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Background: Curing H. pylori infection remains challenging, and the use of most effective first-line therapy represents a therapeutic cornerstone. To monitor the efficacy of first-line therapies in Italy, we designed a systematic review with pooled- data analysis of data published in the last 15 years. Methods: The search was focused on standard regimens and adult patients. Studies that included modified therapy regimens, pediatric patients, case series with less than 5 patients, and those in language other than English were excluded. Results: A total of 40 studies, with 74 therapeutic arms and 13,539 patients were evaluated. Among the 14-day triple therapies, the combination with proton pump inhibitor (PPI), clarithromycin and amoxicillin achieved the highest (77.9%) success rate, whilst the lowest success rate (62.7%) was observed following the 14-day PPI, clarithromycin and tinidazole regimen. The overall efficacy of triple therapies significantly decreased from 75.7% to 72.1% in the last decade. Sequential (88.3% on 3431 patients), concomitant (88.8% on 376 patients), and the bismuth-based quadruple therapy with three-in-one capsule, containing bismuth subcitrate potassium (140 mg), metronidazole (125 mg), tetracycline (125 mg) (90.4% on 999 patients) achieved similarly high eradication rates, but data on concomitant are still limited. The bismuth-based was associated with the higher (38.7%) incidence of side-effects. Conclusions: Data found that all triple therapies, irrespective of drug combination and therapy duration, should be abandoned in Italy due to their unacceptable low success rates. Monitoring the efficacy of standard first-line therapies in other countries could be clinically useful for both patients and clinicians.
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Infecciones por Helicobacter , Helicobacter pylori , Adulto , Amoxicilina/uso terapéutico , Antibacterianos/efectos adversos , Bismuto/uso terapéutico , Niño , Claritromicina/farmacología , Claritromicina/uso terapéutico , Análisis de Datos , Quimioterapia Combinada , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , Inhibidores de la Bomba de Protones/farmacología , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
The COVID-19 pandemic has affected sleep health. Students' sleep health is essential for the performance of neuro-cognitive processes, as well as mental and physical balance. We assume the COVID19 pandemic has modified some sleep habits by prompting environmental and social interaction changes. In this study we surveyed a sample of 300 Brazilian students, with internet access, resident in the Federal District. They completed a questionnaire over two weeks in March 2020, i.e. the second and third week of the social isolation policy enacted in the Federal District due to COVID19. Valid responses from students aged18-24 years were analyzed. The sample was mostly female; 76,3% reported somnolence during the day, 70,2% anxiety and 87,8% worse sleep associated with stress and/or anxiety, which indicated the variables for an educational health intervention design in this context. Further, 53.2% made no effort to avoid screens before sleeping; 73.9% to avoid using the bed for work or watching television and 83.1% to avoid consuming heavy foods before sleeping. We then created an Instagram profile, @comodormimos, which focused on the main sleep issues revealed by participants in the survey. Posts on the profile were based on sleep-related subjects: sleep processes, sleep hygiene practices for students; sleep stages, function and regulation; and sleep-wake circadian rhythms. The profile gained 307 followers, mostly women (61,7%), 18-24 years old. We concluded that the Covid-10 pandemic period increased harmful sleep behavior in students. Further studies are needed to understand the impact of the COVID-19 pandemic on student sleep health.
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Helicobacter pylori (H. pylori) eradication fails in a definite amount of patients despite one or more therapeutic attempts. Curing these patients is progressively more difficult, due to development of antibiotic resistance. Current guidelines suggest testing antibiotic susceptibility in H. pylori isolates following two therapeutic attempts. AIM: to evaluate the development of antibiotic resistance, MIC values trends and therapeutic outcomes in patients who failed at least one H. pylori eradication therapy. METHODS: consecutive patients, referred to perform upper gastrointestinal endoscopy (UGIE) to our Unit from January 2009 to January 2019 following at least one therapeutic attempt were considered. Bacterial resistance towards clarithromycin, metronidazole and levofloxacin was tested. Patients received either a susceptibility-guided therapy or Pylera®. RESULTS: a total of 1223 patients were H. pylori positive, and antibiotic susceptibility was available for 1037. The rate of antibiotic resistance and MIC values significantly increased paralleling the number of previous therapeutic attempts. Eradication rates of antibiogram-tailored therapies remained stable, except for the sequential therapy if used as a third line. As a rescue treatment, the Pylera® therapy achieved cure rates comparable to those of the other culture-guided therapies. CONCLUSIONS: A significant increase in the secondary resistance towards the three tested antibiotics was observed, both as rate and MIC values, in correlation with the number of therapy failures. These findings should be considered when administering an empirical second-line therapy. Pylera® therapy eradication rates are comparable to culture-tailored therapies.
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OBJECTIVES: The Italian National Institute of Health Quality of Life - Core Evaluation Form (ISSQoL-CEF) is a specific questionnaire measuring health-related quality of life for human immunodeficiency virus-infected people in the era of highly active antiretroviral therapy. The main goal of this study was to examine the construct validity of this questionnaire by confirmation of its hypothesized dimensional structure. METHODS: Baseline quality of life data from four clinical studies were collected and a confirmatory factor analysis of the ISSQoL-CEF items was carried out. Both first-order and second-order factor models were tested: Model 1 with nine correlated first-order factors; Model 2 with three correlated second-order factors (Physical, Mental, and Social Health); Model 3 with two correlated second-order factors (Physical and Mental/Social Health); Model 4 with only one second-order factor (General Health). RESULTS: A total of 261 patients were surveyed. Model 1 had a good fit to the data. Model 2 had an acceptable fit to the data and it was the best of all hierarchical models. However, Model 2 fitted the data worse than Model 1. CONCLUSIONS: The findings of in this study, consistent with the results of previous study, pointed out the construct validity of the ISSQoL-CEF.
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A cross-sectional study was performed to evaluate classical risk factors for cardiovascular diseases and subclinical atherosclerosis by carotid ultrasonography in HIV-positive subjects, naïve or treated with antiretroviral agents. A total of 66 patients were enrolled into the study: 21 subjects were naïve to all antiretroviral agents (group A) and 45 patients were treated with antiretroviral therapy for >or=36 months (group B). The prevalence of carotid plaques was significantly higher in group B than in group A (44.7% versus 0%; P = 0.014). In group B, patients with high 10-year risk of coronary heart disease showed a significantly higher intima-media thickness and prevalence of carotid lesions than those with low risk. Moreover, carotid lesions were structurally comparable to classical atherosclerotique plaques observed in the general population, with iso-hyperechonegic aspects and irregular surfaces. The prevalence of carotid atherosclerosis in experienced patients is higher than in those naïve to highly active antiretroviral therapy and seems mostly associated with a longer duration of HIV infection, more severe lipid metabolism alterations, presence of lipodystrophy syndrome and a more elevated 10-year risk of cardiovascular diseases.
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Antirretrovirales/administración & dosificación , Enfermedades de las Arterias Carótidas/epidemiología , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Adulto , Antirretrovirales/efectos adversos , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , UltrasonografíaRESUMEN
Although being a rare occurrence, brain cryptococcoma may represent an emerging issue, because of its relationship with a broadening range of risk factors, including malignancies, neutropenia, end-organ failure, bone marrow and solid-organ transplantation, and multiple underlying causes of primary-secondary immunodeficiency. A cerebral cryptococcoma in a chronic nephropathic HIV-negative subject with homocystinuria, completely cured with neurosurgery and voriconazole after fluconazole failure, is described.
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Antifúngicos/uso terapéutico , Absceso Encefálico/tratamiento farmacológico , Cryptococcus neoformans/efectos de los fármacos , Meningitis Criptocócica/tratamiento farmacológico , Pirimidinas/uso terapéutico , Triazoles/uso terapéutico , Absceso Encefálico/microbiología , Enfermedad Crónica , Fluconazol/uso terapéutico , Seronegatividad para VIH , Humanos , Masculino , Meningitis Criptocócica/microbiología , Persona de Mediana Edad , Insuficiencia Renal/complicaciones , Insuficiencia Renal/tratamiento farmacológico , Factores de Tiempo , Insuficiencia del Tratamiento , Resultado del Tratamiento , VoriconazolRESUMEN
Myotonic dystrophy (DM) is a dominantly inherited neuromuscular disease, highly variable and multisystemic, which is caused by the expansion of a CTG repeat located in the 3' untranslated region of the DMPK gene. Normal alleles show a copy number of 5-37 repeats on normal chromosomes, amplified to 50-3000 copies on DM chromosomes. The trinucleotide repeat shows a trimodal allele distribution in the majority of the examined population. The first class includes alleles carrying (CTG)5, the second class, alleles in the range 7-18 repeats, and the third class, alleles (CTG) > or =19. The frequency of this third class is directly related to the prevalence of DM in different populations, suggesting that normal large-sized alleles predispose toward DM. We studied CTG repeat allele distribution and Alu insertion and/or deletion polymorphism at the myotonic dystrophy locus in two major Ethiopian populations, the Amhara and Oromo. CTG allele distribution and haplotype analysis on a total of 224 normal chromosomes showed significant differences between the two ethnic groups. These differences have a bearing on the out-of-Africa hypothesis for the origin of the DM mutation. In addition, (CTG) > or =19 were exclusively detected in the Amhara population, confirming the predisposing role of these alleles compared with the DM expansion-mutation.
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Elementos Alu/genética , Distrofia Miotónica/genética , Polimorfismo Genético , Proteínas Serina-Treonina Quinasas/genética , Repeticiones de Trinucleótidos , Alelos , Etiopía , Haplotipos , Humanos , Judíos , Distrofia Miotónica/etnología , Proteína Quinasa de Distrofia MiotónicaRESUMEN
Myotonic dystrophy (DM) is a multisystemic disease caused by expansion of a CTG trinucleotide repeat in the 3' untranslated region of the DMPK protein kinase gene on chromosome 19q13.3. The mechanism by which this expansion causes disease remains unknown. It has been suggested that CTG expansion not only affects the expression of the DMPK gene, but also alters the nuclear RNA metabolism and expression of neighboring genes. DMAHP, which is expressed in various human tissues, including skeletal muscle, heart and brain, is immediately distal to the 3' end of DMPK gene, in a CpG island which contains the CTG repeat. Here we report a 4- to 5-fold reduction of the expression of the DMAHP gene in different brain areas of DM patients. Our results demonstrate that [CTG]n expansion alters the brain DMAHP mRNA expression supporting a dominant-negative effect at the cellular level of DM [CTG]n mutation. The reduced brain expression of DMAHP could explain cerebral impairment in DM patients.
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Química Encefálica/fisiología , Proteínas de Homeodominio/biosíntesis , Distrofia Miotónica/metabolismo , ARN Mensajero/biosíntesis , Química Encefálica/genética , ADN/química , ADN/aislamiento & purificación , Cartilla de ADN , Proteínas de Homeodominio/genética , Humanos , Masculino , Persona de Mediana Edad , Distrofia Miotónica/genética , ARN Mensajero/genética , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
The myotonic dystrophy (DM) expansion varies from 50 to 4000 CTG repeats in the 3' untranslated region of the DMPK gene. Direct analysis by Southern blot, after restriction enzyme digestion of genomic DNA, is the method of choice for studying the DM mutation. A long polymerase chain reaction (PCR)-formatted protocol, which involved a single genomic in vitro amplification followed by high concentration agarose gel electrophoresis and oligo-specific hybridization, was used to amplify normal alleles and DM alleles in all examined ranges of expansion (up to 3,700 CTGs) starting from a small amount of genomic DNA (> or = 15 pg). This method is quick, sensitive, and reproducible and reduces the cost of diagnostic laboratory processing.
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Alelos , ADN/análisis , Distrofia Miotónica/genética , Reacción en Cadena de la Polimerasa/métodos , Expansión de Repetición de Trinucleótido/genética , Cartilla de ADN/química , Tamización de Portadores Genéticos/métodos , Humanos , Distrofia Miotónica/diagnóstico , Sensibilidad y Especificidad , Repeticiones de Trinucleótidos/genéticaAsunto(s)
Servicios Contratados/estadística & datos numéricos , Sistemas de Información en Hospital/organización & administración , Servicio de Registros Médicos en Hospital/organización & administración , Servicios Contratados/economía , Servicios Contratados/tendencias , Toma de Decisiones en la Organización , Eficiencia Organizacional , Administración Financiera , Sistemas de Información en Hospital/tendencias , Estados UnidosAsunto(s)
Joint Commission on Accreditation of Healthcare Organizations , Servicio de Registros Médicos en Hospital/normas , Sistemas de Registros Médicos Computarizados/normas , Chicago , Control de Formularios y Registros , Guías como Asunto , Hospitales con 300 a 499 Camas , Hospitales de Enseñanza , Entrevistas como Asunto , Servicio de Registros Médicos en Hospital/organización & administración , Sistemas de Registros Médicos Computarizados/organización & administración , Estados UnidosRESUMEN
The genetic mutation underlying Huntington's disease (HD) has been identified as an expansion and instability of a specific CAG repeat sequence in a gene on chromosome 4. A simple polymerase chain reaction assay has been used for the assessment of the (CAG)n expansion in a 72-year-old woman with typical HD symptoms, but no family history of the disorder. The DNA analysis showed that the patient had an allele with 41 repeat units, in the size range seen in HD chromosomes. Therefore, HD diagnosis is confirmed in this seemingly sporadic case and the disease is newly diagnosed in a large family. The risk of inheriting this unstable expanded allele is discussed. INTRODUCTION--The discovery of an expansion of a trinucleotide (CAG) repeat region in the IT15 gene on the short arm of chromosome 4 has identified the mutational mechanism causing Huntington's disease (HD) and enables the direct diagnosis of affected subjects based on DNA analysis alone. Here a 72-year-old woman with typical HD symptoms, but no family history of the disorder, has been unambiguously diagnosed by using a quick DNA analysis. This is relevant because the disease is newly diagnosed in a large family. MATERIAL AND METHODS--A labelled polymerase chain reaction (PCR) test has been used to amplify the repeat region of the IT15 gene and DNA fragments were analyzed by Polyacrylamide gel electrophoresis. RESULTS--The number the CAG repeats in the proband displayed two alleles of 23 and 41 repeats, respectively. Since normal chromosomes are reported to contain 11-34 repeats, the clinical appearance of HD in the proband is explained by the presence of the repeat expansion. DISCUSSION--The parents of the proposita both died aged over 80 y apparently without neurological signs referable to HD. Hence, this is presumably a sporadic case of the disease. Because of the length of 41 repeats of this HD chromosome, offspring of this proband could inherit the expanded allele with 37 repeats, as expected for the reversal of the trinucleotide expansion. A subject with this intermediate allele could be affected, but would not be affected if the HD IT gene with reduced triplets had recovered its normal function. Thus, in a seemingly sporadic case like the one reported here, despite the PCR analysis, the risk of transmission of HD to her offspring may remain uncertain.
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Enfermedad de Huntington/genética , Repeticiones de Trinucleótidos/genética , Anciano , Alelos , Autorradiografía , ADN/análisis , Cartilla de ADN , Femenino , Expresión Génica , Humanos , Enfermedad de Huntington/diagnóstico , Linaje , Reacción en Cadena de la PolimerasaRESUMEN
A patient with unusually prolonged epileptic aphemic attacks following a surgical lesion in the left frontal lobe is described. Clinical, electroencephalographic and neuropsychological findings are reported. True aphemia is relatively rare and the described case affords the opportunity of emphasizing that a relatively rare disorder of language as aphemia might also occur with true epileptic attacks.
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Afasia de Broca/diagnóstico , Epilepsia Tónico-Clónica/complicaciones , Adulto , Humanos , Trastornos del Lenguaje/diagnóstico , Trastornos del Lenguaje/etiología , Masculino , Mutismo/etiología , Trastornos del Habla/etiología , Terminología como Asunto , Escalas de WechslerRESUMEN
Technology is great, but people make the systems work. This is an example of what can go wrong when the users are not involved in decision making. But working as a team, the transcription and management staffs can create a happy ending!
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Eficiencia , Servicio de Registros Médicos en Hospital/organización & administración , Innovación Organizacional , Procesamiento de Texto/instrumentación , Chicago , Toma de Decisiones en la Organización , Hospitales con más de 500 Camas , Participación en las Decisiones , Registros Médicos/normas , Microcomputadores , Programas Informáticos/normas , Procesamiento de Texto/normas , Recursos HumanosRESUMEN
We prospectively studied 40 patients with uncomplicated optic neuritis (ON) to determine the risk of subsequent multiple sclerosis (MS). All patients were followed for at least 12 years. Ten patients (25%) developed MS. Seven of these 10 patients developed MS within 2 years. Both sexes were at high risk if ON occurred between the ages of 21 and 40. There was an overall increased risk of MS with recurrent ON. The course of MS appeared to be fairly benign during the period of observation.
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Esclerosis Múltiple/etiología , Neuritis Óptica/complicaciones , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Persona de Mediana Edad , Neuritis Óptica/patología , Estudios Prospectivos , RecurrenciaRESUMEN
As part of a multidisciplinary study program, an epidemiological descriptive survey was carried out in the province of Ferrara, northern Italy. The temporal trend of Huntington chorea (HC) in the last century (1871-1987) was determined in the study area, and the patients and subjects at risk were identified with the aim of creating genetic advisory councils offering preventive interventions to eliminate the disease. The final study population consisted of 10 unrelated families with HC and 47 HC cases who lived in the province of Ferrara in the survey period. The estimate of the prevalence rate varied over the time period considered between 3.09 and 0.36 cases per 100,000 inhabitants. The temporal trend was characterized by increasing and decreasing phases, reflecting the incidence (varying between 0.20 and 0.00 annual cases per 100,000 inhabitants) and mortality (varying between 0.21 and 0.00 annual deaths per 100,000 inhabitants) rates. This trend shows that the frequency of HC in the study area was not stable. It was characterized by a cyclic course with a period of about 50 years. In the recent decades of the study, the incidence and the prevalence rates showed a relative increase. Thus, HC persists in the Ferrara population despite a greater public awareness and the recent lower birth rate. A new peak of prevalence is likely in the near future.