Improvement of patient-reported outcomes in severe allergic asthma by omalizumab treatment : the real life observational PROXIMA study

Background: Data on the prevalence of perennial versus seasonal allergic asthma in Italy are lacking; moreover, there is limited evidence on the effect of omalizumab on patient-reported outcomes in Italian patients with severe allergic asthma. PROXIMA, an observational, multicenter study, was designed to assess the prevalence of perennial versus seasonal allergic asthma (cross-sectional phase) and the effect of omalizumab on improving illness perception, quality of life (QoL) and asthma control of Italian patients with severe allergic asthma (longitudinal phase). Methods: The study included a cross-sectional phase (n = 357) and a longitudinal phase (n = 123): during the longitudinal phase, patients received omalizumab (75-600 mg subcutaneously every month) and were followed-up for 12 months. The primary parameter of cross-sectional phase was prevalence of perennial allergic asthma and that of longitudinal phase was proportion of patients with asthma control (assessed using asthma control questionnaire [ACQ]). Secondary parameters assessed were patients' disease perception, level of asthma control, exacerbation rate during both cross-sectional and longitudinal phases, and patients' compliance to and persistence with omalizumab, and patients' QoL during the longitudinal phase. Results: Most patients (95.8%) had perennial allergies; 81% had polysensitization. Of 99 patients in the per-protocol set, 95 (95.96% [95% CI: 89.98-98.89%]) achieved asthma control (ACQ < 4) at both 6 and 12 months of omalizumab treatment; ACQ score decreased after 6 and 12 months (P < 0.0001). Omalizumab treatment resulted in a significant improvement in QoL and patients' illness perception and 87% decrease in exacerbation rate. The compliance rate with omalizumab was high (73.2%). No new safety signals were identified during treatment. Conclusion: This study demonstrated that in severe allergic asthma, omalizumab improves patient-reported outcomes such as patients' illness perception and QoL, while confirming improvement of asthma control and exacerbation rate reduction in Italian patients

Bioenterics intragastric balloon : 7 years experience

Background: Since 1998, we adopted in our clinical practice for treatment of obesity and morbid obesity the BioEnterics Intragastric Balloon (BIB\uae): it has the characteristics of an \u201cideal gastric balloon\u201d (Tarpon Springs Workshop, 1987). Methods: Since March 1998, we placed by the endoscopic approach 518 BIB in 480 patients affected by obesity and morbid obesity; 124 male and 356 female, mean age 41.6 years (18-72), mean weight kg 116.9 (67-229), mean BMI 42 kg/m2 (27.3-81.1). All our patients underwent diet of 1000 Kcal/day and treatment with antisecretory drugs. Results: The mean weight lost was 14.69 kg and the mean reduction in BMI was 5.11 kg/m2. Weight lost was greater in male morbidly obese (BMI >40). Weight lost was accompanied by an improvement of the diseases associated with obesity: diabetes, arterial hypertension and sleep apnea. Conclusions: The best indications for BIB were: morbidly obese patients (BMI >40) and super-obese patients (BMI >50) in prepa- ration for bariatric surgery; obese patients with BMI 35-40 with co- morbilities in preparation for bariatric surgery; obese patients with BMI 30-35 with a chronic disease otherwise unresolved; patients with BMI <30 only in a multidisciplinary approach

The bilio-intestinal bypass

Background: Since 1990, we adopted the bilio-intestinal bypass (BIBP) for all morbidly obese patients eligible for a malabsorption procedure. Since 2001 we used laparoscopic technique. Methods: 148 patients, mean age 35.4 (18-63) years; preoper- ative mean weight kg 148.3 (104-225); mean preoperative BMI 54.1 kg/m2 (40-66.2); mean follow-up 10 years (1-22). 83 patients underwent open and 65 laparoscopic BIBP. Laparoscopic BIBP was performed with five lap ports. Section of the jejunum 30 cm distal to the ligament of Treitz and of mesentery was made by a linear stapler. The cholecysto-jejunal anastomosis was completed with 45-mm linear stapler. A side-to-side anastomosis between the proximal jejunum and the last 12-18 cm of the ileum was cre- ated by firing a 60-mm linear stapler. On the excluded ileum, an anti-reflux valve system was hand-sutured. Results: 5 years postoperatively, mean weight was 89 (62-130) kg, mean BMI was 31 kg/m2 (24-41). Two patients of the 65 laparoscopic patients were converted to open surgery for adhe- sions post-appendectomy. The main late complications were inci- sional hernia (19.3%) and abdominal bloating (2.9%). The rever- sal and conversion rate was 6.5%. There was no death. Conclusions: Our experience showed that 5 years post-BIBP, the weight loss was satisfactory in 90.7% of patients. Using laparoscopic technique, it is possible to reduce pain, in-hospital time, respiratory and thromboembolic complications, convales- cence and incisional hernia

Tratti psichiatrici pre- e post-intervento : studio di un campione di pazienti affetti da grave obesit&#224; sottoposti a bendaggio gastrico regolabile

Scopo. La presente ricerca \ue8 volta a identificare le caratteristiche psicologiche e l\u2019evoluzione della sintomatologia psichica in un gruppo di soggetti affetti da obesit\ue0 sottoposti a intervento chirurgico di bendaggio gastrico regolabile. Materiali e metodi. In questo campione, oltre al colloquio clinico, \ue8 stato utilizzato nel pre-intervento il test SCL-90. Il post-intervento \ue8 stato invece integrato dalla compilazione della BES e della TAS. I pazienti valutati prima dell\u2019intervento sono 220, mentre i pazienti valutati nel follow-up post-operatorio sono 115. La SCL-90 somministrata prima dell\u2019intervento chirurgico mostra valori soprasoglia (>0,7) per i cluster relativi alla somatizzazione, alla sensibilit\ue0 interpersonale, all\u2019ideazione paranoide, alla depressione e al disturbo ossessivo-compulsivo. Discussione. Si nota come anche il cluster depressione sia pi\uf9 accentuato nel gruppo di pazienti che hanno posizionato il pallone endogastrico (valore medio di 0,9), mentre il cluster ansia mostra una media di 0,73 per i pazienti che hanno inserito il pallone contro una media di 0,52 per i pazienti che sono stati sottoposti direttamente a bendaggio gastrico. Conclusioni. Il presente studio dimostra come il valore relativo alla depressione risulti degno di nota nei pazienti indagati prima dell\u2019intervento chirurgico e si normalizza nel follow-up. Questo risultato confermerebbe l\u2019ipotesi che pone come una possibile causa di sintomatologia depressiva l\u2019incremento ponderale. Il presente lavoro dimostra, inoltre, come l\u2019ansia sia presumibilmente controllata dall\u2019eccesso ponderale.AIM: This study identifies psychological features and the evolution of psychiatric symptoms in a group of patients affected by obesity, who underwent adjustable gastric banding. MATERIALS AND METHODS: In this group, other than clinical visit, test SCL-90 is made in preoperative time. In postoperative SCL-90, TAS and BES were carried out. Patients evaluated before and after bariatric surgery were 220 and 115, respectively. SCL-90 test made before bariatric surgery showed high values (>0.7) for cluster related to somatization, interpersonal sensitivity, paranoid ideation, depression and obsessive compulsive disorder. DISCUSSION: Depression symptoms were more important in patients undergoing endogastric balloon placement (mean value of 0.9). Anxious symptoms showed a mean value of 0.73 in patients undergoing endogastric balloon placement as compared to a mean value of 0.52 in patients undergoing gastric banding. CONCLUSIONS: Our findings show that in patients undergoing bariatric surgery, depressive symptoms are more common preoperatively and normalize at follow-up. This confirms that a possible cause of depression is obesity. The present study also shows that anxious symptoms are lower in obese patients

Adjustable gastric banding for morbid obesity. Our experience

BACKGROUND: The adjustable gastric banding is considered the most common procedure in Europe for the treatment of morbid obesity. We report our experience with this procedure, that was introduced in our Departments of Surgery since 1993. METHODS: From December 1993 to December 2004, 684 morbid obese patients (139 males and 545 females) underwent adjustable gastric banding (AGB) in our departments of Surgery. The first 323 patients were operated with perigastric procedure, the following 361 patients with pars flaccida technique. 601 patients were operated with laparoscopic approach, 83 with open approach. The average follow-up is 5 years. RESULTS: Mean BMI decreased from 42.2 to 34 Kg/m2 five years after the operation, with an EWL of 54 %. The main early complications were: intraoperative gastric perforation (5 patients, 1 of which repaired in laparoscopy); hemorrhage from short gastric vessels (3 patient, repaired in laparotomy). The major late complications were: intragastric band migration (7 patients); irreversible dilatation of the gastric pouch (42 patients, treated surgically with band removal or repositioning). CONCLUSION: In our experience laparoscopic adjustable gastric banding is a safe and effective procedure, suitable to most patients, and should be considered as the first choice in the surgical treatment of morbid obesity

Impact of variations in triage cytology interpretation on human papillomavirus–based cervical screening and implications for screening algorithms

AbstractBackgroundWomen positive to human papillomavirus (HPV+) testing at cervical screening need triage, typically cytology and immediate colposcopy in case of atypical squamous cells of undetermined significance (ASCUS) or worse (ASCUS+) or, in cytology-normal HPV+ women, HPV test repeat after 1 year and colposcopy referral if still HPV+. Our hypothesis was that substantial variations in triage positivity and sensitivity may produce little variation in overall referral to colposcopy and on sensitivity of the entire screening process.MethodsCentre- and age-aggregated data from 72,869 women aged 35–64 years were derived from 10 organised screening programmes which have piloted HPV screening in Italy since 2012. Overall colposcopy referral was evaluated as a function of immediate colposcopy referral and overall CIN2+ detection as a function of the proportion of all CIN2+ detected by immediate referral (a proxy of cytology's sensitivity). We fitted additive regression models, adjusted for centre, age, compliance to HPV retesting and to colposcopy, by generalised estimation equations.ResultsThe proportion of HPV+ women directly referred to colposcopy varied across programmes (20–57%; average 37%) and so did CIN2+ detection (49–94%; average 77%). Overall, 63% (range 41–75%) of HPV+ were referred to colposcopy either immediately or at HPV repeat. An absolute 10% increase in immediate colposcopy referral resulted in 4.2% (95% CI: 3.3–5.1%) increase in overall referral. An absolute 10% increase in cytology's sensitivity resulted in a 1.1% (95% CI: 0.1–2.0%) increase in overall CIN2+ detection.ConclusionsRepeat HPV testing limits the effect of subjectivity of cytology interpretation on overall referral and sensitivity. These will change only slightly when replacing cytology with another test if the interval to HPV repeat remains unchanged

Are Red Lists really useful for plant conservation? The New Red List of the Italian Flora in the perspective of national conservation policies

“The New Red List of the Italian flora” includes all the Italian policy species and other species of known conservation concerns for a total of 400 taxa, 65% of which are threatened with extinction. The Red List is based on a huge georeferenced data-set useful for conservation purposes