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S Salmaso

Publications and source records attributed to S Salmaso.

At least 19 recordsLinked to original sources

Tuberculosis and AIDS: a retrospective, longitudinal, multicentre study of Italian AIDS patients. Italian group for the study of tuberculosis and AIDS (GISTA)

We report the results of a retrospective, longitudinal, multicentre study which estimated the cumulative incidence of tuberculosis in patients who eventually develop AIDS, investigated the characteristics of AIDS patients in relation to the development of tuberculosis, and endeavoured to determine the degree of HIV-induced immunosuppression at which tuberculosis occurs. The Infectious Disease Units of 23 hospitals located in 11 of the 20 regions of Italy participated in this study. We investigated 1691 patients with AIDS diagnosed in 1988 and 1989 and reported to the National AIDS Registry by participating units before the end of December 1990. By that time M. tuberculosis had been cultured from 193 patients (11.4%). Compared with intravenous drug users (the largest HIV transmission category), only homosexual men had a statistically significant lower risk of tuberculosis (relative risk = 0.65; 95% confidence interval 0.43-0.99). The median count of CD4+ lymphocytes at the time tuberculosis was diagnosed was 82/mm3 (range 1-752); only four patients (2.1%) had CD4+ lymphocyte counts of more than 500/mm3, and 36 (18.7%) of over 200/mm3. We conclude that in Italy the proportion of AIDS patients who develop tuberculosis is higher than in other industrialised countries and differences in the incidence of tuberculosis among various HIV-transmission categories are less marked than in other western countries. Tuberculosis associated with HIV infection may occur in those with widely differing CD4+ counts, although the risk increases consistently in proportion to the degree of immunosuppression.

Acquired Immunodeficiency Syndrome

Simultaneous infection with three different S. enteritidis strains in a nursing home resident.

A culture taken from a nursing home resident as part of a S. enteritidis outbreak was found to have a mixed infection due to three different strains of S. enteritidis. One of the three strains belonged to phage type (PT) 4, one to PT6 and one reacted with phages but did not conform to any typing scheme (RDNC). All three strains had the 38.9 megadaltons (MDa) plasmid found in the isolates from the outbreak-related cases, in addition the PT6 and RDNC strains harboured a 69.9 MDa plasmid. The importance of phage typing and plasmid analysis for S. enteritidis strain characterization and their epidemiologic and bacterial significance are discussed.

Aged

Tuberculosis in HIV-infected subjects in Italy: a multicentre study. The Gruppo Italiano di Studio Tubercolosi e AIDS.

OBJECTIVES: To evaluate the strength of the association between tuberculosis and HIV infection in Italy, to assess the pattern of this association in relation to HIV transmission categories, and to describe clinical presentation of tuberculosis in a large group of Italian HIV-infected subjects. DESIGN: Multicentre review of clinical records. SETTING: Twenty-one infectious disease hospital units in nine of the 20 administrative regions of Italy. PATIENTS, PARTICIPANTS: All HIV-infected adults observed by each participating unit (in- and outpatients) between 1985 and 1989. MAIN OUTCOME MEASURE: Culture-proven tuberculosis. RESULTS: A total of 306 cases of tuberculosis were observed. Of these, 85 were pulmonary, 167 extrapulmonary, and 54 both pulmonary and extrapulmonary. The proportion of HIV-infected subjects diagnosed with tuberculosis increased during the study period from three out of 1380 (0.2%) in 1985 to 152 out of 6504 subjects (2.3%) in 1989 (P less than 0.0001). Two hundred and twenty-six of the 2760 (8.19%) patients with AIDS had tuberculosis within 12 months of AIDS diagnosis; the proportion of AIDS patients with tuberculosis remained stable after 1985. Compared with AIDS patients who were intravenous drug users, only homosexual AIDS patients had a significantly lower proportion of tuberculosis (178 out of 1958 versus 30 out of 522; P less than 0.02). CONCLUSIONS: Our data show that tuberculosis is quite common among HIV-infected subjects in Italy, and suggest that the risk of tuberculosis in these subjects has not changed. There are some differences between the pattern of the association between tuberculosis and HIV infection in Italy, compared with other industrialized countries.

Adult

Epidemiology of pertussis in a developed country with low vaccination coverage: the Italian experience.

In Italy pertussis vaccination is optional. Fewer than 40% of children younger than 5 years of age are vaccinated, and pertussis remains a common childhood disease. We use data from a variety of sources to examine trends and characteristics of Italian children with pertussis and reasons behind the low vaccine coverage. Approximately 25% of Italian children have experienced clinical pertussis by their fifth birthday. The disease is most severe in those less than 1 year of age; in this group an estimated 1 in 14 cases are hospitalized and 1 in 850 die. The incidence appears to be increasing in the 1- to 4-year age group despite increased vaccination coverage. The low vaccine coverage appears to be caused by the ambivalence of the Italian pediatric community about the vaccine rather than parental concerns about vaccine safety. Legislation is being considered to make pertussis vaccination mandatory.

Child

AIDS cases in adolescents and young adults in Italy: inferences from descriptive epidemiology.

To assess the magnitude of the AIDS epidemic in the Italian adolescent (13-19 years) and young adult (20-24 years) age groups, data on AIDS cases notified to the AIDS Operational Centre as of 31 March 1990 were used. Of the 6068 reported AIDS cases, 0.7% occurred among adolescents and 15.7% among young adults. Among adolescents most cases were haemophiliacs (45.4%), while among young adults, drug use was the most frequently reported mode of transmission (87.5%). Females were more likely than males to contract the disease through the heterosexual contact in both the adolescent (20.0% vs 0%) and in young adult (15.1% vs 0.7%) age groups. Among young adults a geographical trend was present with a decrease in case rates from north to south, while for adolescents the rates were higher in northern and southern than in central Italy. If the incidence of AIDS is to be reduced in Italy, further efforts should be made to target the adolescent age group, since many of the young adult cases are likely to have resulted from HIV infection during adolescence.

Acquired Immunodeficiency Syndrome

Epidemiological use of drug prescriptions as markers of disease frequency: an Italian experience.

All Italian citizens are covered by the National Health Service (NHS) and medical records of individual drug prescriptions are routinely collected and processed. A procedure entitled EPIFAR has been developed which, on the basis of a computer routine, makes it possible to trace back the prescription history of each individual included in the NHS. The validity of information gathered through the EPIFAR procedure to provide estimates of tuberculosis (TB) prevalence has been evaluated. A comparison with routine surveillance data has been made. The EPIFAR procedure identified a total figure of TB patients seven times higher than that from official notifications. A sample survey was conducted among the prescribing physicians in order to quantify the proportion of TB cases among subjects receiving prescriptions of anti-TB drugs. According to general practitioner recall 66.4% of the patients were treated because of TB diagnosis, TB prophylaxis and TB relapse.

Antitubercular Agents

Sexual lifestyles in injecting drug users in Italy: potential for HIV infection transmission. First Multicentre Study Group.

To better target efforts aimed at modifying sexual behaviour among injecting drug users (IDUs), we conducted a detailed analysis of sexual partners and practices reported by 1214 Italian heterosexual drug users during the period June 1985-June 1987. Females were more likely to have only drug-using partners (42.8% vs 17.1%), while males were more likely to have only non drug-using partners (50.5% vs 21.4%). Female drug users were more likely to report either one partner or greater than 10 partners, while males were more likely to report 2-10 partners. Nearly 90% of women with only drug-using partners had only one partner. Overall, 29% of women with only non drug-using partners reported that they always used condoms. This proportion increased to 65% among women with greater than 10 non drug-using partners. In Italy, male IDUs may play a greater role than female IDUs in sexual transmission of HIV infection to the heterosexual non drug-using partners.

Adult

Drug use and HIV-1 infection: report from the Second Italian Multicenter Study.

A cross-sectional study was carried out in October 1988 among clients of public health centers in Italy that provide assistance for drug dependency. In addition to estimating the frequency of HIV-1 infection and of risk factors related to drug use, the study estimated the temporal gap between relevant events in the drug history of each subject. Forty-eight centers participated, representing 16 of the 20 Italian regions. Among 1,038/1,348 subjects, 395 (38%) were carriers of HIV-1 antibodies. Seropositivity was related to the length of heroin use (with the risk of being seropositive increasing by 1% for each month of use), to frequency of sharing injection equipment, and to sexual intercourse with a seropositive partner. Women were more likely to have shared injection equipment and to have engaged in sexual intercourse with seropositive partners. Most subjects began sharing injection equipment within a year of initiating drug use, and the median temporal gap between first drug use and first visit to a drug dependency center was 5 years. A high proportion of both seropositive (87%) and seronegative (74%) subjects reported the adoption of safer drug-use practices. In both groups many behavioral changes (38%) were reported to have been introduced before the initial HIV test. These findings confirm that efforts to reduce HIV infection among drug users in Italy will need to concentrate both on prevention of drug use and on early intervention to reduce high-risk behaviors.

Adult

Risk behaviors for HIV-1 infection in Italian drug users: report from a multicenter study. First Drug User Multicenter Study Group.

In June 1987, a cross-sectional study was carried out on drug users attending public centers for drug dependency in Italy. Observed proportions of HIV seropositives among the 1,363 subjects from 34 public centers in 11 regions included in the study varied widely, with an overall seropositivity rate of 37%. Sharing syringes/needles, already used by other intravenous drug users, for preparing and injecting drugs represented independent risk factors for HIV-1 infection, while sexual lifestyle did not. Risk of infection increased with frequency of sharing equipment for preparing and for injecting drugs. Modification of risk behaviors in drug use was reported more frequently than in sexual lifestyle; both were significantly associated with knowledge of being seropositive for HIV-1 infection.

Acquired Immunodeficiency Syndrome

Survey on tuberculosis reports in a major Italian region.

A survey was carried out on all cases of pulmonary and extrapulmonary tuberculosis reported in the Latium region of Italy during 1986, in order to characterize them from bacteriological and epidemiological points of view. A total of 497 TB notifications were investigated; reliable medical records were traced and consulted for 458 of these. Seventy-six percent of cases was classified as respiratory tb, 21.8% non-respiratory tb and 2% both. Ninety-two percent of all cases had been hospitalized for long periods (mean: 69 days/median: 63 days for cases of respiratory TB and mean: 40/median 29 days for non-respiratory patients). Contrary to the definition of a reportable case in Italy, evidence of Mycobacteria on direct or cultural examination was present in only half of all reported patients. Twenty-seven percent of respiratory cases and 33.3% of non-respiratory had a previous diagnosis of TB mentioned on the clinical record. High daily alcohol intake is reported more frequently among TB patients with respect to the general population, while drug abusers, immigrants and HIV seropositives represent a very low proportion. Delays in notification have been observed and current notification system is evaluated.

Adolescent

Immunization coverage in Italy.

In Italy information on immunization coverage against pertussis, measles, and rubella is absent or incomplete. In 1985 the Istituto Superiore di Sanità (ISS) organized a series of immunization coverage surveys for these diseases in several local health units (Unità Sanitaria Locale) (USL). The surveys were conducted simultaneously in 80 USLs in 1985 with modified EPI cluster sampling techniques, using schools attended by children aged 3 to 10 years as the clusters. Information on previously performed immunizations was collected for each child sampled. The total immunization coverage and proportion of immunized children in eight birth cohorts were calculated.Low immunization coverage was reported by the USLs surveyed, and regional differences in the coverage were apparent between the north, centre, and south of Italy. In addition, a steady or decreasing trend in the use of pertussis vaccine was found, while an increasing coverage was observed for measles and rubella immunizations.

Child

Outbreak of Salmonella napoli infection caused by contaminated chocolate bars.

An outbreak of Salmonella napoli infection in England and Wales in 1982 was detected by the surveillance of routine reports of salmonella infections from hospital and public-health laboratories. Epidemiological investigation quickly identified two types of small chocolate-covered bars, imported from Italy, as the vehicles of infection, and subsequently both were found to be contaminated with the organism. The prompt recognition of this outbreak and rapid identification of the vehicle of infection enabled four-fifths of the consignment of contaminated chocolate to be withdrawn from the market. The 245 reported cases resulted from the sale of 600 000 bars; as these were presumably only a small fraction of the total number of cases, it is likely that many thousands of infections were prevented.

Adolescent

[Seasonal variations and trends in cardiovascular disease mortality in Naples, 1974-1978].

Death certificates of people who died from cardiovascular diseases in the City of Naples from 1974 through 1978 were reviewed. Data were classified according to three different groups of causes of death: 1. from all cardiovascular diseases (codes of the International Classification of Diseases-ICD-, VIII Revision from 393.0 through 458.9), 2. from ischaemic heart diseases (ICD from 410.0 through 411.9) and 3. from acute ischaemic heart diseases (ICD from 410.0 through 411.9). The monthly number of deaths in each group was analyzed using time series techniques to assess the seasonal pattern and the secular trend. A clear seasonal pattern was found in all groups, though in group 3 it was less evident. The maximum number of deaths per month was found to occur during the cold season and the minimum during the summer. The secular trend was found to be stable for groups 1 and 2. Group 3 showed an evident increase over the five years under study.

Cardiovascular Diseases