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Marcellin P.,University Paris Diderot | Cheinquer H.,Hospital de Clinicas de Porto Alegre | Curescu M.,Victor Babes University of Medicine and Pharmacy Timisoara | Dusheiko G.M.,University College London | And 11 more authors.
Hepatology | Year: 2012

The ability to predict which patients are most likely to achieve a sustained virologic response (SVR) with peginterferon/ribavirin would be useful in optimizing treatment for hepatitis C virus (HCV). The objective of this large international noninterventional cohort study was to investigate the predictive value (PV) of a virologic response (VR) by weeks 2, 4, and 12 of treatment on SVR. Treatment-naive HCV monoinfected patients (N = 7,163) age ≥18 years were prescribed peginterferon/ribavirin at the discretion of the treating physician according to country-specific requirements in accordance with the local label. The main outcome measure was the PV of a VR (HCV RNA <50 IU/mL) by weeks 2, 4, and 12 of treatment for SVR24 (HCV RNA <50 IU/mL after 24 weeks of untreated follow-up) by HCV genotype. The overall SVR24 rate was 49.4% (3,541/7,163; 95% confidence interval [CI]: 48.3-50.6%). SVR24 rates in patients with an HCV RNA titer <50 IU/mL by weeks 2, 4, and 12, respectively, were 66.2% (95% CI: 60.4-71.7%), 68.4% (95% CI: 65.7-71.0%), and 60.3% (95% CI: 58.5-62.1%) among genotype 1 patients; 82.0% (95% CI: 76.8-86.5%), 76.3% (95% CI: 73.3-79.1%), and 74.2% (95% CI: 71.3-76.9%) among genotype 2 patients; 67.3% (95% CI: 61.1-73.1%), 67.3% (95% CI: 64.2-70.3%), and 63.8% (95% CI: 61.0-66.6%) among genotype 3 patients; and 59.4% (95% CI: 40.6-76.3%), 63.3% (95% CI: 54.3-71.6%), and 54.3% (95% CI: 47.5-60.9%) among genotype 4 patients. The absence of a VR by week 12 had the highest negative PV across all genotypes. Conclusion: A VR by week 2 or 4 had the highest positive PV for SVR24 and differed according to HCV genotype. © 2012 American Association for the Study of Liver Diseases. Source

Marchetti G.,University of Milan | Nasta P.,University of Brescia | Bai F.,University of Milan | Gatti F.,University of Brescia | And 6 more authors.
PLoS ONE | Year: 2012

Objectives: Microbial translocation (MT) through the gut accounts for immune activation and CD4+ loss in HIV and may influence HCV disease progression in HIV/HCV co-infection. We asked whether increased MT and immune activation may hamper anti-HCV response in HIV/HCV patients. Methods: 98 HIV/HCV patients who received pegylated-alpha-interferon (peg-INF-alpha)/ribavirin were retrospectively analyzed. Baseline MT (lipopolysaccharide, LPS), host response to MT (sCD14), CD38+HLA-DR+CD4+/CD8+, HCV genotype, severity of liver disease were assessed according to Early Virological Response (EVR: HCV-RNA &50 IU/mL at week 12 of therapy or ≥2 log 10 reduction from baseline after 12 weeks of therapy) and Sustained Virological Response (SVR: HCV-RNA &50 IU/mL 24 weeks after end of therapy). Mann-Whitney/Chi-square test and Pearson's correlation were used. Multivariable regression was performed to determine factors associated with EVR/SVR. Results: 71 patients displayed EVR; 41 SVR. Patients with HCV genotypes 1-4 and cirrhosis presented a trend to higher sCD14, compared to patients with genotypes 2-3 (p = 0.053) and no cirrhosis (p = 0.052). EVR and SVR patients showed lower levels of circulating sCD14 (p = 0.0001, p = 0.026, respectively), but similar T-cell activation compared to Non-EVR (Null Responders, NR) and Non-SVR (N-SVR) subjects. sCD14 resulted the main predictive factor of EVR (0.145 for each sCD14 unit more, 95%CI 0.031-0.688, p = 0.015). SVR was associated only with HCV genotypes 2-3 (AOR 0.022 for genotypes 1-4 vs 2-3, 95%CI 0.001-0.469, p = 0.014). Conclusions: In HIV/HCV patients sCD14 correlates with the severity of liver disease and predicts early response to peg-INF-alpha/ribavirin, suggesting MT-driven immune activation as pathway of HIV/HCV co-infection and response to therapy. © 2012 Marchetti et al. Source

BACKGROUND: Falls of hospitalised people and resulting injuries are an important event, particularly in elderly people, since they can be cause of morbidity, disability and mortality. Frequently, fall result in deterioration of quality of life, reduction of personal autonomy and lengthening of stay in hospital. Literature reported one fall in the year in about one third of over 65 years old people; in 25% of old people admitted to hospital; in 43% of total guests in RSA (Ungar et al., 2004, Rubenstein et al., 2002). METHODS: We report data relative to experimental introduction of a new notification system and statistical monitoring, made by the Nursing Directorate of Niguarda Hospital in Milan, in the 8 wards that have recorded the highest number of falls in 2006 and 2007. The reports received (n = 119) made possible to assess the functionality of the system designed with the specific nature of the data collected. Falls of patients with minimal or absent risk factors for falls at the admission (50%) have been analyzed. The relationship of falls with age of patients, drugs assumption and nursing needs have been evaluated. RESULTS: 75% of fallen patients were over 68 years old. Taking a single or a combination of drugs considered as dangerous for falls was a recurring data. The most common modality of falls was to get out of bed. 30% of patients involved presented some nursing care needs (moving and personal hygiene). These needs were not particularly limiting their autonomy, but a nursing support and supervision had been in any case planned. CONCLUSION: Over 68 years old patients, taking drugs dangerous for falls and presenting nursing care needs should be strictly look after by nurses while the mobilization. Source

Bressi C.,University of Milan | Porcellana M.,AO Ospedale Niguarda Ca Granda | Marinaccio P.M.,University of Milan | Nocito E.P.,University of Milan | And 3 more authors.
European Psychiatry | Year: 2012

Objective: To evaluate potential differences in insight among bipolar manic, mixed and bipolar depressed inpatients and assess the role of clinical and demographic characteristics as possible predictors. Method: One hundred and twenty consecutive inpatients divided into three diagnostic groups were studied on admission (T0), at discharge (T1) and at 18. weeks after hospitalization (T2). The Young Mania Rating Scale (YMRS), the Hamilton Rating Scale for Depression (HAMD) and the Scale to Assess Unawareness of Mental Disorder (SUMD) were used. Results: Patients with mixed mania showed highest scores on the SUMD than patients with mania or bipolar depression. It was found a significant relationship between improvements in mania and in the insight. The level of insight at baseline was the only predictor of awareness in social consequences, moreover clinical and demographic characteristics were predictors of insight into mental illness. For what concerns insight about therapy benefits it was influenced by level of mania at baseline. Conclusion: The three general dimensions of insight revealed significant differences among the three groups. Regression models suggest that insight is a multidimensional concept in which some aspects are state-related, associated with psychopathology, whereas others are trait-like qualities, not directly associated with symptoms and predicted only by level at baseline. © 2011 Elsevier Masson SAS. Source

De Girolamo G.,IRCCS Fatebenefratelli | Dagani J.,IRCCS Fatebenefratelli | Purcell R.,University of Melbourne | Cocchi A.,AO Ospedale Niguarda Ca Granda | McGorry P.D.,University of Melbourne
Epidemiology and Psychiatric Sciences | Year: 2012

Purpose of review. In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention. Recent findings. The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes. Summary. Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood. © 2011 Cambridge University Press. Source

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