Implementing an ICT-Based Polypharmacy Management Program in Italy.

Although there is evidence of a growing awareness of the problem, no official policy statements or regulatory guidelines on polypharmacy have been released up to date by Italian Health Authorities. Medication review, application of appropriateness criteria and computerized prescription support systems are all possible approaches in order to improve the quality of prescribing in older persons. More focused training courses on multimorbidity and polytherapy management are encouraged. Furthermore a multidisciplinary approach integrating different health care professionals (physicians, pharmacists, and nurses) may positively impact on reducing the sense of fear related to discontinue or substitute drugs prescribed by others; the fragmentation of therapy among different specialists; reducing costs; and improving adverse drug reaction detection and reporting. Aiming at achieving the individualized pharmacotherapy, a multidisciplinary approach starting with identification of patients and risk for drug-related problems, followed by medication review overtime and use of inappropriateness criteria, supported by computerized systems has been proposed.

Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review

BACKGROUND: Honey is recommended for non-specific acute paediatric cough by the Australian guidelines. Current available randomised clinical trials evaluated the effects of a single evening dose of honey, but multiple doses outcomes have never been studied. OBJECTIVES: To evaluate the effects of wildflower honey, given for three subsequent evenings, on non-specific acute paediatric cough, compared to dextromethorphan (DM) and levodropropizine (LDP), which are the most prescribed over-the-counter (OTC) antitussives in Italy. METHODS: 134 children suffering from non-specific acute cough were randomised to receive for three subsequent evenings a mixture of milk (90 ml) and wildflower honey (10 ml) or a dose of DM or LDP adjusted for the specific age. The effectiveness was evaluated by a cough questionnaire answered by parents. Primary end-point efficacy was therapeutic success. The latter was defined as a decrease in cough questionnaire score greater than 50% after treatment compared with baseline values. RESULTS: Three children were excluded from the study, as their parents did not complete the questionnaire. Therapeutic success was achieved by 80% in the honey and milk group and 87% in OTC medication group (p = 0.25). CONCLUSIONS: Milk and honey mixture seems to be at least as effective as DM or LDP in non-specific acute cough in children. These results are in line with previous studies, which reported the health effects of honey on paediatric cough, even if placebo effect cannot be totally excluded

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Gut barrier in health and disease: focus on childhood.

The gut barrier is a functional unit, organized as a multi-layer system, made up of two main components: a physical barrier surface, which prevents bacterial adhesion and regulates paracellular diffusion to the host tissues, and a deep functional barrier, that is able to discriminate between pathogens and commensal microorganisms, organizing the immune tolerance and the immune response to pathogens. Other mechanisms, such as gastric juice and pancreatic enzymes (which both have antibacterial properties) participate in the luminal integrity of the gut barrier. From the outer layer to the inner layer, the physical barrier is composed of gut microbiota (that competes with pathogens to gain space and energy resources, processes the molecules necessary to mucosal integrity and modulates the immunological activity of deep barrier), mucus (which separates the intraluminal content from more internal layers and contains antimicrobial products and secretory IgA), epithelial cells (which form a physical and immunological barrier) and the innate and adaptive immune cells forming the gut-associated lymphoid tissue (which is responsible for antigen sampling and immune responses). Disruption of the gut barrier has been associated with many gastrointestinal diseases, but also with extra-intestinal pathological condition, such as type 1 diabetes mellitus, allergic diseases or autism spectrum disorders. The maintenance of a healthy intestinal barrier is therefore of paramount importance in children, for both health and economic reasons. Many drugs or compounds used in the treatment of gastrointestinal disorders act through the restoration of a normal intestinal permeability. Several studies have highlighted the role of probiotics in the modulation and reduction of intestinal permeability, considering the strong influence of gut microbiota in the modulation of the function and structure of gut barrier, but also on the immune response of the host. To date, available weapons for the maintenance and repair of gut barrier are however few, even if promising. Considerable efforts, including both a better understanding of the gut barrier features and mechanisms in health and disease, and the development of new pharmacological approaches for the modulation of gut barrier components, are needed for the prevention and treatment of gastrointestinal and extraintestinal diseases associated with gut barrier impairment.

Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review.

BACKGROUND: Honey is recommended for non-specific acute paediatric cough by the Australian guidelines. Current available randomised clinical trials evaluated the effects of a single evening dose of honey, but multiple doses outcomes have never been studied. OBJECTIVES: To evaluate the effects of wildflower honey, given for three subsequent evenings, on non-specific acute paediatric cough, compared to dextromethorphan (DM) and levodropropizine (LDP), which are the most prescribed over-the-counter (OTC) antitussives in Italy. METHODS: 134 children suffering from non-specific acute cough were randomised to receive for three subsequent evenings a mixture of milk (90ml) and wildflower honey (10ml) or a dose of DM or LDP adjusted for the specific age. The effectiveness was evaluated by a cough questionnaire answered by parents. Primary end-point efficacy was therapeutic success. The latter was defined as a decrease in cough questionnaire score greater than 50% after treatment compared with baseline values. RESULTS: Three children were excluded from the study, as their parents did not complete the questionnaire. Therapeutic success was achieved by 80% in the honey and milk group and 87% in OTC medication group (p=0.25). CONCLUSIONS: Milk and honey mixture seems to be at least as effective as DM or LDP in non-specific acute cough in children. These results are in line with previous studies, which reported the health effects of honey on paediatric cough, even if placebo effect cannot be totally excluded.

Side effects of corticosteroid therapy in children with chronic idiopathic thrombocytopenic purpura.

In 29 symptomatic children of both sexes with chronic idiopathic thrombocytopenic purpura (CITP) with platelet counts < or = 30,000/mm3, of mean age 7.2 +/- 1.3 years, the side effects of long-term glucocorticoid therapy were evaluated. Patients were divided into three groups based on the different glucocorticoid protocols they were receiving. Baseline measurements (t0) of height (H) as standard deviation score (SDS), body mass index (BMI) as kg/m2 and bone mineral density (BMD) at the femoral neck (FBMD) and lumbar spine L2-L4 (LBMD) by a dual energy X-ray absorption technique, expressed as Z score, with follow-up measurements at 1 (t1) and 2 (t2) years were assessed. Group I patients (10 pts) treated with oral prednisone (2 mg/kg/die-for one month for 2 cycles) showed significantly different HSDS, BMI, FBMD and LBMD at t1 and t2 (P < 0.005) than other groups treated respectively with pulsed high doses of dexamethasone (24 mg/m2 over 4 days/months for 6 cycles) and methylprednisolone (9 mg/kg/die for 5 days for 3-4 months). These findings suggest that pulsed high doses of glucocorticoid lead to fewer side effects than oral prednisone therapy.

Impact of excess weight and estrogen receptor gene polymorphisms on clinical course of homozygous beta thalassemia.

In homozygous beta thalassemic patients we examined the role played by the interaction of ER gene polymorphisms with adverse environmental factors. A total of 108 homozygous beta thalassemic patients, 60 prepubertal mean age 9,5 +/- 3,7 years (27 M, 33 F) and 48 pubertal mean age 22,2 +/- 5,4 years (21 M, 27 F), regularly treated with red cell transfusion and iron chelation therapy were segregated on the basis of their XbaI and PvuII ER gene polymorphisms. Body mass index (BMI), lipidic pattern and blood pressure values were evaluated in each group. No significant differences were observed between patients segregated by their PvuII ER genotypes. Prepubertal and pubertal patients of both sexes lacking XbaI site showed BMI, HDL, LDL cholesterol significantly different than the other patients. In addition, triglyceride levels and blood pressure values were significantly higher in pubertal patients of both sexes lacking XbaI site than in other patients. ER XbaI polymorphism appear to influence nutritional factors, metabolic status and blood pressure and could be considered additional risk factors for later cardiac involvement in beta thalassemic patients.

[Indoor radon pollution in houses in the Apulian Region of Italy and evaluation of the probability of lung cancer in the population]. / Contaminazione da radon indoor nelle abitazioni pugliesi e valutazione della probabilità di insorgenza di tumore polmonare nella popolazione residente.

BACKGROUND: Radon-222 is a gaseous radioactive chemical which can be transformed into other radioactive chemicals, defined as "products of decay" or "radon's daughter". The modality of radon penetration into the buildings depends on the convection motion created in the ground, which suck it back, so causing the penetration. The principal effect on human health is the increase risk of lung cancer, in proportion to the concentration and the time people spend indoors with exposure to radon. OBJECTIVES: The study proposed to estimate the expected cases of radon-induced lung cancer in the population of Apulia due to contamination by indoor radon. METHODS: The study used the data obtained in a national survey made by ANPA (National Environmental Protection Agency) and ISS (High Health Institute), with the collaboration of the Regional Reference Centres for the Control of Environmental Radioactivity (CRR). In the Apulia Region 310 families (5000 nationwide) were involved, which were selected so as to constitute a representative sample both of the region and the country. Appropriate instruments for the measurement of mean concentrations of indoor radon (passive nuclear trace monitors were installed in the homes of the sample families in two different periods of year). We evaluated the variations of indoor radon concentration in the houses during spring-summer and autumn-winter periods, observing a predictable increase in the latter period. We assessed concentrations in relation to: 1. architectural features and location, 2. construction year, 3. building material, 4. presence of windows. RESULTS: We found higher contamination in the oldest non-cement buildings and on the lower floors. In Lecce and Castrì di Lecce we found a mean radon concentration higher than the national and the regional mean, which is equivalent to annual exposure of 0.54 and 0.46 WLM respectively. For these levels we estimated that the expected cases of radon-induced lung cancer will be 1.5 in Lecce and 1.3 in Castrì per 10,000 inhabitants. CONCLUSION: The results of our investigations confirm that indoor radon pollution is a significant problem as it is one of the main causes of lung cancer. Hence, precautionary measures to reduce as much as possible exposure to indoor radon are highly recommended.

Description of a multicompartmental model of the biodistribution of 111In-DTPA-D-Phe-1-octreotide in human.

The aim of this study was to use compartmental analysis as a theoretical tool to provide quantitative and unitary data for a more precise determination of 111In-OCT concentrations in a tumour site and various body organs. Five subjects (3 male and 2 female) with neoplasias were studied. Structural and parametric identification of the model was based on the plasma, urine, total body and ROI (soft tissue, spleen, kidney and tumour) activity values. The model was of the mammillary type with 5 compartments (blood, soft tissue, spleen, kidneys and urine) for the 4 patients with a negative scintiscan and 6 (blood, soft tissue, spleen, kidneys, urine and tumour) for the adenocarcinoma patient. Numerical constants were determined by running a best-fit procedure with the MINUIT minimisation program (CERN library) using a microVAX 3800 computer. The reliability of the models was also tested. 111In-OCT accumulates in the kidneys and spleen, from which it is slowly released into the blood. Elimination is via the urine at first rapidly, then more slowly. The maximum concentration in the tumour compartment is reached at 12-14 hours and remains almost constant.

[Care of small for gestational age infants: personal caseload]. / Assistenza al neonato piccolo per l'età gestionale: casistica personale.

The Guidelines for Perinatal Care define SGA or IUGR infants those with birthweight < 2500 g and below the tenth percentile for gestational age. In Brindisi's N.I.C.U. in the period from 1/07/1986 to 27/02/1992, 295 newborns were admitted with G.A. = 37.08 +/- 2.87 w (mean +/- s.d.), birthweight = 2013 +/- 505 g, length = 438 +/- 44 mm, head circumference = 307 +/- 31 mm. Among these 80.9% has been discharged in good conditions; 9.4% was discharged with some problems and 9.3% died. In hour Hospital the incidence of SGA at birth has been 1.83% in 1987, 2.13% in 1988, 2.1% in 1990 and 2.3% in 1991, in agreement with the literature's data. In the group of SGA infants, we have had 43.86% with symmetrical IUGR, 39.15% with asymmetrical and 16.98% with intermediate IUGR: In this study, besides, the Authors examine some of the main problems that affected the SGA newborns.

[Dentinal lesions caused by the use of endodontic posts]. / Lesioni dentinali causate dall'impiego di alcuni endoposts.

An endodontic treatment has been effected on 36 extracted teeth, using drills; certain endodontic posts presently on the market have been successively inserted inside 18 teeth: Flexipost (Essential Dental System); Parapost Plus (Whaledent); dentatus (Dentatus). The teeth have been sectionized and watched through a photomicroscope to check an eventual presence of dentinal damages.

[Comparative evaluation of the retentive capacity of endodontic posts]. / Valutazione comparativa delle capacità ritentive di alcuni perni endocanalari.

The retentive capacity of certain endodontic posts was assessed in terms of: pin design, pin diameter and cement employed. The following commercially products were examined: Flexipost (Essential Dental Systems), Parapost Plus (Whaledent) and Dentatus (Dentatus) posts; Phosphacap (Vivadent) and Bondalcap (Vivadent) cements.

[Visco-elastic properties of various composites for the front teeth]. / Studio delle caratteristiche visco-elastiche di alcuni compositi per anteriori.

The rupture load, elasticity modulus and viscosity coefficient of certain composite currently on sale for the reconstruction of front teeth were calculated experimentally. The products examined were: Prismafil (Caulk), Helioprogress (Vivadent), Heliosit (Vivadent), Silux (3M), Concise (3M), Command Ultrafine (Kerr), P30 (3M). The figures obtained relate to 3 different time periods after the preparation of samples.