No abstract

Migrant and Italian HIV-infected patients (n = 5773) enrolled in the ICONA cohort in 2004-2014 were compared for disparities in access to an initial antiretroviral regimen and/or risk of virologic failure (VF), and determinants of failure were evaluated. Variables associated with initiating antiretroviral therapy (ART) were analysed. Primary endpoint was time to failure after at least 6 months of ART and was defined as: VF, first of two consecutive virus loads (VL) >200 copies/mL; treatment discontinuation (TD) for any reason; and treatment failure as confirmed VL >200 copies/mL or TD. A Poisson multivariable analysis was performed to control for confounders. Migrants presented significantly lower CD4 counts and more frequent AIDS events at baseline. When adjusting for baseline confounders, migrants presented a lower likelihood to begin ART (odds ratio 0.80, 95% confidence interval (CI) 0.67-0.95, p 0.012). After initiating ART, the incidence VF rate was 6.4 per 100 person-years (95% CI 4.8-8.5) in migrants and 2.7 in natives (95% CI 2.2-3.3). Multivariable analysis confirmed that migrants had a higher risk of VF (incidence rate ratio 1.90, 95% CI 1.25-2.91, p 0.003) and treatment failure (incidence rate ratio 1.16, 95% CI 1.01-1.33, p 0.031), with no differences for TD. Among migrants, variables associated with VF were age, unemployment and use of a boosted protease inhibitor-based regimen versus nonnucleoside reverse transcriptase inhibitors. Despite the use of more potent and safer drugs in the last 10 years, and even in a universal health care setting, migrants living with HIV still present barriers to initiating ART and an increased risk of VF compared to natives.

Background: The role of the neutrophil-to-lymphocyte ratio (NLR) of peripheral blood has been investigated in relation to several autoimmune diseases. Limited studies have addressed the significance of the NLR in terms of being a marker of disease activity in multiple sclerosis (MS). Methods: This is a retrospective study in relapsing–remitting MS patients (RRMS) admitted to the tertiary MS center of Catania, Italy during the period of 1 January to 31 December 2018. The aim of the present study was to investigate the significance of the NLR in reflecting the disease activity in a cohort of early diagnosed RRMS patients. Results: Among a total sample of 132 patients diagnosed with RRMS, 84 were enrolled in the present study. In the association analysis, a relation between the NLR value and disease activity at onset was found (V-Cramer 0.271, p = 0.013). In the logistic regression model, the variable NLR (p = 0.03 ExpB 3.5, CI 95% 1.089–11.4) was related to disease activity at onset. Conclusion: An elevated NLR is associated with disease activity at onset in RRMS patients. More large-scale studies with a longer follow-up are needed.

The relationship between flowering and growth performance of Posidonia oceanica (L.) Delile in meadows distributed along the south‐eastern coast of Sicily (Italy) was investigated by means of a statistical model (generalized linear mixed model) combined with the lepidochronological analysis. Over a 28‐year period, 67 floral stalk remains were observed. The highest flowering index was recorded in lepidochronological year 1998 (10.1%) and the Inflorescence Frequency per age showed a clear decrease corresponding to 15‐year‐old shoots. The sexual reproductive event had positive effects on rhizome elongation (cm year−1) and leaf production (no. leaves year−1) in the same flowering year, whilst no effect on the rhizome production (mg year−1) was observed. Rhizome growth variables showed significant negative lagged responses in the two years following flowering. On the whole, we calculated that the effect exerted by flowering, in terms of loss on rhizome elongation and production, was about 27% and 38%, respectively. Although it has been demonstrated that recovery from the stress induced by sexual reproduction is limited to the two years after flowering, the magnitude of the reproductive cost may become quite considerable especially in comparison with the whole lifespan of individual shoots.

BackgroundThe introduction of oral disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) changed algorithms of RRMS treatment. ObjectivesTo compare effectiveness of treatment with dimethyl fumarate (DMF) and teriflunomide (TRF) in a large multicentre Italian cohort of RRMS patients. Materials and MethodsPatients with RRMS who received treatment with DMF and TRF between January 1 st , 2012 and December 31 th , 2018 from twelve MS centers were identified. The events investigated were "time-to-first-relapse", "time-to-Magnetic-Resonance-Imaging (MRI)-activity" and "time-to-disability-progression".Results 1,445 patients were enrolled (1,039 on DMF, 406 on TRF) and followed for a median of 34 months. Patients on TRF were older (43.5±8.6 vs 38.8±9.2 years), with a predominance of men and higher level of disability (p<0.001 for all). Patients on DMF had a higher number of relapses and radiological activity (p<.05) at baseline. Time-varying Cox-model for the event "time-to-first relapse" revealed that patients on DMF have a lower relapse-hazard before 38 months of treatment (HRt<38DMF=0.73, CI=0.52-1.03, p<.005). When the time-on-therapy exceeds 38 months, the relapse hazard for DMF patients increase (HRt>38DMF=3.83, CI= 0.89-1.02, p<.005). Both DMTs controlled similarly MRI activity and disability progression. Conclusions Patients on DMF had higher relapse free survival time than TRF group during the first 38 months on therapy.