Treatment of Chronic Hepatitis C in a Patient Affected by Systemic Sclerosis

The currently recommended treatment for patients infected with hepatitis C virus (HCV) is pegilated interferon α (IFN α) plus ribavirin. Despite the numerous benefits of this therapy, there is an increasing concern regarding his tolerance. Among the most common side effects, interferon may trigger the onset or exacerbation of autoimmune diseases. When chronic hepatitis C coexists with an autoimmune disorder, it is not clear whether using interferon is better than avoiding it. We evaluated the disease state of a 55-year old female affected by sistemic sclerosis (SSc), during and after therapy with IFNα pegilated plus ribavirin for chronic HCV infection. We were worried about the potential worsening of the autoimmune disease during the therapy, but we were confident that we would give our patient a short course of peginterferon and ribavirin. A mild, asymptomatic worsening of lung SSc was observed during IFN administration, without life threatening symptoms. After 24 months follow up we observed the maintenance of the virological response and a good control of the rheumatological disease. Thus, in liver disease at high risk of progression and concomitant SSc, the antiviral therapy with IFNα is a feasible approach

Correlation of the score for subjective pain with physical disability, clinical and radiographic scores in recent onset rheumatoid arthritis

BACKGROUND: To analyse the relationship between subjective pain score and other measures of clinical, radiographic and functional status; in particular Larsen radiographic scores and Health Assessment Questionnaire (HAQ); in patients with severe rheumatoid arthritis (RA) with a disease duration of less than 3 years. METHODS: In this cross sectional study of 105 patients with RA (76 women, 29 men: mean age 50.93; mean disease duration 15.86 months; 71% rheumatoid factor positive) subjective pain was assessed according to the Visual Analog Scale (VAS). Correlation coefficients between pain score and disease activity measures (patients' global assessment of disease by VAS, number of tender and swollen joints, morning stiffness, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and titre of rheumatoid factor, radiographic evaluations (Larsen-Dale scores for radiographic damage of the small joints of the hands, wrist and feet), disability measures (health assessment questionnaire [HAQ]), and demographic variables were calculated; hierarchical regression analysis was done with subjective pain score as the dependent variable. RESULTS: The Spearman's correlation coefficient comparing subjective pain and HAQ was 0.421 (p < 0.001), between subjective pain and global assessment of disease and morning stiffness was 0.573 (p < 0.001) and 0.427 (p < 0.001) respectively, and between pain and number of tender and swollen joints 0.037 and 0.050 respectively (p > 0.05). In regression analysis, global assessment of disease by patients explained 32.8% of the variation in pain intensity score, morning stiffness 10.7%, CRP 4.0%, HAQ 3.8% and Larsen-Dale scores explained 2.1%; other variables were not significant in the model. CONCLUSIONS: Pain scores of patients with early severe rheumatoid arthritis are correlated at higher levels with patients' global assessment of disease and with morning stiffness rather than with radiographic or other clinical variables such as number of tender and swollen joints

A tableau calculus for Hajek’s logic BL

We introduce a tableau calculus for Hajek's Basic Logic BL. This calculus has many of the desirable properties of a proof system: it is cut-free, it has the subformula property. correctness of proof can be checked in P-time, and the number of symbols in any branch of the reduction tree of any sequent Gamma is polynomial in the number of symbols of Gamma. As a corollary we obtain an alternative proof of Co-NP completeness of BL

Investigations on Fragments of First Order Branching Temporal Logic

We investigate axiomatizability of various fragments of first order computational tree logic (FOCTL) showing that the fragments with the modal operator F (H, respectively) are non axiomatizable. These results shows that the only axiomatizable fragment is the one with the modal operator next (X) only

White matter hyperintensities and their associations with suicidality in patients with major affective disorders

Introduction: A large body of evidence suggests that predisposition to suicide, an important public health problem, is mediated to a certain extent by neurobiological factors. The objective of this cross-sectional study was to compare the prevalence of white matter hyperintensities (WMH) in patients with major affective disorders with and without histories of suicide attempts. Methods: T2-weighted magnetic resonance images (MRI) of 65 psychiatric inpatients with major depressive disorder or bipolar disorder were rated for the presence of WMH. Diagnoses, presence or absence of suicide risk and substance abuse were determined by the Mini International Neuropsychiatric Interview (MINI). Medical charts were reviewed to ascertain history of suicide attempt and basic clinical variables. Fisher's Exact Tests and logistic regression modeling were used to test the association between WMH and suicidality. Suicidal patients and controls were not matched for demographic variables and exposure to some risk factors. Results: Bivariate analysis showed that the prevalence of WMH was significantly higher in subjects with past suicide attempts (Fisher's Exact Test, p = 0.01) and other clinical indicators of elevated suicide risk. Logistic regression analyses controlling for age, sex, and several clinical risk factors supported this finding (odds ratio = 4.7; 95% confidence interval: 1.4, 16.1). Conclusions: The increased prevalence of WMH in adults with major affective disorders and a history of suicide attempt, compared to similar patients without such a history, is consistent with previous findings in depressed children, youth and young adults. However, the association between WMH and suicidality holds true for both, depressed and bipolar patients. Our results suggest that WMH in patients with major affective disorders might be useful biological markers of suicidality. © 2007 Springer

Clinical and genetic studies in hereditary spastic paraplegia with thin corpus callosum.

Abstract BACKGROUND: A complicated form of recessive hereditary spastic paraplegias (HSPs) with thin corpus callosum (TCC) was first described in Japan, and most of the Japanese families showed linkage to chromosome 15q13-15. A recessive HSP locus (SPG11) has also been mapped to chromosome 15q13-15 in Italian and North American families with and without TCC, and it overlaps the region identified in the Japanese families. OBJECTIVE: To study clinically and genetically 12 Italian families with HSP and TCC. METHODS: The authors investigated 18 affected and 30 healthy individuals from 12 unrelated Italian families with recessive HSP-TCC. Clinical, neurophysiologic, and neuroradiologic studies were undertaken. All patients were negative for SPG7 mutations. Genetic linkage analyses were carried out with polymorphic DNA markers on 15q13-15. RESULTS: Five families were consistent with linkage, thus defining a 19.8-cM region between markers D15S1007 and D15S978, encompassing the SPG11 interval. In one consanguineous family, linkage could be firmly excluded, confirming genetic heterogeneity. Two families appeared not linked to the region, but this could not be firmly proved because of the small family size. The remaining four families were uninformative for linkage purposes. CONCLUSION: HSP-TCC is common in Italy. The phenotype is fairly homogeneous and is associated with impaired cognition. There are at least two loci for HSP-TCC, one of which is on chromosome 15q13-15