Liver international : official journal of the International Association for the Study of the Liver, May 26, 2016
The proportion of HCV infected patients over age 65 years in Western countries is increasing. Thi... more The proportion of HCV infected patients over age 65 years in Western countries is increasing. This growth and the advent of new antiviral therapy bring into the question the real world efficacy and safety of the combination of Sofosbuvir (SOF) and Simeprevir (SMV) plus a flat dose of 800 mg/d ribavirin (RBV) in elderly patients with liver cirrhosis compared to younger patients. Retrospective observational multicenter real life investigation study of SOF/SMV/RBV for a duration of 12 weeks in HCV genotype 1-infected patients with liver cirrhosis. Of the 270 patients enrolled in the study, with compensated cirrhosis, 133 (49.2%) were ≥ 65 years of age. Sustained virological response at 12 weeks (SVR12) was achieved by 94.2% (129/137) of those aged < 65 years and 97.7% (130/133) of those ≥ 65 years. Diabetes was the most common comorbidity in patients ≥ 65 years compared to younger patients (26.3% vs 12.4% p<0.003). The most common adverse event (AE) in elderly patients was a grad...
World journal of gastrointestinal pathophysiology, Jan 15, 2014
To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenter... more To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams. Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy wa...
A highly sensitive nested PCR was carried out in order to detect 2 LTR circles as a marker of rec... more A highly sensitive nested PCR was carried out in order to detect 2 LTR circles as a marker of recent and ongoing viral replication in HIV-1 infected patients with HIV plasma RNA undetectable. This &quot;in house&quot; two-step nested PCR is very sensitive, but it is not feasible for routine tests and presents a high risk of contamination. In order to reduce the time of reactions and crossover contamination, the possibility was explored to carry out a single step nested PCR, in which the two successive amplification rounds are carried out in the same tube. This single step nested PCR has the same sensitivity of the two-step nested, is easy to conduct and requires a short time of reaction. The two different PCR methods were compared and the clinical use of monitoring 2 LTR DNA circles in HIV-1 infected patients with undetectable plasma viral load is discussed.
Human immunodeficiency virus (HIV)-related pulmonary hypertension (HRPR) is a cardiovascular comp... more Human immunodeficiency virus (HIV)-related pulmonary hypertension (HRPR) is a cardiovascular complication of HIV infection that has been recognized in the last years with increasing frequency. The etiology of HRPH is unknown. All the attempts to isolate HIV on pulmonary vessels in HRPH patients failed, and an indirect role for HIV in this disease has been hypothesized. Current theories on the pathogenesis focus on abnormalities of endothelial and smooth muscle cells of pulmonary vasculature. Endothelial and smooth muscle cell injury could be due to a high production or to a reduced clearance of cytokines in these patients. In fact, in several studies high levels of ET-1, IL-1alpha, IL-6 and PDGF in primary pulmonary hypertension (PPH) and in HRPH have been found. HIV gp 120 could induce the production of these cytokines by a stimulation of monocytes/macrophages. A high alpha1-adrenoreceptors stimulation of pulmonary vessels could be also implicated in the pathogenesis of HRPH. Chronic hypoxia is observed with increased frequency in HIV patients, and this could induce a chronic stimulation of alpha1-receptors of pulmonary vasculature with typical pathological changes. However, only a small percentage of HIV- patients develop HRPH. This observation suggests the existence of an idiosyncratic susceptibility to the development of vascular disease. This susceptibility could have a genetic basis, and might be determined by particular major histocompatibility complex alleles.
In recent years, much more thought has been given to the pathogenic role of HIV and to the clinic... more In recent years, much more thought has been given to the pathogenic role of HIV and to the clinical manifestations of HIV-related pulmonary hypertension (HRPH), which currently represents one of the most severe events during HIV disease. HRPH occurs in early and late stages of HIV infection and does not seem to be related to the degree of immune deficiency. Many of the symptoms in HRPH result from right ventricular dysfunction: the first clinical manifestation is effort intolerance and exertional dyspnea that will progress to the point of breathlessness at rest. The diagnosis of HRPH can be made only after all etiologies for pulmonary hypertension have been excluded. Echocardiography has been proven to be an extremely useful tool for diagnosing HRPH, and Doppler echocardiography can be used to estimate systolic pulmonary artery pressure and to monitor the effects of therapy. Assessment of hemodynamic measures by catheterization remains, however, the best test for evaluating response to therapy. Cardiac catheterization is mandatory to characterize the disease and exclude an underlying cardiac shunt as etiology. Vasodilators have been extensively used in the treatment of pulmonary hypertension, since vasoconstriction is a determinant characteristic of this disease. However, HRPH remains a progressive disease for which treatment is often unsatisfactory and there is no cure. As new, more efficient antiretroviral treatment are introduced, clinicians should expect to encounter an increasing number of cases of pulmonary hypertension in HIV+ patients in the future.
The relationship between grade of pulmonary hypertension and factors associated with human immuno... more The relationship between grade of pulmonary hypertension and factors associated with human immunodeficiency virus among patients with HIV infection is poorly documented. This report documents the most extensive attempt made thus far to determine whether a relationship exists between degree of pulmonary hypertension and the following conditions: HIV risk factor, degree of immunosuppression, presence or absence of AIDS, and presence or absence of liver cirrhosis. A retrospective study involving a search of the published literature on primary pulmonary hypertension among HIV cases from 1987 to 1998, using the Medline and Aidsline databases was conducted.Patients for whom secondary causes of pulmonary hypertension could be excluded were selected, and the following information for each was recorded: age, gender, risk factors for HIV infection, HIV disease stage according to the Centers for Disease Control, previous oppor tunistic and neoplastic diseases, CD4+cell count (cells/L), presenc...
The purposes of this study were to analyze the prognostic significance of precordial ST segment d... more The purposes of this study were to analyze the prognostic significance of precordial ST segment depression and to determine whether thrombolytic therapy is effective for all patients with inferior acute myocardial infarction (AMI) or whether there is a different effectiveness for patients with concomitant anterior ST segment depression persisting for 24 hours or longer. Medical charts of 176 patients were studied. On the basis of ECG the patients were subclassified into three groups according to the presence, persistence, or absence of significant ST segment depression: Group 1: anterior ST segment depression persisting for less than 24 hours (45.4%); Group 2: anterior ST segment depression persisting for more than 24 hours (17.6%); Group 3: no anterior ST segment depression (37%). Age, Killip class, peak creatine kinase, hospital deaths, left ventricular ejection fraction, regional wall motion score, postinfarction angina, and ventricular/supraventricular arrhythmia of all patients were studied. Parameters of the three groups were compared: worse results were found in group 1 and the worst in group 2. This result is independent of thrombolytic therapy. Finally, the same parameters of thrombolyzed and nonthrombolyzed groups were compared: no statistically significant difference was observed. Among thrombolyzed patients the number of those with ST depression lasting more than 24 hours is lower than in nonthrombolyzed patients. It can be assumed that thrombolytic therapy in inferior AMI determines a shifting of patients from a worse prognosis group (ST segment depression persisting for more than 24 hours) to a better prognosis group (ST segment depression persisting for less than 24 hours).
Liver international : official journal of the International Association for the Study of the Liver, May 26, 2016
The proportion of HCV infected patients over age 65 years in Western countries is increasing. Thi... more The proportion of HCV infected patients over age 65 years in Western countries is increasing. This growth and the advent of new antiviral therapy bring into the question the real world efficacy and safety of the combination of Sofosbuvir (SOF) and Simeprevir (SMV) plus a flat dose of 800 mg/d ribavirin (RBV) in elderly patients with liver cirrhosis compared to younger patients. Retrospective observational multicenter real life investigation study of SOF/SMV/RBV for a duration of 12 weeks in HCV genotype 1-infected patients with liver cirrhosis. Of the 270 patients enrolled in the study, with compensated cirrhosis, 133 (49.2%) were ≥ 65 years of age. Sustained virological response at 12 weeks (SVR12) was achieved by 94.2% (129/137) of those aged < 65 years and 97.7% (130/133) of those ≥ 65 years. Diabetes was the most common comorbidity in patients ≥ 65 years compared to younger patients (26.3% vs 12.4% p<0.003). The most common adverse event (AE) in elderly patients was a grad...
World journal of gastrointestinal pathophysiology, Jan 15, 2014
To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenter... more To analyze the safety and the adequacy of a sample of liver biopsies (LB) obtained by gastroenterologist (G) and interventional radiologist (IR) teams. Medical records of consecutive patients evaluated at our GI unit from 01/01/2004 to 31/12/2010 for whom LB was considered necessary to diagnose and/or stage liver disease, both in the setting of day hospital and regular admission (RA) care, were retrieved and the data entered in a database. Patients were divided into two groups: one undergoing an ultrasonography (US)-assisted procedure by the G team and one undergoing US-guided biopsy by the IR team. For the first group, an intercostal approach (US-assisted) and a Menghini modified type needle 16 G (length 90 mm) were used. The IR team used a subcostal approach (US-guided) and a semiautomatic modified Menghini type needle 18 G (length 150 mm). All the biopsies were evaluated for appropriateness according to the current guidelines. The number of portal tracts present in each biopsy wa...
A highly sensitive nested PCR was carried out in order to detect 2 LTR circles as a marker of rec... more A highly sensitive nested PCR was carried out in order to detect 2 LTR circles as a marker of recent and ongoing viral replication in HIV-1 infected patients with HIV plasma RNA undetectable. This &quot;in house&quot; two-step nested PCR is very sensitive, but it is not feasible for routine tests and presents a high risk of contamination. In order to reduce the time of reactions and crossover contamination, the possibility was explored to carry out a single step nested PCR, in which the two successive amplification rounds are carried out in the same tube. This single step nested PCR has the same sensitivity of the two-step nested, is easy to conduct and requires a short time of reaction. The two different PCR methods were compared and the clinical use of monitoring 2 LTR DNA circles in HIV-1 infected patients with undetectable plasma viral load is discussed.
Human immunodeficiency virus (HIV)-related pulmonary hypertension (HRPR) is a cardiovascular comp... more Human immunodeficiency virus (HIV)-related pulmonary hypertension (HRPR) is a cardiovascular complication of HIV infection that has been recognized in the last years with increasing frequency. The etiology of HRPH is unknown. All the attempts to isolate HIV on pulmonary vessels in HRPH patients failed, and an indirect role for HIV in this disease has been hypothesized. Current theories on the pathogenesis focus on abnormalities of endothelial and smooth muscle cells of pulmonary vasculature. Endothelial and smooth muscle cell injury could be due to a high production or to a reduced clearance of cytokines in these patients. In fact, in several studies high levels of ET-1, IL-1alpha, IL-6 and PDGF in primary pulmonary hypertension (PPH) and in HRPH have been found. HIV gp 120 could induce the production of these cytokines by a stimulation of monocytes/macrophages. A high alpha1-adrenoreceptors stimulation of pulmonary vessels could be also implicated in the pathogenesis of HRPH. Chronic hypoxia is observed with increased frequency in HIV patients, and this could induce a chronic stimulation of alpha1-receptors of pulmonary vasculature with typical pathological changes. However, only a small percentage of HIV- patients develop HRPH. This observation suggests the existence of an idiosyncratic susceptibility to the development of vascular disease. This susceptibility could have a genetic basis, and might be determined by particular major histocompatibility complex alleles.
In recent years, much more thought has been given to the pathogenic role of HIV and to the clinic... more In recent years, much more thought has been given to the pathogenic role of HIV and to the clinical manifestations of HIV-related pulmonary hypertension (HRPH), which currently represents one of the most severe events during HIV disease. HRPH occurs in early and late stages of HIV infection and does not seem to be related to the degree of immune deficiency. Many of the symptoms in HRPH result from right ventricular dysfunction: the first clinical manifestation is effort intolerance and exertional dyspnea that will progress to the point of breathlessness at rest. The diagnosis of HRPH can be made only after all etiologies for pulmonary hypertension have been excluded. Echocardiography has been proven to be an extremely useful tool for diagnosing HRPH, and Doppler echocardiography can be used to estimate systolic pulmonary artery pressure and to monitor the effects of therapy. Assessment of hemodynamic measures by catheterization remains, however, the best test for evaluating response to therapy. Cardiac catheterization is mandatory to characterize the disease and exclude an underlying cardiac shunt as etiology. Vasodilators have been extensively used in the treatment of pulmonary hypertension, since vasoconstriction is a determinant characteristic of this disease. However, HRPH remains a progressive disease for which treatment is often unsatisfactory and there is no cure. As new, more efficient antiretroviral treatment are introduced, clinicians should expect to encounter an increasing number of cases of pulmonary hypertension in HIV+ patients in the future.
The relationship between grade of pulmonary hypertension and factors associated with human immuno... more The relationship between grade of pulmonary hypertension and factors associated with human immunodeficiency virus among patients with HIV infection is poorly documented. This report documents the most extensive attempt made thus far to determine whether a relationship exists between degree of pulmonary hypertension and the following conditions: HIV risk factor, degree of immunosuppression, presence or absence of AIDS, and presence or absence of liver cirrhosis. A retrospective study involving a search of the published literature on primary pulmonary hypertension among HIV cases from 1987 to 1998, using the Medline and Aidsline databases was conducted.Patients for whom secondary causes of pulmonary hypertension could be excluded were selected, and the following information for each was recorded: age, gender, risk factors for HIV infection, HIV disease stage according to the Centers for Disease Control, previous oppor tunistic and neoplastic diseases, CD4+cell count (cells/L), presenc...
The purposes of this study were to analyze the prognostic significance of precordial ST segment d... more The purposes of this study were to analyze the prognostic significance of precordial ST segment depression and to determine whether thrombolytic therapy is effective for all patients with inferior acute myocardial infarction (AMI) or whether there is a different effectiveness for patients with concomitant anterior ST segment depression persisting for 24 hours or longer. Medical charts of 176 patients were studied. On the basis of ECG the patients were subclassified into three groups according to the presence, persistence, or absence of significant ST segment depression: Group 1: anterior ST segment depression persisting for less than 24 hours (45.4%); Group 2: anterior ST segment depression persisting for more than 24 hours (17.6%); Group 3: no anterior ST segment depression (37%). Age, Killip class, peak creatine kinase, hospital deaths, left ventricular ejection fraction, regional wall motion score, postinfarction angina, and ventricular/supraventricular arrhythmia of all patients were studied. Parameters of the three groups were compared: worse results were found in group 1 and the worst in group 2. This result is independent of thrombolytic therapy. Finally, the same parameters of thrombolyzed and nonthrombolyzed groups were compared: no statistically significant difference was observed. Among thrombolyzed patients the number of those with ST depression lasting more than 24 hours is lower than in nonthrombolyzed patients. It can be assumed that thrombolytic therapy in inferior AMI determines a shifting of patients from a worse prognosis group (ST segment depression persisting for more than 24 hours) to a better prognosis group (ST segment depression persisting for less than 24 hours).
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