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Piccolo P.,University of Rome Tor Vergata | Piccolo P.,Medicine Unit | Lenci I.,University of Rome Tor Vergata | Di Paolo D.,University of Rome Tor Vergata | And 4 more authors.
Antiviral Therapy | Year: 2013

Background: Short-term treatment for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B remains unsatisfactory. The aim of our study was to compare the efficacy and safety of two sequential regimens of pegylated interferon (PEG-IFN)-α and telbivudine (LdT). Methods: Adult patients with biopsy-proven HBeAg-negative chronic hepatitis B, elevated alanine aminotransferase (ALT) and serum HBV DNA≥2,000 IU/ml were randomized 1:1 at baseline to receive PEG-IFN 180 μg/week for 24 weeks followed by LdT 600 mg/day for 24 weeks (PEG-IFN first), or vice versa (LdT first), plus 24-week follow-up; individuals with HCV, HDV or HIV coinfections and lamivudine resistance were excluded. Primary end points were serum HBV DNA<2,000 IU/ml and normal ALT at week 72. Results: A total of 30 patients (86% male, median age 48 years) were enrolled: mean ±sd baseline serum HBV DNA was 5.56 ±1.4 log IU/ml and ALT was 2.9 ±2.5× upper limit of normal. At end of follow-up (week 72), HBV DNA<2,000 IU/ml was achieved in 13.3% of participants in the PEG-IFN first group versus 46.7% of those in the LdT first group (P=0.046). Mean ±sd ALT levels were significantly lower in the LdT first group (1.3 ±0.9 versus 3.2 ±2.7× upper limit of normal; P=0.03). PEG-IFN dose was reduced in 2 (7%) patients and 1 (7%) patient dropped out due to myalgia. Conclusions: Sequential treatment with 24 weeks PEGIFN followed or preceded by 24 weeks of LdT is safe. Virological response rate at week 72 was significantly higher in patients treated with LdT followed by PEGIFN than vice versa. A sequential antiviral regimen of LdT followed by PEG-IFN, if confirmed in larger series, could improve response rates compared with standard PEG-IFN monotherapy. © 2013 International Medical Press.

Franco G.,National Institute for Health
Skinmed | Year: 2012

In the outpatient department of the National Institute for Health, Migration and Poverty (NIHMP) in Rome, Italy, and at the Italian Dermatological Hospital in Mekele, Ethiopia, from January 1, 2007, to December 31, 2009, 47 patients, adults, and children showing typical circular skin lesions referable to cupping were observed. The patients (32 men and 15 women) underwent complete dermatological examination, and their case histories were collected with the aid of a cultural mediator from the same linguistic or cultural area of the patient. The clinical picture included blue-red, circular erythematous spots, sometimes covered with crusts, consistent with recent cupping (figure 1 and figure 2). In some cases, particularly in older lesions, atrophic-cicatricial lesions and irregular, normal-color, slate gray, or hypochromic skin surface were observed (figure 3). Lesions were observed on the back, on the presternal region (figure 4), and, in case of pathologies causing abdominal swelling (i.e., kwashiorkor, intestinal parasitosis), on the abdomen (figure 5). The clinical pictures initially diagnosed as dermatophytoses or lesions caused by traumas or violence were later proved to be cupping-related outcomes or complications.

The paper presents the experience of the linguistic-cultural mediation service of the National Institute for Health, Migration and Poverty (NIHMP), a public structure that carries out clinical research, assistance, prevention, treatment and training activities. A team of linguistic-cultural mediators is involved in the numerous services and activities working with different disciplines and professionals. The paper aims at describing how the linguistic-cultural mediators serve as facilitators in terms of migrant populations' access to social and healthcare services and showing their involvement in a multidisciplinary setting. Copyright © FrancoAngeli.

Dave A.J.,Stanford University | Sethi A.,University of Chicago | Morrone A.,National Institute for Health
Dermatologic Clinics | Year: 2011

Female genital mutilation (FGM) has become more common in the United States with increased immigration to the United States of individuals from areas where the practice is endemic. Although the root causes of FGM may be multiple, the practice is banned in the United States on all women under age 18 and is increasingly being outlawed by individual state legislatures. American dermatologists should expect to see a growing number of patients having undergone FGM who may present with complications ranging from keloids and epidermal cysts to clitoral neuromas and abscess formation. While treatment of such complications is often elusive and unsuccessful, recognition of the practice may prevent future patient abuse and death. The eradication of FGM will require the concerted efforts of many individuals, both within and outside of the health care field, with dermatologists poised to play a crucial role in diagnosis and management in the near future. © 2011 Elsevier Inc.

Dassoni F.,National Institute for Health | Abebe Z.,Ayder Referral Hospital of Mekele University | Naafs B.,Stichting Tropen Dermatologie | Morrone A.,National Institute for Health
Acta Dermato-Venereologica | Year: 2013

Both cutaneous and mucocutaneous leishmaniasis are endemic in Northern Ethiopia. The different clinical presentations depend on the responsible organism and the host's immune response. Localized cutaneous leishmaniasis is the type most frequently seen. Diffuse cutaneous leishmaniasis is relatively rare and usually associated with mucous membrane involvement. Diffuse cutaneous leishmaniasis presents with multiple lesions, can be difficult to diagnose and responds less favourably to treatment. We report here 2 patients with unusual presentations of diffuse cutaneous leishmaniasis presenting with large hypopigmented skin lesions mimicking borderline-tuberculoid leprosy. To our knowledge this presentation has not been described before and may present difficulties in making a definite diagnosis in regions where both leprosy and cutaneous leishmaniasis are endemic. Lepromatous leprosy and diffuse cutaneous leishmaniasis are regularly confused, particularly when no skin smears for acid-fast bacillus or Leishman-Donovan bodies are performed. © 2013 The Authors.

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