Bianchi Melacrino Morelli Hospital
Bianchi Melacrino Morelli Hospital
Crespel A.,Epilepsy Unit |
Crespel A.,French Institute of Health and Medical Research |
Gelisse P.,Epilepsy Unit |
Gelisse P.,French Institute of Health and Medical Research |
And 6 more authors.
Epilepsy and Behavior | Year: 2013
Juvenile myoclonic epilepsy (JME) is a common form of epilepsy and a fairly lifelong disorder that may significantly lower a patient's expectations and potential for a full life. Luckily, it is also a highly treatable disorder, and up to 85% of patients with JME will enjoy satisfactory seizure control. Among anticonvulsants, valproate still stands out as the most efficacious drug, but may be poorly tolerated by some, and is considered unsafe for the fetuses of pregnant women. Alternatives have emerged in recent years, especially levetiracetam, but also topiramate, zonisamide or lamotrigine. In some cases, combination therapy may be useful or even required. One should not forget the potential aggravation induced not only by some commonly used anticonvulsants, especially carbamazepine and oxcarbazepine, but also, in some patients, by lamotrigine. In special settings, older drugs like benzodiazepines and barbiturates may be useful. But the management of JME should also include intervention in lifestyle, with strict avoidance of sleep deprivation and the management of copathologies, including the cognitive and psychiatric problems that are often encountered. With adequate management, there will only remain a small proportion of patients with uncontrolled epilepsy and all of its related problems. Juvenile myoclonic epilepsy is a condition in which the clinician has a fair chance of significantly helping the patient with medication and counseling. © 2013 Elsevier Inc.
Barcella L.,Bianchi Melacrino Morelli Hospital |
Rogolino S.B.,Bianchi Melacrino Morelli Hospital |
Barbaro A.P.,Bianchi Melacrino Morelli Hospital
Minerva Gastroenterologica e Dietologica | Year: 2017
BACKGROUND: Yeast's presence, especially Candida's species, in the intestinal tract is now considered as part of the normal microbial human flora; however, fungal colonization of the colon may induce to fungal infections, becoming a risk not only in immunocompromised patients but also in normalcompetent subjects. The purpose of this epidemiological study was to evaluate the real incidence of yeasts into the fecal samples both from healthy outpatients and from inpatients, except those from wards concerning immunosuppressive and pediatrics pathologies. METHODS: Between September 2014 and October 2015, 685 stool's samples (383 from inpatients and 302 from outpatients) were subjected to culture test on Sabouraud Dextrose Agar and yeasts collected were identified by a semi-automated system Vitek2 (bioMérieux). RESULTS: Percentage of isolation was of 64% (N.=437) in the total fecal samples examined (59% in outpatients and 67% in inpatients) and the most frequently isolated was Candida albicans (63% N.=275) in both populations (60% in outpatients and 65% in inpatients). CONCLUSIONS: These data testify the constant presence in the human gut of a fungal community that, according to us, could be defined as intestinal "mycobiota". This study wishes to be a contribution to discover the relationship established between human and yeasts and to evaluate the colonizing or pathogenetic role performed by these microorganisms. © 2017 EDIZIONI MINERVA MEDICA.
Ferlazzo E.,University of Catanzaro |
Ferlazzo E.,Bianchi Melacrino Morelli Hospital |
Sueri C.,Bianchi Melacrino Morelli Hospital |
Gasparini S.,University of Catanzaro |
And 3 more authors.
Pharmacological Research | Year: 2016
Epilepsy represents the third most common neurological disorders in the elderly after cerebrovascular disorders and dementias. The incidence of new-onset epilepsy peaks in this age group. The most peculiar aetiologies of late-onset epilepsy are stroke, dementia, and brain tumours. However, aetiology remains unknown in about half of the patients. Diagnosis of epilepsy may be challenging due to the frequent absence of ocular witnesses and the high prevalence of seizure-mimics (i.e. transient ischemic attacks, syncope, transient global amnesia or vertigo) in the elderly. The diagnostic difficulties are even greater when patients have cognitive impairment or cardiac diseases. The management of late-onset epilepsy deserves special considerations. The elderly can reach seizure control with low antiepileptic drugs (AEDs) doses, and seizure-freedom is possible in the vast majority of patients. Pharmacological management should take into account pharmacokinetics and pharmacodynamics of AEDs and the frequent occurrence of comorbidities and polytherapy in this age group. Evidences from double-blind and open-label studies indicate lamotrigine, levetiracetam and controlled-release carbamazepine as first line treatment in late-onset epilepsy. © 2016 Elsevier Ltd. All rights reserved.
Maurillo L.,University of Rome Tor Vergata |
Venditti A.,University of Rome Tor Vergata |
Spagnoli A.,University of Rome La Sapienza |
Gaidano G.,University of Piemonte Orientale |
And 11 more authors.
Cancer | Year: 2012
Background: The efficacy of azacitidine for the treatment of high-risk myelodysplastic syndromes has prompted the issue of its potential role even in the treatment of acute myeloid leukemia (AML). Methods: The authors analyzed 82 patients with AML who were diagnosed according to World Health Organization criteria. The median patient age was 72 years (range, 29-87 years), and 27 patients (33%) had secondary AML. Of 62 patients with evaluable cytogenetics, 18 patients (29%) had a poor-risk karyotype, and 44 patients (71%) had an intermediate karyotype. Thirty-five patients (43%) received azacitidine as front-line treatment, and 47 patients (57%) had previously received 1 or more line of chemotherapy. Results: The overall response rate was 32% (26 of 82 patients) and included 12 (15%) complete remissions (CRs), 4 (5%) CRs with incomplete blood count recovery (CRi), and 10 (12%) partial responses (PRs). Responses were observed more frequently among untreated patients compared with pretreated patients; in fact, 17 of 35 untreated patients (48%) responded, including 11 responses (31%) classified as CR/CRi. Conversely, only 9 of 47 pretreated patients (19%) responded, including 5 responses (11%) that were classified as CR/Cri. The response rate was significantly higher for untreated patients (P =.006) and those who had white blood cell counts <10 × 10 9/L (P =.006). For untreated patients who achieved a response, the median overall response duration was 13 months, and the 1-year and 2-years overall survival rates were 58% and 24%, respectively. Conclusions: The current results indicated that azacitidine promises to be an effective therapy for elderly patients with untreated AML and with white blood cell counts <10 × 10 9/L. © 2011 American Cancer Society.
Lionetti E.,SIGENP Italian Society of Pediatric Gastroenterology |
Lionetti E.,Marche Polytechnic University |
Castellaneta S.,SIGENP Italian Society of Pediatric Gastroenterology |
Castellaneta S.,University of Catania |
And 35 more authors.
New England Journal of Medicine | Year: 2014
BACKGROUND The relationship between the risk of celiac disease and both the age at which gluten is introduced to a child's diet and a child's early dietary pattern is unclear. METHODS We randomly assigned 832 newborns who had a first-degree relative with celiac disease to the introduction of dietary gluten at 6 months (group A) or 12 months (group B). The HLA genotype was determined at 15 months of age, and serologic screening for celiac disease was evaluated at 15, 24, and 36 months and at 5, 8, and 10 years. Patients with positive serologic findings underwent intestinal biopsies. The primary outcome was the prevalence of celiac disease autoimmunity and of overt celiac disease among the children at 5 years of age. RESULTS Of the 707 participants who remained in the trial at 36 months, 553 had a standard-risk or high-risk HLA genotype and completed the study. At 2 years of age, significantly higher proportions of children in group A than in group B had celiac disease autoimmunity (16% vs. 7%, P = 0.002) and overt celiac disease (12% vs. 5%, P=0.01). At 5 years of age, the between-group differences were no longer significant for autoimmunity (21% in group A and 20% in group B, P = 0.59) or overt disease (16% and 16%, P=0.78 by the log-rank test). At 10 years, the risk of celiac disease autoimmunity was far higher among children with high-risk HLA than among those with standard-risk HLA (38% vs. 19%, P=0.001), as was the risk of overt celiac disease (26% vs. 16%, P=0.05). Other variables, including breast-feeding, were not associated with the development of celiac disease. CONCLUSIONS Neither the delayed introduction of gluten nor breast-feeding modified the risk of celiac disease among at-risk infants, although the later introduction of gluten was associated with a delayed onset of disease. A high-risk HLA genotype was an important predictor of disease. (Funded by the Fondazione Celiachia of the Italian Society for Celiac Disease; CELIPREV ClinicalTrials.gov number, NCT00639444.) Copyright © 2014 Massachusetts Medical Society.
PubMed | Messina University, Bianchi Melacrino Morelli Hospital, Biomedical University of Rome and University of Catanzaro
Type: | Journal: Annals of vascular surgery | Year: 2016
Endovascular aortic repair (EVAR) has been shown to be a valid and minimally invasive alternative to open abdominal aortic aneurysm repair. A major shortcoming for EVAR is the need to submit patients to regular follow-up to detect potential complications such as endoleak, limb occlusion, aneurysm expansion, aneurysm rupture, infection, structural failure, and migration. In this case report, we describe an uncommon case of late type III endoleak due to complete detachment of the stent-graft main body segment from its suprarenal uncovered fixation stent. It was treated with a custom-made Relay() NBS Plus (Bolton Medical, Barcelona, Spain) thoracic stent graft which also provided extra suprarenal fixation of the thoracic stent graft in the proximal neck. The postoperative period was uneventful and a computed tomography scan 1 year later revealed proper positioning of the stent graft and no signs of endoleak. The successful strategy chosen to correct this complication was at the same time original and infrequent, and also avoided potential complications related to open surgical repair and general anesthesia.
PubMed | Galliera Hospital, Amedeo Of Savoia Hospital, Marche Polytechnic University, Sacco Hospital and 15 more.
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016
The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.
PubMed | University of Genoa, Bianchi Melacrino Morelli Hospital, IRCCS Centro Neurolesi Bonino Pulejo, Irccs Instituto Of Ricerche Farmacologiche Mario Negri and 3 more.
Type: | Journal: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology | Year: 2017
The role of different factors in influencing the risk of seizures during multiple sclerosis (MS) is not known. To perform a systematic review and meta-analysis of risk factors for epilepsy during MS. Pubmed, Google scholar, and Scopus databases were searched. Articles published in English (1986-2016) were included. Nine studies were included (3 retrospective cohort and 6 case-control) enrolling 2845 MS patients (217 with epilepsy; 7.6%). MS patients with epilepsy had a younger age at onset compared to MS patients without seizures (difference in means=-5.42years, 95% CI -7.19 to -3.66, p<0.001). Mean EDSS value at inclusion tended to be higher in patients with epilepsy, without reaching statistical significance (difference in means=0.45, 95% CI -0.01 to 0.91, p=0.054). No differences were observed in sex distribution (OR=0.94, 95% CI 0.51-1.72, p=0.83) and clinical form (OR=1.03, 95% CI 0.33-3.21, p=0.96). Two studies evaluated presence and number of cortical lesions as a risk factor for epilepsy in MS using different MRI techniques: in one study, cortical lesions were more frequently observed in patients with epilepsy (OR=7.06, 95% CI 2.39-20.8; p<0.001). In the other, cortico-juxtacortical lesions were more frequently observed in patients with epilepsy (OR=2.6, 95% CI 1.0-6.5; p=0.047). Studies about risk factors for epilepsy during MS are heterogeneous. Compared to MS patients without seizures, patients with epilepsy have an earlier MS onset and a higher EDSS score after similar disease duration. Clinical form of MS and sex do not predict the appearance of seizures.