6 Gender disparity largely disappears among the elderly. Portiejle JEA, Westendorp RGJ, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Long-term observation of 208 adults with chronic idiopathic thrombocytopenic purpura. 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. Such preferences must be respected. 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 ). The reader is referred elsewhere for a more comprehensive tabulation of drug doses, expected response times, and common side effects.30  Therapy is indicated in all patients who present with bleeding and those with platelet counts less than 20 000 × 109/L because fewer than 10% of adults rapidly attain spontaneous remission. Gli ITP inseriti tramite ricorso, che fine faranno? Kohda K, Kuga T, Kogawa K, et al. 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. e/o in GAE sono numerosi, in tanti hanno fatto anche ricorso per partecipare al concorso per docenti abilitati 2018 e in alcuni casi il Consiglio di Stato si è espresso favorevolmente ammettendoli con riserva . Samuelsson A, Towers TL, Ravetch JV. We rarely, if ever, discourage pregnancy in women with known ITP, but we explain that maternal and fetal complications may occur and additional monitoring and therapy may be needed. Prospective screening of 205 patients with ITP, including diagnosis, serological markers, and the relationship between platelet counts, endogenous thrombopoietin, and circulating anti-thrombopoietin antibodies. Warner MN, Moore JC, Warkentin TE, Santos AV, Kelton JG. Although splenectomy has been performed safely at exceedingly low platelet counts, nonresponders may experience bleeding problems after the procedure. We do not recommend lifelong use of phenoyxmethylpenicillin (250-500 mg orally twice daily) or erythromycin (500 mg orally twice daily) in otherwise healthy adults, in contrast to others.3  Revaccination for pneumococcus is recommended every 5 to 10 years. Diventare ITP - Come iscriversi nelle Graduatorie di Istituto. Spontaneous or posttraumatic ICH or bleeding at other internal sites is uncommon, but not without precedence,24  at platelet counts between 10 000 and 20 000 × 109/L. Conversely, a poor response to treatment may necessitate re-evaluation of the diagnosis, including a bone marrow examination. Consideriamo, in questo articolo gli ITP, una categoria di docenti che può accedere all’insegnamento soltanto con il diploma di scuola secondaria superiore, molti dei quali sono nella III fascia delle graduatorie di Istituto. Cooper N, Stasi R, Cunningham-Randles S, et al. Burrows RF, Kelton JG. Oggi risponderemo a una domanda che molti dei nostri lettori ci pongono frequentemente ovvero: Come faccio ad inserirmi nelle graduatorie? Search for other works by this author on: George JN, Vesely SK. Docenti ITP in seconda fascia dopo sentenze negative. Comprehensive reviews on pathogenesis, laboratory testing, secondary ITP, ITP in children, and treatment are to be found elsewhere.4,5. Optimal dosing for ITP and use in combination with other modalities is under investigation. Docenti ricorso inserimento in GaE: possibile e consigliato iscriversi alle graduatorie provinciali GPS. 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. Chi volesse aderire al ricorso collettivo per l'inserimento in Gae invii una email di PRE-Adesione con i propri dati anagrafici oltre che un recapito telefonico alla mail dell'Associazione associazione.ddl@gmail.com Intravenous immunoglobulin or high-dose methylprednisolone, with or without oral prednisone, for adults with untreated severe autoimmune thrombocytopenic purpura: a randomised, multicenter trial. Once a response is seen, the doses of danazol and the immunosuppressant can be gradually lowered over a period of months, but rarely discontinued entirely.65  Danazol alone is unlikely to work in patients with profound thrombocytopenia unresponsive to corticosteroids or other measures. Aggiornamento GAE: Graduatorie a Luglio 05 Giugno 2019 Aggiornamento GAE: Ultimi giorni per presentare la Domanda 18 Maggio 2019 Ragionieri in Graduatoria: Scarica la Domanda 16 Maggio 2019 Diplomati ITP in GAE: Cosa Fare 15 Maggio 2019 Proroga Domande GAE al 20 Maggio: Nota Miur These include exposure to drugs, herbs, foods, or other substances (eg, quinine) associated with thrombocytopenia; pseudothrombocytopenia; giant platelets; family history consistent with inherited thrombocytopenia; or symptoms/signs suggestive of an underlying disorder that may cause secondary immune thrombocytopenia. Newman GC, Novoa MV, Fodero EM, Lesser ML, Woloski BMR, Bussel JB. Many issues remain unresolved, expert opinions differ for good reason, and it is likely that our own approach will change based on emerging data. Il ricorso, iscritto al numero di registro generale 7015 del 2017, riguarda un consistente numero di insegnanti che chiedevano l’inserimento in GaE e sembra pure in seconda fascia di istituto. This trend has been accelerated by evidence that IV anti-D and anti-CD20 may allow splenectomy to be deferred and possibly avoided.41,47, We use IVIG, IV anti-D, or pulse doses of corticosteroids in known responders to boost the platelet count prior to splenectomy. Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. The largest reported experience involves 14 patients with refractory ITP who were more than 6 months after transplantation at the time of publication.74  Of these, 6 attained stable platelet counts that were greater than 100 000 × 109/L and 2 had partial responses (follow-up 9-42 months). Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. Koren G, Pastuszak A, Ito S. Drugs in pregnancy. Maloisel F, Andres E, Zimmer J, et al. Therapy of adult ITP before splenectomy. Crow AR, Song S, Freedman J, et al. Doan CA, Bouroncle BA, Wiseman BK. Vianelli N, Valdre L, Fiacchini M, et al. The latter, also referred to as incidental or benign thrombocytopenia of pregnancy, is found in 5% to 8% of healthy women with an uneventful pregnancy and accounts for at least 75% of all cases of thrombocytopenia at term.78,92  Thrombocytopenia is generally mild (platelet counts > 70 000 × 109/L in 95% of cases) and there seems to be no impact on maternal or fetal health. DiFino SM, Lachant NA, Kirshner JJ, Gottlieb AJ. Management of idiopathic thrombocytopenic purpura in pregnancy. 59/2017). Per Aderire al Ricorso al Tar del Lazio per i Diplomati ITP in GAE scarica e spedisci la modulistica. Un’altro ostacolo, questa volta riguarda gli ITP che chiedevano l’ingresso in GaE? ITP in Gae o II fascia GI. Hou P, Pang J, Shi Y, et al. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery. Inserimento in II Fascia d’Istituto docenti ITP: colpa di scena. We have recently found IV anti-D to be safe (including for the newborn) and effective, although experience is limited, caution is indicated, and close monitoring of the fetus with sonograms and the newborn with hemoglobin and bilirubin determinations is warranted.81  Splenectomy should be avoided if possible, and deferred to the second trimester when necessary, to avoid abortion. Profound and prolonged peripheral B-cell depletion is universal, but serious infection other than reactivation of hepatitis B in chronic carriers is rare and generally seen only in the context of additional immunosuppression. 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). Pertanto a fronte della pubblicazione del nuovo Decreto Ministeriale n. 506/2018, Aggiornamento delle graduatorie ad Esaurimento, si riapre al possibilità per docenti ITP di poter proporre ricorso al Tar Lazio per l’inserimento nelle GAE e contestuale passaggio nella prima fascia delle graduatorie di Istituto. High-dose cyclophosphamide with autologous lymphocyte-depleted peripheral blood (PBSC) support for treatment of refractory chronic autoimmune thrombocytopenia. di seconda fascia – gdl; ricorso ii fascia – itp – laureati; ricorso mobilità 2019; ricorso concorso docenti 2018 – fase transitoria; ricorso tfa sostegno 2018 itc – laureati no 24cfu We have less personal experience with the use of mycophenolate mofetil.63,64  Treatment is begun with 500 mg orally twice a day and the dose is increased to 1000 to 1500 mg orally twice a day after 2 weeks. We suggest patients wear a MedAlert bracelet. +++ RICORSO COLLETTIVO ITP in GAE +++ Agli ITP diplomati entro il 2001/02. 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. Clonality and cytogenetics are assessed as part of the bone marrow evaluation. 3) inserimento in GAE ITP : con un ordinanza del TAR che riteneva abilitante il diploma ITP si è scatenata la corsa degli avvocati a proporre ricorsi per inserimento in GAE … Kappers-Klunne MC, van't Veer MB. (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. Vesely SK, Perdue JJ, Rizvi MA, Terrell DR, George JN. Newland A, Caulier MT, Schipperus MR, et al. These recommendations may soon require modification based on the success of thrombopoietic agents (see “Experimental therapy”). Mycophenolate mofetil (MMF) for the treatment of steroid-resistant idiopathic thrombocytopenic purpura. Responses are usually noted within 4 to 8 weeks after the first infusion but may occur as late as 4 months. Long term follow-up after splenectomy performed for immune thrombocytopenic purpura (ITP). All febrile illnesses demand careful evaluation and intravenous antibiotics should be provided urgently at the onset of any systemic illness with fever of 38°C (101°F) or higher until bacterial sepsis can be excluded. A retrospective, 11-year analysis of obstetrical patients with idiopathic thrombocytopenic purpura. Intravenous anti-D as a treatment for immune thrombocytopenic purpura (ITP) during pregnancy. Beilin Y, Zahn J, Comerford M. Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm-3. Consideriamo, in questo articolo gli ITP, una categoria di docenti che può accedere all’insegnamento soltanto con il diploma di scuola secondaria superiore, molti dei quali sono nella III fascia delle graduatorie di Istituto. Rapid lasting responses to dexamethasone (40 mg orally daily for 4 d/mo) are reported, although the assertion that this approach increases long-term response compared with prednisone42  requires longer follow-up and confirmation. Copyright © 2005 by The American Society of Hematology, Copyright ©2020 by American Society of Hematology, https://doi.org/10.1182/blood-2004-12-4598, Hemostasis, Thrombosis, and Vascular Biology. Graduatorie provinciali 2020: disposizioni per docenti inseriti nelle graduatorie ad esaurimento e per gli Insegnanti Tecnico Pratici. The major known long-term risk of splenectomy is overwhelming bacterial sepsis, which occurs in less than 1% of adults with uncomplicated ITP.55  We immunize our patients with polyvalent pneumoccocal, H influenzae type b, and quadrivalent meningococcal polysaccharide vaccines at least 2 weeks prior to splenectomy if possible,56,57  although our experience is that most patients respond to vaccination given more than 6 weeks after surgery. 1) ha fornito le istruzioni per l’aggiornamento triennale delle graduatorie a esaurimento. Cooper N, Heddle NM, Haas M, 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 il Diritto dei Diplomati ITP ad entrare in GAE. Combination immunotherapy for patients with refractory ITP or Evan's syndrome (ES) [abstract]. E a quale GPS? The treatment modality depends on the severity of the thrombocytopenia and bleeding, tolerance of treatment, and patient preference as discussed in “Initial therapy for nonemergent indications.” We would generally treat for a minimum of 3 months and a maximum of 12 months, barring evidence of late improvement, before considering splenectomy. We reserve splenic irradiation for the rare patient in whom splenectomy is indicated but hazardous or as a diagnostic test.54. Reiner A, Gernsheimer T, Schlichter SJ. Drugs that interfere with platelet function are discontinued. Il punteggio sarà dato dai titoli dichiarati dagli aspiranti. Idiopathic and secondary thrombocytopenic purpura: clinical study and evaluation of 381 cases over a period of 28 years. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by auto-immune thrombocytopenia. Details of therapy and duration of treatment are discussed in text. 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. Categorie albo, Comunicazioni, Docenti Tag albo, graduatorie ad esaurimento. Stasi R, Pagano A, Stipa E, Amadori S. Rituximab chimeric anti-CD20 monoclonal antibody treatment for adults with chronic idiopathic thrombocytopenic purpura. Le GaE sono in via di pubblicazione, mentre la seconda fascia delle GI sarà pubblicata a settembre. Long-term follow-up of idiopathic thrombocytopenic purpura in 310 patients. Approximately 1% of patients have coexisting immune hemolytic anemia (Evans syndrome) and a smaller percentage have immune neutropenia, which confer a less favorable prognosis. Cines DB, McMillan R. Management of adult idiopathic thrombocytopenic purpura. We generally treat patients in whom splenectomy fails with the anti-CD20 monoclonal antibody, rituximab (375 mg/m2 intravenously every week for 4 weeks). Adult idiopathic thrombocytopenic purpura: clinical findings and response to therapy. Contro ogni pronostico è stato affermato il diritto dei Diplomati ITP ad entrare in GAE… Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Furthermore, counts may drop suddenly at any time.24  A worrisome number of patients who developed ICH did so after acute and often unpredictable events such as viral infection or head trauma, or after inadvertently taking medications that impair platelet function.27  We would argue that the goal of therapy must be individualized on the basis of signs and symptoms, tolerance of treatment, lifestyle, and patient preference. Several comprehensive reviews have been published.2,75. 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 […] Graduatorie ad Esaurimento aa.ss. Age as the major predictor of long-term response to splenectomy in immune thrombocytopenic purpura. Per maggiori informazioni contattaci al seguente numero: 0823/1606821 oppure scrivi una mail: assetscuolalusciano@gmail.com, Dalle 10.00 alle 13:00 e dalle 16:00 alle 20:00, Dopo queste storiche pronunce, la Direzione Nazionale del Sindacato ASSET Scuola ha deciso di. How can we provide the best care for our patients with immune thrombocytopenic purpura? Diz-Kucukkaya R, Hacihanefioglu A, Yenerel M, et al. Gururangan S, Bussel JB. A complete or partial remission occurs in 25% to 50% of patients; many complete responses are durable (> 1 year).60,61  Side effects are mostly related to the first infusion (fever, chills, hypotension, bronchospasm, etc). Management of asplenic patients. If a complete response occurs to oral therapy, we give full doses for an additional 3 months and then strongly consider stopping treatment. McMillan R, Bowditch RD, Tani P, Anderson H, Goodnight S. A non-thrombocytopenic bleeding disorder due to an IgG4-kappa anti-GPIIb/IIIa autoantibody. 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. 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. Frederiksen H, Schmidt K. The incidence of idiopathic thrombocytopenic purpura in adults increases with age. I ricorrenti riceveranno nei prossimi giorni copia della decisione, e le relative istruzioni per l’inserimento. Gestational thrombocytopenia. Sashida G, Ohyashiki JH, Ito Y, Ohyashiki K. Monoclonal constitution of neutrophils detected by PCR-based human androgen receptor gene assay in a subset of idiopathic thrombocytopenic purpura patients. itp itp . 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 I Diplomati ITP devono essere Inseriti in GAE, a sancirlo sono state le storiche pronunce giudiziarie 9234/17 e 6443/17 del Tar Lazio. ITP con ricorso inseriti in seconda fascia o in GAE, chi può partecipare al concorso docenti 2018. Scaradavou A, Woo B, Woloski BMR, et al. An open-label, unit dose-finding study evaluating the safety and platelet response of a novel thrombopoietic protein (AMG531) in thrombocytopenic adult patients (pts) with immune thrombocytopenic purpura (ITP) [abstract]. Navigazione articoli. Michel M, Novoa MV, Bussel JB. Christiaens GCML, Niewenhuis HK, Bussel JB. A dose of 75 μg/kg/d of IV anti-D increases the platelet count more rapidly and for a longer period of time than does 50 μg/kg/d in adults with immune thrombocytopenic purpura (ITP). Berchtold P, Muller D, Beardsley D, et al. Our preference is to use azathioprine (2 mg/kg orally every day adjusted to avoid severe neutropenia), preferably in combination with danazol (10-15 mg/kg/d), typically 600-800 mg per day, as the first approach to chronic immunosuppression because the incidence of acute and serious side effects is lower than with cyclophosphamide and the frequency of lasting remissions is comparable (20%-40%).58  However, responses occur more slowly (typically 3-4 months) and this agent, like danazol, is often stopped prematurely. prn indicates as needed. Our opinion is that it is as unreasonable to apply a “one-size fits all” threshold as it would be to attempt to normalize platelet counts in all patients. Idiopathic thrombocytopenic purpura in the elderly. However, we often use these agents initially because the other suggested treatments typically require weeks to months for their effect to become apparent. Studies of anti-tumor necrosis factor α receptor and anti-interleukin 2 receptor antagonists are too preliminary to evaluate. Nomura S, Kazuo D, Tomomitsu H, Fujimura K, Ikeda Y. I tempi sono ormai maturi al fine di permettere a migliaia di aspiranti docenti di poter far valere i propri diritti. International study to compare antigen-specific methods used for the measurement of antiplatelet autoantibodies. 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 … 3) inserimento in GAE ITP : con un ordinanza del TAR che riteneva abilitante il diploma ITP si è scatenata la corsa degli avvocati a proporre ricorsi per inserimento in GAE … In general, immediate therapy is not required for patients with platelet counts between 20 000 and 50 000 × 109/L in the absence of bleeding or predisposing comorbid conditions such as uncontrolled hypertension, active peptic ulcer disease, anticoagulation, recent surgery, or head trauma.2,3  We recommend maintaining platelet counts above 40 000 to 50 000 × 109/L for patients requiring aspirin, nonsteroidal anti-inflammatory drugs, warfarin, or other antithrombotics.