Epidemiological trends and direct costs of diabetes in a Northern Italy area: 2012 health administrative records analysis LHT n. 20 Verona.

OBJECTIVE: This analysis estimates type 1 and type 2 diabetes direct costs in 2012, in terms of hospital care, outpatient visits, diagnostics and medications, in a local healthcare trust in Northern Italy (ULSS n.20 Verona). METHODS: The Johns Hopkins Adjusted Clinical Group (ACG®) System was used to analyze data, including hospital discharges, emergency room admissions, medical encounter records, disease registries, copayment exemptions, home care services, psychiatric services, rehabilitation services, and medications. Data from general practitioners and nursing homes were not directly available. Patients obtained from the first analysis were subsequently divided in two groups (type 1 and type 2 diabetes) according to ATC drug classification system and age. Costs were estimated from inpatient and outpatients fees and drugs costs. RESULTS: ULSS n. 20 takes care of about 480.000 people. We identified 974 people affected by type 1 diabetes (prevalence 0,2%) and 24.087 people affected by type 2 diabetes (prevalence 5,0%) among the residents in 2012. Hospitalization mean annual cost was 4.753,50€ (SD 9.330,19€) for type 1 diabetes and 1.718,08€ (SD 5.087,34€) for type 2 diabetes. Outpatient care mean annual cost was 1.401,76€ (SD 4.394,88€) for type 1 diabetes and 669,15€ (SD 2.121,24€) for type 2 diabetes. Medications mean annual cost was 1,369,35€ (SD1.781,18€) for type 1 diabetes and 874,07€ (SD 2.832,2€) for type 2 diabetes. CONCLUSIONS: ACG® diabetes data analysis agrees with data obtained by more expensive methods and seems to be a comprehensive and applicable tool to analyze chronic diseases dynamics in the Italian setting in order to prioritize future research and analyze the effects of interventions aimed to ensure the sustainability of public health services. Because of the combination between prevalence data and epidemiological trends, we could be at the eve of a dramatic increase of diabetes costs with major concerns for the Italian NHS ability to withstand.

Effectiveness of cognitive behavioral therapy in the treatment of fibromyalgia syndrome: a meta-analytic literature review.

Fibromyalgia (FM) is a chronic disorder caused by a dysfunction of central nervous system sensitization. This syndrome is characterized by widespread pain and diffuse tenderness, but often also presents fatigue, sleep disturbances, and a whole range of symptoms such as morning stiffness, decreased physical function and dyscognition. FM is usually treated with pharmacological and non-pharmacological treatments. The non-pharmacological interventions include cognitive behavioral therapy (CBT), physiotherapy, acupuncture and patient education programs. In order to evaluate the efficacy of CBT and compare it with other non-pharmacological treatments, we performed a review of the meta-analytic literature. We evaluated the methodological quality of publications found by following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Data showed that CBT does not provide better results than other non-pharmacological treatments on outcomes of pain, fatigue, sleep disturbance and quality of life, at either a short or long-term evaluation. On the contrary, CBT seems to be more effective on symptoms of depression for a short period, whereas it considerably improves the pain self-management and reduces the number of visits to the doctor. The data currently available indicate that cost-effectiveness studies could help us to understand whether the reduction in the number of visits to the doctor could balance the cost of CBT to the health public system.

Simultaneous polymerase chain reaction detection and restriction typing for the diagnosis of human genital papillomavirus infection.

A polymerase chain reaction method has been developed which allows the simultaneous detection of the majority of clinically relevant HPV types. Degenerate HPV-specific primers direct the one-step amplification of a DNA region spanning E1 and E7 genes. This enables an immediate distinction between the two groups of papillomaviruses, characterized by high or low oncogenic potential, simply from the size of amplified DNA. The PCR product can be subjected to a second round of amplification with internal primers, which are specific for 7 high-risk HPV types, HPV-16, -18, -31, -33, -35, -45 and -58. Precise identification of one-step or two-step amplified DNA is done by endonuclease digestion with one or two enzymes. The detection sensitivity, which has been assessed using cloned HPV genomes and HeLa and CaSki cell lines, varies from a few tens to a few hundreds of viral genome equivalents. The accuracy of the method has been confirmed by examining cervical scrapings of 44 patients.

[Cystic microglandular hyperplasia of the cervix uteri. Presentation of 2 clinical cases]. / Iperplasia microghiandolare cistica della portio. Esposizione di due casi clinici.

Two cases of cystic microglandular hyperplasia of the cervix, one with exocervical and the other with endocervical site are reported. These clinical cases were presented because of the rarity of this type of lesion and because of the difficulty of differentiating them from a well-differentiated cervical adenocarcinoma; noteworthy is the lack of a progestinic climate in the two patients, a situation that is considered highly predisposing.

[Ultrasonic aspects and clinical significance of the amniotic band syndrome]. / Aspetto ecografico e significato clinico della sindrome da banda amniotica.

The Authors report one case of amniotic band syndrome identified in the second trimester of pregnancy. Amniotic band syndrome appears to be sufficiently common. The spectrum of possible malformations suggests caution in the evaluation of such findings.

[Total parenteral nutrition in cancer patients]. / La nutrizione parenterale totale nel paziente neoplastico.

The authors analyse the results obtained in a study of 28 cancer patients managed with total parenteral nutrition (TPN) for a period variant from 5 to 19 days. The results fully justify the usefulness of the TPN in cancer patients before the treatment against the cancer.

[Variations of P50 during hemodilution in critical patients]. / Variazioni della P50 in corso di emodiluizione nei pazienti critici.

The Authors analyse the problem about O2 transportation throughout the tissues and report the P50 values based upon two homogenous groups of shocked patients; the first polytransfused, the second hemodilutioned. An increased P50 among hemodilutioned patients appears to be significant.