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Sant'Elia Fiumerapido, Italy

Di Marco V.,University of Palermo | D'Ambrosio R.,University of Milan | Bronte F.,University of Palermo | Saracco G.,Unita di Gastroenterologia | And 22 more authors.
Digestive and Liver Disease | Year: 2016

Background: Iron overload and hepatitis C virus (HCV) infection together can lead to chronic liver damage in thalassemia major (TM) patients. Aims: We investigated viral, genetic, and disease factors influencing sustained virological response (SVR) after peg-interferon and ribavirin therapy in TM patients with HCV infection. Methods: We analyzed 230 TM patients with HCV infection (mean age 36.0 ± 6.3 years; 59.1% genotype 1; 32.2% genotype 2; 3.4% genotype 3; and 5.3% genotype 4; 28.7% carried CC allele of rs12979860 in IL28B locus; 79.6% had chronic hepatitis and 20.4% cirrhosis; 63.5% naive and 36.5% previously treated with interferon alone) treated in 14 Italian centers. Results: By multivariate regression analysis SVR was independently associated with CC allele of IL28B SNP (OR 2.98; CI 95% 1.29-6.86; p = 0.010) and rapid virologic response (OR 11.82; CI 95% 3.83-36.54; p < 0.001) in 136 genotype 1 patients. Combining favorable variables the probability of SVR ranged from 31% to 93%. In genotype 2 patients, only RVR (OR 8.61; CI 95% 2.85-26.01; p < 0.001) was associated with SVR higher than 80%. In 3 patients with cirrhosis a decompensation of liver or heart disease were observed. Over 50% of patients increased blood transfusions. Conclusion: Dual therapy in TM patients with chronic HCV infection is efficacious in patients with the best virological, genetic and clinical predictors. Patients with cirrhosis have an increased risk of worsening liver or heart disease. © 2016 Editrice Gastroenterologica Italiana S.r.l..

Mazzotta E.,Unita di Malattie Infettive | Agostinone A.,Unita di Malattie Infettive | Rosso R.,University of Genoa | Di Biagio A.,University of Genoa | And 7 more authors.
Journal of Bone and Mineral Metabolism | Year: 2011

Osteonecrosis (ON) is a rare disabling complication occurring in patients with human immunodeficiency virus (HIV) infection at a higher frequency than in the general population despite effective combination antiretroviral therapy being made available, as recently documented by several retrospective studies. We designed a multicentric case-control study among HIV-infected patients cared for at institutions in the Italian CISAI group (Italian Study Group for Adverse Events in HIV Infection) to search for additional predictors of ON in this special population. All centers which observed at least one case of ON were requested to report data for central re-evaluation. Parallel HIV-positive, ON-free controls were randomly selected and matched with confirmed cases of ON for sex, age and CD4 T-cell counts at the time of HIV diagnosis. Fifteen cases and controls were included in the final sample. Univariate statistical analyses revealed a significant association between ON and exposure to steroids (P = 0.001), exposure to one or more drugs in addition to HAART (Highly Active Anti-Retroviral Therapy) (P = 0.03), high titers of total serum IgE (P = 0.02), loss of working ability (P = 0.03), triglycerides levels over 200 mg/dL before antiretrovirals (P = 0.03) and cholesterol levels over 200 mg/dL before and after antiretrovirals (P = 0.03 and 0.05, respectively). High serum IgE levels and loss of working ability in advance of ON appeared for the first time as possible predictors of ON in HIV patients, while long-term exposure to steroids, combined hyperlipemia and chronic treatment with other drugs in addition to antiretrovirals were confirmed. Predicting and preventing ON in the individual HIV-infected patient is therefore a clinically challenging opportunity. © 2010 The Japanese Society for Bone and Mineral Research and Springer.

Perilli M.,Applicate | Bottoni C.,Applicate | Grimaldi A.,Unita di Malattie Infettive | Segatore B.,Applicate | And 5 more authors.
Diagnostic Microbiology and Infectious Disease | Year: 2013

The frequency of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae is increasing in Italian hospitals and poses an emerging threat to the management of infections in hospitalized patients. In this study, we report a detailed molecular characterization of a K. pneumoniae subsp. pneumoniae KP1/11 isolate from the decubitus ulcer of a hospitalized patient with a serious infection. K. pneumoniae KP1/11 produces KPC-3 and VIM-2 β-lactamases. The blaKPC-3 gene is harbored in a large plasmid in a complex structure of Tn3-based transposon, Tn4401a. The chromosomal DNA of K. pneumoniae harbored also 2 class 1 integrons with different variable regions: 1) orfD-aacA8; 2) aacA29-blaVIM-2. © 2013 Elsevier Inc.

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