Approval rating and opinion of outpatients and general practitioners toward generic drugs: a questionnaire-based real-world study.

PURPOSE: Generic drugs use in the Liguria region is higher than the Italian average, but lower than in other European countries. No data exist about real-life prescription and level of awareness of generic drugs. In this study, we analyzed demographic, social, economic and cultural factors that may affect the level of awareness of generic drugs and their effective use. METHODS: We conducted a population survey using a structured questionnaire, administered to a sample of 8 outpatient clinics of general practitioners located in different districts of Genoa (Liguria, Italy). Multivariate logistic modeling was adopted to study the relationship between awareness/use of generic drugs and characteristics of subjects. RESULTS: Out of 2,000 outpatients surveyed, 95% were aware of generic drugs: these were mostly females (OR =2.2, 95% CI: 1.4-3.6), >35 years old (OR >6.0 vs 18-35 years), with a high level of education (OR >4.4 vs "elementary sch"), living in the west side of the city (OR =1.9 vs center); of these, only 59% declared that they effectively use generic drugs. Users were younger (OR =3.1, 18-35 years vs >65 years), with a high level of education (high school/university degree vs no title/elementary/secondary school OR =1.7), and were aware of the lower cost compared with branded drugs, and were mainly informed by pharmacists and physicians. CONCLUSIONS: Although subjects were substantially aware of the existence of generic drugs, ~40% still did not use them; doubts about their efficacy seem to be mainly driven by the idea that cheaper drugs lead to lower product quality, in terms of efficacy, safety and tolerability. New education policies on generic drugs are needed.

Paliperidone for the treatment of ketamine-induced psychosis: a case report.

Ketamine is an anaesthetic and analgesic drug synthesized in the 1960s from phencyclidine. The recreational use of ketamine increased among the dance culture of techno and house music, in particular in clubs, discotheques, and rave parties. The psychotropic effects of ketamine are now well known and they range from dissociation to positive, negative, and cognitive schizophrenia-like symptoms. We report a case of a chronic oral consumption of ketamine which induced agitation, behavioral abnormalities, and loss of contact with reality in a poly-drug abuser; these symptoms persisted more than two weeks after the drug consumption had stopped. Antipsychotic treatment with paliperidone led to a successful management of the psychosis, getting a complete resolution of the clinical picture. Paliperidone has proven to be very effective in the treatment of ketamine-induced disorders. Moreover, the pharmacological action and metabolism of paliperidone are poorly dependent from the activity of liver enzymes, so that it seems to be one of the best second generation antipsychotics for the treatment of smokers and alcohol abusers.

A case report on escitalopram-induced hyperglycaemia in a diabetic patient.

The incidence of depression in diabetic patients is quite high; moreover, it has been suggested that the presence of depression itself may increase the risk of diabetes mellitus. Hence, it follows that the simultaneous use of antidiabetic and antidepressant drugs is common. Some clinical evidence indicates that selective serotonin re-uptake inhibitors (SSRIs) could be very useful in treating overweight patients, both with and without diabetes. However, recent deregulation of glucidic metabolism was tested in diabetic subjects treated with antidepressants. Several cases of hyperglycaemia and hypoglycaemia associated with other SSRIs have been published, whereas only one case of escitalopram inducing hyperglycaemia has been noted. The exact mechanism of glucose control impairment in patients taking SSRIs--escitalopram in particular--still remains unclear. We describe a diabetic 83-year-old woman with good glycaemic control (as evinced by glycaemic and glycosylated haemoglobin assay--HbA1c--values) before escitalopram initiation in response to therapy with glibenclamide. Escitalopram resulted in a significantly increased glycaemia values 5 days following administration. Glycaemia values returned to normality only after suspension of escitalopram, despite antidiabetic dosage increase. We report this case to draw attention to escitalopram as a possible cause of glycaemic control loss.

Heparin-induced acute adverse reaction--case report of a patient with acute trauma and a genetic predisposition to thrombotic events: a concurrence of events.

WHAT IS KNOWN AND OBJECTIVE: The most common complication of heparin therapy is bleeding. Allergic reactions to heparin are rare, and the mechanisms are poorly understood. We report on a case of acute systemic reaction after subcutaneous injections of a low-molecular-weight heparin (LMWH) in a patient with a genetic predisposition to thrombotic events and review the literature on heparin-induced acute adverse reaction. CASE SUMMARY: A 57-year-old diabetic, hypertriglyceridemic and hypercholesterolemic man was admitted with a fractured right malleolus sustained while driving. He was prescribed parnaparin sodium 4250 IU subcutaneously once a day. During the third injection, the patient developed widespread pain, sickness and facial rash, followed by a state of stupor (Glasgow Coma Scale 8) and was hospitalized in Neurological Unit. He was found to be a carrier of two genetic mutations (i.e. prothrombin G20210A and MTHFR mutation) associated with an increased risk of thrombotic events. Discontinuation of parnaparin and supportive care led to a sufficient recovery of the patient to be discharged 6 days after admission. WHAT IS NEW AND CONCLUSION: Treatment for heparin-related hypersensitivity reactions is largely supportive and symptomatic. Clinicians should be aware of these rare but potentially serious adverse events. Prothrombin gene mutations are quite common, and guidelines on anticoagulant therapy for affected patients are needed.

The Academy of Science of Bologna and the kidney.

The Academy of Science of Bologna, founded in 1711, played an important role in the development of medicine. Receiving the heritage of Malpighi's and Morgagni's researches, the academy encouraged nephrological studies, which produced articles published in its journal, the Commentarii. Since the Commentarii were widely distributed all over Europe, the nephrological research practiced in Bologna reached all the main academies of science, in a fruitful circulation of knowledge. The paper presents the nephrological contributions to the Commentarii in the 18th century, thus introducing physicians, like Domenico Galeazzi and Luigi Galvani, who were both professors at the University of Bologna and at the Academy of Science. In their work three main topics can be identified: uroscopy, anatomy of the kidney and renal pathologies.

Guilielmus de Saliceto and his contributions to renal medicine.

Guilielmus, one of the most outstanding physicians of the 13th century practised a bedside teaching method and gave guidelines for diagnosing and treating diseases. Written summaries of clinical case histories were his basic didactic instruments and his practise was characterized by a high awareness of doctor-patient relations.

[A method of image enhancement in the use of hydrosoluble uro-angiographic contrast media]. / Un metodo di ottimizzazione dell'immagine nell'impiego di mezzi di contrasto idrosolubili uro-angiografici.

The radiographic contrast, when using hydrosoluble uro-angiographic contrast media, depends on several factors. A phantom and a new method are proposed to assess and optimize the contrast. The phantom allows to simulate three pseudovessels with diameter of 2 mm, 5 mm, and 10 mm, placed in a water-equivalent layer of 20/cm thickness. The phantom is exposed to a photon beam produced by a conventional X ray tube, and the images are obtained using conventional screen film system. The aim of the study is to assess the radiographic contrast between the vessel and the background when modifying the optical density of the radiograph (by different settings of the mAs switching), the X-ray tube high voltage and the diameter of the vessels; the contrast was studied with four different contrast media (Uromiro 24%, Conray 36%, Iopamiro 300 and Iomeron 400) and three X-ray tube high voltages (60 kV, 80 kV, 100 kV). The curve fitting the contrast as a function of the optical density of the background (in each condition of high voltage, diameter of the vessel and contrast media used) is a parabola. A quite narrow distribution of abscissas of the maxima of the parabolas was found, ranging from the minimum optical density 1.21 in the case of 100 kV high voltage and 2 mm diameter to the maximum optical density 1.58 in the case 60 kV and 10 mm. The mean value (1.40) is proposed as the optical density of the background optimizing the contrast according to the screen-film system used. In conclusion, the authors suggest to optimize the use of contrast media, trying to obtain radiographs with an optical density approaching the optimal value in any clinical situation. Therefore tables of the settings of the X-ray tube and generator are required; the tables must take into account the main parameters influencing the settings, such as the source-film distance, the water-equivalent thickness of the patient and the film-screen system used.

The age-old spirit of nephrology from the oldest university in the world.

The University of Bologna began teaching in 1088, and the Faculty of Medicine was granted the same rights as lawyers in 1288, largely due to the reputation and teaching skills of Taddeo Alderotti. Among the other famous names associated through the ages with the Bologna School of Medicine are Malpighi, Valsalva and Murri. From the earliest times in Bologna, nephrologists attempted to show an interaction of the kidney with the outer environment (astronomy and astrology) and with other organs (anatomy) and an integration of the sophisticated structures within the kidney itself (microscopy). At the turn of the 19th century, the biochemical frontier was reached, and a new teaching methodology emphasizing careful consideration of all possible differential diagnoses was developed.