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Listeria monocytogenes Brain Abscess Mimicking Ischemic Stroke in an Immunocompromised Patient: A Case Report
Full text linkListeria monocytogenes (L. monocytogenes) is a Gram-positive bacillus that infects immunocompromised persons, neonates, pregnant women and, occasionally, previously healthy individuals. L. monocytogenes brain abscesses are particularly rare.We present a 62-year-old female on corticosteroid treatment due to a recent diagnosis of autoimmune hepatitis, who suddenly developed right hemiparesis mimicking a stroke. A brain computerized tomography (CT) scan revealed a brain abscess and the blood cultures drawn yielded L. monocytogenes. A conservative treatment without surgical intervention was selected. The patient was commenced on intravenous ampicillin and gentamicin and showed remarkable improvement. She was successfully discharged on oral amoxicillin with probenecid. Since the subsequent magnetic resonance imaging (MRI) study and CT scans exhibited reduction in the size of the abscess, the antimicrobial treatment was discontinued after a three-month period. The patient underwent regular follow-up visits with no signs of relapse
Evoluzione metodologica dell’invalidità civile in Italia: confronto ragionato tra i sistemi valutativi tabellari, di legge e non, che si sono succeduti negli anni
No full textThe authors describe the evolution from 1980 to the present of the tables that describe invalidating states, on which the medical-legal judgments of civil disability in Italy are based.The first part of the work briefly describes the main disabilities, grouped by both body system and percentage value range, that can be found in the tables attached to the main documents applied, or applicable, to the sector: those issued alongside the Ministerial Decree n. 282 of 1980, those that accompanied the Ministerial Decree of February 1982 (still in force today) and those proposed by the Italian Institute of Social Security (INPS) in 2012, which have not yet entered into force.The second part of the paper has two aims. On the one hand, it seeks to underline the change in the pre-eminent type of disability featured in the tables: from osteoarticular diseases, which were the most significant type in the 1980 tables, to neoplastic diseases, which are the most prevalent overall in the 2012 tables.On the other hand, the authors highlight that the tables themselves have evolved, moving towards a more precise definition (both clinical and instrumental) of the organ damage causing the reduction in general working capacity. In the 1980 tables, disability was often evaluated empirically rather than based on the use of functional indices or systematic classification. In the 2012 INPS proposed tables, evaluations of the reduction in working capacity are often based on specific functional parameters for the various organs (EF for the heart, FEV1 for the respiratory system, GFR for the urinary system) or on standardized disability evaluation scales (NYHA classes for heart diseases, EDSS or the Hoehn & Yahr classification for neurological disorders, MMSE or CDR for dementia, the Child-Pugh classification for cirrhogenic hepatopathies)
Corrigendum: Treatments of Advanced Non‑Small Cell Lung Cancer (NSCLC) in an Italian Center: Drug Utilization and the Treatment Costs of Innovative Drugs
Full text linkThere was an error in Discussion section at page 36 in this article by Piantedosi et al. [Farmeconomia. Health economics and therapeutic pathways 2019; 20(1): 27-41; https://doi.org/10.7175/fe.v20i1.1376]. The online version has been corrected on June 5, 201
The Role of Carbon Dioxide Laser Therapy in Penile Kaposi’s Sarcoma: A Case Series of Three HIV-Negative HHV-8-Positive Patients
Full text linkKaposi’s sarcoma (KS) is a rare tumor of vascular origin. It is quite common in HIV patients. It is rarely located on the glans penis, especially in HIV-negative patients (just some tens in the literature). Owing to the rarity of the disease, both the real impact on survival and the most suitable therapy are not known.However, in this 3-patient case series, carbon dioxide laser therapy was effective both for local control and survival. In fact, two late relapses but no disease-related death were recorded. Probably, KS in HIV-negative patients is a slowly progressive disease, not so aggressive as in HIV-positive patients. Laser therapy is easy, fast, and cheap, and may treat the disease radically.If these data are confirmed by further studies, in the foreseeable future, laser therapy may become the gold standard for treating HIV-negative patients affected by penile KS
The Value and Sustainability of Ocrelizumab in Relapsing Multiple Sclerosis: A Cost-Effectiveness and Budget Impact Analysis
Full text linkINTRODUCTION: The availability of ocrelizumab for the relapsing forms of multiple sclerosis (MS) in the Italian markets raised some questions about its economic impact and value compared to the alternative treatment options available.AIM: To assess the cost-effectiveness and budget impact of ocrelizumab compared to the most used second line disease modifying therapies (DMTs) in Italy.METHODS: The study was divided in two phases: Phase 1 – based on the development of a decision analytical Markov model to assess the cost-effectiveness of ocrelizumab compared to natalizumab and fingolimod, and Phase 2 – based on the development of a budget impact model to assess the economic impact of ocrelizumab in Italy. Both models used the National Health System perspective; a lifetime horizon was applied in the cost-effectiveness analysis and a 3-year time horizon in the budget impact. The cost-effectiveness analysis results were reported as incremental cost-effectiveness ratio (ICER) expressed as € per Quality Adjusted Life Year (QALY) gained, the budget impact analysis results were reported as difference in the overall budget (€) between a scenario with and without ocrelizumab.RESULTS: The two analyses reported ocrelizumab as a cost-effective option compared to natalizumab and fingolimod with a positive impact on the overall NHS budget. In the base-case analysis, the ICER was € 2,023 for ocrelizumab compared to fingolimod; while ocrelizumab resulted cost-saving compared to natalizumab. The sensitivity analysis confirmed the base-case analysis results. Further, the use of ocrelizumab was associated to a budget decrease of € 21 million (-2.6%) in a 3-year time horizon.CONCLUSION: The results of our cost-effectiveness and budget impact models reported ocrelizumab as an effective and efficient treatment in patients with relapsing forms of MS who failed a first line DMTs from the Italian NHS perspective
Effectiveness of Long-Acting Injectable Antipsychotics in Schizophrenia: A Literature Review and Bayesian Meta-Analysis Informing Economic Considerations
Full text linkBACKGROUND: Although the use of long-acting injectable antipsychotics (LAIs) is considered an important option in the management of schizophrenia two recent meta-analysis, which aimed to compare LAIs vs oral antipsychotics (OAPs) in terms of relapse rate, showed discordant results.AIM: To investigate factors affecting the efficacy of antipsychotics in terms of relapse prevention in the real-world and to estimate the management cost of an episode of relapse.METHODS: We conducted a literature search using MEDLINE/PubMed with the aim to extract efficacy, effectiveness and adherence data of LAIs and OAPs. The primary outcome was the relative risk (RR) of relapse between two strategies. The extracted RR were included in a series of Bayesian statistical models based on the starting hypotheses. The RR rates obtained from the meta-analysis have been used as input for an economic evaluation of the total costs associated with the management of the patient with schizophrenia from the Italian NHS perspective.RESULTS: The literature search identified 34 studies which met the inclusion criteria and were analyzed. According to the model that best explains the data, in the real-world setting the effectiveness with LAIs is greater than with OAPs, with a more pronounced effect for SGAs than for FGAs. Taking into account generation, route and frequency of administration, the RR decreased with lower administration frequency, with SGA LAI administered once every 90 days which is associated with the greatest reduction in the risk of relapse (-85%). When the results of the meta-analysis are used to feed an economic evaluation the results show that the SGA administered every 90 days is the strategy with the least expected cumulative cost both at 1 (€ 3,509) and 5 years (€ 19,690).CONCLUSION: SGA LAIs administered every 90 days seems to be the best option for the treatment of patient with schizophrenia from both the clinical and economic perspectives.An erratum to this article is available online at: https://doi.org/10.7175/fe.v20i1.140
Il PDTA-HIV nella gestione del paziente cronicizzato: una proposta di documento condiviso
No full text[Clinical / care pathways in the management of the chronically ill patient with HIV: proposal for a shared document]Abstract non presente. Si riporta l\u27inizio dell\u27editoriale La malattia HIV/AIDS ha visto nell’ultimo periodo un radicale cambiamento nelle prospettive di vita delle persone HIV+ e con esso il delinearsi di uno scenario del tutto differente rispetto alle loro esigenze ed aspettative..
La valutazione della disabilità ai fini del riconoscimento dell’indennità di accompagnamento nel soggetto ultra-sessantasettenne
No full textOlder people, the fastest growing part of population, are at the highest risk of acquired disability or cognitive decline and, as a consequence, their claim to receive support services, among which the Attendance Allowance for permanent personal assistance, is increasing. This benefit was introduced in the Italian Civil Incapacity system with the law 18/1980 and some relevant innovations were added with the Law 508/1988 and the Decree 509/1988. From a medico-legal point of view, these regulations, define on the one hand the necessary requirements to get a pension (non-contributory), that is physical and or mental disease determining the incapacity for work and, for infra-18 and over-65-year olds, require the “persistent difficulties” to carry out the “tasks and activities” proper to their age. On the other hand, the Law n. 508/1988 identifies also the necessary conditions to get the Attendance Allowance, for those who are unable to get around and/or are unable to carry out daily life activities without the permanent help of a caregiver.Therefore, these regulations specifically provide, first of all, the recognition of the highest level of severity of the “persistent difficulties” concerning the “tasks” and “activities” of the over 65s (prerequisites) and then the judgment for the Attendance Allowance. However, there are considerable difficulties with the assessment of this kind of disability. In fact, we have specific references about incapacity for work indicating the evaluation path and the guide for the rating of permanent impairment (Ministerial Decree 5 February 1992), but there aren’t specific normative and assessment indications about the ability to perform “tasks and activities” in over-65-year-olds (age requirement has become over 67s since January 2019) which allows the risk of a wide evaluating discretion.Italian institutions, like Ministry of Health or INPS (Italian Institute of Social Security) and others officially involved, have attempted to explain and clarify the above-mentioned rating process, but with unsatisfactory results and in some cases even with regressive ones, producing real distortions and interpretative stretches. The author, therefore, after presenting the medico-legal issues for the evaluation of older adults’ disability based on the current regulations, also criticizes the widely found practice of using an atypical, not multidisciplinary, comprehensive geriatric assessment made only for this purpose and elaborate by a single specialist. In fact, the results of a geriatric assessment, like any other Health Certification, is useful to complete the medical history of the subject alleging disability and, therefore, it must be validated by a proper and extensive medico-legal evaluation
