Liver injury due to amoxicillin vs. amoxicillin/clavulanate: a subgroupnalysis of a drug-induced liver injury case-control study in Italy

Several studies showed that amoxicillin plus clavulanic acid (co-amoxiclav) is one of the most common agents associated to serious Drug Induced Liver Injury (DILI). We estimated the risk of acute serious DILI associated with amoxicillin alone compared with co-amoxiclav, through a multicenter case-control study carried out in nine Italian hospitals from October 2010 to January 2014.Cases were adults, with a diagnosis of acute liver injury. Controls presented acute clinical disorders, not related to chronic conditions and not involving the liver. Adjusted Odds Ratio (ORs) with 95% CI were calculated initially with a bivariate and then multivariate analysis. We analysed 179 cases matched to 1770 controls. Seven cases were exposed to amoxicillin (adjusted OR 1.69, 95% CI 0.72-3.98) and 22 cases to co-amoxiclav (adjusted OR 3.00, 95% CI 1.76-5.40). Co-amoxiclav almost doubled the risk of serious acute liver injury compared to amoxicillin alone. The incidence of co-amoxiclav induced DILI is very low but the widespread use of this drug by the general population makes the risk clinically relevant. The often inappropriate prescription of antimicrobial agents, and in particular of co-amoxiclav, could expose a given patient to a life-threatening risk compared to a negligible clinical benefit

Antidepressant-Induced Acute Liver Injury: A Case-Control Study in an Italian Inpatient Population

Introduction: Pre-marketing clinical trials show that antidepressant-induced liver injury seems to be a rare adverse event. Because of short follow-up trial duration, the incidence of liver injury due to antidepressant use could be underestimated. Objectives: We aimed to quantify the risk of acute liver injury associated with antidepressant use through a caseâcontrol analysis among an inpatient population. Methods: A multicenter study was carried out in nine Italian hospitals from October 2010 to January 2014, within the DILI-IT (Drug-Induced Liver Injury in Italy) study project. After exclusion of all patients with a clear competing cause of liver injury, cases were defined as adults admitted to the hospital with a diagnosis of acute liver injury, while controls had any other acute clinical condition not related to the liver. Antidepressant exposure was evaluated within 90 days prior to the date of the first sign/symptom of liver injury. Odds ratio (OR) with 95% confidence interval (95% CI) was calculated as a measure of risk estimates for liver injury. Results: We included 17 cases exposed to antidepressants matched to 99 controls. According to the features of liver injury, all cases showed symptomatic liver function test abnormalities at hospital admission, with the main signs/symptoms represented by fatigue, nausea, asthenia, or dark urine. Citalopram was the antidepressant mostly involved in the increase of liver enzymes, mainly alanine aminotransferase. Compared with non-use, current use of antidepressants was associated with a significantly increased risk of liver injury (adjusted OR, ORADJ, 1.84; 95% CI 1.02â3.32). Specifically, an increased, but not significant, risk of developing liver injury was observed for citalopram, a selective serotonin-reuptake inhibitor (ORADJ1.82; 95% CI 0.60â5.53). Conclusion: The use of antidepressants is not as safe in terms of liver injury as expected; instead, the risk of antidepressant-induced liver injury is likely underestimated. The lack of significance does not reflect the absence of risk, but rather suggests the need to evaluate it in a wider setting of antidepressant users

Diagnostic delay in adult coeliac disease: An Italian multicentre study

Background: There are few data regarding the diagnostic delay and its predisposing factors in coeliac disease (CD). Aims: To investigate the overall, the patient-dependant, and the physician-dependant diagnostic delays in CD. Methods: CD adult patients were retrospectively enroled at 19 Italian CD outpatient clinics (2011-2021). Overall, patient-dependant, and physician-dependant diagnostic delays were assessed. Extreme diagnostic, i.e., lying above the third quartile of our population, was also analysed. Multivariable regression models for factors affecting the delay were fitted. Results: Overall, 2362 CD patients (median age at diagnosis 38 years, IQR 27-46; M:F ratio=1:3) were included. The median overall diagnostic delay was 8 months (IQR 5-14), while patient- and physician-dependant delays were 3 (IQR 2-6) and 4 (IQR 2-6) months, respectively. Previous misdiagnosis was associated with greater physician-dependant (1.076, p = 0.005) and overall (0.659, p = 0.001) diagnostic delays. Neurological symptoms (odds ratio 2.311, p = 0.005) and a previous misdiagnosis (coefficient 9.807, p = 0.000) were associated with a greater extreme physician-dependant delay. Gastrointestinal symptoms (OR 1.880, p = 0.004), neurological symptoms (OR 2.313, p = 0.042), and previous misdiagnosis (OR 4.265, p = 0.000) were associated with increased extreme overall diagnostic delay. Conclusion: We identified some factors that hamper CD diagnosis. A proper screening strategy for CD should be implemented

Measurement of the polarization of the Xi0 (anti-Xi0) hyperon beam by the NA48/1 experiment

A total of 368415 Xi(0) --> Lambda Xi(0) and 31 171 (Xi(0)) over bar --> (Lambda) over bar pi(0) were selected from data recorded in the NA48/1 experiment during 2002 data taking. From this sample, the polarization of Xi(0) and (Xi(0)) over bar hyperons was measured to be P(Xi 0) = -0.102 +/- 0.012(stat) +/- 0.008(syst) and P((Xi 0) over bar) = -0.01 +/- 0.04(stat) 0.008(syst). The dependence of P(Xi 0) on the Xi(0) transverse momentum with respect to the primary proton beam is also presented. With the same data sample. the ratio of (Xi(0)) over bar and Xi(0) fluxes in proton collisions at 400 GeV/c oil a beryllium target was measure

Determination of the relative decay rate KS -> πeν / KL -> πeν

The decay rate of K-S -> pi ev relative to the rate of K-L -> pi rev has been measured by the NA48 Collaboration in a neutral kaon beam originating from 400 GeV proton-Be interactions at the CERN SPS. The result is 0.993 +/- 0.026(stat) +/- 0.022(syst), compatible with I in agreement with the Standard Model prediction at tree level. It implies B R (K-S -> pi ev) = (7.05 +/- 0.18(stat) +/- 0.16(syst)) X 10(-4)

New high statistics measurement of K-e4 decay form factors and pi pi scattering phase shifts

We report results from a new measurement of the K-e4 decay K-+/- -> pi(+)pi(-)e(+/-)nu by the NA48/2 collaboration at the CERN SPS, based on a partial sample of more than 670 000 K-e4 decays in both charged modes collected in 2003. The form factors of the hadronic current (F,G,H) and pi pi phase difference (delta=delta(s)-delta(p)) have been measured in ten independent bins of the pi pi mass spectrum to investigate their variation. A sizeable acceptance at large pi pi mass, a low background and a very good resolution contribute to an improved experimental accuracy, a factor two better than in the previous measurement, when extracting the pi pi scattering lengths a(0) (0) and a(0) (2). Under the assumption of isospin symmetry and using numerical solutions of the Roy equations, the following values are obtained in the plane (a(0) (0),a(0) (2)): a(0) (0)=0.233 +/- 0.016(stat)+/- 0.007(syst),a(0) (2)=-0.0471 +/- 0.011(stat)+/- 0.004syst. The presence of potentially large isospin effects is also considered and will allow comparison with precise predictions from Chiral Perturbation Theory

A new measurement of the K-+/- -> pi(+/-)gamma gamma decay at the NA48/2 experiment

The NA48/2 experiment at CERN collected two data samples with minimum bias trigger conditions in 2003 and 2004. A measurement of the rate and dynamic properties of the rare decay K-+/- -> pi(+/-)gamma gamma from these data sets based on 149 decay candidates with an estimated background of 15.5 +/- 0.7 events is reported. The model-independent branching ratio in the kinematic range z = (m(gamma gamma)/m(K))(2) > 0.2 is measured to be B-MI(z > 0.2) = (0.877 +/- 0.089) x 10(-6), and the branching ratio in the full kinematic range assuming a particular Chiral Perturbation Theory description to be B(K-pi gamma gamma) = (0.910 +/- 0.075) x 10(-6). (C) 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/)

Search for the dark photon in pi(0) decays

A sample of 1.69 x 10(7) fully reconstructed pi(0) -> gamma e(+)e(-) decay candidates collected by the NA48/2 experiment at CERN in 2003-2004 is analyzed to search for the dark photon (A') production in the pi(0) -> gamma A' decay followed by the prompt A' -> e(+)e(-) decay. No signal is observed, and an exclusion region in the plane of the dark photon mass m(A') and mixing parameter epsilon(2) is established. The obtained upper limits on epsilon(2) are more stringent than the previous limits in the mass range 9 MeV/c(2) pi(+/-)A' decay is also evaluated. (C) 2015 The Authors. Published by Elsevier B.V