Regional Hospital of Lugano

Lugano, Switzerland

Regional Hospital of Lugano

Lugano, Switzerland
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Young J.,University of Basel | Xiao Y.,Analysis Group Inc. | Xiao Y.,McGill University | Moodie E.E.M.,McGill University | And 8 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015

Background: Patients with HIV exposed to the antiretroviral drug abacavir may have an increased risk of cardiovascular disease (CVD). There is concern that this association arises because of a channeling bias. Even if exposure is a risk, it is not clear how that risk changes as exposure cumulates. Methods: We assess the effect of exposure to abacavir on the risk of CVD events in the Swiss HIV Cohort Study. We use a new marginal structural Cox model to estimate the effect of abacavir as a flexible function of past exposures while accounting for risk factors that potentially lie on a causal pathway between exposure to abacavir and CVD. Results: A total of 11,856 patients were followed for a median of 6.6 years; 365 patients had a CVD event (4.6 events per 1000 patientyears). In a conventional Cox model, recent\-but not cumulative\- exposure to abacavir increased the risk of a CVD event. In the new marginal structural Cox model, continued exposure to abacavir during the past 4 years increased the risk of a CVD event (hazard ratio = 2.06; 95% confidence interval: 1.43 to 2.98). The estimated function for the effect of past exposures suggests that exposure during the past 6-36 months caused the greatest increase in risk. Conclusions: Abacavir increases the risk of a CVD event: the effect of exposure is not immediate, rather the risk increases as exposure cumulates over the past few years. This gradual increase in risk is not consistent with a rapidly acting mechanism, such as acute inflammation. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Bucher H.C.,University of Basel | Richter W.,Institute for Lipid Metabolism | Glass T.R.,University of Basel | Magenta L.,Regional Hospital of Lugano | And 7 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2012

Objectives: HIV infection and exposure to certain antiretroviral drugs is associated with dyslipidemia and increased risk for coronary events. Whether this risk is mediated by highly atherogenic lipoproteins is unclear. We investigated the association of highly atherogenic small dense low-density lipoproteins (LDLs) and apolipoprotein B and coronary events in HIV-infected individuals receiving antiretroviral therapy. Methods: We conducted a case-control study nested into the Swiss HIV Cohort Study to investigate the association of small dense LDL and apolipoprotein B and coronary events in 98 antiretroviral drug-treated patients with a first coronary event (19 fatal and 79 nonfatal coronary events with 53 definite and 15 possible myocardial infarctions, 11 angioplasties or bypasses) and 393 treated controls matched for age, gender, and smoking status. Lipids were measured by ultracentrifugation. Results: In models including cholesterol, triglycerides, highdensity lipoprotein cholesterol, blood pressure, central obesity, diabetes, and family history, there was an independent association between small dense LDL and coronary events [odds ratio (OR) for 1 mg/dL increase: 1.06, 95% confidence interval (CI): 1.00 to 1.11] and apolipoprotein B (OR for 10 mg/dL increase: 1.16, 95% CI: 1.02 to 1.32). When adding HIV and antiretroviral therapy-related variables, ORs were 1.04 (95% CI: 0.99 to 1.10) for small dense LDL and 1.13 (95% CI: 0.99 to 1.30) for apolipoprotein B. In both models, blood pressure and HIV viral load was independently associated with the odds for coronary events. Conclusions: HIV-infected patients receiving antiretroviral therapy with elevate small dense LDL and apolipoprotein B are at increased risk for coronary events as are patients without sustained HIV suppression. Copyright © 2012 by Lippincott Williams & Wilkins.

Bibert S.,University of Lausanne | Wojtowicz A.,University of Lausanne | Taffe P.,University of Lausanne | Manuel O.,University of Lausanne | And 7 more authors.
AIDS | Year: 2014

Background: Cytomegalovirus (CMV) retinitis is a major cause of visual impairment and blindness among patients with uncontrolled HIV infections. Whereas polymorphisms in interferon-lambda 3 (IFNL3, previously named IL28B) strongly influence the clinical course of hepatitis C, few studies examined the role of such polymorphisms in infections due to viruses other than hepatitis C virus. Objectives: To analyze the association of newly identified IFNL3/4 variant rs368234815 with susceptibility to CMV-associated retinitis in a cohort of HIV-infected patients. Design and methods: This retrospective longitudinal study included 4884 white patients from the Swiss HIV Cohort Study, among whom 1134 were at risk to develop CMV retinitis (CD4+ nadir <100 /μl and positive CMV serology). The association of CMV-associated retinitis with rs368234815 was assessed by cumulative incidence curves and multivariate Cox regression models, using the estimated date of HIV infection as a starting point, with censoring at death and/or lost follow-up. Results: A total of 40 individuals among 1134 patients at risk developed CMV retinitis. The minor allele of rs368234815 was associated with a higher risk of CMV retinitis (logrank test P=0.007, recessive mode of inheritance). The association was still significant in a multivariate Cox regression model (hazard ratio 2.31, 95% confidence interval 1.09-4.92, P=0.03), after adjustment for CD4+ nadir and slope, HAART and HIV-risk groups. Conclusion: We reported for the first time an association between an IFNL3/4 polymorphismand susceptibility to AIDS-relatedCMV retinitis. IFNL3/4 may influence immunity against viruses other than HCV. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Wang Q.,University of Basel | Elzi L.,University of Basel | Bernasconi E.,Regional Hospital of Lugano | Weber R.,University of Zürich | And 4 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

Background: Prevalence of hypertension in HIV infection is high, and information on blood pressure control in HIV-infected individuals is insufficient. We modeled blood pressure over time and the risk of cardiovascular events in hypertensive HIV-infected individuals. Methods: All patients from the Swiss HIV Cohort Study with confirmed hypertension (systolic or diastolic blood pressure above 139 or 89 mm Hg on 2 consecutive visits and presence of at least 1 additional cardiovascular risk factor) between April 1, 2000 and March 31, 2011 were included. Patients with previous cardiovascular events, already on antihypertensive drugs, and pregnant women were excluded. Change in blood pressure over time was modeled using linear mixed models with repeated measurement. Results: Hypertension was diagnosed in 2595 of 10,361 eligible patients. Of those, 869 initiated antihypertensive treatment. For patients treated for hypertension, we found a mean (95% confidence interval) decrease in systolic and diastolic blood pressure of 20.82 (21.06 to 20.58) mm Hg and 20.89 (21.05 to 20.73) mm Hg/yr, respectively. Factors associated with a decline in systolic blood pressure were baseline blood pressure, presence of chronic kidney disease, cardiovascular events, and the typical risk factors for cardiovascular disease. In patients with hypertension, increase in systolic blood pressure [(hazard ratio 1.18 (1.06 to 1.32) per 10 mm Hg increase], total cholesterol, smoking, age, and cumulative exposure to protease inhibitor-based and triple nucleoside regimens were associated with cardiovascular events. Conclusions: Insufficient control of hypertension was associated with increased risk of cardiovascular events indicating the need for improved management of hypertension in HIV-infected individuals. Copyright © 2012 by Lippincott Williams & Wilkins.

PubMed | University of Lausanne, University of Zürich, University of Geneva, University of Basel and 2 more.
Type: | Journal: AIDS care | Year: 2017

Physical activity (PA) can improve cardiorespiratory status, strength, body composition and quality of life for patients infected with HIV. Evidence from HIV-uninfected populations also shows that PA is associated with a lower risk of mortality, primarily death due to cardiovascular causes. There is, however, a lack of data on how physically active HIV-infected patients are. In this study, we assessed levels of self-reported PA over time in patients enrolled in the Swiss HIV Cohort Study, a large multicentre prospective observational cohort study. We included a total of 10,540 patients who completed at least one report of PA between December 2009 and November 2014 during routine clinical follow-up (scheduled every 6 months). In the first year after December 2009 there was a higher rate of non-response so these data are of a lesser reliability. Over the next four years, the percentage of patients reporting no free-time PA at all declined from 49% to 44%. In contrast, in two Sport Switzerland surveys of the general population in 2008 and 2014, the percentage of individuals reporting no sports activities at all was considerably lower and relatively stable over time (27% in 2008; 26% in 2014). In our analysis, the percentage of patients reporting sedentary activity at work increased from 23% to 26% over the four years. Subgroup findings suggest differences between women and men and between patients classified by their age, stage of infection and CD4 cell count. Integrating PA counselling into the routine care of HIV-infected patients and promoting PA among this population has the potential to improve the general state of health and quality of life for HIV-infected patients and reduce their risk of cardiovascular disease.

Muzzarelli S.,University of Basel | Brunner-La Rocca H.,Maastricht University | Pfister O.,University of Basel | Foglia P.,Regional Hospital of Locarno | And 3 more authors.
European Journal of Heart Failure | Year: 2010

Aims To assess adherence to medical treatment in patients with heart failure (HF) using a specific questionnaire and measurement of the serum concentration of digoxin.Methods and resultsForty patients with symptomatic HF and a clinical indication for digoxin were included in this pilot study. The assessment of adherence to the medical regime was based on two different methods: (i) the CARDIA-Questionnaire and (ii) the measurement of serum digoxin concentration (SDC) at 1 and 6 months. All patients were placed on digoxin treatment (target SDC 0.6-0.8 ng/mL) at baseline. Poor adherence was defined if the patient self-reported taking ≤75 of the prescribed HF medication or had an SDC < 0.4 ng/mL (subtherapeutic range) at the follow-up visits. During the entire follow-up, the proportion of patients with poor adherence was 15 as assessed by the questionnaire, 20 as assessed by the SDC, and 25 if both methods were combined.ConclusionAlthough HF is a symptomatic disease, the proportion of patients with poor adherence to the medical regime in our study was high (up to 25). The objective methodology based on the measurement of the SDC identified a higher number of patients with poor adherence when compared with the CARDIA-Questionnaire. © The Author 2010.

Casini A.,University of Geneva | Lukowski S.,University of Geneva | Quintard V.L.,The Surgical Center | Crutu A.,The Surgical Center | And 4 more authors.
Thrombosis Research | Year: 2014

Introduction Causative mutations leading to congenital quantitative fibrinogen are frequently clustered in FGA encoding the fibrinogen Aα-chain. Mutations of FGB encoding the Bβ-chain are less common and of interest since the Bβ-chain is considered the rate-limiting factor in the hepatic production of the fibrinogen hexamer. Method Four novel FGB mutations were identified in two afibrinogenemic (one new-born and one 30 years old male) and hypofibrinogenemic (a 49 years old female) patient, with heterogeneous thrombotic and bleeding phenotype. The human fibrinogen beta chain precursor protein sequence (P02675) was obtained from the UniProt database. The resulting models were analysed in SwissPdbViewer 4.1 and POV-Ray 3.7. Results The FGB c.895 T>C p.Y299H (numbering from the initiator Met) and the FGB c.1415G>T p.G472V were predicted to be deleterious by SIFT analysis. The first replaces an uncharged aromatic amino acid side chain by a positively charged side chain modifying the balance in the distribution of hydrophobic and hydrophilic of the 10 Å neighbourhood residues. The second replaces one non-charged aliphatic side chain by another without any changes for the 10 Å surrounding region. The FGB c.352C>T p.Q118X leads to a severe premature termination codon and the FGB intron 4: IVS4-1G>C (c719-1G>C) leads to skipping of exon 5 or usage of a cryptic acceptor site located upstream or downstream of the normal site. Conclusions The continuous characterization of novel molecular defects responsible for fibrinogen deficiency combined with modelling of mutant proteins will continue to provide a better comprehension of the complexity of fibrinogen synthesis and physiology. © 2014 Elsevier Ltd. All rights reserved.

Sax H.,University of Geneva | Uckay I.,University of Geneva | Balmelli C.,Regional Hospital of Lugano | Bernasconi E.,Regional Hospital of Lugano | And 7 more authors.
Annals of Surgery | Year: 2011

Objective: To assess the overall burden of healthcare-associated infections (HAIs) in patients exposed and nonexposed to surgery. Background: Targeted HAI surveillance is common in healthcare institutions, but may underestimate the overall burden of disease. Methods: Prevalence study among patients hospitalized in 50 acute care hospitals participating in the Swiss Nosocomial Infection Prevalence surveillance program. Results: Of 8273 patients, 3377 (40.8%) had recent surgery. Overall, HAI was present in 358 (10.6%) patients exposed to surgery, but only in 206 (4.2%) of 4896 nonexposed (P < 0.001). Prevalence of surgical site infection (SSI) was 5.4%. Healthcare-associated infections prevalence excluding SSI was 6.5% in patients with surgery and 4.7% in those without (P < 0.0001). Patients exposed to surgery carried less intrinsic risk factors for infection (age >60 years, 55.6% vs 63.0%; American Society of Anesthesiologists score >3, 5.9% vs 9.3%; McCabe for rapidly fatal disease, 3.9% vs 6.6%; Charlson comorbidity index >2, 12.3% vs 20.9%, respectively; all P < 0.001) than those nonexposed, but more extrinsic risk factors (urinary catheters, 39.6% vs 14.1%; central venous catheters, 17.8% vs 7.1%; mechanical ventilation, 4.7% vs 1.3%; intensive care stay, 18.3% vs 8.8%, respectively; all P<0.001). Exposure to surgery independently predicted an increased risk of HAI (odds ratio 2.43; 95% CI 2.0-3.0). Conclusions: Despite a lower intrinsic risk, patients exposed to surgery carried more than twice the overall HAI burden than those nonexposed; almost half was accountable to SSI. Extending infection control efforts beyond SSI prevention in these patients might be rewarding, especially because of the extrinsic nature of risk factors. Copyright © 2011 by Lippincott Williams & Wilkins.

PubMed | Regional Hospital of Lugano, Swiss Tropical and Public Health Institute, University of Geneva, Center Hospitalier du Valais Romand and Hopital Intercantonal de la Broye
Type: | Journal: Swiss medical weekly | Year: 2016

High blood pressure, the single leading health risk factor worldwide, contributes greatly to morbidity and mortality. This study aimed to add to the understanding of diagnosed and undiagnosed high blood pressure in Switzerland and to evaluate adherence to hypertension guidelines.Included were 3962 participants from the first (2001-2003) and second (2010-2011) follow-ups of the population-based Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults. High blood pressure was defined as blood pressure 140/90 mm Hg and the prevalence of doctor-diagnosed hypertension was based on questionnaire information.High blood pressure was found in 34.9% of subjects, 49.1% of whom were unaware of this condition; 30.0% had doctor-diagnosed hypertension and, although 82.1% of these received drug treatments, in only 40.8% was blood pressure controlled (<140/90 mm Hg). Substantial first-line beta-blocker use and nonadherence to comorbidity-specific prescription guidelines were observed and remained mostly unexplained. Age-adjusted rates of unawareness and uncontrolled hypertension were more than 20% higher than in the USA.There is room for improvement in managing hypertension in Switzerland. Population-based observational studies are essential for identifying and evaluating unmet needs in healthcare; however, to pinpoint the underlying causes it is imperative to facilitate linkage of cohort data to medical records.

Posabella A.,Regional Hospital of Lugano | Galetti K.,Regional Hospital of Lugano | Engelberger S.,Regional Hospital of Lugano | Giovannacci L.,Regional Hospital of Lugano | And 2 more authors.
Rare Tumors | Year: 2014

We report a case of a 63-years-old woman with a ten years history of increasing abdominal girth with associated abdominal pain. Abdomino-pelvic ultrasound and computed tomography scan revealed a large left ovarian cyst. The patient underwent laparotomy, resection of ovarian cyst and hysterectomy with bilateral ovarian resection. The removed huge mucinous cystadenoma, weighed 27 kg. Her post-operative course was unremarkable. © A. Posabella, et al., 2014 Licensee PAGEPress, Italy.

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