RESUMO
AIM: To assess the role of a severity score based on chest radiography (CXR) in predicting the risk of adverse outcomes in coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Of the patients who presented to L. Sacco Hospital (Milan, Italy) between 21 February and 31 March 2020, patients with a laboratory confirmation of COVID-19 who also underwent a CXR were included in the study. To quantify the extent of lung involvement, each CXR image was given a score (Milan score), ranging from 0 to 24, depending on the presence of reticular pattern and/or ground-glass opacities and/or extensive consolidations in each of the 12 areas in which the lungs were divided. The score was calculated by an expert radiologist, blinded to laboratory tests. The ability of the Milan score to predict hospital admission and mortality, after adjusting for some variables (age; gender; comorbidities; time between symptoms onset and admission), using univariate and multivariate statistical analysis was investigated retrospectively. RESULTS: Among the 554 patients, 115 of which (21%) had a negative CXR, the in-hospital mortality was 16% (90/554). At univariate analysis, age, gender, and comorbidities were significant predictors of mortality and hospital admission. At multivariate analysis, adjusting for age and gender, the Milan score was an independent predictor of mortality and hospitalisation. In particular, patients with a Milan score ≥ 9 had a mortality risk five-times higher than those with a lower score. Other independent predictors of mortality were gender and age. CONCLUSIONS: The CXR Milan score was an independent predictive factor of both in-hospital mortality and hospital admission.
Assuntos
COVID-19/diagnóstico por imagem , COVID-19/epidemiologia , Mortalidade Hospitalar , Radiografia Torácica/métodos , Fatores Etários , Idoso , Feminino , Humanos , Itália/epidemiologia , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores SexuaisRESUMO
Sublingual immunotherapy with monomeric carbamylated allergoid (LAIS) is an effective and well tolerated treatment of respiratory allergy. The aim of the present study was to correlate the efficacy of two maintenance doses (1000 AU vs 3000 AU) of LAIS with the immunological modulation of allergen-driven Th1, Th2 and T regulatory cytokines produced in vitro by PBMCs, in patients suffering from mite allergic rhinitis. Forty-eight consecutive patients with mite allergic rhinitis were recruited. Patients were randomly assigned to group A (n=24) or group B (n=24), respectively receiving 1000 AU or 3000 AU weekly during one-year maintenance phase. Each patient was evaluated for rhinitis severity (ARIA protocol), and for drug consumption at the time of the inclusion and after 6 and 12 months of treatment. Patients were also asked to report the perceived severity of the disease and the tolerability of the treatment in a visual analogical scale (VAS). Before and at the end of the treatment allergen-driven release of cytokines by PBMCs in vitro was measured. After 1-year treatment, a statistically significant reduction of all clinical parameters was observed in all patients, associated with reduction of IL-4 and increase of INF-γ secreted in vitro by mite-challenged PBMCs. Notably, the group treated with the higher dose showed significantly better clinical and immunological results. The efficacy of LAIS is correlated to the immune modulation in a clear dose-dependent effect.
Assuntos
Antígenos de Dermatophagoides/administração & dosagem , Dessensibilização Imunológica/métodos , Extratos Vegetais/administração & dosagem , Pyroglyphidae/imunologia , Rinite Alérgica Perene/terapia , Administração Sublingual , Adulto , Alergoides , Animais , Antígenos de Dermatophagoides/efeitos adversos , Células Cultivadas , Distribuição de Qui-Quadrado , Citocinas/metabolismo , Dessensibilização Imunológica/efeitos adversos , Relação Dose-Resposta Imunológica , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Testes Intradérmicos , Itália , Extratos Vegetais/efeitos adversos , Estudos Prospectivos , Rinite Alérgica , Rinite Alérgica Perene/diagnóstico , Rinite Alérgica Perene/imunologia , Índice de Gravidade de Doença , Linfócitos T Reguladores/imunologia , Células Th1/imunologia , Células Th2/imunologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Evidence from epidemiological and clinical studies suggests a possible correlation between serum antioxidant levels and cardiovascular disease risk. High plasma concentrations of lycopene have been associated with reduced prevalence of cardiovascular disease. The aim of this study is to compare plasma concentrations of lycopene in subjects with or without ultrasonic evidence of asymptomatic carotid atherosclerosis. One hundred and twenty subjects underwent physical examination, ultrasonic measurement of common carotid artery intima-media thickness and serum profile analysis. Logistic regression methods and analysis of variance were used to determine whether differences existed between participants with or without evidence of carotid atherosclerosis. Of the 120 participants, 58 exhibited evidence of carotid atherosclerosis. Participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly higher serum concentrations of total cholesterol, LDL-cholesterol and triglycerides. In contrast, participants with ultrasonic evidence of carotid atherosclerosis exhibited significantly lower plasma concentrations of lycopene. These data suggest that higher serum levels of lycopene may play a protective role versus cardiovascular diseases, in particular carotid atherosclerosis.
Assuntos
Carotenoides/sangue , Doenças das Artérias Carótidas/sangue , LDL-Colesterol/sangue , Triglicerídeos/sangue , Adulto , Idoso , Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Feminino , Humanos , Licopeno , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
Ultrasoundelastography (USE) is a new imaging technique that is performed with a normal ultrasound transducer. It provides improved characterization of a tissue or nodule based on the latter's elasticity and stiffness. The aim of the present, prospective study was to assess the validity of USE in characterizing thyroid nodules. USE patterns were analyzed in light of nodule cytology (British Thyroid Association classification) to determine whether these patterns can be used to decide whether or not fine-needle aspiration cytology (FNAC) is indicated. We examined a consecutive series of 617 thyroid nodules in patients referred for the first time to the Endocrinology Unit of Atri Hospital (Atri, [TE]). Patients underwent ultrasonographic and USE examinations of their thyroid nodules, which were then subjected to FNAC. All nodules with Thy 1 cytology were excluded, leaving 567 nodules for analysis. USE findings were classified on the basis of the degree and distribution of elasticity within the lesion: four patterns were identified (1, 2, 3a, 3b, or 4).None of the nodules with Thy 4 cytology (malignant) had USE pattern 1 or 2; patterns 3 and 4 were associated with higher cytologic grades. In conclusion, USE provides additional information on thyroid nodules, which can be used with ultrasound features of the nodules, to decide whether FNAC is indicated. In fact, patterns 1 and 2 do not seem to be associated with Thy 4 cytology.
RESUMO
BACKGROUND: Hymenoptera venom immunotherapy (VIT) is a safe and effective approach to insect sting allergy. However, after discontinuation, relapses can occur in some patients, especially those with a high occupational risk, and they may need to prolong VIT indefinitely. In order to improve adherence, we propose extending the interval between injections of maintenance VIT (MVIT). OBJECTIVE: To evaluate the safety, efficacy, and patient acceptance of a 3-month interval between MVIT injections in a group of Hymenoptera-allergic patients who are occupationally exposed to insect stings. PATIENTS AND METHODS: We included 72 patients with severe systemic reactions to Hymenoptera stings. MVIT was administered for 4 years at intervals increasing up to 3 months and then continued for a further 2 years. Patients were informed of the risk of relapse after discontinuation and of the need for indefinite treatment at 3-month intervals. RESULTS: During the 3-month interval maintenance phase, only 235 local reactions (17.8%) were observed in 17 patients. Sixty patients experienced 125 field re-stings and only 1 experienced a systemic reaction with generalized urticaria. CONCLUSIONS: The study confirms that the conventional MVIT interval of 4 to 6 weeks can be extended to 3 months in most patients with no adverse events, while maintaining safety and efficacy, improving adherence, and guaranteeing safe continuation of professional activity.
Assuntos
Venenos de Abelha/administração & dosagem , Dessensibilização Imunológica/métodos , Hipersensibilidade/terapia , Mordeduras e Picadas de Insetos/terapia , Venenos de Vespas/administração & dosagem , Adolescente , Adulto , Idoso , Venenos de Abelha/imunologia , Dessensibilização Imunológica/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Venenos de Vespas/imunologiaRESUMO
Thyroid cysts and pseudocysts, or hemorrhagic cysts, are quite frequent thyroid pathologies. Surgical theraphy has always been the treatment of choice in this pathology, but percutaneous ethanol injection (PEI) is becoming still more common. PEI was originally used in the treatment of liver nodules and subsequently in solid, hyperfunctioning thyroid nodules, but today it is used exclusively in cysts. The aim of this study was to evaluate the efficacy of PEI in reducing thyroid cyst volume 12 and 84 months after treatment and to compare cost-benefit to that of surgical treatment. The study includes 110 consecutive patients, who all underwent PEI after cytological analysis had excluded the presence of neoplasia. All patients had refused surgical treatment. One patient died during the follow-up due to cerebral hemorrhage. Each patient received an average of 5.3 ± 2.7 PEI treatments. After 12 months, volume was reduced by 82.6% and after 84 months by 93.03%. Dysphonia occurred in 2 cases of which one resolved spontaneously and one received cortisone therapy. The cost of PEI treatment is considerably lower than the cost of surgical therapy (the cost saving in our patient population was about 200,000). PEI should therefore be preferred to surgical treatment due to its efficacy and lower cost.
RESUMO
PURPOSE: To analyse the spectrum of angiographic features in patients monolaterally or bilaterally affected by pseudoexfoliation syndrome (PES), with and without glaucoma, and to evaluate the sensibility and specificity of these features in the diagnosis of glaucoma. METHODS: Sixty-eight patients affected by PES and 20 healthy subjects underwent iris fluorescein angiography (IFA) and iris indocyanine green angiography (IICGA). Angiographic features analysed were hypoperfusion, microneovascularizations, and anastomotic vessels. RESULTS: There was no statistically significant difference among unaffected, unilaterally affected, and bilaterally affected eyes. Patients affected by PES glaucoma showed a statistically significant difference with respect to the other groups for most of the variables. The results of qualitative variables revealed a gradual increase of the vascular involvement in the different groups. Peripupillary tufts, stromal tufts, and radial arterioles showed the best sensibility and specificity values on IFA, whereas radial arterioles and plexuses showed the highest sensibility and specificity values on IICGA. Considering all the parameters, the results were not associated with large effects on the post-test probability of disease. The values of likelihood ratio indicated that none of the examined variables was sufficiently able to discriminate patients affected by PSE glaucoma from the overall group. CONCLUSIONS: Patients clinically affected only monolaterally by PES show microvascular changes, which are similar in both eyes. Glaucoma PES represents a more advanced stage of the disease, with more pronounced alterations, even though no typical microvascular pattern can be identified by iris angiography.
Assuntos
Corantes , Síndrome de Exfoliação/diagnóstico , Angiofluoresceinografia/métodos , Verde de Indocianina , Iris/irrigação sanguínea , Idoso , Diagnóstico Diferencial , Síndrome de Exfoliação/patologia , Feminino , Glaucoma/patologia , Humanos , Iris/patologia , Masculino , Pessoa de Meia-Idade , Estatística como AssuntoRESUMO
Corynebacterium aquaticum, an environmental organism associated with fresh water, has very seldom proved to be a cause of infection, although it has increasingly been isolated from clinical specimens. This report describes an unusual case of bacteremia occurring in an HIV-infected patient, complicated by septic shock and secondary to an epididimo-orchitis. Combination therapy of levofloxacin and metronidazole was used successfully.
Assuntos
Bacteriemia/etiologia , Balneologia , Infecções por Corynebacterium/etiologia , Infecções por HIV/complicações , Choque Séptico/etiologia , Adulto , Humanos , Masculino , Fatores de RiscoRESUMO
The influence of different treatment schedules of sublingual immunotherapy (SLIT) in activating IL-10-producing T-cells, crucial in inducing allergen-specific tolerance, is not completely understood. The present work was designed to evaluate allergen driven interleukin release by mononuclear cells in the early phase of SLIT, after application of different induction schemes. Twenty mite-allergic patients were enrolled, 10 (group A) treated with a traditional 98 day induction scheme and 10 (group B) with a 16 day scheme with monomeric allergoid vaccine. At the end of the induction phase, the cumulative doses taken by group A and group B patients were equivalent to 50.5 and 50.3 microg of mite group 1 allergens, respectively. The release of Th1-, Th2- and Treg-related interleukins was assessed in culture supernatants of 5 microg/ml Der-p1-stimulated mononuclear cells, isolated before and after the induction phases. No relevant treatment-related side effects were observed. Interleukin release was similar in the two groups at the enrolment. Non-stimulated and Der p 1 stimulated release of studied cytokines was similar in the two groups at enrolment. Der p 1 stimulation significantly increased IL-10 release (p<0.0002) after treatment in group B patients, and this effect was higher (p=0.05) compared to group A patients. Furthermore, at the end of SLIT induction TNF-alpha, IL-4 and IFN-gamma production were reduced in group B patients (p<0.05, p=0.062 and p=0.060, respectively). The rapid induction scheme of sublingual immunotherapy induces an early immune suppression more effectively than the slower one. The rapid induction scheme should be the preferential way to start sublingual immunotherapy, particularly when monomeric allergoids are utilized.
Assuntos
Alérgenos/administração & dosagem , Citocinas/metabolismo , Dessensibilização Imunológica , Ácaros/imunologia , Administração Sublingual , Animais , HumanosRESUMO
Quilty effect (QE) is a frequent, yet enigmatic feature of cardiac allograft, since it is apparently devoid of clinical significance, though its association with acute (A) rejection (R) is strongly suspected. It was observed in 126/379 biopsies from 22 patients during the first posttransplant year. Most grade (G)2R biopsies displayed a concomitant QE. The following features typical of QE were identified: (a) focal angiogenesis and lymphangiogenesis associated with bFGF, VEGF-C and VEGF-A expression, (b) marked infiltrate of CD4(+)T and CD20(+)B followed by CD8(+)T lymphocytes arranged around PNAd(+)HEV-like vessels. Most QE appear as distinct B-T-cell-specific areas with lymphoid follicles sometimes endowed with germinal center-like structures containing VCAM-1(+)CD21(+)FDC and CD68(+)macrophages, which frequently expressed CXCL13. These cells were also found in mantle-like zones, where small lymphocytes expressed CXCR5, otherwise in the whole area of not clustered lymphoid aggregates. CXCL13 was also expressed, in association with CD20(+)B lymphocyte recruitment, in G2R biopsies obtained from patients with recurrent AR. QE has features of a tertiary lymphoid tissue suggesting an attempt, by the heart allograft, to mount a local response to a persistent alloantigen stimulation resulting in aberrant CXCL13 production, as also occurs in recurrent AR. CXCL13-CXCR5 emerge as a common molecular pathway for QE and recurrent episodes of AR.
Assuntos
Quimiocinas CXC/metabolismo , Rejeição de Enxerto/patologia , Transplante de Coração/efeitos adversos , Linfangiogênese , Miocárdio/patologia , Receptores de Quimiocinas/metabolismo , Idoso , Proteínas Angiogênicas/análise , Biópsia , Movimento Celular , Quimiocina CXCL13 , Feminino , Rejeição de Enxerto/etiologia , Humanos , Linfócitos , Macrófagos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica , Receptores CXCR5 , RecidivaRESUMO
PURPOSE: To evaluate the refractive and aberrometric outcome of wavefront-guided photorefractive keratectomy (PRK) compared to standard PRK in myopic patients. METHODS: Fifty-six eyes of 56 patients were included in the study and were randomly divided into two groups. The study group consisted of 28 eyes with a mean spherical equivalent (SE) of -2.25+/-0.76 diopters (D) (range: -1.5 to -3.5 D) treated with wavefront-guided PRK using the Zywave ablation profile and the Bausch & Lomb Technolas 217z excimer laser (Zyoptix system) and the control group included 28 eyes with a SE of -2.35+/-1.01 D (range: -1.5 to -3.5 D) treated with standard PRK (PlanoScan ablation) using the same laser. A Zywave aberrometer was used to analyze and calculate the root-mean-square (RMS) of total high order aberrations (HOA) and Zernike coefficients of third and fourth order before and after (over a 6-month follow-up period) surgery in both groups. Preoperative and postoperative SE, un-corrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were evaluated in all cases. RESULTS: There was a high correlation between achieved and intended correction. The differences between the two treatment groups were not statistically significant for UCVA, BCVA, or SE cycloplegic refraction . Postoperatively the RMS value of high order aberrations was raised in both groups. At 6-month control, on average it increased by a factor of 1.17 in the Zyoptix PRK group and 1.54 in the PlanoScan PRK group (p=0.22). In the Zyoptix group there was a decrease of coma aberration, while in the PlanoScan group this third order aberration increased. The difference between postoperative and preoperative values between the two groups was statistically significant for coma aberration (p=0.013). No statistically significant difference was observed for spherical-like aberration between the two groups. In the study group eyes with a low amount of preoperative aberrations (HOA RMS lower than the median value; <0.28 microm) showed an increase of HOA RMS while eyes with RMS higher than 0.28 microm showed a decrease (p<0.05). CONCLUSIONS: Zyoptix wavefront-guided PRK is as safe and efficacious for the correction of myopia and myopic astigmatism as PlanoScan PRK. Moreover this technique induces a smaller increase of third order coma aberration compared to standard PRK. The use of Zyoptix wavefront-guided PRK is particularly indicated in eyes with higher preoperative RMS values.
Assuntos
Córnea/cirurgia , Miopia/cirurgia , Ceratectomia Fotorrefrativa/métodos , Adulto , Astigmatismo/fisiopatologia , Astigmatismo/cirurgia , Córnea/fisiopatologia , Topografia da Córnea , Seguimentos , Humanos , Lasers de Excimer , Miopia/fisiopatologia , Estudos Prospectivos , Acuidade Visual/fisiologiaRESUMO
PURPOSE: Cystatin C has been suggested as a simple method of estimating GFR more accurately than creatinine in children. We compared the diagnostic accuracy of cystatin C with serum creatinine and the Schwartz formula for estimating GFR in patients with UTMs. MATERIALS AND METHODS: We prospectively compared 72 patients with UTMs (20 days to 36 months old, 58 males and 14 females) with a group of 72 healthy controls (10 days to 48 months old, 53 males and 19 females). All patients underwent nuclear medicine clearance investigations with (99m)Tc DTPA. RESULTS: Serum concentration of cystatin C revealed a higher correlation with (99m)Tc DTPA (r = 0.62, p <0.001) than serum concentration of creatinine (r = 0.30, p <0.01) or Schwartz formula (r = 0.51, p <0.001). These results were more evident in patients with uropathy (19) with mild renal impairment. Agreement between methods was assessed using Bland Altman analysis. Mean differences between GFR calculated with (99m)Tc DTPA and cystatin C based GFR estimation or Schwartz formula were -2.6% +/- 46.7% and -73.4% +/- 53.6%, respectively. Diagnostic accuracy in identifying decreased GFR measured as AUC was always highest for cystatin C but hardly sufficient for the 3 variables. Cystatin C performed better in the 0 to 6-month-olds (0.70 +/- 0.08 for cystatin C, 0.58 +/- 0.07 for Schwartz estimate) and patients older than 12 months (0.82 +/- 0.09 for cystatin C, 0.65 +/- 0.11 for Schwartz estimate). CONCLUSIONS: Cystatin C proved to be a superior marker rate over serum creatinine in estimating glomerular filtration in children younger than 3 years with UTMs and mild renal impairment, thus, offering a more specific and practical measure for monitoring GFR.
Assuntos
Creatinina/sangue , Cistatinas/sangue , Taxa de Filtração Glomerular , Sistema Urinário/anormalidades , Sistema Urinário/fisiopatologia , Biomarcadores/sangue , Pré-Escolar , Cistatina C , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Triflusal is an antiplatelet drug related to aspirin, with different pharmacological properties and a lower haemorrhagic risk. We aimed at comparing their effects on platelet and endothelial activation in type 2 diabetes mellitus (T2DM). In a randomized, double-blind, parallel group study, we compared the effects of three daily regimens (300, 600, and 900 mg) of triflusal, and aspirin (100mg/day) on urinary 11-dehydro-thromboxane (TX)B(2), index of in vivo platelet activation, ex vivo platelet function using the analyzer PFA-100, plasma von Willebrand factor (vWF), P-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and serum nitrite and nitrate (NO(2)(-)+NO(3)(-)) in 60 T2DM patients. Triflusal induced a dose-dependent reduction in 11-dehydro-TXB(2) and a prolongation of closure time in the presence of collagen plus epinephrine (Coll/Epi-CT). The effects of the highest triflusal dose were not different from those of aspirin. The closure time in the presence of collagen plus ADP (Coll/ADP-CT), ICAM-1, VCAM-1, and NO(2)(-)+NO(3)(-) were not modified either by triflusal or aspirin. Plasma P-selectin and vWF were reduced by triflusal but not by aspirin. In T2DM triflusal causes a profound inhibition of platelet TXA(2) biosynthesis in vivo, acting on different targets involved in the platelet-endothelial cell interactions.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Agregação Plaquetária/uso terapêutico , Salicilatos/uso terapêutico , Tromboxano B2/análogos & derivados , Adulto , Idoso , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Biomarcadores/sangue , Biomarcadores/urina , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Selectina-P/efeitos dos fármacos , Ativação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/administração & dosagem , Radioimunoensaio , Estudos Retrospectivos , Salicilatos/administração & dosagem , Tromboxano B2/antagonistas & inibidores , Tromboxano B2/biossíntese , Tromboxano B2/urina , Fator de von Willebrand/efeitos dos fármacos , Fator de von Willebrand/metabolismoRESUMO
BACKGROUND: Quality of Life (QoL) measurements are more responsive to clinically significant changes that are not evaluated by conventional clinical measures. OBJECTIVE: The objective of this study is to examine the relationship between bronchial hyperresponsiveness (BHR) and QoL in asthmatic patients. PATIENTS AND METHODS: 394 patients underwent clinical follow-up, pulmonary function tests and the methacholine challenge test (MCHt), and completed the Asthma Quality of Life Questionnaire (AQLQ). RESULTS: 200 patients had a positive MCHt and in 194 it was negative. For all 32 items, asthmatic patients had a median value of 4.7 (4.2-5.9) compared to 5.6 (4.7-6.3) in patients with negative MCHt (p < 0.01). For physical activities, patients with positive MCHt showed a median value of 5.0 (4.5-6.0) compared to 5.7 (4.8-6.3) in patients with negative MCHt (p < 0.05). Median scores of 12 items of symptoms and 5 items of emotions were significantly lower in patients with positive MCHt [4.5 (3.7-5.8) and 5.1 (4.2-6.1)] than in patients with negative MCHt [5.5 (4.4-6.1) and 6.3 (5.2-6.9), respectively, (p < 0.01)]. For items of environmental stimuli the median score was 4.7 (3.7-5.9) in patients with positive MCHt, being significantly lower than in patients with negative MCHt [5.4 (4.2-6.4), p < 0.05]. Patients with positive MCHt had lower values of QoL than patients with negative MCHt. CONCLUSIONS: QoL changes may be more sensitive than evaluation of BHR. The measurement of Qol may be important because it enables us to characterize patients who could be candidates eventually to a pharmacological treatment for BHR because they have an impaired QoL.
Assuntos
Asma/fisiopatologia , Hiper-Reatividade Brônquica/fisiopatologia , Qualidade de Vida , Adolescente , Adulto , Feminino , Humanos , Masculino , Espirometria , Capacidade VitalRESUMO
BACKGROUND: A relationship between Helicobacter pylori infection and dyspeptic symptoms has not yet been demonstrated. AIM: To evaluate any possible difference in symptom score between dyspeptic patients with and without H. pylori infection who have normal upper gastrointestinal endoscopy and no other appreciable gastrointestinal or systemic disease. PATIENTS: A series of consecutive patients affected by upper abdominal disturbances completed a symptoms questionnaire before undergoing upper gastrointestinal endoscopy with a rapid urease test to detect H. pylori infection. Patients with normal upper gastrointestinal endoscopy and abdominal ultrasound were included in the study. The symptoms assessed were burping and belching, bloating, odynophagia, dysphagia, postprandial fullness, heartburn, early satiety, nausea, vomiting, regurgitation, sour taste in mouth, epigastric pain at fasting, epigastric pain postprandial, epigastric pain nocturnal, and pain in right hypocondrium and were scored in terms of intensity and frequency on a scale from 0 to 4. RESULTS: The total number of patients who met the inclusion criteria was 263 out of 1187 examined. A total of 113 H. pylori-positive and 150 H. pylori-negative patients were compared. Among the symptoms evaluated, belching and bloating and heartburn were present in more than 50% of patients of both groups. No statistical difference was found in terms of presence or absence of each symptom, and intensity or frequency between H. pylori-positive and -negative patients. CONCLUSION: H. pylori infection does not seem to be associated with a specific symptom in patients with upper abdominal complaints and normal upper gastrointestinal endoscopy.
Assuntos
Dispepsia/microbiologia , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Adolescente , Adulto , Idoso , Endoscopia Gastrointestinal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de DoençaRESUMO
Atherosclerosis (AT) is a progressive disease characterized by the accumulation of lipids, fibrous materials, and mineral in the arteries. Although many generalized or systemic risk factors predispose to its development, AT affect various regions of the circulation preferentially and yields distinct clinical manifestations depending on the particular circulatory bed affected. The progression of AT is currently believed to involve the interaction of endothelium, monocytes, and leukocytes, as well as the influences of cytokines, oxidized lipoproteins, hypertension, tobacco use, dyslipidemia, homocystinemia, and genetic determinants.
Assuntos
Arteriosclerose/imunologia , Arteriosclerose/patologia , Animais , Arteriosclerose/tratamento farmacológico , Humanos , Fatores de RiscoRESUMO
We performed a retrospective analysis of our experience with dual nucleoside regimens to look for predictors of long term benefit. The study evaluated a cohort of 68 HIV-infected patients treated at 3 Italian hospital-based facilities. The results were evaluated using univariate and multivariate statistical analysis. Fourty-three males and 25 females were treated for 22 +/- 14 months. Sixty three patients (92.6%) suffered no or low-grade side-effects. Thirty-four patients (50%) reached a viral load <400 copies/ml (undetectable). Viremia remained persistently undetectable in 9 cases (13.2%). Variable relapses of viremia were seen in 13 patients (19.1%) even though their therapys were not modified. Eight patients (11.8%) showed relapsing viremias persistently around or below 10,000 copies/ml. All patients reaching undetectable viremia but one showed increasing or stable CD4+ cell counts. Factors predicting favourable response were: pre-treatment CD4+ T-cells >150/microl, pre-treatment viremia <50,000 copies/ml, pre-treatment lymphocytes >1,500/microl, and no previous exposure to NRTI. Total lymphocyte counts and CD4+ T-cells showed a significant correlation. Dual NRTI regimens may be still considered for patients unable to tolerate HAART regimens and presenting with favourable predictors of response.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Adulto , Idoso , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/imunologia , Distribuição de Qui-Quadrado , Estudos de Coortes , Intervalos de Confiança , Quimioterapia Combinada , Feminino , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/farmacologia , Fatores de Tempo , Carga Viral/estatística & dados numéricosRESUMO
During hemodialysis (HD), circulating blood cells can be activated and also engage in dynamic interplay. These phenomena may be important factors behind dialysis membrane bio(in)compatibility. In the present prospective cross-over study, we have used flow cytometry to evaluate the influence of different dialysis membranes on the activation of circulating blood cells (leukocytes, platelets) and their dynamic interactions (formation of circulating platelet-leukocyte and platelet-erythrocyte aggregates) during in vivo HD. Each patient (n = 10) was treated with dialyzers containing membranes of cellulose diacetate, polysulfone and ethylenevinylalcohol (EVAL) in a randomized order. Upregulation of adhesion receptor expression (CD15s, CD11b/CD18) occurred mainly with the cellulosic membrane, though an increase in CD11b/CD18 circulating on neutrophils was also found with both synthetic membranes. Circulating activated platelets (P-selectin/CD63-positive platelets) increased during HD sessions with cellulose diacetate and polysulfone. An increased formation of platelet-neutrophil aggregates was found at 15 and 30 min during dialysis with cellulose diacetate and polysulfone but not with EVAL. Platelet-erythrocyte aggregates also increased with cellulose diacetate and at 15 min with polysulfone as well. Generally in concomitance with the increase in platelet-neutrophil coaggregates, there was an increased hydrogen peroxide production by neutrophils. The results of this study indicate that cellular mechanisms can be activated during HD largely depending on the membrane material, EVAL causing less reactivity than the other two membranes. It appears that each dialysis membrane has multiple and different characteristics that may contribute to interactions with blood components. Our results also indicate that derivatizing cellulose (cellulose diacetate) may be a useful way to improve the biocompatibility of the cellulose polymer and that there may be great variability in the biocompatibility profile of synthetic membranes, dialysis with polysulfone being in general associated with a higher degree of cell activation than EVAL membrane.
Assuntos
Álcoois/farmacologia , Materiais Biocompatíveis/farmacologia , Comunicação Celular/efeitos dos fármacos , Celulose/análogos & derivados , Celulose/farmacologia , Etilenos/farmacologia , Falência Renal Crônica/terapia , Ativação Linfocitária/efeitos dos fármacos , Membranas Artificiais , Ativação Plaquetária/efeitos dos fármacos , Polímeros/farmacologia , Diálise Renal , Sulfonas/farmacologia , Compostos de Vinila/farmacologia , Idoso , Comunicação Celular/fisiologia , Estudos Cross-Over , Feminino , Humanos , Falência Renal Crônica/fisiopatologia , Ativação Linfocitária/fisiologia , Masculino , Pessoa de Meia-Idade , Ativação Plaquetária/fisiologia , Estudos ProspectivosRESUMO
We describe the 8-years follow-up of 80 patients affected by idiopathic, L-dopa-responsive Parkinson's disease. All patients were evaluated at baseline and during the follow-up with visual evoked potential, P300 event related potentials and polysomnography. The patients and their relatives compiled sleep and hallucination questionnaires. Statistical analysis was performed to evaluate if visual abnormalities, abnormal P300 recordings or sleep disturbances were linked to the development and hallucinations. Our results show that abnormal vision and abnormal P300 did not correlate with the incidence of hallucinations. However, the presence of REM sleep behavioral disorder (RBD) was significantly related to the development of hallucinations,independently of age, gender or duration of disease but dependent on the amount of dopaminoagonist treatment.
Assuntos
Agonistas de Dopamina/efeitos adversos , Alucinações/epidemiologia , Doença de Parkinson/fisiopatologia , Transtorno do Comportamento do Sono REM/epidemiologia , Fatores Etários , Agonistas de Dopamina/administração & dosagem , Potenciais Evocados Visuais , Seguimentos , Alucinações/etiologia , Humanos , Estimulação Luminosa , Polissonografia , Transtorno do Comportamento do Sono REM/etiologia , Fatores Sexuais , Inquéritos e Questionários , Transtornos da Visão/fisiopatologiaRESUMO
Cysteinyl leukotrienes (Cys-LTs) are mediators released in asthma and are both direct bronchoconstrictors and proinflammatory substances that mediated several steps in the pathophysiology of chronic asthma, including inflammatory cells recruitment, vascular leakage, and possibly airway remodelling. Available evidence from clinical trials and real world experience derived from managing patients with asthma justifies a broader role for antiLTRAs in asthma management than that recommended in the National Asthma Education and Prevention Programm (NAEPP) and National Health Lung and Blood Institute (NHLBI) treatment guidelines. Leukotriene-receptor antagonist drugs (LTRAs) seem to be effective alternatives to inhaled corticosteroids (ICS) either as monotherapy or as adjunctive therapy that reduces the need for higher doses of ICS in patients with mild-to-moderate persistent asthma. LTRAs may be used as adjunctive therapy for al levels of disease severity because they are effective in combination with ICS during long-term maintenance therapy. The agents seem especially effective in preventing aspirin-induced asthma, exercise-induced asthma (EIA) and they may provide an additional advantage of reducing nasal congestion in patients with both asthma and rhinitis.