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Hepatitis C virus infection and thyroid autoimmunedisorders:A model of interactions between the host and theenvironment

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World Journal of Hepatology 2016年第2期8卷 83-91页

作者： francesca pastore antonio martocchia manuela stefanelli pietro prunas stefania giordano lavinia toussan antonio devito paolo falaschi “Sapienza”University of Rome Faculty of Medicine and PsychologyS.Andrea Hospital00189 RomeItaly

The hepatitis C virus(HCV) infection is an important public health problem and it is associated with hepatic and extrahepatic manifestations. Autoimmune thyroid diseases are common in HCV infected patients and the standard interferon-based treatment is associated with an increase of the immune-mediated thyroid damage. Recent evidence in the literature analyzed critical points of the mechanisms of thyroid damage, focusing on the balance between the two sides of the interaction: The environment(virus infection with potential crossreaction) and the host(susceptibility genes with consistent immune response). The spectrum of antiviral treatment for chronic HCV infection is rapidly expanding for the development of dual o triple therapy. The availability of interferon-free combined treatment with direct antiviral agents for HCV is very promising, in order to ameliorate the patient compliance and to reduce the development of thyroid autoimmunity.

关键词： Hepatitis C virus Thyroid autoimmunity Interferon Antiviral agents Self-tolerance

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Diagnosis of hepatic glycogenosis in poorly controlled type 1 diabetes mellitus

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World Journal of Diabetes 2014年第6期5卷 882-888页

作者： stefania giordano Antonio Martocchia Lavinia Toussan Manuela Stefanelli Francesca Pastore Antonio Devito Marcello G Risicato Luigi Ruco Paolo Falaschi Geriatric Unit "Sapienza" University of RomeFaculty of Medicine and PsychologyS. Andrea Hospital

Hepatic glycogenosis(HG) in type 1 diabetes is a underrecognized complication. Mauriac firstly described the syndrome characterized by hepatomegaly with altered liver enzymes, growth impairment, delay puberty and Cushingoid features, during childhood. HG in adulthood is characterized by the liver disorder(with circulating aminotransferase increase) in the presence of poor glycemic control(elevation of glycated hemoglobin, Hb A1 c levels). The advances in the comprehension of the metabolic pathways driving to the hepatic glycogen deposition point out the role of glucose transporters and insulin mediated activations of glucokinase and glycogen synthase, with inhibition of glucose-6-phosphatase. The differential diagnosis of HG consists in the exclusion of causes of liver damage(infectious, metabolic, obstructive and autoimmune disease). The imaging study(ultrasonography and/or radiological examinations) gives information about the liver alterations(hepatomegaly), but the diagnosis needs to be confirmed by the liver biopsy. The main treatment of HG is the amelioration of glycemic control that is usu-ally accompanied by the reversal of the liver disorder. In selected cases, more aggressive treatment options(transplantation) have been successfully reported.

关键词： Hepatic glycogenosis Type 1 diabetes mellitus Hepatomegaly Glycogen Glucose transporters Insulin Glucokinase Glycogen synthase Glucose-6-phosphatase

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Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice

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World Journal of Gastroenterology 2008年第17期14卷 2757-2762页

作者： stefania Angeloni Cinzia Leboffe Antonella Parente Mario Venditti Alessandra giordano Manuela Merli Oliviero Riggio Department of Clinical Medicine "Sapienza" University of Rome Department of Public Health "Sapienza" University of Rome

AIM： To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis （SBP） in clinical practice. METHODS： All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear （PIN） cell count was 〉 250 cells/mm^3, and empirically treated with cefotaxime. RESULTS： Thirty-eight SBP episodes occurred in 32 cirrhotics （22 men/20 women; mean age： 58.6 ＋ 22.2 years）. Prevalence of SBP, in our population, was 27%. Ascitic fluid culture was positive in nine （24%） cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage （44%） similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. CONCLUSION： In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment andevaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated.

关键词： Spontaneous bacterial peritonitis Cefotaxi-me Antibiotic-resistant pathogens Ascitic polymorpho-nuclear count Cirrhosis

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