ABSTRACT
This retrospective study was conducted on 193 patients treated in three Italian Psoriasis Units with the aim of evaluating the evolution of psoriasis severity and the safety of cyclosporin A (Sandimmun Neoral) in moderate to severe psoriasis, at the regimens usually employed in common clinical practice. Cyclosporin A (CyA) was administered for a mean period of 14 months, the mean number of treatment courses was 1.6 (range 1-4), and the mean dosage ranged from 1.5 to 3.1 mg/kg/die. Ninety percent of patients obtained complete therapeutic success or clinical remission, defined as complete clearance of lesions or clearance of lesions with residual minor pigmentations respectively, when treated with CyA in monotherapy. The mean Psoriasis Area and Severity Index (PASI) decreased from 23.31 before CyA administration to 5.64 at the end of treatment. The clinicians judgement on CyA tolerability was good/very good in 90 percent of cases. Adverse events occurred in 36 percent of patients, with hypertension being the most commonly reported (17.6 percent). The results of this study indicate that in the common clinical practice CyA in moderate to severe psoriasis is usually employed at low doses, resulting both safe and effective.
Subject(s)
Cyclosporine/therapeutic use , Immunosuppressive Agents/therapeutic use , Psoriasis/drug therapy , Adult , Aged , Costs and Cost Analysis , Cyclosporine/adverse effects , Female , Health Care Costs , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: RIGHT (Research for the Identification of the most effective and hIGhly accepted clinical guidelines for the cancer Treatment) is a project promoted by the Italian Association of Medical Oncology (AIOM) to measure the concordance between oncology guidelines and clinical practice. The goal of this pilot phase was to develop and test a reliable process to measure this concordance nationwide. MATERIALS AND METHODS: Twenty Italian centers participated to the survey. Breast cancer (BC) and colorectal cancer (CRC): guidelines issued by AIOM in 2003 were selected. A total of 29 indicators linked to the process of care were abstracted. Patients who had their first visit at the oncology center between February 2004 and June 2005, with a diagnosis of invasive BC (stage 1 or 2), colon cancer (stage 3), rectal cancer (stage T3-4 or N1-2) or advanced CRC were enclosed. RESULTS AND CONCLUSION: One hundred and sixty-one patients (80%) were analyzed. On average, 93% of BC and 80.3% of colorectal patients received recommended care. These first results indicate that the RIGHT system provides a valid measurement of oncology care to assess agreement with guidelines. A second larger phase of this nationwide monitoring program will enable results to be generalized.
Subject(s)
Medical Oncology/standards , Practice Guidelines as Topic , Professional Practice , Societies, Medical , Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Breast Neoplasms/therapy , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/surgery , Colorectal Neoplasms/therapy , Female , Humans , Italy , Male , Middle Aged , Pilot Projects , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Our objectives were to determine the prevalence of psychological distress in a large sample of Italian patients with psoriasis; to establish whether disease severity and psychological distress are associated; to identify the strategies employed to cope with psoriasis; to evaluate the coping strategies employed by dermatologists; and to identify potential predictors of psychological distress. DESIGN: Cross-sectional. SETTING: Thirty-nine Italian dermatology centres. SUBJECTS: One thousand five hundred and eighty (1580) patients with psoriasis. METHODS: Minor psychological distress was evaluated using the General Health Questionnaire-12 (GHQ-12) and major psychopathological distress using the Brief Symptom Inventory (BSI); coping strategies were evaluated using the Brief COPE questionnaire; disease severity was evaluated using the body surface area index. RESULTS: Patients were aged 44 +/- 13 years (mean +/- SD) and were mainly men (57%). Minor psychological distress was present in 46% of patients and major psychopathological distress in 11% of them. Both minor (54% vs. 40%, P < 0.0001) and major (17% vs. 7%, P < 0.0001) distress were more frequent in women than in men. The psychological status of women was worse than that of men independently from the extension of psoriasis. There was no association between the presence of distress and the treatment prescribed by dermatologists. Planning and active coping were the strategies most commonly employed by patients to cope with psoriasis, but there were between-gender differences. Most dermatologists employed a 'problem-orientated' attitude in caring for patients. CONCLUSIONS: (i) Psychological distress was relatively frequent in our patients with psoriasis; (ii) female gender was the most important predictive factor for psychological distress; (iii) there was no association between psoriasis severity and psychological distress; (iv) planning and active coping were the coping strategies most frequently employed by patients; and (v) most dermatologists employed a problem-orientated attitude in caring for patients.
Subject(s)
Adaptation, Psychological , Psoriasis/psychology , Stress, Psychological/etiology , Adolescent , Adult , Cross-Sectional Studies , Female , Humans , Italy/epidemiology , Logistic Models , Male , Middle Aged , Severity of Illness Index , Sex Factors , Stress, Psychological/epidemiology , Surveys and QuestionnairesABSTRACT
The alpha-2,3-sialyltransferase from Neisseria gonorrheae was overproduced in E. coli for exploitation of its substrate specificity and synthetic utility. Several potential acceptor substrates were synthesized in this study, including mono- and oligosaccharides, glycolipids, and glycopeptides and their sulfate derivatives. Some CMP-sialic acid derivatives with modification at the C-5 position were also prepared for evaluation as donor substrates. It was found that the enzyme exhibits a broader acceptor substrate specificity when compared to other sialyltransferases, though the donor specificity is quite limited. Application of the enzyme to the preparative synthesis of representative sialyl glycoconjugates has been demonstrated. On the basis of this work and the work of others, this enzyme is the most versatile and synthetically useful among all sialyltransferases known to date, especially for the synthesis of sulfate-containing glycoconjugates.
Subject(s)
Carbohydrates/chemical synthesis , Neisseria gonorrhoeae/enzymology , Sialyltransferases/metabolism , Carbohydrates/biosynthesis , Cytidine Monophosphate N-Acetylneuraminic Acid/analogs & derivatives , Cytidine Monophosphate N-Acetylneuraminic Acid/metabolism , N-Acetylneuraminic Acid/metabolism , Neisseria gonorrhoeae/genetics , Neisseria gonorrhoeae/metabolism , Sialyltransferases/biosynthesis , Sialyltransferases/genetics , beta-Galactoside alpha-2,3-SialyltransferaseABSTRACT
Os autores apresentam um caso de lipoma gigante de mesenterio, tratado com sucesso cirurgicamente, sem resseccao intestinal.Fazem levantamento bibliografico, no qual se percebe a raridade da patologia. Os lipomas, quando encontrados devem sempre ser ressecados cirurgicamente
Subject(s)
Child , Humans , Female , Intestinal Neoplasms , Lipoma , MesenteryABSTRACT
Os autores apresentam um caso de tuberculose intestinal, com lesao pulmonar associada e que fez, durante o tratamento medico-cirurgico, obstrucao intestinal e perfuracao em peritonio livre. A raridade do fato justifica a publicacao do trabalho
Subject(s)
Middle Aged , Humans , Male , Intestinal Obstruction , Intestinal Perforation , Tuberculosis, Gastrointestinal , Surgical Procedures, OperativeSubject(s)
Adolescent , Middle Aged , Humans , Male , Female , Meckel Diverticulum , Diverticulitis , Gastrointestinal Hemorrhage , Intestinal ObstructionSubject(s)
Adolescent , Middle Aged , Humans , Male , Female , Abdomen, Acute , Hematoma , Rectal Diseases , Diagnosis, DifferentialSubject(s)
Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Mediastinal Diseases , Stomach Volvulus , Surgical Procedures, OperativeABSTRACT
Os autores apresentam um caso de megaduodeno, de etiologia chagasica. Havia concomitancia de megaesofago e fistula colescisto-duodenal. A correcao deu-se por anastomose duodeno-jejunal latero-lateral, em dois planos de sutura, com excelente resultado
