Objective. In October 2004, rofecoxib was removed from the world market because of an increased r... more Objective. In October 2004, rofecoxib was removed from the world market because of an increased risk of myocardial infarction. The aim of the present study was to compare the trend of nonsteroidal antiinflammatory drug (NSAID) use and other analgesics in osteoarthritis (OA) treatment before and after rofecoxib withdrawal in Italian general practice. Methods. From the Caserta-1 Local Health Service database, 97 general practitioners were recruited. Prevalence and incidence of use of any study drug were calculated within 1 year before and after rofecoxib withdrawal. Results. One-year prevalence of nonselective and preferential NSAID use did not change after rofecoxib withdrawal, whereas coxib use fell from 4.4% (95% confidence interval [95% CI] 4.2-4.5%) in the period before rofecoxib withdrawal (period I) to 1.6% (95% CI 1.5-1.7%) in the period after withdrawal (period II). Weak opioids were used in no more than 0.4% (95% CI 0.3-0.5%) in period II, after their introduction to reimbursement in December 2004. Also, 1-year incidence of coxib decreased from 31.3 per 1,000 (95% CI 30.2-32.4%) in period I to 8.7 per 1,000 (95% CI 8.1-9.2%) in period II. The disappearance of rofecoxib was associated with replacement drugs such as newly marketed dexibuprofen and aceclofenac, whereas nimesulide use coincidentally decreased. Conclusion. Rofecoxib withdrawal has markedly changed the prescribing pattern of drugs that are used in OA-related pain treatment, with a striking decrease of coxib use in Italian general practice. Education strategies addressed to health professionals should be planned to improve the management of pain treatment, particularly in degenerative joint diseases.
This is the first case of multiple (triple) pituitary micro-adenomas documented by magnetic reson... more This is the first case of multiple (triple) pituitary micro-adenomas documented by magnetic resonance imaging (MRI) in a living patient and treated by a transsphenoidal microsurgical approach. The patient, a 37-year-old woman, complained of a long history of bifrontal headache, weight gain and oligomenorrhea. Physical examination revealed moderate hirsutism and a slight fat pad overlying the vertebrae. Routine laboratory studies and endocrinological biochemical investigations were normal. A gadolinium-enhanced MRI of the pituitary region revealed three intrapituitary micro-adenomas. A transsphenoidal microsurgical approach to the pituitary gland was carried out and micro-adenomas were completely removed one at a time. One year follow-up showed complete resolution of clinical symptoms and signs and normal biochemical parameters of pituitary function.
Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effe... more Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effect of systemic administration of recombinant human erythropoietin in a rabbit model of subarachnoid hemorrhage-induced acute cerebral ischemia. The animals were divided into three groups: group 1, subarachnoid hemorrhage; group 2, subarachnoid hemorrhage plus placebo; group 3, subarachnoid hemorrhage plus recombinant human erythropoietin (each group, n=8). Experimental subarachnoid hemorrhage
T2DM patients on insulin-only regimens with at least one HbA1c value in the database and six mont... more T2DM patients on insulin-only regimens with at least one HbA1c value in the database and six months continuous eligibility pre-post HbA1c index. Data on HbA1c, insulin regimen, complications and demographic characteristics of all patients were analyzed using descriptive statistics. RESULTS: Of 689 patients, 29% had HbA1c 7% (mean age 52 years; female 40%; mean HbA1c 5.9%; basal-only 73%; basal-bolus 25%) while 71% had HbA1c 7% (mean age 51 years; female 41%; mean HbA1c 9.3%; basal-only insulin 63%; basal-bolus insulin 34%). The nature and incidence of microvascular complications in the two groups were: diabetic foot complications 2% and 6% (p < 0.05), neuropathy 13% and 9%, retinopathy 9% and 13%, kidney disease 5% and 7% for patients with HbA1c <7% and Ն7%, respectively. CONCLUSION: A sizable proportion of T2DM patients were uncontrolled on their current insulin regimen. This may reflect undue delay in insulin initiation and intensification by patients and providers. Moreover, a considerable proportion of patients at goal show signs of complications, signifying the urgency of earlier insulin initiation and more aggressive intensification to ameliorate current sub-optimal glycemic control.
To analyse the prescribing pattern and the safety profile of different atypical antipsychotics an... more To analyse the prescribing pattern and the safety profile of different atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) during the years 2002-2003 in paediatric setting. Two Child Neurology and Psychiatry Divisions of Southern Italy (University of Messina and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Oasi Institute for Research on Mental Retardation and Brain Aging&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of Troina). A retrospective chart review of all children and adolescents starting an incident treatment with atypical antipsychotics or SSRIs was performed. Within the first 3 months of therapy, any potential adverse drug reaction (ADR) was identified and the clinical outcome of psychotropic drug treatment was assessed. Rate of ADR in the first 3 months of therapy with atypical antipsychotics and SSRIs in children and adolescents. On a total of 97 patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; charts being reviewed, 73 (75%) concerned atypical antipsychotics and 24 (25%) SSRIs. Risperidone (N=45, 62%) was the most frequently prescribed antipsychotic drug, followed by olanzapine (24, 32%). Overall, 50 (68%) antipsychotic users reported a total of 108 ADRs during the first 3 months of therapy, leading to drug discontinuation in 23 patients (31%). Among 24 users of SSRI, 12 (50%) received paroxetine, 6 (25%) sertraline, 5 (21%) citalopram and 1 (4%) fluoxetine. Only paroxetine users (21%) reported at least one ADR, however, none of SSRI users withdrew drug treatment within first 3 months. ADRs occurred frequently during first 3 months of treatment with atypical antipsychotics and, to a lesser extent, with SSRIs in children and adolescents. Further investigations are urgently needed to better define the benefit/risk ratio of psychotropic medications in paediatric setting.
Objective To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after r... more Objective To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy. Methods From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed. Results Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8).
Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular preve... more Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events.
Proceedings of the National Academy of Sciences, 2002
Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patient... more Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patients affected by aneurysmal subarachnoid hemorrhage (SAH). Recently, i.p. administration of recombinant human erythropoietin (r-Hu-EPO) has been shown to exert a neuroprotective effect during experimental SAH. The present study was conducted to evaluate further the effect of r-Hu-EPO administration after SAH in rabbits on neurological outcome, degree of basilar artery spasm, and magnitude of neuronal ischemic damage. Experimental animals were divided into six groups: group 1 (n ؍ 8), control; group 2 (n ؍ 8), control plus placebo; group 3 (n ؍ 8), control plus r-Hu-EPO; group 4 (n ؍ 8), SAH; group 5 (n ؍ 8), SAH plus placebo; group 6 (n ؍ 8), SAH plus r-Hu-EPO. r-Hu-EPO, at a dose of 1,000 units͞kg, and placebo were injected i.p. starting 5 min after inducing SAH and followed by clinical and pathological assessment 72 h later. Systemic administration of r-Hu-EPO produced significant increases in cerebrospinal fluid EPO concentrations (P < 0.001), and reduced vasoconstriction of the basilar artery (P < 0.05), ischemic neuronal damage (P < 0.001), and subsequent neurological deterioration (P < 0.05). These observations suggest that r-Hu-EPO may provide an effective treatment to reduce the post-SAH morbidity.
Objective. In October 2004, rofecoxib was removed from the world market because of an increased r... more Objective. In October 2004, rofecoxib was removed from the world market because of an increased risk of myocardial infarction. The aim of the present study was to compare the trend of nonsteroidal antiinflammatory drug (NSAID) use and other analgesics in osteoarthritis (OA) treatment before and after rofecoxib withdrawal in Italian general practice. Methods. From the Caserta-1 Local Health Service database, 97 general practitioners were recruited. Prevalence and incidence of use of any study drug were calculated within 1 year before and after rofecoxib withdrawal. Results. One-year prevalence of nonselective and preferential NSAID use did not change after rofecoxib withdrawal, whereas coxib use fell from 4.4% (95% confidence interval [95% CI] 4.2-4.5%) in the period before rofecoxib withdrawal (period I) to 1.6% (95% CI 1.5-1.7%) in the period after withdrawal (period II). Weak opioids were used in no more than 0.4% (95% CI 0.3-0.5%) in period II, after their introduction to reimbursement in December 2004. Also, 1-year incidence of coxib decreased from 31.3 per 1,000 (95% CI 30.2-32.4%) in period I to 8.7 per 1,000 (95% CI 8.1-9.2%) in period II. The disappearance of rofecoxib was associated with replacement drugs such as newly marketed dexibuprofen and aceclofenac, whereas nimesulide use coincidentally decreased. Conclusion. Rofecoxib withdrawal has markedly changed the prescribing pattern of drugs that are used in OA-related pain treatment, with a striking decrease of coxib use in Italian general practice. Education strategies addressed to health professionals should be planned to improve the management of pain treatment, particularly in degenerative joint diseases.
This is the first case of multiple (triple) pituitary micro-adenomas documented by magnetic reson... more This is the first case of multiple (triple) pituitary micro-adenomas documented by magnetic resonance imaging (MRI) in a living patient and treated by a transsphenoidal microsurgical approach. The patient, a 37-year-old woman, complained of a long history of bifrontal headache, weight gain and oligomenorrhea. Physical examination revealed moderate hirsutism and a slight fat pad overlying the vertebrae. Routine laboratory studies and endocrinological biochemical investigations were normal. A gadolinium-enhanced MRI of the pituitary region revealed three intrapituitary micro-adenomas. A transsphenoidal microsurgical approach to the pituitary gland was carried out and micro-adenomas were completely removed one at a time. One year follow-up showed complete resolution of clinical symptoms and signs and normal biochemical parameters of pituitary function.
Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effe... more Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effect of systemic administration of recombinant human erythropoietin in a rabbit model of subarachnoid hemorrhage-induced acute cerebral ischemia. The animals were divided into three groups: group 1, subarachnoid hemorrhage; group 2, subarachnoid hemorrhage plus placebo; group 3, subarachnoid hemorrhage plus recombinant human erythropoietin (each group, n=8). Experimental subarachnoid hemorrhage
T2DM patients on insulin-only regimens with at least one HbA1c value in the database and six mont... more T2DM patients on insulin-only regimens with at least one HbA1c value in the database and six months continuous eligibility pre-post HbA1c index. Data on HbA1c, insulin regimen, complications and demographic characteristics of all patients were analyzed using descriptive statistics. RESULTS: Of 689 patients, 29% had HbA1c 7% (mean age 52 years; female 40%; mean HbA1c 5.9%; basal-only 73%; basal-bolus 25%) while 71% had HbA1c 7% (mean age 51 years; female 41%; mean HbA1c 9.3%; basal-only insulin 63%; basal-bolus insulin 34%). The nature and incidence of microvascular complications in the two groups were: diabetic foot complications 2% and 6% (p < 0.05), neuropathy 13% and 9%, retinopathy 9% and 13%, kidney disease 5% and 7% for patients with HbA1c <7% and Ն7%, respectively. CONCLUSION: A sizable proportion of T2DM patients were uncontrolled on their current insulin regimen. This may reflect undue delay in insulin initiation and intensification by patients and providers. Moreover, a considerable proportion of patients at goal show signs of complications, signifying the urgency of earlier insulin initiation and more aggressive intensification to ameliorate current sub-optimal glycemic control.
To analyse the prescribing pattern and the safety profile of different atypical antipsychotics an... more To analyse the prescribing pattern and the safety profile of different atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) during the years 2002-2003 in paediatric setting. Two Child Neurology and Psychiatry Divisions of Southern Italy (University of Messina and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Oasi Institute for Research on Mental Retardation and Brain Aging&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of Troina). A retrospective chart review of all children and adolescents starting an incident treatment with atypical antipsychotics or SSRIs was performed. Within the first 3 months of therapy, any potential adverse drug reaction (ADR) was identified and the clinical outcome of psychotropic drug treatment was assessed. Rate of ADR in the first 3 months of therapy with atypical antipsychotics and SSRIs in children and adolescents. On a total of 97 patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; charts being reviewed, 73 (75%) concerned atypical antipsychotics and 24 (25%) SSRIs. Risperidone (N=45, 62%) was the most frequently prescribed antipsychotic drug, followed by olanzapine (24, 32%). Overall, 50 (68%) antipsychotic users reported a total of 108 ADRs during the first 3 months of therapy, leading to drug discontinuation in 23 patients (31%). Among 24 users of SSRI, 12 (50%) received paroxetine, 6 (25%) sertraline, 5 (21%) citalopram and 1 (4%) fluoxetine. Only paroxetine users (21%) reported at least one ADR, however, none of SSRI users withdrew drug treatment within first 3 months. ADRs occurred frequently during first 3 months of treatment with atypical antipsychotics and, to a lesser extent, with SSRIs in children and adolescents. Further investigations are urgently needed to better define the benefit/risk ratio of psychotropic medications in paediatric setting.
Objective To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after r... more Objective To assess whether the prescribing pattern of lipid-lowering drugs (LLD) changed after reimbursement criteria revision in a general practice in southern Italy. Methods From the Caserta-1 Local Health Service database, 93 general practitioners (GPs) who had consistently sent data about their patients during the years 2003-2005 were recruited. Prevalence of use and incidence of new treatments were calculated for each year, stratified by three drug cohorts: statins, omega-3 fatty acids, and fibrates. Subanalyses by gender, age, and indication of use were performed. Results Overall, 1-year prevalence of LLD use increased from 2003 to 2004. After reimbursement criteria revision (November 2004), a slight decrease was observed for statins, from 41.1 (95% CI: 39.9-42.2) per 1,000 inhabitants in 2004 to 40.3 (39.2-41.5) in 2005, while omega-3 utilization fell markedly: 14.6 (13.9-15.3) vs. 5.4 (5.0-5.8).
Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular preve... more Background-Nonadherence to antihypertensive treatment is a common problem in cardiovascular prevention and may influence prognosis. We explored predictors of adherence to antihypertensive treatment and the association of adherence with acute cardiovascular events.
Proceedings of the National Academy of Sciences, 2002
Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patient... more Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patients affected by aneurysmal subarachnoid hemorrhage (SAH). Recently, i.p. administration of recombinant human erythropoietin (r-Hu-EPO) has been shown to exert a neuroprotective effect during experimental SAH. The present study was conducted to evaluate further the effect of r-Hu-EPO administration after SAH in rabbits on neurological outcome, degree of basilar artery spasm, and magnitude of neuronal ischemic damage. Experimental animals were divided into six groups: group 1 (n ؍ 8), control; group 2 (n ؍ 8), control plus placebo; group 3 (n ؍ 8), control plus r-Hu-EPO; group 4 (n ؍ 8), SAH; group 5 (n ؍ 8), SAH plus placebo; group 6 (n ؍ 8), SAH plus r-Hu-EPO. r-Hu-EPO, at a dose of 1,000 units͞kg, and placebo were injected i.p. starting 5 min after inducing SAH and followed by clinical and pathological assessment 72 h later. Systemic administration of r-Hu-EPO produced significant increases in cerebrospinal fluid EPO concentrations (P < 0.001), and reduced vasoconstriction of the basilar artery (P < 0.05), ischemic neuronal damage (P < 0.001), and subsequent neurological deterioration (P < 0.05). These observations suggest that r-Hu-EPO may provide an effective treatment to reduce the post-SAH morbidity.
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