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Gargiulo L, Ibba L, Malagoli P, Amoruso F, Argenziano G, Balato A, Bardazzi F, Burlando M, Carrera CG, Damiani G, Dapavo P, Dini V, Fabbrocini G, Franchi C, Gaiani FM, Girolomoni G, Guarneri C, Lasagni C, Loconsole F, Marzano AV, Maurelli M, Megna M, Orsini D, Sampogna F, Travaglini M, Valenti M, Costanzo A, Narcisi A. A risankizumab super responder profile identified by long-term real-life observation-IL PSO (ITALIAN LANDSCAPE PSORIASIS). J Eur Acad Dermatol Venereol 2024; 38:e113-e116. [PMID: 37611277 DOI: 10.1111/jdv.19464] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Affiliation(s)
- L Gargiulo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - L Ibba
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Malagoli
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - F Amoruso
- Dermatology Unit, Azienda Ospedaliera di Cosenza, Cosenza, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - A Balato
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - F Bardazzi
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - M Burlando
- Department of Dermatology, Dipartimento di Scienze della Salute (DISSAL), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - C G Carrera
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Damiani
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - P Dapavo
- Department of Biomedical Science and Human Oncology, Second Dermatologic Clinic, University of Turin, Turin, Italy
| | - V Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine Ospedale Santa Chiara, Pisa, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - C Franchi
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - F M Gaiani
- Department of Dermatology, Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - G Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - C Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Dermatology, University of Messina, AOU Policlinico G. Martino, Messina, Italy
| | - C Lasagni
- Dermatological Clinic, Department of Specialized Medicine, University of Modena, Modena, Italy
| | - F Loconsole
- Department of Dermatology, University of Bari, Bari, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Maurelli
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - M Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - D Orsini
- UOC Clinical Dermatology - Dermatological Institute S. Gallicano, IRCCS, Rome, Italy
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI) IRCCS, Rome, Italy
| | - M Travaglini
- U.O.S.D. Dermatologica - Centro per la Cura Della Psoriasi, Brindisi, Italy
| | - M Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Di Saverio S, Franchi C, Kremel D, Lark ME, Todero S, Damaskos D. Technique for pancreas-sparing total duodenectomy and reconstruction of a neoduodenum using a free interposed jejunal limb with ampullojejunostomy and Roux-en-Y anastomosis. Br J Surg 2021; 108:e71-e73. [PMID: 33704403 DOI: 10.1093/bjs/znaa097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/12/2022]
Affiliation(s)
- S Di Saverio
- Department of General Surgery, University of Insubria, American Association for the Surgery of Trauma (ASST) Sette Laghi, Varese, Italy
| | - C Franchi
- Department of General Surgery, University of Insubria, American Association for the Surgery of Trauma (ASST) Sette Laghi, Varese, Italy
| | - D Kremel
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M E Lark
- University of Toledo Medical Center, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - S Todero
- St Orsola-Malpighi University Hospital, Alma Mater University of Bologna, Bologna, Italy
| | - D Damaskos
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
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Lombardo M, Vigezzi A, Ietto G, Franchi C, Iori V, Masci F, Scorza A, Macchi S, Iovino D, Parise C, Carcano G. Role of vitamin D serum levels in prevention of primary and recurrent melanoma. Sci Rep 2021; 11:5815. [PMID: 33712642 PMCID: PMC7971007 DOI: 10.1038/s41598-021-85294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/03/2021] [Indexed: 11/26/2022] Open
Abstract
Patients afflicted with melanoma show lower vitamin D serum levels (VDSL) than the healthy population. This hypothesis agrees with its well-known antiproliferative features. An observational study was carried out to collect VDSL in patients suffering from melanoma. Our aim was to identify a potential connection between low VDSL and the risk to incur melanoma. Furthermore, we studied the association between VDSL at the diagnosis of melanoma and other germane prognostic factors. The population held in regard was composed of 154 patients with a diagnosis of melanoma between 2016 and 2019. These patients were retrospectively collected from our follow-up storage. We compared VDSL to clinical and pathological parameters (age, sex, tumour location, Breslow’s depth, Clark’s level, histological subtype, ulceration, et aliqua). Moreover, we recruited a control group with negative melanoma history. Mean and median of VDSL were significantly lower in the melanoma group. Instead, we found a negative association between melanoma and VDSL > 30 ng/L (OR 0.11; p < 0.0001). No correlation between VDSL and both Breslow’s depth and Clark’s level was discovered, but the VDSL comparison between thin (depth ≤ 1 mm) and thick tumours (depth > 1 mm) revealed a statistically significant difference (21.1 ± 8.2 ng/L vs 17.8 ± 8.1; p = 0.01). Moreover, VDSL were significantly lower in melanomas with mitotic rate ≥ 1/mm2 (22.1 ± 8.3 ng/L; p < 0007). Nevertheless, no connection was found between VDSL and both ulceration and positive sentinel nodes (p = 0.76; p = 0.74). Besides, our study revealed no association between VDSL and histological subtype (p = 0.161). Lower VDSL correlate with thick and high mitotic rate tumours. Future prospective studies would investigate if appropriate upkeep of suitable VDSL can decrease the risk of primary and recurrent melanoma diagnosis.
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Affiliation(s)
- M Lombardo
- Department of Dermatology, ASST Dei Sette Laghi, Varese, Italy
| | - A Vigezzi
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy.
| | - G Ietto
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - C Franchi
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - V Iori
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - F Masci
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - A Scorza
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - S Macchi
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - D Iovino
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - C Parise
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
| | - G Carcano
- Department of General, Emergency and Transplants Surgery, Università Dell'Insubria, ASST Dei Sette Laghi, Varese, Italy
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Franchi C, Mannucci PM, Nobili A, Ardoino I. Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people. Eur J Clin Pharmacol 2020; 76:459-465. [PMID: 31853593 DOI: 10.1007/s00228-019-02815-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge. METHODS Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48). RESULTS Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3-63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0-47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge. CONCLUSIONS Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy.
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, Italy
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Franchi C, Rossio R, Ardoino I, Mannucci PM, Nobili A. Inappropriate prescription of benzodiazepines in acutely hospitalized older patients. Eur Neuropsychopharmacol 2019; 29:871-879. [PMID: 31221501 DOI: 10.1016/j.euroneuro.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/06/2019] [Accepted: 05/29/2019] [Indexed: 12/31/2022]
Abstract
Benzodiazepines (BDZs) are widely prescribed in older people. The aims of the study are to assess the prevalence of inappropriate prescription of BZDs and the associated factors in acutely hospitalized older patients. Patients aged 65 years or more hospitalized from 2010 to 2017 in more than 100 Italian internal medicine and geriatric wards in the frame of the REPOSI register were included if prescribed with BDZs at hospital admission or discharge. Appropriateness of prescription was assessed according to the 2015 Beers criteria and their modified French and German versions. Among 4681 patients discharged from hospital, 15% (N = 710) were discharged with BDZs, and 62% of them (N = 441, 95% CI: 58.5%-65.6%) were inappropriately prescribed, being prescribed with BDZ to be always avoided in the elderly (45%), at higher doses than recommended (31%) or with no appropriate clinical conditions (19%). From admission to discharge the prevalence of inappropriate BDZ prescription decreased by 4%, but 62% of patients inappropriately prescribed at admission were still inappropriately prescribed at discharge. Among the 179 patients first prescribed at the time of discharge, half were inappropriately prescribed. Being female (OR 1.32, 95%CI 0.95-1.85), enrolled in REPOSI during the years 2016 and 2017 (OR 1.94, 95%CI 1.10-3.39; OR 1.57, 95%CI 0.95-2.58) and living in nursing homes (OR 2.04, 95%CI 0.95-4.37) were associated with an increased risk to be inappropriately prescribed. This study shows a high prevalence of inappropriate use of BDZ in acutely hospitalized older patients both at hospital admission and discharge.
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Affiliation(s)
- C Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
| | - R Rossio
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - A Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
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Ardoino I, Mannucci PM, Nobili A, Franchi C. Antibiotic use and associated factors in a large sample of hospitalised older people. J Glob Antimicrob Resist 2019; 19:167-172. [PMID: 31051285 DOI: 10.1016/j.jgar.2019.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance.
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Affiliation(s)
- I Ardoino
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy.
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Peris K, Lo Schiavo A, Fabbrocini G, Dini V, Patrizi A, Fusano M, Bianchi L, Guanziroli E, Guarneri C, Parodi A, Bertoldi A, Musumeci ML, Offidani A, Rongioletti F, Pistone G, Malara G, Potenza C, Casari A, Franchi C, Ardigò M, Cusano F, Stingeni L, Amerio P, Mancini LL, Prignano F, Deboli T, Gualberti G, Saragaglia V, Bettoli V. HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 33:766-773. [PMID: 30633405 PMCID: PMC6593467 DOI: 10.1111/jdv.15425] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland-bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. OBJECTIVE The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. METHODS A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex-16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment-General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS-PGA). RESULTS A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex-16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS-PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test-retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated. CONCLUSION Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.
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Affiliation(s)
- K Peris
- Istituto di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Lo Schiavo
- Unità di Dermatologia, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - A Patrizi
- Dermatologia, DIMES (Dipartimento di Medicina clinica Specialistica e Sperimentale), Università di Bologna, Bologna, Italy
| | - M Fusano
- ASST Spedali Civili of Brescia, U.O. Dermatologia e Venereologia, Università di Brescia, Brescia, Italy
| | - L Bianchi
- Unità Operativa di Dermatologia, Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - E Guanziroli
- Dipartimento di Fisiopatologia, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - C Guarneri
- Dipartimento di Scienze Biomediche e Dentali e Imaging Morfofunzionale, Unità di Dermatologia, Università di Messina, Messina, Italy
| | - A Parodi
- DiSSal Sezione di Dermatologia, Università di Genova, Ospedale-Policlinico San Martino, Genoa, Italy
| | - A Bertoldi
- Dipartimento di Dermatologia, Ospedale "Santi Giovanni e Paolo", Venice, Italy
| | - M L Musumeci
- Dermatology Clinic, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - A Offidani
- SOD Clinica di Dermatologia, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ancona, Italy
| | - F Rongioletti
- Clinica Dermatologica, Dipartimento di scienze Mediche e Salute Pubblica, Università di Cagliari, Cagliari, Italy
| | - G Pistone
- Dipartimento Di.Bi. MIS, U.O.C. di Dermatologia e MTS, A.O.U.P "Paolo Giaccone", Palermo, Italy
| | - G Malara
- Struttura Complessa presso la UOC di Dermatologia GOM "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - C Potenza
- Facoltà di Farmacia e Medicina, U.O.C. di Dermatologia "Daniele Innocenzi", Università degli Studi di Roma "Sapienza", Polo Pontino, Italy
| | - A Casari
- Clinica Dermatologica, Policlinico di Modena, Modena, Italy
| | - C Franchi
- UO dermatologia, IRCCS Galeazzi, Milan, Italy
| | - M Ardigò
- U.O.C. di Dermatologia Clinica, IFO-San Gallicano, IRCCS, Rome, Italy
| | - F Cusano
- U.O.C. di Dermatologia, A.O. Gaetano Rummo, Benevento, Italy
| | - L Stingeni
- Sezione di Dermatologia Clinica, Allergologica e Venereologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - P Amerio
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio, Chieti, Italy
| | - L L Mancini
- Unità di Dermatologia, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - F Prignano
- Clinica Dermatologica - ASF Dipartimento di Chirurgia e Medicina Translazionale, Ospedale Piero Palagi, Università di Firenze, Florence, Italy
| | - T Deboli
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - V Bettoli
- Dipartimento di Medicina Clinica e Specialistica, U.O. di Dermatologia, A.O.U. di Ferrara, Ferrara, Italy
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Agosti P, Tettamanti M, Vella FS, Suppressa P, Pasina L, Franchi C, Nobili A, Mannucci PM, Sabbà C. Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients. Eur J Intern Med 2018; 57:25-31. [PMID: 29934241 DOI: 10.1016/j.ejim.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/06/2018] [Accepted: 06/14/2018] [Indexed: 12/31/2022]
Affiliation(s)
- P Agosti
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - M Tettamanti
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - F S Vella
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - P Suppressa
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Sabbà
- Interdisciplinary Department of Medicine, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy
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Cesari M, Franchi C, Cortesi L, Nobili A, Ardoino I, Mannucci PM. Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register. Eur J Intern Med 2018; 56:11-18. [PMID: 29907381 DOI: 10.1016/j.ejim.2018.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 06/04/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related accumulation of deficit model) in a large cohort of hospitalized older persons, in order to benefit from its capacity to comprehensively weight the risk profile of the individual. METHODS Patients aged 65 and older enrolled in the REPOSI register from 2010 to 2016 were considered in the present analyses. Variables recorded at the hospital admission (including socio-demographic, physical, cognitive, functional and clinical factors) were used to compute the FI. The prognostic impact of the FI on in-hospital and 12-month mortality was assessed. RESULTS Among the 4488 patients of the REPOSI register, 3847 were considered eligible for a 34-item FI computation. The median FI in the sample was 0.27 (interquartile range 0.21-0.37). The FI was significantly predictive of both in-hospital (OR 1.61, 95%CI 1.38-1.87) and overall (HR 1.46, 95%CI 1.32-1.62) mortality, also after adjustment for age and sex. CONCLUSIONS The FI confirms its strong predictive value for negative outcomes. Its implementation in cohort studies (including those conducted in the hospital setting) may provide useful information for better weighting the complexity of the older person and accordingly design personalized interventions.
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Affiliation(s)
- M Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - L Cortesi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - I Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - P M Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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10
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Peyvandi F, Palla R, Franchi C, Nobili A, Rosendaal FR, Mannucci PM. Choices of factor VIII products in previously untreated patients with haemophilia A: A global survey. Haemophilia 2018; 24:e266-e268. [PMID: 29869363 DOI: 10.1111/hae.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- F Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - R Palla
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Luigi Villa Foundation, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Franchi C, Ardoino I, Nobili A, Pasina L, Mannucci P, Marengoni A, Perticone F. Pattern of in-hospital changes in drug use in the older people from 2010 to 2016. Pharmacoepidemiol Drug Saf 2017; 26:1534-1539. [PMID: 29027300 DOI: 10.1002/pds.4330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
Affiliation(s)
- C. Franchi
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - I. Ardoino
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - A. Nobili
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - L. Pasina
- Department of Neuroscience; IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”; Milan Italy
| | - P.M. Mannucci
- Scientific Direction; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - A. Marengoni
- Department of Clinical and Experimental Sciences; University of Brescia; Brescia Italy
| | - F. Perticone
- Department of Medical and Surgical Sciences; University Magna Graecia of Catanzaro; Catanzaro Italy
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Spadino S, Altomare A, Cainelli C, Franchi C, Frigerio E, Garutti C, Taglioni M, Altomare GF. Disseminated Granuloma Annulare: Efficacy of Cyclosporine Therapy. Int J Immunopathol Pharmacol 2016; 19:433-8. [PMID: 16831309 DOI: 10.1177/039463200601900219] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Granuloma annulare is an anatomo-clinical entity that is frequently encountered in everyday dermatological practice. We report our experience regarding 4 patients with disseminated granuloma annulare. Each patient was treated with a cycle of cyclosporine therapy for six weeks. A cycle of systemic cyclosporine therapy was started at a dose of 4 mg/kg/day for four weeks, subsequently reduced by 0.5 mg/kg/day every two weeks. The clinical picture more or less completely resolved within three weeks in all of the patients, and there were no relapses during the dose-tapering period or the following 12 months. Cyclosporine was optimally tolerated by all four patients, none of whom experienced any therapy-related side effects. Cyclosporine is a valid therapeutic option for the treatment of disseminated granuloma annulare, although we recommend its use in a protected hospital environment that facilitates patient monitoring.
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Affiliation(s)
- S Spadino
- Institute of Dermatology, University of Milan, IRCCS Galeazzi Orthopedic Institute, Via Galeazzi 4, 20161 Milan, Italy
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Franchi C, Cainelli G, Frigerio E, Garutti C, Altomare GF. Association of Cyclosporine and 311 nM UVB in the Treatment of Moderate to Severe Forms of Psoriasis: A New Strategic Approach. Int J Immunopathol Pharmacol 2016; 17:401-6. [PMID: 15461875 DOI: 10.1177/039463200401700321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Psoriasis is a T-lymphocyte mediated autoimmune disease. The response to therapies targeting T-lymphocytes suggest that the latter is a key cell in the pathogenesis of the disease. Cyclosporine (CsA) inhibits the proliferation and the IL-2 dependent expansion of T-lymphocytes. Ultraviolet radiation is an effective treatment for psoriasis. Several studies have demonstrated a significant improvement of the therapeutic response when narrow-band radiation is issued by TL-01 fluorescent lamp compared to broadband UVB issued by other fluorescent sources. The effects of UVB on the immune system appear to be limited to the cell-mediated compartment of the immune response. In order to reduce the cumulative dose of UVB and limit the toxicity of drugs in the therapy of psoriasis, phototherapy with UVB has been used as treatment in association with other standard therapies. The purpose of the study is to evaluate, in patients with moderate to severe psoriasis a combined therapy with Cyclosporine A and 311 nm UVB phototherapy.
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Affiliation(s)
- C Franchi
- Institute of Dermatology, 'O. Galeazzi' Institute, Milan, Italy
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Giussani G, Canelli V, Bianchi E, Erba G, Franchi C, Nobili A, Sander JW, Beghi E. Long-term prognosis of epilepsy, prognostic patterns and drug resistance: a population-based study. Eur J Neurol 2016; 23:1218-27. [DOI: 10.1111/ene.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G. Giussani
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - V. Canelli
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - E. Bianchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - G. Erba
- Department of Neurology; SEC, University of Rochester; Rochester NY USA
| | - C. Franchi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - A. Nobili
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - J. W. Sander
- Stichting Epilepsie Instellingen Nederland (SEIN); Heemstede The Netherlands
- NIHR University College London Hospitals Biomedical Research Centre; UCL Institute of Neurology; London UK
| | - E. Beghi
- IRCCS − Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
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Orsi GB, Giuliano S, Franchi C, Ciorba V, Protano C, Giordano A, Rocco M, Venditti M. Changed epidemiology of ICU acquired bloodstream infections over 12 years in an Italian teaching hospital. Minerva Anestesiol 2015; 81:980-988. [PMID: 25411769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND We compared the etiology of 203 ICU-acquired laboratory confirmed bloodstream infections (LC-BSI) prospectively collected between January 2000-December 2007 (first period) with 83 LC-BSI recorded between January 2010-December 2012 (second period), after the diffusion in 2008 of K. pneumoniae expressing carbapenem-resistance due to K. pneumoniae carbapenemases production (KPC-CR-Kp). METHODS In the general ICU of teaching hospital "Umberto I" in Rome, all ICU-acquired LC-BSI episodes occurring in patients admitted to ICU≥48h were included. Baseline characteristics, clinical features, antimicrobial resistance and outcome were recorded. All isolated strains multidrug resistance (MDR) were evaluated according to the European Centre for Disease Control (ECDC) guidelines. RESULTS Overall the study included 329 isolates, 214 in 2000-2007 and 115 in 2010-2012. In the second period we registered a Gram-positive reduction (55.1% vs. 26.9%; P<0.01) and Gram-negative increase (40.2% vs. 69.6%; P<0.01). In 2000-2007 staphylococci were responsible for 45.8% LC-BSI's, whereas 18.3% during 2010-2012. Enterobacteriaceae increased dramatically (15.4% vs. 39.2%; P<0.01), especially Klebsiella spp. (5.6% vs. 31.3%; P<0.01). LC-BSI associated mortality decreased among Gram-positive (56.8% vs. 51.6%), but increased in Gram-negative (41.9% vs. 60.0%; P<0.03), especially in Enterobacteriaceae (RR 2.13; 95% CI 1.21 - 3.73; P<0.01). MDR increased remarkably among Enterobacetriaceae (51.5% vs. 73.3%). The study highlighted the associated mortality for Enterobacteriaceae when comparing MDR to non-MDR microorganisms. CONCLUSION ICU-acquired LC-BSI etiology shifted from Gram-positive to Gram-negative during the study period in our ICU. Also associated mortality decreased among the former, whereas it increased in the latter. Last MDR increased enormously among Enterobacteriaceae with the diffusion of KPC (75% of strains), adding significantly to associated mortality (RR 2.17; 1.16-4.05; P<0.01).
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Affiliation(s)
- G B Orsi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy -
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Corrao S, Argano C, Nobili A, Marcucci M, Djade CD, Tettamanti M, Pasina L, Franchi C, Marengoni A, Salerno F, Violi F, Mannucci PM, Perticone F. Brain and kidney, victims of atrial microembolism in elderly hospitalized patients? Data from the REPOSI study. Eur J Intern Med 2015; 26:243-9. [PMID: 25749554 DOI: 10.1016/j.ejim.2015.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 02/08/2015] [Accepted: 02/16/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is well known that atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with a higher risk of stroke, and new evidence links AF to cognitive impairment, independently from an overt stroke (CI). Our aim was to investigate, assuming an underlying role of atrial microembolism, the impact of CI and CKD in elderly hospitalized patients with AF. METHODS We retrospectively analyzed the data collected on elderly patients in 66 Italian hospitals, in the frame of the REPOSI project. We analyzed the clinical characteristics of patients with AF and different degrees of CI. Multivariate logistic analysis was used to explore the relationship between variables and mortality. RESULTS Among the 1384 patients enrolled, 321 had AF. Patients with AF were older, had worse CI and disability and higher rates of stroke, hypertension, heart failure, and CKD, and less than 50% were on anticoagulant therapy. Among patients with AF, those with worse CI and those with lower estimated glomerular filtration rate (eGFR) had a higher mortality risk (odds ratio 1.13, p=0.006). Higher disability levels, older age, higher systolic blood pressure, and higher eGFR were related to lower probability of oral anticoagulant prescription. Lower mortality rates were found in patients on oral anticoagulant therapy. CONCLUSIONS Elderly hospitalized patients with AF are more likely affected by CI and CKD, two conditions that expose them to a higher mortality risk. Oral anticoagulant therapy, still underused and not optimally enforced, may afford protection from thromboembolic episodes that probably concur to the high mortality.
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Affiliation(s)
- S Corrao
- Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; Department of Internal Medicine 2, National Relevance and High Specialization Hospital Trust, ARNAS Civico, Di Cristina Benfratelli, Palermo, Italy.
| | - C Argano
- Biomedical Department of Internal Medicine and Subspecialities (DiBiMIS), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - M Marcucci
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy; Department of Internal Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - C D Djade
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy; Scientific Direction, IRCCS Ca Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122 Milan, Italy
| | - M Tettamanti
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156 Milan, Italy
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy
| | - F Salerno
- Internal Medicine, IRCCS Policlinico San Donato, Department of Medical and Surgery, Sciences, University of Milano, Via Morandi 30, 20097 San Donato, Milan, Italy
| | - F Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - P M Mannucci
- Scientific Direction, IRCCS Ca Granda Maggiore Policlinico Hospital Foundation, Via Pace 9, 20122 Milan, Italy
| | - F Perticone
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Campus Universitario di Germaneto, Viale Europa, 88100 Catanzaro, Italy
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Haas C, Hanson E, Banemann R, Bento A, Berti A, Carracedo Á, Courts C, Cock GD, Drobnic K, Fleming R, Franchi C, Gomes I, Hadzic G, Harbison S, Hjort B, Hollard C, Hoff-Olsen P, Keyser C, Kondili A, Maroñas O, McCallum N, Miniati P, Morling N, Niederstätter H, Noël F, Parson W, Porto M, Roeder A, Sauer E, Schneider P, Shanthan G, Sijen T, Syndercombe Court D, Turanská M, van den Berge M, Vennemann M, Vidaki A, Zatkalíková L, Ballantyne J. RNA/DNA co-analysis from human skin and contact traces – results of a sixth collaborative EDNAP exercise. Forensic Sci Int Genet 2015; 16:139-147. [DOI: 10.1016/j.fsigen.2015.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/12/2014] [Accepted: 01/04/2015] [Indexed: 11/25/2022]
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Pasina L, Brucato AL, Djade CD, Di Corato P, Ghidoni S, Tettamanti M, Franchi C, Salerno F, Corrao S, Marengoni A, Marcucci M, Mannucci PM, Nobili A. Inappropriate prescription of allopurinol and febuxostat and risk of adverse events in the elderly: results from the REPOSI registry. Eur J Clin Pharmacol 2014; 70:1495-503. [DOI: 10.1007/s00228-014-1752-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
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Corrao S, Santalucia P, Argano C, Djade CD, Barone E, Tettamanti M, Pasina L, Franchi C, Kamal Eldin T, Marengoni A, Salerno F, Marcucci M, Mannucci PM, Nobili A. Gender-differences in disease distribution and outcome in hospitalized elderly: data from the REPOSI study. Eur J Intern Med 2014; 25:617-23. [PMID: 25051903 DOI: 10.1016/j.ejim.2014.06.027] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Women live longer and outnumber men. On the other hand, older women develop more chronic diseases and conditions such as arthritis, osteoporosis and depression, leading to a greater number of years of living with disabilities. The aim of this study was to describe whether or not there are gender differences in the demographic profile, disease distribution and outcome in a population of hospitalized elderly people. METHODS Retrospective observational study including all patients recruited for the REPOSI study in the year 2010. Analyses are referred to the whole group and gender categorization was applied. RESULTS A total of 1380 hospitalized elderly subjects, 50.5% women and 49.5% men, were considered. Women were older than men, more often widow and living alone or in nursing homes. Disease distribution showed that malignancy, diabetes, coronary artery disease, chronic kidney disease and chronic obstructive pulmonary disease were more frequent in men, but hypertension, osteoarthritis, anemia and depression were more frequent in women. Severity and comorbidity indexes according to the Cumulative Illness Rating Scale (CIRS-s and CIRS-c) were higher in men, while cognitive impairment evaluated by the Short Blessed Test (SBT), mood disorders by the Geriatric Depression Scale (GDS) and disability in daily life measured by Barthel Index (BI) were worse in women. In-hospital and 3-month mortality rates were higher in men. CONCLUSIONS Our study showed a gender dimorphism in the demographic and morbidity profiles of hospitalized elderly people, emphasizing once more the need for a personalized process of healthcare.
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Affiliation(s)
- S Corrao
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy; Department of Internal Medicine 2, National Relevance Hospital Trust, ARNAS Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - P Santalucia
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy; Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
| | - C Argano
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy
| | - C D Djade
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy; Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - E Barone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DiBiMIS), University of Palermo, Italy
| | - M Tettamanti
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - L Pasina
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - C Franchi
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - T Kamal Eldin
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - A Marengoni
- Department of Clinical and Experimental Science, University of Brescia, Italy
| | - F Salerno
- Medicina Interna, IRCCS Policlinico San Donato, Department of Medical and Surgery Sciences, University of Milano, Italy
| | - M Marcucci
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; Department of Internal Medicine, IRCCS Ca' Granda Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - P M Mannucci
- Scientific Direction, IRCCS Foundation Maggiore Hospital Policlinico, Milan, Italy
| | - A Nobili
- Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Franchi C, Mari D, Tettamanti M, Pasina L, Djade CD, Mannucci PM, Onder G, Bernabei R, Gussoni G, Bonassi S, Nobili A. E-learning to improve the drug prescribing in the hospitalized elderly patients: the ELICADHE feasibility pilot study. Aging Clin Exp Res 2014; 26:435-43. [PMID: 24343853 DOI: 10.1007/s40520-013-0187-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND E-learning is an efficient and cost-effective educational method. AIMS This study aimed at evaluating the feasibility of an educational e-learning intervention, focused on teaching geriatric pharmacology and notions of comprehensive geriatric assessment, to improve drug prescribing to hospitalized elderly patients. METHODS Eight geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control. Clinicians of the two groups had to complete a specific per group e-learning program in 30 days. Then, ten patients (aged ≥75 years) had to be consecutively enrolled collecting clinical data at hospital admission, discharge, and 3 months later. The quality of prescription was evaluated comparing the prevalence of potentially inappropriate medications through Beer's criteria and of potential drug-drug interactions through a specific computerized database. RESULTS The study feasibility was confirmed by the high percentage (90 %) of clinicians who completed the e-learning program, the recruitment, and follow-up of all planned patients. The intervention was well accepted by all participating clinicians who judged positively (a mean score of >3 points on a scale of 5 points: 0 = useless; 5 = most useful) the specific contents, the methodology applied, the clinical relevance and utility of e-learning contents and tools for the evaluation of the appropriateness of drug prescribing. CONCLUSIONS The pilot study met all the requested goals. The main study is currently ongoing and is planned to finish on July 2015.
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Affiliation(s)
- C Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa, 19, 20156, Milan, Italy,
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Pasina L, Djade CD, Tettamanti M, Franchi C, Salerno F, Corrao S, Marengoni A, Marcucci M, Mannucci PM, Nobili A. Prevalence of potentially inappropriate medications and risk of adverse clinical outcome in a cohort of hospitalized elderly patients: results from the REPOSI Study. J Clin Pharm Ther 2014; 39:511-5. [PMID: 24845066 DOI: 10.1111/jcpt.12178] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 04/23/2014] [Indexed: 01/22/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Inappropriate prescribing is highly prevalent for older people and has become a global healthcare concern because of its association with negative health outcomes including ADEs, hospitalization and resource utilization. Beers' criteria are widely utilized for evaluating the appropriateness of medications, and an up-to-date version has recently been published. To assess the prevalence of patients exposed to PIMs at hospital discharge according to the 2003 and 2012 versions of Beers' criteria and to evaluate the risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up. METHODS This cross-sectional study was held in 66 Italian internal medicine and geriatric wards. The sample included 1380 inpatients aged 65 years or older. Prescriptions of PIM were analysed at hospital discharge. We considered all patients with complete 3-month follow-up. RESULTS AND DISCUSSION The prevalence of patients receiving at least one PIM was 20·1% and 23·5% according to the 2003 and 2012 versions of the Beers' criteria, respectively. The 2012 Beers' criteria identified more patients with at least one PIM than the 2003 version, although a high percentage of those patients (72·2%) were also identified by the criteria updated in 2003. The main difference in the prevalence of patients receiving a PIM according to the two versions of Beers' criteria involved prescriptions of benzodiazepines for insomnia or agitation, chronic use of non-benzodiazepine hypnotics, prescription of antipsychotics in people with dementia and oral iron at dosage higher than 325 mg/day. Prescription of PIMs was not associated with a higher risk of adverse clinical events, re-hospitalization and all-cause mortality at 3-month follow-up in both univariate and multivariate analysis, after adjusting for age, sex and CIRS comorbidity index. WHAT IS NEW AND CONCLUSIONS This study found no significant effect of inappropriate drug use according to Beers' criteria on health outcomes among older adults 3 month after discharge. Even though these criteria have been suggested as helpful in promoting appropriate prescribing, reducing drug-related adverse events and associated healthcare costs, to date there is no clear evidence that their application can achieve objective and quantifiable improvements in clinical outcomes. A possible explanation is that both versions of the Beers' criteria have several recognized limitations, one of the main ones being the restricted availability of some drugs in Europe or their limited prescription in everyday clinical practice.
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Affiliation(s)
- L Pasina
- IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
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Haas C, Hanson E, Anjos MJ, Ballantyne KN, Banemann R, Bhoelai B, Borges E, Carvalho M, Courts C, De Cock G, Drobnic K, Dötsch M, Fleming R, Franchi C, Gomes I, Hadzic G, Harbison SA, Harteveld J, Hjort B, Hollard C, Hoff-Olsen P, Hüls C, Keyser C, Maroñas O, McCallum N, Moore D, Morling N, Niederstätter H, Noël F, Parson W, Phillips C, Popielarz C, Roeder AD, Salvaderi L, Sauer E, Schneider PM, Shanthan G, Court DS, Turanská M, van Oorschot RAH, Vennemann M, Vidaki A, Zatkalíková L, Ballantyne J. RNA/DNA co-analysis from human menstrual blood and vaginal secretion stains: results of a fourth and fifth collaborative EDNAP exercise. Forensic Sci Int Genet 2013; 8:203-12. [PMID: 24315610 DOI: 10.1016/j.fsigen.2013.09.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/28/2013] [Indexed: 11/26/2022]
Abstract
The European DNA Profiling Group (EDNAP) organized a fourth and fifth collaborative exercise on RNA/DNA co-analysis for body fluid identification and STR profiling. The task was to identify dried menstrual blood and vaginal secretion stains using specific RNA biomarkers, and additionally test 3 housekeeping genes for their suitability as reference genes. Six menstrual blood and six vaginal secretion stains, two dilution series (1/4-1/64 pieces of a menstrual blood/vaginal swab) and, optionally, bona fide or mock casework samples of human or non-human origin were analyzed by 24 participating laboratories, using RNA extraction or RNA/DNA co-extraction methods. Two novel menstrual blood mRNA multiplexes were used: MMP triplex (MMP7, MMP10, MMP11) and MB triplex (MSX1, LEFTY2, SFRP4) in conjunction with a housekeeping gene triplex (B2M, UBC, UCE). Two novel mRNA multiplexes and a HBD1 singleplex were used for the identification of vaginal secretion: Vag triplex (MYOZ1, CYP2B7P1 and MUC4) and a Lactobacillus-specific Lacto triplex (Ljen, Lcris, Lgas). The laboratories used different chemistries and instrumentation and all were able to successfully isolate and detect mRNA in dried stains. The simultaneous extraction of RNA and DNA allowed for positive identification of the tissue/fluid source of origin by mRNA profiling as well as a simultaneous identification of the body fluid donor by STR profiling, also from old and compromised casework samples. The results of this and the previous collaborative RNA exercises support RNA profiling as a reliable body fluid identification method that can easily be combined with current STR typing technology.
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Affiliation(s)
- C Haas
- Institute of Legal Medicine, University of Zurich, Switzerland.
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Franchi C, Giussani G, Messina P, Montesano M, Romi S, Nobili A, Fortino I, Bortolotti A, Merlino L, Beghi E. Validation of healthcare administrative data for the diagnosis of epilepsy. J Epidemiol Community Health 2013; 67:1019-24. [PMID: 24022813 DOI: 10.1136/jech-2013-202528] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Administrative databases have become an important tool to monitor diseases. Patients with epilepsy could be traced using disease-specific codes and prescriptions, but formal validation is required to obtain an accurate case definition. The aim of the study was to correlate administrative data on epilepsy with an independent source of patients with epilepsy in a district of Lombardy, Northern Italy, from 2000 to 2008. METHODS Data of nearly 320 600 inhabitants in the district of Lecco collected from the Drug Administrative Database of the Lombardy Region were analysed. Among them were included patients who fulfilled the International Classification of Diseases 9 (ICD-9) codes and/or the disease-specific exemption code for epilepsy and those who had at least one EEG record and took antiepileptic drugs (AEDs) as monotherapy or in variable combinations. To ascertain epilepsy cases, 11 general practitioners (GPs) with 15 728 affiliates were contacted. Multiple versions of the diagnostic algorithm were developed using different logistic regression models and all combinations of the four independent variables. RESULTS Among the GP affiliates, 71 (4.5/1000) had a gold standard diagnosis of epilepsy. The best and most conservative algorithm included EEG and selected treatment schedules and identified 61/71 patients with epilepsy (sensitivity 85.9%, CI 76.0% to 92.2%) and 15 623/15 657 patients without epilepsy (specificity 99.8%,CI 99.7% to 99.8%). The positive and negative predictive values were 64.2% and 99.9%. Sensitivity (86.7%) and the positive predictive value (68.4%) increased only slightly when patients with single seizures were included. CONCLUSIONS A diagnostic algorithm including EEG and selected treatment schedules is only moderately sensitive for the detection of epilepsy and seizures. These findings apply only to the Northern Italian scenario.
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Affiliation(s)
- C Franchi
- Laboratory for Quality Assessment of Geriatric Therapies and Services, IRCCS-Istituto di Ricerche Farmacologiche 'Mario Negri', , Milano, Italy
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24
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Marengoni A, Nobili A, Pirali C, Tettamanti M, Pasina L, Salerno F, Corrao S, Iorio A, Marcucci M, Franchi C, Mannucci PM. Comparison of disease clusters in two elderly populations hospitalized in 2008 and 2010. Gerontology 2013; 59:307-15. [PMID: 23364029 DOI: 10.1159/000346353] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND As chronicity represents one of the major challenges in the healthcare of aging populations, the understanding of how chronic diseases distribute and co-occur in this part of the population is needed. OBJECTIVES The aims of this study were to evaluate and compare patterns of diseases identified with cluster analysis in two samples of hospitalized elderly. METHODS Data were obtained from the multicenter 'Registry Politerapie SIMI (REPOSI)' that included people aged 65 or older hospitalized in internal medicine and geriatric wards in Italy during 2008 and 2010. The study sample from the first wave included 1,411 subjects enrolled in 38 hospitals wards, whereas the second wave included 1,380 subjects in 66 wards located in different regions of Italy. To analyze patterns of multimorbidity, a cluster analysis was performed including the same diseases (19 chronic conditions with a prevalence >5%) collected at hospital discharge during the two waves of the registry. RESULTS Eight clusters of diseases were identified in the first wave of the REPOSI registry and six in the second wave. Several diseases were included in similar clusters in the two waves, such as malignancy and liver cirrhosis; anemia, gastric and intestinal diseases; diabetes and coronary heart disease; chronic obstructive pulmonary disease and prostate hypertrophy. CONCLUSION These findings strengthened the idea of an association other than by chance of diseases in the elderly population.
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Affiliation(s)
- A Marengoni
- Geriatric Unit, Spedali Civili, Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy.
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Orsi GB, Franchi C, Marrone R, Giordano A, Rocco M, Venditti M. Laboratory confirmed bloodstream infection aetiology in an intensive care unit: eight years study. Ann Ig 2012; 24:269-278. [PMID: 22913170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
To evaluate laboratory confirmed bloodstream infection (LC-BSI) aetiology we carried out a prospective study in the general 13 bed ICU of the teaching hospital Policlinico Umberto I in Rome. According to CDC case definitions for LC-BSI, all patients admitted >48h between 2000-2007 to ICU were included. Risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 1741 patients (64.8% males, 35.2% females) were included, mean age was 58.1 +/- 19.8, SAPS II score 45.1 +/- 17 and ICU stay 14.0 +/- 21.1 days. Finally, 167 (9.6%) patients developed 203 (11.7%) ICU-acquired LC-BSI and sources of infection were CVC (39.8%), unknown (39.3%), respiratory tract (12.4%), surgical wound (6.5%) and urinary tract (2.0%). Between 2000 and 2007 the incidence of LC-BSI/1000 patient days (14.8 per thousands vs. 7.8 per thousands: p<0.05) and LC-BSI/1000 CVC days (20.7 per thousands vs. 11.4 per thousands; p<0.05) decreased. The onset of infection followed ICU admission by 19.5 +/- 17.7 (mean) and 13 days (median). Crude mortality was 34.8%, and mortality associated with LC-BSI showed a RR 1.61; 95%CI 1.37 - 1.89; p<0.01. The most common pathogens were coagulase negative staphylococci (CNS) (26.2%), methicillin-resistant Staphylococcus aureus (MRSA) (14.9%), Pseudomonas aeruginosa (13.5%), enterococci (9.3%) and Acinetobacter bawnumannii (7.5%). Onset time (days) between ICU admission and LC-BSI was higher (p<0.01) among Gram-negative (22.9 +/- 18.4) compared to Gram-positive (16.6 +/- 15.9), fungi (23.8 +/- 25.3). High early death (<7 days after BSI diagnosis) was associated to A. baumannii (37.5%), Candida spp. (30.0%) and S. aureus (29.7%). Staphylococci presented a very high methicillin resistance (>85%). P. aeruginosa and A. baumannii showed respectively 25% and 68.7% multidrug-resistance. Over 1/3 of Eneterobacteriaceae isolates were extended spectrum beta-lactamase (ESBL), but non resulted resistant to carbapenems. Surveillance showed a high incidence of LC-BSI associated to invasive procedures and the presence of multiresistant bacteria.
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Affiliation(s)
- G B Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.
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26
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Franchi C, Sequi M, Bonati M, Nobili A, Pasina L, Bortolotti A, Fortino I, Merlino L, Clavenna A. Differences in outpatient antibiotic prescription in Italy’s Lombardy region. Infection 2011; 39:299-308. [DOI: 10.1007/s15010-011-0129-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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Franchi C, Frigerio E, Spadino S, Garutti C, Colombo DM, Altomare A, Altomare G. Hepatitis C viral load decreases after ciclosporin treatment for erosive lichen planus. Clin Exp Dermatol 2009; 34:e254-5. [DOI: 10.1111/j.1365-2230.2008.03130.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tzantzoglou S, Franchi C, Pezzella M, Traditi F, Monacelli M. [Anti-rabies measures by the Infectious Disease Prevention Service at the "La Sapienza" University of Rome in the years 2005-2007]. Ann Ig 2009; 21:147-152. [PMID: 19653446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Antirabies service activities of the Infectious Diseases Prophylaxis Centre of the Sapienza University of Rome during the period 2005-2007. Authors analyzed data, of antirabies activity, from 3206 patients treated at the Infectious Diseases Prophylaxis Centre of the University of Rome "La Sapienza" during the period 2005-2007 Dogs were responsible for most bites (92.1%). All patients went first to the Emergency Room where tetanus prophylaxis was administrated only with specific immunoglobulins (51.5%): to such patients we suggested to implement prophylaxis with vaccination. For other patients (19.4%) we prescribed only vaccine tetanus prophylaxis. Antirabies vaccine (PCEC) has been injected in 604 patients (18.8%). Rabies immunoglobulins have been prescribed only to 11 (0.4%) patients that were bitten during travel to Asia or Africa (0.4%). The authors emphasize the opportunity to reduce the administration of anti-tetanus immunoglobulin in Emergency Room by a deeper evaluation of patient's immunity; moreover the authors confirm a clear quantitative reduction of prophylactic interventions against rabies in Italy.
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Affiliation(s)
- S Tzantzoglou
- Dipartimento di Malattie Infettive e Tropicali, Sapienza Università di Roma
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29
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Frigerio E, Ramoni S, Franchi C, Garutti C, Garavaglia M, Splnelli M, Capsoni F, Altomare G. Successful Cyclosporine Treatment in a Case of Amicrobial Pustulosis Associated with Immunological Abnormalities. Int J Immunopathol Pharmacol 2009; 22:243-6. [DOI: 10.1177/039463200902200128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Amicrobial pustulosis associated with autoimmune diseases (APAD) is a clinical entity which was described only recently and few cases are reported in the literature. This condition is characterized by recurrent acute onset with pustular lesions predominantly involving skin folds, genitals, scalp and external auditory canals of young women. The etiopathogenesis of APAD is unknown and the most effective therapeutic treatment seems to be systemic corticosteroids. We describe the case of a 16-year old female patient suffering from APAD successfully treated with cyclosporine A.
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Affiliation(s)
| | | | | | | | | | | | - F. Capsoni
- Rheumatology Division, Institute O. Galeazzi, IRCCS, University of Milan, Italy
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Orsi GB, Franchi C, Giordano A, Rocco M, Ferraro F, Mancini C, Venditti M. Multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit. J Chemother 2008; 20:219-24. [PMID: 18467249 DOI: 10.1179/joc.2008.20.2.219] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Carbapenem-resistant Acinetobacter baumannii was isolated from 15 colonized or infected patients (carriers) between April and July 2004, in a teaching hospital ICU in Rome, Italy. All isolated strains were susceptible only to gentamicin, ampicillin-sulbactam and colistin and displayed the same Random Amplified Polymorphic DNA (RAPD) 1 pattern. Twelve out of 15 strains were susceptible to tigecycline, whereas the remaining three showed intermediate susceptibility. Although infection control measures were reinforced and carriers isolated in separate rooms, A. baumannii transmission continued. Therefore, finally A. baumannii carriers were moved to another available subintensive unit, which was re-equipped, and cared for by dedicated personnel, whereas only the non infected/colonized patients remained in the ICU. This study shows that during an outbreak by multiresistant A. baumannii it may be indispensable to geographically isolate not only patients but also dedicated staff.
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Affiliation(s)
- G B Orsi
- Department of Public Health Sciences, University La Sapienza, Rome, Italy.
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Abstract
Psoriasis is an immune-mediated disease with a chronic relapsing course, and the particularly severe forms that are refractory to traditional therapies are often difficult to manage. Everolimus (Certican; Novartis, Basel, Switzerland) is a new rapamycin-derived macrolide that is used in the prophylaxis of rejection in heart and kidney transplant patients. The mechanism underlying its immunosuppressant and antiproliferative activity is different from, but complementary to, that of calcineurin inhibitors such as ciclosporin. We describe a woman with severe psoriasis treated with everolimus combined with subtherapeutic doses of ciclosporin.
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Affiliation(s)
- E Frigerio
- Institute of Dermatology, Ospedale Galeazzi, University of Milan, Via R Galeazzi 4, 20161 Milan, Italy
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Orsi GB, Scorzolini L, Franchi C, Mondillo V, Rosa G, Venditti M. Hospital-acquired infection surveillance in a neurosurgical intensive care unit. J Hosp Infect 2006; 64:23-9. [PMID: 16839643 DOI: 10.1016/j.jhin.2006.02.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 02/20/2006] [Indexed: 11/25/2022]
Abstract
A prospective study on hospital-acquired infection (HAI) was undertaken in the eight-bed neurosurgical intensive care unit (NSICU) of a teaching hospital in Rome, Italy. All patients admitted for >48 h between January 2002 and December 2004 were included. The infection control team collected the following data from all patients: demographic characteristics, patient origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated micro-organisms and antibiotic susceptibilities. Overall, 323 patients were included in the study. Mean age was 55.5 years (range 17-91), and mean American Society of Anesthesiologists' score was 2.88. Seventy (21.7%) patients developed 132 NSICU HAIs: 43 pneumonias, 40 bloodstream infections (BSIs), 30 urinary tract infections (UTIs), 10 cases of meningitis associated with an external ventricular drain (EVD) and nine surgical site infections (SSIs). The SSI rate was high (5.6%), but a reduction was achieved during the three-year period. There were 7.2 bloodstream infection episodes per 1000 days of device exposure; 11.00 pneumonias per 1000 days of mechanical ventilation and 4.5 UTIs per 1,000 days of urinary catheterisation. Among patients with an EVD, the SSI relative risk was 11.3 [95% confidence intervals (CI) 4.2-30.6; P<0.01]. Sixty-one (18.9%) patients died. Logistic regression analysis showed that mortality was significantly associated with infection [odds ratio (OR)=2.28; 95%CI 1.11-4.71; P=0.02] and age (OR=1.04; 95%CI 1.01-1.06; P=0.002). Candida spp. were the leading cause of UTIs (40.0%) and the third most common cause of BSIs (12.7%). Antibiotic-resistant pathogens included meticillin-resistant staphylococci (77.5%), carbapenem-resistant Pseudomonas aeruginosa (36.4%), and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (75.0%). Although the overall incidence of infection (21.7%) was within the range of published data, the associated mortality, the increasing severity of illness of patients, and the emergence of multi-drug-resistant organisms shows the need to improve infection control measures.
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Affiliation(s)
- G B Orsi
- Department of Public Health Sciences, University La Sapienza, Rome, Italy.
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Orsi G, Franchi C, D'Ettorre G, Mondillo V, Martino P, Vullo V, Rocco M, Venditti M. P12.45 Changing Etiology of Bloodstream Infection in an Intensive Care Unit: a Six Years Experience. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Orsi GB, Ferraro F, Franchi C. [Preoperative hair removal review]. Ann Ig 2005; 17:401-12. [PMID: 16353677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Surgical site infection (SSI) frequency is influenced by several risk factors, among which perioperative hair removal. Traditionally it is part of the procedures carried out on skin before surgery. Although preoperative shaving is widely used in many hospitals, its use should be re-evaluated. Therefore the AA. carried out a systematic literature review about the opportunity, the modality and the risks associated to preoperative hair removal. We found first of all that preoperative shaving (razor) is associated with a significantly higher surgical site infection (SSI) risk. Second, when hair removal is considered necessary by the surgeon, it should be carried out by means of a clipper or depilatory cream. Furthermore hair removal should be performed immediately before surgery and not in advance, to avoid an increased risk of SSI.
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Affiliation(s)
- G B Orsi
- Dipartimento di Scienze di Sanità Pubblica, Università degli Studi di Roma "La Sapienza".
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Petrosillo N, Chinello P, Proietti MF, Cecchini L, Masala M, Franchi C, Venditti M, Esposito S, Nicastri E. Combined colistin and rifampicin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events. Clin Microbiol Infect 2005; 11:682-3. [PMID: 16008625 DOI: 10.1111/j.1469-0691.2005.01198.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cusini M, Salmaso F, Zerboni R, Carminati G, Vernaci C, Franchi C, Locatelli A, Alessi E. 5% Imiquimod cream for external anogenital warts in HIV-infected patients under HAART therapy. Int J STD AIDS 2004; 15:17-20. [PMID: 14769165 DOI: 10.1258/095646204322637191] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The efficacy of imiquimod in the treatment of external genital warts in HIV positive subjects was compared to a group of patients with normal immune function. Imiquimod 5% cream was applied by patients three times a week until resolution for a maximum of 16 weeks. Assessment for response and the occurrence of side effects was performed every four weeks. Thirty-one per cent of 75 HIV positive patients achieved a complete clearance, a partial response was obtained in 24% of subjects while in 45% we observed no clinical response. In the control group a total clearance was obtained in 62% of subjects, a partial response in 24% and no response in 14%. Recurrences occurred in 4/23 HIV patients and 2/31 immunocompetent patients within three months of follow-up. Side effects were minor to moderate. We conclude that imiquimod 5% cream has an acceptable efficacy and safety on HIV patients.
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Affiliation(s)
- M Cusini
- Centro Malattie a Trasmissione Sessuale, Istituto di Scienze Dermatologiche, IRCCS Ospedale Maggiore Milano, Via Pace 9, 20122 Milan, Italy.
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38
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Sticca G, Nardi G, Franchi C, Fortugno SC, Venditti M, Orsi GB. [Hospital infection prevention in an intensive care unit]. Ann Ig 2004; 16:187-97. [PMID: 15554525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Aim of the study was to evaluate the efficacy of the hospital infection preventive procedures adopted in the intensive care unit (ICU) of the "S. Camillo-Forlanini" hospital in Rome. First the following prevention protocols were analysed: invasive procedures (intubation, CVC and urinary catheter), surveillance cultures, infection management and antimicrobial prophylaxis. Comparison with international guidelines was carried out and protocols enforcement by the personnel was verified. Secondly a one year longitudinal surveillance study was performed in order to monitor the following site-specific infection rates: pneumonia (PNE), blood stream infections (BSI), urinary tract infections (UTI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. Overall 302 patients (191 men and 111 women) were admitted; age 55.1 +/- 20.7 years (mean), SAPS II 42.4 +/- 16.2 (mean) and average ward stay 12.5 +/- 21.7 days. Crude mortality was 15.9%. Results showed a total of 37 infection episodes (20 PNE , 7 BSI, 8 UTI and 2 SSI) in 33 patients (10.9%). Infection and mortality rates were among the lowest registered in other italian ICU's. Standardized infection rates associated to invasive procedures were: Ventilator-associated PNE rate (7.8/1000), central venous catheter-associated BSI rate (2.2/1000), urinary catheter-associated UTI rate (2.1/1000). The first (PNE) was higher than the NNIS mean rate, whwreas BSI and urinary catheter associated rates were minor than the mean rates reported by NNIS. Gram-negatives were 61.7%, gram-positives 27.6% and Candida spp. 10.6%. The results confirm the ICU successful preventive strategy.
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Affiliation(s)
- G Sticca
- Dipartimento di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza
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De Rosa F, Lastilla MG, Franchi C, Teggi A. [New trends in chemotherapy of human hydatid disease]. Infez Med 2003; 4:189-203. [PMID: 12858024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The Authors report the current trends in chemotherapy of human hydatid disease, reviewing the most important papers and in particular their own experience, based on treatment with benzoimidazole carbamates of 425 patients affected by hydatid disease. The Authors particularly describe the factors that can influence the outcome of chemotherapy, such as: the drug used and their posology, the age of the cysts and or of the patients, cyst morphology and localization etc.
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Affiliation(s)
- F De Rosa
- Dipartimento di Malattie Infettive e Tropicali, II Cattedra Malattie Infettive, Universita degli Studi di Roma La Sapienza, Rome
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Orsi GB, Raponi M, Sticca G, Branca L, Scalise E, Franchi C, Venditti M, Fara GM. [Hospital infection surveillance in 5 Roman intensive care units]. Ann Ig 2003; 15:23-34. [PMID: 12666322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The A.A. carried out a survey on hospital acquired infection (HAI) in the intensive care units (ICU) of five roman hospitals. The study monitored the following site-specific infection rates: pneumonia (PNE), blood stream infections (BSI), urinary tract infections (UTI), surgical site infections (SSI). According to CDC definitions all patients developing infection 48 hours or more after ward admission were included. Furthermore risk factors (i.e. age, sex, SAPS II), invasive procedures (i.e. endotracheal intubation, vascular and urinary catheterisation), microbiological isolates and their antibiotic susceptibility were screened. The overall 503 patients characteristics (i.e., age, length of stay, case-mix...) showed the wards as general ICU's. Although the SAPS II score was similar, mortality (18.2%-42.9%) and general infection rates (15.4%-40.4%) among the five ICU's were considerably variable (p < 0.05), as HAI episodes distribution by type: PNE (37-88%), BSI (6-42%), UTI (6-24%), SSI (3-7%) (p < 0.05). Also device-associated infection rates such as Ventilator-associated PNE (11.6-24.6@1000), Vascular catheter-associated BSI (3.4-19.2@1000). Urinary catheter-associated UTI (2.6-14.0@1000) and invasive procedures management were different. Among the infected patients the most commonly isolated microorganisms were P. aeruginosa and Staphylococcus spp., which presented a considerable antibiotic resistance. The study showed: 1) sampling (i.e. blood cultures, tracheal aspirate and urine samples) and laboratory methodology indispensable for a correct HAI diagnosis were not standardized in the five ICU's; 2) hospital infection control policy was not carried out in all ICU's. The study showed a lack of standardization which limits the comparability of the general roman ICU's.
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Affiliation(s)
- G B Orsi
- Dip. di Scienze di Sanità Pubblica G. Sanarelli, Università degli Studi di Roma La Sapienza.
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De Rosa FG, Amoroso A, Teggi A, Paparo SB, Franchi C, Ferri GM, Caccavo D, Afeltra A. Anti-neutrophil cytoplasmic antibodies in echinococcus granulosus hydatid disease. Hum Immunol 2001; 62:1122-6. [PMID: 11600219 DOI: 10.1016/s0198-8859(01)00309-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The authors studied the presence of ANCA, evaluated by indirect immunofluorescence (IIF) and ELISA for anti-lactoferrin (LF), and anti-myeloperoxidase antibodies (anti-MPO), in sera of 69 patients with cystic echinococcosis (CE). According to Caremani's classification, 27 patients were considered to have active cysts and 42 patients were considered to have inactive cysts. ANCA were detected in 9 out of 27 patients (33.3%) with active cysts and in 3 out of 42 patients (7.1%) with inactive cysts. Differences between the two groups were statistically significant (P < 0.05). Anti-LF antibodies were found in seven patients (10.14%) and anti-MPO antibodies in ten patients (14.5%).
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Affiliation(s)
- F G De Rosa
- Department of Infectious Diseases, University of Turin, Ospedale Amedeo di Savoia, Corso Svizzera 164, 10149, Turin, Italy
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Abstract
Four hundred forty-eight patients with 929 Echinococcus granulosus hydatid cysts received 3- to 6-month continuous cycles of mebendazole or albendazole treatment and underwent prolonged follow-up by clinical visits and imaging studies (range, 1-14 years) to assess the long-term outcome of treatment. Degenerative changes and relapse were assessed by imaging techniques. At the end of therapy, 74.1% of the hydatid cysts showed degenerative changes. These were more frequent in albendazole-treated than in mebendazole-treated cysts (82.2% vs. 56.1%; P < .001). During long-term follow-up, 104 cysts (22%) had degenerative changes that progressed, whereas 163 cysts (approximately 25%) relapsed. The percentages of relapses in the two drug-treated groups were almost the same. Relapses occurred more frequently in type II cysts of the liver. Cysts recurred most often (78.5%; P < .001) within the first 2 years after treatment ended. Further chemotherapy cycles induced degenerative changes in >90% of relapsed cysts without inducing more frequent or more severe side effects than those observed during the initial cycles.
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Affiliation(s)
- C Franchi
- Department of Infectious and Tropical Diseases, University of Rome La Sapienza, Italy
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Abstract
The expression and subcellular distribution of liver cPKC alpha and beta, nPKC delta and aPKC zeta isoenzymes and the plasma levels of fibrinogen were measured in young, 2- and 6-month-old, and aged, 24-month-old, normal and turpentine-treated rats, to induce an aseptic inflammatory condition and the acute-phase response. In young and old rats a down-regulated expression of cPKC alpha and, to a lesser extent, beta isoenzymes, was observed 8 h after turpentine administration, i.e. at times preceding the maximal expression of fibrinogen mRNA. Under these conditions, the plasma fibrinogen levels peaked by 24 h in young animals, being up to 7-fold over the values of untreated controls at 72 h. By contrast, old untreated control rats showed 4-fold increases of basal plasma fibrinogen levels compared with young controls, with down-regulated expression of cPKC alpha. In old rats, treatment with turpentine increased up to 1.9-fold over the basal control values the fibrinogen concentration within 72 h. Levels similar to those of young turpentine-treated animals were reached at this time. The results of this study suggest a prominent role for cPKC alpha in eliciting the synthesis of fibrinogen after inducing an acute-phase response with turpentine administration in young as well as old rats. This isoform may act by regulating the serine phosphorylation of Stat3 transcription factor, whose activation is under IL-6 control, a multifunctional cytokine that is proving to be a major contributor to the acute-phase response. No evidence for a role of aPKC zeta or of nPKC delta was demonstrated under these conditions.
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Affiliation(s)
- C A La Porta
- Department of General Physiology and Biochemistry, University of Milan, and CNR Center for Research in Cell Pathology, Italy
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Laghi A, Teggi A, Pavone P, Franchi C, De Rosa F, Passariello R. Intrabiliary rupture of hepatic hydatid cysts: diagnosis by use of magnetic resonance cholangiography. Clin Infect Dis 1998; 26:1465-7. [PMID: 9636884 DOI: 10.1086/517667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- A Laghi
- Department of Radiology, University of Rome, Italy
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Teggi A, Giattino M, Franchi C, Lastilla M. [A hypothesis on the significance of an increase in serum transaminases in patients with hydatidosis treated with benzimidazole carbamates]. Recenti Prog Med 1997; 88:452-8. [PMID: 9471639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increase of aminotransferases was observed in 58 out of 448 patients with hydatid disease without other risk factors (28 males and 30 females) during treatment with mebendazole and albendazole; all these patients had liver cysts. The enzymatic increase was always reversible and slight (ranged from 2-4 folds the normal values in most of patients), even without stopping treatment; it was less frequently observed during further cycles of therapy and it was never observed after surgical asportation of the cysts. Jaundice was never observed. The increase of transaminases appeared to be significantly correlated to effectiveness of therapy and to the earlier occurrence of degenerative modifications of the hydatid cysts. The authors hypothesize that besides hepatoxicity (in cases of marked increase of aminotransferases or in patients without liver cysts) slight increase of transaminases could be due to pericystic inflammation secondary to the marked host's immunitary reaction, and so could be considered as an index of therapeutic effectiveness.
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Affiliation(s)
- A Teggi
- Dipartimento di Malattie Infettive e Tropicali, Università La Sapienza, Roma
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Ioppolo S, Notargiacomo S, Profumo E, Franchi C, Ortona E, Rigano R, Siracusano A. Immunological responses to antigen B from Echinococcus granulosus cyst fluid in hydatid patients. Parasite Immunol 1996; 18:571-8. [PMID: 9226695 DOI: 10.1046/j.1365-3024.1996.d01-31.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The immunological reactivity of Echinococcus granulosus antigen B was evaluated in 30 hydatid patients. Antigen B was purified from sheep hydatid cyst fluid by electroelution from a non-reducing SDS-PAGE gel (AgB). In ELISA and immunoblotting (IB), determining antibody production in sera from patients with hydatid disease and with other parasitic infections, purified AgB showed higher specificity than a partially purified antigen named pH5PPT (100% vs 83% in pH5PPT-ELISA and 58% in pH5PPT-IB). AgB-IB achieved higher sensitivity than AgB-ELISA (80% vs 63%). All AgB-IB positive sera recognized the 12 kDa subunit. Qualitative AgB-IB assessment of IgG isotype responses identified IgG4 as the predominant isotype (87%). The other isotypes showed a lower percentage of positive reactions: IgG1, 33%; IgG2, 21%; and IgG3, 17%. PBMC proliferative assay revealed a cellular response to AgB in 100% of patients' PBMC. These findings confirm antigen B, especially its smallest subunit, as a good diagnostic molecule.
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Affiliation(s)
- S Ioppolo
- Laboratorio di Immunologia, Istituto Superiore di Saniti, Roma, Italy
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De Rosa F, Lastilla MG, Franchi C, Teggi A. [Advances of medical treatment of human hydatidosis]. Recenti Prog Med 1996; 87:346-52. [PMID: 8975337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Authors report the current trends in chemotherapy of human hydatid disease, on the basis of their own experience, concerning the medical treatment of 425 patients affected by hydatid disease. The Authors describe the factors that can influence the outcome of chemotherapy, such as: the drugs used and their posology, the age of the cysts and/or of the patients, cyst's morphology and localization.
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Affiliation(s)
- F De Rosa
- Dipartimento di Malattie Infettive e Tropicali, Università La Sapienza, Roma
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Franchi C. [New methods of periodontal disease diagnosis and activity evaluation]. J Parodontol 1988; 7:315-22. [PMID: 3077411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Detienville R, Franchi C, Mirot F. [Synthetic resorbable material: tricalcium phosphate (synthograft)]. Inf Dent 1987; 69:2165-72. [PMID: 3481775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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