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Marinangeli F, Tonini G, Aglietta M, Gentili M, Cappellini F, Giacomelli L, Biasco G. A form to report pain assessment and monitoring in the oncology clinical record: a Delphi process. Future Oncol 2023; 19:1669-1676. [PMID: 37042452 DOI: 10.2217/fon-2022-1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Background: Treatment of cancer pain remains suboptimal worldwide. In Italy, a law requires that pain be regularly assessed and reported in both medical and nursing records. Aim: To provide a homogeneous form to get exhaustive clinical information in the clinical report according to Italian legislation. Methods: A board, including oncologists and pain therapists, designed a form to report the pain characteristics of cancer patients in Italy in clinical records. The form was voted on through a Delphi process among directors of 18 clinical oncology specialization schools in Italy to obtain agreement on its content. Results: A form useful for collecting and reporting comprehensive and homogeneous information on pain among oncologists in Italy was produced. Conclusion: The development of common strategies for pain management can be improved by using this tool.
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Affiliation(s)
- Franco Marinangeli
- Department of Anesthesiology, Pain Treatment & Palliative Care, University of L'Aquila, 67100 L'Aquila, Italy
| | - Giuseppe Tonini
- Medical & Translational Oncology, Foundation Polyclinic Campus-Biomedico University, Roma, Italy
| | - Massimo Aglietta
- Medical Oncology, University of Turin, Oncology Network of Piemonte VdA, Candiolo Institute, FPO- IRCCS, 10060 Candiolo, Turin, Italy
| | - Marta Gentili
- Research Biology Private Practice, Milan, 20154 Milan, Italy
| | | | | | - Guido Biasco
- Medical Oncology, Alma Mater Studiorum, University of Bologna, 40125 Bologna, Italy
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2
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Benini F, Terrenato I, Lazzarin P, Borrometi F, Jankovic M, Torri V, Giacomelli L, Gentili M. Turn off pain: What has changed 4 years later? Acta Paediatr 2020; 109:2428-2429. [PMID: 31994753 DOI: 10.1111/apa.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Franca Benini
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Irene Terrenato
- Biostatistics and Bioinformatic Unit - Scientific Direction, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Pierina Lazzarin
- Pediatric Palliative Care, Pain Service, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care, Department of Oncology, Pausilipon Hospital, AORN Santobono Pausilipon, Naples, Italy
| | - Momcilo Jankovic
- Pediatric Clinics, Foundation MBBM, University of Milano-Bicocca, Monza, Italy
| | - Valter Torri
- Lab Metodologia della Ricerca Clinica, Dipartimento di Oncologia, IRCCS Istituto di Ricerche Farmacologiche 'Mario Negri', Milano, Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.,Polistudium Srl, Milan, Italy
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3
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Iacovelli NA, Torrente Y, Ciuffreda A, Guardamagna VA, Gentili M, Giacomelli L, Sacerdote P. Topical treatment of radiation-induced dermatitis: current issues and potential solutions. Drugs Context 2020; 9:dic-2020-4-7. [PMID: 32587626 PMCID: PMC7295106 DOI: 10.7573/dic.2020-4-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 02/08/2023] Open
Abstract
Approximately 95% of patients receiving radiotherapy (RT) will ultimately develop radiation-induced dermatitis (RID) during or after the course of treatment, with major consequences on quality of life and treatment outcomes. This paper reviews the pathophysiology of RID and currently used topical products for the prevention and treatment of RID. Although there is no consensus on the appropriate management, recent evidence suggests that the use of topical products supports to protect and promote tissue repair in patients with RID. Basic recommendations include advice to wear loose clothing, using electric razors if necessary, and avoiding cosmetic products, sun exposure or extreme temperatures. Based on mechanisms involved and on the clinical characteristics of oncological patients, the profile of the ideal topical product for addressing RID can be designed; it should have limited risk of adverse events, systemic adsorption and drug–drug interactions, should be characterized by multiple clinical activities, with a special focus on localized pain, and should have a careful formulation as some vehicles can block the RT beam.
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Affiliation(s)
| | - Yvan Torrente
- Stem Cell Laboratory, Department of Pathophysiology and Transplantation, Universitá degli Studi di Milano, Milan, Italy.,Unit of Neurology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Dino Ferrari, Milan, Italy
| | - Adriana Ciuffreda
- Medico Chirurgo, Specialista in Dermatologia e Venereologia, Dermatologia Pediatrica, Milan, Italy
| | - Vittorio A Guardamagna
- Division of Palliative Care and Pain Therapy, IRCCS Istituto Europeo di Oncologia IEO, Milan, Italy.,Director of ESMO, Designated Center of Integrated Oncology and Palliative Care, Milan, Italy
| | | | - Luca Giacomelli
- Polistudium SRL, Milan, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Science, University of Milano, Milan, Italy
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4
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Pingue V, Gentili M, Losurdo A, Clementi E, Nardone A. Levetiracetam Improves Upper Limb Spasticity in a Patient With Unresponsive Wakefulness Syndrome: A Case Report. Front Neurosci 2020; 14:70. [PMID: 32116516 PMCID: PMC7015971 DOI: 10.3389/fnins.2020.00070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
Severe spasticity is a frequent and disabling complication in patients presenting disorders of consciousness (DOC) that hinders their rehabilitative process, and is strongly correlated with pain reducing patients’ quality of life. In these patients, abnormal postures may occur as an expression of severe brain damage. Here we present the case of a 52-year-old man in decorticate rigidity following a hypoxic–ischemic encephalopathy due to myocardial infarction who showed improvement of spasticity of upper limbs following intake of levetiracetam combined with the conventional neurorehabilitation program.
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Affiliation(s)
- Valeria Pingue
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- *Correspondence: Valeria Pingue,
| | - Marta Gentili
- Pharmacy Service, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Anna Losurdo
- Pharmacy Service, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
- Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Antonio Nardone
- Neurorehabilitation and Spinal Unit, Institute of Pavia, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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5
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Pozzi M, Galbiati S, Locatelli F, Carnovale C, Gentili M, Radice S, Strazzer S, Clementi E. Severe acquired brain injury aetiologies, early clinical factors, and rehabilitation outcomes: a retrospective study on pediatric patients in rehabilitation. Brain Inj 2019; 33:1522-1528. [PMID: 31446793 DOI: 10.1080/02699052.2019.1658128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Studies on pediatric severe acquired brain injury (sABI) outcomes focused mostly on single etiologies, not clarifying the independent role of clinical factors, and scantly explored inter-dependence between variables. We assessed associations of clinical factors at admission with essential outcomes, controlling for inter-dependence and sABI etiology. Methods: We reviewed the clinical records of 280 patients with traumatic and 292 with non-traumatic sABI, discharged from intensive care to pediatric neurological rehabilitation. We analyzed the distribution of clinical factors based on sABI etiology; conducted a factor analysis of variables; built multivariate models evaluating the associations of variables with death, persistent vegetative states, duration of coma, GOS outcome, length of stay. Results: We described the study sample. Factor analysis of inter-dependence between GCS, time before rehabilitation, dysautonomia, device use, produced the indicators "injury severity" and "neurological dysfunction", independent from sABI etiology, age, sex, and admittance GOS. Multivariate analyzes showed that: coma duration, GOS outcome, and length of stay, which may depend on rehabilitation courses, were directly associated with injury severity, neurological dysfunction, and patients' age; death and persistent vegetative states were also associated with etiology. Conclusion: Future studies should analyze larger cohorts and investigate mechanisms linking specific etiologies and patients' age with outcomes.
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Affiliation(s)
- Marco Pozzi
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Sara Galbiati
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Federica Locatelli
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
| | - Sandra Strazzer
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy
| | - Emilio Clementi
- Acquired Brain Injury Unit, Scientific Institute IRCCS Eugenio Medea , Lecco , Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano , Milan , Italy
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6
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Mazhar F, Pozzi M, Gentili M, Scatigna M, Clementi E, Radice S, Carnovale C. Association of Hyponatraemia and Antidepressant Drugs: A Pharmacovigilance-Pharmacodynamic Assessment Through an Analysis of the US Food and Drug Administration Adverse Event Reporting System (FAERS) Database. CNS Drugs 2019; 33:581-592. [PMID: 30977109 DOI: 10.1007/s40263-019-00631-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hyponatraemia induced by antidepressant drugs is a rare but potentially life-threatening adverse reaction. Whether it is associated with all or only some antidepressant drugs is still unclear. This needs to be clarified to guide antidepressant therapies, especially in patients with electrolytic imbalances. OBJECTIVES The primary objective of this study was to quantify the strength of association between the use of different antidepressant drugs and hyponatraemia by using information reported to the US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS). The secondary objective was to investigate the putative relationship between different antidepressant pharmacological targets and the risks of hyponatraemia induced by antidepressant drugs using the 'pharmacovigilance-pharmacodynamic' method. METHODS We used the FAERS database to conduct a case/non-case analysis on spontaneous reports, focusing on events of hyponatraemia/syndrome of inappropriate antidiuretic hormone secretion (SIADH) reported in connection with the use of antidepressant drugs. Risk was expressed as a measure of disproportionality using the reporting odds ratio while adjusting for sex, age and concomitant medications associated with hyponatraemia/SIADH. We assessed to what extent the receptor-binding properties of antidepressant drugs could associate with the reporting odds ratios of hyponatraemia/SIADH of antidepressant drugs, building a linear regression model that included as independent variables the binding affinities (pKi) to the serotonin transporter, dopamine transporter, norepinephrine transporter, and serotonin 5-HT2C, 5-HT2A and 5-HT1A, and α1- and α2-adrenergic receptors. RESULTS There were 2233 reports identified. The adjusted reporting odds ratio for the association between antidepressant drug use and hyponatraemia was 1.91 (95% confidence interval 1.83-2.00). The association was strongest for mirtazapine, followed by selective serotonin reuptake inhibitors, and lowest with serotonin-modulating antidepressant drugs. A significant linear correlation was found between the adjusted reporting odds ratios for hyponatraemia and pKi for the adrenergic receptors α1 and α2. CONCLUSIONS Hyponatraemia is reported at a disproportionately higher level with classes of antidepressant drugs (noradrenergic and specific serotonergic antidepressant [mirtazapine] and serotonin modulators [vortioxetine]) that are in general considered to have a better profile of tolerability in terms of hyponatraemia. With regard to the presented results, the risk of hyponatraemia with mirtazapine appears to be greater than what was reported in the literature; however, confounding by indication cannot be ruled out. Our pharmacovigilance-pharmacodynamic analysis also indicates that inhibition of the serotonin transporter may not be involved in the hyponatraemia linked to the use of antidepressant drugs.
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Affiliation(s)
- Faizan Mazhar
- Pharmacovigilance Service, Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan ASST Fatebenefratelli-Sacco, Via G. B. Grassi, 74, 20157, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Marta Gentili
- Pharmacovigilance Service, Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan ASST Fatebenefratelli-Sacco, Via G. B. Grassi, 74, 20157, Milan, Italy
| | - Marco Scatigna
- Specialisation School of Clinical Pharmacology and Toxicology, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Pharmacovigilance Service, Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan ASST Fatebenefratelli-Sacco, Via G. B. Grassi, 74, 20157, Milan, Italy.,Scientific Institute, IRCCS E. Medea, Bosisio Parini, LC, Italy
| | - Sonia Radice
- Pharmacovigilance Service, Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan ASST Fatebenefratelli-Sacco, Via G. B. Grassi, 74, 20157, Milan, Italy.
| | - Carla Carnovale
- Pharmacovigilance Service, Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, University of Milan ASST Fatebenefratelli-Sacco, Via G. B. Grassi, 74, 20157, Milan, Italy
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7
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Gentili M, Pozzi M, Peeters G, Radice S, Carnovale C. Review of the Methods to Obtain Paediatric Drug Safety Information: Spontaneous Reporting and Healthcare Databases, Active Surveillance Programmes, Systematic Reviews and Meta-analyses. ACTA ACUST UNITED AC 2019; 13:28-39. [PMID: 29412117 DOI: 10.2174/1574884713666180206164634] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/01/2018] [Accepted: 01/01/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Knowledge of drugs safety collected during the pre-marketing phase is inevitably limited because the randomized clinical trials (RCTs) are rarely designed to evaluate safety. The small and selective groups of enrolled individuals and the limited duration of trials may hamper the ability to characterize fully the safety profiles of drugs. Additionally, information about rare adverse drug reactions (ADRs) in special groups is often incomplete or not available for most of the drugs commonly used in the daily clinical practice. In the paediatric setting several highimpact safety issues have emerged. Hence, in recent years, there has been a call for improved post-marketing pharmacoepidemiological studies, in which cohorts of patients are monitored for sufficient time in order to determine the precise risk-benefit ratio. OBJECTIVE In this review, we discuss the current available strategies enhancing the post-marketing monitoring activities of the drugs in the paediatric setting and define criteria whereby they can provide valuable information to improve the management of therapy in daily clinical practice including both safety and efficacy aspects. The strategies we cover include the signal detection using international pharmacovigilance and/or healthcare databases, the promotion of active surveillance initiatives which can generate complete, informative data sets for the signal detection and systematic review/meta-analysis. CONCLUSION Together, these methods provide a comprehensive picture of causality and risk improving the management of therapy in a paediatric setting and they should be considered as a unique tool to be integrated with post-marketing activities.
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Affiliation(s)
- Marta Gentili
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, 20122 Milano MI, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini LC, Italy
| | - Gabriella Peeters
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, 20122 Milano MI, Italy
| | - Sonia Radice
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, 20122 Milano MI, Italy
| | - Carla Carnovale
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, 20122 Milano MI, Italy
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Rivard A, Gentili M, Koizumi N. Interactive Maps for UNOS Data Visualization. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1013] [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: 11/15/2022] Open
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Carnovale C, Gentili M, Magni C, Mazhar F, Mosini G, Clementi E, Radice S. The impact of a successful treatment of HCV on glyco-metabolic control in diabetic patients. Antivir Ther 2019; 24:147-149. [PMID: 30835253 DOI: 10.3851/imp3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Carlo Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Giulia Mosini
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy.,Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
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10
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Carnovale C, Pozzi M, Dassano A, D'Addio F, Gentili M, Magni C, Clementi E, Radice S, Fiorina P. The impact of a successful treatment of hepatitis C virus on glyco-metabolic control in diabetic patients: a systematic review and meta-analysis. Acta Diabetol 2019; 56:341-354. [PMID: 30478781 DOI: 10.1007/s00592-018-1257-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/06/2018] [Indexed: 01/06/2023]
Abstract
AIMS The effect of HCV eradication following the use of direct-acting antiviral drugs (DAAs) on the glyco-metabolic control is unknown. Through a meta-analysis of available clinical studies, we investigated whether eradication of HCV infection with interferon-free DAAs is associated with improved glyco-metabolic control in diabetic patients. METHODS We searched the PubMed, MEDLINE and Embase, up to 08th June 2018, for all studies evaluating whether eradication of HCV infection with DAAs is associated with changes in glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) levels from baseline in human subjects, without restrictions for study type and language. Data were independently extracted by two researchers using pre-specified forms. Random effects meta-analyses were conducted on HbA1c and FPG levels before/after HCV eradication. RESULTS We found a significant mean reduction in HbA1c levels of - 0.45% (95% CI - 0.60 to - 0.30%; P < 0.001) and in FPG levels of - 22.03 mg/dL (95% CI - 41.61 to - 2.44 mg/dL; P = 0.03), with high heterogeneity between studies (χ2 = 20.4, P < 0.001, I2 = 80% and χ2 = 35.8, P = 0.001, I2 = 94%, respectively). The number of available manuscripts did not allow conducting a meta-regression to elucidate the role of sustained virological response and other confounders in determining the effect of direct-acting antiviral agents on HbA1c reduction. CONCLUSIONS We found a significant improvement in glyco-metabolic control after HCV eradication (in terms of glycated haemoglobin and fasting plasma glucose levels reduction) following direct-acting antiviral treatment in patients with established diabetes, including a consequent positive impact on anti-diabetic therapies.
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Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842, Bosisio Parini, Lecco, Italy
| | - Alice Dassano
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
| | - Francesca D'Addio
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Carlo Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
- Scientific Institute IRCCS Eugenio Medea, 23842, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, Via GB Grassi 74, 20157, Milan, Italy
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, Università di Milano, 20157, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, 20157, Milan, Italy
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11
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Carnovale C, Mahzar F, Scibelli S, Gentili M, Arzenton E, Moretti U, Leoni O, Pozzi M, Peeters GGAM, Clementi E, Medaglia M, Radice S. Central nervous system-active drug abused and overdose in children: a worldwide exploratory study using the WHO pharmacovigilance database. Eur J Pediatr 2019; 178:161-172. [PMID: 30374752 DOI: 10.1007/s00431-018-3281-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
Abstract
Recent epidemiological studies have reported an increase in central nervous system (CNS)-active drug abuse rates in paediatric settings, raising several public health concerns. No study to date has explored this issue worldwide. We performed an extensive analysis of drugs abuse/overdose reported for children in the last decade by using the largest pharmacovigilance database, i.e. the VigiBase, collecting adverse drug reaction reports that involved at least one suspect drug belonging to the Anatomical Therapeutic Chemical code "Nervous System" through the Standardised Medical Dictionary for Drug Regulatory Affairs Queries for Drug abuse. 8.682 reports matched our criteria. An increase in reporting activity was observed, starting from 2014; an intentional overdose was reported more frequently than an accidental one, with a difference between age groups. We retrieved 997 reports with death outcome. These referred more to adolescents (n = 538) than subjects of any other paediatric age group. Paracetamol and opioid analgesics were the most common suspect drugs in deaths across all age groups due to hypoxic-ischaemic encephalopathy, brain death, and cardio-respiratory arrest.Conclusion: The number of reports associated with drug abuse and overdose is increasing (for opioid and paracetamol-containing products) and a considerable number of adverse drug reactions are serious. Data on the patterns of use of such medicines from each country may help in implementing strategies of risk-minimisation and renewing healthcare recommendations worldwide. An increased clinical awareness of drug abuse and overdose is warranted, while continuing to provide effective treatments. What is Known: • The large increase in paediatric prescriptions for CNS-active drugs in the last 20 years has recently raised public health concerns about drug abuse and overdose. • No study to date has examined this issue in paediatric patients worldwide. What is New: • The number of paediatric reports associated with CNS drug abuse and intentional overdose is increasing, including those with fatal outcome; over 4 years; more than 35% of the reports was entered from European countries. • Opioid and paracetamol were most frequently suspected for ADRs with fatal outcome across all age groups, due to hypoxic-ischaemic encephalopathy and cardio-respiratory arrest, suggesting the need to implement strategies of risk-minimisation.
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Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy.
| | - Faizan Mahzar
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Sara Scibelli
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Elena Arzenton
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Ugo Moretti
- Department of Diagnostics and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Olivia Leoni
- Regional Pharmacovigilance Center of Lombardy, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Gabriëlla G A M Peeters
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy.,Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | | | - Sonia Radice
- Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157, Milan, Italy
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Benini F, Lazzarin P, Borrometi F, Jankovic M, Torri V, Giacomelli L, Gentili M. Turn off pain evaluates the quality of pain care provided for paediatric inpatients. Acta Paediatr 2019; 108:16-18. [PMID: 30168610 DOI: 10.1111/apa.14562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/30/2018] [Accepted: 08/27/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Franca Benini
- Pediatric Palliative Care; Pain Service; Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Pierina Lazzarin
- Pediatric Palliative Care; Pain Service; Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care; Department of Oncology; Pausilipon Hospital; AORN Santobono Pausilipon; Naples Italy
| | - Momcilo Jankovic
- Pediatric Clinics; Foundation MBBM; University of Milano-Bicocca; Monza Italy
| | - Valter Torri
- Lab Metodologia della Ricerca Clinica; Dip Oncologia; IRCCS Istituto di Ricerche Farmacologiche ‘Mario Negri’; Milano Italy
| | - Luca Giacomelli
- Department of Surgical Sciences and Integrated Diagnostics; University of Genoa; Genoa Italy
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Carnovale C, Gentili M, Viganò C, Carnaghi G, Beltrami M, Bosi M. Analysis of tolerance to antidepressant drug treatment in FDA Adverse Event Reporting System. Pharmacol Res 2018; 141:616-617. [PMID: 30562572 DOI: 10.1016/j.phrs.2018.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Carla Carnovale
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
| | - Marta Gentili
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy.
| | - Caterina Viganò
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
| | - Giulia Carnaghi
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
| | - Marta Beltrami
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
| | - Monica Bosi
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan, Italy
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Carnovale C, Mazhar F, Pozzi M, Gentili M, Clementi E, Radice S. A characterization and disproportionality analysis of medication error related adverse events reported to the FAERS database. Expert Opin Drug Saf 2018; 17:1161-1169. [DOI: 10.1080/14740338.2018.1550069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Faizan Mazhar
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
- Scientific Institute IRCCS Eugenio Medea, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, “Luigi Sacco” University Hospital, Università di Milano, Milan, Italy
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Carnovale C, Pozzi M, Mazhar F, Mosini G, Gentili M, Peeters GGAM, Clementi E, Radice S. Interactions Between Antiepileptic and Antibiotic Drugs: A Systematic Review and Meta-Analysis with Dosing Implications. Clin Pharmacokinet 2018; 58:875-886. [DOI: 10.1007/s40262-018-0720-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pozzi M, Carnovale C, Peeters GGAM, Gentili M, Antoniazzi S, Radice S, Clementi E, Nobile M. Adverse drug events related to mood and emotion in paediatric patients treated for ADHD: A meta-analysis. J Affect Disord 2018; 238:161-178. [PMID: 29883938 DOI: 10.1016/j.jad.2018.05.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/09/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND ADHD is frequently comorbid with anxiety and mood disorders, which may increase the severity of inattention and hyperactivity symptoms. Emotional symptoms (anxiety, irritability, mood lability) also affect patients without comorbidity or emerge as adverse drug events. The influence of ADHD drugs on emotional symptoms demands investigation to improve therapies. METHODS Systematic review of trials reporting adverse events in patients pharmacologically treated for ADHD. Meta-analysis of the occurrence of irritability, anxiety, apathy, reduced talk, sadness, crying, emotional lability, biting nails, staring, perseveration, euphoria. Meta-regression analysis. RESULTS Forty-five trials were meta-analysed. The most frequently reported outcomes were irritability, anxiety, sadness, and apathy. Methylphenidates, especially immediate-release formulations, were most studied; amphetamines were half as studied and were predominantly mixed amphetamine salts. Reports on atomoxetine were scant. Meta-analysis showed that methylphenidates reduced the risk of irritability, anxiety, euphoria, whereas they worsened the risk of apathy and reduced talk; amphetamines worsened the risk of emotional lability. Factors influencing risks were study year and design, patients' sex and age, drug dose and release formulation. LIMITATIONS Possible discrepancy between adverse events as indicated in clinical trials and as summarised herein. Confounding due to the aggregation of drugs into groups; uninvestigated sources of bias; incomplete lists of adverse events; lack of observations on self-injury. CONCLUSIONS Methylphenidates appeared safer than amphetamines, although younger patients and females may incur higher risks, especially with high-dose, immediate-release methylphenidates. Only atomoxetine holds a black-box warning, but amphetamines and methylphenidates also did not show a safe profile regarding mood and emotional symptoms.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy.
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Gabriëlla G A M Peeters
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Stefania Antoniazzi
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy; Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences L. Sacco, "Luigi Sacco" University Hospital, Università di Milano, 20157 Milan, Italy.
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Lecco, Italy
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Carnovale C, Raschi E, Leonardi L, Moretti U, De Ponti F, Gentili M, Pozzi M, Clementi E, Poluzzi E, Radice S. No signal of interactions between influenza vaccines and drugs used for chronic diseases: a case-by-case analysis of the vaccine adverse event reporting system and vigibase. Expert Rev Vaccines 2018; 17:363-381. [PMID: 29452497 DOI: 10.1080/14760584.2018.1442718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND An increasing number of reports indicates that vaccines against influenza may interact with specific drugs via drug metabolism. To date, actual impact of vaccine-drug interactions observed in the real world clinical practice has not been investigated. METHODS From VAERS and VigiBase, we collected Adverse Event Following Immunization (AEFI) reports for individuals receiving vaccines against influenza recorded as suspect and selected cases where predictable toxicity was recorded with oral anticoagulants, antiepileptics and statins (i.e. hemorrhages, overdosage and rhabdomyolysis, respectively). We applied AEFI and Drug Interaction Probability Scale (DIPS) Algorithms to assess causality of drug-vaccine interactions. RESULTS 116 AEFI reports submitted to VAERS and 83 from Vigibase were included in our analysis; antiepileptics and statins were related to the highest number of indeterminate/consistent (93.7%; 65.3%) and possible/probable (50%; 57.7%) cases according to the AEFI and DIPS, respectively. The majority of cases occurred within the first week after vaccine administration (5-7 days). CONCLUSION The relative paucity of detected interactions does not impact on the benefit of the vaccination against influenza, which remains strongly recommended; this does not exclude that closer monitoring for selected patients exposed to concomitant chronic pharmacological therapies and affected by predisposing factors may be useful.
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Affiliation(s)
- Carla Carnovale
- a Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco , 'Luigi Sacco' University Hospital, Università di Milano , Milan , Italy
| | - Emanuel Raschi
- b Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum , University of Bologna , Bologna , Italy
| | - Luca Leonardi
- b Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum , University of Bologna , Bologna , Italy
| | - Ugo Moretti
- c Department of Diagnostics and Public Health, Section of Pharmacology , University of Verona , Verona , Italy
| | - Fabrizio De Ponti
- b Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum , University of Bologna , Bologna , Italy
| | - Marta Gentili
- a Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco , 'Luigi Sacco' University Hospital, Università di Milano , Milan , Italy
| | - Marco Pozzi
- d Scientific Institute , IRCCS E. Medea , Bosisio Parini , Italy
| | - Emilio Clementi
- d Scientific Institute , IRCCS E. Medea , Bosisio Parini , Italy.,e Clinical Pharmacology Unit, Department Biomedical and Clinical Sciences, CNR Institute of Neuroscience , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Elisabetta Poluzzi
- b Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum , University of Bologna , Bologna , Italy
| | - Sonia Radice
- a Unit of Clinical Pharmacology Department of Biomedical and Clinical Sciences L. Sacco , 'Luigi Sacco' University Hospital, Università di Milano , Milan , Italy
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Carnovale C, Gentili M, Antoniazzi S, Clementi E, Radice S. Levetiracetam-induced rhabdomyolysis: Analysis of reports from the Food and Drug Administration's Adverse Event Reporting System database. Muscle Nerve 2017; 56:E176-E178. [DOI: 10.1002/mus.25972] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Carla Carnovale
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
| | - Marta Gentili
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Emilio Clementi
- Department Biomedical and Clinical Sciences, Clinical Pharmacology Unit, CNR Institute of Neuroscience, Sacco University Hospital; University of Milan; Milan Italy
- Scientific Institute, IRCCS E. Medea; Bosisio Parini LC Italy
| | - Sonia Radice
- Department of Biomedical and Clinical Sciences, Clinical Pharmacology Unit, ASST Fatebenefratelli-Sacco University Hospital; University of Milan; Milan Italy
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Carnovale C, Damavandi PT, Gentili M, Pozzi M, Antoniazzi S, Radice S, Clementi E. On the association between human papillomavirus vaccine and sleep disorders: Evaluation based on vaccine adverse events reporting systems. J Neurol Sci 2017; 380:275-276. [DOI: 10.1016/j.jns.2017.07.051] [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] [Received: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
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Carnovale C, Russo S, Biondelli G, Gentili M, Pozzi M, Antoniazzi S, Radice S, Clementi E. Levocetirizine-induced Psychiatric Disorders in a Pediatric Patient: A Case Report and a Pharmacovigilance Database Analysis. J Pharmacol Pharmacother 2017; 8:74-76. [PMID: 28706402 PMCID: PMC5497403 DOI: 10.4103/jpp.jpp_14_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Simone Russo
- Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano
| | | | | | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini LC, Italy
| | - Stefania Antoniazzi
- Scientific Direction, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | | | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini LC, Italy
- Department of Biomedical and Clinical Sciences, Unit of Clinical Pharmacology, Consiglio Nazionale delle Ricerche, Institute of Neuroscience, ASST Fatebenefratelli-Sacco University Hospital, Università di Milano, Milan
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Antoniazzi S, Carnovale C, Sessa A, Gentili M, Matacena M, Punginelli M, Clementi E, Radice S. Auditory and visual hallucinations after influenza vaccine: a case report. Ther Adv Vaccines 2017; 5:25-27. [PMID: 28344806 DOI: 10.1177/2051013616673554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stefania Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Aurelio Sessa
- General Practitioner, Territorial Health Service of Varese, Varese, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Marco Matacena
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
| | - Maurizia Punginelli
- Pharmaceutical Service, Territorial Health Service of Insubria, Varese, Italy
| | - Emilio Clementi
- Scientific Institute IRCCS E.Medea, Bosisio Parini, Italy and Clinical Pharmacology Unit, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, via G.B. Grassi, 74, I20157 Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
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Affiliation(s)
- M. Gentili
- CEA, DEN, DER, Cadarache, 13108 Saint Paul Lez Durance, France
- Aixi Marseille Université, 13284, Marseille, France
| | - B. Fontaine
- CEA, DEN, DER, Cadarache, 13108 Saint Paul Lez Durance, France
| | - G. Rimpault
- CEA, DEN, DER, Cadarache, 13108 Saint Paul Lez Durance, France
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Rafaniello C, Pozzi M, Pisano S, Ferrajolo C, Bertella S, Sportiello L, Carnovale C, Sullo MG, Cattaneo D, Gentili M, Rizzo R, Pascotto A, Mani E, Villa L, Riccio MP, Sperandeo S, Bernardini R, Bravaccio C, Clementi E, Molteni M, Rossi F, Radice S, Capuano A. Second generation antipsychotics in 'real-life' paediatric patients. Adverse drug reactions and clinical outcomes of drug switch. Expert Opin Drug Saf 2017; 15:1-8. [PMID: 27875914 DOI: 10.1080/14740338.2016.1229301] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Gap in knowledge on benefit/risk ratio of second generation antipsychotics (SGA) in the paediatric population represents a challenge for the scientific community. This study aims to analyse all suspected adverse drug reactions (ADRs) to SGA observed during the study period; compare the safety profiles of risperidone and aripiprazole; evaluate the effect of switching from risperidone to aripiprazole or to a first generation antipsychotic (FGA). METHODS Prospective analysis of spontaneously reported ADRs concerning 184 paediatric outpatients between 2012 and 2014.; clinical outcomes of drug switch were evaluated. RESULTS Out of the 184 patients, 130 experienced at least one ADR; ADRs were usually not serious and more frequently associated with aripiprazole. Switching to aripiprazole was associated with better results than switching to FGAs in the Clinical Global Impression scale- Efficacy (CGI-E) scores (p = 0.018), Disturbed behaviour checklist-parents (DBC-P) self-absorption subscale (p = 0.010); only a trend for difference between changing to aripiprazole vs FGAs in the DBC-P total score (p = 0.054) and social relating subscale (p = 0.053) was observed. CONCLUSIONS SGAs safety data were consistent with the ones already known; however, there is still a need to improve the knowledge in pharmacovigilance field among clinicians. Switching to aripiprazole may be a valid alternative to risperidone.
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Affiliation(s)
- Concetta Rafaniello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Marco Pozzi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Simone Pisano
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Carmen Ferrajolo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Silvana Bertella
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Liberata Sportiello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Carla Carnovale
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Maria Giuseppa Sullo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Dario Cattaneo
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Marta Gentili
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Renata Rizzo
- e Child and Adolescent Neuropsychiatry, Department of Medical and Paediatric Sciences, School of Medicine , University of Catania , Catania , Italy
| | - Antonio Pascotto
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Elisa Mani
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Laura Villa
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Maria Pia Riccio
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Serena Sperandeo
- c Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Psychiatry Division , Second University of Naples , Naples , Italy
| | - Renato Bernardini
- f Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine , University of Catania , Catania , Italy
| | - Carmela Bravaccio
- g Department of Translational Medical Sciences , University Federico II of Naples , Naples , Italy
| | - Emilio Clementi
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy.,d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Massimo Molteni
- b Scientific Institute IRCCS Eugenio Medea , Bosisio Parini, Lecco , Italy
| | - Francesco Rossi
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
| | - Sonia Radice
- d Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences L. Sacco , L. Sacco University Hospital, Università di Milano , Milan , Italy
| | - Annalisa Capuano
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology L. Donatelli, School of Medicine and Surgery , Second University of Naples , Naples , Italy
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Carnovale C, Tabaee Damavandi P, Gentili M, Pozzi M, Antoniazzi S, Radice S, Clementi E. On the association between human papillomavirus vaccine and sleep disorders: Evaluation based on vaccine adverse events reporting systems. J Neurol Sci 2017; 373:179-181. [PMID: 28131183 DOI: 10.1016/j.jns.2016.12.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/23/2016] [Accepted: 12/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
| | - Payam Tabaee Damavandi
- Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
| | - Stefania Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy; Scientific Direction, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.
| | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy; Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital "Luigi Sacco", Milan, Italy
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25
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Pozzi M, Pisano S, Bertella S, Capuano A, Rizzo R, Antoniazzi S, Auricchio F, Carnovale C, Cattaneo D, Ferrajolo C, Gentili M, Guastella G, Mani E, Rafaniello C, Riccio MP, Scuderi MG, Sperandeo S, Sportiello L, Villa L, Radice S, Clementi E, Rossi F, Pascotto A, Bernardini R, Molteni M, Bravaccio C. Persistence in Therapy With Risperidone and Aripiprazole in Pediatric Outpatients: A 2-Year Naturalistic Comparison. J Clin Psychiatry 2016; 77:e1601-e1609. [PMID: 27780333 DOI: 10.4088/jcp.15m10247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/18/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The practical effectiveness of second-generation antipsychotics in children and adolescents is an understudied issue. It is a crucial area of study, though, because such patients are often treated for long-lasting disorders. METHODS We carried out a 24-month (March 2012-March 2014) observational study on an unselected population of pediatric outpatients treated with risperidone, aripiprazole, olanzapine, or quetiapine aiming to (1) describe drug use, (2) compare post hoc the discontinuation rates due to specific causes and dose adjustments by Kaplan-Meier analyses between drugs, and (3) analyze predictors influencing these outcomes by Cox multivariate models. RESULTS Among 184 pediatric patients, 77% patients were prescribed risperidone, and 18% were prescribed aripiprazole. Olanzapine or quetiapine were scantly used; therefore, they were excluded from analyses. Risperidone was prevalent in younger, male patients with disruptive behavioral disorders; aripiprazole, in patients with tic disorders. Overall, discontinuations occurred mostly in the first 6 months, and, at 24 months, the discontinuation numbers were similar between users of risperidone and aripiprazole (41.5% vs 39.4%). In univariate analyses, dose reduction was higher for aripiprazole (P = .033). Multivariate analyses yielded the following predictors: for all-cause discontinuation, baseline severity (hazard ratio [HR] = 1.48, P = .001) and dose increase (HR = 3.55, P = .001); for patient-decided discontinuation, dose change (increase: HR = 6.43, P = .004; reduction: HR = 7.89, P = .049) and the presence of concomitant drugs (HR = 4.03, P = .034), while autistic patients discontinued less (HR = 0.23, P = .050); for clinician-decided discontinuation due to adverse drug reactions, baseline severity (HR = 1.96, P = .005) and dose increase (HR = 5.09, P = .016); for clinician-decided discontinuation due to inefficacy, baseline severity (HR = 2.88, P = .014) and the use of aripiprazole (HR = 5.55, P = .013); for dose increase, none; for dose reduction, the occurrence of adverse drug reactions (HR = 4.74, P = .046), while dose reduction was less probable in autistic patients (HR = 0.22, P = .042). CONCLUSIONS The findings of this study show a similarity between the overall effectiveness of risperidone and aripiprazole in a real-life pediatric outpatient setting.
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Affiliation(s)
- Marco Pozzi
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Simone Pisano
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Silvana Bertella
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Renata Rizzo
- Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy
| | - Stefania Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Fabiana Auricchio
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Carmen Ferrajolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Giuseppe Guastella
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy
| | - Elisa Mani
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Concetta Rafaniello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Maria Pia Riccio
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Maria Grazia Scuderi
- Child and Adolescent Neuropsychiatry, Department of Medical and Pediatric Sciences, School of Medicine, University of Catania, Italy
| | - Serena Sperandeo
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Liberata Sportiello
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Laura Villa
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Via GB Grassi 74, 20157 Milan, Italy. .,Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy.,Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan, Italy
| | - Francesco Rossi
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Second University of Naples, Italy
| | - Antonio Pascotto
- Department of Mental and Physical Health and Preventive Medicine, Child and Adolescent Neuropsychiatry Division, Second University of Naples, Italy
| | - Renato Bernardini
- Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, School of Medicine, University of Catania, Italy
| | - Massimo Molteni
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Lecco, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, University Federico II of Naples, Italy
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Carnovale C, Gentili M, Matacena M, Dimov Di Giusti M, Krnic D, Dolinic B, Kolaric D, Margan Koletic Z, Macolic Sarinic V, Culjak M, Fortino I, Merlino L, Clementi E, Radice S. A retrospective review of paediatric adverse drug reactions reported in Lombardy and Croatia from 2005 to 2013. Expert Opin Drug Saf 2016; 15:35-43. [DOI: 10.1080/14740338.2016.1253678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital ‘Luigi Sacco’, Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital ‘Luigi Sacco’, Università di Milano, Milan, Italy
| | - Marco Matacena
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital ‘Luigi Sacco’, Università di Milano, Milan, Italy
| | - Marina Dimov Di Giusti
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Darko Krnic
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Barbara Dolinic
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Darija Kolaric
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Zeljana Margan Koletic
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Viola Macolic Sarinic
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | - Maja Culjak
- Department for Pharmacovigilance and Rational Pharmacotherapy, Agency for Medical Products and Medical Devices of Croatia, Zagreb, Croatia
| | | | | | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital ‘Luigi Sacco’, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital ‘Luigi Sacco’, Università di Milano, Milan, Italy
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Gentili M, Magni C, Carnovale C, Bolis M, Landonio S, Niero F, Antoniazzi S, Clementi E, Radice S. Breast Hypertrophy Induced by Ombitasvir/Paritaprevir/Ritonavir and Ribavirina. Breast J 2016; 22:708-709. [DOI: 10.1111/tbj.12656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marta Gentili
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Carlo Magni
- Units of Infectious Diseases; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Matteo Bolis
- Units of Infectious Diseases; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Simona Landonio
- Units of Infectious Diseases; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Fosca Niero
- Units of Infectious Diseases; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
| | - Stefania Antoniazzi
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
- Scientific Direction; IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Emilio Clementi
- Scientific Institute; IRCCS E. Medea; Lecco Italy
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; Consiglio Nazionale delle Ricerche; Institute of Neuroscience; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; “Luigi Sacco” University Hospital; Università di Milano; Milan Italy
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Raab M, Gentili M, de Belly H, Thiam HR, Vargas P, Jimenez AJ, Lautenschlaeger F, Voituriez R, Lennon-Duménil AM, Manel N, Piel M. ESCRT III repairs nuclear envelope ruptures during cell migration to limit DNA damage and cell death. Science 2016; 352:359-62. [PMID: 27013426 DOI: 10.1126/science.aad7611] [Citation(s) in RCA: 583] [Impact Index Per Article: 72.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/25/2016] [Indexed: 12/18/2022]
Abstract
In eukaryotic cells, the nuclear envelope separates the genomic DNA from the cytoplasmic space and regulates protein trafficking between the two compartments. This barrier is only transiently dissolved during mitosis. Here, we found that it also opened at high frequency in migrating mammalian cells during interphase, which allowed nuclear proteins to leak out and cytoplasmic proteins to leak in. This transient opening was caused by nuclear deformation and was rapidly repaired in an ESCRT (endosomal sorting complexes required for transport)-dependent manner. DNA double-strand breaks coincided with nuclear envelope opening events. As a consequence, survival of cells migrating through confining environments depended on efficient nuclear envelope and DNA repair machineries. Nuclear envelope opening in migrating leukocytes could have potentially important consequences for normal and pathological immune responses.
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Affiliation(s)
- M Raab
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France. Institut Pierre-Gilles de Gennes, PSL Research University, F-75005 Paris, France
| | - M Gentili
- Institut Curie, PSL Research University, INSERM, U 932, F-75005 Paris, France
| | - H de Belly
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France
| | - H R Thiam
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France
| | - P Vargas
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France. Institut Pierre-Gilles de Gennes, PSL Research University, F-75005 Paris, France
| | - A J Jimenez
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France
| | - F Lautenschlaeger
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France
| | - Raphaël Voituriez
- Laboratoire de Physique Théorique de la Matière Condensée, CNRS UMR 7600, Université Pierre et Marie Curie, Paris, France. Laboratoire Jean Perrin, CNRS UMR 8237, Université Pierre et Marie Curie, Paris, France
| | - A M Lennon-Duménil
- Institut Curie, PSL Research University, INSERM, U 932, F-75005 Paris, France
| | - N Manel
- Institut Curie, PSL Research University, INSERM, U 932, F-75005 Paris, France
| | - M Piel
- Institut Curie, PSL Research University, CNRS, UMR 144, F-75005 Paris, France. Institut Pierre-Gilles de Gennes, PSL Research University, F-75005 Paris, France.
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Carnovale C, Gentili M, Fortino I, Merlino L, Clementi E, Radice S, on behalf the ViGer Group. The importance of monitoring adverse drug reactions in elderly patients: the results of a long-term pharmacovigilance programme. Expert Opin Drug Saf 2016; 15:131-9. [DOI: 10.1517/14740338.2016.1131816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
| | - Ida Fortino
- Regional Health Ministry, Milan, Lombardy Region, Italy
| | - Luca Merlino
- Regional Health Ministry, Milan, Lombardy Region, Italy
| | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital “Luigi Sacco”, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco”, Università di Milano, Milan, Italy
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Carnovale C, Gentili M, Antoniazzi S, Radice S, Clementi E. Montelukast-induced metamorphopsia in a pediatric patient: A case report and a pharmacovigilance database analysis. Ann Allergy Asthma Immunol 2016; 116:370-1. [PMID: 26874930 DOI: 10.1016/j.anai.2016.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
| | - Stefania Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy; Scientific Direction, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy.
| | - Emilio Clementi
- Scientific Institute, IRCCS E. Medea, Bosisio Parini, Lecco, Italy; Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital "Luigi Sacco", Università di Milano, Milan, Italy
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Gentili M, Marinaccio PM, Galimberti C, Carnovale C, Antoniazzi S, Pozzi M, Clementi E, Viganò C, Radice S. A case of dysgraphia induced by sertraline and a review of official spontaneous adverse reaction databases. J Clin Pharm Ther 2016; 41:106-7. [PMID: 26792111 DOI: 10.1111/jcpt.12356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The occurrence of dysgraphia after sertraline intake has never been reported. The objective was to describe a case of this adverse drug reaction and present a review of similar cases held in international databases with a discussion of the possible pharmacological mechanisms. CASE SUMMARY We observed a 60-year-old man who experienced resting tremors, dyskinesia and dysgraphia 2 months after a stepwise increase in sertraline dosing from 50 to 200 mg/day. WHAT IS NEW AND CONCLUSION Dysgraphia is a possible adverse drug reaction to sertraline, and we suggest that inhibition of extrapyramidal dopaminergic activity might be the pharmacological mechanism.
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Affiliation(s)
- M Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - P M Marinaccio
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - C Galimberti
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - C Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - S Antoniazzi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy.,Scientific Direction, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Pozzi
- Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | - E Clementi
- Scientific Institute, IRCCS E. Medea, Lecco, Italy.,Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Consiglio Nazionale delle Ricerche Institute of Neuroscience, University Hospital 'Luigi Sacco', Università di Milano, Milan, Italy
| | - C Viganò
- Psychiatry Unit, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
| | - S Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, 'Luigi Sacco' University Hospital, Università di Milano, Milan, Italy
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Gentili M, Clerico M, Spizzichino M, Fanelli G. Use of a checklist to improve pain control in hospitalized cancer patients: the 38Checkpain project. Future Oncol 2015; 12:199-205. [PMID: 26643066 DOI: 10.2217/fon.15.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Checklists may improve management of patients in different settings. However, no studies have been conducted to investigate the use of this tool to improve inpatient pain control. This study, conducted in Italy, aims to describe the experience, in terms of pain control, of the widespread introduction of a checklist for pain control in oncological patients, according to current Italian legislation. MATERIALS & METHODS In total, 92 Italian centers were randomly assigned to the use of the 38Checkpain to monitor pain management or to continue their standard practice without the use of this tool. RESULTS The 38Checkpain improved the control of pain compared with centers who did not use this tool. CONCLUSION Overall, the findings of this study suggest that the application of the 38Checkpain may help improve control of pain of hospitalized oncological patients.
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Affiliation(s)
- Marta Gentili
- Patient Association 'Vivere Senza Dolore', Piazza EL Morselli 1, 20154 Milano, Italy
| | - Mario Clerico
- Direttore Dipartimento di Oncologia, 'Azienda Sanitaria Locale', Ospedale degli Infermi, Biella, Italy
| | - Marco Spizzichino
- Direttore Ufficio Cure Palliative e Terapia del dolore, Ministero della Salute, Roma, Italy
| | - Guido Fanelli
- Department of Anesthesiology & Department of Anesthesia, Intensive Care & Pain Therapy, University Hospital of Parma, Parma, Italy
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Fabiano V, Carnovale C, Gentili M, Radice S, Zuccotti GV, Clementi E, Perrotta C, Mameli C. Enalapril Associated with Furosemide Induced Acute Kidney Injury in an Infant with Heart Failure. A Case Report, a Revision of the Literature and a Pharmacovigilance Database Analysis. Pharmacology 2015; 97:38-42. [DOI: 10.1159/000441950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
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Lessiani G, Iodice P, Nicolucci E, Gentili M. Lymphatic edema of the lower limbs after orthopedic surgery: results of a randomized, open-label clinical trial with a new extended-release preparation. J BIOL REG HOMEOS AG 2015; 29:805-812. [PMID: 26753640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The lymphedema is a high interstitial protein concentration edema, caused by impaired lymphatic transport capacity. It can be primary or secondary. The secondary form may be caused by a lesion of the lymphatic vessels and/or lymph nodes during diagnostic or therapeutic procedures such as surgical interventions. Often, in clinical practice, there is lymphedema after orthopedic surgery, even in minor orthopedic surgery. Lymphedema, typically presents symptoms of swelling, pain, inflammation, and itching, and it can generate, over the years, acute disability in the affected limbs. The standard therapy is mainly represented by medical treatment, such as manual lymphatic drainage and compression with bandages and stockings. In literature it is documented that lymphedema is responsive to alpha and the gamma benzopyrones. The aim of this study was to determine the effectiveness of delayed extended-release formulation of a compound containing apha-benzo-pyrone (Coumarin), benzo-gamma-pyrone (Troxuretina) and oligomeric proanthocyanidins from Vitis vinifera (OPC), in addition to compression therapy, in the reduction of lymphatic edema after prosthetic hip and knee surgery. In the group treated, after 30 days, a reduction was observed of the edema of 4.8% in the ankle area (p less than 0.008) and 2.7% in the calf area (p less than 0.013). The control group showed no significant reduction. The treated group showed a marked reduction of all the secondary symptoms considered in the study, although variations were not significant. The results show that the compound used was effective in reducing edema after major orthopedic surgery, and consequently in alleviating some related symptoms, such as pain, itching, and burning. As an edema has extensive inflammatory components in patients with reduced mobility, the final data seems interesting, however, further investigations and a better follow-up are required.
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Affiliation(s)
- G Lessiani
- Vascular Medicine Unit, Private Hospital Villa Serena, Città SantAngelo (PE), Italy
| | - P Iodice
- Orthopedic Rehabilitation Unit, Private Hospital Villa Serena, Città SantAngelo (PE), Italy
| | - E Nicolucci
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
| | - M Gentili
- Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy
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Brusadelli T, Carnovale C, Gentili M, Borsadoli C, Speziali A, Perrone V, Pellegrino P, Antoniazzi S, Pozzi M, Radice S, Clementi E. Throbbing headache associated with enoxaparin administration: a case report, a review of pharmacovigilance databases for similar cases and possible mechanisms. J Clin Pharm Ther 2015; 40:342-4. [PMID: 25726970 DOI: 10.1111/jcpt.12257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 02/05/2015] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES To date, no case of headache has been reported with enoxaparin. We present the case of a 60-years-old man, who developed enoxaparin-induced throbbing headache and discuss the possible pharmacological mechanisms. We provide an analysis of enoxaparin-induced headache in three international databases. CASE SUMMARY A few hours after the subcutaneous administration of this drug at therapeutic dose, the patient experienced throbbing headache. Rechallenge on two other separate occasions separated by several days produced the same effect although with reduced intensity when the dose was lowered. The Naranjo Algorithm indicated a 'certain' relationship. WHAT IS NEW AND CONCLUSION We report a case of throbbing headache associated with the use of enoxaparin; with the increasing use of enoxaparin, physicians who prescribe this drug should be aware of this potential ADR. We suggest that it is a heparin class-effect, and therefore, a more general caution is also appropriate.
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Affiliation(s)
- T Brusadelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, Luigi Sacco University Hospital, Università di Milano, Milan, Italy
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Pellegrino P, Carnovale C, Pozzi M, Antoniazzi S, Perrone V, Salvati D, Gentili M, Brusadelli T, Clementi E, Radice S. On the relationship between human papilloma virus vaccine and autoimmune diseases. Autoimmun Rev 2014; 13:736-41. [DOI: 10.1016/j.autrev.2014.01.054] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
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Pellegrino P, Carnovale C, Perrone V, Salvati D, Gentili M, Brusadelli T, Antoniazzi S, Pozzi M, Radice S, Clementi E. Epidemiological analysis on two decades of hospitalisations for meningitis in the United States. Eur J Clin Microbiol Infect Dis 2014; 33:1519-24. [DOI: 10.1007/s10096-014-2102-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/27/2014] [Indexed: 11/29/2022]
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Pellegrino P, Carnovale C, Perrone V, Pozzi M, Salvati D, Gentili M, Brusadelli T, Antoniazzi S, Radice S, Clementi E. Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures. Bone 2014; 59:148-9. [PMID: 24239754 DOI: 10.1016/j.bone.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/03/2013] [Indexed: 11/21/2022]
Affiliation(s)
- Paolo Pellegrino
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Valentina Perrone
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Marco Pozzi
- Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Lecco, Italy
| | - Dionigi Salvati
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Tatiana Brusadelli
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy
| | - Stefania Antoniazzi
- IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy.
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital "Luigi Sacco", Università di Milano, 20157 Milan, Italy; Scientific Institute, IRCCS E. Medea, 23842 Bosisio Parini, Lecco, Italy
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Pellegrino P, Carnovale C, Perrone V, Salvati D, Gentili M, Brusadelli T, Pozzi M, Antoniazzi S, Clementi E, Radice S. On the Association between Human Papillomavirus Vaccine and Primary Ovarian Failure. Am J Reprod Immunol 2013; 71:293-4. [DOI: 10.1111/aji.12190] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Paolo Pellegrino
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Carla Carnovale
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Valentina Perrone
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Dionigi Salvati
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Marta Gentili
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Tatiana Brusadelli
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
| | - Marco Pozzi
- Scientific Institute; IRCCS E. Medea; Lecco Italy
| | | | - Emilio Clementi
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
- Scientific Institute; IRCCS E. Medea; Lecco Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology; Department of Biomedical and Clinical Sciences; University Hospital “Luigi Sacco”; Università di Milano; Milan Italy
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Pellegrino P, Carnovale C, Perrone V, Salvati D, Gentili M, Brusadelli T, Pozzi M, Antoniazzi S, Clementi E, Radice S. On the possible interaction between vaccines and drugs. Eur J Clin Pharmacol 2013; 70:369-71. [DOI: 10.1007/s00228-013-1616-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 11/17/2013] [Indexed: 11/30/2022]
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Saumier N, Gentili M, Dupont H, Aubrun F. [Postoperative intravenous morphine titration in PACU after bariatric laparoscopic surgery]. ACTA ACUST UNITED AC 2013; 32:850-5. [PMID: 24199906 DOI: 10.1016/j.annfar.2013.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 09/25/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is limited information available regarding intravenous (IV) morphine administration in obese patients in PACU. The aim of this study was to compare two IV morphine titration (IMT) regimen in two surgical centers. STUDY DESIGN Observational study. PATIENTS Laparoscopic bariatric surgery in one private (Saint-Grégoire Clinic) and one public (University Hospital of Amiens) surgical center. METHODS A strict and common protocol of IMT was implemented if PACU of both centers according to the recommendations of the French Society of Anaesthesia and Intensive Care. When pain score increased to>30, IMT was titrated every 5 min in 3mg increments until pain relief (VAS≤30 mm). Pain level, dose of morphine (per total and ideal body weight), effectiveness, and side events were recorded. RESULTS Data were recorded for 159 adult patients (129 women). Mean age and BMI were 42±12 yrs and 43.8±6.9 kg/m(2). Ninety-eight patients were eligible for IMT regimen but only 76 patients received IV morphine (47.8 %). Mean dose was 7.3 mg±3.5mg [1-19 mg], (60.4 μg/kg and 115.8 μg/kg). IMT was less frequent, mean dose was greater (8.6±4.2 vs 6.2±2.9 mg) and number of patients with pain relief was higher (73.7 vs 35.6 %) in the public hospital. No severe adverse events have been recorded and there was no difference in both centers regarding these events. CONCLUSION Implementation of a IMT regimen in PACU was not associated with effective pain relief after laparoscopic surgery in obese patients.
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Affiliation(s)
- N Saumier
- Pôle d'anesthésie-réanimation, CHU, place Victor-Pauchet, 80054 Amiens, France
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Garassino MC, Piva S, La Verde N, Spagnoletti I, Iorno V, Carbone C, Febbraro A, Bianchi A, Bramati A, Moretti A, Ganzinelli M, Marabese M, Gentili M, Torri V, Farina G. Randomised phase II trial (NCT00637975) evaluating activity and toxicity of two different escalating strategies for pregabalin and oxycodone combination therapy for neuropathic pain in cancer patients. PLoS One 2013; 8:e59981. [PMID: 23577077 PMCID: PMC3618180 DOI: 10.1371/journal.pone.0059981] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/19/2013] [Indexed: 02/02/2023] Open
Abstract
Purpose Neuropathic pain is commonly associated with cancer. Current treatments include combination opioid and adjuvant therapies, but no guidelines are available for dose escalation strategies. This phase II study compared the efficacy and tolerability of two dose escalation strategies for oxycodone and pregabalin combination therapy. Methods Patients (N = 75) with oncological neuropathic pain, previously untreated with pregabalin, were recruited in 5 Italian institutions between 2007 and 2010. Patients were randomised to two different dose escalation strategies (arm A; N = 38) oxycodone at a fixed dose with increasing pregabalin doses; (arm B; N = 37) pregabalin at a fixed dose with increasing oxycodone doses. Patients were evaluated from daily diaries and follow-ups at 3, 7, 10, and 14 days after beginning treatment with a numerical rating scale (NRS), neuropathic pain scale (SDN), and well-being scale (ESAS). The primary endpoint was a ≥1/3 reduction in pain (NRS); secondary endpoints included the time to analgesia and adverse effects. The study had a 90% probability of detecting the best strategy for a true difference of at least 15%. Results More patients in arm A (76%) than arm B (64%) achieved ≥1/3 overall pain reduction even after controlling for baseline factors (gender, baseline pain). Group A reported fewer side effects than group B; constipation 52.8% vs. 66.7%; nausea: 27.8% vs. 44.4%; drowsiness: 44.4% vs. 55.6%; confusion: 16.7% vs. 27.8%; itching: 8.3% vs. 19.4%. Conclusions Both strategies effectively controlled neuropathic pain, but according to the adopted selection design arm A is preferable to arm B for pain control. Trial Registration ClinicalTrials.gov NCT00637975
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Affiliation(s)
| | - Sheila Piva
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
- * E-mail:
| | - Nicla La Verde
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
| | | | | | - Claudia Carbone
- Department of Oncology Ospedale Serbelloni, Gorgonzola, Italy
| | | | - Anna Bianchi
- Department of Neurology A.O. Sant’Antonio Abate, Gallarate, Italy
| | - Annalisa Bramati
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
| | - Anna Moretti
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
| | | | - Mirko Marabese
- Department of Oncology “Mario Negri” Institute, Milan, Italy
| | - Marta Gentili
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
| | - Valter Torri
- Department of Oncology “Mario Negri” Institute, Milan, Italy
| | - Gabriella Farina
- Department of Oncology, A.O. Fatebenefratelli & Oftalmico, 23, Milan, Italy
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Gatti A, Gentili M, Iorno V, Mammucari M, Tufaro G, Lazzari M, Sabato AF. Beyond the traditional definition of breakthrough pain: an observational study. Adv Ther 2013; 30:298-305. [PMID: 23444055 DOI: 10.1007/s12325-013-0013-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Breakthrough pain (BTP) is traditionally defined as a transitory pain flare in opioid-treated patients with chronic background pain. This definition has, however, been challenged in recent years. This study aimed to analyze BTP prevalence in different pain conditions. METHODS This was a prospective, non-interventional, observational study conducted from June to September 2011 in two Italian pain treatment reference centres. Consecutive patients aged >18 years with oncological or non-oncological pain were eligible for this study; background pain was acute/ subacute (<3 months) or chronic (>3 months). The characteristics of pain were evaluated by means of a structured interview by physicians, and patients were asked to complete a dedicated clinical study form. The following outcomes were assessed: chronic pain duration (in patients with chronic pain), BTP prevalence, and number and severity of daily BTP episodes. All outcomes were assessed in four populations of patients with: (a) chronic oncological pain; (b) chronic non-oncological pain; (c) non-chronic oncological pain; (d) non-chronic non-oncological pain. The correlation between BTP and gender was also investigated. RESULTS Of 1,270 patients with chronic pain, 1,086 had non-oncological pain (85.5%). Most patients (68.6%) with non-oncological pain were female (P = 0.001). Pain duration was significantly longer in non-oncological pain versus oncological pain groups (P = 0.002). BTP prevalence was lower in non-oncological patients (P < 0.001). No differences were reported in terms of number and severity of daily BTP episodes. BTP was more frequent in females with non-oncological pain (P = 0.04). Females had a significantly higher pain severity (P = 0.02) than males. CONCLUSION BTP is frequently reported in patients who do not have BTP according to the traditional definition. BTP frequency and severity is similar in oncological and non-oncological pain.
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Affiliation(s)
- Antonio Gatti
- Emergency Care, Critical Care Medicine, Pain Medicine and Anesthesiology Department, Tor Vergata Polyclinic, University of Rome Tor Vergata, Rome, Italy
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Villevieille T, Delaunay L, Gentili M, Benhamou D. Chirurgie arthroscopique de l’épaule et complications ischémiques cérébrales. ACTA ACUST UNITED AC 2012; 31:914-8. [DOI: 10.1016/j.annfar.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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Hugot P, Aguillon D, Musellec H, Breitel D, Gentili M. [Tracheal tube obstruction mimicking a bronchospasm]. Ann Fr Anesth Reanim 2012; 31:488-490. [PMID: 22513179 DOI: 10.1016/j.annfar.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Nouette-Gaulain K, Lenfant F, Jacquet Francillon D, Belbachir A, Bournigault-Nuquet A, Choquet O, Claisse A, Dujarric F, Francon D, Gentili M, Majoufre-Lefebvre C, Marciniack B, Péan D, Yavordios PG, Leone M. [French clinical guidelines for prevention of perianaesthetic dental injuries. Short text]. Ann Fr Anesth Reanim 2012; 31:272-5. [PMID: 22366392 DOI: 10.1016/j.annfar.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- K Nouette-Gaulain
- Pôle d'anesthésie-réanimation, service d'anesthésie-réanimation III, hôpital des enfants, centre hospitalier universitaire de Bordeaux, université Bordeaux Segalen, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Nouette-Gaulain K, Lenfant F, Jacquet-Francillon D, Belbachir A, Bournigault-Nuquet A, Choquet O, Claisse A, Dujarric F, Francon D, Gentili M, Majoufre-Lefebvre C, Marciniack B, Péan D, Yavordios PG, Leone M. [French clinical guidelines for prevention of perianaesthetic dental injuries: long text]. Ann Fr Anesth Reanim 2012; 31:213-23. [PMID: 22377414 DOI: 10.1016/j.annfar.2012.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Dental injuries represent the most common claims against the anaesthesiologists. Dental lesions are frequent complications of orotracheal intubation and major causal factors are, firstly, preexisting poor dentition, and, secondly, difficult laryngoscopy and tracheal intubation. The aim of this work was to prioritize propositions for prevention in perianaesthetic dental injury and for care in case of dental trauma. METHOD A GRADE consensus procedure consisting of three rounds was conducted. A purposively selected heterogeneous panel (n=15) of experts, comprising 10 practitioners in anesthesiology, one practitioner who is jurist and anaesthesiologist, two practitioners in maxillofacial surgery, and two practitioners in dentist surgery. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the board members. The guidelines represent the best current evidence based on literature search and professional opinion. RESULTS The entire panel completed all three rounds and 31 plus six propositions were written for adult and paediatric clinical practice in anaesthesiology, respectively. The experts highlight the interest of preoperative visit for minimizing dental injuries: the practitioner must identify risk factors for difficult intubation and ventilation, describe precisely patient's preoperative dental condition, including upper incisor most commonly involved teeth in dental trauma. Patients have to be informed by practitioner for risk dental injury and anaesthesiology staff must choose his anesthesia protocol before the induction of intubation narcosis, avoiding insufficient anaesthesia and lack of experience by the anaesthesiologist. The choice of accurate proceeding during laryngoscopy, tracheal intubation and extubation for example, can aid in the prevention of dental injury, reduce the number of claims and the cost of litigation process. DISCUSSION These guidelines delineate an approach for the prevention of perianaesthetic dental trauma and for the immediate or urgent care in case of perianaesthetic dental injury.
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Affiliation(s)
- K Nouette-Gaulain
- Pôle d'anesthésie réanimation, service d'anesthésie-réanimation III, université Bordeaux-Segalen, hôpital des enfants, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Abstract
BACKGROUND Spinal bupivacaine produces a complete anaesthetic block of a longer duration than ropivacaine, which leads to a potentially increased risk of failure. A combination of sufentanil to ropivacaine may improve the block's reliability. METHODS Sixty-four patients, scheduled for varicose vein stripping or the tension-free vaginal tape procedure, were allocated to receive double-blindly, spinal bupivacaine 10 mg (Group 1) or ropivacaine 10 mg without (Group 2) or with sufentanil 2.5 mcg (Group 3), 5 mcg (Group 4). Sensory block was tested with pinprick and motor block was evaluated with the Bromage scale until full recovery. The primary endpoint was to compare the duration of sensory block evaluated by regression to S2. RESULTS In comparison with bupivacaine, ropivacaine produced a shorter duration sensory block (median at 68, 90 and 120 min in groups 2, 3 and 4, respectively, vs. 150 min in Group 1) and motor block (median at 90, 98 and 120 min in groups 2, 3 and 4 vs. 180 min in Group 1). Motor blockade was significantly less important in patients receiving spinal ropivacaine (median values for the Bromage scale at 3 in groups 2, 3 and 4, vs. 1 in Group 1). Pruritus was significantly more frequent in patients receiving spinal sufentanil (Groups 3 and 4 vs. Groups 1 and 2). CONCLUSION Plain bupivacaine 10 mg has a longer recovery profile than the same dose of ropivacaine with or without sufentanil.
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Affiliation(s)
- E Marret
- Department of Anaesthesiology and Critical Care, Tenon University Hospital, University Pierre et Marie Curie, Paris, France.
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Gianni W, Madaio RA, Di Cioccio L, D'Amico F, Policicchio D, Postacchini D, Franchi F, Ceci M, Benincasa E, Gentili M, Zuccaro SM. Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr 2009; 51:273-6. [PMID: 20031238 DOI: 10.1016/j.archger.2009.11.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 11/18/2009] [Accepted: 11/20/2009] [Indexed: 10/20/2022]
Abstract
Several studies indicate that pain, although very common in the elderly, is under-treated, because it is considered as a concomitant effect of aging. This study aimed to evaluate the prevalence of pain among patients in eight Italian geriatric hospital departments, correlated to prescribed therapy. We enrolled 387 patients in the study, 367 of whom were evaluated. Each patient's recovery, co-morbidity, pain intensity, prescribed therapy, side effects, duration of pain, and efficacy of therapy were monitored during two 15-day periods from 15 July to end of August 2008, and from 1 October to 15 November 2008. The results of this study confirmed that hypertension, cardiopathic disease, diabetes, and chronic obstructive pulmonary disease (COPD) are common pathologies, and that pain is present in 67.3% of those recovered in geriatric departments. In general, however, pain is not treated. Indeed only 49% of those with pain had any type of treatment, which was adequate for the pain intensity. In fact 74.5% of patients considered the therapy to be of low or no efficacy. These data demonstrate the presence of pain in a high percentage of elderly patients, which is either not treated, or treated inadequately. Controlling pain is essential in elderly patients in order to allow a normal life and an active role in family and society. The main conclusion is that pain is often poorly considered in the elderly, thus leading to a dangerous under-treatment. We want to underline the crucial clinical impact of such under-treatment in elderly patients.
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Affiliation(s)
- W Gianni
- Istituto Nazionale di Ricerca e Cura per Anziani I.N.R.C.A.-I.R.C.C.S., Unità Operativa di Geriatria Roma, Via Cassia 1167, I-00189 Roma, Italy.
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Affiliation(s)
- P Macaire
- Département d'anesthésie-réanimation, centre clinical, Soyaux, France
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