9797202 - DISEASE ONSET 2
Modulo General pathology and immunology

Subject

Learning outcomes

General pathology and immunology

At the end of the course, the students are expected to know the different types of inflammation and their cellular and molecular mechanisms. The students will also learn about the principles of targeted cancer therapy, the mechanisms of therapy resistance, and the immune evasion strategies employed by tumors. The students will understand the basics of immunopathology, including hypersensitivity reactions, autoimmunity, and immunodeficiencies.

Microbiology

The course aims to provide the student with the cognitive and methodological tools necessary to understand:

1) Microorganisms responsible for human infections covering the complete spectrum of etiological agents: i.e. bacteriology, virology, mycology and parasitology modules.

2) The different “types” of infections; to differentiate a viral infection from that one induced by other microorganisms and parasites.

3)  Infection control strategies

4) Antibiotics and resistance

5) Diagnostic stewardship

With reference to the objective of learning the essential biological characteristics of microorganisms and parasites responsible for human infections, the student must be able to: i) Distinguish microorganisms and parasites within the various stages of aggregation of living matter (metazoans, prokaryotes, eukaryotes, viruses), correlating the degree of organization and function with the pathogenic action; ii) Correlate the phenomenon of variation and mutation of microorganisms and parasites with the pathogenic action and resistance to antimicrobial substances.

iii) Evaluate the degree of survival of microorganisms and parasites in the environment as a critical factor for host infection; iv) Define the principle of "selective toxicity" by aiming at the therapeutic use of antimicrobial substances; Describe and classify the inhibitory mechanisms, the site of action, the spectrum of action of chemo antibiotics, antivirals, antifungal and antiprotozoal substances; v) Indicate the mechanisms of chemo-antibiotic resistance (genotypic and phenotypic) and resistance to other antimicrobial agents (antivirals, antifungals, antiprotozoals); vi) Analyze the limits of antiviral chemotherapy in relation to the biological characteristics of the viruses and pathogenetic characteristics of the viral infection; vii) evaluate the experimental perspectives of interfering on the different functions of microorganisms and parasites by means of inhibiting substances; viii) possess the basic knowledge of basic and molecular phenotypic methodologies of the microbiology laboratory; know the antibiogram, its preparation and its reading for the purpose of clinical efficacy.

Principles of anatomopathology

By the end of the course, students are expected to know the differences between benign and malignant neoplasms, the histological classification of neoplasms, the use of molecular biology for diagnostic, prognostic and therapeutic purposes. the student must also know the grading and staging system of malignant neoplasms. At the end of the course the students will understand the histological basis of the main neoplastic diseases.

Subject

Course format

General pathology and immunology

The teaching will primarily be conducted through in-person lectures with a blend of theory and practical exercises. In the event that teaching is delivered in a blended or remote mode, necessary adjustments may be introduced compared to what has been previously stated, in order to adhere to the planned program as outlined in the Syllabus.

Microbiology

Principles of anatomopathology

Subject

Prerequisites

General pathology and immunology

Basic course Disease Onset 1

Microbiology

Basic course Disease Onset 1

Principles of anatomopathology

Basic course Disease Onset 1

Subject

Attendance

General pathology and immunology

Mandatory attendance.

Microbiology

Principles of anatomopathology

Subject

Course contents

General pathology and immunology

GENERAL PATHOLOGY

·        Inflammation: Classification; Types of Exudates; Chemical Mediators of Inflammation. Fever.

·        Chronic Inflammation and Granulomas. Atherosclerosis.

·        Intracellular Accumulations

·        Pathology of the Extracellular Matrix. Pathologies of Collagen, Proteoglycans, and Elastic Fibers. Amyloid.

·        Tissue Repair, Regeneration, Fibrosis

·        Heat Shock Response; Unfolded Protein Response; Hypoxia-Induced Response; Ischemia-Reperfusion Injury; DNA damage response

·        Hereditary and Sporadic Tumors.

·        Altered Molecular Pathways in Tumors. Principles Of Targeted Cancer Therapy. Molecular Mechanisms of Drug Resistance.

·        Immune Evasion by Tumors. Principles Of Immunotherapy

·        Tumor in vitro models and experimental research

IMMUNOLOGY

·        Transplant Immunology

·        Immune Tolerance. Mechanisms of Central and Peripheral Tolerance.

·        Hypersensitivity. Definition of Allergy, Atopy, Anaphylaxis. Classification of Hypersensitivities.

·        Autoimmunity. Definition and Pathogenic Mechanisms of Autoimmunity. Examples of Major Organ-Specific and Systemic Autoimmune Diseases (Multiple Sclerosis, Rheumatoid Arthritis, Type I Diabetes, Systemic Lupus Erythematosus).

·        Primary And Secondary Immunodeficiencies.

Microbiology

Bacteriology module -  

Special bacteriology:

Taxonomy, Taxonomic classification, characteristics, laboratory identification, mechanisms of pathogenicity, clinical manifestations, sensitivity and resistance to antibiotics of: Gram positive cocci, Gram negative cocci, Enterobacterales, Gram negative non fermenting bacilli, Mycobacteria, Vibrio, Helicobacter, Aerobic spore-forming bacilli and anaerobes, Neisseriae, Streptomyces, Nocardia, Actinomyces, Corynebacterium, Lactobacillus, Listeria, Gardnerella, Clostridium, Haemophilus, pasteurella, Vibrio, Legionella, Brucella, Bordetella, Bacteroides, Campylobacter, Helicobacter, Macteria; Ureaplasma, non-spore-forming anaerobes, Spirochetes, Chlamydia.

The principles of diagnosis of bacterial infections, phenotypic and molecular sensitivity tests

Virology module

1. Viruses and subviral structures

•                  The organization of viral particles Replication of viruses

•                  Subviral pathogens: prions, viroids and virusoids

2. The pathogenesis of viral infection

•                  Method of transmission

•                  Types of viral infection: acute infection and persistent infection (latent, slow, chronic and cytotransforming)

•                  The host's response to viral infection

•                  The interferon system

3. Control of viral infections

•                  Antiviral chemotherapeutic agents. Classification

•                  Mechanism of action and resistance

•                  Combined therapies. Vaccines

4. The principles of diagnostics of viral diseases

•                  Cultivation method

•                  Non-culture and molecular methods. Serological methods

5. Characteristics of the main viruses of medical interest:

•                  Poxviridae, Herpesviridae, Adenoviridae, Human Papillomavirus and Polyomavirus, Parvoviridae, Paramyxoviridae, Orthomyxoviridae, Picornaviridae, Arenaviridae, Bunyaviridae, Caliciviridae, Coronaviridae, Human Flaviridae, Hepviridae, Human Flaviridae, virus HCV, HDV, HEV, HGV).

Module of Mycology and Parasitology

Opportunistic pathogens:

•                  Yeasts: Candida, Cryptococcus, Malassezia, Pneumocystis, Saprochaeta

•                  Filamentous fungi: Mucorales, Entomophthorales, Aspergillus, Fusarium, Lomentospora, dematiaceous fungi, and other fungi responsible for subcutaneous mycoses

Main medically significant parasites:

•                  Protozoa and intestinal parasitosis (Giardia, Entamoeba, Cryptosporidium)

•                  Protozoa and parasitosis in the blood and other sites (Trypanosoma, Leishmania, Trichomonas, Plasmodium, Toxoplasma)

•                  Metazoans (Taenia saginata and Taenia solium, Ascaris lumbricoides, Enterobius vermicularis)

Principles of anatomopathology

·        Benign and malignant neoplasms.

·        Histological classification of neoplasms.

·        Carcinoma in situ and invasive.

·        Histological tumor grade.

·        Metastasis: lymphatic and blood.

·        Tumor staging system: TNM.

Subject

Textbooks

General pathology and immunology

General Pathology

·        Robbins and Cotran, Pathologic Basis of Disease, 10^th edition, Elsevier (2020)

·        Weinberg, The Biology of Cancer, 2^nd edition, Garland Science, (2014)

Immunology

·        Janeway, Immunobiology, 10^th edition, Norton & Company (2022)

Molecular Oncology

Additional educational material (slides, videos, handouts, etc.) will be distributed or indicated during the lessons.

Microbiology

The most recent edition of one of these texts chosen by the student:

TEXT 1: Medical Microbiology - Murray - EDRA Edition

TEXT 2: Medical Microbiology - Sherris - EMSI Edition

TEXT 3: Principles of medical microbiology - Antonelli G., Clementi M., Pozzi G., Rossolini G.M. - Ambrosiana Publishing House

https://onlinelibrary.wiley.com/doi/book/10.1002/9780470688618

Any additional educational material (slides, videos, handouts, etc.) will be distributed or indicated during the lessons.

Principles of anatomopathology

·        Robbins and Kumar, Basic Pathology, 11th edition, Elsevier (2022)

Any additional educational material (slides, videos, handouts, etc.) will be distributed or indicated during the lessons.

Subject

Assessment methods

General pathology and immunology

The final assessment of acquired knowledge is conducted by a blend of written and oral examination. The grade is expressed on a scale of thirty, up to a maximum of 30/30 cum laude (with honors). The final grade is determined by the weighted average of the scores obtained in the course subjects.

The oral examination consists of an interview during which questions will cover at least three different topics from the course curriculum. The assessments aim to evaluate: i) the level of knowledge in the disciplines; ii) the ability to apply this knowledge to solve specific problems related to the disciplines (autonomous problem-solving); iii) clarity of expression; iv) proficiency in medical-scientific language. The assessment of learning can also be conducted remotely if the conditions necessitate it.

For the assignment of the final grade, the following parameters will be considered:

·        Score 29-30 with honors: The student demonstrates an in-depth knowledge of the topics, promptly and correctly integrates and critically analyzes presented situations, independently solving even highly complex problems. They possess excellent communication skills and command medical-scientific language proficiently.

·        Score 26-28: The student has a good understanding of the topics, is able to integrate and critically and logically analyze presented situations, can fairly independently solve complex problems, and presents topics clearly using appropriate medical-scientific language.

·        Score 22-25: The student has a fair understanding of the topics, although it may be limited to the main areas. They can integrate and critically analyze presented situations, although not always in a linear fashion, and present topics fairly clearly with moderate language proficiency.

·        Score 18-21: The student has minimal knowledge of the topics, possesses modest ability to integrate and critically analyze presented situations, and presents topics sufficiently clearly, although their language proficiency may be underdeveloped.

·        Exam not passed: The student lacks the minimum required knowledge of the core content of the course. Their ability to use specific language is minimal or nonexistent, and they are unable to independently apply acquired knowledge.

Microbiology

Principles of anatomopathology

Subject

Examples of common questions and/or exercises

General pathology and immunology

·        Discuss about granulomas

·        Describe the central and peripheral immune tolerance

·        Differences between type II and III hypersensitivity reactions

·        Mechanisms of evasion from cytotoxic responses by cancer cells

·        Main in vitro assays for evaluating cell viability

Microbiology

The Microbiology test is aimed at assessing the level of knowledge regarding the provisions of the specific training objectives, the ability to know how to apply the basic knowledge acquired to the clinic (microbiological implications) and for the resolution of specific problems concerning the relationships between the pathogen and the host

The test takes place through an oral exam.

The oral exam consists of an interview in which 2-3 questions will be asked which concern at least n. 3 different topics of the program (bacteriology, virology and mycology). The test allows to verify: i) the level of knowledge about the main human pathogenic microorganisms; ii) the ability to apply this knowledge to define virulence and pathogenic power in human infections, as well as the main methods of controlling the infection itself; iii) clarity of presentation; iv) the property of medical-scientific language.

Examples of frequently asked questions and / or exercises

Description of the main microbial groups.

Etiopathogenesis of different species

Diagnostic assessment and Aantimicrobial stewardship algorithms

Principles of anatomopathology

·        Differences between benign and malignant neoplasm

·        Definition of carcinoma in situ

·        Describe the staging system of neoplasm

·        Role of molecular biology in malignant neoplasms