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Biomedical subjects

M Musicco

Publications and source records attributed to M Musicco.

At least 55 records · Page 3Linked to original sources
PubMed1993

The psychosocial impact of HIV infection in gay men, drug users and heterosexuals. Controlled investigation.

The aim of this study was to establish the prevalence of current and past psychiatric morbidity in HIV seropositive asymptomatic subjects belonging to three transmission categories (gay men, intravenous drug users, and heterosexuals) compared with that found in HIV seronegative controls from the same groups. A cross-sectional, controlled study including 279 seropositive subjects belonging to groups II and III defined by the Center for Disease Control (94 gay men, 157 intravenous drug users, and 28 heterosexuals) and 159 seronegative subjects (38 gay men, 91 intravenous drug users, and 30 heterosexuals) is reported. Outcome measures included standardised, self-report questionnaires and a semistructured interview to assess current psychopathological status and past psychiatric history. In addition, a psychiatric diagnosis according to DSM-III-R criteria Axis I and II was made in the seropositive subjects. Results showed that these subjects differed very little from the controls and that overall levels of psychiatric disturbances in both groups were low and similar to those found in other life-threatening illnesses. Furthermore, intravenous drug users, regardless of HIV serological status, had the highest levels of psychological morbidity. Psychosocial distress was associated with previous and current lifestyle, independently of HIV status.

Adult↗
PubMed1993

Man-to-woman sexual transmission of HIV: longitudinal study of 343 steady partners of infected men.

To study incidence and risk factors of heterosexually transmitted HIV infection, we followed a cohort of 343 seronegative women, stable, monogamous partners of infected men whose only risk of acquiring HIV was sexual exposure to the infected partner. Nineteen seroconversions occurred in 529.6 person years (py) of observation, yielding an incidence rate of 3.6 per 100 py. The incidence rate was 7.2 per 100 py among women who did not always use or never used condoms and 1.1 among those who always used them [relative risk (RR) 6.6, 95% confidence interval (CI) 1.9-21.9]. Anal sex was associated with a risk increase in only those women not always using condoms (RR 1.4, 95% CI 0.4-4.8). No seroconversions were observed among 22 women using oral contraceptives. One of the women using intrauterine devices seroconverted. In couples who did not always use condoms, seroconversions occurred more frequently in partners of men with symptomatic diseases, with a low CD4+ cell number (< 400 per mm3) or with a detectable p24 antigen. In couples not always using condoms and where the man had a low CD4+ cell count, the joint presence of blood viral antigens and AIDS symptoms conditioned a fivefold increased risk of seroconversion of the woman (RR 5.4, CI 1.4-20.3). At multivariate analysis, women with longer relationships (> or = 1 year) showed a lower risk of seroconversion (RR 0.3, CI 0.1-0.8), and those partners of men positive for p24 antigen in serum had an increased risk of seroconversion (RR = 4.0, CI 0.1-0.8).

CD4-Positive T-Lymphocytes↗
PubMed1992

Parenteral and sexual transmission of human immunodeficiency virus in intravenous drug users: a study of seroconversion. The Northern Italian Seronegative Drug Addicts (NISDA) Study.

To evaluate the role of parenteral and sexual transmission of human immunodeficiency virus, we studied seronegative intravenous drug users recruited from 25 drug dependence treatment centers in northern Italy. All attending intravenous drug users were asked for their consent and screened for antibodies to human immunodeficiency virus; those who were seronegative were enrolled, interviewed about their habits, and invited to follow-up visits. Between 1987 and 1989, 1,195 seronegative intravenous drug users were enrolled, 635 were followed up (mean duration, 11.9 months), and 35 seroconversions were observed. The incidence rate ratios were 3.3 (95% confidence interval (CI) 1.4-7.5) for subjects aged less than 20 years, 2.4 (95% CI 1.2-4.7) for less than 2 years of intravenous drug use, 2.2 (95% CI 0.9-5.5) for syringe sharing, and 1.0 for subjects with a sexual partner who had tested positive for human immunodeficiency virus. A case-control approach, using logistic regression and adjusting for sex, age, area, and prevalence, showed odds ratios of 13.2 (95% CI 3.1-56.8) for frequent syringe sharing and 4.0 (95% CI 1.5-10.4) for sexual contacts with seropositive partners; frequent use of condoms was associated with a reduction in risk that did not reach statistical significance. Parenteral transmission is the most important route of infection with the human immunodeficiency virus among intravenous drug users, and sexual transmission plays a relevant, additive role.

Adult↗
PubMed1992

Factors associated with psychological help-seeking in HIV disease.

The study was aimed at evaluating the psychosocial and psychopathological characteristics of individuals with Human Immunodeficiency Virus (HIV) infection seeking psychological help compared with a sample not seeking help. Two hundred and seventy-one HIV seropositive (HIV+ve) subjects belonging to three transmission categories (90 gay men, 154 intravenous drug users and 27 heterosexuals) who were assessed at their first clinic appointment and offered access to psychological help were studied. Subsequently, it was found that 45 (17%) took advantage of the offer of psychological help, and attended a specialist clinic, while 226 (83%) did not seek help. Stepwise logistic regression analysis was used to establish the characteristics of subjects who received psychological help. Results showed that five factors identified at the time of first clinic appointment were significantly associated with seeking psychological help subsequently: (1) having a current DSM-III-R Axis I psychiatric diagnosis; (2) being single; (3) belief of being affected by a serious physical illness (negative correlation); (4) higher level of education; and (5) no past or current history of substance misuse. The implications of the findings are discussed.

Adaptation, Psychological↗
PubMed1992

Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection.

The study was aimed at evaluating the risk of deliberate self-harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV-seropositive (HIV+) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV+ subjects with a past psychiatric history showed a 7.7-fold increase in the relative risk of DSH, and HIV+ subjects with a history of DSH showed a 5-fold increase in the relative risk of DSH compared with HIV+ individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV+ individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Lacunar versus non-lacunar infarcts: pathogenetic and prognostic differences.

To characterise the pathogenetic and prognostic features of lacunar infarcts, 88 patients with these infarcts were compared with 103 patients with non-lacunar infarcts. Potential cardioembolic sources were significantly more frequent among patients with non-lacunar infarcts (p = 0.0025). Although the prevalence of hypertension was higher among lacunar infarcts, this difference was not statistically significant. However, the distribution of hypertensive patients in the two groups of lacunar and non-lacunar infarcts was influenced by the presence or absence of cardioembolic sources: hypertension was significantly associated with the presence of cardioembolic sources among non-lacunar infarcts, whereas among lacunar infarcts it was significantly more frequent in patients without a cardioembolic source. This indicates that cardioembolism may exert a confounding effect by suppressing the relation between hypertension and lacunar infarcts. In a mean follow up period of 28.1 months, lacunar infarcts had a significantly lower incidence of stroke recurrence and of myocardial infarction (age-adjusted survival analysis: p = 0.0008); mortality from all causes was also lower in patients with lacunar infarct (age-adjusted survival analysis: 0.04 less than p less than 0.05). In a multivariate regression analysis, stroke subtype was an independent predictor of new major vascular events. These findings support the lacunar hypothesis and should be considered in the planning of epidemiological and therapeutic studies in patients with cerebral infarction.

Adult↗
PubMed1992

Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and northern Italy, 1986-1990.

To assess the incidence and time trends of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs) and to evaluate the opportunities for prevention, we studied IVDUs recruited from 23 drug dependence treatment centers in Milan and Northern Italy. Participants were screened for HIV antibodies, and seronegative subjects were enrolled. A preventive intervention, based on counseling and HIV antibody testing, was done, and participants were invited to the centers for follow-up visits. We enrolled 1,532 subjects between 1 January 1987 and 31 October 1990, and we observed 901 subjects for an average of 15.9 months. Forty-one cases of HIV infection occurred, giving a seroconversion rate of 6.1% in 1987, 4.1% in 1988, 2.2% in 1989, and 1.6% in 1990. HIV prevalence decreased from 54% in 1986 to 49% in 1989. Incidence rates were higher in areas with high prevalence. During follow-up, 35 to 55% of the subjects stopped injecting heroin intravenously altogether, and those who did not stop decreased the frequency of syringe sharing. This is probably the reason for the decline in seroconversion rates, while the apparent decline in prevalence may be due to the entry of new seronegative individuals and/or to differential withdrawal of HIV-positive individuals from the IVDU population to the heterosexual (non-IVDU) population.

Adult↗
PubMed1991

Maternal predictors of HIV vertical transmission.

We performed a retrospective study of 57 HIV-positive pregnant women and their children to look for maternal parameters related to rates of vertical transmission of HIV. Sixteen (28%) infants were HIV-infected. There was no positive correlation between maternal risk factors for HIV and vertical transmission of HIV. Multiparity seemed to be related to a higher prevalence of vertical transmission, whereas neither preterm delivery nor cesarean section resulted in different rates of vertical transmission, although they tended to have some protective effect. Maternal beta 2-microglobulin and serum neopterin levels were not related to different rates of vertical transmission of HIV. CD4+ cell counts did so only when cut-off values of 400/mm3 were taken. All the women in CDC group IV and all the HIV p24 antigen-positive transmitted the infection to their infants, whereas only 7/48 women in CDC groups II and III (P = 0.000006) and 9/48 HIV p24 antigen negative women (P = 0.00006) gave birth to infected infants. No other maternal characteristics were associated with different rates of vertical transmission in a multivariate analysis restricted to women in CDC groups II and III and with HIV p24 antigen negativity.

Adult↗
PubMed1991

Soluble interleukin-2 receptor decrease in the sera of HIV-infected patients treated with zidovudine.

Laboratory parameters which are modified following administration of zidovudine are becoming increasingly useful in monitoring the efficacy of treatment of early stages of HIV-1 infection. The serum levels of soluble interleukin (sILR)-2 receptor, which have been reported to increase early in HIV-1 infection, were found to be significantly lower in 24 patients being treated with zidovudine than in 69 patients who were not treated, 28 of whom had CD4+ counts greater than 400 x 10(6)/l, and 41 less than 400 x 10(6)/l, respectively (P less than 0.0001). A prospective study group of 33 subjects treated with zidovudine demonstrated a decrease in sIL-2R during therapy (base values 2113 +/- 1131 versus 1444 +/- 728 after 90 days of therapy; P less than 0.0007). The reduction of sIL-2R was greater in those subjects were p24 antigen became negative during treatment. sIL-2R therefore seems to be a useful tool in the monitoring of therapy with zidovudine.

CD4-Positive T-Lymphocytes↗
PubMed1991

Positive modification of injecting behavior among intravenous heroin users from Milan and northern Italy 1987-1989. NISDA Study.

The prevalence of risk behaviors in 933 intravenous drug users from Milan and other areas of Northern Italy was studied from 1 January 1987 to 15 April 1989. A preventive intervention, based on counseling with HIV antibody testing, was undertaken with i.v. drug users attending detoxication centers, and subjects were followed up in order to evaluate its effects. At enrollment all subjects reported heroin use, 18% also used cocaine and 6% morphine. Seventy-two per cent reported sharing or having shared syringes, with variation across geographical areas. Four hundred and sixty subjects were visited at least twice (mean follow-up was 10.4 months): 30% of these stopped injecting altogether and the frequency of injecting as well as of syringe sharing decreased whereas no improvement was seen in sexual behaviour. Detoxication therapy, combined with HIV testing and counseling proved effective in reducing heroin assumption and the frequency of syringe sharing, whereas the prevalence of risk behaviors in i.v. drug users at recruitment over the years 1987-1988 showed no change, or even increased, despite of general information and health education campaigns against AIDS.

Adult↗
PubMed1991

Acute upper gastrointestinal bleeding in patients with AIDS: a relatively uncommon condition associated with reduced survival.

To determine the cumulative incidence of acute upper gastrointestinal bleeding and its effect upon survival in patients with AIDS, 453 consecutive AIDS patients diagnosed in our hospital between June 1985 and March 1989 were followed for a median period of six months (maximum 42 months). The cumulative probability of acute gastrointestinal bleeding was 3% at six months and 6% at 14 months. This event was associated with significantly reduced survival. Independent risk factors for bleeding were: severe thrombocytopenia at the time of diagnosis and non-Hodgkin's lymphoma as the first clinical manifestation of AIDS. The potential causes of bleeding were investigated in all cases by emergency endoscopy or by necropsy examination in those patients whose clinical condition precluded the procedure. In nine of 15 patients, bleeding was due to lesions specifically associated with AIDS, but in the remainder the source of bleeding was not a direct consequence of HIV infection. We conclude that acute upper gastrointestinal bleeding rarely complicates the course of AIDS, but its occurrence is associated with decreased survival. As many of the causes are potentially treatable, a complete diagnostic approach is indicated in these patients, except those who are terminally ill.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Are sensorimotor strokes lacunar strokes? A case-control study of lacunar and non-lacunar infarcts.

To determine whether sensorimotor strokes should be considered as lacunar syndromes 34 consecutive patients with first-ever ischaemic sensorimotor stroke were evaluated and compared with 103 patients with non-lacunar infarcts and another 88 patients with lacunar infarcts. Potential thromboembolic sources were more frequent in patients with non-lacunar infarcts (p = 0.003, versus sensorimotor strokes). Although the overall prevalence of hypodense lesions at CT scan was not significantly different among the three groups, lacunar lesions were found in 47.1% of sensorimotor strokes, compared with 6.8% of non-lacunar infarcts (p less than 0.0001). In a mean follow up period of 28.7 months, the incidence of stroke and myocardial infarction among sensorimotor strokes was similar to that of patients with lacunar infarct, but significantly lower than in non-lacunar infarcts (p less than 0.05). These results demonstrate important differences between sensorimotor and non-lacunar infarcts, but quite similar findings in sensorimotor and lacunar strokes, and thus support the theory that sensorimotor strokes are commonly due to lacunar lesions.

Adult↗
PubMed1991

Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981.

The incidence of brain abscess was studied on all cases occurring in residents of Olmsted County, Minn., from 1935 through 1981. Thirty-eight cases (9 cases first diagnosed at autopsy) were identified and followed through the Rochester Olmsted County medical record-linkage system at the Mayo Clinic. The incidence rate was 1.3/100,000 person-years (PY), 1.9 in males and 0.6 in females. Incidence decreased from 2.7 in 1935-44 to 0.9 in 1965-81. Rates were higher in children 5-9 years old (2.4) and after age 60 (2.6 PY). An etiologic agent was identified in 29 cases (76%) with streptococci being the most frequently isolated. Case-fatality ratio was 38% (11/29), stable over time. Concurrent bacterial meningitis was the strongest predictor of death. Neurologic sequelae were observed in 8 (44%) of the 18 surviving patients including epilepsy (5 cases), deafness and motor impairment.

Brain Abscess↗
PubMed1991

The occurrence of motor fluctuations in parkinsonian patients treated long term with levodopa: role of early treatment and disease progression.

The aim of this study is to evaluate what factors influence the risk of occurrence of motor fluctuations in patients with Parkinson's disease (PD) with particular reference to the role of early or delayed introduction of levodopa therapy during the course of the disease. One hundred twenty-five consecutive newly diagnosed patients with PD started levodopa treatment at the time diagnosis and were followed for 2 to 10 years. During follow-up, 60 patients had wearing-off or early morning akinesia. We estimated the cumulative time-dependent risk of motor fluctuation occurrence through a multivariable analysis. The risk was lower for patients with tremor-predominant PD, for those with shorter disease duration prior to levodopa, and for those who were relatively older at levodopa initiation. Our results suggest that, as far as motor fluctuations are concerned, disease prognosis is not influenced by early levodopa treatment. These observation support the introduction of levodopa as soon as there is a subjective need for the patients to maintain their level of social and work performance.

Age Factors↗
PubMed1991

Man-to-woman sexual transmission of the human immunodeficiency virus. Risk factors related to sexual behavior, man's infectiousness, and woman's susceptibility. Italian Study Group on HIV Heterosexual Transmission.

To investigate the risk factors for man-to-woman sexual transmission of the human immunodeficiency virus (HIV), we carried out a cross-sectional study of 368 women who were steady partners of HIV-infected men attending 16 Italian clinical centers. Information was collected from the medical records of the infected men and by direct interviews with the women. In a logistic regression analysis, the woman's awareness of her partner's seropositivity (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.0 to 1.1), use of condoms (OR, 0.3; 95% CI, 0.1 to 1), and oral contraceptive use (OR, 0.5; 95% CI, 0.3 to 1.0) were negatively associated with transmission of the HIV infection. An increased risk was found in women having sexual intercourse more than twice a week (OR, 2.4; 95% CI, 1.2 to 4.9) and in women who had been sexually exposed to HIV for between 2 and 5 years (OR, 3.5; 95% CI, 1.8 to 6.7). The transmission rate was higher in couples who engaged in anal sex (OR, 2.8; 95% CI, 1.3 to 6.3); in women reporting vaginitis (OR, 4.9; 95% CI, 2.4 to 10.2) or genital warts (OR, 33.3; 95% CI, 4.5 to 244.1); and in those using intrauterine devices (OR, 3.1; 95% CI, 1.4 to 7.1). The risk for women was also associated with a CD4+ cell count lower than 400/mm3 in their partners. Knowledge of the HIV status of the partner led to increased condom use but did not induce a lower frequency of sexual intercourse or an avoidance of anal sex.

Adolescent↗
PubMed1990

Mortality associated with early and late levodopa therapy initiation in Parkinson's disease.

We evaluated the possible influence of early levodopa treatment on the mortality of Parkinson's disease (PD). One hundred forty-five consecutive parkinsonian patients initiated treatment with levodopa between 1970 and 1983. Ninety-eight of those started levodopa therapy 2 or more years after symptom onset, while 47 received levodopa within the 1st 2 years of the disease. At the end of follow-up, in December 1985, 49 patients had died. Mortality was 2.5 times higher among patients who delayed initiation of levodopa therapy 2 or more years than among those who initiated the therapy earlier. Age and disease severity were the most significant predictors of survival after initiation of levodopa treatment. The risk of death was 10% higher every year of age increase and was 2 and 4 times higher, respectively, for patients at Hoehn and Yahr stages II and III than for patients at Hoehn and Yahr stage I. When we controlled for the effect of age and disease severity on mortality, the cumulative death probability was no longer significantly higher among patients who delayed levodopa treatment than among patients treated within 2 years from disease onset. As far as mortality is concerned, the results show that the time of levodopa treatment initiation during PD has no influence and the drug can be introduced as soon as indicated by the severity of the disease progression.

Female↗
PubMed1990

Incidence and risk factors of HIV infection: a prospective study of seronegative drug users from Milan and northern Italy, 1987-1989.

To assess the incidence of and risk factors for human immunodeficiency virus (HIV) infection among HIV-negative intravenous drug abusers, we studied a cohort of intravenous drug abusers recruited from drug treatment centers in Milan and northern Italy. We enrolled 933 subjects between January 1, 1987 and April 15, 1989 and we followed 460 subjects with one or more visits for a mean follow-up duration of 10.4 months. The incidence rate of HIV infection was 7.4 per 100 person-years, equivalent to a one-year risk of 7.3%. Relative risk was higher in subjects who had been using intravenous drugs for less than 2 years (RR = 2.3). In a case-control analysis, recent frequent syringe sharing was the behavioral variable most strongly associated with HIV infection, with the highest risk in subjects sharing often (OR = 6.1, 90% CI = 2.6-14.7). We found no association with the use of cocaine in addition to heroin nor with sexual habits. Among biologic variables, relative risks were increased in individuals whose T4-lymphocyte count was lower than 1,000 at first visit (RR = 8.5, 90% CI = 2.9-24.3) or who were carrying HBsAg (RR = 1.9, 90% CI = 0.8-4.2).

Acquired Immunodeficiency Syndrome↗