Medicina Generale

Lugano, Switzerland

Medicina Generale

Lugano, Switzerland
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Larrey D.,Servise dHepato Gastro Enterologie et Transplantation | Lohse A.W.,Universitatsklinikum Hamburg Eppendorf | De Ledinghen V.,Hepato Gastroenterologie | Trepo C.,Hospital Of Lhotel Dieu | And 22 more authors.
Journal of Hepatology | Year: 2012

Background & Aims: BI 207127 is a potent non-nucleoside hepatitis C virus (HCV) NS5B polymerase inhibitor in vitro. Methods: In this double-blind, placebo-controlled study, 57 HCV genotype (GT)-1 patients (n = 27 treatment-naïve [TN]; n = 30 treatment-experienced [TE]) with compensated liver disease were randomised for 28-day treatment with 400, 600, or 800 mg BI 207127 three times daily (TID) or placebo (only TN) in combination with peginterferon alfa 2a and ribavirin (PegIFN/RBV). Plasma HCV RNA was measured by Roche COBAS TaqMan assay. Results: HCV RNA decreased in a dose-dependent manner with little difference between 600 mg (TN 5.6 log10, TE 4.2 log 10) and 800 mg (TN 5.4 log10, TE 4.5 log10). Rapid virological response (RVR; HCV RNA <15 IU/ml) at day 28 occurred in 11/19 TN and 4/30 TE patients treated with BI 207127. GT-1b patients had stronger reductions in HCV RNA than GT-1a (RVR: TN 64% vs. 43%; TE 33% vs. 5%). There were no breakthroughs (HCV RNA rebound >1 log10 from nadir) in the TN groups, whereas 3/30 TE patients experienced breakthrough due to P495-mutations. Gastrointestinal adverse events (AEs) and rash were the major AEs and most frequent at higher doses. One and four patients discontinued due to AEs in the 600 and 800 mg groups, respectively. Overall, tolerability was good and better at 600 mg than 800 mg. Conclusions: BI 207127 in combination with PegIFN/RBV demonstrated strong antiviral activity with a favourable safety and tolerability profile. The best benefit/risk ratio was observed at 600 mg. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Bianciardi G.,University of Siena | Lamberti I.,Emergenza Territoriale | Sartini S.,University of Siena | Servi M.,Medicina Generale | And 3 more authors.
Clinical Hemorheology and Microcirculation | Year: 2013

Rett syndrome (RTT) is a post-natal neurological disorder that represents the second most common cause for mental retardation. The presence of cold hands and feet, and blue, a feature frequently observed in these patients, is one of the non-neurological phenotypes that characterizes RTT, up to now not well explained. We have performed videocapillaroscopy in subjects affected by Rett syndrome. We have observed ramified and bushy capillaries, characteristic features of neoangiogenic capillaries, dilated capillaries and an irregular and chaotic microvascular pattern. To quantify these features and to evaluate the microvascular pattern complexity, we have performed a fractal analysis. Fractal dimension and Lempel-Ziv indexes resulted higher in Rett females than in age-matched healthy females (p < 0.001; p < 0.001). Our findings indicate the presence of previously unrecognized microvascular abnormalities in Rett syndrome. © 2013 - IOS Press and the authors. All rights reserved.


Colao A.,University of Naples Federico II | Muscogiuri G.,University of Naples Federico II | Rubino M.,University of Naples Federico II | Vuolo L.,University of Naples Federico II | And 7 more authors.
Endocrine | Year: 2015

Purpose: The aim of this study is to investigate in a population of adolescents living in Regione Campania, undergoing sun exposure at least 9 months per year the prevalence of severe deficiency (<20 ng/ml) or insufficiency (21–29 ng/ml) of 25-Hydroxyvitamin D (25(OH)D) levels and its relationship with individual body weight, use of smoking, and exercise performance. Methods: From October 2012 to October 2013, 373 healthy subjects (153 girls, 223 boys 11–20 years) without chronic diseases were consecutively enrolled in a campaign to prevent metabolic, cardiovascular, and oncological diseases. 25(OH)D assay, BMI, and lifestyle habitudes (smoking and exercise indoor or outdoor) were assessed. Results: In this population, median 25(OH) level was 25.0 ng/ml (95 %CI 23.8–25.2) without any difference between girls (25.0 (95 %CI 23.1–25.7)) and boys (24.3 (95 %CI 23.8–25.2)). Severe deficiency was found in 6 girls (0.02 %), while insufficiency was found in 296 patients (110 girls, 79.3 %). Normal levels were found in 71 patients (37 girls, 19 %). Vitamin D levels were significantly correlated with BMI (r = −0.429, p < 0.0001), smoking (r = −0.241; p < 0.0001), and exercise performance (r = 0.791; p < 0.0001). At the multistep regression analysis, Vitamin D levels were best predicted by exercise performance (t = 19.6, p < 0.0001), less smoking addiction (t = −4.97, p < 0.001), and lower BMI (t = −4.69, p < 0.0001). Conclusions: The current study demonstrates that Vitamin D levels are commonly unsatisfactory in adolescents. Lower levels were found in overweight or obese adolescent, smokers and with low or absence of physical activity outdoors. © 2014, Springer Science+Business Media New York.


Cimmino M.A.,University of Genoa | Cimmino M.A.,Epidemiology Study Group of the Italian Society of Rheumatology SIR | Scarpa R.,Epidemiology Study Group of the Italian Society of Rheumatology SIR | Scarpa R.,University of Naples Federico II | And 4 more authors.
Clinical and Experimental Rheumatology | Year: 2013

Objective: To define the relationship between body mass index (BMI) and pain due to osteoarthritis (OA) of the hand, hip, and knee in patients seen in general practice; to evaluate if overweight is related to co-morbidity and education, and influences the prescription patterns of GPs.Methods: 2,764 Italian GPs recruited 10 consecutive patients with symptomatic OA, diagnosed according to the ACR criteria. Pain intensity on a visual analogue scale, BMI, years of formal education, comorbidities, pharmacological and non-pharmacological interventions, and referral to specialists were recorded.Results: The most painful joints were the knee in 12,827 patients (53.6%), the hip in 5,645 (23.6%), and the hand in 5,467 (22.8%). A BMI indicative of overweight or obesity was found in 74.8% of men and in 68.3% of women. Mean BMI was higher in knee OA (27.9±3.9), in generalised OA (27.5±4.2), and hip OA (27±3.7) than in hand OA (25.5±3.4). The prevalence of obesity for hip and knee OA was higher than that reported for the general Italian population. Obesity was an important risk factor for pain in all OA localisations. Co-morbidities and lower education were associated with obesity and more intense pain (p<0.0001). Obesity and overweight were less frequent in institutionalised patients.Conclusion: Our study confirms that more than two thirds of Italian patients with symptomatic OA seen by GPs are overweight or obese. Obesity is clearly associated with OA pain, a finding which is probably underestimated by GPs who are not used to modulate treatment and specialist referral according to patients' BMI. © Clinical and Experimental Rheumatology 2013.


Rosa F.,Medicina Generale | Ferrari M.,Medicina Generale | Buschiazzo A.,University of Genoa | Lanfranco E.,Medico Specialista Ambulatoriale Laboratorio Analisi
Aging Clinical and Experimental Research | Year: 2013

Neoplastic diseases may be complicated by rheumatic diseases or may be occur with them. Dermatomyositis/polymyositis and polymyalgia rheumatica are described as paraneoplastic syndromes. We report a case with proximal muscular weakness as only symptom of colon cancer in the absence of other symptoms and laboratory abnormalities, and we discuss the nosological classification as a possible atypical form of polymyositis. © 2013 Springer International Publishing Switzerland.


Cimminiello C.,Ufficio Studi e Ricerche | Zambon A.,University of Padua | Polo Friz H.,Medicina Generale
Giornale italiano di cardiologia (2006) | Year: 2016

Cardiovascular disease is the leading cause of premature death in Europe. High blood cholesterol is one of the major cardiovascular risk factors and plays a crucial role in causing cardiovascular disease. A strong positive and linear association between total and LDL cholesterol levels and the risk of cardiovascular events has been widely documented. Every 1.0 mmol/l decrease in LDL cholesterol levels results in a significant reduction in cardiovascular mortality and in the risk of nonfatal myocardial infarction. Lipid-lowering guidelines suggest as first step the use of statins as monotherapy and, in case of failure to achieve the recommended targets, combination therapy of statins with other cholesterol-lowering drugs such as ezetimibe. The results from the recent IMPROVE-IT trial provide evidence that further LDL-cholesterol lowering beyond the recommended targets significantly reduces the rate of cardiovascular events, supporting the concept that "Lower Is Better" while additional long-term data are collected. Non-adherence to statin therapy, often due to adverse drug reactions, results in an increased risk for cardiovascular events. In a non-negligible proportion of patients with hypercholesterolemia receiving maximally tolerated statin therapy, the residual risk remains high. In addition, statin use has been associated with accelerated onset of diabetes in individuals already predisposed to developing diabetes. In conclusion, it is clear that statins are not the universal solution to the problem of high cholesterol levels, and the optimization of lipid-lowering therapy remains a therapeutic challenge.


PubMed | Medicina Generale, University of Padua and Ufficio Studi e Ricerche
Type: Journal Article | Journal: Giornale italiano di cardiologia (2006) | Year: 2016

Cardiovascular disease is the leading cause of premature death in Europe. High blood cholesterol is one of the major cardiovascular risk factors and plays a crucial role in causing cardiovascular disease. A strong positive and linear association between total and LDL cholesterol levels and the risk of cardiovascular events has been widely documented. Every 1.0 mmol/l decrease in LDL cholesterol levels results in a significant reduction in cardiovascular mortality and in the risk of nonfatal myocardial infarction. Lipid-lowering guidelines suggest as first step the use of statins as monotherapy and, in case of failure to achieve the recommended targets, combination therapy of statins with other cholesterol-lowering drugs such as ezetimibe. The results from the recent IMPROVE-IT trial provide evidence that further LDL-cholesterol lowering beyond the recommended targets significantly reduces the rate of cardiovascular events, supporting the concept that Lower Is Better while additional long-term data are collected. Non-adherence to statin therapy, often due to adverse drug reactions, results in an increased risk for cardiovascular events. In a non-negligible proportion of patients with hypercholesterolemia receiving maximally tolerated statin therapy, the residual risk remains high. In addition, statin use has been associated with accelerated onset of diabetes in individuals already predisposed to developing diabetes. In conclusion, it is clear that statins are not the universal solution to the problem of high cholesterol levels, and the optimization of lipid-lowering therapy remains a therapeutic challenge.


Piva A.,Medicina Interna 1 | Filippi A.,Medicina Generale | Simioni N.,Medicina Generale
Italian Journal of Medicine | Year: 2014

A 59-year old woman was admitted for fatigue and arm paresthesias with Trousseau sign. Her medical history included thyroidectomy and hypercholesterolemia recently treated with simvastatin. Laboratory tests showed severe hypokalemia and hypocalcemia, severe increase in muscle enzymes, metabolic alkalosis; low plasma renin activity, increased thyroid-stimulating hormone, normal free thyroxine, increased parathyroid hormone, decreased vitamin D3; alterations in electrolyte urinary excretion, cortisol and aldosterone were excluded. Hypothesizing a statin-related myopathy, simvastatin was suspended; the patient reported use of laxatives containing licorice. Electrolytes normalized with intravenous supplementation. Among many biochemical alterations, none stands out as a major cause for muscular and electrolyte disorders. All co-factors are inter-connected, starting with statin-induced myopathy, worsened by hypothyroidism, secondary hyperaldosteronism and vitamin D deficiency, leading to hypocalcemia and hypokalemia, perpetrating muscular and electrolyte disorders. The importance of considering clinical conditions as a whole emerges with multiple co-factors involved. Another issue concerns herbal products and their potential dangerous effects. © Copyright A. Piva et al., 2014.


Pallucca F.,Medicina Generale
Rivista Italiana della Medicina di Laboratorio | Year: 2010

The metabolic syndrome (MS) is a cluster of conditions that includes abdominal obesity, increased blood glucose, hypertension, abnormal HDL cholesterol and triglycerides levels. In the US about 47 million adults (25%) have MS. In Italy, about 7 million adults are affected by the disease. MS is linked to insulin resistance; in this condition, cells do not respond normally to insulin that becomes less effective at lowering blood sugars. General Practitioners (GP) provide preventive care and health education to patients at risk of cardiovascular disease and diabetes, through educational strategies. These strategies include patient-centered counselling; a four-step triage to select the population at risk; application of the Disease Management Program (DMP) with Care Manager (CM) in order to support GPs and specialists work. Leonardo Project shows that is possible to apply a Disease Care Management Program in patients with major factors determinate MS.


PubMed | Medicina Generale
Type: Case Reports | Journal: Aging clinical and experimental research | Year: 2013

Neoplastic diseases may be complicated by rheumatic diseases or may be occur with them. Dermatomyositis/polymyositis and polymyalgia rheumatica are described as paraneoplastic syndromes. We report a case with proximal muscular weakness as only symptom of colon cancer in the absence of other symptoms and laboratory abnormalities, and we discuss the nosological classification as a possible atypical form of polymyositis.

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