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1. Clinical management of older, frail patients with atrial fibrillation. The proposal of a multidisciplinary working group

Author

Marchionni, N, Fumagalli, S, Bo, M, Boccanelli, A, Boriani, G, Rubboli, A, Violi, F, Di Pasquale, G, Beer, B, Colonna, P, Manetti, L, Pilleri, A, Purificato, F, Ruotolo, G, Sciacqua, A, Taberini, L, Turcato, E, Bozzato, S, Catanzariti, D, Felici, M, Florio, C, Fontana, F, Giomi, A, Masala, R, Mascia, G, Nassiacos, D, Nesti, M, Okoye, C, Pestelli, G, Bassi, V, Curci, S, D'Avino, M, Doimo, S, Faustino, M, Gemmiti, M, Pignatelli, P, Sarli, G, Stefanoni, P, Ciccone, M, Diemberger, I, Gragnano, F, Serafini, F, Marchionni N., Fumagalli S., Bo M., Boccanelli A., Boriani G., Rubboli A., Violi F., Di Pasquale G., Beer B., Colonna P., Manetti L. L., Pilleri A., Purificato F., Ruotolo G., Sciacqua A., Taberini L., Turcato E., Bozzato S., Catanzariti D., Felici M., Florio C., Fontana F., Giomi A., Masala R., Mascia G., Nassiacos D., Nesti M., Okoye C., Pestelli G., Bassi V., Curci S., D'Avino M., Doimo S., Faustino M., Gemmiti M. P., Pignatelli P., Sarli G., Stefanoni P., Ciccone M., Diemberger I., Gragnano F., Serafini F., Marchionni, N, Fumagalli, S, Bo, M, Boccanelli, A, Boriani, G, Rubboli, A, Violi, F, Di Pasquale, G, Beer, B, Colonna, P, Manetti, L, Pilleri, A, Purificato, F, Ruotolo, G, Sciacqua, A, Taberini, L, Turcato, E, Bozzato, S, Catanzariti, D, Felici, M, Florio, C, Fontana, F, Giomi, A, Masala, R, Mascia, G, Nassiacos, D, Nesti, M, Okoye, C, Pestelli, G, Bassi, V, Curci, S, D'Avino, M, Doimo, S, Faustino, M, Gemmiti, M, Pignatelli, P, Sarli, G, Stefanoni, P, Ciccone, M, Diemberger, I, Gragnano, F, Serafini, F, Marchionni N., Fumagalli S., Bo M., Boccanelli A., Boriani G., Rubboli A., Violi F., Di Pasquale G., Beer B., Colonna P., Manetti L. L., Pilleri A., Purificato F., Ruotolo G., Sciacqua A., Taberini L., Turcato E., Bozzato S., Catanzariti D., Felici M., Florio C., Fontana F., Giomi A., Masala R., Mascia G., Nassiacos D., Nesti M., Okoye C., Pestelli G., Bassi V., Curci S., D'Avino M., Doimo S., Faustino M., Gemmiti M. P., Pignatelli P., Sarli G., Stefanoni P., Ciccone M., Diemberger I., Gragnano F., and Serafini F.

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in elderly people. Older patients with AF have several comorbidities and should be treated with complex therapeutic schemes. Arrhythmia complications are also common at an advanced age. Accordingly, AF can be considered a marker of frailty. Few indications can be found concerning the management of frail older subjects in current guidelines. The Frailty in Atrial Fibrillation Survey Study (FAST) was designed to overcome the gap of knowledge about this extremely vulnerable subset of patients. A multidisciplinary team composed by cardiologists, geriatricians and internists participated in the project. In a first phase, a survey was conducted aiming at clarifying specialty-related differences in definition and oral anticoagulant therapy (OAT) management of frail individuals. In the second phase, specific chapters were prepared about AF and frailty epidemiology, the network for the management of the arrhythmia, the diagnostic strategies for AF (including a minimum data set of tools derived from the geriatric multidimensional assessment), OAT and the choice between a rate or a rhythm control strategy. For each chapter, up-to-date evidence and current guideline recommendations were presented and discussed among the 47 Italian centers participating in the project. In the last phase of FAST, the results of the survey and the final draft of the chapters were merged into the present document. A lack of homogeneity in frailty definition existed. The integration among cardiologists, geriatricians and internists can represent the most effective tool to get through these differences improving the management of frail older patients.

Published
2021

2. Single currency and supranational constraints to fiscal policies in the Eurozone during the crisis

Author

Petraglia C. and Purificato F.

Subjects
Expansionary Austerity, European Monetary Union, Sovereign Debt Crisis
Abstract

This paper reviews the current debate on the causes and remedies of the recent European sovereign debt crisis. The survey starts from the observation that different views seem to share the following point: the non-optimality of the Eurozone. The European Institutions have identified two main causes of the crisis: high public debts in the peripheral countries of the Union and their delay in implementing structural reforms. As a consequence, the cost of the adjustment has been exclusively supported by GIPSI countries. However, the recessionary effects produced by austerity policies have been far more intense and long-lasting than predicted. After the failure of fiscal austerity, the heterodox vision has gained credibility: real imbalances between the core and the periphery of the Union are responsible for the current crisis. Ultimately, the main lesson of the crisis is that, given the systematic asymmetries across Member States, the Eurozone will be unable to gain sustainability unless a process of fiscal union will start.

Published
2013

3. Antiretroviral genotypic resistance in plasma RNA and whole blood DNA in HIV-1 infected patients failing HAART

Author

Saracino, A, Gianotti, N, Marangi, M, Cibelli, Dc, Galli, A, Punzi, G, Monno, L, Lazzarin, A, Angarano, G, Dini, M, Del Gobbo, R, Montroni, M, Butini, L, Scalise, G, Ancarani, F, Di Cesare, S, Giacometti, A, Biglino, A, Degioanni, M, Paoloni, M, Mariani, R, Calella, G, Pastore, G, Ladisa, N, Mennea, G, Gritti, Fm, Fasullo, G, Chiodo, F, Borderi, M, Carosi, Giampiero, Castelli, Francesco, Torti, Carlo, Uccelli, C, Rizzardini, G, Visoná, R, Salvo, A, Averna, A, Russo, R, Celesia, Bm, Cosentino, S, Rinaldi, E, Pusterla, L, Carnevale, G, Mondello, P, Petrini, C, Ghinelli, F, Sighinolfi, L, Mazzotta, F, Lo Caputo, S, Pierotti, P, Leoncini, F, Sterrantino, Gk, Corsi, P, Pompei, Ag, Di Toro MT, Purificato, F, Indiveri, F, Setti, M, Murdaca, G, Iannessi, A, Cellini, A, Mariani, A, Scasso, A, De Gennaro, M, Chiodera, A, Castelli, P, Maltempo, K, Mongolo, G, Caggese, L, Schlacht, I, Cargnel, A, Atzori, C, Micheli, V, Moroni, M, Bini, T, Marcatto, I, Chiesa, E, Vigevani, G, Argenteri, B, Capetti, A, Esposito, R, Guaraldi, G, Seghetto, B, Chirianni, A, Gargiulo, M, Abrescia, N, D'Abbraccio, M, Busto, T, Marchitelli, C, Santirocchi, M, Abbadessa, V, Mancuso, S, Meneghetti, F, Pranzetti, M, Ferrari, C, Pizzaferri, P, Stagni, G, Di Candilo, F, Petrelli, E, Balducci, M, Menichetti, F, Polidori, M, Tascini, C, Di Carlo, A, Palamara, G, Antinori, A, Liuzzi, G, Aiuti, F, Mezzaroma, I, Pinter, E, Barbone, B, Vullo, V, Massetti, P, Dell'Isola, S, Mura, Ms, Mannazzu, M, Delias, R, Di Giammartino, D, Tarquini, P, Marranconi, F, Ferretto, R, Caramello, P, Orofino, Gc, Cimino, T, Bramato, C, Di Perri, G, Sinicco, A, Zeme, D, Bonora, S, Trentini, L, Soranzo, Ml, Macor, A, Salassa, B, Branz, F, Delle Foglie, P, Vaglia, A, Rossi, Mc, Ciccone, L, Panzolli, L, Grossi, P, Giola, M, Raise, E, Narne, E, Poggio, A, Demin, F, Mondino, V, Serpelloni, G, Malena, M, Bosco, O., Saracino, A, Gianotti, N, Marangi, M, Cibelli, D, Galli, A, Punzi, G, Monno, L, Lazzarin, A, Angarano, G, and Mancuso, S

Subjects
Anti-HIV Agents, DNA Mutational Analysis, Molecular Sequence Data, Proviral DNA, HIV Infections, HAART failure, medicine.disease_cause, DNA Mutational Analysi, chemistry.chemical_compound, HIV Protease, Proviruses, Antiretroviral Therapy, Highly Active, Virology, Drug Resistance, Viral, medicine, Humans, Multicenter Studies as Topic, HIV Infection, Treatment Failure, Genotyping, Randomized Controlled Trials as Topic, COLD-PCR, Mutation, Plasma RNA, biology, Proviruse, Sequence Analysis, RNA, Anti-HIV Agent, RNA, Sequence Analysis, DNA, biology.organism_classification, HIV Reverse Transcriptase, Reverse transcriptase, Antiretroviral genotypic resistance, Infectious Diseases, chemistry, DNA, Viral, Lentivirus, Immunology, HIV-1, RNA, Viral, DNA, antiretroviral genotypic resistance, haart failure, hiv-1, plasma rna, proviral dna, Human
Abstract

The extent to which HIV-1 proviral DNA mutations cause clinically relevant antiretroviral resistance is still controversial. Paired plasma HIV-1 RNA and whole blood DNA were compared in patients failing HAART to investigate if the additional knowledge of archived mutations could improve the selection of potentially active drugs. Seventy-three HIV-1-infected patients with first/second HAART failure were studied before starting a new regimen based on RNA genotyping. Follow-up data after a 12-week therapy were available. DNA genotyping was retrospectively performed on stored whole blood samples and mutational profiles were compared to those from RNA. The mean number of IAS pol mutations was significantly higher in RNA (4.45 ± 2.76) than in DNA (2.88 ± 2.47) (P < 0.001). DNA genotyping provided a 6% increase in detection of resistance-associated mutations. Among 64/73 patients showing discordant DNA/RNA profiles, 54 (84%) also differed for predicted active drugs. 16/73 (22%) patients had ≥1 mutation revealed by DNA genotyping alone, probably affecting therapy success in 2/16. However, neither RNA/DNA discordance nor detection of isolated DNA mutations were statistically associated with outcome. In conclusion, plasma RNA remains the elective choice for HIV genotyping in patients with therapy failure, even if the detection of proviral resistance-associated mutations, not simultaneously found in RNA, is a frequent event. Therefore, in some cases DNA plus RNA genotyping might assist in choosing more accurately subsequent antiretroviral regimens. © 2008 Wiley-Liss, Inc.

Published
2008

4. Simit Epidemiological Multicentric Study on Hospitalized Immigrants in Italy During 2002

Author

Scotto, G., Saracino, A., Pempinello, R., El Hamad, I., Geraci, S., Panunzio, M., Palumbo, Ernesto, Cibelli, D. C., Angarano, G., Quirino, T., Vigevani, G. M., Balducci, M., Petrelli, E., Bergamasco, A., Cadeo, G., Elhamad, I., Carosi, G., Vitucci, N., Gobbi, M., Allegri, M. P., Toti, M., Piretti, B., De Stefano, C., Mannozzi, P., Mastropietro, C., Paffetti, A., Losappio, R., Fontana, T., Sfara, C., Stagni, G., Salome, G., Soscia, F., Maggi, P., Pastore, G., Miccolis, S., Scalzini, A., Brogi, A., Renda, V., Lancella, L., Ticca, F., Gabbati, A., Mazzotta, A., Villa, M., Viganò, P., Salatino, A., Andreoni, M., Drenaggi, D., Scalise, G., Ciardi, M., D'Elia, S., Limodio, M., Gallo, A. I., Delia, S., Caltabiano, E., Cosentino, G., Raspaglieli, M., Di Gregorio, P., Mariani, R., Paolini, M., Sabbatani, S., Chiodo, F., Casabianca, A., Biglino, A., Galloni, D., Carnevale, G., Pantaleoni, M., Ghinelli, F., Purificato, F., Pompei, A. G., Portelli, V., Chasseur, R., Tassara, A., Benenat, B., Sapienza, M., Sabatini, P., Sabusco, G., Bellardini, G., Zauli, T., Valencic, A., Luzzati, R., Milini, P., Chiodera, A., Sebbia, F., Davi', A., Pizzigallo, E., Scerbo, P., Ferraro, T., Consorte, A., Mariani Toro, G., Gioia, M., Grossi, P., Coviello, G., Sagnelli, E., Azzimi, A., Concia, A., Allegra, M., and Todaro, Gianmarco

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Tuberculosis, Adolescent, Epidemiology, HIV Infections, infectious diseases, Communicable Diseases, Article, Hepatitis, HIV, Hospitalization, Immigration, Infectious diseases, Female, Humans, Italy, Middle Aged, Multicenter Studies as Topic, Poverty, Surveys and Questionnaires, Emigration and Immigration, Public Health, Environmental and Occupational Health, medicine, business.industry, Public health, Environmental and Occupational Health, medicine.disease, Country of origin, tuberculosis, Infectious disease (medical specialty), Immunology, Public Health, business, Viral hepatitis, Malaria, immigration
Abstract

The aim of this article is to retrospectively evaluate the patient characteristics and the most common infectious diseases in immigrant patients hospitalized in 46 Italian infectious disease clinics during 2002. The main Italian infectious disease clinics were invited to fill in a questionnaire that regarded the number and type of hospital admissions, the country of origin, and demographic features (age, sex, and resident state) of immigrants. A total of 46 clinics including 2255 patients participated in the study. Most patients were men (63%) with an age between 16 and 40 years (63.4%) covered by the National Health Service (71%) and coming from Africa (44.3%). The main infectious diseases observed were: 378 (16.76%) cases of HIV infection, 303 (13.43%) cases of tuberculosis diseases, 282 (12.5%) cases of various forms of viral hepatitis, 177 (7.84%) cases of respiratory diseases, and 196 (8.69%) gastrointestinal diseases. Tropical diseases found were 134 (5.94%) including 95 cases of malaria (70.9%). In conclusion, a broad range of diseases was noted in immigrants which were directly correlated with conditions of poverty. Only a few tropical diseases were diagnosed and therefore the immigrant should not be considered as an infectious disease carrier.

Published
2005

5. Treatment of chronic hepatitis B: recommendations from an Italian workshop

Author

Carosi, G., Rizzetto, M., Andreone, P., Angelico, M., Ascione, A., Caporaso, N., Fagiuolim, S., Fattovich, G., Mondelli, M., Niro, G. A., Pontisso, P., Bonino, F., Perno, C. F., Prati, D., Andreoni, M., Angarano, G., Annicchiarico, E., Boncoraglio, R., Brustia, D., Calabrese, N., Carlotto, A., Cavalletto, L., Cavina, M., Chessa, L., Croce, G., De Sanctis, G., Di Candilo, F., Fabris, P., Fracassetti, O., Lanza, A. G., Giuberti, T., Guazzotti, G., Iacovazzi, T., Iovinella, V., Izzi, A., Loperfido, P., Magni, C. F., Marino, N., Messina, V., Michelone, G., Morante, R., Moretti, A., Nasta, P., Nauri, L., Paffetti, A., Pasino, M., Perboni, G., Petrelli, E., Picciotto, A., Pozzi, M., Purificato, F., Re, T., Rinaldi, R., Sani, S., Santoro, R., Schioppa, O., Scotto, G., Siciliano, M., Sorbello, O., Squadrito, G., Taddei, M. T., Traversa, A., Tundo, P., Venezia, G., Vilardo, L., Zignego, A. L., Zoncada, A., and Zuin, M.

Subjects
Liver Cirrhosis, medicine.medical_specialty, Cirrhosis, Immune suppressed, Human immunodeficiency virus (HIV), HIV Infections, Disease, Antiviral therapy, medicine.disease_cause, Antiviral Agents, Immunocompromised Host, Hepatitis B, Chronic, Chronic hepatitis, Interferon, HDV, Internal medicine, Drug Resistance, Viral, HBV, medicine, Humans, Hepatitis B Antibodies, Liver histology, Hepatitis B virus, HCV, HIV, Hepatology, business.industry, Gastroenterology, Hepatitis B, medicine.disease, Hepatitis C, Hepatitis D, Italy, Immunology, business, medicine.drug
Abstract

The changing scenario of hepatitis B virus therapy has encouraged the organisation of a workshop, endorsed by three Italian scientific societies, aimed at defining the current recommendations for hepatitis B virus treatment. Liver histology and stage of disease remain fundamental for treatment decisions; interferon and nucleoside/nucleotide analogues-based therapy represent different strategies for different phases of the hepatitis B virus disease. The recommendations defined: new and lower cut-off of hepatitis B virus–DNA for eligibility to therapy according to disease stage, how to optimise the use of nucleoside/nucleotide analogues and to individualise the monitoring of response and what to do with treatment failures. Specific recommendations have also been given for cirrhosis patients, those immune suppressed and co-infected with HIV and other hepatitis viruses. © 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Published
2008

7. Monetary policy and financial stability in the Economic and Monetary Union

Author

Francesco Purificato, Elvira Sapienza, John, Eatwell, Pasquale, Commendatore, Neri, Salvadori, Purificato, F., and Sapienza, E.

Subjects
Monetary autority, Macroeconomic stability, Financial stability
Abstract

Following the financial crisis, a new theoretical framework has emerged, in which monetary policy aims at price stability and macro-prudential policy aims at financial stability. In 2014, the European in-stitutions established the Single Supervisory Mechanism (SSM) to pursue the objective of financial sta-bility. The new institutional arrangement provides for micro-prudential policy under the direct control of the ECB and macro-prudential policy under the responsibility of NCAs and the supervision of the ECB. The essay presents a literature review and a simple analytical model to assess this new institu-tional design. Despite a still incomplete reform process, as the decision-making process lacks total transparency and the regulatory field is not levelled, the literature review supports the view that the SSM promotes financial stability in the Euro area. According to our model, we positively assess the new institutional framework: an increase in the efficiency of prudential policies to face financial risks allows the ECB to pursue the objective of financial stability without compromising the goal of output stability.

Published
2022

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