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Biomedical subjects

G Ciccone

Publications and source records attributed to G Ciccone.

At least 19 recordsLinked to original sources
PubMed2006

A randomized trial of pegylated-interferon-alpha2a plus ribavirin with or without amantadine in the re-treatment of patients with chronic hepatitis C not responding to standard interferon and ribavirin.

BACKGROUND: There is yet no established treatment for chronic hepatitis C patients non-responder to standard interferon and ribavirin. AIM: To evaluate efficacy and safety of pegylated-interferon-alpha2a plus ribavirin with or without amantadine in such patients. METHODS: 161 non-responders to standard interferon and ribavirin were randomized into two groups: 81 patients (Group 1) were given weekly Peg-IFN-alpha2a 180 microg plus ribavirin 1,000-1,200 mg/daily for 12 months, 80 patients (Group 2) received weekly Peg-IFN-alpha2a 180 microg plus ribavirin 1,000-1,200 mg/daily and amantadine 200 mg/daily for 12 months. RESULTS: At the end of follow-up, HCV-RNA was negative in 29.6% of Group 1 and in 21.2% of Group 2 patients (P = 0.22). Patients with genotypes 1 and 4 responded better to bi-therapy (21.7%) than to triple therapy (17.3%, P = 0.5) while among patients with genotypes 2 and 3 there was a trend towards a higher sustained virological response rate when retreated with triple treatment (80% vs. 75%, P = 0.82). On multivariate analysis, genotype 1 or 4, high body mass index and >20% reduction of Peg-interferon were associated with the treatment failure. CONCLUSIONS: The addition of amantadine does not improve the overall SVR rate in non-responder patients retreated with Peg-IFN and ribavirin; however, about 30% of non-responders may achieve a sustained response, in particular patients with genotypes 2 and 3 show a high SVR (75%).

Adult↗
PubMed2006

Inter-coder agreement for ICD-9-CM coding of stroke.

The objective was to evaluate agreement among neurologists for coding stroke, using the International Classification of Diseases 9th Revision - Clinical Modification (ICD-9-CM). Clinical records of 53 consecutive patients (27 stroke or TIA and 26 other diseases) discharged from our general neurology department were coded by four neurology residents, four general neurologists and four neurologists trained in ICD-coding (experts). Inter-coder agreement was evaluated by the kappa statistic. The overall kappa value for coding 430-438 was 0.77 (95% confidence interval 0.70-0.84) for primary (PDx) and 0.82 (0.77-0.88) for PDx+secondary diagnoses (SDx). It was 0.73-0.86 for the residents, 0.78-0.90 for the neurologists and 0.67-0.88 for the experts. The overall kappa values (PDx, SDx) for specific codes were 0.83-0.88 for 431-intracerebral haemorrhage (residents: 0.75-0.89; neurologists: 0.91-0.96; experts: 0.78-0.88) and 0.48-0.51 for 434-occlusion of cerebral arteries) (residents: 0.26-0.26; neurologists: 0.61-0.66; experts: 0.60-0.65). Agreement was substantial for the whole code group 430-438 and higher for code 431 than 434. Reliability was generally improved when both PDx and SDx were considered. Specific training did not increase inter-coders' agreement.

Aged↗
PubMed2005

Mortality within the first 10 years of the disease in type 2 diabetic patients.

BACKGROUND AND AIMS: An excess of long-term mortality in type 2 diabetes is mainly due to cardiac diseases, predicted by diabetes-related conditions; less is known about early death from clinical diagnosis. The aim of this study was to evaluate pattern and predictors of mortality after a 4.5 year follow-up in a cohort of type 2 diabetic patients, according to diabetes duration. METHODS AND RESULTS: A mortality follow-up was carried out in 1200 patients with < or = 5 years diabetes duration and 2692 patients with >5 (median 2 and 15) years diabetes duration in 1995. Four-year survival was 92.0% and 83.7%, respectively; most deaths are due to cardiovascular diseases (36% and 41%, respectively). The duration of diabetes is no longer a significant predictor of death after adjustments for age, HbA1c and chronic complications (which are all significantly higher in patients who have had diabetes for longer time). In a Cox proportional hazard model, best predictors of death are nephropathy, insulin therapy and pre-existent co-morbidity in both groups. Nephropathy is significantly associated with cardiovascular deaths in the younger cohort. CONCLUSION: Clinical nephropathy is a significant predictor of early and late mortality from clinical diagnosis, above all cardiovascular deaths, indicating that an aggressive approach should be adopted for prevention or treatment of renal impairment right from the clinical onset of diabetes.

Age Factors↗
PubMed2005

Renal damage in patients with Type 2 diabetes: a strong predictor of mortality.

AIMS: (i) To compare mortality rates in a cohort of Type 2 diabetic patients with those of the general population; (ii) to assess the prognostic role of pre-existing chronic conditions; (iii) to evaluate the impact of different severity of renal damage on mortality. METHODS: All 3892 patients with Type 2 diabetes attending our Diabetic Clinic during 1995 and alive on 1 January 1996 were identified and followed for 4.5 years. Information on vital status (100% complete) and causes of death (98.5% complete) for 599 deceased subjects was derived from death certificates. RESULTS: In comparison with the general population, standardized mortality ratios (x 100) were: 125 (95% confidence interval 104-148) in patients aged < 75 and 85 (75-95) in patients > or = 75 years. Cardiovascular diseases and diabetes were responsible for most of the excess deaths. In a Cox-proportional hazard model, renal damage was a powerful predictor of death (hazard ratio = 2.39; 95% confidence intervals = 2.00-2.85). The severity of renal damage was associated with increasing hazard ratios for death from all-cause mortality and from specific causes (especially coronary artery disease, other cardiovascular causes and diabetes) after multiple adjustments. Other significant predictors of death were: greater age, glycated haemoglobin, smoking, lower body mass index, pre-existing coronary and peripheral artery disease and known co-morbidity (cirrhosis and cancer). CONCLUSIONS: Renal damage of any severity is significantly associated with subsequent mortality from all causes and from cardiovascular diseases. These associations are not confounded by pre-existing co-morbidity or coronary diseases.

Age Factors↗
PubMed2005

Changing prevalence of asthma in Turin school children between 1994 and 1999.

BACKGROUND: Asthma is a widespread chronic disorder in children and its prevalence has been on the increase in Europe. Only few studies have described the prevalence variation in respiratory symptoms in Italian regions. The aim of this study, conducted in Turin during the 1998/1999 school year, is to investigate the distribution of respiratory symptoms in a sample of Turin school children and to compare the obtained results with the findings of the SIDRIA study performed in 1994-95. METHODS: The sample in study is composed of all the children attending to three elementary schools in Turin. All of the selected schools had already participated in the 94-95 ISAAC-SIDRIA study. A total of 448 pupils aged 6-10 years received a standardised questionnaire to be filled by parents. RESULTS: Response rate is higher than 97% in all the studies. In 1999 we found that the prevalence of wheezing in the past 12 months was 7.3%. The 13.3% of children had asthma at least once in life and the 5.3% reported an attack in the last year. The comparison of our study results with the ISAAC-SIDRIA (1994-95) shows that the prevalence of asthma and asthma-like symptoms is rather stable among children, while the prevalence of bronchitis reveals a reduction of about 5.5%, but not statistically significant (p=0.094; 95%CI:-11.9;0.9). A considerable reduction in exposure to parents' passive smoke is shown: deltaP%=-4.7 (95%CI: -9.4;-0.1) for maternal smoking in pregnancy, deltaP%=-8.2 and -15.2, respectively for maternal and paternal smoking in the first two years of life. CONCLUSIONS: The results indicate a stable prevalence rate in asthma symptoms in children. A possible explanation of slight variation in asthma prevalence may be due to a reduced exposure to outdoor and indoor risk factors as reported in the questionnaires.

Asthma↗
PubMed2004

Discharge criteria from intensive care unit in brain injured patients.

OBJECTIVE: We investigated the value of information on clinical features and intensity of treatment activity in the Intensive Care Unit (ICU) in predicting the need for further interventions after a patient is discharged from the Intensive Care Unit. Our aim was to assess if this could aid in making decisions about transfer to an Immediate Care Unit (sub-ICU). METHODS: We studied 39 patients with acute brain damage (traumatic or vascular causes). They ranged in age from 15 to 75 years and none had an associated spinal cord injury. The SAPS II, Glasgow Coma Scale (GCS), length of stay in ICU, duration of hospital stay and daily NEMS scores were recorded for each patient. We recorded the activities performed after transfer to an sICU, including complications that required active "life-saving" treatment. The role of each factor was assessed by using the odds ratio (OR), and with linear logistic regression. FINDINGS: 8 of the 39 patients developed a complication in the Sub-ICU. A linear logistic regression analysis demonstrated that the principal features having significant predictive value were:a) age, with an increase in risk of over 10 times for patients that were older than 50 (p=0.011);b) SAPS II scores > or = 50 points, with 24 times an increase in risk (p=0.002); and c) a GCS score < or =5 points, with an increase in risk of almost 7 times (p=0.024). INTERPRETATION: Complications in Sub-ICU are less likely in patients younger than 50 and who have SAPS II and GCS scores within predetermined limits. These indices can help in making decisions about discharge of a patient from ICU to Sub-ICU.

Adolescent↗
PubMed2004

Isolated systolic hypertension in a cohort of type 2 diabetic patients.

BACKGROUND AND AIMS: Previous studies of the adverse effects of isolated and borderline isolated systolic hypertension excluded or under-represented type 2 diabetic patients. The aim of this study was to evaluate the prevalence and role of isolated and borderline isolated systolic hypertension in a cohort of 3892 type 2 diabetic patients. METHODS AND RESULTS: The hypertensive patients were classified as treated (n= 1806; 46.4%), untreated diastolic hypertension (n=407; 10.4%), untreated isolated systolic hypertension (n=166; 4.3%) and untreated borderline isolated systolic hypertension (n=625; 16%). A Cox proportional hazard model including several confounders showed that the patients with untreated isolated systolic hypertension were at significantly higher risk of hospital admissions due to cerebrovascular diseases than the normotensive and untreated diastolic hypertensive patients (HR=2.05; 95% CI: 1.2-3.4 and HR=1.97; 95%CI: 1.1-3.5, respectively). In the same model, borderline isolated systolic hypertension significantly correlated with admissions for cerebrovascular diseases in comparison with normotensive patients (HR=1.73; 95% CI: 1.2-2.6). CONCLUSIONS: This is the first report concerning the prevalence of isolated and borderline isolated systolic hypertension in a large cohort of type 2 diabetic patients. The results are in line with population-based estimates. Our data show that isolated systolic hypertension is an independent predictor of hospital admissions due to cerebrovascular diseases.

Age Distribution↗
PubMed2002

Evidence-based medicine and radiology: how to build a guideline. An attempt in minor head injury.

PURPOSE: To evaluate the use of Evidence-based Medicine (EBM) to build radiological Guidelines, with the aim to have a better compliance by users. It has been decided to work on minor head injury, where we have found, in our institution, a wide and unjustified use of conventional skull x-ray. MATERIAL AND METHODS: A Workgroup, that reunites the main figures that enter in the management of the patient with minor head injury, has been created within our Hospital. The bibliography relative to the problem has been selected, employing criteria that held account of the methodological correctness, and in particular the existing Guidelines have been carefully analysed. It is therefore proceeded drawing up a Guideline that adhered to the principles of the EBM, adapting it to the hospital environment. Subsequently it has been passed to the phase of its implementation, with reunions in small groups of the involved professional figures, the distribution of informative material and the use of poster that reassumed the diagnostic flow-chart. Moreover a survey of the relative data to the number of skull x-ray and brain TC, executed in the patients with head trauma, has been completed. RESULTS: The analysis of the data relative to the variation of the number of demands for skull Rx after introduction of the Guideline has demonstrated a great reduction (-83,8%), with little variation of the number of brain TC (+17,0%); such reduction has naturally implicated an important reduction of costs (-25,2%) and of the x-ray dose to population, measured to the crystalline (34,5%) and to thyroid (-71,0%). CONCLUSIONS: The employ of the EBM in the Guideline creation, beyond representing the more correct methodology, concurs to obtain a greater adhesion from the users involved in management of the patient; in particular this happens if the Guideline is a product of a vast contribution and if it is supported from all additional procedures that can be useful for its implementation.

Costs and Cost Analysis↗
PubMed2001

A randomized 4-arm multicenter study of interferon alfa-2b plus ribavirin in the treatment of patients with chronic hepatitis C not responding to interferon alone.

To determine whether a higher dosage of interferon (IFN) associated with ribavirin and/or prolonged time of administration may improve therapeutic efficacy, we conducted a 4-arm randomized trial on patients with chronic hepatitis C not responding to one or more previous treatment courses with IFN monotherapy. Group 1 (n = 139) received 3 million units (MU) IFN-alpha2b 3 times a week (t.i.w.) plus ribavirin 1,000 mg/d for 12 months; group 2 (n = 162) received 5 MU t.i.w. plus ribavirin for 12 months; group 3 (n = 142) received 3 MU t.i.w. plus ribavirin for 6 months; and group 4 (n = 151) received 5 MU t.i.w. plus ribavirin for 6 months. The primary end point was hepatitis C virus (HCV)-RNA clearance at the end of 6-month follow-up. HCV-RNA was negative in 15% of group 1, 23% of group 2, 11% of group 3, 16% of group 4 (group 2 vs. group 3, P =.04). Among patients with genotypes 1 and 4, sustained response was significantly higher in group 2 vs. group 3 (18% vs. 7%, P =.03; group 1 = 9%, group 4 = 12%, P = not significant [NS]). In patients with genotypes 2 and 3, sustained virologic response was not affected by the different regimens (group 1 = 32%, group 2 = 30%, group 3 = 30%, group 4 = 35%, P = NS). In conclusion, about 23% of nonresponders to IFN monotherapy may achieve a sustained response if re-treated by 5 MU t.i.w. IFN plus ribavirin 1,000 mg/d for 1 year. Patients with genotype 1 should receive a high dosage of IFN plus ribavirin for 12 months, whereas therapy for patients with genotype 2 or 3 should be less aggressive.

Adult↗
PubMed2001

The metabolic syndrome in twins: a consequence of low birth weight or of being a twin?

BACKGROUND: To evaluate if being a twin is a condition at risk of developing metabolic abnormalities in the adult life 'per se' or as a consequence of the lower birth weight. METHODS: 48 monozygotic twins and 50 non-twin controls, both with parental diabetes, were compared; the two groups were comparable for age, sex and body mass index. RESULTS: Twins showed higher values of blood pressure, triglycerides, insulin resistance, fasting insulin, insulin AUCs and higher prevalence of the metabolic syndrome, and, inversely, lower birth weight. After adjustment for birth weight, no significant association was evident with the twin status. Birth weight was inversely associated with the presence of the metabolic syndrome or of at least one or more of its components, while the positive association with the twin status was not significant. CONCLUSIONS: Our data suggest that low birth weight is more relevant than the twin status as a risk factor for the metabolic syndrome and its components.

Adolescent↗
PubMed2000

Low birthweight and metabolic abnormalities in twins with increased susceptibility to Type 2 diabetes mellitus.

AIMS: To evaluate the role of environmental intra-uterine factors in determining the birthweights of twins with increased susceptibility to diabetes and discordant for abnormal responses to the oral glucose tolerance test (OGTT) and verify the possible association of within-pair birthweight differences and metabolic abnormalities in adult life. METHODS: Forty-six monozygotic (MZ) and 32 dizygotic (DZ) twins were enrolled; 13 MZ twins were discordant for impaired glucose tolerance (IGT) and/or hyperinsulinaemia compared to their co-twins. RESULTS: The 13 MZ discordant twins showed significantly lower birthweights than their normal co-twins (P < 0.001). When dividing all twins in those with the highest birthweights within the couple and those with the lowest, all subjects with abnormal OGTT were found in the latter group (P < 0.0001). Within-pair birthweight difference was significantly higher in MZ twins with abnormal OGTT and the metabolic syndrome compared to normal MZ twins. The relative risk of developing the metabolic syndrome was 8.7 (1.6-46.9) when comparing the higher tertile of within-pair birthweight differences (> or = 0.450 kg) to the two lower tertiles (< 0.450 kg). Logistic regression analysis confirmed within-pair birthweight difference as a significant predictor of abnormal responses to the OGTT and the metabolic syndrome. CONCLUSIONS: These data suggest a causative role for environmental intrauterine factors on the determination of birthweight and support the hypothesis that within-pair birthweight difference, rather than an absolute low birthweight, is responsible for the metabolic abnormalities in the adult life.

Adult↗
PubMed2000

Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. SIDRIA Collaborative Group, Italy (Italian Studies on Respiratory Disorders in Children and the Environment).

BACKGROUND: A beneficial effect of fresh fruit consumption on lung function has been observed in several studies. The epidemiological evidence of the effect on respiratory symptoms and asthma is limited. The consumption of fruit rich in vitamin C was examined in relation to wheezing and other respiratory symptoms in cross sectional and follow up studies of Italian children. METHODS: Standardised respiratory questionnaires were filled in by parents of 18 737 children aged 6-7 years living in eight areas of Northern and Central Italy. The winter intake of citrus fruit and kiwi fruit by the children was categorised as less than once per week, 1-2 per week, 3-4 per week, and 5-7 per week. A subset of 4104 children from two areas was reinvestigated after one year using a second parental questionnaire to record the occurrence of wheezing symptoms over the intervening period. RESULTS: In the cross sectional analysis, after controlling for several confounders (sex, study area, paternal education, household density, maternal smoking, paternal smoking, dampness or mould in the child's bedroom, parental asthma), intake of citrus fruit or kiwi fruit was a highly significant protective factor for wheeze in the last 12 months (odds ratio (OR) = 0.66, 95% confidence intervals (CI) 0.55 to 0.78, for those eating fruit 5-7 times per week compared with less than once per week), shortness of breath with wheeze (OR = 0.68, 95% CI 0.56 to 0.84), severe wheeze (OR = 0.59, 95% CI 0.40 to 0.85), nocturnal cough (OR = 0.73, 95% CI 0.65 to 0.83), chronic cough (OR = 0.75, 95% CI 0.65 to 0.88), and non-coryzal rhinitis (OR = 0.72, 95% CI 0.63 to 0.83). In the follow up study fruit intake recorded at baseline was a strong and independent predictor of all symptoms investigated except non-coryzal rhinitis. In most cases the protective effect was evident even among children whose intake of fruit was only 1-2 times per week and no clear dose-response relationship was found. The effect was stronger (although not significantly so (p = 0.13)) in subjects with a history of asthma; those eating fresh fruit at least once a week experienced a lower one year occurrence of wheeze (29. 3%) than those eating fruit less than once per week (47.1%) (OR = 0. 46, 95% CI 0.27 to 0.81). CONCLUSIONS: Although the effect of other dietary components cannot be excluded, it is concluded that the consumption of fruit rich in vitamin C, even at a low level of intake, may reduce wheezing symptoms in childhood, especially among already susceptible individuals.

Ascorbic Acid↗
PubMed2000

Personality characteristics and accompanying symptoms in temporomandibular joint dysfunction, headache, and facial pain.

AIMS: Patients with different facial pain/headache pathologies usually complain of numerous accompanying symptoms relative to systemic dysfunctions or to the patient's personality characteristics. The purpose of this work was: (1) to determine the prevalence of accompanying symptoms in groups of patients with temporomandibular joint (TMJ) dysfunction and other types of facial pain or headache disorders, (2) to assess the patients' personality characteristics and anxiety levels, and (3) to see whether significant differences were found between the groups. METHODS: Two hundred forty-three patients were considered. They had TMJ intracapsular disorder (TMJ, n = 71), tension-type headache (TH, n = 52), migraine (M, n = 68), chronic daily headache (CDH, n = 26), or facial pain disorder as somatoform disorder (FP, n = 26). The presence of 23 symptoms was assessed; the Minnesota Multiphasic Personality Inventory (MMPI) and the Spielberger State and Trait Anxiety Inventory (STAI) were administered and the relative scores were calculated. Four different MMPI clusters (depressive, conversive, emotional, coper) were also considered. Intergroup differences were assessed by Chi-square analysis, 1-way analysis of variance, Bonferroni t test, and a logistic regression model and then standardized for gender and age, taking the tension-type headache group as a common reference group. RESULTS: The TMJ group had: (1) a lower prevalence of almost all symptoms; (2) significantly lower scores of several MMPI and of state anxiety; and (3) odds ratio values < 1 for all symptoms except phobias and for emotional, conversive, and depressive MMPI profiles. The FP and CDH groups had the highest prevalence of the majority of symptoms and higher MMPI and STAI scale elevations. CONCLUSION: It is concluded that some types of headache and facial pain seem to correlate with the presence of a number of accompanying symptoms and with some changes in personality. These changes are particularly relevant in patients with chronic daily headache and facial pain disorder. In contrast, patients with TMJ intracapsular disorders tended to show a low prevalence of accompanying symptoms and a normal personality profile.

Adaptation, Psychological↗
PubMed2000

[Features of traffic near houses and respiratory damage in children: the results of the SIDRIA (Italian Study on Respiratory Problems in Childhood and the Environment)].

A survey was conducted between 1994 and 1995 in ten areas of northern and central Italy in a representative sample of 39,275 children in two age groups (6-7 and 13-14 years; response rate: 94.4%). Detailed information on respiratory health and on exposure to several risk factors, including traffic patterns near their residence, was collected through standardized questionnaires, filled in by parents (and also by subjects of 13-14 years). For children living in metropolitan areas, a clear association was found between a high flow of heavy vehicles near their residence and several respiratory conditions. Combining the current symptoms in mutually exclusive groups, a stronger association was detected for children reporting only bronchitic symptoms, with an odds ratio (OR) of 1.44 (95% confidence interval: 1.17-1.78), whereas the OR for those reporting only asthma or wheeze was 1.10 (0.96-1.26). Weaker associations were found in relation to more generic traffic indicators and for children living in non-metropolitan areas.

Adolescent↗
PubMed1999

Angiotensin I-converting enzyme genotype significantly affects progression of IgA glomerulonephritis in an italian population.

To evaluate the role of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism in the progression of immunoglobulin A glomerulonephritis (IgA-GN), genotype distribution in 81 biopsy-proven cases of IgA-GN was studied. A logistic regression model showed that the risk for homozygous DD was not significantly elevated in patients with IgA-GN compared with healthy subjects (odds ratio = 1.16; confidence interval [CI], 0.4 to 3.3). However, the 5-year (78% v 90%) and 10-year (52% v 82%) renal survival rates for 47 patients with serum creatine (Cr) levels of 1.5 mg/dL or less at biopsy was significantly less in DD patients (n = 18; chi2 = 5.41; P = 0.02). The hazard ratio (HR) for DD (multivariate analysis from Cox proportional model after adjustment for known factors of progression, such as hypertension [HPT] and proteinuria [PTO]) was 3.07 (CI, 1.1 to 9.4). The HR for heavy PTO was 6.1 (CI, 1.9 to 19). The association of DD genotype with progression was even more striking when patients with other risk factors (heavy proteinuria) were excluded, as shown by DD-related risk in the absence (HR = 3.6; CI, 1.1 to 12) and presence (HR = 2; CI, 0.4 to 10) of PTO. The risk ratio was further increased by the coexistence of DD + PTO (HR = 9.16; CI, 1.8 to 15.7). Furthermore, in a cross-sectional study among patients with IgA-GN, a logistic regression model showed that the risk for homozygous DD was greater, although not at a statistically significant level in the end-stage renal failure subgroup compared with the normal renal function subgroup (odds ratio = 3.16; CI, 0.7 to 13.7) after adjustment by sex, age at biopsy, HPT, PTO, and therapy. Last, DD was significantly more frequent in those patients who started hemodialysis at an earlier age (chi2 for trend = 6.81; P = 0.009). Our study further supports that ACE genotype is a risk factor not for the development, but for the worsening of IgA-GN clinical course. However, on the basis of current knowledge, we cannot exclude that I/D polymorphism may simply serve as a prognostic marker, eventually linked with other discrete loci involved in the progression of renal damage.

Adult↗