Impiego degli Inibitori della Pompa protonica (IPP) in Piemonte: indagine sulle abitudini prescrittive dei Medici di Medicina Generale

Proton Pump Inhibitors (PPIs) (Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole and Esomeprazole), one of the most commonly prescribed classes of medications in the primary care setting, are considered a major advance in the treatment of acid-peptic diseases. In Italy PPIs are reimbursed by National Health Service on the basis of CUF (Commissione Unica del Farmaco) 1 and 48 Notes. In 2002 and 2003 a significant increase in PPIs consumption and expenditure have been documented, showing differences between regions. The aim of this study is to investigate and monitor, at regional level, type and entity of PPIs use through a drug utilization study, evaluating prescribing behaviour and compliance of PPIs treatments with CUF Notes indications. The study has been carried out on a sample of 436 General Practitioners belonging to 22 Piemonte's ASL (Aziende Sanitarie Locali). The data analysis shows that acid-related pathologies are significantly more common in patients with at least 50 years of age and the most frequent condition is represented by gastroesophageal reflux disease. Despite the general conditions of PPIs use by General Practitioners in terms of duration and dosage of therapy result in most cases (from 49% to 80% for duration and from 54% to 97% for dosage) compliant with what proposed by CUF Notes, in some cases the same CUF Notes indications seem to be not observed. Consequently the Piemonte Region has decided to plan a guideline on PPIs rational use. Such guideline, expected to be introduced in the regional area, may also be considered as an instrument able to lead to a more appropriate expenditure for this drug class. Moreover, in order to control PPIs expenditure, pharmacoeconomic methodologies can be applied allowing to identify the most cost - effective active substance and therapeutic scheme, overcoming CUF Notes which consider all PPIs use under the same reimbursement conditions

Reproductive biology in the swamp eel Synbranchus marmoratus Bloch 1745 (Teleostei : Synbranchidae). Oogenesis and hormonal of final maturation and ovulation

El presente trabajo se dividió en dos panes. En el capítulo 1 se describió anatomo-liistológicamente el ovario. Se caracterimron las etapas de la oogénesis y la dinámica ovárica anual, que mostró cuatro periodos diferentes: (l) reproductivo, (2) de regresión, (3) de reposo y (4) Vitelogénesis. También se analimron la estructura y función de los centros melano-macrofágicos encontrados en las gónadas. Por último se describió a nivel ultraestructural la aparición y formación de las membranas oocitarias durante el desarrollo folicular. En el capítulo 2 fueron identificados los factores dc liberación de gonadotrofinas (GnRH) presentes en cerebro (variantes salmón y chicken-II). En hipóftsis no se inmunodetectó ninguna forma. Se analizaron las posibles causas. Finalmente se realizaron experiencias de inducción de la maduración final y ovulación de gametas usando un análogo superactivo de GnRH y un antagonista dopaminergico. Los efectos se evaluaron utilizando los siguientes parámetros: (l) liberación de gametas, (2) Histología gonadal y (3) niveles de esteroides sexuales en sangre. Los resultados obtenidos demostraron que: (l) El tratamiento no produjo liberación de gametas, (2) Las gónadas femeninas mostraron inicio de reversión sexual en la totalidad de los casos y (3) los niveles de testosterona y estradiol en sangre aumentaron significativamente respecto de los animales control

Emergency-department accesses in home care paediatric patients: Occurrence and risks of use in a six-year retrospective investigation in Northern Italy

OBJECTIVE: To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. METHODS: A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. RESULTS: A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). CONCLUSION: The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use