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1. Do we Still Need Eligibility Criteria to Recommend PrEP? Impact of National Prescribing Requirements on Retention in Care and Sexually Transmitted Infections Acquisition

Author

Rossotti, R, Tavelli, A, Calzavara, D, De Bona, A, Muccini, C, Moschese, D, Caruso, E, Soria, A, Bossolasco, S, Lapadula, G, Cernuschi, M, Monforte, A, Rossotti, Roberto, Tavelli, Alessandro, Calzavara, Daniele, De Bona, Anna, Muccini, Camilla, Moschese, Davide, Caruso, Enrico, Soria, Alessandro, Bossolasco, Simona, Lapadula, Giuseppe, Cernuschi, Massimo, Monforte, Antonella d'Arminio, Rossotti, R, Tavelli, A, Calzavara, D, De Bona, A, Muccini, C, Moschese, D, Caruso, E, Soria, A, Bossolasco, S, Lapadula, G, Cernuschi, M, Monforte, A, Rossotti, Roberto, Tavelli, Alessandro, Calzavara, Daniele, De Bona, Anna, Muccini, Camilla, Moschese, Davide, Caruso, Enrico, Soria, Alessandro, Bossolasco, Simona, Lapadula, Giuseppe, Cernuschi, Massimo, and Monforte, Antonella d'Arminio

Abstract

Italian guidelines recommend HIV pre-exposure prophylaxis (PrEP) only upon satisfying strict eligibility criteria. The objective of this study is to evaluate if PrEP candidates attending a community-based service comply with these criteria and whether these prescribing conditions affect retention in care and sexually transmitted infections (STIs) acquisition. A retrospective analysis was performed on PrEP candidates evaluated from January 2019 to June 2022. Data were collected from self-administered questionnaires and clinical files. The population was divided in subjects with 0/1 (0/1 C) and >= 2 (>= 2 C) criteria. Descriptive statistics and non-parametric tests were employed to describe study population. Incidence of PrEP discontinuation and of STIs was estimated per 100 persons-year of follow up (PYFU), and incidence rate ratio (IRR) was calculated. Univariate and multivariable Cox regression analyses were used to evaluate the association strength between PrEP drop out and other variables. The analyses enrolled 659 individuals: 422 individuals were included in 0/1 C, 237 in >= 2 C group, respectively. Inconsistent condom use was the most reported prescribing criteria (399 individuals, 60.6%), followed by a previous STI (186 individuals, 28.2%). 0/1 C exhibited lower STIs incidence. PrEP discontinuation was 29% in 0/1 C and 38% in >= 2 C (p = 0.031). Cox model revealed that inconsistent condom use was the only prescribing criteria associated to PrEP persistence. The majority of PrEP candidate did not comply with prescribing conditions. Eligibility criteria failed to identify individuals with better retention in care. Our results suggest that Italian guidelines should be updated removing barriers to prescription.

Published
2024

2. Awareness and perception of accuracy of the Undetectable=Untransmittable message (U=U) in Italy: results from a survey among PLWHA, infectious-diseases physicians and people having unprotected sex.

Author

Cingolani, A., Tavelli, A., Calvino, G. V., Maggiolo, F., Girardi, E., Cozzi-Lepri, A., Perziano, A., Meli, P., Camposeragna, A., Mattioli, S., Calzavara, D., Gagliardini, R., Nozza, S., Antinori, A., and d'Arminio Monforte, A.

Subjects
HIV infection transmission, HIV-positive persons, COMMUNICABLE diseases, ATTITUDES of medical personnel, RISK assessment, INFECTIOUS disease transmission, RESEARCH funding, QUESTIONNAIRES, UNSAFE sex, DISEASE risk factors
Abstract

Evidences on the absence of risk of sexual transmission of HIV by persons living with HIV/AIDS (PLWHA) with undetectable plasma HIV-RNA (HIV-RNA <200 copies/ml) led to the worldwide campaign "U = U" (undetectable = untransmittable). The purpose of this study was to evaluate the perceived accuracy of this message among PLWHA, HIV-negative people having unprotected sex (PHUS) and infectious diseases' (ID) physicians in Italy. A nationwide survey has been conducted using three different anonymous questionnaires (for ID physicians, PLWHA and PHUS). A total of 1121 participants filled the questionnaires: 397 PLWHA; 90 physicians; 634 PHUS. Awareness of U = U message has been reported in 74%, 92% and 47% of PLWHA, ID physicians and PHUS, respectively. The perception of accuracy of the U = U message among those aware was reported as high in 80.4%, 79.5% and 67.3% of PLWHA, ID physicians and PHUS, respectively. Physicians perceived that 11% of PLWHA have a high rate of perception of U = U, whereas among PLWHA, only 34% reported definitive positive messages from physicians. Discrepancies between awareness and perception of accuracy of the message U = U in PLWHA and physicians have been found, suggesting still low confidence in the community regarding the message itself. [ABSTRACT FROM AUTHOR]

Published
2023
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5. Evaluación de la eficacia clínica del láser Nd: YAP en la terapia periodontal no-quirúrgica

Author

Caccianiga, G, Calzavara, D, Baldini, A, Baldoni, R, Bascones, A, Caccianiga, G. L., Calzavara, D., Baldini, A., Baldoni, R. M., Bascones, A., Caccianiga, G, Calzavara, D, Baldini, A, Baldoni, R, Bascones, A, Caccianiga, G. L., Calzavara, D., Baldini, A., Baldoni, R. M., and Bascones, A.

Abstract

AIM. To evaluate the clinical efficiency of Nd:YAP laser in not surgical periodontal therapy. MATERIALS AND METHODS. By means of measurements of clinical index (GI, PPD, CAL) before and after 2, 4, 6, 8, 10 weeks of therapy, the Authors have compared the clinical efficiency of Scaling and Root Planing (SRP) by itself, of laser irradiation by itself, of SRP 4 weeks after laser irradiation and of laser irradiation 4 weeks after SRP. RESULTS. It suggests that, either by GI, or PPD, or CAL, the best not surgical periodontal therapy is the SRP 4 weeks after laser irradiation. DISCUSSION. If applied in the correct combination, the laser therapy end the SRP have an synergic and amplifying action. CONCLUSIONS. The clinical laser approach can to have a considerable importance in the periodontal therapy

Published
2003

6. Cirurgia oral enpacientes bayo terapia anticoagulante: modelo experimental para la evalutacion de la eficacia de la cola de fibrina

Author

Taormina, G, Calzavara, D, CARINI, FABRIZIO, PAPAGNA, RUGGERO, Taormina, G, Calzavara, D, Carini, F, and Papagna, R

Subjects
cirurgia oral, Cola de fibrina
Abstract

Aim of the work: The authors emphasize how an effective emostatic method is extremely important in patients treated with anticoagulating therapy during oral surgery: it can avoid the risk of an excessive emorrhage and the necessity to alter the anticoagu- lating therapeutic regimen. The present study examines the fibrin glue emostatic ability as emostatic support in patients treated with anticoagulating therapy. It expresses the experiment results,based on standards of reference of surgical trauma and considers the anticoagulating therapy intensity. Materials and methods: 20 patients with anticoagulation therapy have been selected within the age of 44 and 79. Following the appropriate techniques extractions of teeth with one, two or three roots have been practiced. After the alveoloplasty a reabsorbable sponge of fibrine is placed and the suture is done. The surgical trauma has been c1assified by means of a quantitative scale which can express it without inaccuracy. The category of trauma for each patient is established by the total of the values obtained from each of the single procedures. It has been possible to evaluate the coefficient of relationship between the intensity of the anticoagulating effect (measured by the lNR) and the number of verified hemorrhagic complications; and also between the grade of surgical trauma and the number of complications. Results and conclusions: The authors demonstrate how the therapeutical usage of fibrin glue can be considered a valid support for the optimization of the haemostatis in patients with induced alterations of the coagulation.

Published
2004

7. Evaluación de la eficacia clínica del láser Nd: YAP en la terapia periodontal no-quirúrgica

Author

Caccianiga, G. L., Calzavara, D., Baldini, A., Baldoni, R. M., Bascones, A., Caccianiga, G, Calzavara, D, Baldini, A, Baldoni, R, and Bascones, A

Subjects
Scaling and root planing, Otorhinolaryngology2734 Pathology and Forensic Medicine, Periodontal therapy, Dentistry (all), Laser
Abstract

AIM. To evaluate the clinical efficiency of Nd:YAP laser in not surgical periodontal therapy. MATERIALS AND METHODS. By means of measurements of clinical index (GI, PPD, CAL) before and after 2, 4, 6, 8, 10 weeks of therapy, the Authors have compared the clinical efficiency of Scaling and Root Planing (SRP) by itself, of laser irradiation by itself, of SRP 4 weeks after laser irradiation and of laser irradiation 4 weeks after SRP. RESULTS. It suggests that, either by GI, or PPD, or CAL, the best not surgical periodontal therapy is the SRP 4 weeks after laser irradiation. DISCUSSION. If applied in the correct combination, the laser therapy end the SRP have an synergic and amplifying action. CONCLUSIONS. The clinical laser approach can to have a considerable importance in the periodontal therapy

Published
2003

9. Cirugía oral en pacientes bajo terapia anticoagulante: modelo experimental para la evaluación de la eficacia de la cola de fibrina

Author

Taormina, G, Papagna, R, Carini, F, Denotti, G, and Calzavara, D

Subjects
fibrin glue, Anticoagulating therapy, cola de fibrina, Terapia anticoagulante, cirugía odontoestomatológica, oral surgery
Abstract

Introducción: En la práctica de cirugía oral en los pacientes bajo terapia anti coagulante, el empleo de un sistema eficaz de acción hemostática es de extrema relevancia, porque puede evitar la alteración del régimen terapéutico anticoagulante y el riesgo de un exceso de sangrado. En el presente trabajo se investiga la capacidad hemostática de la cola de fibrina como presidio hemostático en los pacientes bajo terapia anticoagulante, exponiendo los resultados de la experimentación sobre la base de un Standard de referencia del trauma quirúrgico y de la intensidad de la terapia anticoagulante. Materiales y métodos: Han sido seleccionados 20 pacientes en terapia anticoagulante con una edad comprendida entre los 44 y 79 años, se han realizado, según las modalidades apropiadas, simples exodoncias o más complejas de dientes mono-, bi- y tri-radiculares. Tras la alveoloplastia se ha colocado una esponja de fibrina reabsorbible en forma de gel (Gingistat®) y se ha realizado la sutura. El trauma quirúrgico ha sido clasificado por medio de una escala cuantitativa que puede expresar de forma unívoca el grado de trauma. La categoría de trauma por cada paciente se establece por la suma de los valores obtenidos de cada uno de los procedimientos unitarios. Ha sido posible evaluar el coeficiente de relación entre la intensidad del efecto anticoagulante (medido por medio del lNR) y número de complicaciones hemorrágicas que se han verificado, además de entre el grado de trauma quirúrgico y el número de complicaciones que se han presentado. Resultados y Conclusiones: Se demuestra que el utilizo terapéutico de la cola de fibrina puede ser considerado como un válido soporte por la optimización de la hemostasis en los pacientes con alteraciones de la coagulación inducidas farmacológica mente Aim of the work: The authors emphasize how an effective emostatic method is extremely important in patients treated with anticoagulating therapy during oral surgery: it can avoid the risk of an excessive emorrhage and the necessity to alter the anticoagu- lating therapeutic regimen. The present study examines the fibrin glue emostatic ability as emostatic support in patients treated with anticoagulating therapy. It expresses the experiment results, based on standards of reference of surgical trauma and considers the anticoagulating therapy intensity. Materials and methods: 20 patients with anticoagulation therapy have been selected within the age of 44 and 79. Following the appropriate techniques extractions of teeth with one, two or three roots have been practiced. After the alveoloplasty a reabsorbable sponge of fibrine is placed and the suture is done. The surgical trauma has been classified by means of a quantitative scale which can express it without inaccuracy. The category of trauma for each patient is established by the total of the values obtained from each of the single procedures. It has been possible to evaluate the coefficient of relationship between the intensity of the anticoagulating effect (measured by the lNR) and the number of verified hemorrhagic complications; and also between the grade of surgical trauma and the number of complications. Results and conclusions: The authors demonstrate how the therapeutical usage of fibrin glue can be considered a valid support for the optimization of the haemostatis in patients with induced alterations of the coagulation

Published
2004

10. Evaluación de la eficacia clínica del láser Nd:YAP en la terapia periodontal no-quirúrgica: YAP láser in not surgical periodontal therapy

Author

Caccianiga, GL, Calzavara, D, Baldini, A, Baldoni, RM, and Bascones, A

Subjects
Scaling and Root Planing, Raspado y Alisado Radicular, láser, periodontal therapy, terapia periodontal, laser
Abstract

OBJETIVO. Testar la eficacia clínica de láser Nd:YAP en la terapia periodontal no-quirúrgica. MATERIALES y MÉTODOS. Por medio de la medición de los índices de la enfermedad periodontal (GI, PPD, CAL) realizada al principio y a las 2,4, 6, 8, 10 semanas tras la terapia, se ha confrontado la eficacia del solo tratamiento de Raspado y Alisado Radicular (RAR), de la sola radiación láser, de la radiación láser seguida del RAR a la distancia de 4 semanas, del RAR seguido a distancia de 4 semanas del tratamiento láser. RESULTADOS. La mejor terapia no-quirúrgica de las bolsas periodontales se ha demostrado sin duda la radiación láser seguida a la distancia de 4 semanas, también en relación al GI, que PPD, que al CAL. DISCUSiÓN. Cuando combinados en el correcto protocolo, la terapia láser y el RAR evidencian una acción sinérgica y de amplificación. CONCLUSIÓNES. El empleo clínico del láser puede representar un papel importante en la terapaia periodontal. AIM. To evaluate the clinical efficiency of Nd:YAP laser in not surgical periodontal therapy. MATERIALS AND METHODS. By means of measurements of clinical index (GI, PPD, CAL) before and after 2, 4, 6, 8, 10 weeks of therapy, the Authors have compared the clinical efficiency of Scaling and Root Planing (SRP) by itself, of laser irradiation by itself, of SRP 4 weeks after laser irradiation and of laser irradiation 4 weeks after SRP. RESULTS. It suggests that, either by GI, or PPD, or CAL, the best not surgical periodontal therapy is the SRP 4 weeks after laser irradiation. DISCUSSION. If applied in the correct combination, the laser therapy end the SRP have an synergic and amplifying action. CONCLUSIONS. The clinical laser approach can to have a considerable importance in the periodontal therapy.

Published
2003

11. Implantología post-extracción inmediata: protocolo operativo y evaluaciones oclusales, periodontales y estéticas

Author

Caccianiga, GL, Calzavara, D, Baldini, A, Baldoni, RM, and Bascones, A

Subjects
aesthetics, alveolo, Implant, Implante, alveolus, estética
Abstract

OBJETIVO DEL TRABAJO: Evaluar la eficacia clínica del protocolo quirúrgico relativo a la colocación inmediata del tornillo en el alveolo post-extrativo. MATERIAL Y MÉTODOS: Han sido evaluados, según los criterios de Albrekston y Buser 45 implantes colocados con la técnica post-extractiva, a los 6 meses y a los 3 años tras la colocación del implante. RESULTADOS: El protocolo aplicado se ha demostrado válido, los porcentajes de éxito han sido parecidos con aquellos de la técnica tradicional, con la ventaja de disminuir notablemente el tiempo para la rehabilitación oclusal y con importantes ventajas estéticas para el paciente. CONCLUSIONES: Con este nuevo protocolo quirúrgico implantológico se puede garantizar un elevado porcentaje de éxito con una importante disminución de los tiempos de intervención con mayores ventajas estéticas, funcionales y oclusales. BACKGROUND: The purpose of this work is to evaluate the clinic efficiency of the surgical protocol in relation to the immediate placement of the screw into a post- extractive alveolus. MATERIALS AND METHODS: According to Albrekston and Buser' s criterions, 45 implants which had been placed with the post-extractive technique were scored after 6 months and after 3 years since the placement of the dental implant. RESULTS: The applied protocol has proven to be suitable, the rate of success compared with the traditional technique has been similar, with the advantages of reducing notoriously the time to rehabilitate occ1usion and gaining aesthetics for the patient. CONCLUSIONS: With this new surgical and implantologic protocol it can be guaranteed a high rate of success reducing the intervention phase while adding aesthetic, functional and occ1usal advantages.

Published
2003

12. Evidencia del síndrome neuropático en un estudio neurofisiológico e inmunohistoquímico de las fibras nerviosas en pacientes con síndrome de boca ardiente

Author

Lauritano, D, Calzavara, D, Papagna, R, Baldoni, M, and Bascones, A

Subjects
Burning mouth, Mucosas orales, Oral mucosa, Xerostomia, Xerostomía, Boca ardiente
Abstract

Introducción: El síndrome de la boca ardiente (SBA) es una enfermedad de frecuente aparición, caracterizada para un dolor quemante y ardiente en la lengua y en la cavidad oral, en ausencia de alteraciones estructurales macroscópicas de las mucosas. La etiopatogénesis del SBA no es todavía conocida y por lo tanto no presenta un esquema diagnóstico claro y bien definido. Material y métodos: Para evaluar la hipótesis que contempla una alteración de las fibras nerviosas periféricas de pequeño calibre, asociada o no con una alteración trófica de las mucosas, hemos seleccionados 25 pacientes (7 varones y 18 mujeres, con una edad comprendida entre 36 y 75 años, una media de 54 años) afectados por SBA, que llegaron a nuestra clínica para una serie de exámenes que suelen realizarse de forma rutinaria en las síndromes de dolor neurológico. En todos los pacientes se ha realizado un cuidadoso examen objetivo y una ortopantomografía, con la finalidad de excluir alteraciones de las mucosas y enfermedades odontológicas. En todos los pacientes se han realizado: exámenes hematoquímicos, exámenes objetivos neurológicos, teletermografía de la lengua y de la cara, examen cuantitativo de la sensibilidad térmica de la lengua, de las manos y de la parte dorsal del pie. Los resultados del examen cuantitativo de la sensibilidad térmica de la lengua y de la muñeca se confrontaban con una población control homogénea. En una población de 10 pacientes (3 varones y 7 mujeres; de una edad comprendida entre 34 y 53 años, una media de 49 años) se ha realizado un biopsia de la parte dorsal de la lengua, la biopsias se han analizado con microscopía óptica e inmunofluresencia tras un tratamiento con anticuerpos activos para proteínas neuronales citoplasmáticas (protein gene product 9.5). Resultados: Los datos obtenidos evidenciaban la presencia de una polineuropatía subclínica en el 50% de los pacientes. Especialmente se apreciaban signos de baja funcionalidad de las fibras nerviosas de pequeño calibre de la lengua en casi la mitad de los pacientes examinados. El examen histológico de la mucosa lingual evidenciaba una atrofia discreta en el 70% de los pacientes, mientras que la observación de las fibras nerviosas de pequeño calibre por medio de la inmunofluoresencia hacía suponer la presencia de alteraciones relacionadas con una polineuropatía de tipo periférico. Aims. Burning pain is considered characteristic of chronic neuropathic pain condition in general, and so me recent data seem to suggest peripheral or central nervous system involvement as possible underlying factor in BMS. This study was designed to determinate if burning mouth symptoms could be originated from a peripheal neuropathy of small diameter nerve fibres. Material and methods. The material of the study consisted of 25 patients (18 female, 7 male, 30-75 years; means 54 years). In all patients there were not: oral muco membranes lesions, oral muco membranes diseases, oral correlated diseases, oral dysfunctions, dental and periodontal diseases. Besides there were: no evidence of central nervous system pathology, no evidence of peripheral nervous system pathology, no presence of organic body disfunctions. AIIpatients didn't show significant alterations of blood investigations. AII patients were undermitted to our protocol including: oral and facial clinical examinations, neurological exam, blood investigations, Mc Gill Pain Questionnaire, VAS (visual analogical scale), biopsy of tongue mucosa with hystological and immunofluorescence exams, quantitative somatosensory thermotest and teletermography examination of tongue mucosa. ResuIts. These examinations have showed subclinical polineurophaty in 50% of patients. In particular were observed a loss of function in small diameter nervous fibres in about 50% of patients. Hystological exam of mucosal tongue revealed a moderate atrophy and alterations of structures. Conclusion. Etiology, pathogenetic processes, clinical and diagnostic approaches, therapeutical resolutions and researches of burning mouth syndrome are not clear yet. The local alterations of small diameter sensitive nerve fibres could cause an increase of oral burning, without muco membranes pathologies. These locallesions could justify the bms clinical symptomatology. The hystological alteration of small diameter sensitive nerve fibres could involve meaningful alterations of thermal reactivity of oral and body surfaces. These clinical reactivities are evident in chronic peripheal neuropathy (diabetes). These conclusions and our study results are still provisory. It will be necessary to estend and to increase our results, comparing our research with other bms etio-pathogenetic hypotesis.

Published
2003

13. Evidencia del sindrome neuropático en un estudio neurofisiológico e inmunohistoquímico de las fibras nerviosas en pacientes con síndrome de boca ardiente

Author

Calzavara, D, Lauritano, D, Papagna, R, Baldoni, M, Bascones, A, Bascones, A., LAURITANO, DORINA, Calzavara, D, Lauritano, D, Papagna, R, Baldoni, M, Bascones, A, Bascones, A., and LAURITANO, DORINA

Abstract

Aims. Burning pain is considered characteristic of chronic neuropathic pain condition in general, and so me recent data seem to suggest peripheral or central nervous system involvement as possible underlying factor in BM3. This study was designed to determinate if burning mouth symptoms could be originated from a peripheal neuropathy of small diameter nerve fibres. Material and methods. The material of the study consisted of 25 patients (18 female, 7 male, 30-75 years; means 54 years). In all patients there were not: oral muco membranes lesions, oral muco membranes diseases, oral correlated diseases, oral dysfunctions, dental and periodontal diseases. Besides there were: no evidence of central nervous system pathology, no evidence of peripheral nervous system pathology, no presence of organic body disfunctions. AIIpatients didn't show significant alterations of blood investigations. AIIpatients were undermitted to our protocol including: oral and facial c1inicalexaminations, neurological exam, blood investigations, Mc Gill Pain Questionnaire, VAS(visual analogical scale), biopsy of tongue mucosa with hystological and immunofluorescence exams, quantitative somatosensory thermotest and teletermography examination of tongue mucosa. ResuIts. These examinations have showed subclinical polineurophaty in 50% of patients. In particular were observed a loss of function in small diameter nervous fibres in about 50% of patients. Hystological exam of mucosal tongue revealed a moderate atrophy and alterations of structures. Conclusion. Etiology, pathogenetic processes, c1inicaland diagnostic approaches, therapeutical resolutions and researches of burning mouth syndrome are not c1ear yet. The local alterations of small diameter sensitive nerve fibres could cause an increase of oral burning, without muco membranes pathologies. These locallesions could justify the bms c1inicalsymptomatology. The hystological alteration of small diameter sensitive nerve fibres could involve meaningf

Published
2003

18. Evidencia del síndrome neuropático en un estudio neurofisiológico e inmunohistoquímico de las fibras nerviosas en pacientes con síndrome de boca ardiente

Author

D Lauritano, M Baldoni, A Bascones, D Calzavara, R Papagna, Calzavara, D, Lauritano, D, Papagna, R, Baldoni, M, and Bascones, A

Subjects
dentistry, oral medicine, burning mouth syndrome, Otorhinolaryngology, Mucosas orales, General Dentistry, Xerostomía, Boca ardiente
Abstract

espanolIntroduccion: El sindrome de la boca ardiente (SBA) es una enfermedad de frecuente aparicion, caracterizada para un dolor quemante y ardiente en la lengua y en la cavidad oral, en ausencia de alteraciones estructurales macroscopicas de las mucosas. La etiopatogenesis del SBA no es todavia conocida y por lo tanto no presenta un esquema diagnostico claro y bien definido. Material y metodos: Para evaluar la hipotesis que contempla una alteracion de las fibras nerviosas perifericas de pequeno calibre, asociada o no con una alteracion trofica de las mucosas, hemos seleccionados 25 pacientes (7 varones y 18 mujeres, con una edad comprendida entre 36 y 75 anos, una media de 54 anos) afectados por SBA, que llegaron a nuestra clinica para una serie de examenes que suelen realizarse de forma rutinaria en las sindromes de dolor neurologico. En todos los pacientes se ha realizado un cuidadoso examen objetivo y una ortopantomografia, con la finalidad de excluir alteraciones de las mucosas y enfermedades odontologicas. En todos los pacientes se han realizado: examenes hematoquimicos, examenes objetivos neurologicos, teletermografia de la lengua y de la cara, examen cuantitativo de la sensibilidad termica de la lengua, de las manos y de la parte dorsal del pie. Los resultados del examen cuantitativo de la sensibilidad termica de la lengua y de la muneca se confrontaban con una poblacion control homogenea. En una poblacion de 10 pacientes (3 varones y 7 mujeres; de una edad comprendida entre 34 y 53 anos, una media de 49 anos) se ha realizado un biopsia de la parte dorsal de la lengua, la biopsias se han analizado con microscopia optica e inmunofluresencia tras un tratamiento con anticuerpos activos para proteinas neuronales citoplasmaticas (protein gene product 9.5). Resultados: Los datos obtenidos evidenciaban la presencia de una polineuropatia subclinica en el 50% de los pacientes. Especialmente se apreciaban signos de baja funcionalidad de las fibras nerviosas de pequeno calibre de la lengua en casi la mitad de los pacientes examinados. El examen histologico de la mucosa lingual evidenciaba una atrofia discreta en el 70% de los pacientes, mientras que la observacion de las fibras nerviosas de pequeno calibre por medio de la inmunofluoresencia hacia suponer la presencia de alteraciones relacionadas con una polineuropatia de tipo periferico. EnglishAims. Burning pain is considered characteristic of chronic neuropathic pain condition in general, and so me recent data seem to suggest peripheral or central nervous system involvement as possible underlying factor in BMS. This study was designed to determinate if burning mouth symptoms could be originated from a peripheal neuropathy of small diameter nerve fibres. Material and methods. The material of the study consisted of 25 patients (18 female, 7 male, 30-75 years; means 54 years). In all patients there were not: oral muco membranes lesions, oral muco membranes diseases, oral correlated diseases, oral dysfunctions, dental and periodontal diseases. Besides there were: no evidence of central nervous system pathology, no evidence of peripheral nervous system pathology, no presence of organic body disfunctions. AIIpatients didn't show significant alterations of blood investigations. AII patients were undermitted to our protocol including: oral and facial clinical examinations, neurological exam, blood investigations, Mc Gill Pain Questionnaire, VAS (visual analogical scale), biopsy of tongue mucosa with hystological and immunofluorescence exams, quantitative somatosensory thermotest and teletermography examination of tongue mucosa. ResuIts. These examinations have showed subclinical polineurophaty in 50% of patients. In particular were observed a loss of function in small diameter nervous fibres in about 50% of patients. Hystological exam of mucosal tongue revealed a moderate atrophy and alterations of structures. Conclusion. Etiology, pathogenetic processes, clinical and diagnostic approaches, therapeutical resolutions and researches of burning mouth syndrome are not clear yet. The local alterations of small diameter sensitive nerve fibres could cause an increase of oral burning, without muco membranes pathologies. These locallesions could justify the bms clinical symptomatology. The hystological alteration of small diameter sensitive nerve fibres could involve meaningful alterations of thermal reactivity of oral and body surfaces. These clinical reactivities are evident in chronic peripheal neuropathy (diabetes). These conclusions and our study results are still provisory. It will be necessary to estend and to increase our results, comparing our research with other bms etio-pathogenetic hypotesis.

Published
2003

19. Challenges and opportunities for hepatitis B virus screening in people attending PrEP services: a retrospective prevalence study.

Author

Monti B, Rossotti R, D'Aloia F, Calzavara D, Corsico L, Cernuschi M, Puoti M, Bonfanti P, and Soria A

Abstract

Objectives: Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir to prevent HIV in individuals with hepatitis B virus (HBV) raises concerns about HBV reactivation when stopping event-driven PrEP or redundancy in HBV treatment for continuous PrEP (since tenofovir alone would be enough for HBV). Real-world data from PrEP services could provide useful epidemiological information on HBV prevalence in PrEP attendees in low-prevalence countries., Methods: A retrospective analysis on PrEP attendees of three services in northern Italy were conducted to assess HBV prevalence among PrEP attendees and the need for primary cycle/booster dose HBV vaccination despite previous vaccination during childhood (at birth or 12 years). Risk factors possibly associated with HBV exposure were evaluated with a binary logistic regression analysis, controlling for age, gender, place of birth (Italy vs abroad) and chemsex use (as a proxy of high-risk sexual behaviour for contracting sexually transmitted infections)., Results: Among 10 hepatitis B surface antigen (HBsAg)-positive out of 2152 PrEP attendees (0.46%), PrEP was started in 7 subjects mainly with a daily schedule, 1 has declined after counselling, 2 were lost to follow-up. Around three-fourth of the 2152 PrEP attendees were born in Italy after 1979, thus were previously vaccinated during childhood. The probability of needing a booster for low-titre HBs antibodies was higher among those vaccinated at birth with respect to those vaccinated at 12 years (OR 2.30, 95% CI 1.80 to 2.96). The risk of previous HBV exposure (resulting in either HBsAg+ or antibodies against HBV core antigen [HBcAb]+) was higher for increasing age (OR 3.07, 95% CI 2.49 to 3.78 per 10 years more) and lower for being born in Italy (OR 0.23, 95% CI 0.14 to 0.36)., Conclusions: Our real-world data on a large PrEP cohort suggest that, although uncommon, HBV infection in PrEP users in low-prevalence countries should be considered and managed. In addition, HBV screening offers the opportunity to expand prevention services through vaccination., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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20. Oral HPV infection clearance and acquisition after nonavalent vaccination in men who have sex with men and transgender women: a prospective analysis.

Author

Rossotti R, Nava A, Baiguera C, Baldassari L, Moioli MC, Fanti D, D'Amico F, Calzavara D, Bossolasco S, Tamburini AM, Canetti D, Bana NB, Cernuschi M, Vismara C, and Puoti M

Subjects
Humans, Male, Prospective Studies, Adult, Female, Middle Aged, Vaccination statistics & numerical data, Young Adult, Papillomaviridae genetics, Papillomaviridae immunology, HIV Infections epidemiology, HIV Infections prevention & control, Risk Factors, Mouth virology, Papillomavirus Infections prevention & control, Papillomavirus Infections epidemiology, Papillomavirus Infections virology, Transgender Persons statistics & numerical data, Homosexuality, Male statistics & numerical data, Papillomavirus Vaccines administration & dosage
Abstract

Oral HPV infection is the main risk factor for the development of oropharyngeal carcinoma. Men who have sex with men (MSM), especially if living with HIV (PLWH), are at increased risk of infection and consequently of cancer development. Aim of this study is to evaluate the impact of nonavalent vaccine on oral HPV infection in a cohort of MSM and transgender women (TGW). This prospective study included all MSM and TGW who started nonavalent HPV vaccination from May 2019 to September 2021. Oral rinse was collected before each vaccine administration and after six months of follow up. Descriptive statistics were used. Kaplan Meier probability curves and Cox regression models for HPV acquisition and clearance were calculated. The analysis included 211 individuals (202 MSM and 9 TGW). PLWH were 138 (65.4%). Baseline oral rinse was positive in 30 subjects (14.2%). Positivity rate did not change over time (p = 0.742), even when restricting the analysis only to high-risk genotypes (p = 0.575) and to genotypes covered by vaccine (p = 0.894). The risk to acquire HPV infection was 12.8% at one year and 33.4% at two years after vaccination. The probability to clear the infection was 67.6% at one year and 87.9% at two years. HIV infection had no impact on vaccine efficacy. Age above 45 years was the only factor associated to HPV acquisition (aHR 4.06, 95% CI 1.03-15.98, p = 0.045). Prevalence of oral HPV infection was higher in PLWH, but HIV had no impact on viral clearance or acquisition after vaccination., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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21. Do we Still Need Eligibility Criteria to Recommend PrEP? Impact of National Prescribing Requirements on Retention in Care and Sexually Transmitted Infections Acquisition.

Author

Rossotti R, Tavelli A, Calzavara D, De Bona A, Muccini C, Moschese D, Caruso E, Soria A, Bossolasco S, Lapadula G, Cernuschi M, and Monforte AD

Subjects
Humans, Male, Retrospective Studies, Adult, Female, Italy epidemiology, Anti-HIV Agents therapeutic use, Anti-HIV Agents administration & dosage, Incidence, Middle Aged, Eligibility Determination, Surveys and Questionnaires, Pre-Exposure Prophylaxis statistics & numerical data, Sexually Transmitted Diseases prevention & control, Sexually Transmitted Diseases epidemiology, HIV Infections prevention & control, HIV Infections epidemiology, HIV Infections drug therapy, Retention in Care statistics & numerical data
Abstract

Italian guidelines recommend HIV pre-exposure prophylaxis (PrEP) only upon satisfying strict eligibility criteria. The objective of this study is to evaluate if PrEP candidates attending a community-based service comply with these criteria and whether these prescribing conditions affect retention in care and sexually transmitted infections (STIs) acquisition. A retrospective analysis was performed on PrEP candidates evaluated from January 2019 to June 2022. Data were collected from self-administered questionnaires and clinical files. The population was divided in subjects with 0/1 (0/1 C) and ≥ 2 (≥ 2 C) criteria. Descriptive statistics and non-parametric tests were employed to describe study population. Incidence of PrEP discontinuation and of STIs was estimated per 100 persons-year of follow up (PYFU), and incidence rate ratio (IRR) was calculated. Univariate and multivariable Cox regression analyses were used to evaluate the association strength between PrEP drop out and other variables. The analyses enrolled 659 individuals: 422 individuals were included in 0/1 C, 237 in ≥ 2 C group, respectively. Inconsistent condom use was the most reported prescribing criteria (399 individuals, 60.6%), followed by a previous STI (186 individuals, 28.2%). 0/1 C exhibited lower STIs incidence. PrEP discontinuation was 29% in 0/1 C and 38% in ≥ 2 C (p = 0.031). Cox model revealed that inconsistent condom use was the only prescribing criteria associated to PrEP persistence. The majority of PrEP candidate did not comply with prescribing conditions. Eligibility criteria failed to identify individuals with better retention in care. Our results suggest that Italian guidelines should be updated removing barriers to prescription., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2024
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22. Performance evaluation of a self-administered point-of-care test for anal HPV screening in PrEP users: data from a community-based PrEP service.

Author

Biasioli L, Rossotti R, Tavelli A, De Bona A, Tincati C, Calzavara D, Vinti P, Baiguera C, D'Amico F, Nava A, Repossi R, Bossolasco S, Muccini C, Mulè G, Tesoro D, d'Arminio Monforte A, and Cernuschi M

Subjects
Humans, Male, Adult, Female, Mass Screening methods, Papillomaviridae genetics, Papillomaviridae isolation & purification, Anal Canal virology, Feasibility Studies, Middle Aged, Homosexuality, Male statistics & numerical data, HIV Infections diagnosis, HIV Infections prevention & control, Young Adult, Self-Testing, Papillomavirus Infections diagnosis, Papillomavirus Infections prevention & control, Point-of-Care Testing, Pre-Exposure Prophylaxis, Sensitivity and Specificity
Abstract

Objectives: In this study, we compared the performance of a self-administered point-of-care test (POCT) for anal human papillomavirus (HPV) screening with laboratory gold-standard test in pre-exposure prophylaxis (PrEP) users and evaluated its feasibility., Methods: We enrolled PrEP users from a local community-based PrEP service. Each participant self-collected an anal swab to test anal HPV with a PCR POCT capable of detecting 14 high-risk HPV genotypes. Anonymous questionnaires on self-sampling feasibility were completed. Participants were then referred to local clinics to undergo standard viral genotyping. Concordance between POCT and gold-standard test was measured with absolute agreement and Cohen's kappa. Receiver operating characteristic (ROC) curves were used to calculate POCT sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)., Results: 179 subjects got a valid POCT result, most of them men (98.3%) and men who have sex with men (90.4%). 68.2% tested positive for at least one high-risk HPV genotype on POCT. 150 feasibility questionnaires were collected: 92.7% of compilers found the self-swab easy to perform. For 178 subjects, a gold-standard test valid result was also available: 77% tested positive for at least one high-risk HPV genotype. The median time elapsed between the two tests was 9.8 months, due to COVID-19-related service interruptions. Agreement between POCT and gold-standard test was 79.3% (Cohen's kappa=0.49). POCT showed a sensitivity of 81.0%, a specificity of 73.8%, a PPV of 91.0% and an NPV of 54.4%., Conclusions: POCT showed a moderate agreement with gold-standard test and a discrete sensitivity and specificity, suggesting that it could be a useful and feasible additional tool for HPV screening, especially in low-resource and community-based settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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23. Ageism: the -ism affecting the lives of older people living with HIV.

Author

Guaraldi G, Milic J, Cascio M, Mussini C, Martinez E, Levin J, Calzavara D, Mbewe R, Falutz J, Orkin C, Cesari M, and Lazarus JV

Subjects
Humans, Aged, Social Stigma, Aging, Palliative Care, Ageism, HIV Infections drug therapy
Abstract

WHO defines ageism as stereotypes, prejudice, and discrimination based on age. Ageism is a multidimensional concept that encompasses multiple components related to the individual, the social group, and the institution in different cultural and environmental settings. In people ageing with HIV these elements include self-stigma, discrimination in society, and experiences in care, many of which are unique to older people. In this Position Paper, we use experience of people with HIV and clinicians taking care of them to explore these issues in high-income countries. The intersectionality of multiple -isms, which affect the lives of older people living with HIV, and ageism enhance several HIV-related issues, including self-inflicted stigma, and loneliness. Research is needed to explore how ageism contributes to worse physical, mental, and social wellbeing outcomes for people with HIV. The model of care for older people living with HIV needs to go beyond virological success by adopting a geriatric mindset, which is attentive to the challenge of ageism and is proactive in promoting a comprehensive approach for the ageing population. All stakeholders and the community should work together to co-create institutional strategies and educational programmes and enable respectful intergenerational dialogue to foster a stigma-free future for older people living with HIV., Competing Interests: Declaration of interests GG received research grants and speaker honorarium from Gilead, ViiV, MERCK, and Jansen and attended advisory boards of Gilead, ViiV, and MERCK. JM received speaker honoraria from Gilead and ViiV. MCa attended advisory boards for ViiV and received speaker honoraria from Gilead. EM received research grants from Merck Sharp & Dohme and ViiV; attended advisory boards for Janssen, Gilead, Merck Sharp & Dohme, and ViiV; and received speaker honoraria from Gilead and ViiV. JF received speaker honorarium from ViiV. CO received research grants from Gilead, GSK, ViiV, Merck Sharp & Dohme, AstraZeneca, and Janssen; speaker honoraria from Gilead, GSK, ViiV, Merck Sharp & Dohme, and Janssen; and support for attending meetings from Gilead and ViiV. JVL reports grants to his institution from AbbVie, Gilead, Roche Diagnostics, and Merck Sharp & Dohme and speaker honoraria from AbbVie, Gilead, Intercept, Janssen, and Novo Nordisk. JL, DC, RM, MCe, and CM declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Published
2024
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24. Detection of Asymptomatic Mpox Carriers among High-Ri Men Who Have Sex with Men: A Prospective Analysis.

Author

Rossotti R, Calzavara D, Cernuschi M, D'Amico F, De Bona A, Repossi R, Moschese D, Bossolasco S, Tavelli A, Muccini C, Mulé G, and d'Arminio Monforte A

Abstract

Mpox is traditionally considered a zoonotic disease with endemic circulation in Africa, but the 2022-2023 outbreak reached an unprecedented high number of cases in non-endemic countries, so that it was declared a public health emergency of international concern. The reasons for this extensive global spread, characterized by sexual transmission amongst men who have sex with men (MSM), have not been fully clarified. The existence of asymptomatic carriers with viable viral shedding might be an explanation and is under-debated after retrospective studies suggested that infection without symptoms might have a prevalence of 6.5%. We aimed to prospectively assess the presence of mpox infection in asymptomatic high-risk MSM using HIV pre-exposure prophylaxis and living with HIV. We selected individuals with no signs of active infection nor suggestive symptoms in the previous 21 days. Eligible individuals collected oral and anal swabs to undergo point-of-care testing for mpox and completed a 21-days follow-up. Seventy-two individuals were enrolled, and none tested positive for mpox infection nor developed symptoms during follow-up. We selected a high-risk population with a significant history of sexual exposure, but we failed to detect any asymptomatic infection. This observation might have important consequences in terms of contact management and epidemic control.

Published
2023
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26. High prevalence of anal papillomavirus infection in men who have sex with men PrEP users.

Author

Rossotti R, Nava A, Baiguera C, Calzavara D, D'Amico F, Fanti D, Bana NB, Vismara C, Cernuschi M, Scaglione F, and Puoti M

Abstract

Objectives: Human papillomavirus (HPV) is the most common STI and is associated with a wide range of diseases from anogenital warts to malignancies. Anal HPV infection is considerably more common in men who have sex with men (MSM) living with HIV. Aims of the present study are to (i) describe the prevalence of anal HPV infection in MSM who started pre-exposure prophylaxis (PrEP) and (ii) analyse factors associated with anal infection from genotypes that would be covered by nonavalent vaccination., Methods: This monocentric, cross-sectional study included all subjects who started PrEP from May 2018 to November 2021. PrEP candidates underwent full behavioural and clinical evaluation, including digital anal rectal examination and swabbing for HPV determination. Descriptive statistics, Mann-Whitney U test for continuous and χ 2 tests for categorical variables were adopted. Unadjusted and adjusted regression analyses were performed to assess factors associated with positive anal swabs and to the presence of genotypes covered by the nonavalent vaccination., Results: The analysis included 288 subjects: anal swabs tested positive in 87.2% of cases, 79.2% of the subjects had a high-risk genotype (mainly 16), whereas 67.4% had a genotype covered by nonavalent vaccine. Sexual role was the only factor associated with anal HPV infection. Use of recreational drugs and a diagnosis of ≥2 STIs correlated with the presence of genotypes that would have been covered by vaccine, while previous vaccination had a protective role., Conclusions: PrEP candidates showed a high prevalence of anal HPV infection, especially due to high-risk genotypes, comparable to what has been reported in MSM living with HIV., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2022
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27. The apically incised coronally advanced surgical technique (AICAST) for periodontal regeneration in isolated defects: a case series.

Author

Calzavara D, Morante S, Sanz J, Noguerol F, Gonzalez J, Romandini M, and Sanz M

Subjects
Follow-Up Studies, Guided Tissue Regeneration, Periodontal, Humans, Periodontal Attachment Loss surgery, Regeneration, Retrospective Studies, Treatment Outcome, Alveolar Bone Loss diagnostic imaging, Alveolar Bone Loss surgery, Dental Enamel Proteins, Gingival Recession diagnostic imaging, Gingival Recession surgery
Abstract

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions., Method and Materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively)., Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases., Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues.

Published
2021
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28. Immediate placement and restoration of implants in the esthetic zone: Trimodal Approach therapeutic options.

Author

Cabello G, Fernández DAG, Calzavara D, and Fábrega JG

Subjects
Adult, Female, Humans, Middle Aged, Dental Implantation, Endosseous, Dental Restoration, Permanent, Esthetics, Dental
Abstract

Recently, a number of clinical and animal studies have been published suggesting the advantages of using immediate post-extraction implants under a flapless protocol, followed by the simultaneous placement of an implant-supported provisional restoration (Trimodal Approach [TA]). Indications and risk of complications of this therapeutic option have also been thoroughly discussed in the literature. Different protocols have been advocated in order to minimize the possible esthetic impact of the post-extraction remodeling of the bundle bone. These include a correct implant position, a flapless approach, the use of an immediate implant-supported provisional restoration, and filling the osseous gap with different biomaterials or thickening the mucosal compartment through soft-tissue grafts. These techniques have been mostly indicated when intact alveolar walls are present at the time of tooth extraction. In this article, the conventional TA is described. Thereafter, variations of this option are discussed, being the modification of the osseous compartment (TAO), and the modification of the mucosal and osseous compartments (TAOM).

Published
2015

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