immunomonitoring after infusion of CAR-T cells; 4) evaluation of lymphocyte subpopulations for monitoring immune reconstitution after hematopoietic allogeneic stem cell transplantation. Clinical practice with the specialist in the allogeneic bone marrow transplant section that provides an overview of infectious complications caused by a state of immunodeficiency.

PROFESSIONALISING TRAINING IN MOLECULAR MEDICINE

Code	GP004825
CFU	1
Teacher	Roberta La Starza
Teachers	Roberta La Starza
Hours	25 ore - Roberta La Starza
Learning activities	Altro
Area	Tirocini formativi e di orientamento
Academic discipline	MED/15
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	Technological approaches to genome surveys. Protocols and their applications.
Educational objectives	Ability to address diagnostic investigations and optimize procedures.
Prerequisites	Knowledge of the genetic basis of tumors.
Teaching methods	Tutor system in working groups.
Learning verification modality	Verification of learning is done during the internship with questions and direct interaction with the student
Extended program	Conventional cytogenetics. FISH, PCR, sequencing. Telomeres, Chromosomal instability test. Test on paraffin sections. Nucleic acids, separation. Microarrays.
Obiettivi Agenda 2030 per lo sviluppo sostenibile	3 - health and welfare

PROFESSIONALISING TRAINING IN REUMATHOLOGY

Code	GP005903
CFU	1
Teacher	Carlo Perricone
Teachers	Carlo Perricone
Hours	25 ore - Carlo Perricone
Learning activities	Altro
Area	Tirocini formativi e di orientamento
Academic discipline	MED/16
Type of study-unit	Obbligatorio (Required)
Language of instruction	Italian
Contents	To: Describe the degenerative, autoimmune and inflammatory pathologies of the musculoskeletal system; Analyze the main signs and symptoms related to rheumatic diseases; Identify the diagnostic and assistance pathway of subjects suffering from rheumatologic diseases; Describe the implications of the management of therapeutic agents for rheumatological diseases
Reference texts	Reumatologia. Per studenti e medici di medicina generale a cura di UNIREUMA. IDELSON GNOCCHI IV Ed. 2022.
Educational objectives	At the end of the internship the student must be able to perform a clinical reasoning for diagnostic purposes on the basis of the clinical cases addressed. He must therefore be able to recognize: - The most common rheumatic diseases; - Less common rheumatic disorders that require urgent recognition (example: polymyalgia rheumatica); - Rheumatic diseases of social importance both in terms of diffusion and costs, on which it is possible to intervene with prevention and/or timely recognition (example: rheumatoid arthritis); Must know and interpret: - The significance of the signs and symptoms of rheumatological diseases for general diagnostic purposes as well as their pathogenetic mechanisms; - The main laboratory tests specific to these pathologies and the most common instrumental methods used in rheumatology.
Prerequisites	In order to start the Rheumatology internship, the student should have good knowledge of anatomy and good practice in the general physical examination of the patient.
Teaching methods	The internship includes 25 hours of practical lessons through participation to clinical activities and discussion of clinical cases with tutors.
Other information	Overarching objectives are to carry out a clinical reasoning for diagnostic and therapeutic purposes on the basis of the clinical cases faced.
Learning verification modality	For the professional internship there is no specific exam, but this is included in the final oral exam. The ability to autonomously carry out clinical reasoning for diagnostic purposes will be verified through the interpretation of a clinical case or a laboratory or imaging test. Doctor-patient communication skills and the appropriateness of scientific language will also be assessed.
Extended program	The internship program includes participation in clinical activity and discussion of clinical cases at the Rheumatology Unit.