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Saviano A, Petruzziello C, Cancro C, Macerola N, Petti A, Nuzzo E, Migneco A, Ojetti V. The Efficacy of a Mix of Probiotics ( Limosilactobacillus reuteri LMG P-27481 and Lacticaseibacillus rhamnosus GG ATCC 53103) in Preventing Antibiotic-Associated Diarrhea and Clostridium difficile Infection in Hospitalized Patients: Single-Center, Open-Label, Randomized Trial. Microorganisms 2024; 12:198. [PMID: 38258024 PMCID: PMC10819176 DOI: 10.3390/microorganisms12010198] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Antibiotic-associated diarrhea is a condition reported in 5-35% of patients treated with antibiotics, especially in older patients with comorbidities. In most cases, antibiotic-associated diarrhea is not associated with serious complications, but it can prolong hospitalization and provoke Clostridium difficile infection. An important role in the prevention of antibiotic-associated diarrhea is carried out by some probiotic strains such as Lactobacillus GG or the yeast Saccharomyces boulardii that showed good efficacy and a significant reduction in antibiotic-associated diarrhea. Similarly, the Limosilactobacillus reuteri DSM 17938 showed significant benefits in acute diarrhea, reducing its duration and abdominal pain. AIM The aim of this study was to test the efficacy of a mix of two probiotic strains (Limosilactobacillus reuteri LMG P-27481 and Lacticaseibacillus rhamnosus GG ATCC 53103; Reuterin GG®, NOOS, Italy), in association with antibiotics (compared to antibiotics used alone), in reducing antibiotic-associated diarrhea, clostridium difficile infection, and other gastrointestinal symptoms in adult hospitalized patients. PATIENTS AND METHODS We enrolled 113 (49M/64F, mean age 69.58 ± 21.28 years) adult patients treated with antibiotics who were hospitalized at the Internal Medicine Department of the San Carlo di Nancy Hospital in Rome from January 2023 to September 2023. Patients were randomized to receive probiotics 1.4 g twice/day in addition with antibiotics (Reuterin GG® group, total: 56 patients, 37F/19M, 67.16 ± 20.5 years old) or antibiotics only (control group, total: 57 patients, 27F/30 M, 71 ± 22 years old). RESULTS Patients treated with Reuterin GG® showed a significant reduction in diarrhea and clostridium difficile infection. In particular, 28% (16/57) of patients in the control group presented with diarrhea during treatment, compared with 11% (6/56) in the probiotic group (p < 0.05). Interestingly, 7/57 (11%) of patients treated only with antibiotics developed clostridium difficile infection compared to 0% in the probiotic group (p < 0.01). Finally, 9% (5/57) of patients in the control group presented with vomiting compared with 2% (1/56) in the probiotic group (p < 0.05). CONCLUSIONS Our study showed, for the first time, the efficacy of these two specific probiotic strains in preventing antibiotic-associated diarrhea and clostridium difficile infection in adult hospitalized patients treated with antibiotic therapy. This result allows us to hypothesize that the use of specific probiotic strains during antibiotic therapy can prevent dysbiosis and subsequent antibiotic-associated diarrhea and clostridium difficile infection, thus resulting in both patient and economic health care benefits.
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Affiliation(s)
- Angela Saviano
- Emergency Medicine Department, Polyclinic A. Gemelli Hospital, 00168 Rome, Italy; (A.S.); (A.M.)
- Internal and Emergency Medicine Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Carmine Petruzziello
- Internal Medicine Department, San Carlo di Nancy Hospital, 00165 Rome, Italy; (C.P.); (N.M.); (A.P.); (E.N.)
| | - Clelia Cancro
- Internal and Emergency Medicine Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Noemi Macerola
- Internal Medicine Department, San Carlo di Nancy Hospital, 00165 Rome, Italy; (C.P.); (N.M.); (A.P.); (E.N.)
| | - Anna Petti
- Internal Medicine Department, San Carlo di Nancy Hospital, 00165 Rome, Italy; (C.P.); (N.M.); (A.P.); (E.N.)
| | - Eugenia Nuzzo
- Internal Medicine Department, San Carlo di Nancy Hospital, 00165 Rome, Italy; (C.P.); (N.M.); (A.P.); (E.N.)
| | - Alessio Migneco
- Emergency Medicine Department, Polyclinic A. Gemelli Hospital, 00168 Rome, Italy; (A.S.); (A.M.)
| | - Veronica Ojetti
- Internal and Emergency Medicine Department, Catholic University of the Sacred Heart, 00168 Rome, Italy;
- Internal Medicine Department, San Carlo di Nancy Hospital, 00165 Rome, Italy; (C.P.); (N.M.); (A.P.); (E.N.)
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Saviano A, Petruzziello C, Zanza C, Candelli M, Gabrielli M, Migneco A, Franceschi F, Ojetti V. Role of Fecal Calprotectin in Patients Presenting to the Emergency Department with Abdominal Pain with or without Diarrhea or Rectal Bleeding. Rev Recent Clin Trials 2023:RRCT-EPUB-135647. [PMID: 37921137 DOI: 10.2174/0115748871259008231006071656] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Abdominal pain is a frequent reason for admission to the Emergency Department. It may be a symptom of an underlying "organic" disease or a "functional" manifestation without an underlying anatomic or physiologic alteration. The evaluation of patients with abdominal pain is a challenge for the emergency physician and the selection of patients for second-level radiological examinations or endoscopic procedures is not always easy to perform. Faecal calprotectin could be a useful diagnostic marker to distinguish between "organic" or "functional" form and its determination could be helpful to select patients for further examinations in the context of an emergency setting. MATERIALS AND METHODS This is an observational and retrospective study on 146 patients with abdominal pain and/or diarrhea (with or without rectal bleeding) admitted to the Emergency Department of Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, who collected a fecal sample to evaluate fecal calprotectin. We evaluated and correlated the level of fecal calprotectin with the final diagnosis they received. RESULTS 50/146 patients (34,24%) received a diagnosis of acute diverticulitis, in particular, 14/50 (28%) were complicated and 36/50 (72%) were uncomplicated; 4/146 (2,7%) were cholangitis, 32/146 (21,9%) were colitis, 6/146 (4,1%) gastritis, 42/146 (28,7%), Irritable bowel syndrome and 12/146 (8,2%) Inflammatory bowel disease. For the differential diagnosis between Irriable or inflammatory bowel diseses, our study showed a VPP and a VPN of 100% meanwhile for the differential diagnosis between Acute complicated and uncomplicated diverticulitis, our study showed a VPP of 40% and a VPN of 84%. CONCLUSION In the emergency setting, faecal calprotectin could be a helpful marker to select patients with abdominal pain who need second-level radiological examinations or endoscopic procedures, guiding the emergency physician in the evaluation of such a complex and wideranging symptom.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Carmine Petruzziello
- Department of Emergency Medicine-Ospedale San Carlo di Nancy GVM care and research, Rome
| | - Christian Zanza
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Marcello Candelli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Maurizio Gabrielli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
| | - Alessio Migneco
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome
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Saviano A, Petruzziello C, Brigida M, Morabito Loprete MR, Savioli G, Migneco A, Ojetti V. Gut Microbiota Alteration and Its Modulation with Probiotics in Celiac Disease. Biomedicines 2023; 11:2638. [PMID: 37893012 PMCID: PMC10603901 DOI: 10.3390/biomedicines11102638] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023] Open
Abstract
Celiac disease (CD) is a chronic inflammation of the small intestine triggered by gluten ingestion in genetically predisposed people. Recent literature studies highlight the possible role of the gut microbiota in the pathogenesis of this disease. The gut microbiota is a complex community of microorganisms that can interact with the innate and adaptative immune systems. A condition of dysbiosis, which refers to an alteration in the composition and function of the human gut microbiota, can lead to a dysregulated immune response. This condition may contribute to triggering gluten intolerance, favoring the development and/or progression of CD in genetically susceptible patients. Interestingly, studies on children and adults with CD showed a different microbiome profile in fecal samples, with a different degree of "activity" for the disease. From this point of view, our review aimed to collect and discuss modern evidence about the alteration of the gut microbiota and its modulation with probiotics, with possible future indications in the management of patients affected by CD.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.S.); (A.M.)
| | - Carmine Petruzziello
- Department of Emergency Medicine, Ospedale San Carlo di Nancy, GVM Care and Research, 00165 Rome, Italy
| | - Mattia Brigida
- Gastroenterology Unit, Policlinico Universitario Tor Vergata, 00133 Rome, Italy
| | - Maria Rita Morabito Loprete
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.S.); (A.M.)
| | - Gabriele Savioli
- Department of Emergency Medicine, Fondazione Policlinico San Matteo University Hospital, 27100 Pavia, Italy;
| | - Alessio Migneco
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.S.); (A.M.)
| | - Veronica Ojetti
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Saviano A, Candelli M, Zanza C, Piccioni A, Migneco A, Ojetti V. Gastrointestinal Involvement in Extra-Digestive Disease: Which Is the Role of Fecal Calprotectin? Medicina (Kaunas) 2022; 58:medicina58101384. [PMID: 36295545 PMCID: PMC9608771 DOI: 10.3390/medicina58101384] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/09/2022]
Abstract
Fecal calprotectin (FC) is a very sensitive marker of inflammation of the gastrointestinal tract. Its clinical utility can be appreciated in both intestinal and extraintestinal diseases. Recent evidence suggests a link between intestinal inflammation and dermatological, rheumatic and neurological diseases. This review focuses on the role of FC in non-gastrointestinal disease, such as rheumatic, dermatologic, neurologic and last but not least SARS-CoV-2 infection.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Andrea Piccioni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Alessio Migneco
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Veronica Ojetti
- Department of Internal Medicine, Ospedale San Carlo di Nancy, 00165 Rome, Italy
- Department of Emergency Medicine, Policlinico Gemelli/IRCCS University of Catholic of Sacred Heart, 00168 Rome, Italy
- Correspondence:
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Saviano A, Gayani G, Migneco A, Candelli M, Franceschi F, Ojetti V, Zanza C, Longhitano Y. The Gut Microbiota-Brain Axis in Acute Neurological Disease: Focus on Stroke. Rev Recent Clin Trials 2022; 17:240-244. [PMID: 35319389 DOI: 10.2174/1574887117666220321155508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 10/22/2021] [Revised: 12/27/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023]
Abstract
The gut microbiota is one of the great innovations of modern medicine. In the modern microbiota revolution era, more comprehensive and in-depth studies have been performed regarding the microbial gut communities and their impact on acute and chronic diseases, including those of the nervous system as acute neurological diseases. The microbiota has changed our knowledge of medical conditions; in particular, considering stroke (both ischemic and hemorrhagic), literature studies, experimental and clinical researches indicate that the individual's risk and outcomes are substantially impacted by the gut microbiota. The aim of our review article is to investigate and discuss the recent insights into the emerging role of this complex "gut microbiota-brain axis" in affecting some acute neurological diseases, such as stroke, responsible for a significant number of deaths worldwide. We performed electronic research on PubMed® and collected articles published in the last ten years, finding that changes in the gut microbiota composition could affect various aspects of stroke pathophysiology and individual predisposition, risk, and outcomes. Our review article suggests that there is a strong connection between the gut microbiota and the brain, both in health and in acute neurological diseases such as stroke. Investigating and exploring this relationship can be a challenge useful to learn more about this disabling/deadly condition, and it can be a useful tool to identify novel potential therapeutic approaches, improving an individual's outcomes and life.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Gunawardena Gayani
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Alessio Migneco
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Marcello Candelli
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Ojetti
- Department of Emergency Medicine-Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Christian Zanza
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Foundation Ospedale Alba-Bra Onlus, Verduno (Cuneo), Italy
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Yaroslava Longhitano
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Saviano A, Brigida M, Migneco A, Gunawardena G, Zanza C, Candelli M, Franceschi F, Ojetti V. Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin? Medicina (Kaunas) 2021; 57:medicina57070643. [PMID: 34201542 PMCID: PMC8306447 DOI: 10.3390/medicina57070643] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.
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Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Correspondence:
| | - Mattia Brigida
- Department of Gastroenterology, Università Tor Vergata, 00133 Rome, Italy;
| | - Alessio Migneco
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.M.); (M.C.); (F.F.); (V.O.)
| | - Gayani Gunawardena
- Department of Emergency Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Christian Zanza
- Department of Anesthesiology, Critical Care and Emergency Medicine-Fondazione Nuovo Ospedale Alba-Bra, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy;
| | - Marcello Candelli
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.M.); (M.C.); (F.F.); (V.O.)
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.M.); (M.C.); (F.F.); (V.O.)
| | - Veronica Ojetti
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (A.M.); (M.C.); (F.F.); (V.O.)
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Zanza C, Longhitano Y, Artico M, Cammarota G, Barbanera A, Racca F, Audo A, Ravera E, Migneco A, Piccioni A, Franceschi F. Bedside Cardiac Pocus in Emergency Setting: A Practice Review. Rev Recent Clin Trials 2021; 15:269-277. [PMID: 32738872 DOI: 10.2174/1574887115666200802023306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND In the last years, ultrasound technology has entered clinical practice as a tank and today, it has also allowed no-cardiologists to extend their medical examination without needing to call the consultant and having a good profile of diagnostic accuracy. The ultrasound bedside does not replace the consultant, but it allows not to perform inappropriate consultations with more savings for hospitals. OBJECTIVE The aim was to review the recently published literature to inform the clinician about the most up to date management of use bedside echography in the emergency setting. In this short review, we focused on two types of syndromes, no traumatic- hypotension and dyspnea, common to the three holistic disciplines of medicine, showing the main and basic questions and answers that ultrasound can give us for rapid identification of the problems. METHODS We conducted a systematic review using Pubmed/Medline, Ovid/Willey and Cochrane Library, combining key terms such as "cardiac ultrasound, "cardiac diseases", "emergency medicine", "pocus", "dyspnea", " hypotension". We selected the most relevant clinical trials and review articles (excluding case reports) published in the last 19 years and in our opinion, 59 publications appeared to be the best choice according to the PRISMA statement. In additional papers identified from individual article reference lists were also included. CONCLUSION Recent studies have shown a promise in establishing best practices for evaluation of heart, lung abdomen and deep vessels At the moment, bedside US is widely used in an integrated ultrasound vision just like the holistic view have internal medicine, intensive care and emergency medicine and many medical schools in Europe and the USA are inserting ultrasonography into the core curriculum, but we still have to find a standard method for the training program for minimum competence acquisition.
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Affiliation(s)
- Christian Zanza
- Department of Anesthesiology and Emergency Sciences-Emergency Medicine Division, Policlinico Gemelli/IRCCSUniversity of Catholic of Sacred Heart, Rome, Italy
| | - Yaroslava Longhitano
- Department of Anesthesia and Critical Care Medicine - Critical Care Medicine Division, St. Antonio and Biagio Hospital, Alessandria, Italy
| | - Marco Artico
- Department of Sensory Organs, Sapienza University of Rome, Italy
| | - Gianmaria Cammarota
- Department of Anesthesia and Intensive Care Medicine-Maggiore della Carita Teaching Hospital, Novara, Italy
| | - Andrea Barbanera
- Department of Anesthesia and Critical Care Medicine - Critical Care Medicine Division, St. Antonio and Biagio Hospital, Alessandria, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine - Critical Care Medicine Division, St. Antonio and Biagio Hospital, Alessandria, Italy
| | - Andrea Audo
- Department of Anesthesia and Critical Care Medicine - Critical Care Medicine Division, St. Antonio and Biagio Hospital, Alessandria, Italy
| | - Enrico Ravera
- Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Alessio Migneco
- Department of Anesthesiology and Emergency Sciences-Emergency Medicine Division, Policlinico Gemelli/IRCCSUniversity of Catholic of Sacred Heart, Rome, Italy
| | - Andrea Piccioni
- Department of Anesthesiology and Emergency Sciences-Emergency Medicine Division, Policlinico Gemelli/IRCCSUniversity of Catholic of Sacred Heart, Rome, Italy
| | - Francesco Franceschi
- Department of Anesthesiology and Emergency Sciences-Emergency Medicine Division, Policlinico Gemelli/IRCCSUniversity of Catholic of Sacred Heart, Rome, Italy
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Longhitano Y, Zanza C, Thangathurai D, Taurone S, Kozel D, Racca F, Audo A, Ravera E, Migneco A, Piccioni A, Franceschi F. Gut Alterations in Septic Patients: A Biochemical Literature Review. Rev Recent Clin Trials 2021; 15:289-297. [PMID: 32781963 DOI: 10.2174/1574887115666200811105251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sepsis is a life-threatening organ dysfunction with high mortality and morbidity rate and with the disease progression many alterations are observed in different organs. The gastrointestinal tract is often damaged during sepsis and septic shock and main symptoms are related to increased permeability, bacterial translocation and malabsorption. These intestinal alterations can be both cause and effect of sepsis. OBJECTIVE The aim of this review is to analyze different pathways that lead to intestinal alteration in sepsis and to explore the most common methods for intestinal permeability measurement and, at the same time to evaluate if their use permit to identify patients at high risk of sepsis and eventually to estimate the prognosis. MATERIAL AND METHODS The peer-reviewed articles analyzed were selected from PubMed databases using the keywords "sepsis" "gut alteration", "bowel permeability", "gut alteration", "bacterial translocation", "gut permeability tests", "gut inflammation". Among the 321 papers identified, 190 articles were selected, after title - abstract examination and removing the duplicates and studies on pediatric population,only 105 articles relating to sepsis and gut alterations were analyzed. RESULTS Integrity of the intestinal barrier plays a key role in the preventing of bacterial translocation and gut alteration related to sepsis. It is obvious that this dysfunction of the small intestine can have serious consequences and the early identification of patients at risk - to develop malabsorption or already malnourished - is very recommended to increase the survivor rate. Until now, in critical patients, the dosage of citrullinemia is easily applied test in clinical setting, in fact, it is relatively easy to administer and allows to accurately assess the functionality of enterocytes. CONCLUSION The sepsis can have an important impact on the gastrointestinal function. In addition, the alteration of the permeability can become a source of systemic infection. At the moment, biological damage markers are not specific, but the dosage of LPS, citrulline, lactulose/mannitol test, FABP and fecal calprotectin are becoming an excellent alternative with high specificity and sensitivity.
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Affiliation(s)
- Yaroslava Longhitano
- Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Christian Zanza
- Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Duraiyah Thangathurai
- Department of Anesthesiology, Keck Medical School of University of Southern California, Los Angeles, United States
| | - Samanta Taurone
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Daniela Kozel
- Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Fabrizio Racca
- Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Andrea Audo
- Department of Anesthesia and Critical Care Medicine, St. Antonio and Biagio and Cesare Arrigo Hospital, Alessandria, Italy
| | - Enrico Ravera
- Department of Emergency, Anesthesia and Critical Care, Michele and Pietro Ferrero Hospital, Verduno, Italy
| | - Alessio Migneco
- Department of Anesthesiology and Emergency Sciences,, Policlinico Gemelli/IRCCS - Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Piccioni
- Department of Anesthesiology and Emergency Sciences,, Policlinico Gemelli/IRCCS - Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Franceschi
- Department of Anesthesiology and Emergency Sciences,, Policlinico Gemelli/IRCCS - Catholic University of Sacred Heart, Rome, Italy
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Petruzziello C, Marannino M, Migneco A, Brigida M, Saviano A, Piccioni A, Franceschi F, Ojetti V. The efficacy of a mix of three probiotic strains in reducing abdominal pain and inflammatory biomarkers in acute uncomplicated diverticulitis. Eur Rev Med Pharmacol Sci 2020; 23:9126-9133. [PMID: 31696504 DOI: 10.26355/eurrev_201910_19316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Acute Uncomplicated Diverticulitis (AUD) is defined as the inflammation of a colon diverticulum, often involving colic wall and pericolic fat. Conventional treatment of AUD includes antibiotics, usually ciprofloxacin and metronidazole, fasting, and fluid therapy. The aim of this study was to test the efficacy of a mix of three probiotic strains (Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, Lactobacillus acidophilus LA 201; Lactibiane Iki®, Biocure [PiLeJe Groupe], Italy/PiLeJe Laboratoire, France) in association with conventional antibiotics in treating AUD compared to conventional antibiotics used alone. PATIENTS AND METHODS We enrolled 84 (25M/59F mean age 61.5 ± 11.5 years) consecutive patients who came to the Emergency Department of the Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy, with a diagnosis of AUD confirmed by CT scan. After routine blood test and dosage of C-reactive protein (C-RP), patients were randomly divided into two groups: Probiotic group (42 patients, 10M/32F mean age 32.23 ± 10.3 years) was treated with ciprofloxacin 400 mg twice a day and metronidazole 500 mg three times a day for one week and simultaneously supplemented with the probiotic mix, 1 sachet twice a day for 10 days. Control group (42 patients, 15M/27F mean age 59.01 ± 11.3 years) received the same antibiotic treatment without the probiotic mix. All patients filled a daily Visual Analog Scale (VAS) for assessment of abdominal pain, with a range value from 0 (asymptomatic) to 10, and CRP value was determined on admission and at discharge. RESULTS As regards abdominal pain, on Day 3, Group A showed a significant decrease of 4.06 points (51.4%) in VAS score compared to a decrease of 2.79 points (34.9%) in Group B. On Day 5 the decrease was of 6.3 points (80%) in Group A and of 4.85 points (61%) in Group B. VAS score was reduced by 7.59 points (96%) in Group A and 6.1 points (76%) in Group B on Day 7 +, and by 7.8 points (99%) in Group A and 7.2 points (90%) in Group B on Day 10. About inflammation, Group A showed a decrease in C-RP value of 64%, compared to a decrease of only 35% in Group B. We also observed that the duration of hospitalization was significantly shorter for patients in Group A: 89 h (3.7 days) in Group A vs. 101 h (4.2 days) in Group B (p=0.03). CONCLUSIONS Our results indicated showed that the supplement with the probiotic mix of Bifidobacterium lactis LA 304, Lactobacillus salivarius LA 302, and Lactobacillus acidophilus LA 201 in combination with the standard antibiotic therapy for AUD reduced abdominal pain and inflammation significantly more than antibiotic treatment used alone. These findings could be due to the anti-inflammatory activity of the probiotic mix. Larger studies are needed to validate its use in the clinical practice.
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Affiliation(s)
- C Petruzziello
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
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Ojetti V, Covino M, Brigida M, Petruzziello C, Saviano A, Migneco A, Candelli M, Franceschi F. Non-COVID Diseases during the Pandemic: Where Have All Other Emergencies Gone? Medicina (Kaunas) 2020; 56:medicina56100512. [PMID: 33019514 PMCID: PMC7599851 DOI: 10.3390/medicina56100512] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023]
Abstract
Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.
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Affiliation(s)
- Veronica Ojetti
- Emergency Department—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Largo A. Gemelli, 00168 1 Rome, Italy; (M.C.); (A.M.); (M.C.); (F.F.)
- Università Cattolica del Sacro Cuore—Largo F. Vito, 00168 1 Rome, Italy; (M.B.); (A.S.)
- Correspondence: ; Tel.: +39-06-30153188
| | - Marcello Covino
- Emergency Department—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Largo A. Gemelli, 00168 1 Rome, Italy; (M.C.); (A.M.); (M.C.); (F.F.)
| | - Mattia Brigida
- Università Cattolica del Sacro Cuore—Largo F. Vito, 00168 1 Rome, Italy; (M.B.); (A.S.)
| | - Carmine Petruzziello
- Ospedale Cristo Re, Emergency Department—Via delle Calasanziane, 00168 25 Rome, Italy;
| | - Angela Saviano
- Università Cattolica del Sacro Cuore—Largo F. Vito, 00168 1 Rome, Italy; (M.B.); (A.S.)
| | - Alessio Migneco
- Emergency Department—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Largo A. Gemelli, 00168 1 Rome, Italy; (M.C.); (A.M.); (M.C.); (F.F.)
| | - Marcello Candelli
- Emergency Department—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Largo A. Gemelli, 00168 1 Rome, Italy; (M.C.); (A.M.); (M.C.); (F.F.)
| | - Francesco Franceschi
- Emergency Department—Fondazione Policlinico Universitario A. Gemelli, IRCCS—Largo A. Gemelli, 00168 1 Rome, Italy; (M.C.); (A.M.); (M.C.); (F.F.)
- Università Cattolica del Sacro Cuore—Largo F. Vito, 00168 1 Rome, Italy; (M.B.); (A.S.)
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Ojetti V, Saviano A, Brigida M, Saviano L, Migneco A, Franceschi F. A Review on the Use of Reversal Agents of Direct Oral Anticogulant Drugs in Case of Gastrointestinal Bleeding. Rev Recent Clin Trials 2020; 15:309-320. [PMID: 32579506 DOI: 10.2174/1574887115666200624193938] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/25/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Major bleeding is a life-threatening condition and a medical emergency with high mortality risk. It is often the complication of anticoagulant's intake. Anticoagulants are commonly used for the prevention and treatment of thrombotic events. The standard therapy with vitamin K antagonist (warfarin) has been frequently replaced by direct oral anticoagulants (DOACs). The latter agents (rivaroxaban, apixaban, edoxaban, dabigatran, and betrixaban) showed better efficacy and safety compared to standard warfarin treatment and they are recommended for the reduction of ischemic stroke. Literature data reported a high risk of gastrointestinal bleeding with DOACs, in particular with dabigatran and rivaroxaban. In case of life-threatening gastrointestinal bleeding, these patients could benefit from the use of reversal agents. METHODS We performed an electronic search on PUBMED of the literature concerning reversal agents for DOACs and gastrointestinal bleeding in the Emergency Department from 2004 to 2020. AIM This review summarizes the current evidence about three reversal agents idarucizumab, andexanet alfa and ciraparantag, and the use of the first two in the emergency setting in patients with active major bleeding or who need urgent surgery which physicians indicate for a better management approach in order to increase patient's safety. CONCLUSION Although these agents have been marketed for five years (idarucizumab) and two years (andexanet alfa) respectively, and despite guidelines considering antidotes as first-line agents in treating life-threatening hemorrhage when available, these antidotes seem to gain access very slowly in the clinical practice. Cost, logistical aspects and need for plasma level determination of DOAC for an accurate therapeutic use probably have an impact on this phenomenon.. An expert multidisciplinary bleeding team should be established so as to implement international guidelines based on local resources and organization.
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Affiliation(s)
- Veronica Ojetti
- Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | | | | | - Luisa Saviano
- Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Alessio Migneco
- Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Cardone S, Petruzziello C, Migneco A, Fiori B, Spanu T, D'Inzeo T, Franceschi F, Ojetti V. Age-related Trends in Adults with Urinary Tract Infections Presenting to the Emergency Department: A 5-Year Experience. Rev Recent Clin Trials 2020; 14:147-156. [PMID: 30588887 DOI: 10.2174/1574887114666181226161338] [Citation(s) in RCA: 4] [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: 11/19/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Urinary tract infections (UTIs) are among the most common bacterial infections, affecting 150 million people worldwide each year. Importantly, the incidence of UTI increases markedly with age. The increasing resistance to empirically prescribed antimicrobial agents complicates the management of this disease. This makes UTI an important issue in increasingly aging population and updated epidemiological investigation is advisable. To understand the epidemiological variation in UTI resistance patterns among differently aged populations, we conducted a retrospective study among patients presenting to the emergency department (ED) of a large tertiary-care hospital in Italy during January 2013 and June 2017. METHODS 1281 patients who presented with UTI symptoms to the ED, were stratified into four age categories: young adults (18-44 years old;), adults (45-64), the elderly (65-84), and the oldest old (≥ 85). Inclusion criteria were urine collected in ED patients with UTI symptoms and first positive culture from one given patient in a given year. RESULTS 362 (28.2%) patients had a urine culture with positive result, leading to a total of 459 germs isolated, stratified into four categories: young adults (58 isolates, 12.6%), adults (98, 21.4%), the elderly (174, 37.9%), and the oldest old (129, 28.1%). Escherichia coli represents the 60% of all monomicrobial infections, followed in frequency by Klebsiella pneumoniae (15%), and Enterococcus faecalis (5%). The other 20% of the infections are caused by various germs. The most common association of germs in polymicrobial is E. coli + E. faecalis, accounting for the 28% of all infections. Overall, we found a peak of susceptibility to amoxicillin (AMX) in the oldest old ( 81%), significantly higher compared to young adults (54%), adults (47%) and elderly (35%) (p<0,001). For ciprofloxacin (CIP) there is a greater susceptibility in the young adult (55.5%), but not so marked compared to the other three groups; for fosfomicin (FOS) the susceptibility was greater in the group of adults (60%) compared to young adults, elderly and the oldest old. Also for trimethoprim/ sulfamethoxazole (TMP-SMX) we found greater susceptibility in the adult group (60%), followed by the oldest old (57,6%), young adults (49%) and elderly (47%). CONCLUSION Age-related differences in antimicrobial-resistant microorganisms were evident for adults with UTI, and could potentially contribute to the risk of inappropriate empirical therapy in elderly patients. Thus, different empirical antimicrobial regimens should be considered for distinct age groups.
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Affiliation(s)
- Silvia Cardone
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Petruzziello
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Alessio Migneco
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Barbara Fiori
- Microbiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Teresa Spanu
- Microbiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Tiziana D'Inzeo
- Microbiology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Ojetti
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
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Petruzziello C, Migneco A, Cardone S, Covino M, Saviano A, Franceschi F, Ojetti V. Supplementation with Lactobacillus reuteri ATCC PTA 4659 in patients affected by acute uncomplicated diverticulitis: a randomized double-blind placebo controlled trial. Int J Colorectal Dis 2019; 34:1087-1094. [PMID: 31011868 DOI: 10.1007/s00384-019-03295-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Accepted: 04/05/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Acute uncomplicated diverticulitis (AUD) is an inflammation of the colon diverticulum. We tested the efficacy of Lactobacillus reuteri 4659 (L. reuteri) in treating AUD. Primary outcome was reduced abdominal pain and inflammatory markers (C-RP). Secondary outcome was reduced hours of hospitalization. PATIENTS AND METHODS A double-blind, placebo RCT was conducted with 88 (34M/54F mean age 61.9 ± 13.9) patients with a diagnosis of AUD. Group A (44 patients, 26F): ciprofloxacin 400 mg/bid and metronidazole 500 mg/tid for 1 week, plus L. reuteri/bid for 10 days. Group B (44 patients, 28F): same antibiotic therapy for 1 week, plus placebo/bid for 10 days. All patients completed a daily visual analog scale (VAS) for abdominal pain. RESULTS Between days 1 and 3, the group A pain decreased by 4.5 points; group B decreased by 2.36 points (p < 0.0001). Between days 1 and 5, the group A decreased by 6.6 points; group B by 4.4 points (p < 0.0001). Between days 1 and 7, the group A decreased by 7.6 points; group B decreased by 5.6 points (p < 0.0001). Between days 1 and 10, the group A decreased by 8.1 points; group B decreased by 6.7 points (p < 0.0001). For C-RP value, the mean decrease between admission and after 72 h was 45.3 mg/L for group A and 27.49 mg/L for group B (p < 0.0001). CONCLUSIONS Our RCT showed that supplementation of the standard AUD therapy with L. reuteri strain 4659 significantly reduced abdominal pain and inflammatory markers compared with the placebo group. It also resulted in a shorter period of hospitalization, and thus has economic benefits. TRIAL REGISTRATION TRIALGOV: NCT03656328.
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Affiliation(s)
| | - Alessio Migneco
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Cardone
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Francesco Franceschi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Veronica Ojetti
- Università Cattolica del Sacro Cuore, Rome, Italy.
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
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Covino M, Petruzziello C, Onder G, Migneco A, Simeoni B, Franceschi F, Ojetti V. A 12-year retrospective analysis of differences between elderly and oldest old patients referred to the emergency department of a large tertiary hospital. Maturitas 2018; 120:7-11. [PMID: 30583768 DOI: 10.1016/j.maturitas.2018.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Received: 06/14/2018] [Revised: 11/05/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Globally, the average age of the population is increasing. Patients aged >65 years attending hospital emergency departments (EDs) differ from younger patients; in particular, they often present with multiple comorbidities. Our retrospective study evaluates the number of attendances at our ED by elderly patients in the 12 years from January 2005 to December 2017. Our first aim was to evaluate differences presented by elderly patients regarding symptoms, clinical features, color code (i.e. priority assigned to the case, where red is highest and yellow is medium), waiting time and outcome. PATIENTS AND METHODS We analyzed data from 201,580 patients aged >65, divided into two groups: 65-84 years and >85 years. Clinical and demographic data were collected from the computerized clinical record (GIPSE®). RESULTS 201,580 patients fulfilled the inclusion criteria, of whom 93,262 (46.3%) were male. There were 162,373 patients aged 65-84, and 39,207 aged >85. Patients aged >85 presented more complex cases, and were admitted more frequently with a red color code and were more frequently hospitalized. Larger proportions of this group had dementia, and attended the ED for trauma or gastrointestinal bleeding. The group aged 65-84 were admitted more frequently with a yellow color code and then discharged. They typically attended the ED for chest and abdominal pain. CONCLUSION There is an increase in the request for health care especially in an emergency setting. The hospitalization of elderly patients is associated with a deterioration in motor skills and quality of life. Being able to reduce hospitalization in the elderly means avoiding disruption to the home care of people with dementia, and reducing both the risk of falls and hospital infections. In Italy, a program (as already experimented with in the USA) dedicated to the elderly who attend hospital EDs is desirable.
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Affiliation(s)
- Marcello Covino
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Carmine Petruzziello
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Graziano Onder
- Geriatric Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Alessio Migneco
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Benedetta Simeoni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Francesco Franceschi
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Veronica Ojetti
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
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Ojetti V, Petruzziello C, Cardone S, Saviano L, Migneco A, Santarelli L, Gabrielli M, Zaccaria R, Lopetuso L, Covino M, Candelli M, Gasbarrini A, Franceschi F. The Use of Probiotics in Different Phases of Diverticular Disease. Rev Recent Clin Trials 2018; 13:89-96. [PMID: 29607785 DOI: 10.2174/1574887113666180402143140] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 01/16/2018] [Revised: 03/13/2018] [Accepted: 03/27/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Diverticular Disease (DD) is a common clinical condition with a dramatic increasing of the prevalence among industrialized countries. Based on the most used classification, DD may be divided into asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease and complicated diverticular disease. Since recent studies pointed out the role of GUT microbiota imbalance in promoting diverticular formation and inflammation, we have designed a systematic review focusing on the possible role of probiotics in the management of this condition. METHODS According to PRISMA, we identified studies on DD patients treated with probiotics, by searching on Pubmed, Embase, Cochrane and ResearchGate. RESULTS 13 studies were included in this review based on our selection criteria: 3 double-blind randomized placebo-controlled, 6 open randomized, and 4 non-randomized open studies. CONCLUSION This is the first systematic review providing an updated measure of evidence on the efficacy of probiotics in a different phase of DD. Even though the majority of studies are still preliminary, current data show a possible clinical application of certain probiotic strains in all stages of DD. Further investigation is then required to better understand when and how probiotics can be used in different phases of DD.
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Affiliation(s)
- Veronica Ojetti
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Carmine Petruzziello
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Silvia Cardone
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Luisa Saviano
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Alessio Migneco
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Luca Santarelli
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Maurizio Gabrielli
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Raffaella Zaccaria
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Loris Lopetuso
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Marcello Covino
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Marcello Candelli
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
| | - Francesco Franceschi
- Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, Catholic University of Rome, Rome, Italy
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Ojetti V, Petruzziello C, Migneco A, Gnarra M, Gasbarrini A, Franceschi F. Effect of Lactobacillus reuteri (DSM 17938) on methane production in patients affected by functional constipation: a retrospective study. Eur Rev Med Pharmacol Sci 2017; 21:1702-1708. [PMID: 28429333] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Constipation is a common symptom affecting up to 30% of the Western population and is strongly associated with the presence of intestinal methanogens, which may directly inhibit motor activity. Two recent studies performed on adult and children affected by chronic constipation showed that the supplementation with L. reuteri significantly improved bowel movements. Whether its action is related to a decreasing of methane (CH4) production has never been tested. We have therefore designed a study aimed at testing this hypothesis. PATIENTS AND METHODS Data of 20 adults (12 females, mean age 36.2 ± 13.7) affected by functional constipation, treated with the probiotic L. reuteri (DSM 17938) for 4 weeks who performed a H2/CH4 lactulose breath test (LBT) in our institution showing a CH4 production higher than 5 ppm were retrospectively analyzed from March to June 2015. Data recorded in their stool diary, reporting the frequency of defecations and stool consistency were also analysed, as well as the result of the LBT performed at the end of the treatment with L. reuteri. RESULTS Four weeks of L. reuteri administration was associated with a significant decrease of mean CH4 production determined by LBT (from 20.8 ± 15 to 8.9 ± 8.6; p < 0.0001 CI 95%) and of AUC value (from 5101.5 ± 3571.13 to 2128.4 ± 2110.8; p < 0.0001 CI 95%). Moreover, a total disappearance of CH4 production (< 5 ppm at LBT) was observed in 11 patients, while, we did not observe any significant decrease of H2 production (from 13.2 ± 8.8 to 11.4 ± 7.3, CI 95%, n.s.). CONCLUSIONS This study highlights for the first time the beneficial effect of Lactobacillus reuteri (DSM 17938) on chronic constipation, via a significant decrease of CH4 production.
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Affiliation(s)
- V Ojetti
- Department of Medical Sciences, Division of Gastroenterology, Catholic University of the Sacred Heart, Rome, Italy.
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Petruzziello C, Sinatti D, Gnarra M, Migneco A, Tesori V, Graziani C, Gasbarrini A, Franceschi F, Ojetti V. May Gender or Ethnicity Affect Delta Over Baseline Values Obtained by 13-C Urea Breath Test? Rev Recent Clin Trials 2017; 12:187-192. [PMID: 28814259 DOI: 10.2174/1574887112666170816155703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION 13C-urea breath test (UBT) is a non-invasive test for detecting active H. pylori infection. Previous studies showed a correlation of delta over baseline (DOB) values with bacterial load, mucosal inflammation and successful eradication. Gender has been shown to affect DOB in children. Aim of our study was to verify whether gender or ethnicity affects DOB in adults. PATIENTS AND METHODS We retrospectively analyzed data of 2922 patients (1024M/1898F mean age 47±15 years) that underwent UBT in our outpatient unit, from October 2015 to October 2016. Patients were divided based on gender and ethnicity; mean DOB values were then compared. RESULTS 686 pts (23.4%, 258M/428F, mean age 45±17 years) of 2922 pts showed a positive UBT. Prevalence of H. pylori infection was significantly higher in males compared to females (29% vs 22%; p=0,03). Females showed a significant higher mean DOB (34±25 vs 27,6±22; p=0,008). A total of 2922 UBT were performed during the study period (F:1898, 65%; M: 1024 35%). The prevalence of H. pylori infection is 32% in those from Eastern Countries, 28% in those from South America and 40% in both those coming from Africa and Asia. We found significantly lower DOB values in Italians compared to non-Italian (mean DOB 36±27 vs 69±32; p<0.0001). CONCLUSION Our study showed that in our geographic area, prevalence H. pylori infection is higher in males. Moreover, it demonstrates for the first time in our geographic area that adult females show a significantly higher DOB compared to males (p=0,008). Whether this effect may be due to hormonal differences, able to influence gastric emptying, bacterial load, or even the production of urease by H. pylori, merits further investigation.
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Affiliation(s)
- Carmine Petruzziello
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Dario Sinatti
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Maria Gnarra
- Dermatology Unit, Columbia University Medical Center, NYC, New York-NY. United States
| | - Alessio Migneco
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Valentina Tesori
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Cristina Graziani
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Antonio Gasbarrini
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Francesco Franceschi
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
| | - Veronica Ojetti
- Department of Gastroenterology and Internal Medicine, Catholic University, Rome. Italy
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Franceschi F, Saviano L, Petruzziello C, Gabrielli M, Santarelli L, Capaldi L, Di Leo M, Migneco A, Gilardi E, Merra G, Ojetti V. Safety and efficacy of low doses of diclofenac on acute pain in the emergency setting. Eur Rev Med Pharmacol Sci 2016; 20:4401-4408. [PMID: 27831630] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Diclofenac is the most widely prescribed non-steroidal anti-inflammatory drug worldwide. Data collected during the last 10 years reported a dose-duration dependent increasing of cardiovascular risk associated with the use of diclofenac, supporting the evidence of a close association with the degree of COX-2 inhibition achieved in vivo. Nevertheless, the amplitude of cardiovascular risk associated with the administration of diclofenac at low doses and for the short-term duration is still poorly defined. Indeed, data did not show a clear and strong increasing of the risk for daily doses of 75 and of 50 mg. Concerning duration, while the identification of a safe temporal window is less defined, some studies reported an absence or a very low risk when the exposure is shorter than 30 days. Today, new low-dosage diclofenac formulations are available, allowing to reduce the systemic exposure, the degree of COX-2 inhibition and possibly the risk of occurrence of cardiovascular events. This is the reason why those new formulations may represent the ideal drug for the management of pain in the emergency setting.
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Affiliation(s)
- F Franceschi
- Emergency Medicine Department, Catholic University of the "Sacred Heart" of Rome, School of Medicine, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
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19
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Ojetti V, Ianiro G, Tortora A, D'Angelo G, Di Rienzo TA, Bibbò S, Migneco A, Gasbarrini A. The effect of Lactobacillus reuteri supplementation in adults with chronic functional constipation: a randomized, double-blind, placebo-controlled trial. J Gastrointestin Liver Dis 2014; 23:387-91. [PMID: 25531996 DOI: 10.15403/jgld.2014.1121.234.elr] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS There is a growing interest for the use of probiotics for chronic constipation. A recent randomized controlled trial (RCT) showed a positive effect of Lactobacillus reuteri (L. reuteri) on bowel movement frequency in infants with chronic constipation. The aim of the present study was to evaluate the effects of L. reuteri in adult patients with functional constipation. METHODS A double-blind, placebo RCT was conducted in 40 adults (18M/22F, 35+/-15 years) affected by functional constipation according to the Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri (DSM 17938), or matching placebo for 4 weeks. The increase of bowel movements/week was the primary outcome, while the improvement of stool consistency was the secondary outcome. RESULTS At week 4, the mean increase in bowel movements/week was 2.6 (SD +/-1.14, 95% CI:1.6-3.6) in the L. reuteri group and 1.0 (SD+/-1. 95% CI:0.12-1.88) in the placebo group (p=0.046). At the end of the treatment, the mean bowel movements/week was 5.28+/-1.93 in the L. reuteri group and 3.89+/-1.79 in the placebo group. There was a not significant difference in the stool consistency between the two groups. CONCLUSIONS L. reuteri is more effective than the placebo in improving bowel movement frequency in adult patients with functional constipation as previously demonstrated in children, even if it seems to have no effect on stool consistency.
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Affiliation(s)
- Veronica Ojetti
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy.
| | - Gianluca Ianiro
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Annalisa Tortora
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Giovanna D'Angelo
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | | | - Stefano Bibbò
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Alessio Migneco
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Division of Gastroenterology Catholic University Rome, Italy
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Addolorato G, Leggio L, Ferrulli A, Cardone S, Bedogni G, Caputo F, Gasbarrini G, Landolfi R, Nesci A, Vonghia L, D'Angelo C, Mirijello A, Malandrino N, Capristo E, Cammarota G, Rapaccini GL, Pozzi G, Martinotti G, Di Nicola M, De Filippis R, Janiri L, Portale G, Tilli P, Buccelletti F, Migneco A, Gentiloni NS, Nicotra N. Dose-Response Effect of Baclofen in Reducing Daily Alcohol Intake in Alcohol Dependence: Secondary Analysis of a Randomized, Double-Blind, Placebo-Controlled Trial. Alcohol Alcohol 2011; 46:312-7. [DOI: 10.1093/alcalc/agr017] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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21
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Ojetti V, Pellicano R, Fagoonee S, Migneco A, Berrutti M, Gasbarrini A. Helicobacter pylori infection and diabetes. Minerva Med 2010; 101:115-119. [PMID: 20467410] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The bacterium Helicobacter pylori (H. pylori), prime causal agent of gastroduodenal diseases, has been involved in various aspects of several extragastric manifestations. Although currently available data do not provide proof of its role in most of them, a potential relationship cannot be ruled out. In the present review, the consistency of a role of H. pylori infection in the pathogenesis of diabetes mellitus (DM) as well as in the gastric abnormalities of diabetics is analyzed and critically discussed. Several controversies emerge from the epidemiological data. The clinical consequence of H. pylori infection in terms of metabolic control seems to be low. Regarding interventional studies, the bacterial eradication rate is significantly lower in DM patients than in controls. The difference in the eradication rate observed between adults and children affected by diabetes could be due to the fact that the latter have no history of repeated infectious diseases and antibiotic treatments, with minor antibiotic-resistant H. pylori strain selection. Finally, a higher H. pylori re-infection rate in DM patients than in general population has been shown.
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Affiliation(s)
- V Ojetti
- Department of Internal Medicine, Catholic University, Rome, Italy
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Ojetti V, Lauritano EC, Barbaro F, Migneco A, Ainora ME, Fontana L, Gabrielli M, Gasbarrini A. Rifaximin pharmacology and clinical implications. Expert Opin Drug Metab Toxicol 2009; 5:675-82. [PMID: 19442033 DOI: 10.1517/17425250902973695] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rifaximin is a semisynthetic, rifamycin-based non-systemic antibiotic, with a low gastrointestinal absorption and a good antibacterial activity. The antibacterial action covers Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Its antimicrobial action is based on its property to bind to the beta-subunit of bacterial DNA-dependent RNA polymerase inhibiting, thereby, the bacterial RNA synthesis. Rifaximin contributes to restore gut microflora imbalance, becoming an important therapeutic agent in several organic and functional gastrointestinal diseases such as hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. This antibiotic has the advantage of low microbial resistance and few systemic adverse events and is safe in all patient populations, including young children.
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Affiliation(s)
- Veronica Ojetti
- Internal Medicine Department, Catholic University of Sacred Heart, Gemelli Hospital, Rome, Italy. veronica.ojetti tin.it
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Ojetti V, Gabrielli M, Migneco A, Lauritano C, Zocco MA, Scarpellini E, Nista EC, Gasbarrini G, Gasbarrini A. Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet. Scand J Gastroenterol 2008; 43:174-7. [PMID: 17917999 DOI: 10.1080/00365520701676138] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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: 02/04/2023]
Abstract
OBJECTIVE In a recent study by our group, it was shown that a large proportion of patients with lactose malabsorption and with no bacterial overgrowth are affected by silent coeliac disease (CD). Our aim was to evaluate the effect of a gluten-free diet on lactose malabsorption assessed using the hydrogen lactose breath test (LBT) and also the relationship with normalization of duodenal biopsies in coeliac patients. MATERIAL AND METHODS Fifteen patients (11 F, 4 M; mean age 35.8+/-6) affected by CD with a positive LBT and negative glucose breath test were enrolled. All were started on a gluten-free diet and were re-evaluated after 6 months by LBT and after 12 months by both LBT and upper gastrointestinal endoscopy with biopsies. RESULTS LBT normalization was observed in 1 out of 15 patients (6.7%) after 6 months and in 9 of the remaining 14 (64.2%) after 12 months. Duodenal biopsies showed normal villi in 8 patients, partial villous atrophy in 5 and total atrophy in 2. CONCLUSIONS The present study shows that a large proportion of CD patients experience a regression of lactose malabsorption after receiving a gluten-free diet. This may be related to normalization of the brush border with an improvement of lactase enzyme activity. LBT should be performed after 12 months in CD patients on a gluten-free diet in order to assess the persistence/disappearance of lactose malabsorption, thus avoiding an unnecessary lactose-free diet.
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Ojetti V, Aguilar Sanchez JA, De Simone C, Migneco A, Capizzi R, Schiavino D, Nucera E, Patriarca G, Gasbarrini G, Gasbarrini A. The role of immune serological parameters and allergological tests in psoriasis. J Eur Acad Dermatol Venereol 2008; 22:621-2. [DOI: 10.1111/j.1468-3083.2007.02432.x] [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: 11/28/2022]
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Migneco A, Ojetti V, Covino M, Mettimano M, Montebelli MR, Leone A, Specchia L, Gasbarrini A, Savi L. Increased blood pressure variability in menopause. Eur Rev Med Pharmacol Sci 2008; 12:89-95. [PMID: 18575158] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Blood pressure variability represents an independent risk factor for cardiovascular diseases. To detect possible blood pressure variability changes from fertile to menopausal status, we enrolled consecutively 219 women: 104 fertile women (46.6 +/- 3.4 years) and 115 menopausal women (53.9 +/- 3.98 years). We evaluated for each patient the body mass index (BMI), 24 h, daytime, night-time systolic and diastolic mean blood pressure values and blood pressure variability data by means of an Ambulatory Blood Pressure Monitoring device. We found a significant higher mean age, body mass index, systolic and diastolic 24 h, day and night-time blood pressure variability in menopausal women when compared to fertile women. Age and BMI were significantly correlated to most blood pressure variability data with the Spearman Rank test. The multivariate logistic regression with dichotomic variables showed that the menopausal status is independently correlated to 24 h systolic (p < 0.0005) and diastolic (p < 0.05) variability, systolic (p < 0.05) and diastolic (p < 0.05) daytime pressure variability and systolic night-time pressure variability (p < 0.05). Furthermore, we found independent correlations between age 24 h systolic (p < 0.05) and night-time diastolic blood pressure variability (p < 0.05), while the BMI was indepententely correlated to BMI 24h diastolic (p < 0.01), daytime systolic (p < 0.01) and diastolic (p < 0.05) blood pressure variability. These data show a significant increase of blood pressure variability in menopausal women when compared to fertile women, even after exclusion of confounding factors, such as aging and BMI. Menopausal status, aging and BMI increase may all, independently, contribute to the enhanced blood pressure variability we found in menopausal women.
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Affiliation(s)
- A Migneco
- Department of Internal Medicine, Catholic University, Rome, Italy
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26
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Ojetti V, Persiani R, Nista EC, Rausei S, Lecca G, Migneco A, Cananzi FCM, Cammarota G, D'Ugo D, Gasbarrini G, Gasbarrini A. A case-control study comparing methylene blue directed biopsies and random biopsies for detecting pre-cancerous lesions in the follow-up of gastric cancer patients. Eur Rev Med Pharmacol Sci 2007; 11:291-296. [PMID: 18074937] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To compare the accuracy of Methylene Blue (MB) targeted biopsies with random biopsies in detecting intestinal metaplasia and dysplasia in the follow-up of patients after gastrectomy for gastric cancer. METHODS Thirty patients (21 Billroth II, 9 Billroth 1) for cancer, referred to the Gastroenterology Unit for an elective esophagogastroduodenoscopy (EGD), were enrolled. All endoscopies were performed with a high-resolution videoendoscope with an adjustable image magnification: EG-485ZH (Fujinon, Omiya, Japan). During EGD three random biopsies were taken in the stomach and, after staining with MB, three targeted biopsies were taken from every stained area. RESULTS In 28 patients traditional endoscopy showed hyperemia of the anastomosis, in 2 patients a lesion. After MB in 6/30 there were stained area (2 lesions seen with traditional endoscopy and 4 blue areas in other patients). As regards histology: 24 patients showed inflammation, while 2 patients with alterations in traditional endoscopy and with MB showed metaplasia and high grade dysplasia. In 4/30 (13.3%) patients MB guided biopsies showed significant lesions (3 intestinal metaplasia, 1 low grade dysplasia) while random biopsies showed only inflammation. CONCLUSIONS After partial gastrectomy, the mucosa of the residual stomach usually undergoes severe changes, and these lesions are known to be pre-cancerous. The diagnostic accuracy of the MB technique seems to be superior to random biopsies for identification of intestinal metaplasia, dysplasia, and may be helpful in targeting biopsies and early endoscopic treatment.
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Affiliation(s)
- V Ojetti
- Department of Surgery, Catholic University, Rome, Italy.
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Rizzo M, Migneco A, Mansueto P, Tringali G, DI Lorenzo G, Rini GB. Therapeutic patient education in oncology: pedagogical notions for women's health and prevention. Eur J Cancer Care (Engl) 2007; 16:9-11. [PMID: 17227347 DOI: 10.1111/j.1365-2354.2006.00716.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Therapeutic patient education has been defined by the World Health Organization as a comprehensive approach to support patients and their families to better understanding of their diseases. In oncology, the contribution of therapeutic education may enable the patients to have adequate information of the illness, to actively participate in the management of the disease, to understand how to live with the illness, to learn how to face the critical moments of the clinical course, and to live in harmony with all health professionals. In addition, there may be several advantages for health professionals: a reduction in emotional labour, increased professional satisfaction, and a reduction in the potential tensions and conflicts with patients and their relatives. We suggest that therapeutic patient education in oncology may be useful for both patients and health professionals and probably lead to a reduction in the costs of healthcare delivery.
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Affiliation(s)
- M Rizzo
- Department of Clinical Medicine and Emerging Diseases, University of Palermo, Palermo, Italy.
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Ojetti V, Migneco A, Nista EC, Gasbarrini G, Gasbarrini A, Pitocco D, Ghirlanda G. H pylori re-infection in type 1 diabetes: a 5 years follow-up. Dig Liver Dis 2007; 39:286-7. [PMID: 17275424 DOI: 10.1016/j.dld.2006.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 11/14/2006] [Indexed: 12/11/2022]
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Ojetti V, De Simone C, Aguilar Sanchez J, Capizzi R, Migneco A, Guerriero C, Cazzato A, Gasbarrini G, Amerio P, Gasbarrini A. Malabsorption in psoriatic patients: cause or consequence? Scand J Gastroenterol 2006; 41:1267-71. [PMID: 17060119 DOI: 10.1080/00365520600633529] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The etiopathogenesis of psoriasis is still unclear. Associations between gut and skin diseases are well known, since psoriatic patients show a high prevalence of coeliac disease. Small-bowel abnormalities can cause clinical or, more frequently, laboratory alterations that give rise to malabsorption. The aim of the study was to evaluate the prevalence of malabsorption in psoriatic patients. MATERIAL AND METHODS Fifty-five (29 M, 26 F, mean age 51+/-8 years) psoriatic patients in the Dermatology Centre of our hospital and 65 healthy controls (36 M, 29 F, mean age 47+/-9 years) were screened for malabsorption using a D-xylose test. Psoriatic subjects who resulted positive were further investigated in order to reach a better characterization of the malabsorption using serum antigliadin, anti-endomysium and anti-transglutaminase antibodies, H2 lactulose breath test, the parasitological faecal test and colonoscopy with retrograde ileoscopy. RESULTS Altered D-xylose absorption was found in 60% (33/55) of psoriatic patients and in 3% (2/65) of controls. Of the former, 6% had coeliac disease, 21% had bacterial overgrowth, 3% had parasitic infections and 1 patient presented eosinophilic gastroenteritis. CONCLUSIONS Malabsorption was more prevalent among psoriatic patients than among controls. Coeliac disease, bacterial overgrowth, parasitic infestations and eosinophilic gastroenteritis could be possible causes of malabsorption in these patients. Further studies are needed to clarify the pathogenesis and possible causative associations between gut and skin diseases.
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Affiliation(s)
- Veronica Ojetti
- Department of Internal Medicine, Catholic University, Rome, Italy.
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Cianci R, Citro F, Migneco A, Baldoni F, Minisci MC, Di Daniele N, De Lorenzo A. Body fluid compartments in hypertension. Eur Rev Med Pharmacol Sci 2006; 10:75-8. [PMID: 16705952] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND OBJECTIVES There is a correlation between the fluid and ionic homeostasis and blood pressure but it is not known if these body fluid changes represent the cause or rather the effect of the blood pressure rise. We have estimated the compartmental distribution of body fluids by means of the Bioimpedance Spectroscopy (BIS) analysis in a hypertensive cohort compared to control subjects. MATERIAL AND METHODS We have enrolled 28 hypertensive patients (14 females, 14 males, mean age 47 +/- 5) and a sex- and age-matched control group of 37 healthy subjects (17 females and 20 males, mean age 45 +/- 8). They underwent anthropometric measurements, then extracellular (ECW) and intracellular water (ICW) were assessed using BIS. RESULTS Both mean weight and BMI of hypertensive patients resulted significantly higher than of the control group (p < 0.05). We found higher ICW values in hypertensive compared to normotensive subjects. This difference was proportional to the difference of mean blood pressure values, reaching significance only as regards the stage II hypertensive subgroup (p < 0.03). DISCUSSION Our data confirm that the blood pressure increases are associated to TBW, and caused mainly by ICW increases. The BIS, a simple, reliable, non invasive and cost effective methodical approach, estimating the distribution of body fluids, offers new possibility of the management of the hypertensive disease, to establish a more appropriate antihypertensive treatment. Moreover, the BIS, estimating the volume restoration of the different body compartments, may be helpful in evaluating the effectiveness of the pharmacological treatment.
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Affiliation(s)
- R Cianci
- Division of Human Nutrition, University of Rome Tor Vergata, Italy
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Abstract
Coeliac disease is an autoimmune enteropathy triggered by the ingestion of gluten in susceptible individuals. The clinical presentation of coeliac disease is variable and several extra-intestinal manifestations, as well as an association with autoimmune diseases, have been described. In particular, there are many links between liver disease and coeliac disease. Here we report the case of a young Caucasian woman with acute liver failure, selected as a possible candidate for liver transplantation. Investigation of the patient led to the diagnosis of coeliac disease. A gluten-free diet led to the reversal of the severe liver failure, without the necessity for any surgical or medical treatment.
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Affiliation(s)
- Veronica Ojetti
- Departments of Emergency Medicine, Catholic University, Rome, Italy
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Abstract
Helicobacter pylori [H. pylori], one of the most common chronic infections worldwide, is the main etiologic agent of gastritis, peptic ulcer and gastric cancer. Patients with diabetes mellitus are often affected by chronic infections. Many studies have evaluated the prevalence of H. pylori infection in diabetic patients and the possible role of this condition in their metabolic control. Some studies found a higher prevalence of the infection in diabetic patients and a reduced glycaemic control, while others did not support any correlation between metabolic control and H. pylori infection. There are only a few studies on the eradication rate of H. pylori in diabetic patients. Most of these papers concluded that standard antibiotic therapy allows a significantly lower H. pylori eradication rate than is observed in control groups matched for sex and age. Changes in the microvasculature of the stomach with a possible reduction of antibiotic absorption, the presence of gastroparesis and the frequent use of antibiotics for recurrent bacterial infections with the development of resistant strains could be some of the mechanisms underlying this phenomenon. A quadruple therapy may be used as the second line approach with a good eradication rate, even if an antibiotic selected according to a specific H. pylori antibiogram is considered the gold standard in these patients. As regards the gastrointestinal symptoms of H. pylori infected individuals, many studies showed that they are as frequent in patients with type 1 diabetes as in the general population. The incidence of H. pylori recurrence after 12 months follow-up is significantly higher in type 1 diabetic subjects when compared to controls. Reduced lymphocyte activity, neutrophil dysfunction with failure of chemotaxis and a possible reservoir of H. pylori in dental plaque may explain the higher rate of re-infection in these patients.
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Affiliation(s)
- Veronica Ojetti
- Department of Internal Medicine, Catholic University, Gemelli Hospital, Largo Gemelli, 8, 00168, Rome, Italy.
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Ojetti V, Nucera G, Migneco A, Gabrielli M, Lauritano C, Danese S, Zocco MA, Nista EC, Cammarota G, De Lorenzo A, Gasbarrini G, Gasbarrini A. High prevalence of celiac disease in patients with lactose intolerance. Digestion 2005; 71:106-10. [PMID: 15775678 DOI: 10.1159/000084526] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2004] [Accepted: 01/07/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Acquired lactase deficiency is a common cause of gastrointestinal symptoms but its etiology remains unclear. Celiac disease could lead to lactase deficiency and is much more common than previously suspected. Several studies have highlighted the prevalence of lactose intolerance in celiac disease, but studies assessing the prevalence of celiac disease in lactose intolerance are lacking. We evaluated the prevalence of celiac disease in patients with a positive H2-lactose breath test compared to a control group. METHODS This retrospective study included 54 patients (15 males/39 females; mean age 37.8 +/- 7 years) from southern Italy, referred to the Gastroenterology Unit for bloating and diarrhea after the introduction of milk or dietary lactose. They had a positive H2-lactose breath test and a negative H2-glucose breath test. 50 blood donors were drawn from a similar population, matched for sex and age, and enrolled as a control group. All patients were screened for possible celiac disease by measuring the serum level of IgA antibodies to endomysium, anti-transglutaminase and total IgA. Patients positive for at least one of these markers were submitted to upper gastrointestinal endoscopy. RESULTS None of the patients had a IgA deficiency. 24% of the patients showed positivity of celiac disease antibodies compared to 2% in the control group (p < 0.001). Histologic samples of these patients showed villous atrophy (53.8% Marsh type IIIa, 38.4% Marsh IIIb, and 7.6% with Marsh type IIIc) confirming the celiac disease, while in the control subjects duodenal biopsies were normal. CONCLUSIONS A high prevalence of celiac disease was observed in patients with a positive H2-lactose breath test compared to healthy controls. In these subjects lactase deficiency seems to be the only manifestation of celiac disease. We suggest serologic screening for celiac disease in all patients with a positive H2-lactose breath test before beginning a milk-exclusion diet.
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Ojetti V, Migneco A, Bononi F, De Lorenzo A, Gentiloni Silveri N. Calcium channel blockers, beta-blockers and digitalis poisoning: management in the emergency room. Eur Rev Med Pharmacol Sci 2005; 9:241-6. [PMID: 16128045] [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] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Calcium channel blockers and beta-blockers intoxications account for up to 65% of deaths for cardiovascular drugs, causing severe clinical symptoms refractory to standard medications. The most serious poisonings are those resulting from verapamil and propanolol ingestion. Both support and antidotic therapy are necessary for these potentially unstable patients. Supportive measures and the use of digoxin-specific antibody fragments are first line treatment for digitalis glycoside poisoning.
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Affiliation(s)
- V Ojetti
- Department of Emergency Medicine, Catholic University--Rome, Italy
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Testa A, Ojetti V, Migneco A, Serra M, Ancona C, De Lorenzo A, Gentiloni Silveri N. Use of amiodarone in emergency. Eur Rev Med Pharmacol Sci 2005; 9:183-90. [PMID: 16080639] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Amiodarone is one of the most common anti-arrhythmic drugs used in the Emergency Department. Recent guidelines on cardiac arrest with shockable rhythm [refractory ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT)] recommend amiodarone as anti-arrhythmic of first choice. Amiodarone is also first choice drug in the treatment of various ventricular and supra-ventricular tachyarrhythmias. This paper deals with the main therapeutical indications of amiodarone in emergency medicine: dosage, side effects, contraindications and pharmacological interactions are reviewed. Amiodarone is effective for control of hemodynamically stable VT, polymorphic VT and wide-complex tachycardia of uncertain origin. It is also helpful for ventricular rate control of rapid atrial arrhythmias in patients with severely impaired left ventricular (LV) function, when digitalis has been ineffective, and is an adjunct to electrical cardioversion. The major side effects of amiodarone are hypotension, bradycardia and peripheral phlebitis. Major contraindications to the intravenous (i.v.) injection of amiodarone are bradycardia, senoatrial block, severe disturbs of conduction, second or third degree atrio-ventricular blocks. Other contraindications are hypotension, severe respiratory failure, hepatocellular failure and hyperthyroidism. Pharmacological interactions are reported with HMG-CoA reductase inhibitors, class I antiarrhythmic agents and other drugs which contribute to prolong QT interval, digoxin, oral anticoagulants and general anaesthesia.
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Affiliation(s)
- A Testa
- Department of Emergency Medicine, Catholic University, Rome, Italy
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Ojetti V, Migneco A, Manno A, Verbo A, Rizzo G, Gentiloni Silveri N. Management of acute pancreatitis in emergency. Eur Rev Med Pharmacol Sci 2005; 9:133-40. [PMID: 15945503] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review focuses on the medical and endoscopic approachs to patients with acute mild or severe pancreatitis. Acute pancreatitis is an acute inflammatory process of the pancreas whose the main determinant of the outcome is the extent of pancreatic necrosis. After the diagnosis, a severity assessment using scoring systems and early contrast enhanced Computed Tomography should be performed in all patients within 48 hours from the admission. All cases of severe acute pancreatitis should be managed initially in intensive care units with full systems support. Patients with gallstone pancreatitis should have definitive Endoscopic Retrograde Colangio-Pancreatography (ERCP) or surgical management of the gallstones.
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Affiliation(s)
- V Ojetti
- Department of Emergency Medicine, Catholic University, Rome, Italy
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Migneco A, Ojetti V, Testa A, De Lorenzo A, Gentiloni Silveri N. Management of thyrotoxic crisis. Eur Rev Med Pharmacol Sci 2005; 9:69-74. [PMID: 15850146] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The thyrotoxic crisis is a medical emergency caused by an exacerbation of the hyperthyroid state characterized by decompensation of one or more organ systems. Early recognition and aggressive treatment are fundamental in limiting the morbidity and mortality associated with this condition. The crisis has an abrupt onset, and is evoked by a precipitating factor such as infectious diseases, ketoacidosis, acute trauma, thyroidal surgery, 131-I radio-metabolic treatment, administration of iodine-containing materials (amiodarone), parturition. The clinical picture is characterized by four main features: fever, tachycardia or supraventricular arrhythmias, central nervous system symptoms and finally gastrointestinal symptoms. The diagnosis of thyrotoxic crises is often made on the basis of clinical findings alone, since it is difficult in most emergency departments to obtain rapid confirmatory laboratory or nuclear medicine tests. The ultrasound thyroid scan, if available in the emergency room, may suggest an hyperthyroid state showing typical images of Basedow's disease or nodular goiter with their characteristic color-Doppler pattern of hyperactivity, easily distinguishable from a normal gland. The principles of thyroid storm treatments are: reduction of circulating TH's levels; inhibition of the peripheral effects of circulating thyroid hormones (TH); supportive care, in order to reverse systemic decompensation and treatment of the underlying precipitating event.
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Affiliation(s)
- A Migneco
- Department of Emergency Medicine, Catholic University - Rome (Italy)
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Migneco A, Ojetti V, De Lorenzo A, Silveri NG, Savi L. Hypertensive crises: diagnosis and management in the emergency room. Eur Rev Med Pharmacol Sci 2004; 8:143-52. [PMID: 15636400] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Hypertensive crises are commonly observed in an emergency room. Regardless blood pressure values, hypertensive crises are classified in emergencies, characterized by life-threatening acute organ damage, and urgencies, with no evidence of acute or progressive organ injury. In an hypertensive emergency an appropriate and immediate management with parenteral drugs is mandatory, while in an hypertensive urgency blood pressure should be decreased within 24-48 h with orally active agents. This article reviews the spectrum of clinical syndromes that comprise hypertensive emergencies, focusing on specific drugs and therapeutic strategies available in the emergency department, based on current literature. Since no randomized prospective trials are available, an evidence-based approach recommending an optimal therapeutical management is not possible. Much of the therapy is therefore entirely empirical and based on the underlying pathophysiologic and clinical findings. Further studies are needed to clarify pathophysiologic mechanisms in order to optimize therapeutic approach.
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Affiliation(s)
- A Migneco
- Dept of Emergency Medicine, Catholic University, Rome (Italy)
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Abstract
OBJECTIVES One-week triple therapy, a combination of acid suppression with two antibiotics, is the gold standard for anti-Helicobacter pylori treatment. There is increasing evidence of H. pylori resistance to classical triple therapy. Recently, it was reported that the amoxicillin-clavulanate combination had a slightly higher activity than amoxicillin alone against H. pylori, and that beta-lactamase inhibitors had 'in-vitro' antibacterial activity against H. pylori. SETTING To evaluate the efficacy of 1 week triple therapy omeprazole, clarithromycin and amoxicillin plus clavulanate compared with omeprazole, clarithromycin and amoxicillin for H. pylori eradication. The study was open randomized. SUBJECTS Sixty dyspeptic patients (36 male, 24 female; mean age 53 +/- 9 years) with Helicobacter pylori infection never treated before, were enrolled and randomly assigned to two different 7-day triple therapies: (i) (n = 30) amoxicillin 875 mg plus clavulanic acid 125 mg b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACCO); (ii) (n = 30) amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACO). Bacterial eradication was assessed by 13C-urea breath test 4-6 weeks after therapy. Information on gastrointestinal symptoms and antibiotic-related side-effects were recorded using a questionnaire. RESULTS All patients completed the study. A significantly higher H. pylori eradication rate with ACCO compared with ACO: (26/30) 86.6 vs. (20/30) 66.6%, respectively (P < 0.05) were observed. No major side-effects were reported, whilst 8% patients complained of mild side-effects; no significant differences were noted between the two groups. CONCLUSIONS Our results suggest that amoxicillin and clavulanate in combination achieve a higher H. pylori eradication rate than amoxicillin alone, without any increase in side-effects. The combination of amoxicillin and clavulanate may represent an alternative therapeutic scheme for the treatment of H. pylori infection.
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Affiliation(s)
- V Ojetti
- Departments of Internal Medicine and Gastroenterology, Gemelli Teaching Hospital, Catholic University of Rome, Rome, Italy
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Migneco A, Ojetti V, Specchia L, Franceschi F, Candelli M, Mettimano M, Montebelli R, Savi L, Gasbarrini G. Eradication of Helicobacter pylori infection improves blood pressure values in patients affected by hypertension. Helicobacter 2003; 8:585-9. [PMID: 14632672 DOI: 10.1111/j.1523-5378.2003.00180.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Arterial hypertension is a risk factor for atherosclerosis of whose pathogenesis is unknown. Growing evidence underscores the causative role of endothelial dysfunction. A possible association between Helicobacter pylori infection and cardiovascular and autoimmune disorders has been found. The release of cytotoxic substances either of bacterial origin or produced by the host may represent mediators of these systemic sequelae. The aim of our study was to determine the prevalence of H. pylori infection in hypertensive patients and the effects of H. pylori eradication on blood pressure and on digestive symptoms. MATERIALS AND METHODS Seventy-two hypertensive patients (34 male and 38 female; mean age 53 +/- 12 years) and 70 normotensive controls (35 male and 35 female; mean age 52 +/- 10 years) were enrolled. All patients were subjected to a first ambulatory blood pressure monitoring (ABPM) at enrollment, a 13C urea breath test and a test for IgG-CagA antibodies, and completed the validated dyspepsia questionnaire. H. pylori-positive patients were treated with triple therapy (amoxicillin, clarithromycin and ranitidine bismute citrate) for 7 days. Control of eradication was assessed by 13C urea breath test, and all patients underwent a second ABPM 6 months after enrollment. RESULTS H. pylori infection was 55% in hypertensive patients, with 90% CagA positivity, and 50% in controls, with 60% CagA positivity. At the first ABPM, blood pressure values were similar in H. pylori-positive and -negative individuals; positive patients showed a significant increase in pyrosis and epigastric pain compared to negative patients. H. pylori was eradicated in 80% of patients and in 85% of controls. At the second ABPM, we found a statistically significant decrease in 24-hour mean blood pressure values when compared to the first ABPM only in the eradicated hypertensive group. CONCLUSIONS Our study demonstrated a significant decrease in blood pressure values, in particular in diastolic blood pressure values, after H. pylori eradication in hypertensive patients. A high prevalence of CagA positivity was found. The association between cardiovascular disease and H. pylori infection seems pronounced only in CagA-positive patients. The possible links between hypertensive disease and H. pylori infection may involve the activation of the cytokine cascade with the release of vasoactive substances from the primary site of infection, or molecular mimicry between the CagA antigens of H. pylori and some peptides expressed by endothelial cells and smooth muscle cells.
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Affiliation(s)
- Alessio Migneco
- Department of Medical Pathology, Catholic University, Rome, Italy
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Ojetti V, Aguilar Sanchez J, Guerriero C, Fossati B, Capizzi R, De Simone C, Migneco A, Amerio P, Gasbarrini G, Gasbarrini A. High prevalence of celiac disease in psoriasis. Am J Gastroenterol 2003; 98:2574-5. [PMID: 14638373 DOI: 10.1111/j.1572-0241.2003.08684.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ojetti V, Aguilar Sanchez J, Guerriero C, Fossati B, Capizzi R, De Simone C, Migneco A, Amerio P, Gasbarrini G, Gasbarrini A. High prevalence of celiac disease in psoriasis. Am J Gastroenterol 2003. [PMID: 14638373 DOI: 10.1016/s0002-9270(03)01717-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ojetti V, Di Campli C, Mutignani M, Migneco A, Tridente A, Silveri NG, Gasbarrini G, Gasbarrini A. Real time endoscopic imaging of oxyradical generation in pig stomach during ischemia-reperfusion. Dig Liver Dis 2003; 35:309-13. [PMID: 12846402 DOI: 10.1016/s1590-8658(03)00073-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Oxygen-free radicals generation is considered to be a major cause of gastric injury during reperfusion. Chemiluminescence has been used to assess real-time free radical release on the surface of isolated organs. AIMS To evaluate the combined use of chemiluminescence and gastroendoscopy techniques and to assess the real-time production of free radicals during ischemic damage of the gastric wall in an animal model. PATIENTS AND METHODS For the experiment, an optical junction was set up between a fibroendoscope and a luminograph apparatus. Three pigs were submitted to gastrofibroendoscopy before, during and after 30 min of clamping of the coeliac artery. Under basal conditions, at the end of the ischemic phase and at the beginning of reperfusion, 1 mM of lucigenin, a specific superoxide enhancer, was injected in the left gastric artery of the animal. The endoscopic live images and chemiluminescence emission were recorded and successively superimposed to measure rate and spatial distribution of photon emission (photons/s). RESULTS Free radical production was not observed under basal conditions or during the ischemic phase, but significantly increased during reperfusion reaching a maximum peak after 15 min (0.6+/-0.2 photons x 10(5)/s) and decreased progressively thereafter. The superimposition of live and chemiluminescence images allowed the determination of the regional production rate and distribution of photons. CONCLUSIONS Preliminary observations, in an animal model, on an innovative imaging system which allows the visualization of rate and spatial distribution of reactive oxygen species formation are presented. This new endoscopic technique could be useful for the assessment of oxidative gastric mucosal injury in several gastric diseases; however, further studies remain necessary to determine the applicability of this technique in humans.
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Affiliation(s)
- V Ojetti
- Department of Internal Medicine, Catholic University, Rome, Italy
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Gasbarrini A, Ojetti V, Cuoco L, Cammarota G, Migneco A, Armuzzi A, Pola P, Gasbarrini G. Lack of endoscopic visualization of intestinal villi with the "immersion technique" in overt atrophic celiac disease. Gastrointest Endosc 2003; 57:348-51. [PMID: 12612514 DOI: 10.1067/mge.2003.116] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The endoscopic appearance of the duodenal folds can predict the presence of celiac disease. However, endoscopic alterations can be minimal and the disease can have a "patchy" distribution histopathologically. The observation that intestinal villi can be better visualized when the duodenum is filled with water led to the development of an endoscopic "immersion technique" to assess celiac disease. METHODS Endoscopy with duodenal biopsies was performed in 20 patients with malabsorption syndrome (positive for antiendomysial antibodies) and in 30 patients with reflux-like symptoms (negative for antiendomysial antibodies). Duodenal hypotonia was induced pharmacologically, water was introduced, and the mucosa was observed for the presence of villi. Photographs were obtained for subsequent analysis. The endoscopic appearance was classified from 1 (folds certainly present) to 4 ("scalloped valvulae"); villous structures were classified from 1 (definitely present) to 3 (definitely absent). RESULTS Celiac disease was confirmed histopathologically in all patients with positive antiendomysial antibodies. The endoscopic appearance of the duodenum with air insufflation alone had a positive predictive value for the diagnosis of celiac disease of 84% and a specificity of 87%. Visualization of villi with the "immersion technique" had a higher positive predictive value (99%) and specificity (99%). CONCLUSIONS A lack of visualization of intestinal villi in the descending duodenum with the "immersion technique" may increase the diagnostic accuracy of endoscopy for celiac disease. This technique could also be useful for targeting duodenal biopsies.
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Affiliation(s)
- Antonio Gasbarrini
- Internal Medicine and Gastroenterology, Gemelli Teaching Hospital, Catholic University of Rome, Italy
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Mettimano M, Romano-Spica V, Ianni A, Specchia M, Migneco A, Savi L. AGT and AT1R gene polymorphism in hypertensive heart disease. Int J Clin Pract 2002; 56:574-7. [PMID: 12425365] [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: 02/27/2023] Open
Abstract
Left ventricular hypertrophy in patients with hypertension is a main clinical prognostic entity The aim of this study was to evaluate the association between mutations at genes of the renin-angiotensin system (RAS) and the development of left ventricular hypertrophy. Genetic polymorphism in angiotensinogen (AGT) and angiotensin Il-type 1 receptor (AT1R) genes was examined in a group of well-selected essential hypertensive caucasians with left ventricular involvement (n = 40) and a group of healthy unrelated caucasians (n = 150). Cardiac morphology and function were assessed by M-mode echocardiography. Molecular variants were analysed by amplified fragment length polymorphism. We observed a statistically significant difference both for AGT and AT1R genotype distribution in patients with left ventricular hypertrophy compared with controls (p<0.05). A 0.49 and 0.225 frequency was detected among cases for T and C mutant alleles at AGT and AT1R genes. Mutations in RAS genes are involved in the pathophysiology of target-organ damage in essential hypertension. Evaluation of molecular factors conferring a risk of developing heart involvement may lead to better identification of patient subgroups and more effective control of the clinical course.
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Affiliation(s)
- M Mettimano
- Hypertension Centre, Department of Internal Medicine, Catholic University Medical School, Rome, Italy
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Ojetti V, Pitocco D, Bartolozzi F, Danese S, Migneco A, Lupascu A, Pola P, Ghirlanda G, Gasbarrini G, Gasbarrini A. High rate of helicobacter pylori re-infection in patients affected by type 1 diabetes. Diabetes Care 2002; 25:1485. [PMID: 12145262 DOI: 10.2337/diacare.25.8.1485] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ojetti V, Gasbarrini A, Migneco A, Flore R, Santoliquido A, De Martini D, Agnes S, Gentiloni Silveri N, Pola P. Lamivudine-induced muscle mitochondrial toxicity. Dig Liver Dis 2002; 34:384-5. [PMID: 12118960 DOI: 10.1016/s1590-8658(02)80136-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Mettimano M, Lanni A, Migneco A, Specchia ML, Romano-Spica V, Savi L. Angiotensin-related genes involved in essential hypertension: allelic distribution in an Italian population sample. Ital Heart J 2001; 2:589-93. [PMID: 11577832] [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] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND Blood pressure is a quantitative multifactorial trait influenced by environmental and genetic determinants. Although several candidate genes have been associated with the development of essential hypertension, the mechanisms of individual susceptibility still remain unclear. Knowledge on the distribution of genetic polymorphisms in different populations is fundamental for the assessment of the predictive value of genetic variation. METHODS We genotyped 300 healthy normotensive subjects from the Italian population for three polymorphisms, at the angiotensinogen (AGT, M and T), angiotensin II type 1 receptor (ATIR, A and C) and angiotensin-converting enzyme (ACE, D and I) genes. Polymorphisms were analyzed by polymerase chain reaction and restriction enzyme digestion. Statistical analysis was performed to verify the agreement with the Hardy-Weinberg equilibrium. RESULTS The observed allelic distribution was in accordance with estimates reported for Caucasian populations. Variant allelic frequencies were 0.36 for the T and C alleles at the AGT andAT1R locus and 0.47 for the I allele of the ACE gene. AT1R and ACE genotype frequencies were in Hardy-Weinberg equilibrium, while there was a deviation of the AGT genotypes from those predicted by the equation. CONCLUSIONS The studied polymorphisms are largely distributed in the Italian population sample, with a frequency of homozygous subjects for mutant alleles ranging from 9 to 22%. Epidemiology of mutations in the genes involved in blood pressure regulation provides tools to evaluate susceptibility to hypertension.
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Affiliation(s)
- M Mettimano
- Hypertension Center Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Mettimano M, Specchia ML, Migneco A, Savi L. Microalbuminuria as a marker of cardiac damage in essential hypertension. Eur Rev Med Pharmacol Sci 2001; 5:31-6. [PMID: 11860221] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A subclinical elevation in urinary albumin excretion (UAE) microalbuminuria is frequently seen in essential hypertension. The level of blood pressure appears to be an important factor in the development of microalbuminuria. Moreover there is some evidence to indicate that microalbuminuria may be an early marker of increased cardiovascular risk. Aim of this study was to evaluate the prevalence of UAE in hypertensives with normal left ventricular mass and to study any association with blood pressure level and with possible modification in left ventricular function. A group of 112 subjects diagnosed as having stage 1-2 essential hypertension were included in the study. Patients underwent urinary collection to evaluate UAE and to 24/hours arterial blood pressure monitoring. Moreover a complete echocardiography was performed. According with UAE levels patients were divided into three groups: A: UAE 0-15 mg/24 h, B: UAE 16-29 mg/24 h, C: UAE 30-300 mg/24 h. We found a significant correlation between 24/h SBP, 24/h DBP and UAE. We observed a significant correlation between impaired diastolic function and UAE. UAE is influenced by BP levels with better correlation with 24/h systolic values. UAE is associated with subclinical decrease of left ventricular function and may be an early marker of cardiac involvement.
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Affiliation(s)
- M Mettimano
- Istituto Patologia Medica, Center for the Study of Hypertension, Catholic University Medical School, Rome, Italy
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Mettimano M, Pichetti F, Fazzari L, Migneco A, Specchia L, Romano Spica V, Savi L. Combination therapy with beta-adrenergic blockade and amlodipine as second line treatment in essential hypertension. Int J Clin Pract 2000; 54:424-8. [PMID: 11070565] [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: 02/18/2023] Open
Abstract
In hypertension both beta-blockers and calcium antagonists are drugs with proved efficacy. Because only half the patients respond to a single drug, even at full dosage, a second hypotensive agent is frequently required to obtain adequate blood pressure control. The combination of a dihydropyridine calcium antagonist and a beta-blocker can be justified by their different mechanisms of action. A randomised double blind parallel group study versus placebo was performed, in order to assess the efficacy of atenolol combined with amlodipine in the treatment of stage I-II essential hypertension not controlled by atenolol alone. Twenty-four-hour arterial blood pressure monitoring showed that amlodipine added to atenolol produced a statistically significant reduction of blood pressure values compared with placebo in patients whose blood pressure was not controlled by atenolol alone. Blood pressure circadian rhythm was unchanged. The reduction of side-effects, obtained by adding a dihydropyridine derivate to a beta-blocker, confirms the effectiveness of this combination.
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Affiliation(s)
- M Mettimano
- Department of Internal Medicine, Catholic University of Rome, Italy
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