Influence of sex and gender on the management of late-stage knee osteoarthritis.

PURPOSE: The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA presentation, care, and outcomes after TKA. METHODS: The survey questions were elaborated by a multidisciplinary scientific board composed of 1 pain specialist, 4 orthopedic specialists, 2 physiatrists, and 1 expert in gender medicine. The survey included 5 demographic questions and 20 topic questions. Eligible physician respondents were those who treat patients during all phases of care (pain specialists, orthopedic specialists, and physiatrists). All survey responses were anonymized and handled via remote dispersed geographic participation. RESULTS: Fifty-six physicians (71% male) accepted the invitation to complete the survey. In general, healthcare professionals expressed that women presented worse symptomology, higher pain intensity, and lower pain tolerance and necessitated a different pharmacological approach compared to men. Pain and orthopedic specialists were more likely to indicate sex and gender differences in knee OA than physiatrists. Physicians expressed that the absence of sex and gender-specific instruments and indications is an important limitation on available studies. CONCLUSIONS: Healthcare professionals perceive multiple sex and gender-related differences in patients with knee OA, especially in the pre- and perioperative phases of TKA. Sex and gender bias sensitivity training for physicians can potentially improve the objectivity of care for knee OA among TKA candidates.

Epidemiology of pulmonary embolism in Apulia from analysis of current data.

BACKGROUND AND AIMS: Pulmonary embolism (PE) is a relatively common cardiovascular emergency: present evidence suggests that PE is the third most acute cardiovascular disease after cardiac ischemic syndromes and stroke. The aim of this study is to evaluate hospital admissions for PE in the Apulia Region of Italy in the period 2001-2007 through an analysis of the Apulia Region hospital patient discharge database. METHODS: Patients were selected on the basis of admissions between 01/01/2001 and 31/12/2007 with ICD-9-CM code of 415.11 (Iatrogenic pulmonary embolism and infarction) or 415.19 (Other pulmonary embolism and infarction) as principal or secondary diagnosis. RESULTS: The number of patients selected from the database was 4,303. The raw annual admission data shows an increasing trend from 13.9x100,000 residents in 2001 to 18.9 x 100,000 residents in 2007. The average patient age was 68.7 years and 59% were females and 41%. There were 470 deaths in hospital (10.9% of patients). CONCLUSIONS: PE is associated with much health care and a substantial economic burden, yet many PE and general venous thromboembolism (VTE) events are preventable. It remains the responsibility of individual hospitals to identify specific areas in which they can improve their VTE prophylaxis rates to obtain positive results from the reporting initiatives and incentive programs.

Feasibility and validation of telespirometry in general practice: The Italian "Alliance" study.

INTRODUCTION: At variance from office spirometry, telespirometry has not been tested as a tool for improving the ability of general practitioners (GPs) to manage chronic airway diseases. METHODS: After adequate training, 937 Italian GPs agreed to perform telespirometry in subjects attending their clinics who had risk factors, persistent respiratory symptoms, or a previous diagnosis of asthma or COPD. Each subject performed at least three forced expiratory manoeuvres using a turbine spirometer. Traces were sent by telephone to a Telespirometry Central Office, where they were interpreted by a pulmonary specialist, according to defined criteria. The result was sent in real time to the GP to assist the management of the patient. RESULTS: During 2 years, 20,757 telespirometries were performed, with a mean of 22.2+/-25.2 examinations for each GP. 70% of the tests met the criteria for good or partial co-operation, allowing spirometric abnormalities to be detected in more than 40% of the tracings. The rate of telespirometries that could not be evaluated at all was reasonably low (9.2%). For a subset of the telespirometries, a comparison between acceptability criteria for telespirometry and those recommended for laboratory (ATS) or office spirometry showed that the majority of telespirometries with good co-operation satisfied completely, or with minor deviations, the ATS and Office criteria. CONCLUSIONS: Telespirometry was well accepted by Italian GPs, who obtained acceptable screening traces in a large percentage of subjects. Therefore it might be considered a useful alternative to office spirometry in improving the management of chronic airway diseases by GPs.

Hospitalisation for COPD in Puglia: the role of hospital discharge database to estimate prevalence and incidence.

BACKGROUND AND AIM: Chronic Obstructive Pulmonary Disease (COPD), although largely preventable, is a great health burden in all the countries worldwide. Statistics of morbidity and mortality of COPD show the need for correct management of the disease. Chronic Obstructive Respiratory Diseases (DRG 88) are in 9th place for discharge in in-patient hospital admission. It is necessary to establish specific indicators which are efficacious and relevant for the patient, the doctor and the health manager. This study will analyse the information in respect of hospital admissions (Hospital discharge database) in Puglia for the period 2000-2005. METHODS: The analysis was carried out utilising the Puglia Region hospital patient discharge database, selecting those patients with admission for chronic respiratory disease as principal or secondary diagnosis. RESULTS: Chronic respiratory diseases are more frequent in males and in people over 45 years old with frequency increasing with age. Geographical distribution shows that there are greater rates of hospitalisation in big cities and in the neighbourhood of industrial areas. Although the trend over time is slight. A higher percentage of re-admission has been found for patients with COPD, and the interval between the two admissions occurs within one or two months; the diagnosis at the second admission is the same as for the first. 10.6% of discharge forms report one diagnosis, especially in patients older than 65 years of age. Little could be said about diagnostic procedures because these are not reported on the discharge form. CONCLUSION: Hospitalisation data confirms expectations regarding age and sex of patients. The high hospitalisation rates indicate that in-patients care still remains the only viable treatment for COPD and other chronic respiratory diseases. The high number of exacerbations reflect the absence of out-patients service or community care, and the same diagnosis in more than one episode shows the lack of efficiency of health services and disease management. This data is necessary to understand disease distribution and the modification of disease management in order to reduce health care costs, to increase efficacy in disease control and to limit repeated exacerbation and so to obtain the maximum benefit for the patients.

Multicenter randomized trial comparing meropenem (1.5 g daily) and imipenem/cilastatin (2 g daily) in the hospital treatment of community-acquired pneumonia.

An open, multicenter study with 144 patients, aged between 18 and 94 years, was performed to compare the efficacy and safety of meropenem with imipenem/cilastatin in the hospital treatment of community-acquired pneumonia. Patients were randomized to receive either intravenous meropenem (500 mg every 8 h) or intravenous imipenem/cilastatin (1,000 mg every 12 h). The primary end point was considered to be clinical efficacy and the secondary end points were bacteriological response and safety assessment. At the end of therapy, cure or improvement in signs and symptoms as a satisfactory clinical response was observed in 57 of 64 (89.1%) meropenem-treated patients and in 60 of 66 (90.9%) imipenem/cilastatin patients. The mean duration of treatment was 10 days for meropenem and 9.7 days for imipenem/cilastatin. In patients who were followed up for weeks 2-4, the response was satisfactory (100%) for both treatments. A satisfactory bacteriological response, defined as either presumed or confirmed eradication of all pathogens, was found in eight patients who had received meropenem and in 14 patients who had received imipenem/cilastatin. Response was considered satisfactory in 100% of the meropenem group and in 92.9% of the imipenem/cilastatin group and at follow-up, it was 100% for both treatments. Drug-related adverse events were reported in three (4.2%) meropenem-treated patients and in eight (11.0%) imipenem/cilastatin-treated patients. None of these events was classified as serious. The results of this study show that the clinical and bacteriological efficacy and tolerability of meropenem (500 mg every 8 h) are similar to that of imipenem/cilastatin (1,000 mg every 12 h) in the hospital treatment of community-acquired pneumonia.

[Gastric localization of sarcoidosis]. / Localizzazioni gastriche in corso di sarcoidosi.

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by an immunological disorder with accumulation of activated lymphocytes and macrophages in all the organs and apparatus. The intrathoracic lymphnodes and the lung remain the most common sites of such disease. The gastrointestinal sarcoidosis, particularly of the stomach, is very rare. The stomach may be the primitive or the secondary (systemic sarcoidosis) site of sarcoid granuloma. The endoscopic aspects of the gastric mucosa are variable: localized or diffused hyperemia, single or multiple ulcers, aspects of atrophic gastritis with easy bleeding during contact, rigid mucosa and so on. Generally asymptomatic, the disease may show symptoms as pain in the epigastrium, nausea, vomiting, haematemesis and so on. The wide range of gastric pathologies resembling sarcoidosis both on a histological level and on a clinic-endoscopical one (syphilis, histoplasmosis, Crohn's disease, stomach cancer) require an extremely accurate diagnosis above all for the setting out of the therapy with steroids which are the most appropriate drugs (prednisone). Three out of thirty-two patients observed for respiratory problems, already affected by cutaneous and pulmonary sarcoidosis, started suffering from gastric symptoms of different kind: pain in the epigastrium, haematemesis, weight loss, nausea and post-prandial vomiting. Gastroscopy and biopsy, with histopathologic examination of gastric mucosal specimens taken from the most suspicious sites, confirmed the diagnosis of sarcoidosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Thymostimulin administration modulates polymorph metabolic pathway in patients with chronic obstructive pulmonary disease.

Several studies outline the imbalance of phagocyte functions in chronic obstructive pulmonary disease (COPD). In this regard, here, we have assessed either monocyte- and polymorphonuclear cell (PMN)-mediated chemotactic, phagocytic and killing capacities or PMN-triggered metabolic pathway in a group of COPD patients before and at different times after thymostimulin administration. Before therapy, an increase of O2-generation and a decrease of myeloperoxidase release were found in these individuals when compared to controls. Moreover, a reduction of either PMN-mediated chemotaxis and killing or monocyte chemotactic capacities was observed. By contrast, no differences were seen in terms of beta-glucuronidase release, monocyte-mediated killing and PMN or monocyte phagocytic function. During a one-year monitoring following immunotherapy, O2- production and myeloperoxidase activity fell within normal values, while phagocyte functional capacities were unaffected by such a treatment. Furthermore, COPD subjects exhibited a significant improvement of their clinical status as assessed during a one-year followup. All together, these findings suggest a potential role for thymostimulin in the treatment of COPD patients.

Natural and antibody-dependent cellular cytotoxicity in patients with active sarcoidosis.

Lymphocyte surface markers, natural killer activity, antibody-dependent cellular cytotoxicity and lymphocyte binding to target cells were evaluated in a group of 16 subjects with active sarcoidosis. A reduction of E-RFC and a relative increase of EA-RFC were observed. At the same time, ADCC activity was similar to that of normal controls, while NK cytotoxicity was significantly decreased. On the other hand, the percentage of conjugates between lymphocytes and target cells was lower than in controls. These observations account for a selective defect of NK activity, suggesting that the NK assay might be an useful tool to support the impairment of cellular immunity in active sarcoidosis.