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9. Practice guidelines for the treatment of hepatitis C: recommendations from an AISF/SIMIT/SIMAST Expert Opinion Meeting

Author

Prati, D, Gasbarrini, A, Mazzotta, F, Sagnelli, E, Carosi, G, Abrescia, N, Alberti, Alfredo, Ambu, S, Andreone, P, Andriulli, A, Angelico, M, Antonucci, G, Ascione, A, Belli, Ls, Bruno, R, Bruno, S, Burra, Patrizia, Camma, C, Caporaso, N, Cariti, G, Cillo, U, Coppola, N, Craxi, A, DE LUCA, A, DE MARTIN, E, DI MARCO, V, Fagiuoli, S, Ferrari, C, Gaeta, Gb, Galli, M, Grieco, A, Grossi, P, Licata, A, Maida, I, Mangia, A, Marino, N, Maserati, R, Missale, G, Mondelli, M, Nasta, P, Niro, G, Persico, M, Petrelli, E, Picciotto, A, Piscaglia, F, Pollicino, T, Puoti, C, Puoti, M, Raimondo, G, Rumi, Mg, Santantonio, T, Smedile, A, Squadrito, G, Baroni, Gs, Taliani, G, Tavio, M, Toti, M, Bonino, F, Brunetto, Mr, Cacopardo, B, Caremani, M, Cauda, R, Colombo, M, DI PERRI, G, Donato, F, Farci, P, Fattovich, G, Filice, G, Ghinelli, F, Guadagnino, V, Lazzarin, A, Levrero, M, Licata, G, Orani, A, Paffetti, A, Pastore, G, Piccinino, F, Pizzigallo, E, Pontisso, Patrizia, Portelli, V, Rizzetto, M, Rossi, A, Stroffolini, T, Ubaldi, E, Santantanio, T, Alberti, A., Antonucci, Gf, Craxi, A., Prati D, Gasbarrini A, Mazzotta F, Sagnelli E, Carosi G, Abrescia N, Alberti A, Ambu S, Andreone P, Andriulli A, Angelico M, Antonucci GF, Ascione A, Belli LS, Bruno R, Bruno S, Burra P, Cammà, C, Caporaso N, Cariti G, Cillo U, Coppola N, Craxì, A, De Luca A, De Martin E, Di Marco, V, Fagiuoli S, Ferrari C, Gaeta GB, Galli M, Grieco A, Grossi P, Licata, A, Maida I, Mangia A, Marino N, Maserati R, Missale G, Mondelli M, Nasta P, Niro G, Persico M, Petrelli E, Picciotto A, Piscaglia F, Pollicino T, Prati D, Puoti C, Puoti M, Raimondo G, Rumi MG, Sagnelli E, Santantonio T, Smedile A, Squadrito G, Baroni GS, Taliani G, Tavio M, Toti M, Bonino F, Brunetto MR, Cacopardo B, Caremani M, Cauda R, Colombo M, Di Perri G, Donato F, Farci P, Fattovich G, Filice G, Ghinelli F, Guadagnino V, Lazzarin A, Levrero M, Licata G, Orani A, Paffetti A, Pastore G, Piccinino F, Pizzigallo E, Pontisso P, Portelli V, Rizzetto M, Rossi A, Stroffolini T, Ubaldi E., Italian Association for the Study of the Liver, Italian Society of Infectious, Tropical Disease, Italian Society for the Study of Sexually Transmitted Diseases: Prati D., Gasbarrini A., Mazzotta F., Sagnelli E., Carosi G., Abrescia N., Alberti A., Ambu S., Andreone P., Andriulli A., Angelico M., Antonucci G.F., Ascione A., Belli L.S., Bruno R., Bruno S., Burra P., Cammà C., Caporaso N., Cariti G., Cillo U., Coppola N., Craxì A., De Luca A., De Martin E., Di Marco V., Fagiuoli S., Ferrari C., Gaeta G.B., Galli M., Grieco A., Grossi P., Licata A., Maida I., Mangia A., Marino N., Maserati R., Missale G., Mondelli M., Nasta P., Niro G., Persico M., Petrelli E., Picciotto A., Piscaglia F., Pollicino T., Puoti C., Puoti M., Raimondo G., Rumi M.G., Santantonio T., Smedile A., Squadrito G., Baroni G.S., Taliani G., Tavio M., Toti M., Bonino F., Brunetto M.R., Cacopardo B., Caremani M., Cauda R., Colombo M., Di Perri G., Donato F., Farci P., Fattovich G., Filice G., Ghinelli F., Guadagnino V., Lazzarin A., Levrero M., Licata G., Orani A., Paffetti A., Pastore G., Piccinino F., Pizzigallo E., Pontisso P., Portelli V., Rizzetto M., Rossi A., Stroffolini T., Ubaldi E., Prati, D, Gasbarrini, A, Mazzotta, F, Sagnelli, E, Carosi, G, Abrescia, N, Alberti, A, Ambu, S, Andreone, P, Andriulli, A, Angelico, M, Antonucci, G, Ascione, A, Belli, L, Bruno, R, Bruno, S, Burra, P, Caporaso, N, Cariti, G, Cillo, U, Coppola, N, De Luca, A, De Martin, E, Fagiuoli, S, Ferrari, C, Gaeta, G, Galli, M, Grieco, A, Grossi, P, Maida, I, Mangia, A, Marino, N, Maserati, R, Missale, G, Mondelli, M, Nasta, P, Niro, G, Persico, M, Petrelli, E, Picciotto, A, Piscaglia, F, Pollicino, T, Puoti, C, Puoti, M, Raimondo, G, Rumi, M, Santantonio, T, Smedile, A, Squadrito, G, Baroni, G, Taliani, G, Tavio, M, Toti, M, Bonino, F, Brunetto, M, Cacopardo, B, Caremani, M, Cauda, R, Colombo, M, Di Perri, G, Donato, F, Farci, P, Fattovich, G, Filice, G, Ghinelli, F, Guadagnino, V, Lazzarin, A, Levrero, M, Licata, G, Orani, A, Paffetti, A, Pastore, G, Piccinino, F, Pizzigallo, E, Pontisso, P, Portelli, V, Rizzetto, M, Rossi, A, Stroffolini, T, and Ubaldi, E

Subjects
Liver Cirrhosis, ANTIVIRAL TREATMENT, Human immunodeficiency virus (HIV), HIV Infections, Hepacivirus, ANTIVIRAL THERAPY, PEGYLATED INTERFERON-ALPHA-2B, LIVER-TRANSPLANTATION, PEGINTERFERON ALPHA-2A, HIV-INFECTED PATIENTS, VIRUS-COINFECTED PATIENTS, RAPID VIROLOGICAL RESPONSE, Antiviral therapy, medicine.disease_cause, Gastroenterology, Polyethylene Glycols, HBV, guidelines, Acute hepatitis, Chronic hepatitis, Settore MED/12 - Gastroenterologia, liver transplantation, Hepatitis C, Recombinant Proteins, acute hepatitis, antiviral therapy, chronic hepatitis, cirrhosis, elderly patients, hbv, hcv, hdv, hiv, CLINICAL PRACTICE GUIDELINES, Cirrhosis, HCV, Drug Therapy, Combination, Antiviral therapy Acute hepatitis Chronic hepatitis,Cirrhosis, Elderly patients, HBV, HCV, HDV, HIV Liver transplantation, Elderly patient, Acute hepatiti, medicine.medical_specialty, Genotype, Alpha interferon, Interferon alpha-2, CHRONIC HEPATITIS C, Antiviral Agents, Hepatitis B, Chronic, Internal medicine, HDV, Drug Resistance, Viral, Ribavirin, medicine, Humans, Cirrhosi, Hepatology, business.industry, Settore MED/09 - MEDICINA INTERNA, Interferon-alpha, HIV, Hepatitis C, Chronic, medicine.disease, Elderly patients, Family medicine, Expert opinion, Chronic hepatiti, business
Abstract

It is increasingly clear that a tailored therapeutic approach to patients with hepatitis C virus infection is needed. Success rates in difficult to treat and low-responsive hepatitis C virus patients are not completely satisfactory, and there is the need to optimise treatment duration and intensity in patients with the highest likelihood of response. In addition, the management of special patient categories originally excluded from phase III registration trials needs to be critically re-evaluated. This article reports the recommendations for the treatment of hepatitis C virus infection on an individual basis, drafted by experts of three scientific societies.

Published
2010

11. Factors associated with access to antiviral treatment in a multicentre cross-sectional study of patients with chronic hepatitis B in Italy

Author

Antonucci G, Mazzotta F, Puoti M, Angeletti C, Girardi E, Santantonio T, Ambu S, Colucci M, Angarano G, Marino N, Rinaldi R, Bellissima P, Armignacco O, Carosi G, Sagnelli E, Coorte Epatiti B. SIMIT Group, GAETA, Giovanni Battista, Antonucci, G, Mazzotta, F, Puoti, M, Angeletti, C, Girardi, E, Santantonio, T, Ambu, S, Gaeta, Giovanni Battista, Colucci, M, Angarano, G, Marino, N, Rinaldi, R, Bellissima, P, Armignacco, O, Carosi, G, Sagnelli, E, and Coorte Epatiti B., SIMIT Group

Abstract

A multicentre cross-sectional survey was performed to provide an accurate picture of patients with chronic hepatitis B (CHB) cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes factors associated with access to the treatment of CHB in a country where barriers to treatment are not expected to exist because of comprehensive coverage under the National Health System (NHS). The study was performed in 74 IDCs. The analysis focused on 3305 patients with CHB of 3760 HBsAg-positive patients enrolled from March to September, 2008. To account for missing values, a Multiple Imputation method was used. Treatment was reported in 2091 (63.3%) patients. In the multivariate analysis, an increased chance of getting treatment was independently associated with 10 years increase of age at diagnosis (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1-1.3, P < 0.001), HBeAg positivity (aOR 1.8, 95% CI 1.1-2.8, P < 0.001), cirrhosis (aOR 3.6, 95% CI 2-6.3, P = 0.012), HDV (aOR 1.6, 95% CI 1.02-2.5, P = 0.042) and HIV positivity (aOR 6.5, 95% CI 4-10.8, P < 0.001). Conversely, a decreased chance was associated with female gender (aOR 0.6, 95% CI 0.5-0.7, P < 0.001), immigration (aOR 0.6, 95% CI 0.5-0.9, P = 0.009), alcohol consumption (aOR 0.7, 95% CI 0.5-0.98, P = 0.04) and HCV positivity (aOR 0.5, 95% CI 0.3-0.8, P = 0.005). Our study shows that Italian IDCs treat a high percentage of patients with CHB. Nevertheless, disparities exist which are not related to the severity of disease limiting access to antiviral therapy of CHB, even in a country with a universal healthcare system.

Published
2012

12. Predictability of sustained virological response to pegylated interferon alpha-2b Plus ribavirin therapy by week-8 viral response in HIV-positive patients with chronic hepatitis C virus infection

Author

Angeli E, Mainini A, Cargnel A, Uberti Foppa C, Orani A, Carbone R, Andreoni M, Schiavini M, Giorgi R, Rizzardini G, Gubertini G, ICoS 2 G.r.o.u.p. Azzini M, Mian P, Pristerà R, Quirino T, Sagnelli E, Pizzigallo E, Dalessandro M, Ghinelli F, Sighinolfi L, Leoncini F, Ambu S, Cancellieri C, Di Cesare S, Pagano G, Dodi F, Di Biagio A, Cassola G, Piscopo R, Benedetti M, Moroni M, Milazzo L, Lazzarin A, D'Arminio Monforte A, Bongiovanni M, Ferrari C, Degli Antoni A, Alberici F, Sacchini D, Menichetti F, Polidori M, Magnani G, Ursitti MA, Antonucci G, Rosati S, Narciso P, Bellagamba R, Babudieri S, Maida I, Grossi P, Tambini R., SAGNELLI, Caterina, Angeli, E, Mainini, A, Cargnel, A, Uberti Foppa, C, Orani, A, Carbone, R, Andreoni, M, Schiavini, M, Giorgi, R, Rizzardini, G, Gubertini, G, Azzini M, ICoS 2 G. r. o. u. p., Mian, P, Pristerà, R, Quirino, T, Sagnelli, E, Pizzigallo, E, Dalessandro, M, Ghinelli, F, Sighinolfi, L, Leoncini, F, Ambu, S, Cancellieri, C, Di Cesare, S, Pagano, G, Dodi, F, Di Biagio, A, Cassola, G, Piscopo, R, Benedetti, M, Moroni, M, Milazzo, L, Lazzarin, A, Sagnelli, Caterina, D'Arminio Monforte, A, Bongiovanni, M, Ferrari, C, Degli Antoni, A, Alberici, F, Sacchini, D, Menichetti, F, Polidori, M, Magnani, G, Ursitti, Ma, Antonucci, G, Rosati, S, Narciso, P, Bellagamba, R, Babudieri, S, Maida, I, Grossi, P, and Tambini, R.

Abstract

Chronic hepatitis C is frequent and aggressive in HIV-positive patients. Identification of early predictors of response to anti-HCV therapy is needed for a lower rate of response and higher discontinuations, compared to HCV mono-infected subjects. The aim of our study was to evaluate the predictive value of virological response (VR) at week 4-8-12 of Pegylated interferon alpha-2b (PEG-IFN) plus ribavirin (RBV) on sustained virological response (SVR) in HIV-HCV co-infected patients. 100 patients were treated with PEG-IFN (1.5 mcg/Kg/w) plus RBV (> or =10.6 mg/kg/d) and randomized for 24-48 or 48-72 weeks, respectively for genotype 2-3 and 1-4, in case of response (HCV-RNA PCR negativity) at the end of standard therapy (24 weeks for genotype 2-3, 48 weeks for genotype 1-4). Transcription-Mediated Amplification (TMA) assay for HCV-RNA was also applied. 27 patients reached end-of-treatment response (9 genotype 1-4, 18 genotype 2-3), 21 achieved SVR (8 genotype 1-4, 13 genotype 2-3). 35 patients dropped, 15 due to side-effects. SVR was statistically related to lower baseline HCV-RNA and to VR at week 4-8-12, with PPV 64%, 53% and 58%, and NPV 81%, 96% and 88%, respectively. In 27 patients, TMA was performed and confirmed standard PCR, except in two cases of relapse, who were PCR negative but TMA positive at week-12. In conclusion, VR at week 8 showed the highest NPV on SVR (96%). The study of viral kinetics requires further investigations in HIV-positive patients to guarantee a cost-effective therapy and to guide individually the duration of treatment. In this setting, TMA might be useful.

Published
2009

17. Replication capacity in relation to immunologic and virologic outcomes in HIV-1-infected treatment-naive subjects

Author

Skowron, G, Spritzler, Jg, Weidler, J, Robbins, Gk, Johnson, Va, Chan, Es, Asmuth, Dm, Gandhi, Rt, Lie, Y, Bates, M, Pollard, Rb, NIH/NIAID ACTG 384 Protocol Team, Monogram, Biosciences, Vella, S, Chiesi, C, Arcieri, R, Pirillo, Mf, Galluzzo, Cm, Pia Germinario EA, Amici, R, Marzi, M, Nobile, A, Di Nallo, R, Polizzi, C, Coronado, O, Fasulo, G, Carosi, Giampiero, Castelli, Francesco, Di Pietro, M, Vichi Ospedale, F, Sterrantino, G, Ambu, S, Cargnel, A, Meraviglia, P, Niero, F, Capetti, A, d'Arminio Monforte, A, Sollima, S, Balotta, C, Delia, S, Ciardi, M, Soranzo, Ml, Macor, A, D'Ettorre, G, Forcina, G, Bassetti, D, Di Biagio, A, Minoli, L, Maserati, R, Ghinelli, F, Sighinolfi, L, Riva, A, Scalise, G, Santoro, D, Rinaldi, E, Chiodo, F, Borderi, M, Guaraldi, G, Esposito, R, Ferrari, C, Pasetti, G, Abrescia, N, Busto, A, Chirianni, A, Gargiulo, M, Izzo, Cm, Sbreglia, C, Alberici, F, Sacchini, D, Magnani, G, and Zoboli, G.

Subjects
Adult, Male, medicine.medical_specialty, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Virus Replication, Gastroenterology, Virus, Article, Pharmacotherapy, Internal medicine, Immunopathology, medicine, Humans, Pharmacology (medical), Sida, Aged, biology, Middle Aged, Viral Load, biology.organism_classification, CD4 Lymphocyte Count, Infectious Diseases, Lentivirus, Immunology, HIV-1, Female, Viral disease, Viral load
Abstract

Objectives: To evaluate the association between baseline (BL) replication capacity (RC) (RC BL ) and immunologic/virologic parameters (at BL and after 48 weeks on therapy) in HIV-1-infected subjects initiating antiretroviral therapy. Methods: RC BL was determined using a modified Monogram PhenoSense HIV drug susceptibility assay on plasma HIV-1 from 321 treatment-naive subjects from AIDS Clinical Trials Group 384. Univariate and multivariable analyses were performed to determine the association of RC BL with BL and on-therapy virologic and immunologic outcomes. Results: Higher RC BL was associated with lower baseline CD4 (CD4 BL ) (r = -0.23, P < 0.0001), higher baseline HIV-1 RNA (r = 0.25, P < 0.0001), higher CD4 BL activation percent (r = 0.23, P < 0.0001), and lower CD4 BL memory count (r = -0.21, P = 0.0002). In a multivariable model, week 48 CD4 increase (ΔCD4 48 ) was associated with lower CD4 BL memory count and higher CD4 BL -naive percent (P = 0.004, P = 0.015, respectively). The interaction between CD4 BL and RC BL was significant (P = 0.018), with a positive association between RC BL and ΔCD4 48 in subjects with higher CD4 BL and a negative association at lower absCD4 BL . Conclusions: At baseline, higher RC was significantly associated with higher HIV-1 RNA, higher CD4 cell activation, lower CD4 cell count, and lower CD4 memory cell count. These factors may interact, directly or indirectly, to modify the extent to which CD4 recovery occurs in patients starting antiretroviral therapy at different CD4 BL counts.

Published
2009

22. Virologic and immunologic response to regimens containing nevirapine or efavirenz in combination with 2 nucleoside analogues in the Italian Cohort Naive Antiretrovirals (I.Co.N.A.) study

Author

Cozzi-Lepri, Alessandro, Phillips, Andrew N., D'Arminio Monforte, Antonella, Piersantelli, Nicoloò, Orani, Anna, Petrosillo, Nicola, Leoncini, Francesco, Scerbo, Antonio, Tundo, Paolo, Abrescia, Nicola, Montroni, M., Scalise, G., Costantini, Alessia, Del Prete, M. S., Tirelli, U., Nasti, G., Pastore, G., Ladisa, N., Perulli, L. M., Suter, F., Arici, C., Chiodo, F., Gritti, F. M., Colangeli, V., Fiorini, C., Guerra, L., Carosi, G., Cadeo, G. P., Castelli, F., Minardi, C., Vangi, D., Rizzardini, G., Migliorino, G., Manconi, P. E., Piano, P., Ferraro, T., Scerbo, A., Pizzigallo, E., Ricci, Fiammetta, Rinaldi, E., Pusterla, L., Carnevale, G., Galloni, D., Viganò, P., Mena, M., Ghinelli, F., Sighinolfi, L., Leoncini, F., Mazzotta, F., Ambu, S., Lo Caputo, S., Angarano, G., Grisorio, B., Ferrara, S., Grima, P., Tundo, P., Pagano, G., Piersantelli, N., Alessandrini, A., Piscopo, R., Toti, M., Chigiott, S., Soscia, F., Tacconi, L., Orani, A., Castaldo, G., Scasso, A., Vincenti, A., Scalzini, A., Alessi, F., Moroni, M., Lazzarin, A., Cargnel, A., Vigevani, G. M., Caggese, L., d’Arminio Monforte, A., Bongiovanni, M., Novati, R., Delfanti, F., Merli, S., Pastecchia, C., Moioli, C., Esposito, R., Mussini, C., Abrescia, N., Chirianni, A., Izzo, OMAR CARLO ENRICO, Piazza, M., De Marco, M., Montesarchio, V., Manzillo, E., Nappa, S., Colomba, A., Abbadessa, V., Prestileo, T., Mancuso, S., Filice, G., Minoli, L., Bruno, R., Maserati, R., Pauluzzi, S., Tosti, A., Alberici, F., Sisti, M., Menichetti, F., Smorfa, A., De Stefano, C., Lagala, A., Zauli, T., Ballardini, G., Bonazzi, L., Ursitti, M. A., Ciammarughi, R., Ortolani, P., Ortona, L., Dianzani, F., Antinori, A., Antonucci, G., D’Elia, S., Ippolito, G., Narciso, P., Petrosillo, N., Rezza, G., Vullo, V., De Luca, A., Del Forno, A., Capobianchi, M. R., Zaccarelli, M., De Longis, P., Ciardi, M., Girardi, E., D’Offizi, G., Noto, P., Pezzotti, P., Bugarini, R., Lichter, M., Mura, M. S., Mannazzu, M., Caramello, P., Caramello, A., Soranzo, M. L., Gennero, L., Sciandra, M., Salassa, B., Grossi, P. A., Basilico, C., Poggio, A., Bottari, G., Raise, E., Pasquinucci, S., De Lalla, F., Tositti, G., Resta, F., and Chimienti, A.

Subjects
Cyclopropanes, Adult, Male, medicine.medical_specialty, Efavirenz, Nevirapine, Settore MED/17 - Malattie Infettive, Adolescent, Antiretroviral Therapy, Pharmacology, Efficacy, Cohort Studies, chemistry.chemical_compound, Drug Therapy, Antiretroviral Therapy, Highly Active, Internal medicine, Oxazines, medicine, Humans, Immunology and Allergy, Highly Active, Viral, Sida, Aged, Acquired Immunodeficiency Syndrome, biology, Reverse-transcriptase inhibitor, business.industry, Middle Aged, biology.organism_classification, Confidence interval, Benzoxazines, CD4 Lymphocyte Count, Infectious Diseases, chemistry, Alkynes, Cohort, Combination, RNA, Viral, RNA, Drug Therapy, Combination, Female, business, Cohort study, medicine.drug
Abstract

This nonrandomized study compared the virologic and immunologic responses to potent regimens containing either efavirenz or nevirapine after considering potential systematic differences between patients receiving these drugs. Virologic failure was defined as the first of 2 consecutive measurements of virus load >500 human immunodeficiency virus RNA copies/mL. Of the 694 patients included in the analysis, 460 (66.3%) started nevirapine and 234 (33.7%) started efavirenz. The adjusted relative hazard of virologic failure for patients who started nevirapine, compared with those who started efavirenz, was 2.08 (95% confidence interval, 1.37-3.15; P=.0006). In addition, patients receiving efavirenz tended to recover 5 CD4 cells/microL more per quarter (P=.05). Although comparisons of drug efficacy in nonrandomized studies should be viewed with caution, no results from randomized controlled comparisons of these drugs are thought to be available. The findings of this study are in agreement with those of other observational studies.

Published
2002

23. Lo studio di coorte I.CO.N.A. (Italian CohOrt Naive Antiretrovirals): caratteristiche all’arruolamento dei primi 1676 soggetti

Author

DARMINIO MONFORTE, A, Arici, C, Ippolito, G., Rezza, G., Angarano, G., Carosi, G., Vhiodo, F., Dianzani, F., Di Luzio Paparatti, U., Lazzarin, A., Ortona, L., Garattini, L., Musicco, M., Pezzotti, P., Vella, S., Abrescia, N., Aceti, A., Alberici, F., Armignacco, O., Bonazzi, L., Cadeo, G. P., Cadrobbi, P., Caggese, L., Cargnel, A., Carnevale, G., Chirianni, A., Ciammarughi, R., Colomba, A., D'Amato, C., De Lalla, F., D'Elia, S., Dealla Santa, M., De Rienzo, B., De Stefano, C., Ferraro, T., Filice, G., Fiori, G. P., Gavazzeni, G., Ghinelli, F., Gioannini, P., Grilone, W., Grima, P., Grisorio, B., Gritti, F. M., Leoncini, F., Manconi, P. E., Mazzotta, F., Milazzo, F., Minoli, L., Montroni, M., Narciso, P., Orani, A., Pauluzzi, S., Piazza, M., Piersantelli, N., Pizzigallo, E., Poggio, A., Reaise, E., Ranieri, S., Resta, F., Rizzo, F., Rosci, M. A., Scalise, G., Scalzini, A., Scasso, A., Soranzo, M. L., Soscia, F., Suter, F., Tirelli, U., Toti, M., Viganò, P., Vigevani, G. M., Vullo, V., Ravasio, L., Girardi, E., Federico, M. D., Castelli, Francesco, Colangeli, V., Capobianchi, M., Sinnone, M. S., Antinori, A., Boccia, L., Mannazzu, M., Sisti, M., DE LOngis, P., Ursitti, M. A., Vangi, D., Scaggiante, R., Moioli, M. C., Adriani, B., Pan, A., Montesarchio, M., Arlotti, M., Prestileo, T., Palmieri, F., Franzetti, M., Ciardi, M., Smorfa, A., Mussini, C., Armignacco, L., Cosco, L., Patruno Savino, F. A., Torre, D., Sighinolfi, L., Sciandra, M., Giacobbi, D., Tundo, P., Ferrara, S., Guerra, L., Ambu, S., Piano, P., Lo Caputo, S., Rizzardini, G., Maserati, R., Costantini, A., D'Offizi, G. P., Castaldo, G., Tosti, A., Nappa, S., Piscopo, R., Ricci, F., Bottari, V., Pasquinucci, S., Ballardini, G., Chimienti, A., Alessandrini, A., Zaccarelli, M., Del Prete, M. S., Costa, P., Vincenti, A., Salassa, B., Tacconi, L., Bottura, P., Nasti, G., Incandela, L., Ghiselli, G. C., Pusterla, L., Lichtner, M., and Moroni, M.

Published
1997

35. The morphological characteristics of the sparganum stage of the Malaysian Spirometra species.

Author

Kavana, N. J., Lim, L. H. S., and Ambu, S.

Subjects
TAPEWORMS, PSEUDOPHYLLIDEA, SPECIES, MORPHOLOGY
Abstract

Background: The present study describes the morphology of sparganum (larva) of the Malaysian Spirometra spp. collected from naturally infected frogs (Rana cancrivora) from rice fields in Tanjung Karang, Malaysia. Materials and Methods: Spargana of Spirometra spp. collected from naturally infected frogs (Rana cancrivora) were used for the morphological studies. Stretched on a metal ruler, measurements of the worm were recorded. Specimens were stained in Alum-carmine. Results: The length of the body ranged from 11-50 mm and the width ranged from 0.5-1.5 mm. Specimens stained with Alum-carmine showed ridges (formation of segments) on the surface of the body, and no sexual organs in the body. Conclusion: The Malaysian Spirometra spp. are similar in measurement and morphology to Spirometra erinacei but further studies are required for confirmation. [ABSTRACT FROM AUTHOR]

Published
2015

37. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz

Author

van Leth, Frank, Conway, Brian, Laplumé, Hector, Martin, Des, Fisher, Martin, Jelaska, Ante, Wit, Ferdinand W, Lange, Joep MA, Laplumé, H, Lasala, MB, Losso, MH, Bogdanowicz, E, Lattes, R, Krolewiecki, A, Zala, C, Orcese, C, Terlizzi, S, Duran, A, Ebensrteijn, J, Bloch, M, Russell, O, Russell, DB, Roth, NR, Eu, B, Austin, D, Gowers, A, Quan, D, Demonty, J, Peleman, R, Vandercam, B, Vogelaers, D, van der Gucht, B, van Wanzeele, F, Moutschen, MM, Badaro, R, Grinsztejn, B, Schechter, M, Uip, D, Netto, EN, Coelho, SS, Badaró, F, Pilotto, JH, Schubach, A, Barros, ML, Leite, OHM, Kiffer, CRV, Wunsch, CT, Nunes, D, Catalani, A, de Cassia Alves, Lira R, Dossin, TJ, D'Alló de Oliveira, MT, Martini, S, Conway, B, de Wet, JJ, Montaner, JSG, Murphy, C, Woodfall, B, Sestak, P, Phillips, P, Montessori, V, Harris, M, Tesiorowski, A, Willoughby, B, Voigt, R, Farley, J, Reynolds, R, Devlaming, S, Livrozet, JM, Rozenbaum, W, Sereni, D, Valantin, MA, Lascoux, C, Milpied, B, Brunet, C, Billaud, E, Huart, A, Reliquet, V, Charonnat, MF, Sicot, M, Esnault, JL, Slama, L, Staszewski, S, Bickel, M, Lazanas, MK, Stavrianeas, N, Mangafas, N, Zagoreos, I, Kourkounti, S, Paparizos, V, Botsi, Ch, Clarke, S, Brannigan, E, Boyle, N, Chiriani, A, Leoncini, F, Montella, F, Francesco, L, Ambu, S, Farese, A, Gargiulo, M, Di Sora, F, Lavria, F, Folgori, F, Beniowski, M, Boron Kaczmarska, A, Halota, W, Prokopowicz, D, Bander, DB, Leszuzyszyn-Pynka, MLP, Wnuk, AW, Bakowska, E, Pulik, P, Flisiak, R, Wiercinska-Drapalo, A, Mularska, E, Witor, A, Antunes, F, Sarmento, RSE, Doroana, M, Horta, AA, Vasconcelos, O, Andrews, SM, Huisamen, CB, Johnson, D, Martin, O, Bekker, L-G, Maartens, G, Wilson, D, Visagie, CJ, David, NJ, Rattley, M, Nettleship, E, Martin, DJ, Keyser, V, Moraites, TM, Moorhouse, MA, Pitt, JA, Orrell, CJ, Bester, C, Parboosing, R, Moodley, P, Gathiram, V, Woolf, D, Bernasconi, E, Magenta, L, Cardiello, P, Kroon, E, Ungsedhapand, C, Fisher, M, Wilkins, EGL, Stockwell, E, Day, J, Daintith, RS, Perry, N, Timaeus, C, Intosh-Roffet, J Mc, Powell, A, Youle, M, Tyrer, M, Madge, S, Drinkwater, A, Cuthbertson, Z, Carroll, A, Becker, S, Katner, H, Rimland, D, Saag, MS, Thompson, M, Witt, M, Aguilar, MM, LaVoy, A, Illeman, M, Guerrero, M, Gatell, J, Belsey, E, Hirschel, B, Potarca, A, Cronenberg, M, Kreekel, L, Meester, R, Khodabaks, J, Botma, H-J, Esrhir, N, Farida, I, Feenstra, M, Jansen, K, Klotz, A, Mulder, M, Ruiter, G, Bass, CB, Pluymers, E, de Vlegelaer, E, Leeneman (VCL), R, Carlier, H, van Steenberge, E, and Hall, D

Abstract

Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL).Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine.Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance.Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV (P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively (P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) =100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event.Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.

Published
2004
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38. Impact of Mutations Conferring Reduced Susceptibility to Lamivudine on the Response to Antiretroviral Therapy

Author

Perno, Carlo Federico, Cozzi-Lepri, Alessandro, Balotta, Claudia, Forbici, Federica, Violin, Michela, Bertoli, Ada, Facchi, Guido, Pezzotti, Patrizio, Angarano, Gioacchino, Arici, Claudio, Narciso, Pasquale, Orani, Anna, Raise, Enzo, Scalzini, Alfredo, Poggio, Antonio, Ippolito, Giuseppe, Moroni, Mauro, Monforte, Antonella d'Arminio, Montroni, M, Scalise, G, Costantini, A, Del Prete, MS, Tirelli, U, Nasti, G, Pastore, G, Perulli, LM, Suter, F, Arici, C, Chiodo, F, Gritti, FM, Colangeli, V, Fiorini, C, Guerra, L, Carosi, G, Cadeo, GP, Castelli, F, Minardi, C, Vangi, D, Rizzardini, G, Migliorino, G, Manconi, PE, Piano, P, Ferraro, T, Cosco, L, Pizzigallo, E, Ricci, F, Vigevani, GM, Pusterla, L, Carnevale, G, Pan, A, Viganò, P, Mena, M, Ghinelli, F, Sighinolfi, L, Leoncini, F, Mazzotta, F, Ambu, S, Lo Caputo, S, Angarano, G, Grisorio, B, Ferrara, S, Grima, P, Tundo, P, Pagano, G, Piersantelli, N, Alessandrini, A., Piscopo, R., Toti, M, Chigiotti, Soscia, F, Tacconi, L, Orani, A, Castaldo, G, Scasso, A, Vincenti, A, Scalzini, A, Alessi, F, Moroni, M, Lazzarin, A, Cargnel, A, Milazzo, F, Caggese, L, Monforte, A d'Arminio, Melzi, S, Delfanti, F, Carini, B, Adriani, B, Garavaglia, S, Moioli, C, Esposito, R, Mussini, C, Abrescia, N, Chirianni, A, Perrella, O, Piazza, M, De Marco, M, Montesarchio, V, Manzillo, E, Nappa, S, Cadrobbi, P, Scaggiante, R, Colomba, A, Abbadesse, V, Prestileo, T, Mancuso, S, Filice, G, Minoli, L, Savino, FA Patruno, Maserati, R, Pauluzzi, S, Baldelli, F, Petrelli, E, Ciotti, A, Alberici, F, Sisti, M, Menichetti, F, Smorfa, A, De Stefano, C, La Gala, A, Zauli, T, Ballardini, G, Bonazzi, L, Ursitti, MA, Ciammarughi, R, Giordani, S, Ortona, L, Dianzani, F, Ippolito, G, Antinori, A, Antonucci, G, D'Elia, S, Narciso, P, Petrosillo, N, Vullo, V, De Luca, A, Del Forno, A, Zaccarelli, M, De Longis, P, Ciardi, M, D'Offizi, G, Palmieri, F, Lichter, M, Capobianchi, MR, Girardi, E, Pezzotti, P, Rezza, G, Mura, MS, Mannazzu, M, Caramello, P, Sinicco, A, Soranzo, ML, Quaglia, S, Sciandra, M, Salassa, B, Torre, D, Basilico, C, Poggio, A, Bottari, G, Raise, E, Pasquinucci, S, De Lalla, F, Tositti, G, Resta, F, Chimienti, A, Lepri, A Cozzi, and Phillips, AN

Published
2001
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39. The management of hepatitis B virus/HIV-1 co-infected patients starting their first HAART regimen. Treating two infections for the price of one drug?

Author

Puoti, M., Cozzi-Lepri, A., Ancarani, F., Raffaele Bruno, Ambu, S., Ferraro, T., Tundo, P., Santantonio, T., Toti, M., Bonasso, M., D Arminio Monforte, A., Puoti M., Cozzi-Lepri A., Ancarani F., Bruno R., Ambu S., Ferraro T., Tundo P., Santantonio T., Toti M., d'Arminio Monforte A. HepaI.CoNa, and Verucchi G. (Bologna)

Subjects
HAART, HBV, HIV, CHRONIC HEPATITIS B, HIV/HBV

41. Impact of mutations conferring reduced susceptibility to lamivudine on the response to antiretroviral therapy

Author

Perno, C. F., Cozzi-Lepri, A., Balotta, C., Forbici, F., Violin, M., Bertoli, A., Facchi, G., Pezzotti, P., Angarano, G., Arici, C., Narciso, P., Orani, A., Raise, E., Scalzini, A., Poggio, A., Ippolito, G., Moroni, M., D Arminio Monforte, A., Montroni, M., Scalise, G., Costantini, A., Del Prete, M. S., Tirelli, U., Nasti, G., Pastore, G., Perulli, L. M., Suter, F., Chiodo, F., Gritti, F. M., Colangeli, V., Fiorini, C., Guerra, L., Carosi, G., Cadeo, G. P., Francesco Castelli, Minardi, C., Vangi, D., Rizzardini, G., Migliorino, G., Manconi, P. E., Piano, P., Ferraro, T., Cosco, L., Pizzigallo, E., Ricci, F., Vigevani, G. M., Pusterla, L., Carnevale, G., Pan, A., Viganò, P., Mena, M., Ghinelli, F., Sighinolfi, L., Leoncini, F., Mazzotta, F., Ambu, S., Lo Caputo, S., Grisorio, B., Ferrara, S., Grima, P., Tundo, P., Pagano, G., Piersantelli, N., Alessandrini, A., Piscopo, R., Toti, M., Chigiotti, Soscia, F., Tacconi, L., Castaldo, G., Scasso, A., Vincenti, A., Scalzini, F., and Alessi, F.

44. The influence of thyroxine and propyl thiouracil on Parastrongylus malaysiensis infection in rats.

Author

Kamis, A., Ahmad, R., Chang, J., and Ambu, S.

Abstract

Daily intramuscular injection with thyroxine (T4) at a dose of 2.5 μg/100 g body weight decreased the larvae and adult worm burden of Parastrongylus malaysiensis in the brain and pulmonary arteries of male Sprague-Dawley albino rats. In contrast, rats treated with propyl thiouracil (PTU), an antithyroid drug, at a dose of 3.75 mg/100 g body weight retained greater numbers of larvae and adult worms. The results may reflect the contrasting immunomodulatory effects of T4 and PTU that influence the susceptibility of the host. [ABSTRACT FROM AUTHOR]

Published
1994
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45. Protective effects of madecassoside, a triterpenoid from Centella asiatica , against oxidative stress in INS-1E cells.

Author

Tan SC, Rajendran R, Bhattamisra SK, Krishnappa P, Davamani F, Chitra E, Ambu S, Furman B, and Candasamy M

Abstract

Progressive decline in β cell function and reduction in the β cell mass is important in type 2 diabetes. Here, we tested the hypothesis that madecassoside's previously demonstrated in vivo protective effects on the β cell in experimental diabetes were exerted directly. We investigated the effects of madecassoside in protecting a β cell line (INS-1E) against a variety of agents. INS-1E cells were treated with madecassoside in the presence of high glucose (HG), a cytokine mixture, hydrogen peroxide (H 2 O 2 ), or streptozotocin (STZ). HG, the cytokine mixture, H 2 O 2 and STZ each produced a significant decrease in cell viability; this was significantly reversed by madecassoside. Pre-treatment with madecassoside reduced the number of apoptotic cells induced by HG, the cytokine mixture, H 2 O 2, and STZ, and concentration-dependently reduced ROS production. Madecassoside also significantly enhanced glucose-induced insulin secretion. The results suggest that madecassoside's in vivo effects are exerted directly on the β cell.

Published
2024
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46. Effect of madecassoside in reducing oxidative stress and blood glucose in streptozotocin-nicotinamide-induced diabetes in rats.

Author

Tan SC, Rajendran R, Bhattamisra SK, Krishnappa P, Davamani F, Chitra E, Ambu S, Furman B, and Candasamy M

Subjects
Rats, Animals, Blood Glucose, Niacinamide pharmacology, Streptozocin pharmacology, Rats, Wistar, Oxidative Stress, Antioxidants pharmacology, Antioxidants metabolism, Hypoglycemic Agents pharmacology, Plant Extracts pharmacology, Plant Extracts chemistry, Diabetes Mellitus, Experimental chemically induced, Diabetes Mellitus, Experimental drug therapy, Triterpenes pharmacology, Insulins pharmacology
Abstract

Objectives: Madecassoside (MAD) is a triterpenoid constituent of Centella asiatica (L.) Urb., an ethnomedical tropical plant, extracts of which were shown to reduce blood glucose in experimental diabetes. This study examines MAD for its anti-hyperglycaemic effects and tests the hypothesis that it reduces the blood glucose in experimentally induced diabetic rats by protecting the β-cells., Methods: Diabetes was induced using streptozotocin (60 mg/kg, i.v.) followed by nicotinamide (210 mg/kg, intraperitoneal (i.p.)). MAD (50 mg/kg) was administered orally for 4 weeks, commencing 15 days after induction of diabetes; resveratrol (10 mg/kg) was used as a positive control. Fasting blood glucose, plasma insulin, HbA1c, liver and lipid parameters were measured, along with antioxidant enzymes and malondialdehyde as an index of lipid peroxidation; histological and immunohistochemical studies were also undertaken., Key Findings: MAD normalized the elevated fasting blood glucose levels. This was associated with increased plasma insulin concentrations. MAD alleviated oxidative stress by improving enzymatic antioxidants and reducing lipid peroxidation. Histopathological examination showed significant recovery of islet structural degeneration and an increased area of islets. Immunohistochemical staining showed increased insulin content in islets of MAD-treated rats., Conclusions: The results demonstrate an antidiabetic effect of MAD associated with preservation of β-cell structure and function., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2023
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47. Inhibition of breast cancer xenografts in a mouse model and the induction of apoptosis in multiple breast cancer cell lines by lactoferricin B peptide.

Author

Rahman R, Fonseka AD, Sua SC, Ahmad M, Rajendran R, Ambu S, Davamani F, Khoo AS, and Chitra E

Subjects
Animals, Antineoplastic Agents pharmacology, Cell Line, Female, Humans, Lactoferrin pharmacology, MCF-7 Cells, Mice, Mice, Inbred NOD, Mice, SCID, Antineoplastic Agents therapeutic use, Apoptosis drug effects, Lactoferrin therapeutic use, Mammary Neoplasms, Experimental drug therapy
Abstract

Breast cancer has a diverse aetiology characterized by the heterogeneous expression of hormone receptors and signalling molecules, resulting in varied sensitivity to chemotherapy. The adverse side effects of chemotherapy coupled with the development of drug resistance have prompted the exploration of natural products to combat cancer. Lactoferricin B (LfcinB) is a natural peptide derived from bovine lactoferrin that exhibits anticancer properties. LfcinB was evaluated in vitro for its inhibitory effects on cell lines representing different categories of breast cancer and in vivo for its suppressive effects on tumour xenografts in NOD-SCID mice. The different breast cancer cell lines exhibited varied levels of sensitivity to apoptosis induced by LfcinB in the order of SKBR3>MDA-MB-231>MDA-MB-468>MCF7, while the normal breast epithelial cells MCF-10A were not sensitive to LfcinB. The peptide also inhibited the invasion of the MDA-MB-231 and MDA-MB-468 cell lines. In the mouse xenograft model, intratumoural injections of LfcinB significantly reduced tumour growth rate and tumour size, as depicted by live imaging of the mice using in vivo imaging systems (IVIS). Harvested tumour volume and weight were significantly reduced by LfcinB treatment. LfcinB, therefore, is a promising and safe candidate that can be considered for the treatment of breast cancer., (© 2021 The Authors. Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.)

Published
2021
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48. Association between long-term exposure to ambient air pollution and prevalence of diabetes mellitus among Malaysian adults.

Author

Wong SF, Yap PS, Mak JW, Chan WLE, Khor GL, Ambu S, Chu WL, Mohamad MS, Ibrahim Wong N, Ab Majid NL, Abd Hamid HA, Rodzlan Hasani WS, Mohd Yussoff MFB, Aris HTB, Ab Rahman EB, and M Rashid ZB

Subjects
Adult, Aged, Aged, 80 and over, Air Pollutants analysis, Diabetes Mellitus etiology, Female, Humans, Malaysia epidemiology, Male, Middle Aged, Particulate Matter analysis, Prevalence, Young Adult, Air Pollution adverse effects, Diabetes Mellitus epidemiology, Environmental Exposure adverse effects
Abstract

Background: Malaysia has the highest rate of diabetes mellitus (DM) in the Southeast Asian region, and has ongoing air pollution and periodic haze exposure., Methods: Diabetes data were derived from the Malaysian National Health and Morbidity Surveys conducted in 2006, 2011 and 2015. The air pollution data (NO x , NO 2 , SO 2 , O 3 and PM 10 ) were obtained from the Department of Environment Malaysia. Using multiple logistic and linear regression models, the association between long-term exposure to these pollutants and prevalence of diabetes among Malaysian adults was evaluated., Results: The PM 10 concentration decreased from 2006 to 2014, followed by an increase in 2015. Levels of NO x decreased while O 3 increased annually. The air pollutant levels based on individual modelled air pollution exposure as measured by the nearest monitoring station were higher than the annual averages of the five pollutants present in the ambient air. The prevalence of overall diabetes increased from 11.4% in 2006 to 21.2% in 2015. The prevalence of known diabetes, underdiagnosed diabetes, overweight and obesity also increased over these years. There were significant positive effect estimates of known diabetes at 1.125 (95% CI, 1.042, 1.213) for PM 10 , 1.553 (95% CI, 1.328, 1.816) for O 3 , 1.271 (95% CI, 1.088, 1.486) for SO 2 , 1.124 (95% CI, 1.048, 1.207) for NO 2 , and 1.087 (95% CI, 1.024, 1.153) for NO x for NHMS 2006. The adjusted annual average levels of PM 10 [1.187 (95% CI, 1.088, 1.294)], O 3 [1.701 (95% CI, 1.387, 2.086)], NO 2 [1.120 (95% CI, 1.026, 1.222)] and NO x [1.110 (95% CI, 1.028, 1.199)] increased significantly from NHMS 2006 to NHMS 2011 for overall diabetes. This was followed by a significant decreasing trend from NHMS 2011 to 2015 [0.911 for NO 2 , and 0.910 for NO x ]., Conclusion: The findings of this study suggest that long-term exposure to O 3 is an important associated factor of underdiagnosed DM risk in Malaysia. PM 10 , NO 2 and NO x may have mixed effect estimates towards the risk of DM, and their roles should be further investigated with other interaction models. Policy and intervention measures should be taken to reduce air pollution in Malaysia.

Published
2020
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49. Association between dietary patterns and overweight risk among Malaysian adults: evidence from nationally representative surveys.

Author

Shyam S, Khor GL, Ambak R, Mahadir B, Hasnan M, Ambu S, Chu WL, and Aris T

Subjects
Adolescent, Adult, Body Mass Index, Carbonated Beverages statistics & numerical data, Cross-Sectional Studies, Diet, Western statistics & numerical data, Female, Humans, Income, Malaysia epidemiology, Male, Meat statistics & numerical data, Middle Aged, Nutrition Surveys, Risk Factors, Rural Population, Vegetables, Young Adult, Diet statistics & numerical data, Feeding Behavior, Obesity epidemiology, Overweight epidemiology
Abstract

Objective: To investigate the association between dietary patterns (DP) and overweight risk in the Malaysian Adult Nutrition Surveys (MANS) of 2003 and 2014., Design: DP were derived from the MANS FFQ using principal component analysis. The cross-sectional association of the derived DP with prevalence of overweight was analysed., Setting: Malaysia., Participants: Nationally representative sample of Malaysian adults from MANS (2003, n 6928; 2014, n 3000)., Results: Three major DP were identified for both years. These were 'Traditional' (fish, eggs, local cakes), 'Western' (fast foods, meat, carbonated beverages) and 'Mixed' (ready-to-eat cereals, bread, vegetables). A fourth DP was generated in 2003, 'Flatbread & Beverages' (flatbread, creamer, malted beverages), and 2014, 'Noodles & Meat' (noodles, meat, eggs). These DP accounted for 25·6 and 26·6 % of DP variations in 2003 and 2014, respectively. For both years, Traditional DP was significantly associated with rural households, lower income, men and Malay ethnicity, while Western DP was associated with younger age and higher income. Mixed DP was positively associated with women and higher income. None of the DP showed positive association with overweight risk, except for reduced adjusted odds of overweight with adherence to Traditional DP in 2003., Conclusions: Overweight could not be attributed to adherence to a single dietary pattern among Malaysian adults. This may be due to the constantly morphing dietary landscape in Malaysia, especially in urban areas, given the ease of availability and relative affordability of multi-ethnic and international foods. Timely surveys are recommended to monitor implications of these changes.

Published
2020
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50. Focal spleen lesions in visceral leishmaniasis, a neglected manifestation of a neglected disease: report of three cases and systematic review of literature.

Author

Rinaldi F, Giachè S, Spinicci M, Corsi P, Ambu S, Gianfaldoni G, Rigacci L, Arena U, Bartoloni A, and Zammarchi L

Subjects
Adult, Diagnosis, Differential, Humans, Italy, Leishmaniasis, Visceral diagnostic imaging, Male, Middle Aged, Neglected Diseases diagnostic imaging, Spleen diagnostic imaging, Splenic Diseases diagnostic imaging, Leishmaniasis, Visceral pathology, Neglected Diseases pathology, Spleen pathology, Splenic Diseases pathology
Abstract

Background: The Mediterranean area is endemic for the zoonotic form of visceral leishmaniasis (VL) caused by Leishmania infantum, a species which has been recently associated with unexpected epidemiological and clinical features., Method: We report the result of a systematic review of the literature on VL unusually presenting with spleen focal lesions, including three previously unpublished cases., Results: A total of 28 cases of VL with multiple spleen focal lesions were retrieved. Twenty-six (93%) were acquired in the Mediterranean area, where L. infantum is endemic. Thirteen cases were diagnosed in children, and the remaining 15 cases in middle-aged adults, of whom 9 were immunosuppressed. Four patients (14%) underwent diagnostic splenectomy, while the diagnosis was confirmed by less invasive techniques in the remaining patients. The most common radiological patterns were: multiple subcentimetric or centimetric spleen lesions (size ≤ 1 cm in 14 of 19 cases, 74%), hypoechoic at ultrasonography (25 of 26 cases, 99%) and hypodense at CT scan (9 of 10 cases, 90%). PET-CT (available for four patients) showed an intense FDG spleen uptake. MRI and contrast-enhanced ultrasonography, available for two and one cases each, showed complex patterns., Conclusions: VL must be added to the list of possible differential diagnosis of spleen focal lesions and health care provider awareness about this condition will avoid unnecessary invasive diagnostic procedures.

Published
2019
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