Valutazione del turn over dei farmaci antiretrovirali in particolare da IP a NNRTI

Objective: To determine the turnover for each antiretroviral drugs present in TP’s of patients under care for HIV infection, with a special focus on PI’s and NNRTI’s. Design/Methods: We have carried out a retrospective analysis with the aim of evaluating the turnover of each drug in the 3-year period 1998-2000. Using a specifically designed software, it was possible to determine the changes in TP for each single patient. We then calculated a different weighted percentage for each drug on the basis of the time interval from the drug entry to its exclusion from the TP: the shorter the interval, the greater the assigned weight. Finally we carried out a cluster analysis in order to obtain homogeneous groups of molecules showing the same degree of therapy switches. We established that a higher average score corresponds to a higher therapy switch rate. Results: Zidovudine/Lamivudine combination, Indinavir, Lamivudine, Nerivapine and Nelfinavir are the drugs with the lowest turnover. On the other hand, Saquinavir, Didanosine, Zidavudine, and Stavudine show the highest turnover. Conclusion: The introduction of NNRTI’s with the associated switch from PI’s (Saquinavir, Nelfinavir) and the Zidavudine/Lamivudine combination enables a simplification of the treatment. This practice appeared to be a good choice in the 3-year period under consideration. The adoption of these therapeutic solutions reduce the turnover, consequently giving more stability to TP’s

Surgical treatment of scoliosis in a rare disease: arthrogryposis

<p>Abstract</p> <p>Background</p> <p>The reported incidence of scoliosis in arthrogryposis varies from 30% to 67% and, in most cases, the curves progress rapidly and become stiff from early age.</p> <p>The authors report six cases of scoliosis in arthrogryposis to assess the role of surgical treatment.</p> <p>Methods</p> <p>Six cases (3 males, 3 females; mean age at surgery 13.2 years) with arthrogryposis multiplex congenita associated with the characteristic amyoplasia were reviewed: they were operated on for scoliosis at the authors' Spine Surgery Department between 1987 and 2008.</p> <p>Surgery was performed using the Harrington-Luque instrumentation (2 cases), the Luque system (1), a hybrid segmental technique with hooks and screws (1) and spinal anchoring with pedicle screws (2).</p> <p>Results</p> <p>The patients were clinically and radiologically reviewed at a mean follow-up of 4.2 years, ± 2.7 (range, 1 to 9 years). Three minor postoperative complications were encountered; a long-term pulmonary complication was seen in one case after reintervention and was successfully resolved after 10 days. Surgery was successful in the other 5 cases, where solid arthrodesis was achieved and no significant curve progression was observed at follow-up.</p> <p>Conclusions</p> <p>The experience acquired with the present case series leads the authors to assert that prompt action should be taken when treating such aggressive forms of scoliosis. In case of mild spinal deformities in arthrogryposis, brace treatment should be attempted, the evolution of the curves being unpredictable; however, when the curve exceeds 40° and presents with marked hyperkyphosis, hyperlordosis or pelvic obliquity, surgery should not be delayed.</p

The prognostic value of the previous nephrectomy in pretreated metastatic renal cell carcinoma receiving immunotherapy: a sub-analysis of the Meet-URO 15 study

Nephrectomy is considered the backbone of managing patients with localized and selected metastatic renal cell carcinoma (mRCC). The prognostic role of nephrectomy has been widely investigated with cytokines and targeted therapy, but it is still unclear in the immunotherapy era

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P &lt; .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Induction de l'offre de prestations médicales par la demande : un essai de quantification pour la Suisse

Cette analyse donne pour la première fois une estimation des requêtes de prestations et services médicaux demandées directement par les patients à leurs médecins traitants, requêtes qui allaient au-delà de la prescription du médecin (induction de l'offre par la demande). Le 34,3% des consultations médicales (équivalentes pour l'année 2000 en Suisse à 19,4 millions de visites) ont donné lieu à au moins une requête supplémentaire de prestations de la part du patient. Dans les 75,7% des cas ces requêtes ont été totalement acceptées par le médecin traitant et pour le 18,7% elles l'ont été partiellement. Les demandes supplémentaires des patients concernaient, par ordre d'importance, les examens diagnostiques (15,8% des consultations totales), les rendez-vous chez d'autres médecins (12%), les ordonnances de médicaments , les certificats de maladie (8,7%) et des approfondissements ou des séjours dans des établissements de soins (4,4%). Les principales variables explicatives de l'induction de l'offre par la demande sont, (facteurs de risque) le mauvais état de santé subjectif (OR 2.343), le revenu &lt; ou = à fr. 3000.-/mois (OR 1.766), avoir passé plus de 2 visites médicales dans les deux derniers mois (OR 1.693) ainsi que (facteur de protection) l'appartenance à la religion protestante (OR 0.645). Le coût annuel à la charge de l'assurance de base dû à l'induction de l'offre par la demande a été estimé, par défaut, à 2,7 milliards de francs pour l'année 2000, ce qui représente 17% des coûts totaux facturés par les assureurs maladies à l'ensemble des fournisseurs de prestations pour l'assurance de base. [Auteurs] Diese Analyse enthält zum ersten Mal eine Schätzung der medizinischen Leistungen, die von den Patienten direkt bei ihren behandelnden Ärzten erbeten werden - Leistungen, die über die Verordnungen der Ärzte hinausgehen (Nachfrage-induziertes Angebot). In 34,3% der Konsultationen (dies entspricht in der Schweiz für das Jahr 2000 19,4 Millionen Arztbesuchen) wurde von den Patienten mindestens ein zusätzlicher Wunsch nach Leistungen ausgesprochen. In 75,7% der Fälle wurden diese Forderungen vom behandelnden Arzt vollständig akzeptiert und in 18,7% teilweise. Die zusätzlichen Wünsche der Patienten betrafen in absteigender Reihenfolge: diagnostische Untersuchungen (15,8% der Konsultationen), Termine bei anderen Ärzten (12%), Medikamentenverordnungen, Arztzeugnisse (8,7%) und Nachbetreuung oder stationäre Behandlung (4,4%). Die hauptsächlichen Variablen für die Induktion eines Angebotes durch Nachfrage sind schlechter subjektiver Gesundheitszustand (OR 2.343), Einkommen unter 3000 SFr. pro Monat (OR 1.766), mehr als zwei Arztbesuche in den zwei vergangenen Monaten (OR 1.693) - als Risikofaktoren - sowie Zugehörigkeit zur protestantischen Konfession (OR 0.654) als Schutzfaktor. Die jährlichen Kosten zu Lasten der Grundversicherung durch diese Nachfrage-induzierten Angebote werden auf 2,5 Milliarden Franken für das Jahr 2000 geschätzt; dies entspricht 17% der totalen Kosten, die von den Versicherern den Anbietern von medizinischen Leistungen in der Grundversicherung vergütet wurden. [Autoren]]]> Health Services Needs and Demand ; Physicians, Family ; Attitude of Health Personnel ; Attitude to Health ; Referral and Consultation fre oai:serval.unil.ch:BIB_DD25FF4280E4 2022-05-07T01:28:25Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_DD25FF4280E4 Swiss Recommendations for Adult Cystic Fibrosis Care: Urinary diseases https://www.revmed.ch/Guidelines/Swiss-Recommendations-for-Adult-Cystic-fibrosis-Care Koutsokera, Angela Bullani, Roberto info:eu-repo/semantics/bookPart incollection 2019-05-01 Swiss Recommendations for Adult Cystic Fibrosis Care Cystic fibrosis; incontinence eng https://serval.unil.ch/resource/serval:BIB_DD25FF4280E4.P001/REF.pdf http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_DD25FF4280E41 info:eu-repo/semantics/altIdentifier/urn/urn:nbn:ch:serval-BIB_DD25FF4280E41 info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/openAccess Copying allowed only for non-profit organizations https://serval.unil.ch/disclaimer application/pdf oai:serval.unil.ch:BIB_DD265C977F60 2022-05-07T01:28:25Z <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_DD265C977F60 Trisomy 1q generating translocations in Wilms tumor info:doi:10.1016/S0165-4608(98)00237-4 info:eu-repo/semantics/altIdentifier/doi/10.1016/S0165-4608(98)00237-4 info:eu-repo/semantics/altIdentifier/pmid/10686941 Betts, D. R. Ilg, E. C. Oezahin, H. von der Weid, N. Niggli, F. K. info:eu-repo/semantics/article article 1999-07 Cancer Genetics and Cytogenetics, vol. 112, no. 2, pp. 138-43 info:eu-repo/semantics/altIdentifier/pissn/0165-4608 <![CDATA[Unbalanced translocations generating trisomy of 1q are common in Wilms tumor (WT). We present eight unbalanced 1q translocations from seven tumors and a review of the literature. An unbalanced translocation that results in a der(16)t(1q;16q) chromosome represents more than half of the published +1q generating translocations in WT. This translocation is also common to many other tumor types. Four of the tumors presented here contained this chromosome and,in two cases, it was the primary acquired cytogenetic abnormality within the tumor. The other four translocations involved 9q31, 9q34, 17p1?, and 21p11 as the partner to 1q. The chromosome 17 and 21 translocations occurred within the same tumor as apparently independent events. In contrast with the 16q translocations, these other translocations were secondary cytogenetic events, thereby indicating a role in tumor progression rather than initiation. Probes mapping to 1q12 and 1q21 were employed for fluorescence in situ hybridization and it was demonstrated that different 1q breakpoints are possible. In this series, the majority of breakpoints either mapped to 1q12 or were centromeric to this region

Trophodynamic effects of trawling on the feeding ecology of pandora, Pagellus erythrinus, off the northern Sicily coast (Mediterranean Sea)

10 pages, 3 figures, 4 tablesBecause trawling disturbs benthic organisms, it could affect the diet of benthic-feeding fish with implications for food-web dynamics. The present study assessed the effects of commercial trawling on the trophodynamics and diet of pandora, Pagellus erythrinus, by comparing its stomach contents and stable-isotope (Δ15N and 13C) composition in two trawled and two untrawled gulfs in northern Sicily (central Mediterranean). Fish were collected on muddy bottoms at 50100-m depth. Higher abundance and biomass and a slightly larger mean body length were found in the untrawled gulfs. The feeding habits were similar although more selective in the untrawled gulfs. The diet was mainly composed of decapod crustaceans (especially the brachyuran crab Goneplax rhomboides) and of polychaetes. The trophic level of pandora, estimated by its Δ15N values, was higher in the untrawled gulfs. No clear trend between trawled and untrawled gulfs was found for the source of carbon in the diet Δ(13C). The diet of a benthic feeder such as pandora may be used as an indirect indicator of trawling disturbance, as long as stomach contents and stable-isotope analysis are used jointly to assess the diet and trophodynamics of a speciesSamples fromGCAST and GPATT analysed in this studywere collected with permission of the Italian Ministry of Agriculture and Forestry (Project No. 6A84/2003)Peer Reviewe