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Search Results: 1 - 10 of 215436 matches for " Claudio L. Bassetti "
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Eye Movements Discriminate Fatigue Due to Chronotypical Factors and Time Spent on Task – A Double Dissociation
Dario Cazzoli, Chrystalina A. Antoniades, Christopher Kennard, Thomas Nyffeler, Claudio L. Bassetti, René M. Müri
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087146
Abstract: Systematic differences in circadian rhythmicity are thought to be a substantial factor determining inter-individual differences in fatigue and cognitive performance. The synchronicity effect (when time of testing coincides with the respective circadian peak period) seems to play an important role. Eye movements have been shown to be a reliable indicator of fatigue due to sleep deprivation or time spent on cognitive tasks. However, eye movements have not been used so far to investigate the circadian synchronicity effect and the resulting differences in fatigue. The aim of the present study was to assess how different oculomotor parameters in a free visual exploration task are influenced by: a) fatigue due to chronotypical factors (being a ‘morning type’ or an ‘evening type’); b) fatigue due to the time spent on task. Eighteen healthy participants performed a free visual exploration task of naturalistic pictures while their eye movements were recorded. The task was performed twice, once at their optimal and once at their non-optimal time of the day. Moreover, participants rated their subjective fatigue. The non-optimal time of the day triggered a significant and stable increase in the mean visual fixation duration during the free visual exploration task for both chronotypes. The increase in the mean visual fixation duration correlated with the difference in subjectively perceived fatigue at optimal and non-optimal times of the day. Conversely, the mean saccadic speed significantly and progressively decreased throughout the duration of the task, but was not influenced by the optimal or non-optimal time of the day for both chronotypes. The results suggest that different oculomotor parameters are discriminative for fatigue due to different sources. A decrease in saccadic speed seems to reflect fatigue due to time spent on task, whereas an increase in mean fixation duration a lack of synchronicity between chronotype and time of the day.
The Frontal Eye Field Is Involved in Visual Vector Inversion in Humans – A Theta Burst Stimulation Study
Katrin Jaun-Frutiger, Dario Cazzoli, René M. Müri, Claudio L. Bassetti, Thomas Nyffeler
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0083297
Abstract: In the antisaccade task, subjects are requested to suppress a reflexive saccade towards a visual target and to perform a saccade towards the opposite side. In addition, in order to reproduce an accurate saccadic amplitude, the visual saccade vector (i.e., the distance between a central fixation point and the peripheral target) must be exactly inverted from one visual hemifield to the other. Results from recent studies using a correlational approach (i.e., fMRI, MEG) suggest that not only the posterior parietal cortex (PPC) but also the frontal eye field (FEF) might play an important role in such a visual vector inversion process. In order to assess whether the FEF contributes to visual vector inversion, we applied an interference approach with continuous theta burst stimulation (cTBS) during a memory-guided antisaccade task. In 10 healthy subjects, one train of cTBS was applied over the right FEF prior to a memory-guided antisaccade task. In comparison to the performance without stimulation or with sham stimulation, cTBS over the right FEF induced a hypometric gain for rightward but not leftward antisaccades. These results obtained with an interference approach confirm that the FEF is also involved in the process of visual vector inversion.
Fatigue and Sleep-Disordered Breathing in Multiple Sclerosis: A Clinically Relevant Association?
Ulf Kallweit,Christian R. Baumann,Michael Harzheim,Hildegard Hidalgo,Dieter P?hlau,Claudio L. Bassetti,Michael Linnebank,Philipp O. Valko
Multiple Sclerosis International , 2013, DOI: 10.1155/2013/286581
Abstract: Background. Fatigue in patients with multiple sclerosis (MS) is highly prevalent and severely impacts quality of life. Recent studies suggested that sleep-disordered breathing (SDB) significantly contributes to fatigue in MS. Study Objective. To evaluate the importance of routine respirography in MS patients with severe fatigue and to explore the effects of treatment with continuous positive airway pressure (CPAP). Patients and Methods. We prospectively assessed the presence of severe fatigue, as defined by a score of ≥5.0 on the Fatigue Severity Scale (FSS), in 258 consecutive MS patients. Ninety-seven patients (38%) suffered from severe fatigue, whereof 69 underwent overnight respirography. Results. We diagnosed SDB in 28 patients (41%). Male sex was the only independent associate of SDB severity ( ). CPAP therapy in 6 patients was associated with a significant reduction of FSS scores ( versus , ), but the scores remained pathological (≥4.0) in all patients. Conclusion. Respirography in MS patients with severe fatigue should be considered in daily medical practice, because SDB frequency is high and CPAP therapy reduces fatigue severity. However, future work is needed to understand the real impact of CPAP therapy on quality of life in this patient group. 1. Introduction Although fatigue has been increasingly recognized over the past two decades as one of the most frequent and most debilitating symptoms in patients with MS, there are still no insights into its neurobiological mechanisms, and current treatment options are highly frustrating [1–4]. In clinical practice, MS patients complaining about fatigue are usually first scrutinized for additional and potentially treatable comorbidities, such as depression, pain, anemia, or sleep-wake disturbances [5]. If there is no such cause of fatigue, the patient is considered to suffer from “MS-related fatigue,” that is, a disease-inherent symptom related to the underlying neuroimmunological and neurodegenerative processes, and off-label symptomatic treatment with stimulants of the central nervous system may be recommended [3]. Recently, the need to search for sleep-wake disorders in MS patients has been reemphasized, as several groups observed a significant correlation with fatigue [6–10]. Specifically, sleep-disordered breathing (SDB) has been proposed as a potential risk factor for fatigue in MS. In the last year, a cross-sectional study in 48 MS patients suggested a predisposition for SDB [11], and two studies found that severe fatigue in MS was significantly associated with SDB and respiratory-related
Bench-to-bedside review: Therapeutic management of invasive candidiasis in the intensive care unit
Matteo Bassetti, Ma?gorzata Mikulska, Claudio Viscoli
Critical Care , 2010, DOI: 10.1186/cc9239
Abstract: Fungal infections are being increasingly diagnosed in patients admitted to the intensive care unit (ICU). Advances in medical science allow patients with severe and complicated diseases to survive, and thus a population of subjects vulnerable to a range of infections is created. Candida is the most common fungal pathogen in ICU patients, and the main clinical forms are bloodstream infection, followed by peritonitis and other abdominal infection, endocarditis, and so forth. Most of the patients included in studies on epidemiology or treatment of invasive candidiasis had candidemia (approximately 68 to 90%), with or without other sites affected, while peritonitis was the second most common disease (approximately 7 to 30% of subjects) [1-3].Candidemia is a life-threatening infection with high morbidity and mortality, especially in immunocom promised and critically ill patients [4-7]. In the ICU, this infection may represent up to 15% of nosocomial infections and the crude mortality rate has been found as high as 25 to 60%, varying according to the study design and the population - with the estimated attributable mortality as high as 47% [8-11]. Additionally, the estimated costs of each episode of invasive candidiasis in hospitalised adults are tremendous [11,12]. Finally, nosocomial fungal infections have one of the highest rates of inappropriate therapy - consisting mostly of omission of initial empirical therapy and an inadequate dose of fluconazole - which has been associated with increased mortality [13-16].Moreover, during the past decade, several new antifungal drugs have been developed and obtained approval for treatment of Candida infections. Among them, echinocandins are the most important from the point of view of treating candidemia in critically ill patients. Epidemiology, risk factors, diagnosis and, in particular, treatment strategies and guidelines will therefore be discussed further.Candidemia is one of the most frequent and most serious infections in p
INVASIVE CANDIDIASIS IN NON-HEMATOLOGICAL PATIENTS.
Malgorzata Mikulska,Matteo Bassetti,Sandra Ratto,Claudio Viscoli
Mediterranean Journal of Hematology and Infectious Diseases , 2011, DOI: 10.4084/mjhid.2011.
Abstract: Candida is one of the most frequent pathogens isolated in bloodstream infections, and is associated with significant morbidity and mortality. In addition to haematological patients, there are several other populations with a substantial risk of developing invasive candidiasis (IC). These include patients undergoing prolonged hospitalisation with the use of broad-spectrum antibiotics, those fitted with intravascular catheters, admitted to both adult and neonate intensive care units (ICU) or gastrointestinal surgery wards and subjects with solid tumours undergoing cytotoxic chemotherapy. As a general rule, every immunocompromised patient might be at risk of Candida infection, including, for example, diabetic patients. The epidemiology of species responsible for IC has been changing, both at local and worldwide level, shifting from C. albicans to non-albicans species, that can be intrinsically resistant to fluconazole (C. krusei and, to some extent, C. glabrata), difficult to eradicate because of biofilm production (C. parapsilosis) or than might acquire resistance to azole during therapy. Delaying the specific therapy has been shown to increase morbidity and mortality, but traditional microbiological diagnosis is poorly sensitive and slow. Thus, culture-based treatment may result in therapy started too late. In order to reduce the mortality in IC, several management strategies have been developed: prophylaxis, empirical and pre-emptive therapy. Compared to prophylaxis, the latter approaches allow to reduce the use of antifungals by targeting only patients at very high risk of IC. Non-invasive serological markers and scores based on clinical prediction rules such as the presence of risk factors or Candida colonisation, have been developed with the aim of allowing prompt initiation of treatment. Although the use of these diagnostic tools in pre-emptive strategies is promising, the performance and cost-effectiveness should be tested in large trials. Agents recommended for initial treatment of candidemia in severely ill patients include echinocandins and lipid formulations of amphotericin B, while stable patients without risk factors for azole-resistance might be treated with fluconazole.
A comparative evolutionary study of transcription networks
A. L. Sellerio,B. Bassetti,H. Isambert,M. Cosentino Lagomarsino
Quantitative Biology , 2008,
Abstract: We present a comparative analysis of large-scale topological and evolutionary properties of transcription networks in three species, the two distant bacteria E. coli and B. subtilis, and the yeast S. cerevisiae. The study focuses on the global aspects of feedback and hierarchy in transcriptional regulatory pathways. While confirming that gene duplication has a significant impact on the shaping of all the analyzed transcription networks, our results point to distinct trends between the bacteria, where time constraints in the transcription of downstream genes might be important in shaping the hierarchical structure of the network, and yeast, which seems able to sustain a higher wiring complexity, that includes the more feedback, intricate hierarchy, and the combinatorial use of heterodimers made of duplicate transcription factors.
Epidemiology, Species Distribution, Antifungal Susceptibility and Outcome of Nosocomial Candidemia in a Tertiary Care Hospital in Italy
Matteo Bassetti, Lucia Taramasso, Elena Nicco, Maria Pia Molinari, Michele Mussap, Claudio Viscoli
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024198
Abstract: Candida is an important cause of bloodstream infections (BSI), causing significant mortality and morbidity in health care settings. From January 2008 to December 2010 all consecutive patients who developed candidemia at San Martino University Hospital, Italy were enrolled in the study. A total of 348 episodes of candidaemia were identified during the study period (January 2008–December 2010), with an incidence of 1,73 episodes/1000 admissions. Globally, albicans and non-albicans species caused around 50% of the cases each. Non-albicans included Candida parapsilosis (28.4%), Candida glabrata (9.5%), Candida tropicalis (6.6%), and Candida krusei (2.6%). Out of 324 evaluable patients, 141 (43.5%) died within 30 days from the onset of candidemia. C. parapsilosis candidemia was associated with the lowest mortality rate (36.2%). In contrast, patients with C. krusei BSI had the highest mortality rate (55.5%) in this cohort. Regarding the crude mortality in the different units, patients in Internal Medicine wards had the highest mortality rate (54.1%), followed by patients in ICU and Hemato-Oncology wards (47.6%). This report shows that candidemia is a significant source of morbidity in Italy, with a substantial burden of disease, mortality, and likely high associated costs. Although our high rates of candidemia may be related to high rates of BSI in general in Italian public hospitals, reasons for these high rates are not clear and warrant further study. Determining factors associated with these high rates may lead to identifying measures that can help to prevent disease.
Tigecycline use in serious nosocomial infections: a drug use evaluation
Matteo Bassetti, Laura Nicolini, Ernestina Repetto, Elda Righi, Valerio Del Bono, Claudio Viscoli
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-287
Abstract: Prospective observational study of tigecycline use was conducted in a 1500 beds university hospital. From January 1, 2007 and January 31, 2010, 207 pts were treated with tigecycline for the following indications: intra-abdominal, pneumonia, bloodstream and complicated skin and soft tissue infections and febrile neutropenia. The therapy was targeted in 130/207 (63%) and empirical in 77/207 (37%) patients. All bacteria treated were susceptible to tigecycline. Median duration of tigecycline therapy was 13 days (range, 6-28). Clinical success was obtained in 151/207 (73%) cases, with the highest success rate recorded in intra-abdominal infections [81/99 (82%)]. Microbiological success was achieved in 100/129 (78%) treated patients. Adverse clinical events were seen in 16/207 patients (7.7%):Considering the lack of data on tigecycline for critically ill patients, we think that the reported data of our clinical experience despite some limitations can be useful for clinicians.The management of hospital-acquired bacterial infections is becoming a significant challenge for health care providers because of the increased prevalence of multidrug-resistant (MDR) bacteria like methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Acinetobacter baumannii, Klebsiella pneumoniae, carbapenemase -producing Enterobacteriaceae, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Increased morbidity and mortality, duration of hospitalization, and medical care costs are all associated with MDR organisms [1]. Delay of appropriate empiric antimicrobial therapy is known to increase morbidity and mortality among affected patients and inadequate therapy has been found to be associated with excess mortality and increased duration of hospitalization [2]. There is a high rate of resistance to commonly used antimicrobial agents, including beta-lactams (penicillins and cephalosporins), fluoroquinolones, aminoglycosides and glycopepti
Epidemiological trends in nosocomial candidemia in intensive care
Matteo Bassetti, Elda Righi, Alessandro Costa, Roberta Fasce, Maria Molinari, Raffaella Rosso, Franco Pallavicini, Claudio Viscoli
BMC Infectious Diseases , 2006, DOI: 10.1186/1471-2334-6-21
Abstract: In a retrospective study we studied the etiology of candidemia in critically ill patients over a five-year period (1999–2003) in the ICU of the San Martino University Hospital in Genoa, Italy.In total, 182 episodes of candidaemia were identified, with an average incidence of 2.22 episodes/10 000 patient-days/year (range 1.25–3.06 episodes). Incidence of candidemia increased during the study period from 1.25 in 1999 to 3.06/10 000 patient-days/year in 2003. Overall, 40% of the fungemia episodes (74/182) were due to C.albicans, followed by C. parapsilosis(23%), C.glabrata (15%), C.tropicalis (9%) and other species (13%). Candidemia due to non-albicans species increased and this was apparently correlated with an increasing use of azoles for prophylaxis or empirical treatment.The study demonstrates a shift in the species of Candida causing fungemia in a medical and surgical ICU population during a 5 year period. The knowledge of the local epidemiological trends in Candida species isolated in blood cultures is important to guide therapeutic choices.Candida is an increasing cause of bloodstream infection (BSI), causing significant mortality and morbidity, especially in non-neutropenic critically ill patients. Its overall incidence raised fivefold in the past ten years and Candida spp. is currently between the fourth and the sixth most common nosocomial bloodstream isolate in American and European studies [1,2]. Despite the availability of effective antifungal therapy, mortality in the last decade remained high, ranging from 36% to 63% [3]. In terms of species of Candida, recently, a shift towards non-albicans species was reported by some authors especially in hematological and transplanted patients [4-7]. Some of these emerging species has been correlated with increased virulence [8], and sometimes, but not always, with increased mortality [9]. An increasing role for non-albicans species was also noticed in studies performed among ICU patients, although the issue is somew
Book Review, Pierre-Joseph Proudhon, Contro l’Unità d’Italia, Articoli scelti
Caterina Bassetti
Mediterranean Journal of Social Sciences , 2011,
Abstract: Book Review, Pierre-Joseph Proudhon, Contro l’Unità d’Italia, Articoli scelti, Torino, Miraggi Edizioni. ISBN 978-88-96910-06-1Il prossimo anniversario del cento cinquantenario dell’Unità d’Italia rappresenta un’importante occasione per riscoprire le radici della nostra identità, offrendo la possibilità di uno sguardo nuovo, una nuova attenzione che sappia andare oltre la celebrazione retorica, per ripensare il Risorgimento e individuarne quegli elementi fondativi di un comune “senso di appartenenza nazionale e popolare”. La ricchezza e la complessità del moto risorgimentale italiano si sviluppano all’interno di una rivoluzione libertaria che attraversa tutta l’Europa ed è solo nel quadro più generalmente europeo che se ne coglie il duplice carattere di movimento nazionale e insieme questione internazionale
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