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Buonfrate D.,Sacro Cuore Hospital
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin | Year: 2016

Strongyloides stercoralis is a soil-transmitted helminth widely diffused in tropical and subtropical regions of the world. Autochthonous cases have been also diagnosed sporadically in areas of temperate climate. We aimed at defining the epidemiology of strongyloidiasis in immigrants and Italians living in three northern Italian Regions. Screening for S. stercoralis infection was done with serology, confirmation tests were a second serological method or stool agar culture. A case-control approach was adopted and patients with a peripheral eosinophil count ≥ 500/mcL were classified as cases. Of 2,701 individuals enrolled here 1,351 were cases and 1,350 controls; 86% were Italians, 48% women. Italians testing positive were in 8% (97/1,137) cases and 1% (13/1,178) controls (adjusted odds ratio (aOR) 8.2; 95% confidence interval (CI): 4.5-14.8), while positive immigrants were in 17% (36/214) cases and in 2% (3/172) controls (aOR 9.6; 95% CI: 2.9-32.4). Factors associated with a higher risk of infection for all study participants were eosinophilia (p < 0.001) and immigration (p = 0.001). Overall, strongyloidiasis was nine-times more frequent in individuals with eosinophilia than in those with normal eosinophil count. This article is copyright of The Authors, 2016.


Benetos A.,University of Lorraine | Benetos A.,Nancy University Hospital Center | Labat C.,University of Lorraine | Rossignol P.,University of Lorraine | And 9 more authors.
JAMA Internal Medicine | Year: 2015

IMPORTANCE: Clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals older than 80 years. However, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality. OBJECTIVE: To assess all-cause mortality in institutionalized individuals older than 80 years according to systolic BP (SBP) levels and number of antihypertensive drugs. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study included elderly residents of nursing homes. The interaction between low (<130 mm Hg) SBP and the presence of combination antihypertensive treatment on 2-year all-cause mortality was analyzed. A total of 1127 women and men older than 80 years (mean, 87.6 years; 78.1% women) living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Blood pressure was measured with assisted self-measurements in the nursing home during 3 consecutive days (mean, 18 measurements). Patients with an SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants. MAIN OUTCOMES AND MEASURES: All-cause mortality over a 2-year follow-up period. RESULTS: A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in patients with low SBP who were receiving multiple BP medicines compared with the other participants. Three sensitivity analyses confirmed the significant excess of risk: propensity score-matched subsets (unadjusted HR, 1.97; 95% CI, 1.32-2.93; P < .001; adjusted HR, 2.05; 95% CI, 1.37-3.06; P < .001), adjustment for cardiovascular comorbidities (HR, 1.73; 95% CI, 1.29-2.32; P < .001), and exclusion of patients without a history of hypertension who were receiving BP-lowering agents (unadjusted HR, 1.82; 95% CI, 1.33-2.48; P < .001; adjusted HR, 1.76; 95% CI, 1.28-2.41; P < .001). CONCLUSIONS AND RELEVANCE: The findings of this study raise a cautionary note regarding the safety of using combination antihypertensive therapy in frail elderly patients with low SBP (<130 mm Hg). Dedicated, controlled interventional studies are warranted to assess the corresponding benefit to risk ratio in this growing population. Copyright 2015 American Medical Association. All rights reserved.


De Bari B.,University of Lausanne | Alongi F.,Sacro Cuore Hospital | Lestrade L.,Hopitaux Universitaires Of Geneva Hug | Giammarile F.,University Claude Bernard Lyon 1
Critical Reviews in Oncology/Hematology | Year: 2014

Among PET radiotracers, FDG seems to be quite accepted as an accurate oncology diagnostic tool, frequently helpful also in the evaluation of treatment response and in radiation therapy treatment planning for several cancer sites. To the contrary, the reliability of Choline as a tracer for prostate cancer (PC) still remains an object of debate for clinicians, including radiation oncologists. This review focuses on the available data about the potential impact of Choline-PET in the daily clinical practice of radiation oncologists managing PC patients. In summary, routine Choline-PET is not indicated for initial local T staging, but it seems better than conventional imaging for nodal staging and for all patients with suspected metastases. In these settings, Choline-PET showed the potential to change patient management. A critical limit remains spatial resolution, limiting the accuracy and reliability for small lesions. After a PSA rise, the problem of the trigger PSA value remains crucial. Indeed, the overall detection rate of Choline-PET is significantly increased when the trigger PSA, or the doubling time, increases, but higher PSA levels are often a sign of metastatic spread, a contraindication for potentially curable local treatments such as radiation therapy. Even if several published data seem to be promising, the current role of PET in treatment planning in PC patients to be irradiated still remains under investigation. Based on available literature data, all these issues are addressed and discussed in this review. © 2014 Elsevier Ireland Ltd.


Santini M.,San Filippo Neri Hospital | Gasparini M.,Instituto Clinico Humanitas | Landolina M.,Fondazione Policlinico S. Matteo IRCCS | Lunati M.,Niguarda Ca Granda Hospital | And 8 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives The purpose of this analysis was to evaluate the correlation between atrial tachycardia (AT) or atrial fibrillation (AF) and clinical outcomes in heart failure (HF) patients implanted with a cardiac resynchronization therapy defibrillator (CRT-D). Background In HF patients, AT and AF have high prevalence and are associated with compromised hemodynamic function. Methods Forty-four Italian cardiological centers followed up 1,193 patients who received a CRT-D according to current guidelines for advanced HF, New York Heart Association functional class 10 min occurred in 361 of 1,193 (30%) patients. The composite end point (deaths or HF hospitalizations) occurred in 174 of 1,193 (14.6%). Multivariate time-dependent Cox regression analyses showed that composite end point risk was higher among patients with device-detected AT/AF (hazard ratio [HR]: 2.16, p = 0.032), New York Heart Association functional class III or IV compared with II (HR: 2.09, p = 0.002), and absence of beta-blockers (HR: 1.36, p = 0.036). Furthermore, the composite end point risk was inversely associated with left ventricular ejection fraction (HR: 1.04, p = 0.045), increasing by a factor of 4% for each 1% decrease in left ventricular ejection fraction. Conclusions In HF patients with CRT-D, device-detected AT/AF is associated with a worse prognosis. Continuous device diagnostics monitoring and Web-based alerts may inform the physician of AT/AF occurrences and identify patients at risk of cardiac deterioration or patients with suboptimal rate or rhythm control. (Italian ClinicalService Project; NCT01007474) © 2011 American College of Cardiology Foundation.


Requena-Mendez A.,University of Barcelona | Chiodini P.,London School of Hygiene and Tropical Medicine | Bisoffi Z.,Sacro Cuore Hospital | Buonfrate D.,Sacro Cuore Hospital | And 2 more authors.
PLoS Neglected Tropical Diseases | Year: 2013

Background: Strongyloidiasis is frequently under diagnosed since many infections remain asymptomatic and conventional diagnostic tests based on parasitological examination are not sufficiently sensitive. Serology is useful but is still only available in reference laboratories. The need for improved diagnostic tests in terms of sensitivity and specificity is clear, particularly in immunocompromised patients or candidates to immunosuppressive treatments. This review aims to evaluate both conventional and novel techniques for the diagnosis of strongyloidiasis as well as available cure markers for this parasitic infection. Methodology/Principal Findings: The search strategy was based on the data-base sources MEDLINE, Cochrane Library Register for systematic review, EmBase, Global Health and LILACS and was limited in the search string to articles published from 1960 to August 2012 and to English, Spanish, French, Portuguese and German languages. Case reports, case series and animal studies were excluded. 2003 potentially relevant citations were selected for retrieval, of which 1649 were selected for review of the abstract. 143 were eligible for final inclusion. Conclusions: Sensitivity of microscopic-based techniques is not good enough, particularly in chronic infections. Furthermore, techniques such as Baermann or agar plate culture are cumbersome and time-consuming and several specimens should be collected on different days to improve the detection rate. Serology is a useful tool but it might overestimate the prevalence of disease due to cross-reactivity with other nematode infections and its difficulty distinguishing recent from past (and cured) infections. To evaluate treatment efficacy is still a major concern because direct parasitological methods might overestimate it and the serology has not yet been well evaluated; even if there is a decline in antibody titres after treatment, it is slow and it needs to be done at 6 to 12 months after treatment which can cause a substantial loss to follow-up in a clinical trial. © 2013 Requena- Méndez et al.


News Article | November 21, 2016
Site: www.eurekalert.org

A suite of sensors can predict heart failure events by detecting when a patient's condition is worsening, according to John Boehmer, professor of medicine, Penn State College of Medicine, who presented the findings at the recent American Heart Association annual meeting in New Orleans. Heart failure is responsible for more than 1 million hospitalizations each year and more than $20 billion in costs. The new technique could help prevent costly hospitalizations and poor health outcomes, including death. Current efforts to manage heart failure by monitoring weight and symptoms have not significantly reduced hospitalizations. More than one in five patients are readmitted within 30 days after being hospitalized for heart failure. An international team of researchers, which included Boehmer set out to investigate if implantable devices already used in heart failure patients could be retrofitted with sensors to track their condition. Their results will also be published in JACC Heart Failure. Nine hundred heart failure patients were followed for up to one year. At the beginning of the study, the researchers uploaded software to each patient's implanted defibrillator, a battery-powered device that delivers an electric shock if the patient's heart stops beating. The software allowed the defibrillators to also act as sensors, monitoring the patients' heart rate, activity, breathing, heart sounds and electrical activity in the chest. Over the study period, the suite of sensors detected 70 percent of heart failure events in patients. This detection was often more than a month before the events occurred. Sensitivity at this level far exceeded the researchers' goal of greater than 40 percent detection. While there were false positives, the number was within an acceptable range. "If you're going to monitor a hundred patients, it becomes a fairly manageable number of alerts that you have to deal with," said Boehmer, a cardiologist at Penn State Health Milton S. Hershey Medical Center. Boston Scientific developed the system -- which they named HeartLogic -- and funded the study. "This is a new and clinically valuable measure of worsening heart failure, and it combines a number of measures of the physiology and heart failure, much like a doctor will look at a patient," Boehmer said. "Doctors look at all their signs and symptoms, get some tests, and put it all together and make a decision about how well or ill the patient is. HeartLogic does it similarly. It integrates a number of measurements of what's going on with the patient, including breathing, activity and heart sounds, and puts that all together to give us an index that we believe is both sensitive and specific for heart failure." In this way, Boehmer said, the technology can help monitor the patient's condition so heart failure events can be prevented before they happen. "It's like having high blood sugar, if you're managing diabetes," Boehmer explained. "The doctor doesn't need to know about every high blood sugar and every high blood sugar doesn't result in a hospitalization. But you want to treat it before it gets very high and the patient becomes so symptomatic they become ill and end up in the hospital. This is the same concept." A pilot study and intervention trials to test the system's safety, physician acceptance and use, and patient outcomes, are planned to investigate benefits to patients. Other researchers on this project were Ramesh Hariharan, University of Texas Physicians, EP Heart, Houston, Texas; Fausto G. Devecchi, Cardiac Arrhythmia Service, Lutheran Health Network, Fort Wayne, Indiana; Andrew L. Smith, Emory University, Atlanta, Georgia; Giulio Molon, Cardiology Dept, Sacro Cuore Hospital, Negrar, Italy; Alessandro Capucci, Università Politecnica delle March, Ancona, Italy; Qi An, Viktoria Averina, Craig M. Stolen, Pramodsingh H. Thakur, Julie A. Thompson, Ramesh Wariar, and Yi Zhang, all at Boston Scientific, St. Paul, Minnesota; and Jagmeet P. Singh, Massachusetts General Hospital Heart Center, Boston, Massachusetts.


Ballestri S.,Pavullo Hospital | Ballestri S.,University of Modena and Reggio Emilia | Lonardo A.,University of Modena and Reggio Emilia | Bonapace S.,Sacro Cuore Hospital | And 3 more authors.
World Journal of Gastroenterology | Year: 2014

Non-alcoholic fatty liver disease (NAFLD) has emerged as a public health problem of epidemic proportions worldwide. Accumulating clinical and epidemiological evidence indicates that NAFLD is not only associated with liver-related morbidity and mortality but also with an increased risk of coronary heart disease (CHD), abnormalities of cardiac function and structure (e.g., left ventricular dysfunction and hypertrophy, and heart failure), valvular heart disease (e.g., aortic valve sclerosis) and arrhythmias (e.g., atrial fibrillation). Experimental evidence suggests that NAFLD itself, especially in its more severe forms, exacerbates systemic/hepatic insulin resistance, causes atherogenic dyslipidemia, and releases a variety of pro-inflammatory, pro-coagulant and pro-fibrogenic mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications. Collectively, these findings suggest that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions to decrease the risk for CHD and other cardiac/arrhythmic complications. The purpose of this clinical review is to summarize the rapidly expanding body of evidence that supports a strong association between NAFLD and cardiovascular, cardiac and arrhythmic complications, to briefly examine the putative biological mechanisms underlying this association, and to discuss some of the current treatment options that may influence both NAFLD and its related cardiac and arrhythmic complications. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.


Bonapace S.,Sacro Cuore Hospital | Perseghin G.,San Raphael Scientific Institute | Perseghin G.,University of Milan | Molon G.,Sacro Cuore Hospital | And 5 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - Data on cardiac function in patients with nonalcoholic fatty liver disease (NAFLD) are limited and conflicting. We assessed whether NAFLD is associated with abnormalities in cardiac function in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - We studied 50 consecutive type 2 diabetic individuals without a history of ischemic heart disease, hepatic diseases, or excessive alcohol consumption, in whom NAFLD was diagnosed by ultrasonography. A tissue Doppler echocardiography with myocardial strain measurement was performed in all patients. RESULTS - Thirty-two patients (64%) had NAFLD, and when compared with the other 18 patients, age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, and medication use were not significantly different. In addition, the left ventricular (LV) mass and volumes, ejection fraction, systemic vascular resistance, arterial elasticity, and compliance were also not different. NAFLD patients had lower e′ (8.2 ± 1.5 vs. 9.9 ± 1.9 cm/s, P < 0.005) tissue velocity, higher E-to-e′ ratio (7.90 ± 1.3 vs. 5.59 ± 1.1, P < 0.0001), a higher time constant of isovolumic relaxation (43.1 ± 10.1 vs. 33.2 ± 12.9 ms, P < 0.01), higher LV-end diastolic pressure (EDP) (16.5 ± 1.1 vs. 15.1 ± 1.0 mmHg, P < 0.0001), and higher LV EDP/end diastolic volume (0.20 ± 0.03 vs. 0.18 ± 0.02 mmHg, P < 0.05) than those without steatosis. Among the measurements of LV global longitudinal strain and strain rate, those with NAFLD also had higher E/global longitudinal diastolic strain rate during the early phase of diastole (E/SR E). All of these differences remained significant after adjustment for hypertension and other cardiometabolic risk factors. CONCLUSIONS - Our data show that in patients with type 2 diabetes and NAFLD, even if the LV morphology and systolic function are preserved, early features of LV diastolic dysfunction may be detected. © 2012 by the American Diabetes Association.


Buonfrate D.,Sacro Cuore Hospital | Requena-Mendez A.,Barcelona Center for International Health Research Hospital Clinic | Angheben A.,Sacro Cuore Hospital | Munoz J.,Barcelona Center for International Health Research Hospital Clinic | And 3 more authors.
BMC Infectious Diseases | Year: 2013

Background: Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.Methods: We conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions.Results: Records screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%).Conclusions: Proper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS. © 2013 Buonfrate et al.; licensee BioMed Central Ltd.


Buonfrate D.,Sacro Cuore Hospital | Formenti F.,Sacro Cuore Hospital | Perandin F.,Sacro Cuore Hospital | Bisoffi Z.,Sacro Cuore Hospital
Clinical Microbiology and Infection | Year: 2015

Strongyloides stercoralis differs from the other soil-transmitted helminths because it puts infected subjects at risk of a fatal syndrome (in cases of immunosuppression for medical conditions, immunosuppressant therapies, or both). Chronic strongyloidiasis is often a non-severe condition, or is sometimes even asymptomatic, but diagnosis and effective therapy are essential in order to eradicate the infection and the life-long risk involved. Therefore, diagnostic methods need to be highly sensitive. Stool microscopy and the Kato-Katz technique are commonly used in prevalence studies, but they are inadequate for S.stercoralis detection. This is probably the main reason why the global prevalence has long been underestimated. Concentration methods, the Baermann technique and Koga agar plate culture have better, but still unsatisfactory, sensitivity. Serological tests have demonstrated higher sensitivity; although some authors have concerns about their specificity, it is possible to define cut-off values over which infection is almost certain. In particular, the luciferase immunoprecipitation system technique combined with a recombinant antigen (NIE) demonstrated a specificity of almost 100%. ELISA coproantigen detection has also shown promising results, but still needs full evaluation. Molecular diagnostic methods are currently available in a few referral centres as in-house techniques. In this review, on the basis of the performance of the different diagnostic methods, we outline diagnostic strategies that could be proposed for different purposes, such as: prevalence studies in endemic areas; individual diagnosis and screening; and monitoring of cure in clinical care and clinical trials. © 2015 The Authors.

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