Giuliano Soffiati

Efficacy of 7 day lansoprazole-based triple therapy for Helicobacter pylori infection in elderly patients.

Background: The prevalence of Helicobacter pylori increases with age. However, data regarding the effects of anti‐H. pylori treatments in the elderly are very scarce.

Cure of Helicobacter pylori infection in the elderly : effects of eradication on gastritis and serological markers

Background: Specific data on anti‐H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti‐H. pylori therapies and the behaviour of serum anti‐H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti‐H. pylori treatment.

Cure of Helicobacter pylori infection in elderly patients: comparison of low versus high doses of clarithromycin in combination with amoxicillin and pantoprazole

Advancing age may influence clarithromycin’s pharmacokinetics. No studies have yet compared the effects of different dosages of clarithromycin in combination with a proton pump inhibitor and amoxicillin in elderly patients.

The Clinical Usefulness of Serum Pepsinogens, Specific IgG Anti-HP Antibodies and Gastrin for Monitoring Helicobacter pylori Treatment in Older People

OBJECTIVE: to evaluate the clinical usefulness of Pepsinogen A (PGA) and C (PGC), PGA/PGC ratio, gastrin, and specific IgG anti‐HP antibodies (anti‐HP Ab) in monitoring the effect of cure for Helicobacter pylori (HP) infection in older people.

In vitro removal of therapeutic drugs with a novel adsorbent system

Background/Aim: Substances in the middle molecular weight range have been shown to play a significant pathogenetic role in as diverse disorders as end-stage renal disease and multiple organ failure. To overcome the limitations in the amount removed by hemofilters, new sorbents with a high biocompatibility are actively being developed. Furthermore, biocompatible sorbents by their nonspecific adsorptive behavior could have great impact on detoxification treatment in exogenous intoxications. We performed an in vitro evaluation of a newly developed highly biocompatible sorbent cartridge (Betasorb®), examining its adsorptive capacity concerning therapeutic drugs. Methods: Uremic blood spiked with a range of therapeutic drugs was recirculated for 2 h in an in vitro hemoperfusion circuit containing a Betasorb device for hemoperfusion. The drug concentrations before and after the passage of the cartridge were measured, and the total amount removed was calculated. Results: The sorbent showed effective removal of glycopeptide antibiotics, digoxin, theophylline, phenobarbital, phenytoin, carbamazepine, and valproic acid. Moderate removal could be demonstrated for tacrolimus and cyclosporine A; aminoglycosides were removed to a small extent only. Conclusions: Betasorb hemoperfusion shows a potent adsorptive capacity concerning therapeutic drugs (except aminoglycosides) and could be of major value in the treatment of intoxications. On the other hand, drug monitoring and possible adjustments are necessary during Betasorb hemoperfusion to maintain the therapeutic ranges of the drugs in blood.

Vasopressin, atrial natriuretic factor and renal water homeostasis in premature newborn infants with respiratory distress syndrome

Arginine vasopressin (AVP), human atrial natriuretic peptide (hANP), and body fluid and electrolyte balance were examined during the first five days of life in eleven premature infants (birthweight 1610 +/- 240 g, gestation 30 +/- 1 weeks) receiving mechanical ventilation for respiratory distress syndrome (RDS). Plasma hANP and urine AVP concentrations were determined by radioimmunoassay on the first, third and fifth days. Arginine vasopressin urine levels remained constantly elevated during the study period (mean +/- SD 13.5 +/- 7.8 day 1, 12.0 +/- 9.9 day 3, 13.2 +/- 5.1 ng/l day 5, p = n.s.), while plasma hANP was significantly increased on the third day (626 +/- 495 vs. 298 +/- 240 pg/ml on day 1, p < .05). Urine sodium concentration, urine osmolality and osmolality and osmolar clearance were elevated significantly as well on day 3, p < .05, and correlated to hANP levels. Body weight decreased during the study by 8.2% on the third day and by 11.3% of birthweight on the fifth day. A significant increase in creatinine clearance occurred after the third day (p < .01), while free water clearance remained essentially the same during the first five days of life. We speculate that an increase in plasma hANP concentration on day 3 of life results in a natriuresis and osmolar diuresis without correlations or temporal relationships to hypervasopressinemia of the premature neonate with RDS.

Definition of reference limits for autoantibodies to thyroid peroxidase and thyroglobulin in a large population of outpatients using an indirect method based on current data.

CONTEXT The reference limits for thyroid antibodies are generally made by measuring thyroid peroxidase and thyroglobulin antibody values in a group of healthy subjects (direct method), as proposed by the National Academy of Clinical Biochemistry. OBJECTIVE To define the upper reference limits of thyroid peroxidase and thyroglobulin, by using an indirect method to analyze data from a large number of outpatients that were stored in the information system of a general hospital laboratory. DESIGN Thyroid peroxidase and thyroglobulin values from 21 492 patients, who had undergone antithyroid antibody measurements, were retrieved from the laboratory information system; the upper reference limits (in the top 97.5 percentile) were calculated using the indirect Kairisto method, after exclusion of outliers. RESULTS The mean upper reference limits for females and males were 15 kIU/L and 9 kIU/L for thyroid peroxidase, and 21 kIU/L and 19 kIU/L for thyroglobulin, respectively. The upper limits showed minimal or no differences in the different age classes in either females or males. CONCLUSIONS Using a vast population of patients, we demonstrated that the upper limits for thyroid antibodies are much lower than the values obtained with classic, direct methods and that they do not vary in relation to age and sex.

Monitoring high-dose heparin levels by ACT and HMT during extracorporeal circulation: diagnostic accuracy of three compact monitors

The correct monitoring of heparin therapy and its reversal determines the successful conduct of cardiovascular surgery with extracorporeal circulation (ECC). The activated coagulation time (ACT) and the heparin management test (HMT) are the most frequently used tests in the operating room. Three compact monitors for ACT or HMT are here evaluated. Forty samples were obtained, at 10-min intervals, from eight patients during ECC. The ACT or HMT was immediately performed using: Hemochron Junior™ ACT, CoaguCeck™ Pro (ACT) and Rapid Point Coag (HMT). Data were compared between them and with the heparin levels, measured as anti-Xa. The simple least squares linear regression among, respectively, Hemochron Junior ACT, CoaguCeck Pro ACT, Rapid Point Coag HMT and anti-Xa activity were i = 452.3, s = 15.2, Sy/x = 37.5, r = 0.18; i = 411.9, s = 22.1, Sy/x = 48.7, r = 0.21 and i = 479.4, s = 9.0, Sy/x = 9.3; r = 0.41. CoaguCeck Pro ACT results were above the upper detection limit (500 s) in 37 of 40 determinations. The comparison between ACT Hemocron and HMT Rapid Point Coag shows i = 35.7, s = 0.9, Sy/x = 35.4, r = 0.68, with a bias of 29.0 s (CI: 17.9-40.1), 95% of agreement between -41.5 s (CI: -60.7 to -22.3) and 99.5 s (CI: 80.4-118.7). Taking a concentration of 2.0 U/ml of heparin to discriminate between high- and low-risk conditions, receiver-operator characteristic (ROC) curve was used to rank the performance of the methods. Areas under the ROC curve± SE for Hemochron Junior ACT and Rapid Point Coag HMT were 0.629± 0.097 and 0.543± 0.096. The results obtained by HMT appear similar to those obtained by the ACT for monitoring high-dose heparin therapy in patients undergoing ECC. HMT appeared to perform better than ACT in measuring the heparin effect, while the ROC analysis gives a little more accuracy for ACT. Neither of the two methods is able to achieve enough evidence of diagnostic accuracy. Since these tests are widely used, and there are no laboratory alternatives, a real comparison with the outcome of the patients should be helpful for an evidence-based evaluation of these point-of-care tests.

Statin Therapy Is Associated with Decreased Small, Dense Low-Density Lipoprotein Levels in Patients Undergoing Peritoneal Dialysis

Cardiovascular disease is a major cause of morbidity and mortality among hemodialysis (HD) and peritoneal dialysis (PD) patients, and dyslipidemia plays an important role in its pathogenesis. In particular, small, dense LDL (sd-LDL) particles have been recently highlighted as an emerging cardiovascular risk factor. PD patients exhibit a more overtly abnormal lipid profile than HD patients, probably due to the metabolic interference of the peritoneal dialysis fluid. Statins are the main drugs for the treatment of dyslipidemia and they are able to decrease all LDL subclasses levels, but it remains unclear whether they can influence the proportion of sd-LDL. Only few studies regarding the effect of statins on the proportion of these particles have been performed in HD patients and, to our knowledge, no trials have been carried out in PD patients. Therefore, we compared the lipid profile and the proportion of sd-LDL in two populations of HD and PD patients. Our study suggests that statin therapy may be effective in reducing both the absolute amount and the proportion of sd-LDL in patients with a more overtly abnormal lipid profile, such as patients undergoing peritoneal dialysis. Statins do not seem to be effective in altering sd-LDL levels in patients undergoing hemodialysis with other factors that can influence LDL subtractions generation, such as hypertension and diabetes mellitus. If and when our results prove to be reproducible in large-scale studies, such studies should provide new insights into sd-LDL and its actual role in atherogenesis in patients undergoing hemodialysis or peritoneal dialysis.

Heart-Kidney Biomarkers in Patients Undergoing Cardiac Stress Testing

We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF) with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL). Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n = 16), the patients in the high ischemia group (n = 18) demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P = .06) in the detectable NGAL group, and 0.9 vs. 3.8 (P = .03) at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P = .03). LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P = .03) and 55.1 vs. 63.8 (P = .04), respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.