Ospedale Regionale

Lugano, Switzerland

Ospedale Regionale

Lugano, Switzerland
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PubMed | University of Basel, Ospedale Regionale and Emergency Service
Type: | Journal: BMC infectious diseases | Year: 2016

Louse-borne relapsing fever (LBRF) is a neglected disease that has been restricted to East Africa for many decades. Several cases in refugees from the Horn of Africa have been recently diagnosed in four European countries.We report four additional cases of LBRF in asylum seekers from Somalia and Eritrea who presented with fever shortly after arriving in Switzerland during a seven-month period. Multiple spirochetes were visualized on stained blood films which were identified as Borrelia recurrentis by 16S rRNA gene sequencing. All patients recovered after antibiotic treatment with ceftriaxone and/or doxycycline. Concurrent infections (malaria and tuberculosis) were diagnosed in half of our patients. Possible modes of transmission and preventive measures are discussed.These reported cases highlight the ongoing transmission of LBRF in migrants from East Africa. Diagnosis of LBRF cases and prevention of autochthonous transmission in asylum seeker camps are important steps for the near future.

Manzoni P.,S Anna Hospital | Stolfi I.,Policlinico Umberto I | Messner H.,Ospedale Regionale | Cattani S.,University of Modena and Reggio Emilia | And 16 more authors.
Pediatrics | Year: 2012

BACKGROUND: Lactoferrin is a mammalian milk glycoprotein involved in innate immunity. Recent data show that bovine lactoferrin (bLF) prevents late-onset sepsis in preterm very low birth weight (VLBW) neonates. METHODS: This is a secondary analysis of data from a multicenter randomized controlled trial where preterm VLBW neonates randomly received bLF (100 mg/day; group A1), bLF + Lactobacillus rhamnosus GG (10 6 colony-forming units per day; group A2), or placebo (group B) for 6 weeks. Here we analyze the incidence rates of fungal colonization, invasive fungal infection (IFI), and rate of progression from colonization to infection in all groups. RESULTS: This study included 472 neonates whose clinical, nutritional, and demographical characteristics were similar. Overall, the incidence of fungal colonization was comparable (17.6%, 16.6%, and 18.5% in A1, A2, and B, respectively; P = .89 [A1] and .77 [A2]). In contrast, IFIs were significantly decreased in A1 and A2 (0.7% and 2.0%, respectively) compared with B (7.7%; P = .002 [A1] and .02 [A2]), and this was significantly true both in <1000 g (0.9% [A1] and 5.6% [A2], vs 15.0%) and in 1001 to 1500 g infants (0% and 0% vs 3.7%). The progression rate colonization-infection was significantly lower in the bLF groups: 3.7% (A1) and 12% (A2), vs 41.9%; P < .001 (A1) and P = .02 (A2). No IFI-attributable deaths occurred in the treatment groups, versus 2 in placebo. No adverse effects or intolerances occurred. CONCLUSIONS: Prophylactic oral administration of bLF reduces the incidence of IFI in preterm VLBW neonates. No effect is seen on colonization. The protective effect on IFI is likely due to limitation of ability of fungal colonies to progress toward invasion and systemic disease in colonized infants. Copyright © 2012 by the American Academy of Pediatrics.

Mellai M.,Neuro bio oncology Center | Monzeglio O.,Neuro bio oncology Center | Piazzi A.,University of Piemonte Orientale | Caldera V.,Neuro bio oncology Center | And 6 more authors.
Journal of Neuro-Oncology | Year: 2012

MGMT (O6-methylguanine-DNA methyltransferase) promoter hypermethylation is a helpful prognostic marker for chemotherapy of gliomas, although with some controversy for low-grade tumors. The objective of this study was to retrospectively investigate MGMT promoter hypermethylation status for a series of 350 human brain tumors, including 275 gliomas of different malignancy grade, 21 glioblastoma multiforme (GBM) cell lines, and 75 non-glial tumors. The analysis was performed by methylation-specific PCR and capillary electrophoresis. MGMT expression at the protein level was also evaluated by both immunohistochemistry (IHC) and western blotting analysis. Associations of MGMT hypermethylation with IDH1/IDH2 mutations, EGFR amplification, TP53 mutations, and 1p/19q co-deletion, and the prognostic significance of these, were investigated for the gliomas. MGMT promoter hypermethylation was identified in 37.8% of gliomas, but was not present in non-glial tumors, with the exception of one primitive neuroectodermal tumor (PNET). The frequency was similar for all the astrocytic gliomas, with no correlation with histological grade. Significantly higher values were obtained for oligodendrogliomas. MGMT promoter hypermethylation was significantly associated with IDH1/IDH2 mutations (P = 0.0207) in grade II-III tumors, whereas it had a borderline association with 1p deletion (P = 0.0538) in oligodendrogliomas. No other association was found. Significant correlation of MGMT hypermethylation with MGMT protein expression was identified by IHC in GBMs and oligodendrogliomas (P = 0.0001), but not by western blotting. A positive correlation between MGMT protein expression, as detected by either IHC or western blotting, was also observed. The latter was consistent with MGMT promoter hypermethylation status in GBM cell lines. In low-grade gliomas, MGMT hypermethylation, but not MGMT protein expression, was associated with a trend, only, toward better survival, in contrast with GBMs, for which it had favorable prognostic significance. © Springer Science+Business Media, LLC. 2012.

Kovari H.,University of Zürich | Ledergerber B.,University of Zürich | Cavassini M.,University of Lausanne | Ambrosioni J.,University of Geneva | And 6 more authors.
Journal of Hepatology | Year: 2015

Background & Aims The landscape of HCV treatments is changing dramatically. At the beginning of this new era, we highlight the challenges for HCV therapy by assessing the long-term epidemiological trends in treatment uptake, efficacy and mortality among HIV/HCV-coinfected people since the availability of HCV therapy. Methods We included all SHCS participants with detectable HCV RNA between 2001 and 2013. To identify predictors for treatment uptake uni- and multivariable Poisson regression models were applied. We further used survival analyses with Kaplan-Meier curves and Cox regression with drop-out as competing risk. Results Of 12,401 participants 2107 (17%) were HCV RNA positive. Of those, 636 (30%) started treatment with an incidence of 5.8/100 person years (PY) (95% CI 5.3-6.2). Sustained virological response (SVR) with pegylated interferon/ribavirin was achieved in 50% of treated patients, representing 15% of all participants with replicating HCV-infection. 344 of 2107 (16%) HCV RNA positive persons died, 59% from extrahepatic causes. Mortality/100 PY was 2.9 (95% CI 2.6-3.2) in untreated patients, 1.3 (1.0-1.8) in those treated with failure, and 0.6 (0.4-1.0) in patients with SVR. In 2013, 869/2107 (41%) participants remained HCV RNA positive. Conclusions Over the last 13 years HCV treatment uptake was low and by the end of 2013, a large number of persons remain to be treated. Mortality was high, particularly in untreated patients, and mainly due to non-liver-related causes. Accordingly, in HIV/HCV-coinfected patients, integrative care including the diagnosis and therapy of somatic and psychiatric disorders is important to achieve mortality rates similar to HIV-monoinfected patients. © 2015 European Association for the Study of the Liver.

Corso G.,Stroke Unit | Bottacchi E.,Stroke Unit | Giardini G.,Stroke Unit | Giovanni M.D.,Stroke Unit | And 3 more authors.
Neurological Sciences | Year: 2013

Our aim was to prospectively ascertain the incidence of first-ever stroke and ischaemic stroke subtypes, mortality, functional outcome and recurrence in Northern Italy. We identified all possible cases of stroke (1st January 2004 and 31st December 2008). Multiple overlapping sources were used. Standard definitions for incident cases, pathological types and infarction subtypes were used. Patient characteristics were identified and analysed, case-fatality was ascertained from administrative databases, and outcome was assessed in all surviving patients by modified Rankin Scale. We identified 1,326 incident strokes. The pathological diagnosis was confirmed in 94 % of cases. The incidence of first-ever stroke was 80.2 per 100,000 (95 % CI 73-87) when adjusted to world population. The incidence of embolic stroke was significantly greater in women than in men (p < 0.001) whereas the incidence of atherothrombotic stroke was significantly greater in men than in women (p < 0.001). The case-fatality of incident strokes was 9.5 % at 7 day, 16.1 % at 28 day, and 29.9 % at 1 year. Case-fatality of ischaemic stroke was lower than that of other pathological types (p < 0.0001). Hypertension was the most important risk factor, and atrial fibrillation was the most common in embolic stroke. Increasing age, female gender and embolic stroke subtypes were associated with an adverse outcome. Data on stroke incidence and case-fatality were similar to those of other high-income countries. However, differences were found in the distribution of risk factors and prognosis across the stroke types and ischaemic stroke subtypes. Gender differences in long-term functional outcomes were significant. © 2012 The Author(s).

Kovari H.,University of Zürich | Ledergerber B.,University of Zürich | Battegay M.,University of Basel | Rauch A.,University Clinic of Infectious Diseases | And 6 more authors.
Clinical Infectious Diseases | Year: 2010

Background. Chronic liver disease in human immunodeficiency virus (HlV)-infected patients is mostly caused by hepatitis virus co-infection. Other reasons for chronic alanine aminotransferase (ALT) elevation are more difficult to diagnose. Methods. We studied the incidence of and risk factors for chronic elevation of ALT levels (greater than the upper limit of normal at ≥2 consecutive semi-annual visits) in participants of the Swiss HIV Cohort Study without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who were seen during the period 2002-2008. Poisson regression analysis was used. Results. A total of 2365 participants were followed up for 9972 person-years (median age, 38 years; male sex, 66%; median CD4+ cell count, 426/μL; receipt of antiretroviral therapy [ART], 56%). A total of 385 participants (16%) developed chronic elevated ALT levels, with an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI], 3.5-4.3 cases per 100 person-years). In multivariable analysis, chronic elevated ALT levels were associated with HIV RNA level >100,000 copies/mL (incidence rate ratio [IRR], 2.23; 95% CI, 1.45-3.43), increased body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) (BMI of 2529.9 was associated with an IRR of 1.56 [95% CI, 1.24-1.96]; a BMI 5≥30 was associated with an IRR of 1.70 [95% CI, 1.16-2.51]), severe alcohol use (1.83 [1.19-2.80]), exposure to stavudine (IRR per year exposure, 1.12 [95% CI, 1.07-1.17]) and zidovudine (IRR per years of exposure, 1.04 [95% CI, 1.00-1.08]). Associations with cumulative exposure to combination ART, nucleoside reverse-transcriptase inhibitors, and unboosted protease inhibitors did not remain statistically significant after adjustment for exposure to stavudine. Black ethnicity was inversely correlated (IRR, 0.52 [95% CI, 0.33-0.82]). Treatment outcome and mortality did not differ between groups with and groups without elevated ALT levels. Conclusions. Among patients without hepatitis virus co-infection, the incidence of chronic elevated ALT levels was 3.9 cases per 100 person-years, which was associated with high HIV RNA levels, increased BMI, severe alcohol use, and prolonged stavudine and zidovudine exposure. Long-term follow-up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortality. © 2010 by the Infectious Diseases Society of America. All rights reserved.

Kohler P.,Cantonal Hospital St Gallen | Kohler P.,University of Zürich | Schmidt A.J.,Cantonal Hospital St Gallen | Schmidt A.J.,Federal office of Public Health of Fribourg | And 8 more authors.
AIDS | Year: 2015

Objectives: To describe the HIV care cascade for Switzerland in the year 2012. Design/methods: Six levels were defined: (i) HIV-infected, (ii) HIV-diagnosed, (iii) linked to care, (iv) retained in care, (v) on antiretroviral treatment (ART), and (vi) with suppressed viral load. We used data from the Swiss HIV Cohort Study (SHCS) complemented by a nationwide survey among SHCS physicians to estimate the number of HIV-patients not registered in the cohort. We also used Swiss ART sales data to estimate the number of patients treated outside the SHCS network. Based on the number of patients retained in care, we inferred the estimates for levels (i) to (iii) from previously published data. Results: We estimate that (i) 15 200 HIV-infected individuals lived in Switzerland in 2012 (margins of uncertainty, 13 400-19 300). Of those, (ii) 12 300 (81%) were diagnosed, (iii) 12 200 (80%) linked, and (iv) 11 900 (79%) retained in care. Broadly based on SHCS network data, (v) 10 800 (71%) patients were receiving ART, and (vi) 10 400 (68%) had suppressed (<200 copies/ml) viral loads. The vast majority (95%) of patients retained in care were followed within the SHCS network, with 76% registered in the cohort. Conclusion: Our estimate for HIV-infected individuals in Switzerland is substantially lower than previously reported, halving previous national HIV prevalence estimates to 0.2%. In Switzerland in 2012, 91% of patients in care were receiving ART, and 96% of patients on ART had suppressed viral load, meeting recent UNAIDS/WHO targets. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

PubMed | University of Lausanne, University of Zürich, Ecole Polytechnique Federale de Lausanne, Ospedale Regionale and 5 more.
Type: Journal Article | Journal: Open forum infectious diseases | Year: 2016

Background. The impact of human genetic background on low-trauma fracture (LTF) risk has not been evaluated in the context of human immunodeficiency virus (HIV) and clinical LTF risk factors. Methods. In the general population, 6 common single-nucleotide polymorphisms (SNPs) associate with LTF through genome-wide association study. Using genome-wide SNP arrays and imputation, we genotyped these SNPs in HIV-positive, white Swiss HIV Cohort Study participants. We included 103 individuals with a first, physician-validated LTF and 206 controls matched on gender, whose duration of observation and whose antiretroviral therapy start dates were similar using incidence density sampling. Analyses of nongenetic LTF risk factors were based on 158 cases and 788 controls. Results. A genetic risk score built from the 6 LTF-associated SNPs did not associate with LTF risk, in both models including and not including parental hip fracture history. The contribution of clinical LTF risk factors was limited in our dataset. Conclusions. Genetic LTF markers with a modest effect size in the general population do not improve fracture prediction in persons with HIV, in whom clinical LTF risk factors are prevalent in both cases and controls.

PubMed | Ospedale Regionale.
Type: Journal Article | Journal: Bioscience trends | Year: 2016

Spontaneous esophageal perforation (Boerhaaves syndrome) is an uncommon and challenging condition with significant morbidity and mortality. Surgical treatment is indicated in the large majority of cases and different procedures have been described in this respect. We present the results of a mono-institutional evaluation of the management of spontaneous esophageal perforation over a 20-year period. The charts of 25 patients with spontaneous esophageal perforation treated at the Surgical Department of the University Hospital of Lausanne were retrospectively studied. In the 25 patients, 24 patients were surgically treated and one was managed with conservative treatment. Primary buttressed esophageal repair was performed in 23 cases. Nine postoperative complications were recorded, and the overall mortality was 32%. Despite prompt treatment postoperative morbidity and mortality are still relevant. Early diagnosis and definitive surgical management are the keys for successful outcome in the management of spontaneous esophageal perforation. Primary suture with buttressing should be considered as the procedure of choice. Conservative approach may be applied in very selected cases.

PubMed | University of Lausanne, University of Zürich, Ospedale Regionale, University Hospital and 3 more.
Type: | Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America | Year: 2016

HCV infection has been associated with increased non-liver-related morbidity and mortality. However, studies have yielded inconsistent results.The incidence of clinical events in HIV-infected HCV-seropositive and incidence-density-matched HCV-seronegative participants of the Swiss HIV Cohort Study from 08/1994 to 12/2014 was studied. We compared firstly, HCV-seropositive with HCV-seronegative participants, and secondly, HCV-viremic with successfully treated nonviremic patients. Poisson regression was used to assess differences between these groups.We included 2503 HCV-seropositive participants, 540 with spontaneous HCV-clearance, 1294 untreated HCV-RNA-positive, 345 treated with SVR, 281 treated without SVR, and 2503 HCV-seronegative controls. After a mean follow-up of 8.2 years, we observed 107/18 (HCV-seropositive/HCV-seronegative) liver events, 41/14 kidney events, 230/121 osteoporosis/fractures, 82/94 diabetes mellitus, 114/129 cardiovascular events, 119/147 non-AIDS malignancies, 162/126 HIVCDC B/C events, 106/10 liver-related deaths, and 227/218 non-liver-related deaths. Compared to HCV-negative controls, HCV-seropositive participants had an increased risk of liver events (IRR 6.29[95% CI 3.52-11.22]), liver-related death (8.24[3.61-18.83]), kidney events (2.43[1.11-5.33]), and osteoporosis/fracture (1.43[1.03-2.01]). Among HCV-seropositive individuals, treated participants without SVR versus those with SVR had a higher risk of liver events (6.79[2.33-19.81]), liver-related death (3.29[1.35-8.05]), and diabetes mellitus (4.62[1.53-13.96]). Similar but not statistically significant differences were found between untreated HCV-RNA positive patients and those with SVR.While HCV-exposure was associated with an increased risk of kidney disease and osteoporosis/fracture, this risk did not seem to be dependent of persistent HCV-RNA. Successful HCV treatment was associated with a lower incidence of liver disease, liver-related death and diabetes mellitus while the other conditions studied were less affected.

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