Analisi ed implicazioni cliniche degli stimoli attivanti il Binge Eating in pazienti af-fetti da Disturbi della Condotta Alimentare

Premessa: Il binge eating o “abbuffata compulsiva” è un sintomo altamente egodistonico che può avere luogo in tutti i disturbi alimentari. Obiettivo: L’obiettivo del presente studio è quello di esaminare i diversi fattori (esterni, emozionali, cognitivi e fisiologici) che possono innescare la crisi di binge eating in pazienti con disturbi alimentari e confrontare la frequenza di questi stimoli attivanti o “binge eating triggers” nei sottocampioni appartenenti a categorie diagnostiche differenti. Metodologia: L’analisi è stata condotta attraverso la somministrazione del Binge Eating Trigger Checklist (BETCH), un questionario che valuta il tipo di situazioni (e il disagio provato per ciascuna di esse) che il soggetto riconosce come antecedenti dell’episodio di binge eating. Risultati: La combinazione di triggers più rappresentata nel campione risulta composta da stimoli attivanti emozionali, combinati con stimoli esterni ambientali. I triggers più frequenti sono quelli che comportano anche il maggior disagio. Dal confronto tra i 3 gruppi diagnostici, è risultato che pazienti con BN riportano non solo un numero di triggers medio per abbuffata maggiore, ma anche il relativo disagio associato appare più marcato. Inoltre, è emerso che i pazienti con AN provano minore impulso all’abbuffata a confronto con i BN quando percepiscono un senso di solitudine, mentre i pazienti con BED attribuiscono le loro crisi decisamente più all’umore depresso. Conclusioni: Il binge eating, come percepito e riferito dai pazienti con disturbi alimentari, non è precipitato da un unico specifico trigger, ma da una combinazione di stimoli attivanti diversi che non differiscono significativamente tra gruppi diagnostici diversi

Superinfections caused by carbapenem-resistant Enterobacterales in hospitalized patients with COVID-19: a multicentre observational study from Italy (CREVID Study)

Objectives To describe clinical characteristics and outcomes of COVID-19 patients who developed secondary infections due to carbapenem-resistant Enterobacterales (CRE). Methods Retrospective observational study including COVID-19 patients admitted to 12 Italian hospitals from March to December 2020 who developed a superinfection by CRE. Superinfection was defined as the occurrence of documented bacterial infection >48 h from admission. Patients with polymicrobial infections were excluded. Demographic, clinical characteristics and outcome were collected. Isolates were classified as KPC, metallo-beta-lactamase (MBL) and OXA-48-producing CRE. A Cox regression analysis was performed to identify factors independently associated with 30 day mortality. Results Overall, 123 patients (median age 66 years, IQR 59-75) were included. The majority of infections occurred in the ICU (81, 65.9%), while 42 (34.1%) in medical wards. The most common types of infection were bloodstream infections (BSI) (n = 64, 52%), followed by urinary-tract infections (UTI) (n = 28, 22.8%), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) (n = 28, 22.8%), intra-abdominal infections (n = 2, 1.6%) and skin infections (n = 1, 0.8%). Sixty-three (51.2%) infections were caused by KPC-, 54 (43.9%) by MBL-, and 6 (4.8%) by OXA-48-producing CRE. Thirty-day mortality was 33.3% (41/123). On Cox regression analysis, HAP/VAP compared with UTI (HR 7.23, 95% CI 2.09-24.97, P = 0.004), BSI compared with UTI (HR 3.96, 95% CI, 1.33-11.77, P = 0.004), lymphopenia on admission (HR 3, 95% CI 1.44-6.26, P = 0.003) and age (HR 1.05, 95% CI 1.02-1.08, P = 0.002) were predictors of 30 day mortality. Conclusions Superinfections by CRE were associated with high risk of 30 day mortality in patients with COVID-19. HAP/VAP was the strongest predictor of death in these patients

AMPA receptor GluA2 subunit defects are a cause of neurodevelopmental disorders.

AMPA receptors (AMPARs) are tetrameric ligand-gated channels made up of combinations of GluA1-4 subunits encoded by GRIA1-4 genes. GluA2 has an especially important role because, following post-transcriptional editing at the Q607 site, it renders heteromultimeric AMPARs Ca2+-impermeable, with a linear relationship between current and trans-membrane voltage. Here, we report heterozygous de novo GRIA2 mutations in 28 unrelated patients with intellectual disability (ID) and neurodevelopmental abnormalities including autism spectrum disorder (ASD), Rett syndrome-like features, and seizures or developmental epileptic encephalopathy (DEE). In functional expression studies, mutations lead to a decrease in agonist-evoked current mediated by mutant subunits compared to wild-type channels. When GluA2 subunits are co-expressed with GluA1, most GRIA2 mutations cause a decreased current amplitude and some also affect voltage rectification. Our results show that de-novo variants in GRIA2 can cause neurodevelopmental disorders, complementing evidence that other genetic causes of ID, ASD and DEE also disrupt glutamatergic synaptic transmission

Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data

OBJECTIVE: We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy. METHODS: A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered. RESULTS: The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal €25 million, €15 million, and €9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were €50.13 and €55.50 million for 1000 patients treated in 2016 and 2017, respectively. CONCLUSIONS: This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV

La valutazione del rischio cardiovascolare nel personale della riabilitazione dell'AOUP

Le malattie cardiovascolari sono tra le principali cause di morbosità, invalidità e mortalità in Italia. Sono in gran parte prevenibili, in quanto riconoscono, accanto a fattori di rischio non modificabili (età, sesso e familiarità), anche fattori modificabili, legati a comportamenti e stili di vita (fumo, abuso di alcol, scorretta alimentazione, sedentarietà). Con questa tesi abbiamo voluto indagare il rischio cardiovascolare del personale della riabilitazione dell' Azienda Ospedaliero Universitaria Pisana (AOUP), capire quali condizioni influenzano maggiormente questo rischio, per poter successivamente mettere in atto gli accorgimenti necessari per ridurlo

SYSTEMIC HYPNOSIS WITH DEPRESSED INDIVIDUALS AND THEIR FAMILIES

Historically, depression has been considered almost exclusively from an intrapersonal viewpoint, focusing almost entirely on the depressed individual in treatment. In this article, the focus is shifted to an interpersonal view of depression, emphasizing the role of family and cultural influences on the evolution of depression and its successful treatment. Patterns of hypnosis that can be applied in a systemic treatment framework are described and illustrated with case examples

Systemic Hypnosis with Depressed Individuals and Their Families

Historically, depression has been considered almost exclusively from an intrapersonal viewpoint, focusing almost entirely on the depressed individual in treatment. In this article, the focus is shifted to an interpersonal view of depression, emphasizing the role of family and cultural influences on the evolution of depression and its successful treatment. Patterns of hypnosis that can be applied in a systemic treatment framework are described and illustrated with case examples