SantAntonio Abate Hospital
SantAntonio Abate Hospital
Vidale S.,SantAnna Hospital |
Arnaboldi M.,SantAnna Hospital |
Bezzi G.,Sondrio Hospital |
Bono G.,University of Insubria |
And 9 more authors.
International Journal of Stroke | Year: 2012
Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the diagnostic workup exceeds the time limit. In this article, we described the design of a study conducted in the northern Lombardy, within the district of Sondrio, Lecco, Como, and Varese. The awaited results of this study are reduction of avoidable delay, organization of an operative stroke emergency network, and identification of highly specialized structures. The study schedules education and data registration with implementation and training of acute stroke management algorithms. The use of standardized protocols during prehospital and in-hospital phase can optimize acute stroke pathways. The results of this study could contribute to the assessment of an effective and homogeneous health system to manage acute stroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.
Baroncini D.,SantAntonio Abate Hospital |
Ghezzi A.,SantAntonio Abate Hospital |
Annovazzi P.O.,SantAntonio Abate Hospital |
Colombo B.,San Raffaele Hospital |
And 7 more authors.
Multiple Sclerosis | Year: 2016
Background: Natalizumab and fingolimod have not been compared in controlled trials but only in observational studies, with inconclusive results. Objectives: The objective of this study is to compare the effect of natalizumab and fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS). Methods: We included all consecutive RRMS patients switched from first-line agents (glatiramer acetate/interferons) to natalizumab or fingolimod, with a follow-up of 24 months. Data of relapses, Expanded Disability Status Scale score and brain magnetic resonance imaging (MRI) scans were collected. We used propensity score (PS) matching and intention-to-treat analysis. Results: We retained 102 patients in each cohort after PS matching, with similar baseline characteristics. More patients discontinued natalizumab compared to fingolimod (33% vs 11%, p < 0.001), mainly for progressive multifocal leukoencephalopathy (PML) concern. No serious adverse events occurred in the two cohorts. Compared to fingolimod, the natalizumab group presented a higher percentage of relapse-free patients (66% vs 80%, p = 0.015), a higher percentage of disability-improved patients (6% vs 15%, p = 0.033), a lower percentage of MRI-active patients (38% vs 14%, p = 0.001) and a higher percentage of patients with no evidence of disease activity (NEDA-3; 44% vs 70%, p < 0.001) after 2 years of follow-up. Disability worsening was not statistically different in the two groups. Conclusion: Natalizumab is superior to fingolimod in RRMS patients non-responding to first-line agents. © The Author(s), 2015.
PubMed | San Raffaele Hospital, San Raffaele Scientific Institute and SantAntonio Abate Hospital
Type: Journal Article | Journal: Multiple sclerosis (Houndmills, Basingstoke, England) | Year: 2016
Natalizumab and fingolimod have not been compared in controlled trials but only in observational studies, with inconclusive results.The objective of this study is to compare the effect of natalizumab and fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis (RRMS).We included all consecutive RRMS patients switched from first-line agents (glatiramer acetate/interferons) to natalizumab or fingolimod, with a follow-up of 24months. Data of relapses, Expanded Disability Status Scale score and brain magnetic resonance imaging (MRI) scans were collected. We used propensity score (PS) matching and intention-to-treat analysis.We retained 102 patients in each cohort after PS matching, with similar baseline characteristics. More patients discontinued natalizumab compared to fingolimod (33% vs 11%, p<0.001), mainly for progressive multifocal leukoencephalopathy (PML) concern. No serious adverse events occurred in the two cohorts. Compared to fingolimod, the natalizumab group presented a higher percentage of relapse-free patients (66% vs 80%, p=0.015), a higher percentage of disability-improved patients (6% vs 15%, p=0.033), a lower percentage of MRI-active patients (38% vs 14%, p=0.001) and a higher percentage of patients with no evidence of disease activity (NEDA-3; 44% vs 70%, p<0.001) after 2years of follow-up. Disability worsening was not statistically different in the two groups.Natalizumab is superior to fingolimod in RRMS patients non-responding to first-line agents.
PubMed | Sondrio Hospital, AREU Lombardy Emergency Urgency Regional Agency, Niguarda Ca Granda Hospital, SantAnna Hospital and 5 more.
Type: | Journal: International journal of cardiology | Year: 2016
Thrombolysis represents the best therapy for ischemic stroke but the main limitation of its administration is time. The avoidable delay is a concept reflecting the effectiveness of management pathway. For this reason, we projected a study concerning the detection of main delays with following introduction of corrective factors. In this paper we describe the results after these corrections.Consecutive patients admitted for ischemic stroke during a 3-months period to 35 hospitals of a macro-area of Northern Italy were enrolled. Each time of management was registered, identifying three main intervals: pre-hospital, in-hospital and total times. Previous corrective interventions were: 1.increasing of population awareness to use the Emergency Medical Service (EMS); 2.pre-notification of Emergency Department; 3.use of high urgency codes; 4.use of standardised operational algorithm. Statistical analysis was conducted using time-to-event analysis and Cox proportional hazard regression.1084 patients were enrolled. EMS was alerted for 56.3% of subjects, mainly in females and severe strokes (p<0.001). Thrombolytic treatment was performed in 4.7% of patients. Median pre-hospital and in-hospital times were 113 and 105min, while total time was 240. High urgency codes at transport contributed to reduce pre-hospital and in-hospital time (p<0.05). EMS use and high urgency codes promoted thrombolysis. Treatment within 4.5hours from symptom onset was performed in 14% of patients more than the first phase of study.The implementation of an organizational system based on EMS and concomitant high urgency codes use was effective to reduce avoidable delay and to increase thrombolysis.
PubMed | Boston Scientific Italia, SS Giacomo e Cristoforo Hospital, S Giovanni Battista Hospital, Card G Panico Hospital and 14 more.
Type: | Journal: International journal of cardiology | Year: 2016
Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation.We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6months, 220 (71%) patients showed a 10% reduction in LVESV. The median [25th-75th] QI was 14.3% [7.2-21.4] and was significantly related to reverse remodeling (r=+0.22; 95%CI: 0.11-0.32, p=0.0001). The cut-off value of QI that best predicted LV reverse remodeling after 6months of CRT was 12.5% (sensitivity=63.6%, specificity=57.1%, area under the curve=0.633, p=0.0002). The time to the event death or cardiovascular hospitalization was significantly longer among patients with QI>12.5% (log-rank test, p=0.0155), with a hazard ratio (HR) of 0.3 [95%CI: 0.11-0.78]. In the multivariate regression model adjusted for baseline parameters, a 10% increment in QI (HR=0.61[0.44-0.83], p=0.002) remained significantly associated with CRT response.Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodeling and better outcome from death or cardiovascular hospitalization. QI is an easy-to-measure variable that could be used to predict CRT response at the time of pacing site selection or pacing configuration programming.
Granata A.,St Giovanni Of Dio Hospital |
Zanoli L.,University of Catania |
Insalaco M.,St Giovanni Of Dio Hospital |
Valentino M.,Santantonio Abate Hospital |
And 6 more authors.
Clinical and Experimental Nephrology | Year: 2015
Grey-scale ultrasound has an important diagnostic role in nephrology. The absence of ionizing radiations and nephrotoxicity, rapidity of execution, excellent repeatability, the possibility to perform the test at the patient’s bed and the low cost represent important advantages of this technique. Paired with real-time sonography and colour-power-Doppler contrast-enhanced ultrasound (CEUS) reduces the diagnostic gap with computed tomography (CT) and magnetic resonance (MR) and represents a major step in the evolution of clinical ultrasound. Although there are several situations in which contrast-enhanced CT and MR are indicated (i.e. evaluation of cystic or ischemic lesions, traumatisms and ablative therapies of the native and transplanted kidney), the use of CT contrast media presents a high risk of contrast-induced nephropathy (i.e. in elderly people, subjects with comorbidities and those with renal dysfunction), while gadolinium-based RM contrast agents are contraindicated for the risk of nephrogenic systemic fibrosis (i.e. in patients with severe renal dysfunction). In these situations, CEUS may be a viable alternative, however, as any technique associated with the infusion of pharmacological substances, the potential advantages and risks of CEUS should be critically evaluated. In this regard, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has published the guidelines for the use of CEUS for the kidney imaging and the International Contrast Ultrasound Society (ICUS) has been recently founded. The aim of this review is to offer an updated overview of the potential applications of CEUS in nephrology, reporting some indications and possible risks associated to its use. © 2014, Japanese Society of Nephrology.
Rizzello V.,San Giovanni Addolorata Hospital |
Rizzello V.,Coordinating Center |
Lucci D.,Coordinating Center |
Maggioni A.P.,Coordinating Center |
And 7 more authors.
Acute Cardiac Care | Year: 2012
Background: The Italian network on acute coronary syndromes outcome (IN-ACS Outcome) study is a nationwide observational, multicenter study with the aim to describe clinical epidemiology, management, 30-days and one-year outcomes of ACS in Italy. Methods: All consecutive patients admitted for ACS to 38 hospitals, between December 2005 and February 2007, were enrolled in the study. Patient in-hospital details and follow-up data at 30-days and one-year were collected using a web-based CRF and stored in a central database. Results: A total of 6045 patients (age 68 ± 13 years) were enrolled: 2313 patients (38.3%) had ST elevation myocardial infarction (STEMI) and 3732 (61.7%) patients had NSTE-ACS. Primary PCI was performed in 1085 (46.9%) STEMI patients, thrombolysis in 590 (25.5%) patients, whereas 638 (27.6%) patients were not reperfused. Among patients with NSTE-ACS, coronary angiography was performed in 2797 (75%) patients, PCI in 1797 (48.2%) patients and CABG in 213 (5.7%) patients. Thirty-days and one-year mortality rates were 5.8% and 9.8%, in STEMI patients and 3.1% and 8.6%, in NSTE-ACS patients. Conclusions: The IN-ACS Outcome study showed that the management of ACS is still suboptimal. Although 30-days mortality is low, the one-year mortality is still substantial. © 2012 Informa UK, Ltd.
Geraci A.,Santa Maria del Prato Hospital |
Zatta D.,Santa Maria del Prato Hospital |
Strazzabosco C.,Santa Maria del Prato Hospital |
Tomasello G.,University of Palermo |
And 4 more authors.
Minerva Ortopedica e Traumatologica | Year: 2012
Aim: Osteoarthritis (OA) is a degeneration of articular cartilage. Four components of the cartilage structure, glucosamine, chondroitin collagen type II and hyaluronic acid are available in a food supplement. It has been claimed that they reduce the pain of OA and help rebuild cartilage in patients with early OA. Methods: A multicentre, randomized, double-blind ascorbic acid controlled study was carried out in patients with osteoarthritis of the knee. The purpose of the study was to evaluate the effectiveness of a food supplement sachet containing glucosamine sulfate (500 mg), chondrotin sulfate (400 mg), hydrolyzed collagen type II and hyaluronic acid mixture (300 mg), L-carnitine fumarate (345 mg). One hundred twenty patients suffering from osteoarthritis of the knee were randomized into 2 groups. Sixty randomized patients in group A received a single sachet daily for 60 days. Sixty randomized patients in group B received a placebo sachet daily containing 1 gram of ascorbic acid. Clinical follow-up was performed at 2, 4, 8, and 12 weeks. The degree of knee pain was assessed using a VAS score. WOMAC score, KOOS scale and Lequesne index were used to assess the knee injury and OA outcome score. Results: The reduction of VAS score from baseline through week 12 was statistically significant only in group A (P<0.05). WOMAC and KOOS scales showed improvement only in Group A for pain at week 4, for stiffness and difficulty in carrying out normal physical activities at week 8. Also the Lequesne index showed an improvement exclusively in group A, after week 4. Conclusion: The results show that the combination of substances contained in the food supplement studied can be considered as a response to pain symptoms in patients with mild to moderate osteoarthritis.
Zagnoni S.,Santantonio Abate Hospital
Journal of Cardiovascular Medicine | Year: 2016
AIMS: Several studies have shown sex differences in acute coronary syndromes (ACS), but their understanding is far from complete. Thus, the study aims to evaluate sex differences in management and outcomes of unselected patients with ACS. METHODS AND RESULTS: From 22 April 2009 to 29 December 2010, 6394 consecutive patients with ACS (44.7% ST-elevation myocardial infarction) were prospectively enrolled and followed for 6 months. Women (N?=?1894, 29.6%) were older, had more comorbidities, and worse clinical presentation than men. Fewer women underwent reperfusion [68.0% women vs. 84.1% men, P?0.0001, adjusted odds ratio (OR): 0.53, 95% confidence interval (CI): 0.43–0.66] in ST-elevation myocardial infarction, and coronary angiography during hospitalization (72.2% women vs. 81.1% men, P?0.0001, adjusted OR: 0.70, 95% CI: 0.57–0.85) in no-ST-elevation ACS. Women had worse outcomes than men during hospitalization, and at 6-month follow-up. At multivariable analysis, female sex was significantly associated with a higher risk of in-hospital Thrombolysis in Myocardial Infarction major bleedings (OR: 1.80, 95% CI: 1.09–2.96, P?=?0.02), but not of 6-month death. CONCLUSION: Women with ACS in clinical practice present a clustering of high-risk features that may contribute to their worse outcomes as compared with men, although female sex is not an independent predictor of death at 6-month follow-up. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.