Can percutaneous cholecystostomy be a definitive treatment in the elderly?

Aim: The aim of the present study was to discuss our experience with percutaneous cholecystostomy (PC), analysing the outcomes and investigating the clinical factors, which might predict the future need for surgery. Patients and Methods: Forty-two patients with acute calculous cholecystitis underwent PC over a 122-month period at a single institution. Patients' demographics, clinical features and management were retrospectively analysed. Results: There were 20 females (47.6 per cent) and 22 males (52.4 per cent), with a median age of 83 years (interquartile range: 75\u201387 years). The American Society of Anesthesiologists (ASA) score was III for 7 patients and IV for 35 patients. Thirty-one patients (71.4 per cent) had moderate cholecystitis, and 11 (26.2 per cent) had severe cholecystitis. During the index admission, six patients (14.2 per cent) required endoscopic retrograde cholangiopancreatography (ERCP), cholecystectomy was performed in three (7.2 per cent) and four patients (9.5 per cent) died due to septic shock. Nine patients were readmitted for recurrent biliary symptoms, and six of them underwent cholecystectomy. All patients who underwent cholecystostomy and ERCP did not have any recurrence and/or cholecystectomy. The Charlson Comorbidity Index score was significantly higher in patients who did not have subsequent surgery (9 vs 7, P = 0.02). Conclusions: PC can be a valuable treatment option for high-risk patients, and a definitive treatment for the elderly with high CCI. Patients who have undergone PC and ERCP might have a lower probability to develop recurrent biliary symptoms than those who have undergone PC alone. \ua9 2016 College of Surgeons of Hong Kon

Real world use of biological drugs in patients with psoriasis/psoriatic arthritis: a retrospective, population-based study from Southern Italy in the years 2010-2014

BACKGROUND: Biological drugs, such as infliximab, etanercept, adalimumab, ustekinumab, golimumab and certolizumab are third-line therapy for psoriasis (PsO) and psoriatic arthritis (PsA), but they may be used at earlier stage in severe forms. This study investigated the pattern of use and costs of biological drugs for PsO/PsA in a large population from Southern Italy during the years 2010-2014. METHODS: This was a retrospective, population-based, drug-utilization study, using healthcare administrative databases of the ASL (Local Health Unit) and two hospitals of Messina Province (Sicily) in the years 2010-2014. Incident users of adalimumab, ustekinumab, infliximab, etanercept and golimumab for PsO/PsA were characterized. Yearly prevalence of use and costs, as well as time to treatment discontinuation and switch were assessed. RESULTS: During the study period, 517 patients received at least one study drugs prescription for PsO/PsA and 304 (58.8%) were incident users, mostly treated with adalimumab (33.6%). Incident users were mostly males (59.8%), with a median age of 49 years. The prevalence of biological drugs users in PsO/PsA increased from 4.3 to 6.9 per 10,000 inhabitants from 2011 to 2014. Pharmaceutical expenditure of the study drugs almost doubled (from 2.6 to 4.7 million euros over 5 years of observation). During the first year of treatment, discontinuation occurred in 31.8% of incident users and switch was not infrequent (7.4%). CONCLUSIONS: Prevalence of use and costs of biological drugs for PsO/PsA substantially increased in recent years in a large population of Southern Italy. Larger uptake of lowest cost biological drugs, and biosimilars whenever available, may help access to the most innovative drugs

MEDICATION-RELATED OSTEONECROSIS OF JAWS (MRONJ) PREVENTION AND DIAGNOSIS: ITALIAN CONSENSUS UPDATE 2020.

The Medication-Related Osteonecrosis of Jaws (MRONJ) diagnosis process and its prevention play a role of great and rising importance, not only on the Quality of Life (QoL) of patients, but also on the decision-making process by the majority of dentists and oral surgeons involved in MRONJ prevention (primary and secondary). The present paper reports the update of the conclusions from the Consensus Conference\u2014held at the Symposium of the Italian Society of Oral Pathology and Medicine (SIPMO) (20 October 2018, Ancona, Italy)\u2014after the newest recommendations (2020) on MRONJ were published by two scientific societies (Italian Societies of Maxillofacial Surgery and Oral Pathology and Medicine, SICMF and SIPMO), written on the inputs of the experts of the Italian Allied Committee on ONJ (IAC-ONJ). The conference focused on the topic of MRONJ, and in particular on the common practices at risk of inappropriateness in MRONJ diagnosis and therapy, as well as on MRONJ prevention and the dental management of patients at risk of MRONJ. It is a matter of cancer and osteometabolic patients that are at risk since being exposed to several drugs with antiresorptive (i.e., bisphosphonates and denosumab) or, more recently, antiangiogenic activities. At the same time, the Conference traced for dentists and oral surgeons some easy applicable indications and procedures to reduce MRONJ onset risk and to diagnose it early. Continuous updating on these issues, so important for the patient community, is recommended

How did the Introduction of Biosimilar Filgrastim Influence the Prescribing Pattern of Granulocyte Colony-Stimulating Factors? Results from a Multicentre, Population-Based Study, from Five Italian Centres in the Years 2009\u20132014

Background Granulocyte colony-stimulating factors (G-CSFs) are biological products for which the main indication of use is chemotherapy-induced neutropenia. Biosimilars of G-CSFs have been available in Europe since 2007. Objective The objective of this study was to investigate the prescribing pattern of G-CSFs in five Italian centres using different healthcare policy interventions to promote the use of biosimilars in routine care. Methods This retrospective, population-based drug utilization study was conducted during the years 2009\u20132014 using the administrative databases of the Caserta, Treviso and Palermo Local Health Units (LHUs) and the Tuscany and Umbria regions. G-CSF users were characterized and the prevalence of use, proportion of biosimilar users and switching pattern of different G-CSFs were evaluated over time and across centres. Results Overall, 30,247 patients were treated with G-CSFs in the years 2009\u20132014, of which 29,083 (96.2 %) were na\uefve users. The overall prevalence of G-CSF use increased from 0.8 per 1000 inhabitants in 2009 to 1.1 per 1000 in 2014. An increase in the proportion of the use of the biosimilar filgrastim by the total G-CSF users was observed in all centres: from 0.2 % (2009) to 66.2 % (2014). However, heterogeneity across different centres was reported, with the largest increase in Treviso LHU (from 0 to 89.1 % from 2009 to 2014). During the first year of treatment, switching between different G-CSFs was frequent (20.3 %). Conclusions Heterogeneity in the use of G-CSF and, in particular, biosimilar filgrastim across different Italian centres was observed, probably due to different regional healthcare policy interventions. During the first year of treatment, switching between different G-CSFs was frequent. Considering the impact of biological drugs on pharmaceutical expenses, it is necessary to harmonize healthcare policies promoting the use of biological drugs with the lowest cost