Prospective evaluation of hepatic steatosis in HIV-infected patients with or without hepatitis C virus co-infection

SummaryBackgroundLimited data are available on hepatic steatosis (HS) in HIV patients who are not infected with hepatitis C virus (HCV). The aims of this study were to assess the prevalence of HS and its risk factors in HIV patients with and without HCV infection, and to evaluate whether HS correlates with advanced liver fibrosis and/or cardiovascular disease risk.MethodsFifty-seven HIV mono-infected and 61 HIV/HCV co-infected patients were enrolled consecutively. All patients underwent liver ultrasound and transient elastography. The main parameters of liver function, HIV and HCV viral loads, CD4+ cell counts, and data on highly active antiretroviral therapy (HAART) were recorded. Cardiovascular disease risk was evaluated using the 10-year Framingham risk score.ResultsHS prevalence in the whole HIV population was 53% (54% in mono-infected patients and 51% in co-infected patients). HS was associated with lipodystrophy and triglyceride values (p1 year (p<0.01). By multivariate analysis, only triglyceride levels (p<0.02) and Framingham risk score (p<0.05) were independently associated with HS in both HIV groups. No correlation was observed between HS and advanced liver fibrosis, measured by transient elastography.ConclusionsHS was common in HIV patients, occurring in about half of the population. HS was found to be linked with the Framingham risk score, but was not correlated with advanced liver fibrosis. We suggest that in our HIV population with HS, the burden of cardiovascular disease risk is greater than that of liver disease progression

Vitamin D and Osteoporosis in HIV/HCV Coinfected Patients: A Literature Review

Vitamin D deficiency further increases the risk of osteoporosis in HIV-positive patients coinfected with hepatitis C virus (HCV); however, it is still unclear whether HCV-related increased fracture risk is a function of the severity of liver disease. The aim of this review was to identify studies on associative vitamin D deficiency patterns in high-risk populations such as HIV/HCV coinfected patients. We did this by searching MEDLINE and EMBASE databases, from inception to August 2014, and included bibliographies. The final 12 articles selected are homogeneous in terms of age but heterogeneous in terms of sample size, participant recruitment, and data source. Most of the HIV/HCV coinfected patients have less than adequate levels of vitamin D. After reviewing the selected articles, we concluded that vitamin D deficiency should be regarded as a continuum and that the lower limit of the ideal range is debatable. We found that vitamin D deficiency might influence liver disease progression in HIV/HCV coinfected patients. Methodological issues in evaluating vitamin D supplementation as a relatively inexpensive therapeutic option are discussed, as well as the need for future research, above all on its role in reducing the risk of HCV-related fracture by modifying liver fibrosis progression

Relazione tecnica sulle attività della campagna oceanografica “Evatir 2011”

La campagna oceanografica “Evatir 2011”, condotta a bordo della N/O “G. Dallaporta”, è stata la seconda campagna di valutazione acustica della biomassa pelagica nelle acque del Tirreno condotta grazie alla collaborazione tra i ricercatori dell’IAMC-CNR e del VNIRO di Mosca. Le ricerche condotte in tale periodo sono state finalizzate principalmente alla valutazione della biomassa e della distribuzione spaziale delle popolazioni di piccoli pelagici. Le specie target sono le principali specie commerciali di piccoli pelagici in Mediterraneo, ovvero l’acciuga (Engraulis encrasicolus) e la sardina (Sardina pilchardus). Si tratta di specie a ciclo di vita breve caratterizzate da ampie oscillazioni interannuali nella biomassa. Negli anni in cui i livelli di biomassa sono particolarmente bassi l’effetto di un elevato sforzo di pesca porterebbe ad un collasso di tali risorse anche da un anno all’altro. Il collasso di tali specie è stato ben documentato in letteratura mostrando che i tempi di recupero sono molto lunghi e hanno effetti socio-economici catastrofici anche sulle comunità marinare che vivono grazie agli introiti derivanti dalla pesca e commercializzazione di prodotti in scatola. Sono stati nel contempo acquisiti dati CTD al fine di studiare possibili influenze delle variabili ambientali sulla distribuzione spaziale delle specie oggetto di studio

Relazione tecnica sulle attività della campagna oceanografica “Evatir 2015”

La campagna oceanografica “EVATIR 2015”, condotta a bordo della N/O “G. Dallaporta”, è la quinta campagna di valutazione acustica della biomassa pelagica nelle acque del Tirreno condotta dall’IAMC-CNR. La campagna è parte integrante del Progetto "Estensione della Campagna acustica Medias (Mediterranean International Acoustic Survey) nelle sub aree geografiche (GSA) 9 (Mar Ligure e Mar Tirreno settentrionale) e 10 (Mar Tirreno centrale e meridionale)" (CUP n. J52I15002440006), finanziato dal Mipaaf nell'ambito del Fondo Europeo per gli Affari Marittimi e la Pesca (FEAMP). Infatti, il FEAMP prevede un sostegno per le attività di raccolta e gestione e utilizzo dei dati, così come previsto all’art. 25, parr. 1 e 2, del Reg. (UE) 1380/2013 e ulteriormente specificato nel Reg. (CE) 199/2008. Le ricerche condotte in tale periodo sono state finalizzate principalmente alla valutazione della biomassa e della distribuzione spaziale delle popolazioni di piccoli pelagici ed allo studio delle relative condizioni ambientali. Le specie target del progetto sono l’acciuga europea (Engraulis encrasicolus) e la sardina (Sardina pilchardus), specie chiave sia a livello commerciale che ecologico. Le specie ittiche di piccoli pelagici, come sardine e acciughe, rappresentano uno dei prodotti sbarcati più importanti dalle marinerie del Mediterraneo e siciliane. Purtroppo, la gestione di queste risorse è abbastanza complicata poiché si tratta di specie a breve ciclo di vita, caratterizzate da ampie oscillazioni interannuali nella abbondanza dello stock dovuta principalmente al fallimento del reclutamento annuale. La variabilità nel reclutamento e le conseguenti oscillazioni di biomassa sono principalmente legate alla variabilità di habitat e in misura minore allo sforzo di pesca. L’obiettivo principale dei piani di monitoraggio di queste risorse si basa sulla possibilità di valutare di anno in anno le fluttuazioni di abbondanza dello stock e il conseguente livello di reclutamento, al fine di una della gestione sostenibile della pesca delle risorse stesse

Quality assurance for automatically generated contours with additional deep learning

Objective: Deploying an automatic segmentation model in practice should require rigorous quality assurance (QA) and continuous monitoring of the model’s use and performance, particularly in high-stakes scenarios such as healthcare. Currently, however, tools to assist with QA for such models are not available to AI researchers. In this work, we build a deep learning model that estimates the quality of automatically generated contours. Methods: The model was trained to predict the segmentation quality by outputting an estimate of the Dice similarity coefficient given an image contour pair as input. Our dataset contained 60 axial T2-weighted MRI images of prostates with ground truth segmentations along with 80 automatically generated segmentation masks. The model we used was a 3D version of the EfficientDet architecture with a custom regression head. For validation, we used a fivefold cross-validation. To counteract the limitation of the small dataset, we used an extensive data augmentation scheme capable of producing virtually infinite training samples from a single ground truth label mask. In addition, we compared the results against a baseline model that only uses clinical variables for its predictions. Results: Our model achieved a mean absolute error of 0.020 ± 0.026 (2.2% mean percentage error) in estimating the Dice score, with a rank correlation of 0.42. Furthermore, the model managed to correctly identify incorrect segmentations (defined in terms of acceptable/unacceptable) 99.6% of the time. Conclusion: We believe that the trained model can be used alongside automatic segmentation tools to ensure quality and thus allow intervention to prevent undesired segmentation behavior

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p &lt; 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p &lt; 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p &lt; 0.0001) or urgent (20.4% vs. 38.5%; p &lt; 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p &lt; 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P &lt; 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes

La Scienza e l'immaginario

L’attività di divulgazione della cultura scientifica ha un ruolo fondamentale sulla società, sia in termini di applicazioni innovative che di pianificazione dell’ambiente. I ricercatori dell’IAS-CNR di Capo Granitola operano da anni nell’ambito della diffusione della cultura scientifica, attraverso processi complessi e percorsi di divulgazione in partnership con istituti scolastici del territorio, realizzando attività seminariali, convegni direttamente nelle scuole, nonché visite didattiche guidate degli alunni nei laboratori dell’Istituto ed esperimenti interdisciplinari sull’ambiente marino. Tali processi divulgativi si sono sviluppati creando numerosi percorsi, in maniera per certi aspetti analoga a quella per cui dalla mescolanza dei tre colori fondamentali si è in grado di ottenere un numero pressoché illimitato di tinte diverse. Lo scopo di questa “mescolanza” è stato quello di ottenere un ventaglio di competenze e strumentazioni che consentissero di indagare i differenti aspetti dell’ecosistema marino da diversi punti di vista ed in maniera sinergica, tale da restituire un quadro il più ricco possibile di “tinte” e particolari. (Scienza e arte di Salvatore Mazzola) La Scienza e l'immaginario di Angela Cuttitta. Il progetto “La Scienza e l’Immaginario” nasce dalla collaborazione tra l’IAS - CNR di Capo Granitola e l’Accademia di Belle Arti di Palermo, che attraverso un approccio multidisciplinare ha voluto sperimentare l’unione tra il mondo scientifico e quello artistico, mettendo i giovani artisti, attraverso proiezioni e seminari scientifici, nelle condizioni di scoprire il mondo dell’ambiente marino e degli ecosistemi in esso presenti. Il progetto è nato dalla consapevolezza di come sia necessario operare sul piano della diffusione e divulgazione della cultura scientifica nei più vasti contesti sociali, a partire dall’ambito scolastico. Le azioni divulgative mirano, infatti, a diffondere la conoscenza dei processi geologici, chimico-fisici, climatici e biologici in modo pervasivo, non limitato a singole categorie/settori. La funzione strategica di tali azioni è quella di stimolare idee ed iniziative nonché di sviluppare una maggiore sensibilità nei confronti dei fenomeni che ci circondano, quale presupposto essenziale per una corretta programmazione politico-gestionale. Lo spirito che ha mosso tutte gli attori del progetto è stato quello di sensibilizzare gli studenti nei confronti della tutela delle risorse marine proprie del loro territorio e di sviluppare e promuovere la cultura come volano dello sviluppo sostenibile, della pace e dell’integrazione sociale, in armonia con quanto indicato dal Consiglio Europeo di Lisbona 2000. Grazie al lavoro di docenti e di ricercatori, l’arte come forma espressiva si è rivelata uno strumento valido e innovativo di divulgazione della cultura scientifica e ha portato alla creazione di suggestioni sui ragazzi che hanno percepito e realizzato forme e armonie espresse in questa mostra. L’impegno per questa manifestazione rappresenta, quindi, un appuntamento importante con le forze vive siciliane nel campo delle scienze del mare segnatamente ad esperti di biologia, chimica, fisica ed al mondo fantastico dell’arte, al fine di esprimere con le varie tecniche pittoriche un momento di riflessione culturale

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population