Cosenza, Italy
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Siniscalchi A.,Annunziata Hospital | Iannacchero R.,Pugliese Ciaccio Hospital | De Sarro G.,University of Catanzaro | Gallelli L.,University of Catanzaro
Current Vascular Pharmacology | Year: 2016

Stroke is an acute condition characterized by a sudden decrease in blood flow to brain tissue, resulting in immediate deprivation of both glucose and oxygen. Different mechanisms are involved in the pathogenesis of stroke, but increasing evidence suggests that one of the processes worsening clinical outcome is inflammation with the synthesis and the release of pro-inflammatory cytokines that activate several cells contributing to the progression of brain injury. Monoclonal antibody therapy has proved useful and safe for the treatment of several systemic diseases. In contrast, the evidence is limited for the treatment of stroke. More studies are needed in order to standardize the method of treatment and establish if it is safe and effective. © 2016 Bentham Science Publishers.


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | Malferrari G.,Santa Maria Nuova Hospital | Pirritano D.,San Giovanni Of Dio Hospital | And 3 more authors.
Journal of Basic and Clinical Physiology and Pharmacology | Year: 2014

Stroke represents the most frequent cause of permanent disability in adults worldwide. Cerebral ischemia triggers the pathological pathways of the ischemic cascade and causes irreversible neuronal injury in the ischemic core within minutes of the onset. Elements of the immune system are involved in all stages of ischemic cascade from acute intravascular events triggered by the interruption of blood supply, to the parenchymal processes leading to brain damage and to the ensuing tissue repair. In this review, we will provide a brief overview of current understanding of the role of cytokines and brain inflammation during acute ischemic stroke. © 2014 by Walter de Gruyter Berlin/Boston.


Zappacosta R.,University of Chieti Pescara | Zappacosta R.,Annunziata Hospital | Gatta D.M.P.,University of Chieti Pescara | Marinucci P.,University of Chieti Pescara | And 4 more authors.
Expert Review of Molecular Diagnostics | Year: 2015

Objective: Colposcopy is widely used to triage women with mild cervical abnormalities. However, this approach is associated with low specificity and predictive value. The efficacy of E6/E7 mRNA test for this purpose has been demonstrated, but studies estimating its cost-effectiveness are still lacking. Given the limited healthcare financial resources, such an evaluation is a priority. Methods: We analyzed the clinical history of 432 women referred to colposcopy and colposcopy-directed biopsy for persisting ASCUS and LSIL, and compared three alternative triage protocols: immediate colposcopy; reflex HPV DNA testing and HPV DNA plus mRNA tests in sequence. Results: Molecular tests in sequence significantly reduce colposcopy referral, cost for assessed women, and cost for CIN2 detected. On the other hand, incremental cost-effectiveness ratio of this protocol was the highest. Conclusion: Our preliminary data, providing an estimation of the economic burden deriving from the introduction of E6/E7 mRNA test in the triage algorithm of patients with mild cervical abnormalities, may be useful for future healthcare policy. © 2015 Informa UK, Ltd.


Anticoli S.,San Camillo Forlanini Hospital | Pezzella F.R.,San Camillo Forlanini Hospital | Pozzessere C.,San Camillo Forlanini Hospital | Gallelli L.,University of Catanzaro | And 3 more authors.
Journal of Stroke and Cerebrovascular Diseases | Year: 2015

Background Acute ischemic lesions on diffusion-weighted magnetic resonance imaging (DWI-MRI) are reliable predictors of recurrent stroke at 90 days. However, to date, limited information on transient ischemic attack (TIA) patients with positive DWI lesions for stroke risk from 1 to 5 years is available. In this study, we evaluated the role of positive DWI lesions and vascular risk factors on stroke, cardiovascular death, and mortality at 90 days (T0), 1 year (T1), and 5 years (T2). Moreover, we also evaluated the association between stroke risk and the presence of DWI lesions. Methods We performed an observational study on consecutive patients admitted to the emergency department of San Camillo-Forlanini Hospital, Rome, Italy, from January 2007 to November 2012. Over the study period, 4300 patients with TIA or ischemic stroke were examined by stroke specialists in an emergency room setting within 1 hour from admittance. Results In 510 of 4300 patients (11.86%), a TIA was diagnosed, and 445 patients satisfy the study inclusion criteria. For all 445 patients, the mean ABCD2 score was 4.35 ± 1.30. Using DWI-MRI, we identified acute ischemic lesions in 185 patients (41.57%). We did not observe any correlation between duration of symptoms, ABCD2 score, and positive or negative DWI lesions. Positivity for DWI was not associated with the presence of diabetes mellitus, hypertension, smoking habit, or age; however, an association with weakness was observed. We documented a time-dependent increase in the absolute risk of stroke: T0: 1.35% (95% confidence interval [CI],.81-2.8); T1: 4.78% (95% CI, 2.88-7.47); T2: 9.02% (95% CI, 4.66-5.70). We did not record any difference in stroke risk in patients with positive DWI lesions: T0: hazard ratio [HR], 1.43; 95% CI,.35-5.88; log-rank P =.60; T1: HR, 1.04; 95%CI,.42-2.61; log-rank P =.91; T2: HR,.83; 95% CI,.25-2.67; log-rank P =.86. Conclusions This long-term follow-up study in TIA patients documents that both positive and negative DWI patients treated with fast-track had similar long-term risks of stroke. © 2015 National Stroke Association.


Siniscalchi A.,Annunziata Hospital | Bonci A.,U.S. National Institute on Drug Abuse | Mercuri N.B.,University of Rome Tor Vergata | De Siena A.,Lamezia Terme Hospital CZ | And 4 more authors.
Current Neurovascular Research | Year: 2015

Cocaine abuse remains a devastating medical problem for our society. Current concepts suggest that both hemorrhagic and ischemic stroke, particularly in young people, can result as a consequence of cocaine exposure. We provide an analysis of mechanisms of injury and a discussion of the pharmacological management of stroke following cocaine use. Preclinical research suggests that the cause of cocaine-mediated stroke is multifactorial and involves vasospasm, changes in cerebral vasculature, and platelet aggregation. We suggest that drugs able to induce vasospastic, thrombogenic, or neurotoxic effects of cocaine could be suitable as therapeutic agents. In contrast caution should be exerted when using anti-platelet and thrombolytic agents in cocaine users with stroke.


Corsonello A.,Research Hospital of Cosenza | Abbatecola A.M.,Italian National Research Center on Aging | Fusco S.,Messina University | Luciani F.,Annunziata Hospital | And 4 more authors.
Clinical Microbiology and Infection | Year: 2015

Infectious diseases are more prevalent in older people than in younger adults, and represent a major healthcare issue in older populations. Indeed, infections in the elderly are often associated with higher morbidity and mortality, and may present atypically. Additionally, older patients are generally treated with polypharmacy regimens, which increase the likelihood of drug-drug interactions when the prescription of an antimicrobial agent is needed. A progressive impairment in the functional reserve of multiple organs may affect either pharmacokinetics or pharmacodynamics during aging. Changes in body composition occurring with advancing age, reduced liver mass and perfusion, and reduced renal excretion may affect either pharmacokinetics or pharmacodynamics. These issues need to be taken into account when prescribing antimicrobial agents to older complex patients taking multiple drugs. Interventions aimed at improving the appropriateness and safety of antimicrobial prescriptions have been proposed. Educational interventions targeting physicians may improve antimicrobial prescriptions. Antimicrobial stewardship programmes have been found to reduce the length of hospital stay and improve safety in hospitalized patients, and their use in long-term care facilities is worth testing. Computerized prescription and decision support systems, as well as interventions aimed at improving antimicrobial agents dosage in relation to kidney function, may also help to reduce the burden of interactions and inherent costs. © 2014 European Society of Clinical Microbiology and Infectious Diseases.


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | De Sarro G.,University of Catanzaro
Current Neuropharmacology | Year: 2010

Many studies investigated the use of antiepileptic drugs (AEDs) in several neurological diseases other than epilepsy. These neurological disorders, usually, involve neuronal excitability through the modulating of ion channels, receptors and intracellular signaling pathways, and are the targets of the AEDs. This article provides a review of the clinical efficacy of both conventional and newer AEDs in hyperkinetic movement disorders. Some of these indications for AEDs have been established, while others are under investigation. The modulation of GABAergic transmission may explain the neuronal hyper-excitability that underlies some forms of hyperkinetic movement disorders. So, AEDs able to increase GABAergic neurotransmission may play a role in hyperkinetic movement disorders treatment. Therefore, AEDs could represent a useful therapeutic option in the management of hyperkinetic movement disorders where the available treatments are ineffective. ©2010 Bentham Science Publishers Ltd.


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | De Sarro G.,University of Catanzaro
Clinical Drug Investigation | Year: 2013

Dysaesthetic pain is a common neuropathic pain in patients with multiple sclerosis. Both tricyclic antidepressants (i.e., amitriptyline and duloxetine) and antiepileptic drugs (i.e., carbamazepine, gabapentin and pregabalin) represent first-line treatment of neuropathic pain. However, topiramate, an antiepileptic drug, also demonstrated clinical efficacy in these patients. In this report we describe the case of a 42-year-old woman with an 8-year history of multiple sclerosis who developed dysaesthetic pain in the lower limbs, and was successfully treated with topiramate at a final dose of 150 mg/day. About 8 months after beginning topiramate treatment, the patient had not shown any dysaesthetic pain, and no adverse events related to topiramate had been recorded. © 2012 Springer International Publishing Switzerland.


Siniscalchi A.,Annunziata Hospital | Gallelli L.,University of Catanzaro | Avenoso T.,University of Catanzaro | Squillace A.,University of Catanzaro | de Sarro G.,University of Catanzaro
Annals of Pharmacotherapy | Year: 2011

OBJECTIVE: To report on a patient with trigeminal neuralgia who responded positively to combined carbamazepine/oxycodone treatment. CASE SUMMARY: A 48-year-old woman with a 4-month history of left facial pain consisting of episodes lasting less than 5 minutes was brought to our institution for clinical evaluation. Clinical, laboratory, and neuroradiologic findings led to a diagnosis of idiopathic trigeminal neuralgia. Carbamazepine treatment was started at 200 mg every 12 hours and increased at discharge to 300 mg every 8 hours. Two weeks later the patient was readmitted with trigeminal neuralgia symptoms that had persisted since the previous admission, although they had decreased in intensity. Carbamazepine was reduced to 200 mg every 8 hours and oxycodone 5 mg every 12 hours was added to the treatment regimen, with a complete resolution of pain within 7 days. DISCUSSION: Pathophysiological mechanisms involved in both the genesis and the maintenance of trigeminal neuralgia have not yet been defined. Several hypotheses could explain this disorder, ranging from peripheral neural ectopic pacemaker to central disinhibition. Both the interruption of the sodium channel and the modulation of both k- and μ-opioid receptors contributed to antinociceptive effects in trigeminal neuralgia. CONCLUSIONS: Treatment with a combination of carbamazepine, a sodium channel blocker, and oxycodone, a mixed k- and μ-opioid receptor agonist, may be useful in alleviating symptoms of trigeminal neuralgia.


Siniscalchi A.,Annunziata Hospital
Current drug safety | Year: 2013

Some papers reported the development of adverse drug reactions in patients with Down's syndrome during the treatment with antiepileptic drugs. However, at this time, no data have been published concerning the development of tremor in patients with Down's syndrome treated with sodium valproate. We report a 17-year-old man with epilepsy and Down's syndrome who experienced tremor during the treatment with a low dosage of sodium valproate. The Naranjo probability scale documented a possible association between tremor and sodium valproate. Sodium valproate was changed to lamotrigine with both a rapid improvement of tremor and an optimal control of symptoms. In conclusion we documented that sodium valproate is able to induce in a patient with epilepsy and Down's syndrome, the development of tremor probably through the decreased activity of GABAergic neurotrasmission; however, further studies may be performed in order to validate this observation.

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