Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic

Background

Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination.

Methods

Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed.

Results

Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (<30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others; in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID.

Conclusions

A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake.

Key messages

• This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs.

• A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.

Design of a care pathway for Hepatitis C: a pilot study with three University Hospitals from Tuscany

 

Monitoring and evaluation activities are recognised as key to quality improvement in healthcare performance. The present study is intended to design a performance evaluation system for care pathway for patients with chronic Hepatitis C virus (HCV) infection, to follow them along the continuum of care throughout regional healthcare services, from diagnosis to treatment course completion. Four phases of the care pathway, namely diagnosis, linkage to care, treatment, and outcome were identified. Each phase of the care pathway was populated by a set of observation and evaluation indicators. Data sources were: administrative health data from the Tuscany Regional Healthcare System; patient-reported experience and outcome measures collected by means of questionnaires administered by the health professionals during patients’ consultation in the three University Hospitals of the Tuscany Region. The availability of data, collected from the administrative flows and thanks to the active involvement of health professionals, showed the feasibility of designing a care pathway for HCV. More particularly, using administrative data, three performance indicators were calculated for the prevention phase, two for the linkage to care phase and two more for the treatment and outcome phases, respectively. Moreover, two indicators related to linkage to care and outcome phases were designed, but data require further investigation. On the other hand, using patient-reported experience data, four indicators can be calculated for the linkage to care phase, while regarding patient-reported outcomes, the feasibility of calculation depends on the number of patients that will be involved in follow-up visits. The care pathway designed may be useful to: identify shortcomings of the healthcare services for chronic HCV patients; foster quality improvement actions; inform allocation of resources to accelerate HCV elimination in Tuscany.

Key messages

• The authors propose a care pathway for Hepatitis C, consisting of four distinct phases, populated respectively with diagnosis, linkage to care, treatment, and outcome indicators.

• The care pathway can be used as a management tool for the identification of possible quality improvement actions to be undertaken with respect to the healthcare services provided to HCV patients.

Viral hepatitis micro-elimination: models of care and barriers to implementation in 5 EU/EEA prisons

Introduction

Coverage of essential prevention and control services and adequate monitoring schemes for viral hepatitis are often suboptimal in prison settings. Yet, evidence shows that targeted interventions are feasible and effective in reducing viral hepatitis burden and decreasing virus circulation among people living in prison and the community at large. To promote transferability and improvement of prison health quality in EU/EEA the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) will identify and disseminate models of care for viral hepatitis elimination in prisons.

Methods

The models of care were gathered using a data collection tool that has been designed for this purpose based on the literature review and agreed with an expert advisory group. Based on the results of the data collection, a survey for healthcare staff working in 5 selected prison institutions in the EU/EEA has been developed.

Results

The following models of care were collected: HCV micro-elimination in prison; transitional care for HCV treatment or HBV prevention/treatment; HCV or HBV care services tailored to women living in prison; HBV or HAV/HBV vaccination in prison settings. Harm reduction and drug treatment services in the prison are essential at all steps of the prevention and continuum of care. Among barriers identified were: engagement of people living in prison and prison governance structure, availability of infrastructural and human resources, daily prison organisation, inter-sectorial collaboration within prison and between prison and community services, training for prison staff and lack of systematic monitoring.

Conclusions

Evidence of effective and acceptable interventions in prison to prevent and control viral hepatitis is essential to foster inclusion of prison setting within national elimination programmes. Intra-EU benchmarking may help promote awareness, to allocate adequate resources, monitor of impact and ultimately the achievement of the elimination goal.

Using default opt-out strategies to undercover the unknown HCV infections: a scoping review

Background

Following the advent of directly acting antivirals (DAAs) a global effort is underway to eliminate viral hepatitis C (HCV) by 2030. Yet identification of infected individuals and access to dedicated services may pose a challenge to the achievement elimination targets. A scoping review to synthesize studies that explored the efficacy of opt-out strategies to improve HCV testing capacity was conducted.

Methods

We searched PubMed and Scopus (from 2015 to March 2022) for all English original articles and systematic reviews addressing opt-out strategies for HCV testing in different settings, published in the WHO's European Region Countries. We excluded articles that focused on other testing implementation strategies.

Results

A total of 136 articles were screened at the title and abstract level, of which 41 were also assessed at full text for eligibility after deduplication. In the end, 30 articles met the inclusion criteria. Studies originated from 19 different countries of the WHO's European Region, with the most prevalent being France (26.9%, 11/41). The 43.3% of the articles addressed opt-out testing strategies in emergency departments (EDs), 36.6% into prisons, 13.3% in primary care, and 6.6% among people who use drugs. Opt-out default testing was found to be effective in EDs and prisons, whereas only 2 articles tested the efficacy of opt-out strategies for HCV testing in primary care settings.

Conclusions

Opt-out strategies resulted in increased testing rates and higher cost-effectiveness in different settings, especially EDs and prisons. However, to identify individuals with undiagnosed infections, birth cohorts screening in the general population may be needed. Further research is needed to assess the utility of an opt-out default testing strategy in primary care settings.

Key messages

POS0241 JAK INHIBITORS IN PATIENTS WITH ACTIVE RHEUMATOID ARTHRITIS: EXPLORING EARLY RESPONSE ON CENTRAL SENSITIZATION AND CATASTROPHISM SYMPTOMS

Background

Catastrophizing has been demonstrated to be linked with central sensitization (CS), although few studies have investigated the potential of interactions between catastrophizing and CS in patients receiving JAK inhibitors.

Objectives

To explore the link between changes in Simplified Disease Activity Index (SDAI) and changes in pain catastrophizing, pain intensity, neuropathic pain component (NPC) and CS symptoms that occur with the introduction of a novel treatment targeting the JAK/STAT signalling pathway.

Methods

115 patients in an ongoing prospective observational analysis filled out questionnaires at the start and conclusion of the research, using the Pain Catastrophizing Scale (PCS) and Central Sensitization Inventory (CSI). The study included 22 patients on tofacitinib monotherapy (5 mg BD), 19 on tofacitinib and MTX, 19 on baricitinib monotherapy (4 mg OD), 14 on baricitinib and MTX, 17 on upadacitinib monotherapy (15 mg OD), 16 on upadacitinib and MTX, and 8 on filgotinib (200mg OD) and MTX. The disease activity index was evaluated by the simplified disease activity index (SDAI). The US scoring system validated in the US-CLARA was used. The Semantic Questionnaire for Rheumatology (SQR) and PainDETECT questionnaire (PDQ), were used to assess pain severity and NPC. Using multivariable linear regression models, we investigated the connection between changes in SDAI and in CSI, PCS, PDQ, SQR and US score.

Results

At baseline, the percentage of RA patients who exceeded the thresholds for the presence of NPC (PDQ > 19 points) of the CSI (> 40 points) and PCS (> 30 points) were 43.5%, 36.5%, and 62.6%, respectively. After 4 weeks of treatment, the patient-reported scores and the disease composite index decreased significantly, SRQ (p<0.0001), PDQ (p=0.0084), PCS (p=0.0066), CSI (p=0.0165) and SDAI (p<0.0001).The US score did not change significantly (5.25 to 5.03; p=0.248). SDAI achieved 10.6% remission and 15.2% low disease activity at week 4. Multivariate regression analysis indicated that changes in SDAI were exclusively connected to changes in catastrophizing (coefficient=0.500, P=0.0224).

Conclusion

After starting a Jak inhibitor, pain catastrophizing, but not articular inflammation on US, diminishes along with disease activity. These findings provide credence to the concept of catastrophizing as a dynamic construct that may be adjusted by therapy aimed at reducing inflammatory disease activity and pain levels in the RA patient.

References

[1]Hammer HB, et al. Pain catastrophizing, subjective outcomes, and inflammatory assessments including ultrasound: results from a longitudinal study of rheumatoid arthritis patients. Arthritis Care Res 2018;70:703–12

[2]Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15

Table 1.

Multivariate regression analysis, using SDAI (Simplified Disease Activity Index) changes as dependent variable.

Independent variablesCoefficientStd. ErrorTP(Constant)-0.7239ACPA, titre-0.00024100.002528-0.09530.9242Age, yrs-0.090630.1028-0.8810.3803BMI-0.16000.2787-0.5740.5671Disease duration, yrs-0.10030.1611-0.6230.5347Educational level, yrs-0.10720.3703-0.2890.7728Diff. CSI0.31940.19841.6100.1105Diff. SRQ0.070180.37260.1880.8509Diff US score1.22480.70241.7440.0842Diff PCS0.50090.21602.3180.0224Diff PDQ0.18600.22710.8190.4146

Abbreviations: ACPA= Anti-Citrullinated Protein/peptide Antibody; BMI= Body Mass Index; CSI= Central Sensitization Inventory; SRQ= Semantic Questionnaire for Rheumatology; US= Ultrasonography; PCS= Pain Catastrophizing Scale; PDQ= PainDETECT Questionnaire.

Disclosure of Interests

None declared

POS0524 THE VALUE OF ULTRASOUND AND MAGNETIC RESONANCE IMAGING SCORING TECHNIQUES FOR DETECTING JOINT INFLAMMATION AND DAMAGE IN RHEUMATOID ARTHRITIS PATIENTS IN EXPLAINING FUNCTIONAL IMPAIRMENT AND HANDGRIP STRENGTH: A PILOT STUDY

Background

Composite disease activity ratings, which are used to assess the severity of rheumatoid arthritis (RA), may not effectively reflect the illness’s spatial impact on the hands. In RA, assessments of handgrip strength (HGs) and functional deficits are a kind of objective examination that focuses on the hands.

Objectives

The goal of this study was to see if there was a link between joint inflammation and damage in the wrists and hands, as measured by ultrasound (US) and magnetic resonance imaging (MRI), functional disability as measured by hand-specific self-report questionnaires, and composite disease activity indices.

Methods

Sixty-six female patients with RA were investigated (age 55.6 ± 12.2 years, range 20-80 years; disease duration 4.4 ± 3.0 years). The DAS28-CRP, the SDAI, the CDAI, and US and MRI scoring techniques such as the UltraSound-CLinical ARthritis Activity (US-CLARA) and modified Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score [SAMIS] were all used as baseline assessments (mod SAMIS) (Figure 1). Without contrast injection, the mod SAMIS score was rated for the presence/absence and semiquantitative assessments of synovitis, bone erosion (ERO), and bone marrow edema (BME). All patients had HGs and completed the shortened Disability of Arm, Shoulder, and Hand Questionnaire (QuickDASH), the Arthritis Impact Measurement Scales hand and finger function subscale, and the upper extremity function sub-score of the ROAD.

Figure 1.

The modified simplified SAMIS magnetic resonance score (mod SAMIS) scoring spreadsheet. The MRI was graded for the presence/absence of synovitis and semiquantitative ratings of bone marrow oedema and bone erosion, without contrast injection.

Results

The mod SAMIS total score and the US-CLARA had a strong correlation (rho=0.377, p=0.0018) for all patients. Among the SAMIS sub-scores, there was a significant relationship between mod SAMIS bone oedema (SAMIS-BME) and US-CLARA (rho=0.799, p<0.001) and mod SAMIS synovitis (SAMIS-synovitis) and US-CLARA (rho=0.539, p<0.001). There were also significant negative relationships between the HGs score and the mod SAMIS total score and US-CLARA (rho = -0.309, p=0.011 and rho = -0.775, p<0.0001, respectively). The HGs and disease activity composite indices, as well as hand-specific self-report questionnaires, were shown to have high relationships (p<0.0001) in individuals with RA. The hand and finger function sub-scales, as well as the mod SAMIS erosion (SAMIS-ERO) and HGs, exhibited no significant relationship. For each of the three components, interobserver agreement was good to excellent (intraclass correlation values = 0.713, 0.912, and 0.821, respectively) (synovitis, BME, and BME) (Figure 2).

Figure 2.

Scatterplot with linear regression lines displays the relationship between (A) mod SAMIS total score vs HGs, (B) US-CLARA vs HGs, and (C) US-CLARA vs mod SAMIS total score.

Conclusion

BME and synovitis have an impact on upper-extremity function. The US-CLARA and mod SAMIS total score are promising solutions for semi-quantitative evaluation of joint inflammation and damage in RA. These shortened scores might cut down on image processing time in US and MRI-controlled RA investigations, as well as make using these imaging modalities in RA treatment response evaluation studies simpler.

References

[1]Salaffi F, Carotti M, Farah S, Ceccarelli L, Di Carlo M. Handgrip Strength Features in Rheumatoid Arthritis Patients Assessed Using an Innovative Cylindrical-Shaped Device: Relationships With Demographic, Anthropometric and Clinical Variables. J Med Syst. 2021, 9;45(11):100.

[2]Salaffi F, Di Carlo M, Iannone F, Fedele AL, Epis OM, Pellerito R, Foti R, Passiu G, Punzi L, Furini F, Sarzi-Puttini P, Carletto A, Gremese E, Lapadula G, Ferraccioli G. The UltraSound-CLinical ARthritis Activity (US-CLARA) index: Properties of a new composite disease activity index for rheumatoid arthritis. Semin Arthritis Rheum. 2018;47(5):619-629.

Disclosure of Interests

None declared.

School-based sexuality education in Italy 2016-2020: a highly heterogeneous scenario

Background

In Italy, sexuality education (SE) is not part of school curricula. SE and, specifically, comprehensive SE (CSE), as defined by UNESCO, is one of the most important means of promoting sexual well-being among young people and a key component for sexually transmitted infections' (STI) prevention. School-based SE has the potential to reach most young people, is cost-effective and valued by students. The aim of this study was to describe school-based SE educational activities (EA) implemented in Italy during 2016-2020.

Methods

An online survey was developed and piloted to collect information on duration, content and methods used to implement the EA. The survey was disseminated at national and regional level between August-October 2020. IBM SPSS Statistics 26 was used to perform descriptive analysis of the data, while a framework from UNESCO was adapted to perform a qualitative analysis.

Results

A total of 219 reported EA were carried out in secondary schools. The analysis describes a highly heterogeneous scenario in terms of EA geographical coverage across the country (most EA delivered in 4/20 regions), providers (70% private, 30% public) and objectives. The qualitative analysis of content, objectives, and methodology identified 62 EA (29%) classifiable as CSE, with median duration of 3 days. The remainder EA had a risk-based approach, largely focussing on STI prevention (35%). Many EA (29%) were single-session interventions. Limited time availability for extra-curricular activities was reported as a key challenge. Only 97 EA performed evaluation (44%). In 53 EA (24%) both pre and post knowledge assessment were delivered and in 114 (52%) satisfaction was evaluated.

Conclusions

Italy is one of a few European countries still lacking a dedicated policy for school-based SE. According to available data, SE is not systematically and equally delivered across the country. Action is urgently needed to incorporate SE in school curricula. (Funding: Italian Ministry of Health)

Key messages

This study shows the absence of a comprehensive and shared approach to SE in Italy, with heterogeneous geographical coverage and providers and a lack of systematic objectives and evaluation. The results highlight the need to develop theoretical and practical guidelines for the implementation of CSE in Italy and the integration of sexuality education in school curricula.

Imaging Stray Magnetic Field of Individual Ferromagnetic Nanotubes

We use a scanning nanometer-scale superconducting quantum interference device to map the stray magnetic field produced by individual ferromagnetic nanotubes (FNTs) as a function of applied magnetic field. The images are taken as each FNT is led through magnetic reversal and are compared with micromagnetic simulations, which correspond to specific magnetization configurations. In magnetic fields applied perpendicular to the FNT long axis, their magnetization appears to reverse through vortex states, that is, configurations with vortex end domains or in the case of a sufficiently short FNT with a single global vortex. Geometrical imperfections in the samples and the resulting distortion of idealized magnetization configurations influence the measured stray-field patterns.

Prevalence of antibodies against Bubaline herpesvirus (BuHV-1) among Mediterranean water buffalo (Bubalus bubalis) with implications in buffalo trade

BACKGROUND

Both Bovine herpesvirus (BoHV-1) and Bubaline herpesvirus (BuHV-1) have been reported to cross the species barrier. Antibody seroconversion in glycoprotein E (gE) blocking ELISA during BuHV-1 infection has been documented. Recent diagnostic efforts have focused on the development and application of discriminatory tests to distinguish between infections with BoHV-1 and BuHV-1.

OBJECTIVE

To evaluate the impact and distribution of these two infections in water buffalo farms in two regions (Piedmont (n = 3) and Campania (n = 10), Italy) where infectious bovine rhinotracheitis control programs have been implemented.

ANIMALS AND METHODS

Sampling was carried out on 13 buffalo farms comprising 1089 animals using specific gE-indirect ELISA's test able to discriminate among BoHV-1 and BuHV-1 infections.

RESULTS

59.0% of animals reacted positive to ELISA (irrespective of whether BoHV-1 or BuHV-1 antigen was used) and 86.4% of these were reactive to BuHV-1 only, whereas 11.8% showed absorbance values for both antigens and were classified as inconclusive. There was a statistically significant age-related difference in BuHV-1 infection rates but not in overall individual (47% vs. 58%) or herd prevalence (100% vs. 90%) of infection between the two regions.

CONCLUSION

The low percentage of sera reactive to BoHV-1 (1.8%, 12/643) indicates that BuHV-1 may be the main circulating alphaherpesvirus infection in Mediterranean water buffalo in the two study areas. Since Bubalus bubalis is included in Directive 64/432/EEC on animal health problems affecting intra-community trade in bovine animals, diagnostic testing with nonspecific ELISA for BoHV-1 infection in buffalo may yield false-positive reactions. This scenario could lead to economic losses and hamper buffalo trade and movement, particularly for reproduction purposes.

Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure

Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity.

Voluntary and controlled weight loss can reduce symptoms and proton pump inhibitor use and dosage in patients with gastroesophageal reflux disease: a comparative study

A wide variety of pieces of evidence has suggested that obesity is associated with a significant increase in the risk for gastroesophageal reflux disease (GERD) symptoms and its complications. The aim of this study was to evaluate the effect of weight loss on reflux symptoms in overweight/obese patients with proven GERD. We enrolled overweight/obese patients with typical GERD symptoms and erosive esophagitis. At baseline, patients underwent detailed reflux symptoms evaluation and anthropometric assessment, and were divided into two treatment groups: group A received proton pump inhibitor (PPI) and a personalized hypocaloric diet and aerobic exercise; and group B received PPI and a 'standard of care diet'. The dietetic treatment was considered effective if at least 10% of weight loss was achieved within 6 months. All patients were evaluated in terms of anthropometric data, GERD symptoms, and PPI use. In group A, mean body mass index (BMI) decreased from 30.3 ± 4.1 to 25.7 ± 3.1 (P < 0.05), and mean weight decreased from 82.1 ± 16.9 kg to 69.9 ± 14.4 kg (P < 0.05). In group B, there was no change in BMI and weight. Symptom perception decreased (P < 0.05) in both groups during PPI therapy, but a higher improvement was recorded in group A. In group A, PPI therapy was completely discontinued in 27/50 of the patients, and halved in 16/50. Only 7/50 continued the same PPI dosage. In group B, 22/51 halved the therapy and 29/51 maintained full dosage of therapy, but none was able to discontinue PPI due to a symptom recurrence. Overall, weight loss of at least 10% is recommended in all patients with GERD in order to boost the effect of PPI on reflux symptom relief and to reduce chronic medication use.

[Perception of risk of biological agents among a group of health workers]

In the context of "direct" or "indirect" patient care, residual risk of biological agents exposure constitute a hazard for health and safety, that cross and affects all health care workers. For the development and implementation of effective "prevention and control" actions, even against nosocomial infections, it is nevertheless most important to acquire objective information on the level of risk perception demonstrated by relevant staff for assistance. The aim of this contribution was therefore to study the attitudes and behaviours of health sector workers in relation to the specific "biological agents risk". The survey was carried out in a italian hospital, and 25 in the study adhered responsible for the safety and 219 nurses, identified as exposed to biological agents (244 subjects), who were given a specially designed questionnaire. The results of the study, which will be described in detail, has helped to identify critical issues related to the management of "biological agents risk", and at the same time to set up a program for improvement of prevention and protection, aimed at a substantial reduction of the same risk factor.

Calprotectin is a stronger predictive marker of relapse in ulcerative colitis than in Crohn's disease

BACKGROUND AND AIMS

The clinical course of inflammatory bowel disease is characterised by a succession of relapses and remissions. The aim of our study was to assess whether the predictive value of faecal calprotectin-a non-invasive marker of intestinal inflammation-for clinical relapse is different in ulcerative colitis (UC) and Crohn's disease (CD).

METHODS

Seventy nine consecutive patients with a diagnosis of clinically quiescent inflammatory bowel disease (38 CD and 41 UC) were followed for 12 months, undergoing regular clinical evaluations and blood tests. A single stool sample was collected at the beginning of the study from each patient and the calprotectin concentration was assessed by a commercially available enzyme linked immunoassay.

RESULTS

In CD, median calprotectin values were 220.1 mug/g (95% confidence interval (CI) 21.7-418.5) in those patients who relapsed during follow up, and 220.5 mug/g (95% CI 53-388) in non-relapsing patients (p=0.395). In UC, median calprotectin values were 220.6 mug/g (95% CI 86-355.2) and 67 microg/g (95% CI 15-119) in relapsing and non-relapsing patients, respectively (p<0.0001). The multivariate Cox (proportional hazard) regression model, after adjustment for possible confounding variables, showed a twofold and 14-fold increase in the relapse risk, respectively, in those patients with CD and UC in clinical remission who had a faecal calprotectin concentration higher than 150 microg/g.

CONCLUSIONS

Faecal calprotectin proved to be an even stronger predictor of clinical relapse in UC than in CD, which makes the test a promising non-invasive tool for monitoring and optimising therapy.

Role of faecal calprotectin as non-invasive marker of intestinal inflammation

BACKGROUND/AIM

Faecal calprotectin, a neutrophil granulocyte cytosol protein, is considered a promising marker of intestinal inflammation. We assessed and compared the faecal calprotectin concentration in patients with organic and functional chronic intestinal disorders.

PATIENTS AND METHODS

The study was carried out, using a commercially available ELISA test, measuring calprotectin in stool samples collected from 131 patients with inflammatory bowel diseases, 26 with intestinal neoplasms, 48 with irritable bowel syndrome and 34 healthy subjects.

RESULTS

Median faecal calprotectin was significantly increased in Crohn's disease (231 microg/g, 95% confidence interval (CI) 110-353 microg/g), ulcerative colitis (167 microg/g, 95% CI 59-276 microg/g), and neoplasms (105 microg/g, 95% CI 0-272 microg/g), whereas normal values were found in patients with irritable bowel syndrome (22 microg/g, 95% CI 9-35 microg/g) and in healthy subjects (11 microg/g, 95% CI 3-18 microg/g). A positive correlation was observed with clinical activity scores in Crohn's disease and ulcerative colitis. In both groups, patients with clinically active disease showed higher calprotectin levels than those observed in patients with quiescent disease (405 microg/g, 95% CI 200-610 microg/g vs. 213 microg/g, 95% CI 85-341 microg/g in CD patients, p<0.05, and 327 microg/g, 95% CI 104-550 microg/g vs. 123 microg/g, 95% CI 40-206 microg/g in UC patients, p<0.001).

CONCLUSIONS

Faecal calprotectin appears to be a promising and non-invasive biomarker of intestinal inflammation. If these findings are confirmed, it may provide a useful test for the diagnosis and follow up of inflammatory bowel diseases.

Cytotoxicity of a new endodontic filling material

In vitro cell cultures have been widely used as a means of evaluating cytotoxicity of root canal filling materials. Following ANSI/ADA spec. no. 41, the aim of the present study was to investigate the biological compatibility of a new sealer (FibreFill) and compare it with some commercially available endodontic sealers (Bioseal and Acroseal). Mouse 3T3 fibroblasts were seeded and cultured and subsequently extracts of the cements were added. After 24 hours incubation, the cellular vitality of fibroblasts was evaluated by the neutral red uptake test (NRU), which measures the membrane permeability. Data were collected and statistically analysed. Results showed that all tested materials exhibited mild cytotoxic effects, which are compatible with normal clinical use, and no statistically significant difference was noted between FibreFill and the other tested materials. Therefore, selection amongst these sealers should be based on other factors.

Compatibility study between ibuproxam and pharmaceutical excipients using differential scanning calorimetry, hot-stage microscopy and scanning electron microscopy

Differential scanning calorimetry (DSC) was used as a screening technique for assessing the compatibility of ibuproxam with some currently employed pharmaceutical excipients. The influence of processing effects (simple blending, cogrinding or kneading) on drug stability was also evaluated. On the basis of DSC results, ibuproxam was found to be compatible with corn starch, avicel and sodium carboxymethylcellulose. Some drug-excipient interaction was observed with polyethyleneglycol 4000, palmitic acid, stearic acid, Ca and Mg stearate. Actual solid-phase interactions of the drug with polyvinylpolypyrrolidone and polyvinylpirrolidone K30 were induced by mechanical treatments. Hot-stage microscopy (HSM) and scanning electron microscopy (SEM) were of help in interpreting the DSC results and excluding in all cases relevant pharmaceutical incompatibilities.