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Biomedical subjects

F Chiodo

Publications and source records attributed to F Chiodo.

At least 109 records · Page 6Linked to original sources
PubMed1998

Randomized trial of trimethoprim-sulfamethoxazole versus pyrimethamine-sulfadiazine for therapy of toxoplasmic encephalitis in patients with AIDS. Italian Collaborative Study Group.

The aim of the present pilot study was to compare the efficacy and safety of trimethoprim (TMP) and sulfamethoxazole (SMX) with those of the standard therapy pyrimethamine (P)-sulfadiazine (S) for the treatment of toxoplasmic encephalitis in patients with AIDS. This was a pilot, multicenter, randomized, and prospective study. Patients were randomly assigned to receive TMP (10 mg/kg of body weight/day) and SMX (50 mg/kg/day) or P (50 mg daily) and S (60 mg/kg/day) as acute therapy (for 4 weeks) and then as maintenance therapy for 3 months at half of the original dosage. Seventy-seven patients were enrolled and randomized to the study: 40 patients were treated with TMP-SMX and 37 were treated with P-S. There was no statistically significant difference in clinical efficacy during acute therapy. In contrast, patients randomized to TMP-SMX appeared more likely to achieve a complete radiologic response after acute therapy. Adverse reactions were significantly more frequent in patients treated with P-S, and skin rash was the most common adverse event noted in these patients. In conclusion, the results of the study suggest that TMP-SMX appears to be a valuable alternative to P-S, in particular in patients with opportunistic bacterial infections.

AIDS-Related Opportunistic Infections↗
PubMed1998

Pulmonary Kaposi's sarcoma in AIDS patients treated with combined chemotherapy and recombinant human granulocyte colony-stimulating factor.

Optimal delivery of chemotherapy in AIDS patients with Kaposi's sarcoma (KS) is frequently limited by hematological toxicity, mainly neutropenia. We have conducted an open-label study to investigate the safety and efficacy of recombinant human granulocyte colony-stimulating factor (filgrastim, r-metHuG-CSF) administration in 25 AIDS patients with pulmonary KS treated with Adriamycin, bleomycin, and vincristine (ABV) combination. The patients were assigned to receive r-metHuG-CSF (Neupogen, Dompé, Biotec, 5 mg/kg of body weight per day) injected subcutaneously for 3-5 days before chemotherapy until the absolute neutrophil count was higher than 25 x 10(9); r-metHuG-CSF was then discontinued 5 days before chemotherapy. Patients were eligible to resume r-metHuG-CSF 3 days after completing the anticancer regimen until normalization of the absolute neutrophil count occurred, for a maximum of 10 days. The cytotoxic regimen included vincristine 1.4 mg/m2, bleomycin 10 mg/m2, and doxorubicin 20 mg/m2, every 2 weeks. The overall response rate was 58% with a complete response rate of 18%. Median survival was 11 months and median response duration was 6 months. Adverse effects consisted of transient nausea and vomiting in 48% of patients, and moderate headache in 43%. Hematologic toxicities included anemia in 27%, and mild to moderate neutropenia (grade II-III) in 38%. The mean leukocyte and neutrophil nadirs were 1920 and 850 mm3. The mean duration of neutropenia was 3.2 days. The combination of r-metHuG-CSF and ABV chemotherapy was well tolerated. Administration of r-metHuG-CSF within 5 days before chemotherapy appears to be an acceptable treatment with important clinical implications. We stress that further studies are needed to determine the maximum tolerable doses of combination chemotherapy supported by G-CSF in AIDS-associated KS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Xanthomonas maltophilia: an emerging pathogen in patients with HIV disease.

Fifty-four episodes of Xanthomonas maltophilia infection were observed in 52 HIV-infected patients out of 2062 assessed (2.52%) over a 6-year period: sepsis/bacteraemia in 44 cases, lower airways infection in 5 cases, urinary tract infection and pharyngitis in 2 cases each, and lymph node involvement in one patient. X. maltophilia represented the fourth most common non-mycobacterial bacterial pathogen responsible for bacteraemia in HIV-infected patients: 44 cases out of 721 diagnosed (6.1%). When compared with non-typhoid Salmonella spp. bacteraemia, an increased risk to develop X. maltophilia disseminated infection was seen according to the progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, central venous catheterization, previous antibiotic and/or corticosteroid treatment, and hospitalization. In 3 patients suffering from concurrent AIDS-related disorders, X. maltophilia infection contributed to death, while a recurrence occurred in 2 cases only. Due to the poor antimicrobial susceptibility of this pathogen (also confirmed in our series), X. maltophilia bacteraemia associated with advanced HIV infection and concurrent risk factors, may represent a potentially severe disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

AZT plus methotrexate in HIV-related non-Hodgkin's lymphomas.

AZT is a thymidine analogue useful in the treatment of AIDS. It has been demonstrated that this compound can possess a significant antineoplastic activity when combined with de novo thymidylate synthesis inhibitors, such as 5-fluorouracil (5FU) and methotrexate (MTX). Here we report a review of our data concerning the efficacy and tolerance of the combination AZT + MTX in HIV-related non Hodgkin's lymphomas (NHL). Twenty-nine patients were treated, at weekly intervals, with three (patient 1 to 10) or six (patient 11 to 29) consecutive courses of MTX 1g/m2 and increasing doses of oral AZT (2, 4 and 6g/m2) with leucovorin rescue. Of 26 evaluable patients, a total (complete + partial) response rate of 77% was obtained. The median complete response duration was 16.8 months. There was one therapy-related death due to septic shock. Grade III-IV neutropenia was observed after 19% of the courses, but was prevented by G-CSF administration in 82/119 courses. Grade III-IV anemia was observed after 9% of the courses. In conclusion, the combination AZT + MTX was effective and well tolerated in our series of HIV-related NHL patients.

Adult↗
PubMed1998

[Smectite in AIDS-associated chronic idiopathic diarrhea].

BACKGROUND: A prospective clinical survey was carried out in order to determine the effects of Smectite in patients with AIDS-associated chronic idiopathic diarrhea. METHODS: A total of 22 patients has been included in this study. All patients received smectite, 3 g orally three times daily far from meals for a period of 10-21 days. The outcome of chronic diarrhea has been evaluated during treatment. RESULTS: A significant reduction of duration of diarrhea, of frequency of stool number, and of the amount of liquid stools, has been recorded in all patients after the third and the fourth day of treatment. No major adverse effects and drug interactions have been documented in all treated patients. CONCLUSIONS: Smectite may be considered as adjuvant therapy in patients with AIDS-associated chronic idiopathic diarrhea by virtue of its efficacy and tolerability.

English Abstract↗
PubMed1998

Imported tropical diseases in subjects with HIV infection.

The authors report a case of Plasmodium falciparum malaria and a case of lymphatic filariasis caused by Brugia malayi, imported by HIV-infected patients during trips in endemic countries. The clinical and laboratory picture, as well as treatment response of imported malaria and filariasis did not differ significantly in patients with HIV infection compared with immunocompetent subjects. The exposition to tropical diseases during exotic travels has to be taken into account, in the differential diagnosis of infectious disorders complicating the course of HIV disease.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Quality control of data produced in biological population surveillance studies on the risk of environmental lead poisoning].

The biological surveys of the general population against the risk of lead intoxication carried out in Italy--in accomplishment both of the EEC directive EEC 77/312 and the Presidential Decree 496/1982--have been always conceived as multicentric activities. Therefore, starting from the first campaign carried out in 1979, strict quality control procedures have been adopted. In brief, each participant laboratory used internal quality control samples and took part in external quality assessment exercises. In addition, ten percent of the blood samples collected during the campaign were analyzed as blind duplicate by both participating laboratories and a reference laboratory. In this paper the quality control procedures adopted will be presented and discussed in detail together with the quality of results obtained in each campaign.

Environmental Exposure↗
PubMed1998

[Lead exposure: risk evaluation for the general Italian population in 1990].

The second Italian campaign for the biological surveillance of the general population against the risk of lead intoxication has been carried out according to the regulations contained in the Presidential Decree DPR 496/82. The investigations of the second campaign--based on the measurement of blood lead levels (PbB)--have been carried out mainly between 1992 and 1996 by various operating centers in some Italian regions. A work group from the Istituto Superiore di Sanità (Italian National Institute of Health) coordinated the activity of the various centers and organised an appropriate quality control program to guarantee the quality of the analytical data collected. A total of 7749 non exposed subjects (4346 females and 3403 males) has been examined, 1170 of which (559 females and 611 males) were under 15 years of age. The median PbB was, for adults, 86 micrograms/l in males and 53.5 micrograms/l in females. As for subjects under the age of 15, PbB levels were 50 micrograms/l and 43 micrograms/l in males and females, respectively. Our investigation confirms the correlation between blood lead levels, wine, and cigarette smoking. The comparison with the results of previous investigations shows a reduction between 40% and 50% of PbB in the general Italian population during the 1985-96 period. It should be pointed out that in certain areas more than 5% of subjects under 15 years of age had PbB exceeding the level (100 micrograms/l) considered safe for avoiding irreversible injury to the central nervous system.

Adolescent↗
PubMed1998

[Environmental lead exposure in the Venetian population from 1976-1992].

Blood lead levels observed in the general population of Venice and the surrounding area are reported for the period between 1976 and 1992. A time dependent decrease of blood lead levels is evident and parallels the step wise decrease of lead levels in gasoline which took place between 1981 and 1991. The observed lowering time trend of blood lead levels could possibly be ascribed, perhaps not negligibly, to technological improvements, the development of new analytical procedures and the continuous practice of quality control.

Adolescent↗
PubMed1998

[Evaluation of environmental lead exposure in Latium: 2d DPR 496/82 campaign].

In the Latium region, according to the regulations contained in the presidential decree DPR 496/82, the investigations of the second campaign--based on the measurement of blood lead levels (PbB)--have been carried out between 1992 and 1994. Three samples of subjects were examined: adult subjects (33 males and 628 females) living in Priverno, a small town in the South of the Latium region; adults subjects living in the Rome area (81 males and 168 females; subjects under the age of 15 (65 males and 54 females) living in the Rome area. Concerning Priverno, the median PbB was 70 micrograms/l in males and 40 micrograms/l in females; in Rome 66 micrograms/l and 42 micrograms/ l in males and females, respectively. In subjects under the age of 15, PbB levels were 40.5 micrograms/l and 35.5 micrograms/l in males and females, respectively. As for adults PbB levels were significantly higher in female than in male subjects and in subjects aged 41 years and over in comparison with subjects aged 15-40 years. PbB levels were significantly higher in wine drinkers in comparison with non-drinkers. The difference between smokers and non smokers was significant only in female subjects living in Rome. In multiple regression analysis the association of PbB with age, sex, alcohol consumption and smoking habit were confirmed, and a positive relation between PbB and the condition of being living in Rome. As for Rome, the comparison with the results of previous investigations shows a reduction between 50% and 60% of PbB during the 1985-1992 period.

Adult↗
PubMed1998

[Lymph node dissemination of a serious Pneumocystis carinii respiratory infection in AIDS: histopathological and ultrastructural aspects].

A case report of isolated lymph node extension of atypical respiratory Pneumocystis carinii infection which occurred in an HIV-infected patient undergoing aerosolized pentamidine prophylaxis is presented with its histopathological and ultrastructural features. AIDS-associated extrapulmonary and disseminated pneumocystosis are discussed on the ground of their frequency, localizations, risk factors, clinical presentation, and outcome.

AIDS-Related Opportunistic Infections↗
PubMed1997

C-reactive protein elevation and early outcome in patients with unstable angina pectoris.

C-reactive protein, a reactant of the acute phase of inflammation, has been shown to be increased in patients with unstable angina. Moreover, it has recently been found that increased C-reactive protein is associated with a poor outcome during hospitalization in selected patients with severe unstable angina. The aim of this study was to investigate the prognostic value of C-reactive protein elevation in a large population with unstable angina. We measured serum levels of this marker in 140 patients hospitalized with unstable angina (class IIIB of the Braunwald classification, mean time from last anginal episode 5 +/- 5 hours). Thirty-nine of them (28%) had increased serum levels on hospital admission and 33 (24%) experienced an adverse outcome (myocardial infarction or refractory angina) during hospitalization. Kaplan-Meier analysis showed that the probability of developing cardiac events during hospitalization was not different between patients with and without abnormal C-reactive protein levels. Furthermore, the incidence of ischemia at Holter monitoring during the first 72 hours after hospitalization was not different between patients with and without abnormal C-reactive protein. In a representative population of patients with unstable angina, a sizable proportion had increased serum C-reactive protein levels; however, abnormal concentrations of C-reactive protein do not predict an adverse outcome in the early phase after the acute episode.

Aged↗
PubMed1997

3'-Azido 3'-deoxythymidine + methotrexate as a novel antineoplastic combination in the treatment of human immunodeficiency virus-related non-Hodgkin's lymphomas.

We have previously reported that 3'-azido 3'-deoxythymidine (AZT) can possess a significant antineoplastic activity when combined with drugs that disrupt de novo thymidylate synthesis, such as 5-fluorouracil and methotrexate (MTX). The aim of the present study was to evaluate the efficacy and the tolerance of the combination AZT + MTX in human immunodeficiency virus (HIV)-related non-Hodgkin's lymphoma (NHL). Twenty-nine patients (22 men and 7 women), either newly diagnosed or pretreated, have been enrolled in the trial; the median age was 34 years, 45% had acquired immunodeficiency syndrome before lymphoma and 19 patients had less than 100 CD4 lymphocytes/microL. Histologic diagnoses were mainly Burkitt (27%) and diffuse large B-cell lymphoma (45%); extranodal involvement was present in 20 patients. The treatment plan included three weekly courses of MTX at 1 g/m2 (days 1, 8, and 15) plus oral AZT at 2 g/m2 (days 1, 2, and 3), 4 g/m2 (days 8, 9, and 10), and 6 g/m2 (days 15, 16, and 17), plus leucovorin rescue. From the eleventh patient on, in case of complete or partial remission, the treatment was continued with three additional courses, using AZT at the maximum dose. In 26 evaluable patients, the total (complete + partial) response rate was 77% (95% confidence interval, 58% to 89%), with complete remission (CR) in 46% of the patients (95% confidence interval, 29% to 65%). The median CR duration was 12.8 months. Grade III-IV neutropenia and anemia were observed in 52% and 31% of the courses, respectively. There was one therapy-related death due to bacteremia followed by septic shock; the only other recorded infection was a herpes vaginalis. In conclusion, we suggest that AZT + MTX is an effective and well-tolerated regimen in HIV-related NHL.

Adolescent↗
PubMed1997

Fluconazole as prophylaxis against fungal infection in patients with advanced HIV infection.

BACKGROUND: There is limited information regarding the usefulness of primary antifungal prophylaxis in patients with advanced human immunodeficiency virus (HIV) disease. OBJECTIVE: To evaluate the efficacy and safety of oral fluconazole treatment for the prevention of systemic fungal diseases related to the acquired immunodeficiency syndrome. METHODS: We evaluated the clinical records of more than 1300 HIV-infected patients followed up for 6 years to identify subjects with a CD4+ lymphocyte count less than 0.20 x 10(9)/L (200/microL) and no prior systemic fungal disease. We compared 128 patients who received oral fluconazole (100 mg/d every third week) with 121 subjects who received no antifungal treatment. MAIN OUTCOME MEASURES: The occurrence of visceral mycoses or death was considered an end point. The frequency of esophageal candidiasis and extrapulmonary cryptococcosis and their related clinical and laboratory features, as well as overall patient survival, were assessed and compared between the 2 study groups. RESULTS: Subjects not treated with fluconazole experienced a significantly higher incidence of systemic mycoses than patients who received fluconazole: 28.4 vs 8.8 cases per 100 patient-years (P < .001). Fluconazole treatment was more effective in preventing esophageal candidiasis than cryptococcosis and was more effective in subjects with a CD4+ cell count less than 0.10 x 10(9)/L. Moreover, fungal complications occurred later and were associated with a significantly lower CD4+ cell count among treated vs untreated patients, while the duration of antiretroviral therapy did not play a significant role. Although mortality rates were similar in the 2 study groups, the fatal outcome of disease was less frequently caused by a fungal disease in subjects who underwent fluconazole prophylaxis. Fluconazole had a favorable tolerability profile. CONCLUSIONS: In our experience, primary fluconazole prophylaxis proved safe and effective in the prevention of systemic candidiasis and cryptococcosis in patients with advanced HIV disease but it did not improve overall survival. Prospective controlled trials are advisable to confirm efficacy, to find the drug of choice and its best dosage and schedule of administration, to identify patient subgroups showing the most favorable cost-benefit ratios, and to evaluate the effects on overall life expectancy and the risk of emergence and spread of antifungal drug resistance.

AIDS-Related Opportunistic Infections↗
PubMed1997

Bacteremia and respiratory involvement by Alcaligenes xylosoxidans in patients infected with the human immunodeficiency virus.

Seven cases of Alcaligenes xylosoxidans bacteremia and/or respiratory disease in patients infected with the human immunodeficiency virus (HIV) are described. Reported only thrice previously in this setting, these bacterial complications occurred during different phases of HIV infection and were associated with leukopenia-neutropenia in four patients and a central vascular catheter in two. Although the majority of cases were diagnosed after day 3 of hospitalization, a distinct source of infection was never identified. In four patients with advanced underlying disease, a polymicrobial infection was present. In vitro resistance to aminoglycosides, first-generation cephalosporins, and aztreonam was identified, but treatment with fluoroquinolones, piperacillin, or an aminoglycoside in combination with either ceftazidime or pefloxacin was successful in all cases. The relevance of Alcaligenes xylosoxidans and related species of gram-negative non-glucose fermenting bacilli as opportunistic pathogens in the immunocompromised host and in the setting of HIV infection is briefly reviewed.

AIDS-Related Opportunistic Infections↗
PubMed1997

Tuberculous pericarditis and AIDS: case reports and review.

Pericarditis is one of the most common cardiac complications in the course of HIV disease. Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries. Two cases of tuberculous pericarditis in adult patients with AIDS occurred over a 12-month period at our clinic, which prompted a literature review of the published cases of tuberculous pericarditis in AIDS. Of note is that in the first patient pericardial effusion represented the AIDS-defining illness and was an expression of a disseminated tuberculous disease. The second patient developed a fatal pericarditis due to a multiple-drug resistant Mycobacterium tuberculosis infection.

AIDS-Related Opportunistic Infections↗