Publications by authors named "Nicolò Gentiloni Silveri"

35 Publications

Sudden unexpected fatal encephalopathy in adults with OTC gene mutations-Clues for early diagnosis and timely treatment.

Orphanet J Rare Dis 2014 Jul 16;9:105. Epub 2014 Jul 16.

Background: X-linked Ornithine Transcarbamylase deficiency (OTCD) is often unrecognized in adults, as clinical manifestations are non-specific, often episodic and unmasked by precipitants, and laboratory findings can be normal outside the acute phase. It may thus be associated with significant mortality if not promptly recognized and treated. The aim of this study was to provide clues for recognition of OTCD in adults and analyze the environmental factors that, interacting with OTC gene mutations, might have triggered acute clinical manifestations.

Methods: We carried out a clinical, biochemical and molecular study on five unrelated adult patients (one female and four males) with late onset OTCD, who presented to the Emergency Department (ED) with initial fatal encephalopathy. The molecular study consisted of OTC gene sequencing in the probands and family members and in silico characterization of the newly detected mutations.

Results: We identified two new, c.119G>T (p.Arg40Leu) and c.314G>A (p.Gly105Glu), and three known OTC mutations. Both new mutations were predicted to cause a structural destabilization, correlating with late onset OTCD. We also identified, among the family members, 8 heterozygous females and 2 hemizygous asymptomatic males. Patients' histories revealed potential environmental triggering factors, including steroid treatment, chemotherapy, diet changes and hormone therapy for in vitro fertilization.

Conclusions: This report raises awareness of the ED medical staff in considering OTCD in the differential diagnosis of sudden neurological and behavioural disorders associated with hyperammonemia at any age and in both genders. It also widens the knowledge about combined effect of genetic and environmental factors in determining the phenotypic expression of OTCD.
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http://dx.doi.org/10.1186/s13023-014-0105-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304088PMC
July 2014

Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score.

BMC Infect Dis 2012 Aug 8;12:184. Epub 2012 Aug 8.

Emergency Department Azienda Ospedaliera Sant'Andrea, School of Medicine and Psychology Sapienza Univesity, Rome, Italy.

Background: The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization.

Methods: This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient.

Results: MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P < 0.0001), while PCT values in controls were 0.06 ng/ml versus 0.56 ng/ml in patients (P < 0.0001). In all patients there was a statistically significant stepwise increase in MR-proADM levels in accordance with PCT values (P < 0.0001). MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P < 0.0001 and P = 0.0012 respectively).In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79.

Conclusions: The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient's care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and considerably reduced costs.
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http://dx.doi.org/10.1186/1471-2334-12-184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447640PMC
August 2012

Comparison of diagnostic accuracy between three different rules of interpreting high sensitivity troponin T results.

Intern Emerg Med 2012 Aug 23;7(4):365-70. Epub 2012 May 23.

Department of Emergency Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy.

With the introduction of high sensitivity troponin-T (hs-TnT) assay, clinicians face more patients with 'positive' results but without myocardial infarction. Repeated hs-TnT determinations are warranted to improve specificity. The aim of this study was to compare diagnostic accuracy of three different interpretation rules for two hs-TnT results taken 6 h apart. After adjusting for clinical differences, hs-TnT results were recoded according to the three rules. Rule1: hs-TnT >13 ng/L in at least one determination. Rule2: change of >20 % between the two measures. Rule3: change >50 % if baseline hs-TnT 14-53 ng/L and >20 % if baseline >54 ng/L. The sensitivity, specificity and ROC curves were compared. The sensitivity analysis was used to generate post-test probability for any test result. Primary outcome was the evidence of coronary critical stenosis (CCS) on coronary angiography in patients with high-risk chest pain. 183 patients were analyzed (38.3 %) among all patients presenting with chest pain during the study period. CCS was found in 80 (43.7 %) cases. The specificity was 0.62 (0.52-0.71), 0.76 (0.66-0.84) and 0.83 (0.74-0.89) for rules 1, 2 and 3, respectively (P < 0.01). Sensitivity decreased with increasing specificity (P < 0.01). Overall diagnostic accuracy did not differ among the three rules (AUC curves difference P = 0.12). Sensitivity analysis showed a 25 % relative gain in predicting CCS using rule 3 compared to rule 1. Changes between two determinations of hs-TnT 6 h apart effectively improved specificity for CCS presence in high-risk chest pain patients. There was a parallel loss in sensitivity that discouraged any use of such changes as a unique way to interpret the new hs-TnT results.
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http://dx.doi.org/10.1007/s11739-012-0787-8DOI Listing
August 2012

Early recognition of the 2009 pandemic influenza A (H1N1) pneumonia by chest ultrasound.

Crit Care 2012 Feb 17;16(1):R30. Epub 2012 Feb 17.

Department of Emergency Medicine, A, Gemelli University Hospital, Rome, Italy.

Introduction: The clinical picture of the pandemic influenza A (H1N1)v ranges from a self-limiting afebrile infection to a rapidly progressive pneumonia. Prompt diagnosis and well-timed treatment are recommended. Chest radiography (CRx) often fails to detect the early interstitial stage. The aim of this study was to evaluate the role of bedside chest ultrasonography (US) in the early management of the 2009 influenza A (H1N1)v infection.

Methods: 98 patients who arrived in the Emergency Department complaining of influenza-like symptoms were enrolled in the study. Patients not displaying symptoms of acute respiratory distress were discharged without further investigations. Among patients with clinical suggestion of a community-acquired pneumonia, cases encountering other diagnoses or comorbidities were excluded from the study. Clinical history, laboratory tests, CRx, and computed tomography (CT) scan, if indicated, contributed to define the diagnosis of pneumonia in the remaining patients. Chest US was performed by an emergency physician, looking for presence of interstitial syndrome, alveolar consolidation, pleural line abnormalities, and pleural effusion, in 34 patients with a final diagnosis of pneumonia, in 16 having normal initial CRx, and in 33 without pneumonia, as controls.

Results: Chest US was carried out without discomfort in all subjects, requiring a relatively short time (9 minutes; range, 7 to 13 minutes). An abnormal US pattern was detected in 32 of 34 patients with pneumonia (94.1%). A prevalent US pattern of interstitial syndrome was depicted in 15 of 16 patients with normal initial CRx, of whom 10 (62.5%) had a final diagnosis of viral (H1N1) pneumonia. Patients with pneumonia and abnormal initial CRx, of whom only four had a final diagnosis of viral (H1N1) pneumonia (22.2%; P<0.05), mainly displayed an US pattern of alveolar consolidation. Finally, a positive US pattern of interstitial syndrome was found in five of 33 controls (15.1%). False negatives were found in two (5.9%) of 34 cases, and false positives, in five (15.1%) of 33 cases, with sensitivity of 94.1%, specificity of 84.8%, positive predictive value of 86.5%, and negative predictive value of 93.3%.

Conclusions: Bedside chest US represents an effective tool for diagnosing pneumonia in the Emergency Department. It can accurately provide early-stage detection of patients with (H1N1)v pneumonia having an initial normal CRx. Its routine integration into their clinical management is proposed.
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http://dx.doi.org/10.1186/cc11201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396276PMC
February 2012

Efficacy and safety of vernakalant in recent-onset atrial fibrillation after the European medicines agency approval: systematic review and meta-analysis.

J Clin Pharmacol 2012 Dec 13;52(12):1872-8. Epub 2011 Dec 13.

Department of Emergency Medicine, Catholic University of the Sacred Heart Largo F. Vito 1, 00168, Rome, Italy.

Vernakalant is an emergent antiarrhythmic drug that, in preclinical studies, has demonstrated high efficacy in restoring sinus rhythm and safety in patients with rapid recent-onset atrial fibrillation. The aim of this work was to evaluate the efficacy and safety of vernakalant for cardioversion of recent-onset atrial fibrillation. PubMed, EMBASE, Clinical Trials Registry, and European Medicines Agency public reports were searched for randomized clinical trials, until May 2011, of vernakalant compared with controls (placebo/other antiarrhythmic drug) in enrolled patients with high ventricular rate atrial fibrillation. Five randomized trials that met inclusion criteria enrolled a total of 1099 patients. Among these, 810 had recent-onset atrial fibrillation. When compared with controls (placebo/other oral antiarrhythmic drugs), vernakalant was associated with a significant increase in cardioversion within 90 minutes from drug infusion (relative risk, 8.4; 95% confidence interval, 4.4-16.3; P < .00001). Compared with controls, vernakalant was not associated with a significant difference in serious adverse events (relative risk, 0.9; 95% confidence interval, 0.6-1.4; P = .64). The authors conclude that compared with controls, vernakalant is effective and safe for rapidly converting recent-onset atrial fibrillation. Questions remain surrounding safety because 1 unpublished trial was discontinued for this reason. Further cost-effective analysis and comparison with other antiarrhythmic agents, such as class I antiarrhythmic agents, should be investigated, especially in the emergency department.
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http://dx.doi.org/10.1177/0091270011426876DOI Listing
December 2012

Prospective evaluation of epidemiological, clinical, and microbiological features of pandemic influenza A (H1N1) virus infection in Italy.

J Med Virol 2011 Dec;83(12):2057-65

Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.

Since several characteristics of pandemic influenza A (H1N1) virus infection remain to be determined, this study aimed to describe clinical features and complications of patients infected with H1N1. Subjects affected by influenza-like illnesses and a control group of asymptomatic patients were enrolled prospectively at an Emergency Department from October 2009 to April 2010. At enrollment, clinical data and nasopharyngeal swabs for virological analyses were obtained. Ill subjects were followed until recovery and swabs were collected weekly in patients infected with H1N1. Of 318 patients enrolled, 92 (28.9%) were positive to H1N1. Patients infected with H1N1 were mainly young adults and complained classic influenza-like symptoms. Fever was observed for a median time of 5 (IQR 3-7) days. Hospitalization occurred in 27.7% with 2% requiring intensive care unit admission: median length of hospitalization was 6 days (IQR 5-9). Pneumonia was diagnosed in 19.6% of patients. A similar proportion of lower airways involvement and of clinical complications was observed in subjects testing positive or negative for H1N1. However, patients infected with H1N1 were younger and hospitalized for a shorter period as compared to the control group (P = 0.002 and P = 0.045, respectively). Older age, asthma/chronic obstructive pulmonary disease and hypertension were associated with an increased risk of pneumonia. Viral shedding was observed for at least 1 week in 21.3% of patients. Asymptomatic infection was uncommon (1.1%). Respiratory syndromes caused by H1N1 and factors associated with disease severity were investigated and compared to influenza-like illnesses of other origin. Such findings might contribute to improve clinical and epidemiological management of the disease.
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http://dx.doi.org/10.1002/jmv.22231DOI Listing
December 2011

Prevalence of virulent Helicobacter pylori strains in patients affected by idiopathic dysrhythmias.

Intern Emerg Med 2013 Jun 12;8(4):333-7. Epub 2011 May 12.

Internal Medicine Department, Catholic University, Rome, Italy.

Helicobacter pylori virulent strains have been shown to affect cardiovascular diseases through molecular mimicry mechanisms. Silent autoimmune myocarditis has been hypothesized to be the cause of idiopathic dysrhythmias (IA). The aim of this study is to assess the prevalence of virulent H. pylori strains in patients affected by IA. In this study,54 patients (40 men, mean age 44 ± 17 years) affected by IA and 50 healthy subjects (34 men, mean age 45 ± 9) were evaluated. IA, defined as dysrhythmias with no evidence of other cardiac pathology, were either supraventricular (SVA, 23 patients; mean age 45 ± 15 years) or ventricular (VA, 31 patients; mean age 42 ± 18 years). H. pylori infection and gastrointestinal (GI) symptoms were evaluated. H. pylori strains expressing the cytotoxin-associated gene A (cagA) and the vacuolating-cytotoxin A (vacA) were also assessed through western blot. The prevalence of H. pylori is similar in IA patients and in controls (42 vs. 44%; p > 0.05); H. pylori infection is observed in 48 and 39% of the patients are affected by SVA and VA, respectively. The prevalence of CagA-positive strains is increased in IA patients compared to controls (65 vs. 42%; p < 0.01); similarly, the prevalence of VacA-positive strains is also increased in IA patients (74 vs. 46%; p < 0.006). Excluding belching, infected patients did not show any difference in GI symptoms, when compared to non-infected subjects. From this study it is concluded that there is an epidemiological link between CagA and VacA-positive H. pylori strains in IA patients.
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http://dx.doi.org/10.1007/s11739-011-0621-8DOI Listing
June 2013

Disparities in management of new-onset atrial fibrillation in the emergency department despite adherence to the current guidelines: data from a large metropolitan area.

Intern Emerg Med 2011 Apr 13;6(2):149-56. Epub 2011 Feb 13.

Department of Emergency Medicine, Catholic University of the Sacred Heart, Largo F. Vito 1, 00168, Rome, Italy.

Atrial Fibrillation management is still a matter for debate. Past research has largely been based on the outpatient setting in which patients are followed during ambulatory visits. Very little data exist on the optimal management of AF in the Emergency Department (ED). This study investigated which factors drive different AF treatments in the ED, describing their use in different hospitals. Finally, the efficacy of different strategies in terms of cardioversion in the ED was analyzed. Charts of patients treated for atrial fibrillation (AF) were collected in 6 EDs in a large metropolitan area over a 24-consecutive month period and were reviewed and analysed. Demographics, comorbidities, treatment strategy and ED outcome were collected. Inclusion criteria were symptom onset <3 weeks and stable hemodynamic conditions at presentation. A propensity score was used to adjust for baseline clinical characteristics and to compare the efficacy of different treatments. 3,085 patients were included in the analysis. Variables associated with a rhythm control strategy were onset of symptoms <48 h, age, dyspnea, palpitations, renal failure and the presence of a mechanical valve. Different EDs applied different strategies in terms of drugs used and the electrocardioversion rate, showing heterogeneity in AF management. Adjusting for the propensity score, electrocardioversion and antidysrhythmic drugs of class Ic were more effective than a wait-and-watch strategy in the ED. Despite international guidelines being respected, AF management is heterogeneous in different ED settings. A rhythm control strategy with electrocardioversion and Class Ic drugs is more effective than a wait-and watch approach during the ED visit. Further research, toward an evidence-based approach to the emergent management of AF in the ED, is still needed.
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http://dx.doi.org/10.1007/s11739-011-0537-3DOI Listing
April 2011

Predictive value of NT-proBNP for cardioversion in a new onset atrial fibrillation.

Eur J Emerg Med 2011 Jun;18(3):157-61

Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy.

Objective: To detect the clinical use of N-terminal pro B-type natriuretic peptide (NT-proBNP) values for predicting cardioversion in a new onset atrial fibrillation (AF) in the emergency department.

Methods: NT-proBNP was measured in 200 patients admitted to the emergency department, in the observational unit with primary diagnosis of a new onset AF (<2 weeks). Cohort was divided into rate-control and rhythm-control groups according to the strategy used by the admitting physician. Patients treated with electric cardioversion were excluded. Primary endpoint was conversion to sinus rhythm during hospital admission.

Results: In rhythm and rate controls, NT-proBNP was lower in patients who restored sinus rhythm (P<0.001). Same result was observed even when logistic regression was used to adjust for differences at baseline clinical characteristics. NT-proBNP of less than 450 pg/ml was associated with cardioversion in both the groups (likelihood ratio of 0.19 for rate control, and 0.27 for rhythm control) whereas a value of more than 1800 pg/ml was associated with persistent AF at discharge (likelihood ratio of 2.02 and 2.01, respectively).

Conclusion: In the acute setting of a new onset AF, NT-proBNP seems to predict cardioversion in rate-control and rhythm-control strategies when it is less than 450 pg/ml or more than 1800 pg/ml. In this ranges of values it might help to allocate resources and plan for patient admission and further management. There is a grey area (450-1800 pg/ml) in which NT-proBNP did not seem to be clinically useful.
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http://dx.doi.org/10.1097/MEJ.0b013e328342f2bfDOI Listing
June 2011

Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects.

Ultrasound Med Biol 2011 Jan;37(1):44-52

Department of Emergency Medicine, A. Gemelli University Hospital, Rome, Italy.

The purpose of this study was to set an effective standardized method to assess diaphragmatic kinetics by ultrasound. Forty healthy volunteers were submitted to a B- and M-mode ultrasound study using a convex transducer positioned in the subcostal anterior area for transverse scanning. Ultrasound examination was completed in 38/40 cases (95%), spending on average <10 min for examination. The resting and forced diaphragmatic excursions were 18.4 ± 7.6 and 78.8 ± 13.3 mm, respectively, unrelated to demographic or anthropometric parameters: intraobserver variability on three successive measurements resulted in 6.0% and in 3.9%, respectively. An inexperienced sonographer completed the ultrasound examination in 37/40 cases, spending on average >15 min, with significant, although marginal, interobserver variability (31.9% and 14.7% for resting and forced diaphragmatic excursion, respectively). Bedside ultrasonography by an anterior subcostal transverse scanning on semi-recumbent patient proves to be a safe, feasible, reliable, fast, relatively easy and reproducible way to assess diaphragm movement.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2010.10.004DOI Listing
January 2011

[Evaluation of gastric emptying and gastrointestinal symptoms in dyspeptic patients before and after hydropinic therapy].

Recenti Prog Med 2010 Oct;101(10):389-92

Istituto di Medicina Interna, Universita Cattolica del Sacro Cuore, Policlinico Agostino Gemelli, Roma.

Dispepsy is one of the most diffuse syndromes in general population. The high number of subjects affected from this pathology and the very annoying symptomatology does so as that the pharmaceutical costs of antacids and of prokinetics are very high. Aim of the study is to assess if a hydropinic therapy is able to facilitate digestive processes of the dispeptic patients accelerating gastric emptying. The 30 recruited subjects, 20 patients and 10 healthy volunteers, have answered to test about their symptoms and have executed a 13C octanoic acid breath test in order to estimate the gastric emptying to a basal time, and 30 days after supplementation of mineral water, 1.5 liters/day, for 21 days. At the end of the study, both the time of gastric emptying and the gastrointestinal symptoms improved after the hydropinic therapy, demonstrating that a supplementazione with mineral water can induce a benefit in the dispeptics subjects.
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October 2010

Utility of routine thyroid-stimulating hormone determination in new-onset atrial fibrillation in the ED.

Am J Emerg Med 2011 Nov 13;29(9):1158-62. Epub 2010 Aug 13.

Department of Emergency Medicine, Catholic University of the Sacred Heart, Rome, Italy.

Introduction: Hyperthyroidism is a relative uncommon but important cause of atrial fibrillation. The aim of this study was to investigate the utility of routine thyroid-stimulating hormone (TSH) determination in the emergency department (ED) in patients presenting to the ED with stable, new-onset atrial fibrillation. We derive a set of clinical criteria in which TSH is likely to be normal and therefore thyroid function evaluation deferrable to a different time from ED visit.

Methods: Cross-sectional observational study in a university hospital. Thyroid-stimulating hormone was measured in all patients admitted to the ED observational unit for new-onset atrial fibrillation in a 30 consecutive months' period. Patients' clinical characteristics and treatment received in the ED were recorded. Recursive partitioning analysis technique was used to determine which predictors were associated with a TSH level less than 0.35 μIU/mL.

Results: Of 433 patients enrolled, 47 (10.8%) had a low TSH. Thyroid-stimulating hormone highly correlated with FT3 and FT4 levels (P < .001) confirming its good predictive value as screening tool. Recursive partitioning analysis showed that previous thyroid disease (P < .01), stroke/transient ischemic attack (P < .01), and hypertension (P = .10) were associated with low TSH. The final model had sensitivity of 93% and specificity of 31%, corresponding to a negative likelihood ratio of 0.02 (0.01-0.07).

Conclusion: Hyperthyroidism is present in nearly 10% of new-onset atrial fibrillation. Although thyroid function screening is recommended in all patients, a simple model that included previous thyroid disease, stroke, and hypertension might help to identify those patients at high risk (low TSH) in the ED.
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http://dx.doi.org/10.1016/j.ajem.2010.06.010DOI Listing
November 2011

Fulminant endogenous gas gangrene: role of ultrasonography in the emergency setting.

Am J Emerg Med 2010 Jun 26;28(5):643.e1-3. Epub 2010 Mar 26.

Department of Emergency Medicine, A Gemelli University Hospital, 00168 Rome, Italy.

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http://dx.doi.org/10.1016/j.ajem.2009.09.008DOI Listing
June 2010

The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain.

Intern Emerg Med 2010 Oct 18;5(5):401-9. Epub 2010 May 18.

Emergency Department, A. Gemelli University Hospital, Rome, Italy.

The epigastrium is the site where pain coming from both abdominal and extra-abdominal organs is frequently referred. Although acute or chronic diseases of the stomach, duodenum, liver, pancreas and biliary tree are the most common causes of acute epigastric pain, several other entities, potentially more severe, should also be suspected and investigated. Clinical bedside ultrasonography (US) is actually the first-line imaging in acute epigastric pain patients presenting to the hospital Emergency Department (ED) because it is rapid, noninvasive, relatively inexpensive and focused, repeatable and reliable. Moreover, the systematic use of emergency US as a complement to routine management might save economic resources by avoiding further costs for complications and substantially reducing the time for making an accurate diagnosis. The purpose of this paper is to review the US spectrum of the most common diseases responsible for acute epigastric pain onset. We also propose a focused, well codified US protocol, that we call the "$ approach", based on our clinical experience and the current literature for acute non-traumatic epigastric pain evaluation in an emergency setting. Its systematic application by the emergency physician may reduce the wait for diagnosis and the over-usage of second-line radiological techniques, including computed tomography, as well as to increase the diagnostic accuracy with potential benefits for patient (safety), physician (efficacy) and the institution (efficiency).
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http://dx.doi.org/10.1007/s11739-010-0395-4DOI Listing
October 2010

Coronary atherosclerotic burden in patients with infection by CagA-positive strains of Helicobacter pylori.

Coron Artery Dis 2010 Jun;21(4):217-21

Institute of Cardiology, Catholic University of Sacred Heart, Rome, Italy.

Objectives: Cytotoxic associated gene-A (CagA)-positive strains of Helicobacter pylori emerged as a possible atherosclerotic stimulus. Nevertheless, whether CagA-positivity is associated with more extensive or severe atherosclerotic coronary burden has never been studied.

Methods: Forty consecutive patients with coronary artery disease (CAD) and twenty consecutive patients with normal coronary arteries undergoing coronary angiography were enrolled. All patients underwent evaluation of classical atherogenic risk factors and assessment of anti-urease B and anti-CagA antibodies titer. Either the severity of coronary stenosis (stenosis score) or the extent of coronary atherosclerosis (extent score) was evaluated in CAD patients.

Results: The anti-CagA antibody titer was significantly higher in patients with CAD as compared with normal coronary arteries patients [85 (10-108.75) vs. 47.3 (17-64) RU/ml, P=0.02], whereas there were no differences in anti-urease B titer between the two groups. A significant correlation was found between anti-CagA antibody titer and extent score (R=0.35, P=0.03), whereas stenosis score was similar (R=0.25, P=0.11). On the contrary, no significant correlation was found between anti-urease B antibody titer and either extent or stenosis score. Moreover, CagA-positive patients had a more extensive CAD (P=0.029) when compared with CagA-negative patients. Interestingly, whereas serum glucose, LDL levels, anti-urease B, and anti-CagA antibodies were predictors of extent score at univariate analysis, at multivariate analysis anti-CagA antibody titer only was an independent predictor of the extent of coronary atherosclerosis (B=0.051, standard error of B=0.042, P=0.04).

Conclusion: These results support the association between CagA-positive H. pylori infection and coronary atherosclerotic burden. Further studies are needed to better elucidate the mechanism by which CagA-positive strains may promote atherosclerosis.
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http://dx.doi.org/10.1097/MCA.0b013e3283399f36DOI Listing
June 2010

[Helicobacter pylori and atherosclerosis. A review of the literature].

Recenti Prog Med 2009 Feb;100(2):91-6

Istituto di Medicina Interna, Università Cattolica del Sacro Cuore, Roma.

Several studies have investigated potential role of Helicobacter pylori (Hp) in the pathogenesis of atherosclerosis. Postulated mechanisms are various, even though results are still controversial. Here we propose an overview of actual knowledge about this topic, comparing studies in favour with those against the relationship between Hp and atherosclerosis.
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February 2009

Sonographic detection of spontaneous pneumomediastinum.

J Ultrasound Med 2008 Oct;27(10):1507-9

Departments of Emergency Medicine, Catholic University, Agostino Gemelli Hospital, Rome, Italy.

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http://dx.doi.org/10.7863/jum.2008.27.10.1507DOI Listing
October 2008

Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.

Chest 2008 Jan 9;133(1):204-11. Epub 2007 Oct 9.

Operative Unit of Emergency Medicine, Ospedale di Castelnuovo Garfagnana, Lucca, Italy.

Background: The role of chest ultrasonography (US) in the diagnosis of pneumothorax (PTX) has been established, but how it compares with lung CT scanning in the diagnosis of radiooccult PTX and in the determination of its topographic extension has not yet been completely evaluated.

Objective: To determine the diagnostic accuracy of chest US in the emergency department (ED) in the diagnosis of occult PTX in trauma patients and to define its ability to determine PTX extension.

Design: An 18-month prospective study.

Patients: A total of 109 conscious, spontaneously breathing patients who had been admitted to the ED for chest trauma or polytrauma.

Methods: All eligible patients underwent a standard anteroposterior supine chest radiograph (Rx) and a spiral CT lung scan within 1 h of ED admission. Lung US was carried out by an operator who was unaware of the other examination results, both for diagnosis and for the quantitative delimitation of the PTX.

Results: Twenty-five traumatic PTXs were detected in the 218 hemithoraxes (109 patients; 2 patients had a bilateral PTX) evaluated by spiral CT scan; of these, only 13 of 25 PTXs (52%) were revealed by chest Rx (sensitivity, 52%; specificity, 100%), while 23 of 25 PTXs (92%) were identified by lung US with one false-positive result (sensitivity, 92%; specificity, 99.4%). In 20 of 25 cases, there was agreement on the extension of the PTX between CT lung scan and lung US with a mean difference of 1.9 cm (range, 0 to 4.5 cm) in the localization of retroparietal air extension; chest Rx was not able to give quantitative results.

Conclusions: Lung US scans carried out in the ED detect occult PTX and its extension with an accuracy that is almost as high as the reference standard (CT scanning).
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http://dx.doi.org/10.1378/chest.07-1595DOI Listing
January 2008

The ultrasonographic deep sulcus sign in traumatic pneumothorax.

Ultrasound Med Biol 2006 Aug;32(8):1157-63

Operative Unit of Emergency Medicine, Castelnuovo Garfagnana Hospital, Lucca, Italy.

A series of 186 patients with blunt chest trauma was studied with transthoracic ultrasonography to diagnose pneumothorax and to evaluate its size and location. The results were compared with bedside chest radiography and spiral CT scan. The prevalence of pneumothorax on CT scan was 56/186 (30.1%). Pneumothorax was proven on radiography in 30/56 cases without false positive results: "radiographic deep sulcus sign" was evident in 3/29 cases, 26/29 cases being occult. The ultrasound study demonstrated the presence of pneumothorax in 55/56 patients: one occult pneumothorax was missed and no false positive results were observed. The CT scan differed of +/-2.3 cm (range 1-5 cm) from the US study in evaluating size and location of pneumothorax. In conclusion, ultrasound study may detect occult pneumothorax undiagnosed by standard plain radiography. It reflects accurately the extent of pneumothorax if compared with CT scan, outlining the "ultrasonographic deep sulcus sign" on anterior chest wall.
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http://dx.doi.org/10.1016/j.ultrasmedbio.2006.04.006DOI Listing
August 2006

Unusual acute abdomen: to operate or not to operate?

Lancet 2006 May;367(9521):1548

General Surgery Unit-Department of Surgery, Catholic University, Rome, Largo A Gemelli 8, 00168 Rome, Italy.

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http://dx.doi.org/10.1016/S0140-6736(06)68655-8DOI Listing
May 2006

Interaction between Helicobacter pylori infection and untreated coeliac disease on gastric histological pattern.

Scand J Gastroenterol 2006 May;41(5):532-5

Department of Internal Medicine, Catholic University the Sacred Heart, Rome, Italy.

Objective: Helicobacter pylori infection is the major agent of gastric damage. Coeliac disease may affect the morphology and function of the entire gastrointestinal tract from the stomach to the colon. The aim of this study was to assess the gastric histological pattern in patients with H. pylori and untreated coeliac disease.

Material And Methods: We retrospectively enrolled 183 H. pylori-positive patients with (85, group A) and without (98, group B) untreated coeliac disease. The groups were similar for age, gender and smoking habit, and all the patients came from the same geographical area. Histological evaluation of gastric pattern was performed on 4 biopsies (2 in the antrum, 2 in the corpus). Gastric damage was classified according to the modified Sydney System. Diagnosis of H. pylori infection was based on positivity to histology. The chi-square test was used to assess differences between groups. A p-value <0.05 was considered significant.

Results: Group A showed a significantly higher prevalence of follicular gastritis than group B (23.5% versus 12.2%, p=0.045). A significantly lower prevalence of atrophic gastritis was observed in group A compared with that in group B (6% versus 22.5%, p=0.002). The prevalence of chronic superficial gastritis, activity degree and intestinal metaplasia was similar between the two groups.

Conclusions: In patients with H. pylori infection, untreated coeliac disease could represent a risk factor for follicular gastritis and is associated with a lower prevalence of atrophic gastritis. The complex interaction between H. pylori and untreated coeliac disease on Th-1/Th-2 balance in the gastric mucosa could explain these results.
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http://dx.doi.org/10.1080/00365520500349549DOI Listing
May 2006

[Asthma: current therapeutic approach].

Recenti Prog Med 2005 Oct;96(10):494-8

Asthma is a chronic reversible respiratory disease characterized by inflammation and bronchial smooth muscle contraction. The therapeutic approach must improve the acute symptoms, avoid disease exacerbations and prevent the pulmonary functional decay.
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October 2005

[A case of cardiogenic syncope in a drug-addict patient].

Ital Heart J Suppl 2004 Oct;5(10):824-8

Dipartimento di Emergenza, Università Cattolica del Sacro Cuore, Roma.

Torsade de pointes is a polymorphic ventricular tachycardia, associated with prolonged QT interval and characterized by twisting of the mean electrical axis of the QRS complexes around an isoelectric line. The long QT syndrome can be divided into two categories, congenital and acquired. The congenital long QT syndrome may be caused by some gene mutation, whereas the acquired form is usually associated with drugs and electrolyte imbalance. It usually remains asymptomatic or causes presyncope, although it may degenerate into ventricular fibrillation and may cause sudden death. The different presentation depends on the polymorphism that characterizes genotypic and phenotypic expression of proteic channel subunits, and on drug toxicity that provoke subunit dysfunction. The case report presented here is an example of prolonged QT interval syndrome in a patient with cocaine abuse and electrolyte disturbances.
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October 2004

A "progressive" visual loss.

Ann Ital Med Int 2004 Apr-Jun;19(2):118-21

Dipartimento di Emergenza e Accettazione, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli di Roma.

An unusual cause of acute-onset and progressively worsening visual loss is presented. A 60-year-old woman was referred for left homonymous hemianopsia to our Emergency Medicine Department because of a suspected vascular accident. Ten years earlier she had been diagnosed as having chronic lymphocytic leukemia. Brain computed tomography and magnetic resonance imaging revealed "bilateral foci of white matter abnormalities in the occipital regions, compatible with a diagnosis of progressive multifocal leukoencephalopathy". Her cerebrospinal fluid was positive for papovavirus JC. Progressive multifocal leukoencephalopathy due to papovavirus JC, a typical complication in AIDS patients, is a rare complication in patients with other immunosuppressive conditions, such as chronic lymphocytic leukemia.
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September 2004

Taurine reduces mortality in diabetic rats: taurine and experimental diabetes mellitus.

Adv Exp Med Biol 2003 ;526:67-73

Department of Pharmacology and Center for Biotechnology Development and Biodiversity Research, University of Sassari, Italy.

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http://dx.doi.org/10.1007/978-1-4615-0077-3_9DOI Listing
February 2004

HCV infection and extrahepatic manifestations.

Hepatogastroenterology 2003 Jul-Aug;50(52):1149-54

Emergency Department, Rome University, La Sapienza, Italy.

Hepatitis C virus infection is associated with various extrahepatic manifestations such as mixed cryoglobulinemia, membranoproliferative glomerulonephritis and porphyria cutanea tarda. The link between mixed cryoglobulinemia and hepatitis C virus infection is actually well known. Interferon alpha therapy decreases hepatitis C viremia and improves the clinical signs and biochemical abnormalities of cryoglobulinemia. The rare combination of hepatitis C and panarteritis nodosa has still not been confirmed. The sicca syndrome also seems to be associated with hepatitis C virus, but this is not the typical Sjogren's syndrome. It is not yet well established if hepatitis C virus plays a pathogenic role in the development of thyroid dysfunction and autoimmune thyroiditis. Probably interferon therapy may be implicated in the development in this and other extrahepatic manifestations of hepatitis C virus infection. Although an epidemiological association of hepatitis C with lichen planus, neuropathies and other diseases has been observed, the etiological role and the pathogenic involvement of the hepatitis C infection remains unclear. Extrahepatic clinical manifestations are frequently observed in hepatitis C virus patients and involve primarily the joints, muscles, and skin. The most frequent immunological abnormalities include mixed cryoglobulins, antinuclear antibodies, and anti-smooth muscle antibodies.
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October 2003