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Biomedical subjects

G Traversa

Publications and source records attributed to G Traversa.

At least 19 recordsLinked to original sources
PubMed2006

Placement of two overlapping uncovered metallic stents for malignant gastric outlet and duodenal obstruction due to colon cancer.

Malignant obstruction of the gastric outlet and duodenum is frequently due to extrinsic involvement by tumors from contiguous organs, in particular from pancreas and gallbladder. The treatment of malignant gastroduodenal stenoses is difficult. Many patients have advanced malignant disease and are too ill to undergo surgical approach. Surgical gastrojejunostomy has been considered the palliative treatment of choice. Metallic stents can be useful in this condition with adequate palliation obtained in most cases. We report a case in which self-expanding metallic stents were placed for stenoses of the gastric outlet and duodenum due to a colon cancer.

Adenocarcinoma↗
PubMed2004

The geographic relationship between the use of antimicrobial drugs and the pattern of resistance for Streptococcus pneumoniae in Italy.

OBJECTIVES: A temporal relationship between the increasing use of antibiotics and the increasing levels of antibiotic resistance has been established for Streptococcus pneumoniae. There are also data that support the presence of a geographic correlation between the level of resistance and the pattern of use among different countries and even within the same country. The aim of this study was to evaluate the potential geographic correlation between the use of beta-lactams and erythromycin in different Italian regions and the resistance of these antibiotics to invasive strains of S. pneumoniae during the period 1999-2000. METHODS: Ecological study. RESULTS: In Italy the mean level of resistance for penicillin and erythromycin was 11.4% and 28.9%, respectively. The highest level of resistance for both antibiotics was observed in central and southern regions (i.e. Campania, Lazio and the combined regions of Calabria, Puglia and Sicilia). These regions were also those with the highest consumption of antibiotics. A strong correlation was found between the prevalence of resistance to erythromycin and the regional use of macrolides (r=0.93, P=0.001) and beta-lactams (r=0.84, P=0.002). With regard to penicillin resistance, the greatest correlation was observed for oral penicillin (r=0.85, P=0.002). CONCLUSION: Our study provides further evidence of the association between regional level of antibiotic use and prevalence of antibiotic resistance.

Anti-Bacterial Agents↗
PubMed2001

Risk management of HBsAg or anti-HCV positive healthcare workers in hospital.

Recommendations are made for controlling the transmission of the hepatitis B and hepatitis C viruses from healthcare workers to patients. These recommendations were based both on the literature and on experts' opinions, obtained during a Consensus Conference. The quality of the published information and of the experts' opinions was classified into 6 levels, based on the source of the information. The recommendations can be summarised as follows: all healthcare workers must undergo hepatitis B virus vaccination and adopt the standard measures for infection control in hospitals; healthcare workers who directly perform invasive procedures must undergo serological testing and the evaluation of markers of viral infection. Those found to be positive for: 1) HBsAg and HBeAg, 2) HBsAg and hepatitis B virus DNA, or 3) anti-hepatitis C virus and hepatitis C virus RNA must abstain from directly performing invasive procedures; no other limitations in their activities are necessary. Infected healthcare workers are urged to inform their patients of their infectious status, although this is left to the discretion of the healthcare worker; whose privacy is guaranteed by law. If exposure to hepatitis B virus occurs, the healthcare worker must undergo prophylaxis with specific immunoglobulins, in addition to vaccination.

Algorithms↗
PubMed2001

Niflumic acid and cutaneous reactions in children.

In a case control study of adverse drug reactions in children, the odds ratio of developing a serious mucocutaneous event among users of niflumic acid, adjusted for concomitant use of all other drugs, was 4.9 (95% CI 1.9 to 12.8). Given the availability of safer analgesics and antipyretics, there is no indication, in our opinion, that requires the prescription of substances which bear an increased risk.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Preprogramming and control activity of bimanual self-paced motor task in Parkinson's disease.

OBJECTIVE: The authors investigated programming (Bereitschaftspotential or BP) and control activity (Skilled Performance Positivity or SPP) of a bimanual, sequential, skilled motor act in off-therapy Parkinson's disease (PD) patients. METHODS: We recorded Movement Related Potentials (MRPs) in 12, non-demented, off-therapy parkinsonian patients and in 17 control subjects who were performing a skilled, time-locked motor act, which was not routine in their everyday life but had to be learned: the Skilled Performance Task (SPT). BP, SPP and correct performances were evaluated in grand average waveforms and in sequential blocks. RESULTS: The analysis of correct performances showed that accuracy in PD patients was significantly lower than in the control group and this accuracy did not improve throughout the blocks. A significantly low level of performances was associated with an increased BP amplitude (P<0.05) and decreased SPP amplitude (P<0.05) in PD patients. CONCLUSION: Our findings suggest that skill motor learning is impaired in non-demented unmedicated PD patients. We discuss the view that PD patients may allocate more attentional resources, as suggested by the increased BP amplitude, the decreased SPP amplitude and the low correct performances, in order to perform a new skilled motor act.

Aged↗
PubMed2000

[Pharmaco-epidemiologic indicators for the analysis of drug consumption at the regional level].

The analysis of drug use is often limited to the description of per capita pharmaceutical expenditure. Differences that are observed in the comparison are attributable to the specific age and gender distribution of the compared populations, and to prescriptive behaviors of general practitioners. Aim of this paper is to analyze drug prescription in a local health unit of the Friuli-Venezia Giulia region. In order to take into account differences in age distribution among health districts we used "weighted" populations. An in depth analysis has been carried out on antihypertensive drugs to evaluate differences in GPs' prescriptive behavior. Both the differences among districts in the level of drug use, and variability observed in antihypertensive use in the population, suggest that drug prescription might be partly inappropriate.

Adolescent↗
PubMed1998

Drug use and acute leukemia.

OBJECTIVE: To study the occurrence of acute leukemia in relation to preceding use of drugs a case-control study has been carried out in Rome, Italy. PATIENTS AND METHODS: Two hundred and two patients (age >15 years) with a diagnosis of acute leukemia during the period July 1992-June 1994 were enrolled. For each patient, 10 controls matched by age and gender were randomly drawn from the source population. Through the individual beneficiary code the information relevant to the drugs received within the National Health Service during the period January 1989-December 1992 was retrieved. The use of drugs was considered etiologically related to leukemia if the prescription occurred before the 12 months preceding the diagnosis. Exposure was categorized as 'any use' (at least one prescription during the etiologic period), 'high use' (duration of use greater than the median in the control group) and, for NSAIDs, 'very high use' (duration of use greater than 180 days). RESULTS: Among drugs suspected to cause leukemia, users of high doses of chloramphenicol presented an OR of 1.8 (95% CI: 0.6-5.3). Among other categories of drugs with an increase in the ORs, though not statistically significant, we found tricyclic antidepressants (OR=1.7; 0.8-3.4) and oral contraceptives (OR=1.8; 0.8-4.0). No excess risk was observed for users of calcium-channel blockers (OR=0.9; 0.5-1.7). Use of very high doses of NSAIDs appeared to decrease the occurrence of acute leukemia (OR=0.4; 0.1-1.5). CONCLUSION: Even with several limitations, this study provides an initial frame of reference for the potential causal role of drugs in acute leukemia.

Journal Article↗
PubMed1998

Ketorolac use in outpatients and gastrointestinal hospitalization: a comparison with other non-steroidal anti-inflammatory drugs in Italy.

OBJECTIVE: To compare the risk of hospitalization for gastroduodenal ulcer associated with the use of ketorolac and other non-steroidal anti-inflammatory drugs (NSAIDs). METHODS: A cohort and a nested case-control study were carried out. All residents in the region of Umbria (Italy), aged 35-84 years, who had been given at least one NSAID prescription in 1993 and 1994 were identified. Exposure to drugs was ascertained through a drug prescription database. We estimated rate ratios of hospitalization for gastroduodenal ulcer with or without complications in the current, recent or past period according to exposure to different NSAIDs. RESULTS: Rate ratio estimates, adjusted for age and sex, were 2.8 for any current NSAID and 1.4 for any recent NSAID. The highest rate ratios of lesions of any severity for current NSAID use were observed for piroxicam (RR: 4.6) and ketorolac (RR: 3.4). For gastrointestinal haemorrhage or perforation the highest rate ratios were those for ketorolac (RR: 5.9) and piroxicam (RR: 4.8). Rate ratio estimates did not change after adjustment for concomitant use of gastrotoxic drugs, use of gastroprotective agents not associated with NSAIDs and prior use of NSAIDs. CONCLUSION: Our study demonstrates the need to adhere to the restrictions relating to the indications and duration of use of ketorolac. At present piroxicam represents a greater public health concern since it is confirmed to be among the most gastrotoxic NSAIDs and is one of the most commonly prescribed NSAIDs in Italy.

Adult↗
PubMed1998

Prescription of neuroleptics for children and adolescents in Italy.

The objective of this study was to describe the use of neuroleptics among children and adolescents in the province of Rome. Subjects 5 to 19 years of age who received neuroleptic prescriptions within the National Health Service between 1986 and 1991 were identified. Prevalence and incidence of use were estimated. The yearly prevalence of use during the study period ranged from 1.3 to 1.7 per 1000 inhabitants. The incidence during 1989 was 1.1 per 1000, with a marked increase with age. Haloperidol was the drug most frequently prescribed; 59.2% of the subjects received only one prescription during the year. Among subjects with more than one prescription, 42.3% received neuroleptics in combination. The observed pattern of use suggests that in current practice neuroleptics are also used for the treatment of nonpsychotic conditions. The analysis of data derived from a prescription monitoring system may provide an important contribution to the description of neuroleptic use among children and adolescents.

Adolescent↗
PubMed1998

[Ethics problems in phase IV of drug studies].

Phase IV clinical studies include all investigations carried out after the approval of drugs. The objective of these studies is well defined: to gain additional knowledge on efficacy and safety of drugs. There are uncertainties however with regard to which kind of study design is appropriate to provide scientifically valid contributions. In the present article we will clarify why an experimental design (e.g. randomized clinical trial) is ordinarily required, on the basis of scientific and ethical concerns, to answer questions concerning efficacy even after drug commercialization. Viceversa, non experimental designs (from case series analysis to cohort and case control studies) are indicated to investigate drug effects in current practice if the objective is to evaluate safety.

Clinical Trials, Phase IV as Topic↗
PubMed1997

Siesta, night sleep and blood pressure dropping.

BACKGROUND: The drop in blood pressure during the night sleeping hours is well documented. Less is known about the drop in blood pressure during daytime sleep. The objective of this survey is to describe the dropping during conventional and referred sleeping hours of night and afternoon sleep, and the relation of the dropping to individual characteristics.METHODS: One hundred and seven consecutive patients, who had undergone blood pressure monitoring between February 1993 and October 1994, were studied. Takeda automatic monitors programmed to provide readings at 0.5 h intervals during a period of 24 h were used. For each patient the following information was recorded: age, sex, height and weight, creatinine, and actual sleeping hours recorded on a diary. RESULTS: There was a clinically important decline both in diastolic (12 mmHg) and in systolic (15 mmHg) blood pressure during night sleep compared with awake time blood pressure. A greater decline was observed among untreated hypertensive individuals. No difference in the average blood pressure during the night sleep was observed between conventional sleeping hours and sleeping hours as recorded by the patient. Among patients with afternoon nap, a similar blood pressure was recorded during the sleeping hours (night and afternoon). No association was found between body mass index, estimated creatinine clearance and awake-asleep differences in blood pressure; only a weak correlation was found between age and blood pressure differences. CONCLUSION: Our findings confirm that a substantial decline of blood pressure occurs during night and afternoon sleep compared with that during awake time. We did not find a clinically relevant difference in blood pressure between conventional day-periods and awake and sleeping hours as reported by the patients.

Journal Article↗
PubMed1996

Drug prescription in Italy.

Drug use in Italy in the period 1983-1991 has been analysed. The twenty most used substances accounted for about 20% of the sold packages. The effect of marketing of new drugs is worth noting: new and more expensive drugs are preferred even when effective, safe and less expensive alternatives are available. Prescribers have to face a highly dynamic pharmaceutical market in which 30% of substances (among the 300 most sold) changes every five years. Other than a more rational formulary, independent information and continuing education have to be considered as tools to improve a more rational prescribing.

Cost-Benefit Analysis↗
PubMed1996

Prescriptions for mesalazine and sulphasalazine: a prevalence estimate of patients treated for inflammatory bowel disease in Rome.

BACKGROUND: Sulphasalazine and 5-amino salicyclic acid drugs are specifically indicated for the treatment of inflammatory bowel disease. AIM: To use drug consumption by a given population as a marker to estimate the number of patients with inflammatory bowel disease. METHODS: Prescriptions for sulphasalazine and mesalazine were identified for the 133000 inhabitants of a local health unit in Rome. Other prescriptions received by the patients, who were users of sulphasalazine or mesalazine, were also studied. RESULTS: 99465 patients received at least one prescription for any drug in 1991. Three hundred and seventy-six patients were prescribed sulphasalazine and/or mesalazine, an average of 3.8 prescriptions per patient. These patients were exposed more frequently than the general population to other drugs often used in inflammatory bowel disease treatment, for example, corticosteroids, anti-diarrhoeal drugs and intestinal anti-infectives. We identified that 258 of 100000 inhabitants were prescribed either sulphasalazine or mesalazine; 127 of 100000 inhabitants received full-dose treatment for at least 30 days, and 42.8 of 100000 inhabitants received prescriptions of either drug, also associated with systemic corticosteroids. CONCLUSION: The consumption of drugs used specifically for inflammatory bowel disease may act as a marker for the prevalence of the condition in a community.

Aminosalicylic Acids↗
PubMed1995

Gangliosides and Guillain-Barré syndrome.

Cases of Guillain-Barré syndrome (GBS) associated with parenteral use of gangliosides have been reported in several European countries. To evaluate the hypothesis of association between ganglioside exposure and occurrence of GBS, a case-control study was conducted. GBS cases discharged during 1989 from public and private hospitals in three Italian provinces were identified: 42 GBS cases and 420 controls matched on age and gender were enrolled. Data of onset of symptoms of GBS was taken from clinical records. Exposure status of subjects was ascertained through the regional computerized drug prescription monitoring system. The odds ratio of association between ganglioside use, in the 30 days prior to onset of symptoms, and GBS was 9.1 (95% confidence interval 2.8-29.4). Although there are formidable difficulties in distinguishing prodromal therapy of GBS from drug causation, the association with ganglioside therapy is strong and supportive of the hypothesis of a role of ganglioside preparations in the occurrence of GBS.

Adult↗
PubMed1995

Gastroduodenal toxicity of different nonsteroidal antiinflammatory drugs.

Although the etiologic relation between nonsteroidal antiinflammatory drug (NSAID) use and gastrointestinal lesions is well documented, newly introduced NSAIDs deserve a fresh examination for their risk/benefit ratio. To estimate the association between consumption of ketorolac and the occurrence of gastroduodenal lesions, we conducted a case-control study. The study population comprised 600 outpatients with a confirmed endoscopic diagnosis of ulcer and erosion in 1991 and 1992 and 6,000 community controls matched by age and sex. We retrieved the prescription history through a computerized prescription monitoring system. We defined exposure to each study drug as "current" (month of endoscopy and preceding month), "recent" (second or third month preceding endoscopy). and "past" (fourth to sixth month preceding endoscopy). Current users of NSAIDs showed a 30% increase in the incidence of gastroduodenal lesions [odds ratio (OR) = 1.3; 95% confidence interval (CI) = 0.98 - 1.8] after adjustment for recent or past use of any NSAID, recent or past gastrotoxic therapy, recent or past use of gastroprotective drugs, and recent or past use of any other drug. Among NSAIDs, ketorolac was the only one showing a distinctly elevated risk of gastroduodenal lesions (OR = 4.2; 95% CI = 1.9-9.4). Current use of any NSAID was associated with almost a doubling of risk for ulcer alone (OR = 1.9; 95% CI = 1.3-3.0); no elevation in risk was found for erosions. The adjusted relative risk for ulcer associated with current use of ketorolac was 9.8 (95% CI = 3.4-28.10. Recent and past use of NSAIDs does not increase the risk of ulcer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Use and misuse of antidepressant drugs in a random sample of the population of Rome, Italy.

Prescribing patterns of antidepressant drugs were studied, over a period of 30 months, in a random sample of 8743 residents of the area of Rome, Italy. Data from the regional outpatient drug monitoring system were used. The proportion of subjects receiving, during the study period, at least one prescription of antidepressant drugs, was 5.4%; the female-to-male ratio was 2.1. Consumption prevalence increased with age. The single most prescribed drug was fluoxetine followed by amitriptyline and ademetionine. For a surprisingly high proportion of subjects, the observed length of treatment was shorter than expected on the basis of current knowledge in clinical pharmacology. Inappropriate diagnostic and therapeutic procedures are likely explanations.

Amitriptyline↗