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Magazzù G, Aquilina S, Barbara C, Bondin R, Brusca I, Bugeja J, Camilleri M, Cascio D, Costa S, Cuzzupè C, Duca A, Fregapane M, Gentile V, Giuliano A, Grifò A, Grima AM, Ieni A, Li Calzi G, Maisano F, Melita G, Pallio S, Panasiti I, Pellegrino S, Romano C, Sorce S, Tabacchi ME, Taormina V, Tegolo D, Tortora A, Valenti C, Vella C, Raso G. Recognizing the Emergent and Submerged Iceberg of the Celiac Disease: ITAMA Project-Global Strategy Protocol. Pediatr Rep 2022; 14:293-311. [PMID: 35736659 PMCID: PMC9227897 DOI: 10.3390/pediatric14020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 12/12/2022] Open
Abstract
Coeliac disease (CD) is frequently underdiagnosed with a consequent heavy burden in terms of morbidity and health care costs. Diagnosis of CD is based on the evaluation of symptoms and anti-transglutaminase antibodies IgA (TGA-IgA) levels, with values above a tenfold increase being the basis of the biopsy-free diagnostic approach suggested by present guidelines. This study showcased the largest screening project for CD carried out to date in school children (n=20,000) aimed at assessing the diagnostic accuracy of minimally invasive finger prick point-of-care tests (POCT) which, combined with conventional celiac serology and the aid of an artificial intelligence-based system, may eliminate the need for intestinal biopsy. Moreover, this study delves deeper into the "coeliac iceberg" in an attempt to identify people with disorders who may benefit from a gluten-free diet, even in the absence of gastrointestinal symptoms, abnormal serology and histology. This was achieved by looking for TGA-IgA mucosal deposits in duodenal biopsy. This large European multidisciplinary health project paves the way to an improved quality of life for patients by reducing the costs for diagnosis due to delayed findings of CD and to offer business opportunities in terms of diagnostic tools and support.
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Affiliation(s)
- Giuseppe Magazzù
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
- Correspondence:
| | - Samuel Aquilina
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Christopher Barbara
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Ramon Bondin
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Ignazio Brusca
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | | | - Mark Camilleri
- Department of Pathology, Mater Dei Hospital, 2090 Msida, Malta; (C.B.); (M.C.)
| | - Donato Cascio
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Stefano Costa
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Chiara Cuzzupè
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Annalise Duca
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Maria Fregapane
- Ospedale Fatebenefratelli, Buccheri La Ferla, 90123 Palermo, Italy; (I.B.); (M.F.)
| | - Vito Gentile
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Angele Giuliano
- AcrossLimits Ltd., 4013 Birkirkara, Malta; (J.B.); (A.D.); (A.G.)
| | - Alessia Grifò
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Anne-Marie Grima
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Antonio Ieni
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giada Li Calzi
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Fabiana Maisano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Giuseppinella Melita
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Socrate Pallio
- Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, 98122 Messina, Italy;
| | - Ilenia Panasiti
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Pellegrino
- DAI Materno-Infantile, AOU Policlinico G. Martino, 98124 Messina, Italy; (S.C.); (S.P.)
| | - Claudio Romano
- Dipartimento di Patologia Umana dell’Adulto e dell’Età Evolutiva “Gaetano Barresi”, Università di Messina, 98122 Messina, Italy; (C.C.); (A.G.); (A.I.); (F.M.); (G.M.); (I.P.); (C.R.)
| | - Salvatore Sorce
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
- Facoltà di Ingegneria e Architettura, Università degli Studi di Enna “Kore”, 94100 Enna, Italy
| | - Marco Elio Tabacchi
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Vincenzo Taormina
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
| | - Domenico Tegolo
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Andrea Tortora
- DAI Scienze Mediche, AOU Policlinico G. Martino, 98124 Messina, Italy;
| | - Cesare Valenti
- Dipartimento di Matematica e Informatica, Università di Palermo, 90133 Palermo, Italy; (M.E.T.); (D.T.); (C.V.)
| | - Cecil Vella
- Department of Paediatrics, Mater Dei Hospital, 2090 Msida, Malta; (S.A.); (R.B.); (A.-M.G.); (C.V.)
| | - Giuseppe Raso
- Dipartimento di Fisica e Chimica-“E. Segrè”, Università di Palermo, 90133 Palermo, Italy; (D.C.); (V.G.); (G.L.C.); (S.S.); (V.T.); (G.R.)
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Duca A, Reviriego-Agudo L, Parra González M, Charco Mora P. Evaluation of the baska laryngeal mask during general anesthesia with positive pressure ventilation. Trends in Anaesthesia and Critical Care 2017. [DOI: 10.1016/j.tacc.2017.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benítez-Gutiérrez L, de Mendoza C, Baños I, Duca A, Arias A, Treviño A, Requena S, Citores MJ, Cuervas-Mons V. Drug-Induced Lung Injury in a Liver Transplant Patient Treated With Sofosbuvir. Transplant Proc 2016; 48:2515-2518. [PMID: 27742338 DOI: 10.1016/j.transproceed.2016.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
New direct-acting antivirals (DAAs) have dramatically improved sustained virologic response (SVR) rates in patients treated for chronic hepatitis C. Although the safety of these agents has been very good in registration trials, unexpected side effects have been reported after much broader use of DAAs on marketing. We retrospectively examined all liver transplant recipients with chronic hepatitis C that received sofosbuvir-based regimens at our clinic. A total of 24 liver transplant recipients with recurrent chronic hepatitis C had received sofosbuvir up to April 2015. Regimens were as follows: sofosbuvir+simeprevir (8), SOF+ledipasvir (6), sofosbuvir+daclatasvir (5) and sofosbuvir+ribavirin (5). Overall, treatment was very well tolerated with only mild adverse events in 42% of patients. However, a 52-year-old woman developed severe respiratory failure within 10 days after beginning sofosbuvir+daclatasvir. High-resolution computerized tomography showed areas of diffused ground-glass opacities in both lungs, suggesting drug-induced lung injury. The bronchoalveolar lavage showed marked signs of acute inflammation without recovering any infectious agent. The patient was treated with high-dose corticosteroids and steadily recovered. DAA therapy was not discontinued, but sofosbuvir was replaced by simeprevir. She reached sustained virologic response after completing 24 weeks of DAA therapy. Given the close temporal association, radiologic and bronchoalveolar lavage findings, and negative work-up for infectious agents, we postulated that sofosbuvir was the most likely explanation for drug-induced lung injury in our patient.
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Affiliation(s)
- L Benítez-Gutiérrez
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain.
| | - C de Mendoza
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - I Baños
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Duca
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Arias
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain
| | - A Treviño
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - S Requena
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - M J Citores
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Internal Medicine Laboratory, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - V Cuervas-Mons
- Internal Medicine Department and Liver Transplantation Unit, Puerta de Hierro University Hospital, Majadahonda, Spain; Department of Medicine, Autonomous University, Madrid, Spain
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Hattink B, Meiland F, van der Roest H, Kevern P, Abiuso F, Bengtsson J, Giuliano A, Duca A, Sanders J, Basnett F, Nugent C, Kingston P, Dröes RM. Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom. J Med Internet Res 2015; 17:e241. [PMID: 26519106 PMCID: PMC4642792 DOI: 10.2196/jmir.4025] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 04/07/2015] [Accepted: 06/21/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers. OBJECTIVE The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers. METHODS For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia. Secondary outcome measures were empathy, quality of life, burden, and caregivers' sense of competence. RESULTS STAR was rated positively by all user groups on both usefulness and user friendliness. Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia; both the experimental and the control group increased in score. Regarding empathy, significant improvements were found in the STAR training group on distress, empathic concern, and taking the perspective of the person with dementia. In the experimental group, however, there was a significant reduction in self-reported sense of competence. CONCLUSIONS The STAR training portal is a useful and user-friendly e-learning method, which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy.
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Affiliation(s)
- Bart Hattink
- VU University medical center Amsterdam, Department of Psychiatry, Amsterdam, Netherlands.
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de la Fuente S, Citores MJ, Baños I, Duca A, Cuervas-Mons V. Long-term survivors after pediatric liver transplatation are at increased risk for development of cardiovascular disease events: analysis of 30 cases. Transplant Proc 2014; 46:3111-3. [PMID: 25420837 DOI: 10.1016/j.transproceed.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Liver transplantation (LT) in adult patients is associated with a higher incidence of cardiovascular risk factors (CVRF), chronic kidney disease (CKD), and cardiovascular disease mortality than the general population. Available information about these problems in adult patients with LT from a pediatric age is limited. The aim of this study was to analyze the incidence of CVRF, risk of developing CKD, and risk of 10-year coronary event in adult patients who received LT in childhood. METHODS Thirty adult patients (11 female, 19 male; mean age, 29.3 years) who underwent LT in childhood were analyzed, and CVRF, estimated glomerular filtration rate, and current immunosuppressive regimen were recordered. The risk of 10-year coronary event was calculated with the use of validated equations (Framingham and Regicor) and compared with the estimated risk in the general population. RESULTS None of the patients had CVRF before LT, except 1 patient who received a transplant because of familial hypercholesterolemia. Median age of patients at the time of study was 28.6 years (range, 19.3-43.1 y), and mean follow-up after LT was 17.83 ± 5.21 years. Twenty-nine patients (96.7%) were receiving a calcineurin inhibitor (69% tacrolimus, 31% cyclosporine), along with steroids in 13 of them. The average CVRF per patient was 2, and 11 patients (43.33%) had ≥3. Thirteen patients (43.33%) had CKD. The estimated risk of developing a coronary event at 10 years according to the Framingham score was 3%, higher than expected in the general population of same age and sex. With the use of the Regicor equation, adapted to the Spanish population, the estimated cardiovascular risk was 1.6%, corresponding to Spanish men without CVRF aged 50-55 years. None of the patients had cardiovascular events during the follow-up. CONCLUSIONS Our data show a high incidence of CVRF and CKD in young adults who received LT in childhood, resulting in an increased risk of cardiovascular disease.
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Affiliation(s)
- S de la Fuente
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
| | - M J Citores
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - I Baños
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - A Duca
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - V Cuervas-Mons
- Unidad de Trasplante Hepático, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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Ramos Martínez A, Duca A, Muñez Rubio E, Valverde Herreros ML, Ramírez Feito C. [Osteomyelitis due to Escherichia coli complicating a closed humeral fracture]. An Med Interna 2007; 23:588-90. [PMID: 17371148 DOI: 10.4321/s0212-71992006001200008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients with indwelling urethral catheters have an important risk of developing Escherichia coli bacteremia. Several cases of hematogenous vertebral osteomyelitis due to E. coli after diagnostic or therapeutic urinary tract procedures have been reported. An 88-years-old male patient with indwelling urethral catheter was admitted because of a closed subcapital humeral fracture and macroscopic hematuria due to bladder carcinoma. During his hospital admission he was treated with bladder irrigations with glycine solution. Also a cystoscopy was done. On 8th day after admission the size of his left shoulder increased. Free air in the proximity of the humeral fracture was observed at X-ray radiography and at CT scan. The patient was operated and an abscess close to the fracture with malodorous pus was drained. A culture of pus yielded E. coli. In order to prevent infections similar cases, use of indwelling urethral catheters should be strictly limited to patients that do not have any other option.
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Affiliation(s)
- A Ramos Martínez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Universidad Autónoma, Madrid, Spain.
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Pavel M, Iacobovici A, Duca A. [Oxidase activity at the erythrocyte level]. Rev Med Chir Soc Med Nat Iasi 1987; 91:301-4. [PMID: 3685692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
A method for the simultaneous determination of cyanocobalamin, cobinamide (Factor B), and hydroxocobalamin in the solid state is described. The method is based on heating at 120 degrees for cobinamide and at 140-145 degrees for cyanocobalamin (15-20 min). The cyano content in the sample is distilled as hydrocyanic acid, trapped in 0.1 M potassium nitrate at pH 12-13, and determined by means of the cyanide ion-selective electrode. The error of this method, statistically established, does not exceed +/-3%.
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Goldstein S, Ciupitoiu A, Vasilescu V, Duca A. Quantitative determination of vitamin B12 by cyan dosage, with infrared absorption spectrophotometry. Mikrochim Acta 1975:117-23. [PMID: 1134397 DOI: 10.1007/bf01271528] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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