Pancreatic adenocarcinoma (PDAC) is the most frequent histological type of malignancy in the panc... more Pancreatic adenocarcinoma (PDAC) is the most frequent histological type of malignancy in the pancreas. Extracellular matrix (ECM), plays a critical role during the process of human carcinogenesis and the possible diversity in matricellular proteins composition of ECM may have a significant impact on the clinical course of PDAC. Aim of this paper was to evaluate the expression of three matricellular proteins, including Periostin (POSTN), Tenascin (TNS) and Osteopontin (OPN), in PDAC from long-survival (LS) and non-long survival (NLS) patients. A total of 30 PDAC were analyzed, 15 from patients that survived more than 60 months after surgery (LS) and 15 that died from the disease within 24 (NLS). RNA was extracted and OPN, TNS and POSTN mRNA levels were evaluated by qRT-PCR. LS and NLS samples showed the same type of POSTN and TN isoforms. On the contrary, OPN seems to be preferentially expressed in NLS PDAC. Moreover, OPNb and OPNc isoforms were expressed exclusively in NLS samples. In conclusion, Our data led to hypothesize a possible relationship between the expression of different isoforms of each of these proteins and the clinical outcome of patients with PDAC.
Cancer biomarkers : section A of Disease markers, Jan 6, 2018
Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is ... more Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is currently the only effective treatment for PDAC, most patients survive less than 20 months after tumor resection. The primary goal was to investigate alterations in KRAS, TP53, SMAD4 and CDKN2A/p16 in tumors from patients with exceptionally long survival after surgery. Tumors from 15 patients with PDAC that survived more than 55 months after surgery ("LS") were analyzed for KRAS, TP53, IDH1, NRAS and BRAF using next-generation sequencing. SMAD4 and CDKN2A/p16 was tested using immunohistochemistry. MGMT promoter methylation was investigated. Tumors from "LS" have a lower prevalence of KRAS and TP53 mutations and had more frequently SMAD4 retained expression, if compared with that of patients died within 24 months from surgery. The survival of patients with wild-type KRAS and TP53 tumors was more than twice longer than that of patients bearing KRAS and TP53 mutations (9...
Anisakiasis is a parasitic infection caused by the consumption of raw fish containing larvae of t... more Anisakiasis is a parasitic infection caused by the consumption of raw fish containing larvae of the Anisakis species. Since the first description in 1960 of a patient suffering from this pathogen, in the Netherlands, most of the cases have been reported in Japan, where consumption of raw fish is common, but the number of cases is increasing worldwide. The first case identified in Italy dates back to 1996 and a few cases have been reported since then. In Italy the intestinal form occurs almost as frequently as the gastric form, which is far more frequent in Japan. Intestinal Anisakiasis represents a diagnostic challenge as it is clinically misdiagnosed and most of the patients require surgery due to the occurrence of complications such as bowel occlusion or perforation. Practically no cases of the intestinal form are diagnosed preoperatively. We report the first case, to our knowledge, of intestinal Anisakiasis in which surgery was avoided, due to a prompt diagnosis suspected on intestinal biopsies. A literature review of Anisakiasis cases reported in Italy is also carried out.
Background & AimsThe treatment of chronic hepatitis B infection (CHB) in children is still an are... more Background & AimsThe treatment of chronic hepatitis B infection (CHB) in children is still an area of great uncertainty. Vitamin E is an immunostimulating/antioxidant compound proven to be safe and effective for the treatment of adult CHB. The aim of this phase 2 controlled study was to evaluate the safety and efficacy of vitamin E for the treatment of paediatric HBeAg‐positive CHB.MethodsForty‐six children were randomized in a 1:1 ratio to receive vitamin E at a dose of 15 mg/kg/day (in galenic preparation) or no treatment for 12 months and were monitored for the subsequent 12 months. Clinical, biochemical, haematological and serovirological evaluations were carried out every 3 months.ResultsNo significant side effects were associated with the vitamin E treatment. At the end of the study, anti‐HBe seroconversion was obtained in 7 of 23 (30.4%) of vitamin E‐treated versus 1 of 23 (4.3%) of the control patients (P = 0.05), while a virological response (≥2 log decrease in HBV‐DNA from...
Italian journal of gastroenterology and hepatology, 1999
Recently, in vitro and in vivo studies demonstrated that non-steroidal anti-inflammatory drugs ar... more Recently, in vitro and in vivo studies demonstrated that non-steroidal anti-inflammatory drugs are able to enhance the activity of interferon alpha. To evaluate the efficacy and tolerability of ketoprofen (a non-steroidal anti-inflammatory drug) plus interferon alpha (group B) compared to interferon alpha plus ribavirin (group C) and interferon alpha alone (group A) in chronic hepatitis C non-responders after a 5-month course with interferon alpha. Without stopping interferon alpha, 49 patients were randomized to receive one of the three treatment regimens for 4 months. Three patients discontinued the therapy. One out of 16 patients in group A, 6/16 in group B and 5/14 in group C, alanine aminotransferase returned to normal at the end of the therapies (B vs A: p=0.04); serum hepatitis C virus-RNA became negative in 1 patient in group A and in 4 patients in both group B and group C. Six months after treatment, normal alanine transferase and negative hepatitis C virus-RNA were observe...
The benefit of lamivudine (LAM) in hepatitis B virus (HBV) infection is compromised by the progre... more The benefit of lamivudine (LAM) in hepatitis B virus (HBV) infection is compromised by the progressively increasing emergence of drug-resistant mutant strains. Although the addition of adefovir dipivoxil (ADV) usually induces complete suppression of viral replication, primary non-response to ADV in LAM resistant patients has been reported in a variable percentage of cases. Here we report a case of a patient with HBV infection and hepatocellular carcinoma who started LAM therapy and subsequently developed virological breakthrough. The patient was given ADV, but HBV-DNA negativisation was not reached. However, HBV clearance was obtained when the patient was switched from ADV to tenofovir. Virological evaluations showed two well-known LAM-related mutations (rtL180M and rtM204I) in addition to reverse-transcriptase rtQ215H. This is the first case suggesting that this mutation may have an impact on viral replication. Finally, we also report that rtQ215H is responsive to tenofovir.
Background: Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To dat... more Background: Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To date, PAC causes are still largely unknown. Antigens and replicative sequences of oncogenic hepatitis B (HBV) and hepatitis C (HCV) virus were detected in different extra-hepatic tissues, including pancreas. Objective: a systematic review and meta-analysis of epidemiological studies assessing PAC risk in patients with HBV/HCV chronic infections. Methods: In September 2012, we extracted the articles published in Medline, Embase and the Cochrane Library, using the following search terms: "chronic HBV" and "HCV", "hepatitis", "PAC", "risk factors", "epidemiology". Only case/control (C/C), prospective/retrospective cohort studies (PCS/RCS) written in English were collected. Results: four hospital-based C/C studies and one PCS, in HBV-infected patients and two hospital-based C/C studies and one RCS in HCV-infected subjects met inclusion criteria. In these studies HBsAg positivity enhanced significantly PAC risk (RR ¼ 1.18, 95% CI:1.04e1.33), whereas HBeAg positivity (RR ¼ 1.31, 95% CI:0.85e2.02) as well as HBsAg negative/HBcAb positive/HBsAb positive pattern (RR ¼ 1.12, 95% CI:0.78e1.59) and HBsAg negative/HBcAb positive/HBsAb negative pattern (RR ¼ 1.30, 95% CI:0.93e1.84) did not. Relationship between PAC risk and anti-HCV positivity was not significant, although it reached a borderline value (RR ¼ 1.160, 95% CI:0.99e1.3). Conclusions: HBV/HCV infection may represent a risk factor for PAC, but the small number of available researches, involving mainly populations of Asian ethnicity and the substantial variation between different geographical areas in seroprevalence of HBV/HCV-antigens/antibodies and genotypes are limiting factors to present meta-analysis.
Background/Aims: Interferon-a plus ribavirin seem to be more effticacious than interferon monothe... more Background/Aims: Interferon-a plus ribavirin seem to be more effticacious than interferon monotherapy in chronic hepatitis C. In a multicenter randomized trial, we evaluated the efficacy of this association for interferon-a resistant chronic hepatitis C. Methods: Fifty patients who were non-responders to recombinant or lymphoblastoid interferon-a were randomized to receive either ribavirin (800 mg/day) plus leucocytic interferon-a (3 mega units thrice weekly) or the same dose of interferon-a alone, for 6 months. Effects of therapy were evaluated by serum aminotransferase and hepatitis C virus RNA levels and control liver biopsies. Results: At the end of treatment, aminotransferase levels become normal in 9/26 patients receiving combination therapy (35% [confidence interval, 16% to 53%]) and in 2/24 receiving interferon-a alone (8% EPATITIS H C virus (HCV) is the most frequent cause of chronic viral hepatitis in the Western world (1,2). The disease is often silent and usually presents a mild course, but it can progress to cirrhosis and to hepatocellular carcinoma (3). At present, the only therapy of proven benefit for patients with chronic hepatitis C is interferon-a (IFN-CZ). However, IFN-a treatment alone is unsatisfactory on a long-term basis, as only 10 to 25% of patients treated with conventional schedules achieve a sustained response (4). Many patients who normalize alanine
Background: Although the number of elderly people is progressively increasing in the world, old a... more Background: Although the number of elderly people is progressively increasing in the world, old and very old patients have been underrepresented and understudied in trials evaluating the efficacy of chronic illness management models. The usual hospital indicators and practice guidelines do not consider the effects of complexityco-morbidity, social support, functional and cognitive status, patient adherence to therapy, risk of adverse drug reactionsin these subjects. The aim of this observational, multi-centric cohort study was to carefully assess factors contributing to the complexity of care for patients admitted to internal medicine wards. This was done by evaluating the severity of disease and degree of stability at admission, co-morbidity, age-related impairments, and the need for discharge planning plus post-discharge support. Methods: A total of 386 patients from 11 internal medicine wards in Emilia-Romagna and Marche, Italy, enrolled in a given week were evaluated. At admission, the following variables were recorded: demographic characteristics, medical history, global clinical-social prognostic evaluation, co-morbidity, severity of illness, presence of shock or hemodynamic instability, coma, and frequencies and causes of unscheduled hospital re-admission. Results: Cancer, congestive heart failure, pneumonia, stroke, and chronic obstructive pulmonary disease were the most frequent primary diagnoses. The complexity of our case study was characterized by several concomitant diseases. Over 50% of the patients were considered severe or more than severe, and over 20% extremely severe, with very high co-morbidity indices and illness severity scores. Some 55% of our patients were in need of partial or total care; 10% had some speech impairment, and 63% needed in-home health care after hospital discharge.
Using endoscopic ultrasonography (EUS) a large part of the portal venous system can be visualized... more Using endoscopic ultrasonography (EUS) a large part of the portal venous system can be visualized. In 40 patients with portal hypertension (PH) and in 48 control subjects EUS displayed the azygos, splenic, mesenteric and portal veins in both groups. However, esophageal and gastric varices, peri- esophageal and peri-gastric collateral veins and submucosal gastric venules were displayed only in patients with PH. EUS was inferior to endoscopy for detecting and grading esophageal varices (p less than 0.0005), but superior in the detection of varices in the fundus of the stomach (p less than 0.0005). EUS cannot be considered a reliable method for the study of esophageal varices: it has an overall sensitivity of 50%, does not permit flow measurements, and does not provide information that could be used to estimate the risk of bleeding. EUS has been demonstrated to be superior to endoscopy in the diagnosis of gastric varices. This finding is extremely important for the optimal selection of treatment of patients with portal hypertension. EUS can detect portal hypertensive gastropathy; thus inflammatory gastritis can be more easily distinguished from congestive gastropathy and therapeutic decisions are strongly influenced.
An association between monoclonal gammopathies and chronic liver diseases has been reported. To d... more An association between monoclonal gammopathies and chronic liver diseases has been reported. To determine the prevalence of monoclonal gammopathies in patients with chronic hepatitis C virus (HCV) infection and the possible association of monoclonal gammopathies with HCV genotypes. Prospective study. Departments of internal medicine and hematology at two university hospitals in Italy. 239 HCV-positive and 98 HCV-negative patients with chronic liver diseases were recruited consecutively. Clinical data were gathered, liver histologic examination was done, serum immunoglobulin and cryoglobulin levels were measured, and immunoelectrophoresis was done for monoclonal component detection. Patients with monoclonal gammopathy had serum HCV RNA measured and HCV genotype determined by polymerase chain reaction and had histologic examination of bone marrow. Monoclonal band was detected in 11% of HCV-positive patients and in 1% of HCV-negative patients (P = 0.004). The prevalence of HCV genotype 2a/c was higher in patients with monoclonal gammopathies than in those without (50% compared with 18%; P = 0.009). The prevalence of monoclonal gammopathies in patients with HCV-related chronic liver disease is striking and is often associated with genotype 2a/c infection.
The primary aim of World Journal of Clinical Cases (WJCC, World J Clin Cases) is to provide schol... more The primary aim of World Journal of Clinical Cases (WJCC, World J Clin Cases) is to provide scholars and readers from various fields of clinical medicine with a platform to publish high-quality clinical research articles and communicate their research findings online. WJCC mainly publishes articles reporting research results and findings obtained in the field of clinical medicine and covering a wide range of topics, including case control studies, retrospective cohort studies, retrospective studies, clinical trials studies, observational studies, prospective studies, randomized controlled trials, randomized clinical trials, systematic reviews, meta-analysis, and case reports.
In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the... more In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the globe, even in countries where vaccination programs have been strongly implemented. In these regions in 2021, a reduction in the number of hospitalizations and deaths compared to 2020 was observed. This decrease is certainly associated with the introduction of vaccination measures. The process of the development of effective vaccines represents an important challenge. Overall, the breakthrough infections occurring in vaccinated subjects are in most cases less severe than those observed in unvaccinated individuals. This review examines the factors affecting the immunogenicity of vaccines against SARS-CoV-2 and the possible role of nutrients in modulating the response of distinct immune cells to the vaccination.
S e la disciplina Storia della Medicina studia l'e-voluzione del pensiero medico basandosi e-... more S e la disciplina Storia della Medicina studia l'e-voluzione del pensiero medico basandosi e-sclusivamente su fonti storico-letterarie, la paleopatologia indaga sulle malattie del passato attraverso l'esame diretto dei resti umani antichi, scheletrici o mummificati. Questa disciplina si ba-sa sui metodi investigativi dell'anatomia patolo-gica, però si avvale anche dell'apporto dell'an-tropologia e dell'archeologia 1. Grazie alle osser-vazioni dei paleopatologi si realizza pertanto un contatto tra la medicina moderna, che utilizza le più moderne e sofisticate tecnologie e le malattie del passato. Mediante il contributo della paleopatologia si ottiene un duplice risultato: quello antropologi-co e quello medico. La crescita della conoscenza antropologica è collegata all'evidenza che l'in-sieme delle malattie che affliggono qualsiasi gruppo umano, nel passato come nel presente, non è un evento casuale, ma la risultante del rapporto tra l'uomo e l'...
Pancreatic adenocarcinoma (PDAC) is the most frequent histological type of malignancy in the panc... more Pancreatic adenocarcinoma (PDAC) is the most frequent histological type of malignancy in the pancreas. Extracellular matrix (ECM), plays a critical role during the process of human carcinogenesis and the possible diversity in matricellular proteins composition of ECM may have a significant impact on the clinical course of PDAC. Aim of this paper was to evaluate the expression of three matricellular proteins, including Periostin (POSTN), Tenascin (TNS) and Osteopontin (OPN), in PDAC from long-survival (LS) and non-long survival (NLS) patients. A total of 30 PDAC were analyzed, 15 from patients that survived more than 60 months after surgery (LS) and 15 that died from the disease within 24 (NLS). RNA was extracted and OPN, TNS and POSTN mRNA levels were evaluated by qRT-PCR. LS and NLS samples showed the same type of POSTN and TN isoforms. On the contrary, OPN seems to be preferentially expressed in NLS PDAC. Moreover, OPNb and OPNc isoforms were expressed exclusively in NLS samples. In conclusion, Our data led to hypothesize a possible relationship between the expression of different isoforms of each of these proteins and the clinical outcome of patients with PDAC.
Cancer biomarkers : section A of Disease markers, Jan 6, 2018
Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is ... more Pancreatic adenocarcinoma (PDAC) is one of the deadliest human malignancies. Although surgery is currently the only effective treatment for PDAC, most patients survive less than 20 months after tumor resection. The primary goal was to investigate alterations in KRAS, TP53, SMAD4 and CDKN2A/p16 in tumors from patients with exceptionally long survival after surgery. Tumors from 15 patients with PDAC that survived more than 55 months after surgery ("LS") were analyzed for KRAS, TP53, IDH1, NRAS and BRAF using next-generation sequencing. SMAD4 and CDKN2A/p16 was tested using immunohistochemistry. MGMT promoter methylation was investigated. Tumors from "LS" have a lower prevalence of KRAS and TP53 mutations and had more frequently SMAD4 retained expression, if compared with that of patients died within 24 months from surgery. The survival of patients with wild-type KRAS and TP53 tumors was more than twice longer than that of patients bearing KRAS and TP53 mutations (9...
Anisakiasis is a parasitic infection caused by the consumption of raw fish containing larvae of t... more Anisakiasis is a parasitic infection caused by the consumption of raw fish containing larvae of the Anisakis species. Since the first description in 1960 of a patient suffering from this pathogen, in the Netherlands, most of the cases have been reported in Japan, where consumption of raw fish is common, but the number of cases is increasing worldwide. The first case identified in Italy dates back to 1996 and a few cases have been reported since then. In Italy the intestinal form occurs almost as frequently as the gastric form, which is far more frequent in Japan. Intestinal Anisakiasis represents a diagnostic challenge as it is clinically misdiagnosed and most of the patients require surgery due to the occurrence of complications such as bowel occlusion or perforation. Practically no cases of the intestinal form are diagnosed preoperatively. We report the first case, to our knowledge, of intestinal Anisakiasis in which surgery was avoided, due to a prompt diagnosis suspected on intestinal biopsies. A literature review of Anisakiasis cases reported in Italy is also carried out.
Background & AimsThe treatment of chronic hepatitis B infection (CHB) in children is still an are... more Background & AimsThe treatment of chronic hepatitis B infection (CHB) in children is still an area of great uncertainty. Vitamin E is an immunostimulating/antioxidant compound proven to be safe and effective for the treatment of adult CHB. The aim of this phase 2 controlled study was to evaluate the safety and efficacy of vitamin E for the treatment of paediatric HBeAg‐positive CHB.MethodsForty‐six children were randomized in a 1:1 ratio to receive vitamin E at a dose of 15 mg/kg/day (in galenic preparation) or no treatment for 12 months and were monitored for the subsequent 12 months. Clinical, biochemical, haematological and serovirological evaluations were carried out every 3 months.ResultsNo significant side effects were associated with the vitamin E treatment. At the end of the study, anti‐HBe seroconversion was obtained in 7 of 23 (30.4%) of vitamin E‐treated versus 1 of 23 (4.3%) of the control patients (P = 0.05), while a virological response (≥2 log decrease in HBV‐DNA from...
Italian journal of gastroenterology and hepatology, 1999
Recently, in vitro and in vivo studies demonstrated that non-steroidal anti-inflammatory drugs ar... more Recently, in vitro and in vivo studies demonstrated that non-steroidal anti-inflammatory drugs are able to enhance the activity of interferon alpha. To evaluate the efficacy and tolerability of ketoprofen (a non-steroidal anti-inflammatory drug) plus interferon alpha (group B) compared to interferon alpha plus ribavirin (group C) and interferon alpha alone (group A) in chronic hepatitis C non-responders after a 5-month course with interferon alpha. Without stopping interferon alpha, 49 patients were randomized to receive one of the three treatment regimens for 4 months. Three patients discontinued the therapy. One out of 16 patients in group A, 6/16 in group B and 5/14 in group C, alanine aminotransferase returned to normal at the end of the therapies (B vs A: p=0.04); serum hepatitis C virus-RNA became negative in 1 patient in group A and in 4 patients in both group B and group C. Six months after treatment, normal alanine transferase and negative hepatitis C virus-RNA were observe...
The benefit of lamivudine (LAM) in hepatitis B virus (HBV) infection is compromised by the progre... more The benefit of lamivudine (LAM) in hepatitis B virus (HBV) infection is compromised by the progressively increasing emergence of drug-resistant mutant strains. Although the addition of adefovir dipivoxil (ADV) usually induces complete suppression of viral replication, primary non-response to ADV in LAM resistant patients has been reported in a variable percentage of cases. Here we report a case of a patient with HBV infection and hepatocellular carcinoma who started LAM therapy and subsequently developed virological breakthrough. The patient was given ADV, but HBV-DNA negativisation was not reached. However, HBV clearance was obtained when the patient was switched from ADV to tenofovir. Virological evaluations showed two well-known LAM-related mutations (rtL180M and rtM204I) in addition to reverse-transcriptase rtQ215H. This is the first case suggesting that this mutation may have an impact on viral replication. Finally, we also report that rtQ215H is responsive to tenofovir.
Background: Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To dat... more Background: Pancreatic adenocarcinoma (PAC) is an aggressive cancer with a poor prognosis. To date, PAC causes are still largely unknown. Antigens and replicative sequences of oncogenic hepatitis B (HBV) and hepatitis C (HCV) virus were detected in different extra-hepatic tissues, including pancreas. Objective: a systematic review and meta-analysis of epidemiological studies assessing PAC risk in patients with HBV/HCV chronic infections. Methods: In September 2012, we extracted the articles published in Medline, Embase and the Cochrane Library, using the following search terms: "chronic HBV" and "HCV", "hepatitis", "PAC", "risk factors", "epidemiology". Only case/control (C/C), prospective/retrospective cohort studies (PCS/RCS) written in English were collected. Results: four hospital-based C/C studies and one PCS, in HBV-infected patients and two hospital-based C/C studies and one RCS in HCV-infected subjects met inclusion criteria. In these studies HBsAg positivity enhanced significantly PAC risk (RR ¼ 1.18, 95% CI:1.04e1.33), whereas HBeAg positivity (RR ¼ 1.31, 95% CI:0.85e2.02) as well as HBsAg negative/HBcAb positive/HBsAb positive pattern (RR ¼ 1.12, 95% CI:0.78e1.59) and HBsAg negative/HBcAb positive/HBsAb negative pattern (RR ¼ 1.30, 95% CI:0.93e1.84) did not. Relationship between PAC risk and anti-HCV positivity was not significant, although it reached a borderline value (RR ¼ 1.160, 95% CI:0.99e1.3). Conclusions: HBV/HCV infection may represent a risk factor for PAC, but the small number of available researches, involving mainly populations of Asian ethnicity and the substantial variation between different geographical areas in seroprevalence of HBV/HCV-antigens/antibodies and genotypes are limiting factors to present meta-analysis.
Background/Aims: Interferon-a plus ribavirin seem to be more effticacious than interferon monothe... more Background/Aims: Interferon-a plus ribavirin seem to be more effticacious than interferon monotherapy in chronic hepatitis C. In a multicenter randomized trial, we evaluated the efficacy of this association for interferon-a resistant chronic hepatitis C. Methods: Fifty patients who were non-responders to recombinant or lymphoblastoid interferon-a were randomized to receive either ribavirin (800 mg/day) plus leucocytic interferon-a (3 mega units thrice weekly) or the same dose of interferon-a alone, for 6 months. Effects of therapy were evaluated by serum aminotransferase and hepatitis C virus RNA levels and control liver biopsies. Results: At the end of treatment, aminotransferase levels become normal in 9/26 patients receiving combination therapy (35% [confidence interval, 16% to 53%]) and in 2/24 receiving interferon-a alone (8% EPATITIS H C virus (HCV) is the most frequent cause of chronic viral hepatitis in the Western world (1,2). The disease is often silent and usually presents a mild course, but it can progress to cirrhosis and to hepatocellular carcinoma (3). At present, the only therapy of proven benefit for patients with chronic hepatitis C is interferon-a (IFN-CZ). However, IFN-a treatment alone is unsatisfactory on a long-term basis, as only 10 to 25% of patients treated with conventional schedules achieve a sustained response (4). Many patients who normalize alanine
Background: Although the number of elderly people is progressively increasing in the world, old a... more Background: Although the number of elderly people is progressively increasing in the world, old and very old patients have been underrepresented and understudied in trials evaluating the efficacy of chronic illness management models. The usual hospital indicators and practice guidelines do not consider the effects of complexityco-morbidity, social support, functional and cognitive status, patient adherence to therapy, risk of adverse drug reactionsin these subjects. The aim of this observational, multi-centric cohort study was to carefully assess factors contributing to the complexity of care for patients admitted to internal medicine wards. This was done by evaluating the severity of disease and degree of stability at admission, co-morbidity, age-related impairments, and the need for discharge planning plus post-discharge support. Methods: A total of 386 patients from 11 internal medicine wards in Emilia-Romagna and Marche, Italy, enrolled in a given week were evaluated. At admission, the following variables were recorded: demographic characteristics, medical history, global clinical-social prognostic evaluation, co-morbidity, severity of illness, presence of shock or hemodynamic instability, coma, and frequencies and causes of unscheduled hospital re-admission. Results: Cancer, congestive heart failure, pneumonia, stroke, and chronic obstructive pulmonary disease were the most frequent primary diagnoses. The complexity of our case study was characterized by several concomitant diseases. Over 50% of the patients were considered severe or more than severe, and over 20% extremely severe, with very high co-morbidity indices and illness severity scores. Some 55% of our patients were in need of partial or total care; 10% had some speech impairment, and 63% needed in-home health care after hospital discharge.
Using endoscopic ultrasonography (EUS) a large part of the portal venous system can be visualized... more Using endoscopic ultrasonography (EUS) a large part of the portal venous system can be visualized. In 40 patients with portal hypertension (PH) and in 48 control subjects EUS displayed the azygos, splenic, mesenteric and portal veins in both groups. However, esophageal and gastric varices, peri- esophageal and peri-gastric collateral veins and submucosal gastric venules were displayed only in patients with PH. EUS was inferior to endoscopy for detecting and grading esophageal varices (p less than 0.0005), but superior in the detection of varices in the fundus of the stomach (p less than 0.0005). EUS cannot be considered a reliable method for the study of esophageal varices: it has an overall sensitivity of 50%, does not permit flow measurements, and does not provide information that could be used to estimate the risk of bleeding. EUS has been demonstrated to be superior to endoscopy in the diagnosis of gastric varices. This finding is extremely important for the optimal selection of treatment of patients with portal hypertension. EUS can detect portal hypertensive gastropathy; thus inflammatory gastritis can be more easily distinguished from congestive gastropathy and therapeutic decisions are strongly influenced.
An association between monoclonal gammopathies and chronic liver diseases has been reported. To d... more An association between monoclonal gammopathies and chronic liver diseases has been reported. To determine the prevalence of monoclonal gammopathies in patients with chronic hepatitis C virus (HCV) infection and the possible association of monoclonal gammopathies with HCV genotypes. Prospective study. Departments of internal medicine and hematology at two university hospitals in Italy. 239 HCV-positive and 98 HCV-negative patients with chronic liver diseases were recruited consecutively. Clinical data were gathered, liver histologic examination was done, serum immunoglobulin and cryoglobulin levels were measured, and immunoelectrophoresis was done for monoclonal component detection. Patients with monoclonal gammopathy had serum HCV RNA measured and HCV genotype determined by polymerase chain reaction and had histologic examination of bone marrow. Monoclonal band was detected in 11% of HCV-positive patients and in 1% of HCV-negative patients (P = 0.004). The prevalence of HCV genotype 2a/c was higher in patients with monoclonal gammopathies than in those without (50% compared with 18%; P = 0.009). The prevalence of monoclonal gammopathies in patients with HCV-related chronic liver disease is striking and is often associated with genotype 2a/c infection.
The primary aim of World Journal of Clinical Cases (WJCC, World J Clin Cases) is to provide schol... more The primary aim of World Journal of Clinical Cases (WJCC, World J Clin Cases) is to provide scholars and readers from various fields of clinical medicine with a platform to publish high-quality clinical research articles and communicate their research findings online. WJCC mainly publishes articles reporting research results and findings obtained in the field of clinical medicine and covering a wide range of topics, including case control studies, retrospective cohort studies, retrospective studies, clinical trials studies, observational studies, prospective studies, randomized controlled trials, randomized clinical trials, systematic reviews, meta-analysis, and case reports.
In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the... more In recent weeks, the rate of SARS-CoV-2 infections has been progressively increasing all over the globe, even in countries where vaccination programs have been strongly implemented. In these regions in 2021, a reduction in the number of hospitalizations and deaths compared to 2020 was observed. This decrease is certainly associated with the introduction of vaccination measures. The process of the development of effective vaccines represents an important challenge. Overall, the breakthrough infections occurring in vaccinated subjects are in most cases less severe than those observed in unvaccinated individuals. This review examines the factors affecting the immunogenicity of vaccines against SARS-CoV-2 and the possible role of nutrients in modulating the response of distinct immune cells to the vaccination.
S e la disciplina Storia della Medicina studia l'e-voluzione del pensiero medico basandosi e-... more S e la disciplina Storia della Medicina studia l'e-voluzione del pensiero medico basandosi e-sclusivamente su fonti storico-letterarie, la paleopatologia indaga sulle malattie del passato attraverso l'esame diretto dei resti umani antichi, scheletrici o mummificati. Questa disciplina si ba-sa sui metodi investigativi dell'anatomia patolo-gica, però si avvale anche dell'apporto dell'an-tropologia e dell'archeologia 1. Grazie alle osser-vazioni dei paleopatologi si realizza pertanto un contatto tra la medicina moderna, che utilizza le più moderne e sofisticate tecnologie e le malattie del passato. Mediante il contributo della paleopatologia si ottiene un duplice risultato: quello antropologi-co e quello medico. La crescita della conoscenza antropologica è collegata all'evidenza che l'in-sieme delle malattie che affliggono qualsiasi gruppo umano, nel passato come nel presente, non è un evento casuale, ma la risultante del rapporto tra l'uomo e l'...
Uploads
Papers by Sirio Fiorino