Investigation of the effects of vitamin D and calcium on intestinal motility: In vitro tests and implications for clinical treatment

The presence of vitamin D receptors in small intestine muscle cells may lead one to think that vitamin D may act locally, influencing intracellular calcium concentration and contributing to the contraction-relaxation regulation of the intestinal smooth muscle cells. This study investigates the potential effects of vitamin D and calcium on intestinal motility using an in vitro test. Different calcium concentrations added to the tissue not pre-treated with 1,25-dihydroxycholecalciferol [1α,25(OH)2D3] produced no response at low doses (1.25×10–3 and 2.0×10–3 mol L–1) and only a very weak response at higher concentration (3.0×10–3 mol L–1). The addition of 1α,25(OH)2D3 (1.44×10–10 mol L–1) had no effect on isolated ileum motility. When calcium (3.0×10–3 mol L–1) was added after at least 3 hours, it evoked evident and persistent contractions for 60-90 minutes. The contractions were at about 40 % of the peak produced by acetylcholine.Thus, simultaneous intake of vitamin D and calcium might be a useful co-adjuvant in intestinal atony therapy aimed to stimulate normal gut motility in humans. These findings imply that supplemental vitamin D may be important in all cases where calcium has to be prescribed

Ruptured hepatoblastoma: A case report and literature review

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A world wide public health problem: the principal re-emerging infectious diseases.

The extraordinary progress in the knowledge of infectious disease, the discovery of antibiotics and effective vaccines are among the great achievement of the nineteenth and twentieth centuries. These achievement have led to a dramatic reduction in the levels of mortality from these diseases. According to the World Health Organization, the term "re-emerging infectious diseases" refers to infectious diseases, which although well known, have not been of recent public health importance. However, climate change, migration, changes in health services, antibiotic resistance, population increase, international travel, the increase in the number of immune-depressed patients ,etc have lead to the re-emergence of these diseases. The climate changes are exposing sectors of the population to inadequate fresh air, water, food and resources for survival which, in consequence, provoke increases in both internal and international migration. In this particular period in which we find ourselves, characterized by globalization, the international community has become aware that the re-emergence of these diseases poses an important risk for public health underlines the necessity to adopt appropriate strategies for their prevention and control. The re-emerging diseases of the twenty-first century are a serious problem for public health and even though there has been enormous progress in medical science and in the battle against infectious diseases, they are still a long way from being really brought under control. A well organized monitoring system would enable the epidemiological characteristics of the infectious diseases to be analyzed and the success or otherwise of preventive interventions to be precisely evaluated. For this reason, the World Health Organization and the European Union have discussed the formation of a collaborative network for the monitoring and control of re-emerging diseases and has initiated special programmes. The battle between humanity and infectious disease has a history lasting thousands of years and is destined to continue in the future emphasizing the need to adopt combined policies for the prevention and control of re-emerging diseases

Dietary habits in Italy: the importance of the Mediterranean diet.

The Mediterranean diet is the heritage of millennia of exchange of people, cultures and foodstuffs throughout the Mediterranean basin. This diet is characterized by abundance of vegetables and fruits, bread, fish, olive oil, poultry, a relatively low consumption of red meat and a moderate consumption of wine during a meal and is well-defined by the food pyramid. Nowadays a standard Western diet has become far more common in Italy, against Mediterranean diet, which stands as a model of health sustainability: it is therefore necessary also to promote suitable resource management and to support quality in food. Practical and large scale projects should be activated, aimed to produce advice about meals both for families and for the different kinds of community, respectively

REVISIONE DELLA LETTERATURA SUL COSTO-EFFICACIA DELLA VACCINAZIONE CONTRO IL PAPILLOMAVIRUS UMANO.

INTRODUZIONE: Il Papillomavirus umano (HPV) è una delle più frequenti Malattie Sessualmente Trasmesse (MST). L’infezione cronica con determinati sottotipi è la causa principale di cancro dell’utero e lesioni precancerose. Si stima che almeno il 50% della popolazione adulta si infetti con il virus nel corso della vita. La prevalenza dell’infezione nei soggetti affetti dal tumore o da lesioni precancerose varia dall’85% al 99%. Secondo l'Agenzia Internazionale per la Ricerca sul Cancro (IARC) oltre l'85% del carico globale di malattia si verifica nei paesi in via di sviluppo, dove rappresenta il 13% di tutti i tumori femminili. Ad alto rischio sono le regioni orientali e occidentali dell'Africa (Age Standardized Rates [ASR] superiore a 30 per 100.000), l’Africa meridionale (ASR 26,8 per 100.000), l’Asia meridionale e centrale (ASR 24,6 per 100.000), il Sud America e l’ Africa equatoriale (ASR 23.9 e 23,0 per 100.000 rispettivamente). I tassi sono più bassi in Asia occidentale, Nord America e Australia / Nuova Zelanda (ASR meno di 6 per 100.000). Il cancro cervicale rimane il tumore più comune nelle donne solo in Africa Orientale, Asia Centrale e Melanesia. Diversi paesi hanno condotto specifiche valutazioni di costo-efficacia sulla vaccinazione HPV; l'OMS raccomanda che il rapporto costo-efficacia della vaccinazione venga stabilito prima di essere offerta come parte dei programmi nazionali di vaccinazione. Obiettivo di questo studio è di fornire una rassegna degli studi costo-efficacia pubblicati sulla vaccinazione. MATERIALI E METODI: La ricerca bibliografica è stata condotta sul database scientifico MEDLINE per identificare gli articoli focalizzati sul rapporto costo-efficacia della vaccinazione. L'identificazione degli articoli è stata effettuata analizzando i titoli e gli abstract scaturiti dai risultati della ricerca; il testo completo di tutti i lavori è stato recuperato e letto al fine di identificare i lavori da prendere in considerazione per la revisione. La ricerca è stata limitata agli articoli in lingua inglese e i risultati sono aggiornati a Maggio 2014. Sono state escluse dall’analisi, review, editoriali, lettere. Il razionale per eventuali criteri di esclusione è dovuto principalmente alla mancanza di pertinenza di informazioni sulla costo-efficacia. RISULTATI: I risultati della letteratura sono presentati secondo i differenti paesi. Negli Stati Uniti il costo per QALY (Quality Adjusted Life Years) guadagnato con l'aggiunta della vaccinazione alle dodicenni insieme alle pratiche di screening già esistenti varia da $3,906 a$ 14,723 a seconda della versione del modello applicato (coorte vs popolazione), se si assumono come fattori la herd immunity, il tipo di HPV bersaglio del vaccino (bivalente, quadrivalente) e se vengono inclusi i benefici sulla prevenzione dei tumore associati all’HPV (anali, vulvari, orofaringei). Un altro studio statunitense invece ha valutato l’efficacia della vaccinazione nelle donne over 30 dimostrando che i benefici sono modesti. Nel Regno Unito vaccinare le dodicenni con il vaccino quadrivalente, considerando una copertura dell’80%, è costo-efficace considerando il limite di spesa di circa 30.000 £ per QALY guadagnato, se la durata media della protezione offerta dal vaccino è più di 10 anni. Un modello statunitense adattato al contesto italiano, assumendo un tasso di copertura sempre dell’80% per la coorte delle dodicenni, ha stimato un risparmio dell’1.5% e del 3% rispettivamente per quanto riguarda benefici per la salute e costi medici direttamente associati. La vaccinazione HPV assieme ai programmi di screening attuali consentirebbe di evitare in Italia 1.432 casi di cancro del collo dell'utero (-63,3%) e 513 decessi (-63,4%) rispetto al solo screening, con un rapporto incrementale costo-efficacia (ICER) di € 9.569 per ogni ulteriore anno di vita aggiustato anche per la qualità della vita (QALY). CONCLUSIONI: I risultati scaturiti dalla revisione degli studi economici dimostrano che la vaccinazione contro l'HPV produce benefici immediati dal punto di vista epidemiologico in termini di costi evitati specifici per i sistemi sanitari nazionali di ogni paese. Il rapporto costo-efficacia della vaccinazione contro l'HPV è stato confermato da vari studi anche se le stime variano a seconda delle ipotesi formulate. Gli studi considerati variano in base al tipo di modello utilizzato (dinamico, statico, ibrido) così come per l’assunzione rispetto al problema decisionale (prezzo del vaccino, outcomes, copertura vaccinale); per questo motivo una comparazione diretta può risultare impegnativa. Ad ogni modo i nostri risultati suggeriscono che i più importanti determinanti del costo efficacia sulla vaccinazione sono il prezzo del vaccino, l’efficacia della campagna di screening e il livello soglia costo-efficacia utilizzato. Tali risultati impongono ai decision-makers di superare ogni barriera che possa ostacolare il raggiungimento della tutela contro l'infezione da HPV. Sono auspicabili valutazioni future nei vari paesi alla luce dei risultati ottenuti che si concentrino sulle criticità che ancora sussistono

The HPV infection in males: an update.

The role of Human papillomavirus (HPV) in malignant and non-malignant genital diseases in females is well known and the corresponding epidemiological burden has been widely described, in males instead, less is known about the role of the virus in anal, penile and head and neck cancer, and the burden of malignant and non-malignant HPV-related diseases. There are many types of HPV that can infect the epithelium: some types can cause genital warts (low risk genotype), other types (high risk genotypes) can cause cancers of the penis, anus or oropharynx. Relative to females, males tend to be less knowledgeable about the infection: some may view its consequences as less likely and severe for themselves than for females, and thus could perceive vaccination as unnecessary. Including boys in the vaccination program generally exceeded conventional thresholds of good value for money, even under favorable conditions of vaccine protection and health benefits; however, uncertainty still exists in many areas that can either strengthen or attenuate the findings achieved

Le principali malattie infettive emergenti degli ultimi decenni.

Nell’ambito delle grandi conquiste dell’umanità,il XIX e XX secolo, ed in particolare gli anni a noi più vicini, devono essere ricordati per gli straordinari progressi sulla conoscenza delle malattie infettive che hanno rappresentato per millenni la principale causa di malattia e morte per l’uomo. Infatti ad opera della batteriologia, ed in particolare dei cosiddetti “cacciatori di microbi”, ossia scienziati, ricercatori, studiosi che con pochi mezzi a disposizione e rischiando esiti negativi (basti citare Jenner, Pasteur, Koch, ecc.) per la maggior parte delle malattie infettive sono stati scoperti gli agenti eziologici. Successivamente, grazie alla messa a punto di vaccini efficaci ed alla scoperta degli antibiotici, unitamente al miglioramento generalizzato delle condizioni di vita, milioni di persone sono state salvate permettendo la diminuzione dell’incidenza e della mortalità per malattie infettive quali il vaiolo, la tubercolosi, il colera, la poliomielite, la difterite, l’influenza ecc. Gli anni del ‘900 erano iniziati con una progressiva scomparsa delle malattie infettive, ma una modifica sostanziale della catena epidemiologica influenzata da complesse interazioni tra ospite agente patogeno e ambiente fisico,ecologico e sociale ha fatto emergere nuove malattie. Secondo l’OMS si considerano “malattie infettive emergenti” quelle dovute ad infezioni di nuova identificazione e, quindi precedentemente sconosciute, che possono riguardare la sanità pubblica a livello locale e internazionale. Nel 1976, in occasione di un convegno dell’American Legion negli Stati Uniti, si verificarono 182 casi di polmonite con 34 decessi attribuiti ad un microrganismo patogeno prima sconosciuto,la Legionella. Negli anni ’80, fu rilevata una forma di immunodeficienza acquisita dovuta all’HIV, virus responsabile dell’AIDS: la trasmissione all’uomo si deve ad un virus che ha compiuto, come nel 2003 per la SARS (Sindrome Acuta Respiratoria Grave), nel 2005 per l’influenza aviaria (H5 N1) e più recentemente nel 2010 per l’influenza suina (H1 N1), il cosiddetto “salto di specie” dall’animale all’uomo. Nella malattia di Creutzfeld-Jacob, o malattia della “mucca pazza” (BSE Encefalopatia Spongiforme Bovina), la trasmissione avviene per via alimentare attraverso un prione. Negli ultimi anni virus che si diffondevano soltanto in alcune aree del mondo hanno mostrato la capacità di emergere e di diffondersi a livello mondiale: in Italia nell’estate del 2007 si sono verificati casi di Chickungunya, virus trasmesso dalla zanzara tigre. Da quanto esposto è opportuno attuare strategie di prevenzione poichè la storia dell’umanità è sempre stata funestata da epidemie e pandemie che ne hanno condizionato a volte pesantemente l’evoluzione ed il progresso. Il nostro periodo storico, caratterizzato dalla globalizzazione, dispone di mezzi scientifici e tecnologici ad alto livello in grado di caratterizzare geneticamente gli agenti patogeni e di fare diagnosi precoce nell’uomo. L’informazione permette di affrontare coscientemente le situazioni di emergenza contenendo così paure ancestrali ed educando la popolazione ad un opportuno comportamento che ogni singola emergenza impone

Aging populations: the health and quality of life of the elderly.

The progressive tendency for the age structure of the population to shift towards the elderly has been observed in all developed countries and this has important implications for health, society, economics and epidemiology. According to the most recent estimates for the world, the number of persons aged over 60 years will double from the present number, 756 to 1400 millions by 2030. In Italy, by the year 2050, 34.6% of the population will be aged more than 65 years. This will have important implications for health. There are medical conditions that occur almost exclusively among the elderly and these are sometimes referred to as syndromes or geriatric pathologies; other conditions that can occur at younger ages, may present with different symptoms, and cause complications in the elderly. More than just the single pathologies, the presence of two or more conditions simultaneously may have a critical impact on the health status of the elderly. As their ages increase, the elderly may be considered "frail"; factors, not only physical but also psychological cognitive and social, contribute to this syndrome and all must be considered together in the diagnosis and treatment of the elderly patient. These subjects are at greater risk of physical and cognitive decline, disability and death. As the elderly are an increasing fraction of the total patient load, their problems require that the structure and organization of health services be accordingly adjusted and also that the cultural and professional training of doctors and other medical personnel is appropriate. As a consequence, the objective of governments should be to promote the health and the quality of life of the elderly and this would include primary secondary and tertiary prevention applied in a variety of different settings. The choice of the preventive measures should be determined by the general health status of the elderly individuals, of whom 60-75% are classified as healthy, 20-30% are diagnosed as suffering chronic diseases, and 2-10% are regarded as "frail". For pathologies which do not require hospitalization, among the other existing services there is also Integrated Home Help (Assistenza Domiciliare Integrata, ADI) and Medically Assisted Residences (Residenze Sanitarie Assistenziale, RSA)

The human papillomavirus vaccination: a review of the cost-effectiveness studies

Background. The Human Papillomavirus (HPV) is one of the most common sexually transmitted viruses, its infection with certain subtypes is the primary cause of cervical cancer. Several countries conducted specific cost-effectiveness evaluations toward HPV vaccination. The constant growth of healthcare demand, in an economic context characterized by limited resources, requires that the decision-making process be based on the comparison of alternative choices. This study offers an overview of the published cost-effectiveness studies about HPV vaccination. Bibliographic Retrieval Method. The research was performed on the scientific databases MEDLINE and SCOPUS in order to find out journal articles focused on cost-effectiveness of the HPV vaccination. The rational for any exclusion criteria of data in the search is mainly due to lack of relevance to cost-effectiveness information. Results. The literature results were presented according to different groups of countries worldwide. A total of 24 articles were finally retrieved. In spite of the different models and assumptions, most studies showed the cost-effectiveness of vaccination; only two studies considered the vaccination as not cost effective. Conclusion. HPV vaccination may determine a cost reduction for country-specific National Health Systems. However, the cost-effectiveness of universal HPV vaccination still remains an open debate. It is important that economic analysis of universal HPV vaccination adopts large perspectives than is the case with the existing literature, focusing on the critical issues that still exist in many areas. Reducing cost, increasing duration of efficacy, and integrating vaccines into existing screening and treatment procedures in a cost-effective manner are of crucial importance even as they are a major challenge.Background. The Human Papillomavirus (HPV) is one of the most common sexually transmitted viruses, its infection with certain subtypes is the primary cause of cervical cancer. Several countries conducted specific cost-effectiveness evaluations toward HPV vaccination. The constant growth of healthcare demand, in an economic context characterized by limited resources, requires that the decision-making process be based on the comparison of alternative choices. This study offers an overview of the published cost-effectiveness studies about HPV vaccination. Bibliographic Retrieval Method. The research was performed on the scientific databases MEDLINE and SCOPUS in order to find out journal articles focused on cost-effectiveness of the HPV vaccination. The rational for any exclusion criteria of data in the search is mainly due to lack of relevance to cost-effectiveness information. Results. The literature results were presented according to different groups of countries worldwide. A total of 24 articles were finally retrieved. In spite of the different models and assumptions, most studies showed the cost-effectiveness of vaccination; only two studies considered the vaccination as not cost effective. Conclusion. HPV vaccination may determine a cost reduction for country-specific National Health Systems. However, the cost-effectiveness of universal HPV vaccination still remains an open debate. It is important that economic analysis of universal HPV vaccination adopts large perspectives than is the case with the existing literature, focusing on the critical issues that still exist in many areas. Reducing cost, increasing duration of efficacy, and integrating vaccines into existing screening and treatment procedures in a cost-effective manner are of crucial importance even as they are a major challenge

A pilot study of the effect of pantothenic acid in the treatment of post-operative ileus: results from an orthopedic surgical department

Objectives. Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions. Patients and Methods. This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule. Results. 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001). Discussion. This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients. Clin Ter 2012; 163(3):e121-126OBJECTIVES: Post-operative ileus can also occur in other types of surgery not strictly related to abdomen. The objective of this study was to investigate the efficacy of pantothenic acid administration to stimulate intestinal peristalsis in case of post-operative ileus and estimate the most effective dose. This vitamin can be used for the treatment of chronic atonic intestine or for chronic constipation, but therapeutic indications are not precise in these conditions. PATIENTS AND METHODS: This pilot study has used patients divided in groups treated in post-operative period with physiological solution for patients in control group (Placebo) and Dexpantenolo, which is a derivative in alcohol of pantothenic acid, for all the actively treated patients. The treatments were administered intravenously during the second and third post-operative day, according to the treatment schedule. RESULTS: 60 patients were recruited and they were allocated to five treatment groups or one control group. For males, the median time of the first bowel evacuation was 90 hours while for females the median time was 84 hours (p=0.891). For patients who received a spinal anesthetic, the median time was 72 hours, while for those who received a peridural anesthetic the median time was 96 hours (p=0.571). Between six treatment groups, instead, there is a significant difference between the median times from the operation to the first bowel evacuation (p<0.001). Linear regression model obtained using as outcome evacuation hours after surgery show that only variable which significantly affects time between operation and the first bowel evacuation is treatment dose (Beta = -0.868, p<0.001). DISCUSSION: This study would seem to indicate that pantothenic acid is effective for treatment of post-operative intestinal ileus; there is a dose response relationship between pantothenic acid and the decreasing time from surgical operation to first bowel evacuation. However, this study is preliminary; further studies are necessary, preferably randomized and with a larger number of patients