The HCV Sicily Network: a web-based model for the management of HCV chronic liver diseases

Epidemiological studies report that in Sicily reside about 30,000 citizens with a diagnosis of chronic hepatitis due to HCV. The availability of direct antiviral action (DAA) is a real therapeutic breakthrough, but the high cost of the therapeutic regimes limits their use and forced the National Health System to establish clinical priority for the treatment

Diagnostic accuracy of fecal calprotectin assay in distinguishing organic causes of chronic diarrhea from irritable bowel syndrome: a prospective study in adults and children

Fecal calprotectin (FC) has been proposed as a marker of inflammatory bowel disease (IBD), but few studies have evaluated its usefulness in patients with chronic diarrhea of various causes. We evaluated the diagnostic accuracy of a FC assay in identifying "organic" causes of chronic diarrhea in consecutive adults and children

Linee guida per la diagnosi, il trattamento e il supporto dei pazienti affetti da demenza

Il termine demenza descrive una serie di sintomi cognitivi, comportamentali e psicologici che possono includere perdita di memoria, difficoltà di ragionamento e di comunicazione e cambiamenti della personalità che compromettono la capacità di svolgere le attività quotidiane. Nel 2013 un rapporto della Alzheimer’s Society ha rilevato che nel Regno Unito erano circa 815.000 le persone affette da demenza (prevalenza 1/14 abitanti di età >65 anni), un numero destinato ad aumentare sino a 1.143.000 entro il 2025. Nel novembre 2017 erano 456.739 i pazienti con una diagnosi certa di demenza nei registri di medicina generale, rispetto ai 290.000 del periodo 2009-2010, la differenza in gran parte imputabile ad un aumento del numero di diagnosi. Nonostante questo miglioramento nella diagnosi della demenza, si stima che circa 1 caso su 3 non venga riconosciuto correttamente; inoltre, circa la metà delle persone affette da demenza non riceve un adeguato supporto dopo la diagnosi. Questo articolo riassume le raccomandazioni più recenti del National Institute for Health and Care Excellence (NICE) per la valutazione, la gestione e il supporto delle persone affette da demenza e dei loro caregiver. La linea guida (LG) aggiorna e sostituisce integralmente la LG NICE sulla demenza del 2006. Raccomandazioni, dettagli completi delle evidenze e il PDTA sono disponibili sul sito del NICE. Le raccomandazioni del NICE sono basate su revisioni sistematiche delle migliori evidenze disponibili e su una esplicita considerazione della costo-efficacia. Quando le evidenze disponibili sono limitate, le raccomandazioni sono basate sull’esperienza del gruppo che ha prodotto la linea guida – Guideline Development Group’s (GDG) – e sulle norme di buona pratica clinica. I livelli di evidenza delle raccomandazioni cliniche sono indicati in corsivo tra parentesi quadre

Long-term follow-up of hepatitis C virus-positive patients with persistently normal serum transaminases

Material and methods. This study prospectively evaluated the progression of liver disease in a group of anti-HCV-positive patients with persistently normal ALT levels (PNALT) who were HCV-RNA positive. Patients selected for this study were those who presented with PNALT according to the Italian Association for the Study of the Liver (AISF) criteria in the year 1995/96 and underwent liver biopsy. They were divided into two groups according to their ALT evolution. Forty-five patients were included in this study. Results. After a median follow-up time of 180 months twenty-five of them maintained PNALT, but two of these developed liver cirrhosis (LC) in a mean time of 174 and 202 months, respectively). Twenty patients had flares of ALT and three of them developed LC in a mean time of 162-178 months. Twelve of these patients underwent current antiviral treatment; six patients were SVR. At baseline, the 5 patients who progressed to LC had age and BMI significantly higher than patients without LC (P < 0.005 and P < 0.01, respectively). Grading (P < 0.006) and staging (P < 0.003) were also more severe at histology, while serum HDL-C levels were statistically lower (P < 0.002). Comparing patients with flares of transaminases with and without LC, we found a significant difference at baseline for age, BMI, HDL-C, grading and staging (P < 0.05; P < 0.01 and P < 0.003, respectively). Conclusion. In HCV-RNA positive patients associated with PNALT the grade of disease activity increased over the years in only half of patients and a higher degree of liver fibrosis at baseline was the major relevant factor for progression

Management of Patients with Gastric or Gastroesophageal Junction Cancer: From Theory to Integrated Clinical Path- ways Implementation in the Real World

Introduction: Best care of esophagogastric junction and gastric cancer (EGC) requires a complex, timely interaction between members of a multi-disciplinary team (MDT). An integrated clinical pathway (ICP) is necessary to achieve this goal as well as the implementation of its use in daily practice. The objective of this study was to elaborate on an integrated clinical pathway for the multi-disciplinary management of ECG. Authors also put in act an implementation program to improve adherence to guidelines thought an ICP. Method: This prospective work carried out by a multi-institutional MDT in Italy identified expert panel extracted relevant recommendations and/or statements from published papers and guidelines obtaining a set of crucial interventions employed the Estimate-Talk-Estimate method. A flow-chart diagram was elaborated to elicit the process at a glance. The primary outcome measure was the elaboration of an ICP with a high consensus rate also reported as a snapshot diagram and its implementation in daily clinical practice. An accredited certification body agency validated results, and an implementation process was started in several hospitals known to treat ECG. Results: A methodologist aggregated a multi-disciplinary panel of experts from different institutions. The panel elaborated a flow-chart diagram with crucial intervention highlight and connecting lines, as well as outcome measures. An accredited certification body agency validated the entire process, representing the basis for empowerment and implementation among patients and oncological professionals in various hospitals. Conclusion: The multi-disciplinary and multi-institutional expert panel successfully elaborated on a validated ICP for all stages ECG. An in-hospital implementation program has been programmed

European Society of ColoProctology: guideline for haemorrhoidal disease

Aim: The goal of this European Society of ColoProctology project was to establish a multidisciplinary, international guideline for haemorrhoidal disease (HD) and to provide guidance on the most effective (surgical) treatment for patients with HD. Methods: The development process consisted of six phases. In phase one we defined the scope of the guideline. The patient population included patients with all stages of haemorrhoids. The target group for the guideline was all practitioners treating patients with haemorrhoids and, in addition, healthcare workers and patients who desired information regarding the treatment management of HD. The guideline needed to address both the diagnosis of and the therapeutic modalities for HD. Phase two consisted of the compilation of the guideline development group (GDG). All clinical members needed to have affinity with the diagnosis and treatment of haemorrhoids. Further, attention was paid to the geographical distribution of the clinicians. Each GDG member identified at least one patient in their country who could read English to comment on the draft guideline. In phase three review questions were formulated, using a reversed process, starting with possible recommendations based on the GDG’s knowledge. In phase four a literature search was performed in MEDLINE (Ovid), PubMed, Embase (Ovid) and the Cochrane Database of Systematic Reviews. The search was focused on existing systematic reviews addressing each review question, supplemented by other studies published after the time frame covered by the systematic reviews. In phase five data of the included papers were extracted by the surgical resident (RT) and checked by the methodologist (JK) and the GDG. If needed, meta-analysis of the systematic reviews was updated by the surgical resident and the methodologist using Review Manager. During phase six the GDG members decided what recommendations could be made based on the evidence found in the literature using GRADE. Results: There were six sections: (i) symptoms, diagnosis and classification; (ii) basic treatment; (iii) outpatient procedures; (iv) surgical interventions; (v) special situations; (vi) other surgical techniques. Thirty-four recommendations were formulated. Conclusion: This international, multidisciplinary guideline provides an up to date and evidence based summary of the current knowledge of the management of HD and may serve as a useful guide for patients and clinicians

Current epidemiology of HCV in Sicily: the RESIST-HCV model

Background: Real-world data to guide hepatitis C virus (HCV)- related public health initiatives and linkage to care of patients are lacking in our region. Aims: To describe the epidemiological features of a large cohort of patients with chronic HCV infection from Sicily included in a regional network aimed at DAA treatment (RESIST-HCV). Methods: Demographic and clinical data were recorded on a web-based platform before starting treatment with DAAs. Gender, year of birth, HCV genotype, co-infections, stages of liver disease and co-morbidities were analyzed. Chi-square with Yates correc- tion was appliedto assess the differences between cohorts. Results: Overall, 15,270 patients were registered on the HCV- RESIST platform from March 2015 to March 2019. The analysis of demographic and viral features showed a clear-cut bimodal distribution, defining two cohorts of patients. The first (cohort 1) includes 9.939 patients (65%) born between the years 1930 and 1959, while the second (cohort 2) included 5.331 patients (35%) born between 1960 and 1999. When comparing the two cohorts, cohort 1 had a higher rate of infection with HCV Gt 1b or 2 (90% vs 47%; p&lt;0.0001), higher rate of cirrhosis (49.5% vs 37.5% in cohort 2; p &lt; 0.001), hepatocellular carcinoma (3.3% vs 0.6%; p &lt; 0.0001), diabetes (26.8% vs 10.3%; p &lt; 0.0001) and of arterial hypertension (50.4% vs 13.5%; p &lt; 0.0001). By converse, in cohort 2 there was a higher proportion of males (71.3% vs 48.7%; p &lt; 0.0001), subjects na\uefve to IFN-based treatment (66.2% vs 62.5%; p &lt; 0.0001), infection with HCV Gt 1a, 3 or 4 (53% vs 10%; p &lt; 0.0001), HIV co-infection (7.8% vs 1%; p &lt; 0.0001), and PWIDs(12% vs 1%; p &lt; 0.0001). Conclusions: In Sicily, a region where HCV is still endemic, chronic HCV infection has a bimodal distribution, with two dif- ferent cohorts affected. One cohort reflects a first epidemic wave, mostly fueled by Gt 1b and 2, through unsafe medical prac- tices and non-sexual intrafamilial spreading between 1940 and 1990. About half of these patients has developed cirrhosis and many have co-morbidities that may worsen the prognosis. Another cohort originated between 1970 and 2000 mostly through nee- dle sharing and unsafe sex, thus frequently associating with HIV, and is sustained mostly by Gt1a and 3. In order to reach the WHO elimination targets by 2020, graduated screening poli- cies according to this mode of distribution of HCV should be devised