PubMed Health⌕ Search

Biomedical subjects

P Villari

Publications and source records attributed to P Villari.

At least 19 recordsLinked to original sources
PubMed2004

Methodological quality of studies and patient age as major sources of variation in efficacy estimates of influenza vaccination in healthy adults: a meta-analysis.

A meta-analysis of randomized and quasi-randomized control trials evaluating influenza vaccination efficacy in healthy adults was carried out to investigate potential sources of heterogeneity among the published studies. The pooled estimates of vaccine efficacy were 22% (95% CI = 16-28) for preventing clinically diagnosed cases of influenza and 63% (95% CI = 53-71) for preventing laboratory confirmed cases of influenza. These estimates are likely to vary substantially according to the age of the subjects, with vaccine efficacy decreasing significantly with the increase of the mean age of the patients, and to the methodological quality of trials, with low quality trials associated with an overestimation of influenza vaccine efficacy. Some evidence of publication bias was found, particularly when the outcome assessed was clinically diagnosed influenza. Further high-quality clinical trials, designed to facilitate future pooled analyses, are needed to provide definitive answers for policy-makers.

Aging↗
PubMed2003

Opioid plasma concentration during switching from morphine to methadone: preliminary data.

Opioid switching is often used to improve the opioid response in cancer patients experiencing poor analgesia or adverse effects. However, no data are available on plasmatic changes of opioids and their metabolites during these phases, and whether there exists a relationship with the clinical events. In a prospective study of 10 consecutive cancer patients on oral morphine but with uncontrolled pain (greater >4 on a numerical scale of 0 to 10) and/or moderate to severe opioid adverse effects (on a level of 2 and 3 of a verbal scale) and not responsive to adjuvant medications, switching to oral methadone was performed using a fixed ratio of 5:1, leaving extra-doses of 1/5 of the daily dose of methadone calculated as needed. Blood samples were obtained at the same hour for four days, before the switching, and then on day 1, 2, and 3. The intensity of pain and the adverse effects were assessed daily to calculate the switching score before and after switching. Completed blood samples were obtained in 9 patients. One patient was separately considered, because of his renal impairment. Significant improvements in pain intensity as well as adverse effects within an average period of 1-2 days were observed. Morphine, morphine-6-glucuronide, and morphine-3-glucuronide were progressively cleared from plasma to almost disappear within three days. Methadone rapidly achieved a stable concentration in 1-2 days. The doses of methadone were changed, but not significantly, and tended to decrease in the following days, according to the clinical situation. The results of this study confirm the need to stop rapidly morphine, and to use a priming dose of methadone, rather than using progressive decrements and increments of morphine and methadone, respectively, during opioid switching. This method allows for a rapid clearance of morphine and its metabolites are rapidly cleared, except in patients with renal failure. Opioid plasma changes substantially overlap the clinical changes observed in these patients, in terms of benefit between analgesia and adverse effects.

Administration, Oral↗
PubMed2003

Meta-analysis of published studies or meta-analysis of individual data? Caesarean section in HIV-positive women as a study case.

Very few comparative evaluations of meta-analysis of published data and meta-analysis using individual patient data have appeared in the medical literature. The association between type of delivery and HIV perinatal transmission appears to be an excellent study case, given the recent publication of the meta-analysis of individual patient data by the International Perinatal HIV Group. In this paper, we report the results of a meta-analysis of the published studies, which show a statistically significant reduction of perinatal HIV transmission rate with Caesarean section. The results are surprisingly similar to those of the recently published meta-analysis of individual patient data, indicating that, in the absence of significant confounding, the two meta-analytic methods are likely to give consistent results. In this era of constrained resources for biomedical research, caution should be taken in abandoning meta-analysis of published data for studying epidemiological associations of public health interest.

Cesarean Section↗
PubMed2003

Molecular typing of Aeromonas isolates in natural mineral waters.

A total of 103 isolates of Aeromonas spp. were obtained over a 3-year period from a natural mineral water and from surface streams located within the boundaries of the watershed of the natural mineral water wells and were typed by macrorestriction analysis of genomic DNA with XbaI and by pulsed-field gel electrophoresis. All Aeromonas caviae isolates from the natural mineral water belonged to the same clone, and an analogous clonal identity was found among Aeromonas hydrophila isolates. These two clones expressed no hemolytic or cytotoxic activities. Aeromonas isolates from surface waters showed high molecular heterogeneity and were not related to the clones found in the natural mineral water. The presence of aeromonads chronically found in the natural mineral water was a likely consequence of a localized development of a biofilm, with no exogenous contamination of the aquifer. Molecular fingerprinting of drinking water isolates is a useful tool in explaining possible reasons for bacterial occurrences.

Aeromonas↗
PubMed2002

Healthcare personnel and hand decontamination in intensive care units: knowledge, attitudes, and behaviour in Italy.

The purpose of this study was to evaluate knowledge, attitudes, and behaviour regarding hand decontamination in personnel of intensive care units (ICUs) in Italy. All ICU physicians and nurses in 19 and five randomly selected hospitals in Campania and Calabria (Italy) were mailed a questionnaire focusing on demographics and practice characteristics; knowledge about prevention of hospital acquired infection; attitudes and behaviour with respect to hand decontamination; and use of gloves. A total of 413 questionnaires were returned giving a response rate of 66.6%. Overall, 53.2% agreed with the correct responses on knowledge related to infection control, and this knowledge was significantly higher in neonatal and medicine-surgery wards and in larger ICUs. A positive attitude was reported by the large majority who agreed that hand decontamination reduces the risk of infection in patients (96.8%) and personnel (86.2%), and the positive attitude was significantly higher among older and female personnel and in those with a higher level of knowledge. Only 60% always decontaminate hands at the start of a shift, and 72.5% before and after a patient contact. Higher compliance is reported for invasive manoeuvres, such as urinary catheters (96.5%) and intravenous lines (77.1%). Routine hand decontamination between each patient was significantly higher in females, and in neonatal and medicine-surgery ICUs. Our results suggest that interventions should not only be focused on predisposing factors (knowledge), but also on enabling (facilitating) and reinforcing (gratifying) factors.

Adult↗
PubMed2002

Molecular epidemiology of Stenotrophomonas maltophilia in a university hospital.

The aim of this investigation was to study the molecular epidemiology of Stenotrophomonas maltophilia in a university hospital in Italy. Sixty-one clinical isolates were collected from 43 patients during a two-year period. The majority of specimens were from the respiratory tract (41 of 43) of patients in the adult intensive care unit (ICU) (19 of 43) or cystic fibrosis (CF) patients (13 of 43). Genotypic analysis by pulsed-field gel electrophoresis (PFGE) of clinical isolates identified 31 different PFGE patterns. Although most patients were infected or colonized by different S. maltophilia clones, clones with identical genotype were isolated in patients from ICU, where two separate outbreaks were identified. Antimicrobial susceptibility identified a multi-resistant phenotype in all S. maltophilia PFGE clones. The majority of PFGE clones identified (six of seven clones from patients in the ICU) were susceptible to fluoroquinolones. Mechanical ventilation was associated with S. maltophilia acquisition in the ICU.

Cross Infection↗
PubMed2001

Switching from morphine to methadone to improve analgesia and tolerability in cancer patients: a prospective study.

PURPOSE: To evaluate the clinical benefits of switching from morphine to oral methadone in patients who experience poor analgesia or adverse effects from morphine. PATIENTS AND METHODS: Fifty-two consecutive cancer patients receiving oral morphine but with uncontrolled pain and/or moderate to severe opioid adverse effects were switched to oral methadone administered every 8 hours using different dose ratios. Intensity of pain and adverse effects were assessed daily, and the symptom distress score (DS) was calculated before and after switching. RESULTS: Data were analyzed for 50 patients. Switching was considered effective in 80% of the patients; results were achieved in an average of 3.65 days. In the 10 patients who switched to methadone because of uncontrolled pain, a significant reduction in pain intensity (P <.005) and an average of a 33% increase in methadone doses necessary (P <.01) were found after an average of 3.5 days. DS significantly decreased from an average of 8.4 to 4.5 (P <.0005). In the 32 patients switching because of uncontrolled pain and morphine-related adverse effects, significant improvement was found in pain intensity (P <.0005), nausea and vomiting (P <.03), constipation (P <.001), and drowsiness (P <.01), but a significant increase in the methadone dose of an average of 20% (P <.004) was required. CONCLUSION: In most patients with cancer pain referred for poor pain control and/or adverse effects, switching to oral methadone is a valid therapeutic option. In the clinical setting of poor pain control, higher doses of methadone are necessary with respect to the equianalgesic calculated dose ratios previously published.

Administration, Oral↗
PubMed2001

Rifampicin in opioid-induced itching.

Pruritus is prevalent in 5-12% of palliative care patients. Rifampicin has been shown to be useful both as initial treatment and as salvage treatment after failure of other agents to control the pruritus associated with the cholestatic jaundice of malignancy. We report the case of a 65-year-old woman who complained of severe pruritus after morphine treatment. The use of rifampicin 300 mg twice a day by the i.v. route was successful, and after opioid switching it was no longer necessary to maintain rifampicin in the therapeutic regimen. Controlled clinical trials are warranted to confirm this preliminary observation.

Aged↗
PubMed2001

Gabapentin for opiod-related myoclonus in cancer patients.

Chronic opioid medication has been found to cause myoclonus in patients taking it for cancer pain. Gabapentin seemed a likely candidate for the treatment of this myoclonus and has indeed proved useful, as illustrated in this paper by two case histories.

Acetates↗
PubMed2001

Molecular epidemiology of an outbreak of Serratia marcescens in a neonatal intensive care unit.

OBJECTIVE: To investigate and control a biphasic outbreak of Serratia marcescens in a neonatal intensive care unit (NICU). DESIGN: Epidemiological and laboratory investigation of the outbreak. SETTING: The NICU of the 1,470-bed teaching hospital of the University "Federico II," Naples, Italy. PATIENTS: The outbreak involved 56 cases of colonization by S marcescens over a 15-month period, with two epidemic peaks of 6 and 3 months, respectively. Fourteen (25%) of the 56 colonized infants developed clinical infections, 50% of which were major (sepsis, meningitis, or pneumonia). METHODS: Epidemiological and microbiological investigations, analysis of macrorestriction pattern of genomic DNA through pulsed-field gel electrophoresis (PFGE) of clinical and environmental isolates, and institution of infection control measures. RESULTS: Analysis of macrorestriction patterns of genomic DNA by PFGE demonstrated that the vast majority of S marcescens isolates, including three environmental strains isolated from two handwashing disinfectants and the hands of a nurse, were of the same clonal type. The successful control of the outbreak was achieved through cohorting of noncolonized infants, isolation of S marcescens-infected and -colonized infants, and an intense educational program that emphasized the need for adherence to glove use and handwashing policies. The NICU remained open to new admissions. CONCLUSIONS: Outbreaks caused by S marcescens are very difficult to eradicate. An infection control program that includes molecular typing of microorganisms and the proper dissemination among staff members of the typing results is likely to be very effective in reducing NICU-acquired infections and in controlling outbreaks caused by S marcescens, as well as other multiresistant bacteria.

Cross Infection↗
PubMed2000

Molecular typing of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis: comparison of results obtained in a multilaboratory effort using identical protocols and MRSA strains.

Pulsed-field gel electrophoresis (PFGE) has become the gold standard of molecular methods in epidemiological investigations. In spite of its high resolving power, use of the method has been hampered by inadequate laboratory-to-laboratory reproducibility. In the project described here we have addressed this problem by organizing a multilaboratory effort in which the same bacterial strains (subtype variants of the Iberian and Brazilian methicillin-resistant Staphylococcus aureus--MRSA--clones) were analyzed by twenty investigators in thirteen different laboratories according to an indentical protocol, which is reproduced here in detail. PFGE patterns obtained were analyzed at a central laboratory in order to identify specific technical problems that produced substandard macrorestriction patterns. The results including the specific technical problems and their most likely causes are described in this communication. Also listed are seven major epidemic clones of MRSA which have been characterized by molecular fingerprinting techniques and the prototypes of which have been deposited at the American Type Culture Collection, from where they will be available for interested investigators for the purpose of typing MRSA isolates. It is hoped that this communication will contribute to the improvement of the reproducibility and technical/aesthetic quality of PFGE analysis.

Bacterial Typing Techniques↗
PubMed2000

Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three-year period.

Coagulase-negative staphylococci, especially Staphylococcus epidermidis, are increasingly important nosocomial pathogens, particularly in critically ill neonates. A 3-year prospective surveillance of nosocomial infections in a neonatal intensive care unit (NICU) was performed by traditional epidemiologic methods as well as molecular typing of microorganisms. The aims of the study were (i) to quantify the impact of S. epidermidis on NICU-acquired infections, (ii) to establish if these infections are caused by endemic clones or by incidentally occurring bacterial strains of this ubiquitous species, (iii) to evaluate the use of different methods for the epidemiologic typing of the isolates, and (iv) to characterize the occurrence and the spread of staphylococci with decreased glycopeptide susceptibility. Results confirmed that S. epidermidis is one of the leading causes of NICU-acquired infections and that the reduced glycopeptide susceptibility, if investigated by appropriate detection methods such as population analysis, is more common than is currently realized. Typing of isolates, which can be performed effectively through molecular techniques such as pulsed-field gel electrophoresis but not through antibiograms, showed that many of these infections are due to clonal dissemination and, thus, are potentially preventable by strict adherence to recommended infection control practices and the implementation of programs aimed toward the reduction of the unnecessary use of antibiotics. These strategies are also likely to have a significant impact on the frequency of the reduced susceptibility of staphylococci to glycopeptides, since this phenomenon appears to be determined either by more resistant clones transmitted from patient to patient or, to a lesser extent, by strains that become more resistant as a result of antibiotic pressure.

Birth Weight↗
PubMed2000

Prevalence and molecular characterization of Aeromonas spp. in ready-to-eat foods in Italy.

A survey was carried out in Italy to ascertain the prevalence of Aeromonas spp. in ready-to-eat foods (vegetables, cheeses, meat products, and ice creams) and the level of molecular heterogeneity of the isolates found by macrorestriction analysis of genomic DNA with pulsed-field gel electrophoresis (PFGE). In total, 46 (14.4%) of the 320 food samples examined were found positive for Aeromonas spp. The highest percentages of isolation were discovered in vegetables, particularly lettuce (45.0%), endive (40.0%), and rucola (20.0%). Ricotta was the only cheese type analyzed that showed a high frequency of isolation (45.0%). Among meat products, salami and raw ham (25.0% of samples positive) and, to a lesser extent, baloney (5.0%) were found positive for Aeromonas spp. Aeromonas hydrophila was the most common isolate from foods of animal origin, whereas Aeromonas caviae was the dominant species in vegetables. No motile aeromonads were found in ice cream samples. Aeromonas isolates showed a high level of genetic heterogeneity, because 24 PFGE patterns were identified among 27 A. hydrophila strains and 20 PFGE patterns were found in 23 A. caviae isolates. In conclusion, consumers of ready-to-eat foods in Italy are regularly exposed to many genetically distinct strains of A. hydrophila and A. caviae without evident signs of malaise, and therefore, few of these strains, if any, are likely to be pathogenic.

Aeromonas↗