The HCV Sicily Network: A web-based model for the management of HCV chronic liver diseases

Epidemiological studies report that in Sicily reside about 30,000 citizens with a diagnosis of chronic hepatitis due to HCV. The availability of direct antiviral action (DAA) is a real therapeutic breakthrough, but the high cost of the therapeutic regimes limits their use and forced the National Health System to establish clinical priority for the treatment.The HCV Sicily Network is a web-based model of best medical practice, which was designed to improve the management and the treatment of HCV chronic hepatitis and cirrhosis. The network includes 41 centers and 84 gastroenterologists or infectivologists connected by a web platform that recorder the diagnosis and the clinic priority for the…

HEAT SHOCK PROTEINS AND AUTOIMMUNE SYSTEM ACTIVATION IN IBD: ARTICULAR MANIFESTATIONS AND THE EPIDEMIOLOGICAL FREQUENCY IN ORTHPEDICS

clinical evidence suggest that arthritis is one of the complications of inflammatori bowel disease (IBD) of which the etiological causes are still not completely understood. Among the possible explanations the most probable theory is poor regulation of the intestinal immune system, which causes a cross-like immune reactivity against the resident micro flora. Arthritis is these subjects involves different joints and is asymmetric, with greater involvement of the large joints of the lower limbs. Joints may also be involved with the spinal forms of sacroileitis and ankilosing spondylitis. This clinical evidence explains the existence of Lesnioski-Crohn's disease, a variant of IBD in which pati…

La ripresa agonistica dopo intervento di LCA del ginocchio

Role of MR arthrography in shoulder micro-instability: personal experience.

Muscle lesions, a frequent event in sport, often cause hematomas. In fact, both in the traumatic direct injuries, as in American football, and in the traumatic indirect ones, as in strength sports, lesions interesting leg's Muscles Cause intra- and extramuscular hematomas. A diagnosis in a short time, allow LIS to evaluate the lesion rank and plan a surgery approach. Authors present high resolution Ultrasound (HRSU) as a new diagnostic method for this kind of lesion. It allows us to confirm clinic diagnosis, define the lesion's areas and follow-up. Moreover, HRSU has all important role in therapy, promoting in real time the blood's aspiration from lesion's area. Three phases after trauma, d…

Multidrug-resistant Gram-negative post-neurosurgical meningitis and the role of intraventricular colistin: a case series

: The aim of this study was to report the clinical experience of intraventricular colistin for the treatment of multi-resistant Gram-negative post-surgical meningitis in a tertiary hospital. Post-neurosurgical meningitis (PNM) is one of the life-threatening complications of neurosurgical procedures, and is frequently sustained by Acinetobacter baumannii and Klebsiella pneumoniae. Here we describe our experience of five cases of PNM caused by gram-negative multi-drug resistant (MDR) bacteria, treated with intraventricular (IVT) colistin, admitted to the Neurosurgery Unit of A.R.N.A.S. Civico of Palermo, Italy, from January 2016 to June 2020. In four patients the cerebrospinal fluid (CSF) cul…

Infectious diseases among foreign prisoners: results of a hospital-based management model in Palermo.

Foreign prisoners have a high vulnerability in terms of morbidity and access to care in overcrowded Italian prisons. This paper presents and comments on the management model of infectious diseases in foreign prisoners at our outpatient clinic, in order to describe a model of management for these conditions. Overall, 133 subjects (mean age 35.5 years) from 29 countries were followed for a period of 15 years. The most commonly represented area of origin (54.1%) was the Maghreb region. HCV infection (40.6%), HIV (22.5%), HBV (9.8%) and co-infection (15%, HIV/HCV or HIV/HBV) were observed. Ten subjects had tuberculosis, and only 30% of them were compliant with the treatment. Only 46.3% of HCV m…

Bleeding in orthopaedic surgery: The role of blood transfusion and erythropoietin alpha

High energy trauma is often responsable for acute bleeding. Long bone and pelvis fractures are correlated with increased blood loss. Hypovolaemia could become a life threatening complication especially in elderly patients because of the reduced physiological response. Furthemore it could compromise the course of associated morbidities. Haemorrage is also associated in both comminuted fractures and osteoporosis. An increased intraoperative bleeding often occurs when a prolonged surgical time is required to obtain an appropriate ostheosynthesis. The final consequence of a major bleeding is hypovolaemic shock. the reduced oxygen tension of the tissue may be responsible for heart attack, arrhyt…

Hip viscosupplementation under ultra-sound guidance riduces NSAID consumption in symptomatic hip osteoarthritis patients in a long follow-up. Data from italian registry

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) consumption is strictly related to a high gastrointestinal and cardiovascular mortality and morbidity rate. Osteoarthritis Research Society International (OARSI) recommendations in patients with symptomatic hip or knee OA stated that NSAIDs should be used at the lowest effective dose but their long-term use should be avoided if possible. OARSI guidelines for the treatment of the hip OA include the use of viscosupplementation, which aims to restore physiological and rheological features of the synovial fluid. Objective: Aim of this multicentric, open and retrospective study is to investigate if NSAID consumption may be reduced by t…

HBV virological suppression: still not enough to save from hepatocellular carcinoma. A case report on a 15-year, real-life story

Among HIV-infected patients worldwide, 2-4 million are chronically infected with HBV. We report a 15-year, real-life story of a patient with HBV-HIV coinfection, who developed HCC despite high treatment adherence and complete viral suppression. The aim of our report is to alert the infectious diseases community to monitor the possible development of HCC regardless of high treatment adherence and complete viral suppression.

La riabilitazione nella ricostruzione del legamento crociato anteriore (prima parte)

Gli autori considerano la ricostruzione del L.C.A. per formulare un razionale di riabilitazione post- chirurgica che, nel rispetto delle leggi della biologia per l'attecchimneto del neolegamento, acceleri il recupero funzionale del paziente.Sottolinenano l'importanza di iniziare il porgramma riabilitativo sin dal gioro dopo l'intervento per poi proseguire rispettando le fasi ed i tempi per una corretta esecuzione dell'esercizio terapeutico.Definiscono le sequele terapeutiche ed indicano le tecniche di più frequente impiego.

Ruolo dell'interazione NK/KIR nella storia naturale delle infezioni virali

Immunological mechanisms involved in the genesis of the immune response against viral infections take into account the activation of both innate adaptative response. Innate immune defenses trigger a rapid local response, which is often sufficient to control viral infection, and promotes the subsequent activation of specific immune defenses. Natural killer (NK) cells that constitute a subpopulation of lymphocyte-related cells are a key factor of innate immune response and play a role in defense against viral infections by killing infected cells or by producing cytokines and interacting with adaptative immune system's cells. Killer immunoglobulin-like receptors (KIRs) regulate the activation …

Safety of intra-articular hip injection of hyaluronic acid products by ultrasound guidance: an open study from ANTIAGE register.

Abstract. – OBJECTIVE: We developed a standardized technique for ultrasound guided intra-articular injection of the hip joint with the purpose of extending routine intra-articular injection of hyaluronans and steroids to the hip, as commonly used in the knee. In this article we report the safety of this technique in an extended series of patients. PATIENTS AND METHODS: Patients were injected supine with an anterosuperior approach under ultrasound guidance. The Us probe is applied with a target device for biopsy. RESULTS: The standardised technique was used to inject 1906 patients with 4002 injections of hyaluronan products over a four-year period. The treatment was well tolerated with few, …

Long-term outcomes comparison of different types of des in elderly patients from a real-world experience

OBJECTIVE: We sought to evaluate the impact on long-term clinical outcomes of different types of drug-eluting stents (DES) in elderly patients. BACKGROUND: Elderly patients constitute a fast-growing portion of cardiovascular patients, however, they are not adequately represented in clinical trials. Moreover, few data comparing different type of DES in elderly patients are available. METHODS: From a total of 2,330 consecutive patients treated at our institution with DES, we selected 207 elderly patients (≥ 75 years of age) who underwent, from May 2002 to December 2006, sirolimus-eluting stent (SES group, 116 patients [pts], 56%) or paclitaxel-eluting stent (PES group, 91 pts, 43.9%) implanta…

Logica riabilitativa nell'osteoporosi vertebrale

L'importanza dell'esercizio terapeutico nel trattamento integrato dell'osteoporosi vertebrale deriva dal fatto che produce sul tessuto osseo effetti metabolici positivi. Scopo del rpogramma chinesiterapico è di ottenere un buon tonotrofismo dei musocli deficitari e rilassare quelli che per compenso sono in uno stato di contrattura permanente e quindi dolorosa. Il compito del fisiatra deve indirizzarsi verso l'istruzione e l'adattamento della vita personale e di relazione del soggetto osteoporotico.

Femoral neck's fracture in Fahr's Syndorme

Fahr's syndrome is a rare neurological diseas characterized by the presence of idiopathic deposition of calcium in aeras of the brain that control movements.

La riabilitazione nella ricostruzione del legamento crociato anteriore (seconda parte)

Gli autori descrivono il trattamento riabilitaivo nella ricostruzione del L.C.A. dalla II alla III settimana dopo l'intervento, allorquando inizia la concessione del carico. Sottolineano l'importanza del trattamento propriocettivo per far acquistare al paziente la sensazione di stabilità del ginocchio operato. Rilevano che, agli effetti di un reiserimento ottimale nell'attività agonistica, il riallineamento allo sforzo ed agli stress risulta di rilevante significato. Infine sottolineano il valore degli aspetti psicologici di riabilitazione che non trascurano anche la personalità e le motivazioni del paziente.