Ticino Medical Tribune is the official publication of the Ordine dei medici del Cantone Ticino (OMCT). The Institute of Family Medicine collaborates and ensures the scientific quality of the contributions published in the peer-reviewed section.
Interdisciplinary Approach in Complex Oncological Clinical Cases
We report a complex case of a patient with multiple comorbidities managed through a multidisciplinary approach involving oncologists, cardiologists, and clinical pharmacologists. This integrated collaboration enabled an evidence-based therapeutic decision, tailored to the patient’s elevated cardiovascular risk profile. Clinical pharmacology played a pivotal role in personalizing and safely monitoring the therapeutic strategy, which was defined by oncologists in close coordination with cardiologists to optimize outcomes and minimize adverse effects.
Copyright (c) 2026 All content published in Tribuna Medica Ticinese is protected by copyright. The authors retain the copyright to their works and grant the journal a license for publication. Unauthorized reproduction, distribution, or use of the published content is prohibited, except as permitted by law or with the written permission of the authors and the publisher. Respecting copyright ensures the integrity and protection of scientific work.
Malattia Leventinese o degenerazione maculare legata all’età?
La malattia leventinese e la degenerazione maculare senile sono due malattie oculari fenotipicamente molto simili ma con un'eziologia del tutto diversa. La prima infatti è una malattia genetica ereditaria, scoperta nella Valle Leventina. La degenerazione maculare legata all'età è invece una malattia degenerativa molto nota e diffusa. In questo articolo analizziamo aspetti clinici e tecniche diagnostiche delle due malattie.
Fasciotomy: yes or no? A case of benign subcutaneous emphysema
A 54-year-old woman presented with a swollen hand 15 hours after a superficial incision between her fingers by a letter opener. She was afebrile and hemodynamically stable, with minimal pain. On examination, there was crepitus from the dorsum of the hand to the forearm, without any inflammatory signs. Radiographs revealed subcutaneous emphysema without fascial involvement, and inflammatory markers were normal. Infectious causes such as necrotizing fasciitis were ruled out; a diagnosis of benign subcutaneous emphysema was retained. Mechanisms likely included a bellows effect, a one-way valve entry, and spread through a locus minoris resistentiae. The patient recovered fully with immobilization and prophylactic antibiotics.
Quando l’orecchio fa tossire: il riflesso dimenticato di Arnold; When the ear makes you cough: the forgotten Arnold’s reflex.
Coughing is the mechanical response to stimulation of certain anatomical structures linked to the innervation of the vagus nerve, and frequently leads to consulting the physicians. The differential diagnosis of the causes of coughing is very broad. Understanding the origin of this symptom is very important, as treatment options differ significantly depending on the triggering factor. The entire diagnostic process still poses a challenge today. If not conducted properly, in some cases, it leads to very expensive and not very useful exams. The causes of coughing are not always pathological. Among these is Arnold's reflex, which is nothing more than a physiological response to mechanical stimulation of the ear, discovered two centuries ago. It is a rare condition, the frequency of which increases in people with chronic cough. A comprehensive medical history, in addition to an otoscopic examination, are simple and sufficient tools for diagnosing Arnold's reflex
The Use of Artificial Intelligence in the Diagnosis of Cutaneous Melanoma
Artificial intelligence (AI) is reshaping melanoma diagnosis through convolutional neural networks (CNNs), achieving accuracy comparable to, and sometimes exceeding, that of expert dermatologists. Prospective studies and systematic reviews highlight the benefits of Augmented Intelligence, combining algorithmic output with clinical judgment to enhance sensitivity and specificity. Nonetheless, important limitations persist, including dataset bias, underrepresentation of darker skin types, and insufficient external validation. Ethical, regulatory, and trust-related issues remain critical. Overall, AI represents a promising support tool in dermatology, but requires transparency, robust clinical validation, and specialist supervision to ensure safe and responsible integration into clinical practice.
Lipedema: an Overlooked Clinical Challenge in Women's Health -From Early Diagnosis to Multidisciplinary Management
Lipoedema is a chronic, progressive, and painful disorder characterised by symmetrical accumulation of subcutaneous adipose tissue in the limbs, with typical sparing of the hands and feet, and a marked predominance in females. Onset most frequently occurs during hormonal transitions such as puberty, pregnancy, and menopause, and may be associated with a hereditary predisposition. The pathophysiology involves the interaction of genetic and hormonal factors, in association with microvascular and lymphatic dysfunction, adipocyte hyperplasia and hypertrophy, and chronic inflammatory processes. The clinical picture includes spontaneous or pressure-induced pain, hypersensitivity, easy bruising, and functional limitations, with a significant psychosocial impact. Diagnosis is clinical, based on positive criteria and the exclusion of conditions with similar presentations such as obesity, lymphoedema, lipo-hypertrophy, and Dercum’s disease. Management is primarily conservative and includes regular physical exercise, compression therapy, and complex decongestive lymphatic therapy. In refractory cases, liposuction is a surgical option with low risk and excellent outcomes. Poor awareness of the condition and the absence of specific biomarkers contribute to substantial underdiagnosis. Early recognition by general practitioners is crucial for timely referral to an angiologist, who serves as a reference figure for excluding vascular comorbidities and defining a multidisciplinary diagnostic and therapeutic pathway involving nutritionists, psychologists, and physiotherapists, with the aim of preventing disease progression and improving quality of life.
Chronic Fatigue Syndrome: a challenge in family medicine
Fatigue is common and usually resolves with rest. If it persists despite adequate recovery, it may indicate myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), characterized by profound asthenia with somatic and neurocognitive disturbances. Often underdiagnosed, it can be triggered by infections, stress, psychiatric disorders, vitamin deficiencies, endocrine dysfunctions, or surgical procedures. This case report describes a patient affected after a severe infection.
Copyright (c) 2025 All content published in Tribuna Medica Ticinese is protected by copyright. The authors retain the copyright to their works and grant the journal a license for publication. Unauthorized reproduction, distribution, or use of the published content is prohibited, except as permitted by law or with the written permission of the authors and the publisher. Respecting copyright ensures the integrity and protection of scientific work.
Endogenous Brewery Syndrome: A Rare Cause of Alcohol Intoxication
Endogenous brewery syndrome, also known as “auto-brewery syndrome,” is a very rare condition in which the intestinal microbiota ferments ingested carbohydrates into ethanol, leading to episodes of alcohol intoxication in the absence of alcohol consumption. To date, only about one hundred cases have been reported, with clinical manifestations ranging from dizziness and ataxia to overt intoxication and medicolegal complications. Even rarer is urinary fermentation, characterized by ethanol presence in urine without corresponding blood elevation. Predisposing factors include dysbiosis, high-carbohydrate diets, diabetes, and immunosuppression. Diagnosis relies on a thorough medical history, carbohydrate challenge tests, and microbiological investigations. Treatment involves carbohydrate restriction, antifungal (or antibiotic) therapy, and microbiota-balancing strategies. This syndrome highlights the metabolic role of the microbiota and its clinical and legal implications.
A case of refractory hypomagnesemia: when supplementation is not enough
A 90-year-old male patient was hospitalized following syncope without prodromal symptoms. Clinical examination revealed a positive Chvostek sign and brisk deep tendon reflexes. Laboratory tests demonstrated severe hypomagnesemia (0.21 mmol/L), hypokalemia (2.8 mmol/L), and hypocalcemia (corrected calcium 1.81 mmol/L), along with a prolonged QTc interval (510 msec) on electrocardiography. Initial management included intravenous electrolytes replacement, discontinuation of pantoprazole (known to impair magnesium absorption) and metformin (associated with chelation effects). After an initial improvement, we switched from intravenous to oral magnesium supplementation, but magnesium levels declined again. Further history-taking revealed that the patient consumed exclusively soda (carbonated soft drinks such as cola-based beverages). These drinks contain phosphoric acid, which acts as a chelating agent, binding magnesium and inhibiting its intestinal absorption. Discontinuation of this beverage intake led to normalization of magnesium levels. Finally, the syncope of our patient is most likely attributable to an arrhythmia secondary to electrolyte disturbances. The most severely altered electrolyte is magnesium, which has contributed to the development of both hypokalemia and hypocalcemia. The origin of this disturbance is probably multifactorial, involving the use of proton pump inhibitors (and possibly metformin), the malnutrition commonly seen in elderly patients, and the exclusive consumption of soda, resulting in a chelating effect.
Solitary plasmacytoma is a rare form of plasma cell neoplasm with a single location and no signs of multiple myeloma. In its extramedullary form, the prognosis, after curative surgery or radiotherapy, is quite positive. We present the case of a patient with a classic disease presentation and a 9-year follow-up without signs of recurrence or progression to multiple myeloma.
Beyond the Surface: Clinical and Diagnostic Aspects of Acquired Perforating Dermatosis
Perforating dermatoses represent a group of skin disorders characterized by the elimination of dermal connective tissue through the epidermis. In adults, this condition is associated with underlying systemic diseases, particularly diabetes mellitus and chronic kidney disease, and is often triggered by chronic friction or scratching, resulting in repeated skin trauma. We present the case of a patient with a typical clinical presentation.
Preventing acute radiodermatitis with photobiomodulation therapy: a literature review
Radiation-induced dermatitis (RID) is one of the most common acute toxicities associated with external beam radiotherapy, particularly in breast cancer patients. In general patients develop mild to moderate RID, however it can affect quality of life, and few effective preventive strategies are currently available. The aim of this narrative review is to examine the current evidence supporting the use of photobiomodulation therapy (PBM) for the prevention of acute RID in breast cancer patients, focusing on mechanisms of action and its integration into standard care. Emphasis was placed on studies involving breast cancer radiotherapy and on evidence from major clinical trials. PBM, a non-invasive light-based intervention, has been shown to reduce the incidence and severity of grade ≥2 RID in multiple trials. Treatment protocols typically involve near-infrared light (808–905 nm) applied 1–2 times weekly during radiotherapy. All reviewed studies reported high patient tolerability and no negative oncologic outcomes. PBM was one of the few modalities endorsed in recent international guidelines for RID prevention. PBM is a safe and effective option for preventing acute RID in breast cancer patients undergoing curative radiotherapy. With growing clinical support and guideline endorsement, PBM is well positioned for broader adoption as part of routine supportive cancer care. Future research should focus on protocol standardization and expanding its use to other cancer populations.
radiation-induced dermatitis, breast cancer, radiotherapy, photobiomodulation therapy, skin toxicity
Polypharmacy in general internal medicine in italian-speaking Switzerland: an analysis of SWICOS data
Polypharmacy, defined as the concurrent daily use of five or more distinct medications, represents an increasingly relevant challenge in clinical practice. Although the term has existed since the 19th century, its clinical significance has grown substantially over recent decades. Using data from the Swiss Cohort Study (SWICOS) - a prospective, population-based investigation conducted between 2015 and 2018 - we assessed the prevalence and determinants of polypharmacy in the Mesolcina valley. Data collection included demographic characteristics, lifestyle factors, comorbidities, and pharmacological treatments. Polypharmacy prevalence was evaluated in 474 participants aged 18 years or older (268 [56%] women and 206 [44%] men). The most frequently used drug classes, listed in decreasing order of frequency, were: analgesics and anti-inflammatory agents (N=108), vitamins (N=86), cardiovascular medications (N=81), proton pump inhibitors (N=44), lipid-lowering agents (N=40), antiplatelet agents (N=33), psychotropic drugs (N=28), oral contraceptives (N=18), antidiabetic agents (N=14), and anticoagulants (N=8). Prevalence of polypharamacy increased significicantly with age: it was observed in 10 of 236 individuals (4.2%) aged 18–49 years, in 23 of 180 (13%) aged 50–69 years, and in 24 of 58 (41%) aged ≥70 years. Prevalence was similar between sexes. In conclusion, polypharmacy increases with advancing age in Mesolcina valley, reflecting broader demographic and clinical trends observed in aging populations.
Lesione del legamento crociato anteriore: l'intervento non è obbligatorio
Anteriore cruciate ligament (ACL) injury is the most common ligament injury of the knee joint, frequently affecting both professional and amateur athletes. Surgical options - such as ligament reconstruction, regeneration or augmentation - are widely adopted; however, conservative management remains a valid alternative in selected cases. This narrative review aims to synthesize the most recent evidence on ACL injury treatment strategies, highlighting the factors that guide clinical decision-making. Recent literature increasingly emphasizes that patient age alone should no longer be the primary determinant of treatment choice. Instead, the individual's activity level and functional demands play a more significant role in selecting the most appropriate therapeutic approach. Moreover, targeted rehabilitation programs that include muscle strengthening and proprioceptive exercises have shown to improve outcomes across both surgical and non-surgical pathways. This interventions contribute to joint stability, functional recovery, and overall patient satisfaction. Importantly, the presence of associated meniscal injuries often shifts the balance in favor of surgical interventions due to the increased risk of long term degeneration. Further research is needed to refine patient selection criteria and optimize individualized treatment protocols.
Carbon monoxide poisoning: emerging and overlooked causes
Carbon monoxide poisoning is a subtle and insidious medical emergency. Due to its ability to mimic other conditions such as influenza, food poisoning, vestibular disorders, acute coronary syndrome, or epileptic seizures, it has been referred to as the “chameleon of emergencies”. While fires are a well-recognized source of carbon monoxide exposure, cases in which the origin remains unknown to both physicians and patients are increasingly reported. To enhance awareness of emerging and overlooked sources of carbon monoxide poisoning and summarize its pathophysiology, we conducted a narrative review. We systematically searched the National Library of Medicine. The toxicity of carbon monoxide relies on impaired blood oxygen transport and inhibition of the mitochondrial respiratory chain in the tissues. Less recognized sources include domestic combustion appliances (boilers, water heaters, stoves, ovens, and fireplaces), external heating sources (heating mushrooms), motor vehicle exhaust (cars, motorcycles, scooters, lawnmowers), sports-related activities (mud bogging, ice resurfacing machines), misuse of barbecues, portable power generators, and the use of narghile and cigarettes. Given the nonspecific presentation of carbon monoxide poisoning, improving recognition and diagnostic strategies is essential. Greater awareness among healthcare professionals, along with the integration of advanced diagnostic tools such as pulse oximeters capable of measuring carboxyhemoglobin levels, could facilitate earlier diagnosis and improve patient outcomes.
Cefepime and Neurotoxicity: An Underestimated Complication in the Geriatric Population
Cefepime is a widely used fourth-generation cephalosporin for the treatment of nosocomial infections but is known for its potential neurotoxicity, particularly in elderly and frail patients. This condition, characterized by cognitive impairment and confusion, occurs more frequently in the presence of renal insufficiency and/or suboptimal dosing. This paper discusses the mechanism underlying cefepime-induced neurotoxicity, the associated risk factors, and the clinical implications for monitoring and optimizing antibiotic therapy in frail patients.
Hypertension prevalence, management, and treatment outcomes in southern Switzerland
Hypertension is a major public health concern worldwide, significantly contributing to cardiovascular morbidity and mortality. This study investigates the prevalence, management, and treatment outcomes of hypertension in the Italian-speaking region of Switzerland. A total of 1,202 individuals participated in the study, undergoing office blood pressure measurements and 24-hour ambulatory blood pressure monitoring (ABPM). Results indicate that over 40% of the examined population exhibited hypertensive blood pressure levels according to the 2024 ESC and 2023 ESH guidelines. A key finding is that one in four individuals with office hypertension experienced stress-induced hypertension, highlighting the importance of ABPM in distinguishing context related elevations from sustained hypertension. Additionally, three-quarters of those diagnosed with office hypertension presented with Grade 1 hypertension, underscoring the need for early intervention through lifestyle modifications and pharmacological treatment when necessary. Alarmingly, a significant proportion of hypertensive individuals did not receive adequate treatment. Among hypertensive patients, 74% were untreated, and among those undergoing treatment, 80% failed to reach target blood pressure levels. The study found that 85% of patients on monotherapy remained hypertensive, indicating the potential need for combination therapy and treatment optimization. These findings emphasize the essential role of primary care physicians in diagnosing and managing hypertension effectively. Physicians must ensure accurate blood pressure assessment, promote lifestyle changes, and tailor pharmacological interventions to individual needs. A comprehensive, multifaceted approach incorporating patient education, regular monitoring, and evidence-based treatment strategies is crucial to improving hypertension control and reducing the associated cardiovascular risks. This study highlights the urgent need for enhanced public health strategies to address hypertension and its long-term consequences effectively.
Hypertension, Prevalence, Management, Treatment outcomes, Switzerland
Suprascapular nerve syndrome is a neuropathy with shoulder pain (due to sensory fibers from the glenohumeral and acromioclavicular joints) and weakness of supraspinatus and infraspinatus muscles. We show the case of a 40 years old female patient with a didactic clinical and ultrasound-imaging presentation.
Young athletes’ and parents’ knowledge of sports-related concussion in Italian-speaking Switzerland: a pilot study
Purpose. Knowledge about sports-related concussion (SRC) symptoms, prevention and management is critical to minimise severe consequences in paediatric patients, yet evidence on SRC knowledge among young athletes and their parents in the European context is scarce. This pilot study aims to test the feasibility and acceptability of population-based study on SRC knowledge and associated factors in the Italian-speaking part of Switzerland. Methods. The CKBBQ was translated and adapted to fit the cultural context. Linguistic and face validity were assured before collecting pilot data. Participants were recruited in early 2024 through sports coaches of high-risk team sports. Descriptive statistics, t-tests, and bivariate correlations were performed to evaluate SRC knowledge levels in young athletes and parents and how it might differ based on socio-demographic and information-related factors. Results. Data from 61 parents and 45 young athletes revealed that sociodemographic factors are not associated with SRC knowledge, but having received SRC information in the past year is a significant and positive predictor. Also, using dyadic data, a significant positive correlation was found between parents’ and adolescents’ SRC knowledge. Conclusions. SRC information is crucial in improving SRC knowledge. A large-scale population-based prevalence study is needed to corroborate these findings and inform future SRC information interventions adapted to the specific cultural context. The study highlights the importance of reducing barriers to questionnaire access and involving key stakeholders including the sports doctor catering for this population.
La sindrome di Parsonage-Turner, una causa (non proprio) rara di dolore alla spalla
Parsonage-Turner syndrome (PTS) is a pathology that mainly affects the brachial plexus in its upper or middle part and the peripheral nerves that originate from it. In the past, it was considered a rare disease, but recent studies show an annual incidence of about 1/1000. The clinical presentation has a characteristic course with a relatively rapid, often nocturnal onset of pain, most often localized in the proximal region of the arm and the trapezius muscle. The pain is usually not elicited by shoulder movements and is particularly severe at night. In the days following the onset of the first symptoms, there is a progressive paresis of part of the muscles of the shoulder. The diagnosis is based on the essential formulation of a clinical suspicion and subsequent confirmation by ENMG and imaging studies. While the main pain resolves spontaneously after 3–4 weeks, the motor disorder and a more dull pain persists much longer and usually resolves within 1–3 years. While PTS was considered a benign disease in the past, there is now increasing evidence that a significant proportion of patients develop a chronic course characterized by persistent pain, weakness and fatigue in the affected extremity. Better clinical courses, however, appear to be favored by early treatment. It is therefore crucial to make the diagnosis as early as possible.
Renal damage and Mycoplasma pneumoniae infection: reasoned hypothesis and literature review
Mycoplasma pneumoniae is a well-recognized pathogen responsible for community-acquired respiratory infections, particularly atypical pneumonia. Beyond its respiratory involvement, this microorganism is often associated with extra-respiratory manifestations. However, available reviews only marginally address the potential occurrence of kidney injury. The aim of this study was to investigate the relationship between Mycoplasma pneumoniae and kidney disease through expert analysis and a comprehensive literature review. Four possible mechanisms underlying kidney injury were identified: cardiorenal syndrome; pigment nephropathy resulting from hemolysis or rhabdomyolysis; “direct” kidney injury including interstitial nephritis, IgA nephropathy, or hemolityc uremic syndrome; nephrotoxicity caused by medications used to treat Mycoplasma pneumoniae infection or to relieve symptoms. Renal impairment associated with M. pneumoniae predominantly occurs during the infection rather than as a post-infectious complication. This renal impairment is probably caused directly by Mycoplasma pneumoniae, cytokines, or by immunologically mediated mechanisms characteristic of the early immune response. This study highlights the need for clinicians to consider renal complications in patients with M. pneumoniae, particularly those presenting with systemic symptoms.
Mycoplasma pneumoniae; renal injury; hemolysis; rhabdomyolysis; Schönlein-Henoch vasculitis