Use of Hematopoietic Growth Factor in the Management of Hematological Side Effects Associated to Antiviral Treatment for Hcv Hepatitis

Haematological abnormalities are common during combination antiviral therapy for chronic hepatitis C. Although dose reduction or discontinuation can easily treat these side effects, they can adversely affect the efficacy of combination antiviral therapy reducing the likelihood of a sustained viral response (SVR). To avoid potentially diminishing a patient’s chance of response, many physicians have begun using growth factors off-label to manage anaemia and neutropenia in hepatitis C. Haematopoietic growth factors are generally well tolerated and they may be useful for managing haematological side effects of anti-HCV therapy improving patients’ quality of life. To date, the role and benefit of these agents during anti-HCV therapy and their positive impact on SVR have not conclusively determined in the published studies. However, the possibility of a benefit to individual outpatients remains, and an individualized approach is recommended. This review explores the incidence, clinical significance, and management of anaemia, neutropenia and thrombocytopenia associated with combination therapy for HCV infection

Rest tremor in Parkinson's disease: body distribution and time of appearance

Objective To assess body distribution and timing of appearance of rest tremor in Parkinson's disease. Methods Information was obtained by a computerized database containing historical information collected at the first visit and data collected during the subsequent follow-up visits. Information on rest tremor developed during the follow-up could be therefore obtained by our own observation in a proportion of patients. Results Among 289 patients, rest tremor was reported at disease onset in 65.4% of cases and detected at last follow-up examination in 74.4% of patients. Analysis of patients who did not report rest tremor at disease onset indicated that 26% of such patients (9% in the overall population) manifested rest tremor over the disease course. Rest tremor spread to new sites in 39% of patients who manifested rest tremor at disease onset. Regardless of tremor presentation at disease onset or during the follow-up, upper limb was the most frequent tremor localization. Over the follow-up, rest tremor developed faster in the upper limb than in other body sites. The risk of developing rest tremor during the follow-up was not affected by sex, side of motor symptom onset and site of tremor presentation. However, age of disease onset > 63 years was associated with an increased risk of rest tremor spread. Conclusions This study provides new information about body distribution and timing of rest tremor appearance during the course of early stages of Parkinson's disease that may help clinicians in patients' counselling

EFFICACIA DEL CARBOSSIMETILGLUCANO NELLA REGRESSIONE DELLE ALTERAZIONI CITOLOGICHE CERVICALI DI BASSO GRADO HPV CORRELATE

Lo studio si propone di valutare l’efficacia del carbossimetil?glucano (Colpofix®) in pazienti con citologia anormale includendo pazienti che allo screening presentano citologia deponente per ASCUS-LSIL, suddivise poi in pazienti con referto citologico di ASCUS o LSIL e colposcopia negativa e pazienti con citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1, le quali, avendo prospettato loro la possibilità di scelta tra trattamento fisico distruttivo e follow-up, decidono per il follow-up. Metodi. Presso l’ambulatorio di Laserchirurgia e Patologia Cervico-Vaginale dell’ Istituto di Scienze Ginecologiche , Perinatologia e Puericultura dell’Università degli Studi “La Sapienza” di Roma, sede Policlinico Umberto I , nel periodo compreso tra settembre 2007 e dicembre 2008 sono state reclutate un totale di 60 pazienti che allo screening presentavano citologia deponente per ASCUS-LSIL suddivise in due sottogruppi: pazienti con referto citologico di ASCUS o LSIL e colposcopia negativa e pazienti con citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1, le quali, avendo prospettato loro la possibilità di scelta tra trattamento fisico distruttivo e follow-up, hanno deciso per il follow-up. Il trattamento prevede la somministrazione di carbossimetil?glucano gel nebulizzante in ragione di una applicazione al giorno (5 erogazioni) per 20 giorni, seguiti da 10 giorni di pausa ed un ulteriore ciclo di 20 giorni. Le pazienti sono state valutate con controllo colpo-citologico a 3, 6 e 12 mesi dalla fine della terapia. Risultati. Nel gruppo di pazienti con citologia positiva e colposcopia negativa, su un totale di 30, 10 (33%) presentavano diagnosi di ASCUS, 20 (67%) di LSIL. Al primo controllo colpo-citologico a 3 mesi 8 su 10 pazienti (80%) con diagnosi iniziale di ASCUS sono risultate negative, 7 su 20 pazienti (35%) con diagnosi iniziale di LSIL sono risultate negative; al controllo colpo-citologico a 6 mesi 10 su10 pazienti (100%) con diagnosi iniziale di ASCUS sono risultate negative, 14 su 20 pazienti (70%) con diagnosi iniziale di LSIL sono risultate negative; al controllo a 12 mesi 17 su 20 pazienti (85%) con diagnosi iniziale di LSIL sono risultate negative mentre 3 pazienti (15%) sono andate perse al follow-up. Delle 30 pazienti che presentavano allo screening citologia anormale, colposcopia positiva ed esame istologico deponente per HPV-CIN1 al primo controllo colpo-citologico a 3 mesi 6 su 30 pazienti (20%) sono risultate negative, al controllo colpo-citologico a 6 mesi 18 su 30 pazienti (60%) sono risultate negative , al controllo colpo-citologico a 12 mesi 24 su 30 pazienti (80%) sono risultate negative. La persistenza di CIN1-HPV, confermata istologicamente, è stata riscontrata in 4 su 30 pazienti (13%), per le quali è stata scelta la terapia fisico distruttiva come trattamento finale, mentre 2 su 30 pazienti (6%) sono andate perse al follow-up. Conclusioni. Il nostro studio ha evidenziato, con un follow-up semestrale di 12 mesi, in donne che hanno fatto regolare uso secondo lo schema proposto del carbissimetilbetaglucano, la totale regressione delle lesioni citologiche di LSIL, con colposcopia negativa, dell’85%, e la totale regressione delle lesioni istologiche di CIN1-HPV dell’80%, rappresentando quindi una valida alternativa al trattamento fisico distruttivo immediato e al semplice “wait and see”, in quanto provvista di una buona tollerabilità al farmaco, basso costo, alta adesione delle pazienti e netto miglioramento dell’indice di regressione delle lesioni a 12 mesi

Relationship between retinal microvascular impairment and subclinical atherosclerosis in SLE

objectives: patients with SLE have higher cardiovascular (CV) risk compared with healthy controls (HC) and are characterised by accelerated atherosclerosis; intima media thickness (IMT), marker of subclinical atherosclerosis, is higher in patients with SLE than in HCs. Retinal microvascular impairment detected through optical coherence tomography angiography (OCTA) was investigated as a marker of systemic vascular involvement in SLE.the aim of the study was to evaluate the relationship between retinal vascular impairment and IMT in SLE. methods: cross-sectional study recruiting patients with SLE and HCs. Data of the study population were collected. CV risk was evaluated through the american college of cardiology/american heart association (ACC/AHA) guidelines, framingham and QRESEARCH risk estimator V.3 (QRISK3) scores. Both groups underwent OCTA and carotid ultrasound with IMT assessment.Statistical analysis was accomplished using Pearson/Spearman, t-test/Mann-Whitney or χ2 test. Variables statistically significant at univariate regression analysis were tested in an age-corrected and sex-corrected multivariate regression model. results: 43 patients with SLE and 34 HCs were recruited.patients with SLE showed higher triglycerides (p=0.019), triglycerides-glucose (TyG) Index (p=0.035), ACC/AHA guidelines (p=0.001), Framingham Risk Scores (p=0.008) and a reduced superficial (p<0.001) and deep (p=0.005) whole retinal vessel density (VD) compared with HCs.In SLE univariate analysis, deep whole VD showed a negative correlation with IMT (p=0.027), age (p=0.001), systolic blood pressure (p=0.011), QRISK3 Score (p<0.001), systemic lupus international collaborating clinics damage index (p=0.006) and apolipoprotein B (p=0.021), while a positive correlation was found with female sex (p=0.029). Age-adjusted and sex-adjusted multivariate analysis confirmed QRISK3 score (p=0.049) and IMT (p=0.039) to be independent risk factors for reduced retinal VD. conclusions: patients with SLE showed lower retinal VD and higher CV risk indicators compared with HCs. Among patients with SLE, QRISK3 Score and IMT were found to be independent risk factors for retinal vascular impairment, suggesting a role of OCTA in evaluating preclinical CV involvement in SLE. moreover, TyG index could represent a biomarker of CV risk in patients with SLE compared with HCs

An Italian Multicenter Study on the Epidemiology of Respiratory Syncytial Virus During SARS-CoV-2 Pandemic in Hospitalized Children

Since the beginning of 2020, a remarkably low incidence of respiratory virus hospitalizations has been reported worldwide. We prospectively evaluated 587 children, aged <12 years, admitted for respiratory tract infections from 1 September 2021 to 15 March 2022 in four Italian pediatric hospitals to assess the burden of respiratory viruses during the COVID-19 pandemic in Italy. At admission, a Clinical Respiratory Score was assigned and nasopharyngeal or nasal washing samples were collected and tested for respiratory viruses. Total admissions increased from the second half of October 2021 to the first half of December 2021 with a peak in early November 2021. The respiratory syncytial virus (RSV) incidence curve coincided with the total hospitalizations curve, occurred earlier than in the pre-pandemic years, and showed an opposite trend with respect to the incidence rate of SARS-CoV-2. Our results demonstrated an early peak in pediatric hospitalizations for RSV. SARS-CoV-2 may exhibit a competitive pressure on other respiratory viruses, most notably RSV