A Vimercati

Università degli Studi di Bari Aldo Moro, Bari, Apulia, Italy

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Publications (121)273.75 Total impact

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    ABSTRACT: Objective: To evaluate the prevalence and consequences of late antenatal booking (13 or more weeks gestation) in a national observational study of pregnant women with HIV. Methods: The clinical and demographic characteristics associated with late booking were evaluated in univariate analyses using the Mann-Whitney U test for quantitative data and the chi-square test for categorical data. The associations that were found were re-evaluated in multivariable logistic regression models. Main outcomes were preterm delivery, low birthweight, nonelective cesarean section, birth defects, undetectable (<50 copies/mL) HIV plasma viral load at third trimester, delivery complications, and gender-adjusted and gestational age-adjusted Z scores for birthweight. Results: Rate of late booking among 1,643 pregnancies was 32.9%. This condition was associated with younger age, African provenance, diagnosis of HIV during pregnancy, and less antiretroviral exposure. Undetectable HIV RNA at third trimester and preterm delivery were significantly more prevalent with earlier booking (67.1% vs 46.3%, P < .001, and 23.2% vs 17.6, P = .010, respectively), whereas complications of delivery were more common with late booking (8.2% vs 5.0%, P = .013). Multivariable analyses confirmed an independent role of late booking in predicting detectable HIV RNA at third trimester (adjusted odds ratio [AOR], 1.7; 95% CI, 1.3-2.3; P < .001) and delivery complications (AOR, 1.8; 95% CI, 1.2-2.8; P = .005). Conclusions: Late antenatal booking was associated with detectable HIV RNA in late pregnancy and with complications of delivery. Measures should be taken to ensure an earlier entry into antenatal care, particularly for African women, and to facilitate access to counselling and antenatal services. These measures can significantly improve pregnancy management and reduce morbidity and complications in pregnant women with HIV.
    HIV Clinical Trials 05/2014; 15(3):104-15. · 2.30 Impact Factor
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    ABSTRACT: BACKGROUND: Atazanavir and lopinavir represent the main HIV protease inhibitors recommended in pregnancy, but comparative data in pregnant women are limited. METHODS: Women from a national observational study, exposed in pregnancy to either atazanavir or lopinavir, were compared for glucose and lipid profiles, liver function tests, CD4 count, HIV RNA and main pregnancy outcomes. Statistical methods included univariate and multivariable analyses. RESULTS: The study population included 428 pregnancies (lopinavir, 322; atazanavir, 106). The lopinavir group was characterized by higher rates of HIV diagnosis in pregnancy and treatment indication for maternal health, lower CD4 counts, higher HIV RNA levels, less frequent antiretroviral treatment at conception and shorter duration of drug exposure during pregnancy. No differences in pregnancy outcomes, glucose metabolism and weight gain were observed. The two groups also showed in a multivariable analysis similar odds for detectable HIV RNA in the third trimester (adjusted OR 0.85, 95% CI 0.35-2.10, P = 0.730). Total lipid levels were significantly higher in the lopinavir group (median values in the third trimester 239 versus 221 mg/dL for total cholesterol and 226 versus 181 mg/dL for triglycerides; P < 0.001 for both comparisons) and bilirubin levels were significantly higher in the atazanavir group (1.53 versus 0.46 mg/dL, P < 0.001). CONCLUSIONS: In this observational study atazanavir and lopinavir showed similar safety and activity in pregnancy, with no differences in the main pregnancy outcomes. Atazanavir use was associated with a better lipid profile and with higher bilirubin levels. Overall, the study findings confirm that these two HIV protease inhibitors represent equally valid alternative options. KEYWORDS: HIV RNA, bilirubin, cholesterol, pre-term delivery, triglycerides
    Journal of Antimicrobial Chemotherapy 05/2014; 69(5):1377-84. · 5.34 Impact Factor
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    ABSTRACT: Objective We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection. DesignObservational study. SettingUniversity and hospital clinics. PopulationPregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy. Methods The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses. Main outcome measuresBirth defects, defined according to the Antiretroviral Pregnancy Registry criteria. ResultsA total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9–4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9–4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and first-trimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51–1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51–1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56–2.55; protease inhibitors, OR 0.92, 95% CI 0.43–1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%). Conclusions This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.
    BJOG An International Journal of Obstetrics & Gynaecology 11/2013; 120(12). · 3.76 Impact Factor
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    Clinical Infectious Diseases 04/2013; 56(8):1190-3. · 9.37 Impact Factor
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    ABSTRACT: The aim of this study was to report the clinical features, management, and outcome of complete hydatidiform mole with a coexisting viable fetus. Two cases are reported. In both cases ultrasound examination demonstrated a normally growing live fetus alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. The hCG levels were significantly increased and fetal karyotypes were normal. A cesarean section performed at 28 weeks' gestation in the first case and at 26 weeks' gestation in the second one resulted in the delivery of live normal infant and two adjoining placentas in both cases. Microscopic examination of the abnormal placentas confirmed complete hydatidiform mole. The babies did well and serial maternal serum hCG levels showed a declining trend and were undetectable by a few months after delivery. Continuation of a twin pregnancy with complete hydatidiform mole (CHMF) is an acceptable option. There is, although, an increased risk of developing maternal and fetal complications. Close surveillance of an ongoing pregnancy is compulsory to detect potential early signs of complications.
    Journal of prenatal medicine. 01/2013; 7(1):1-4.
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    ABSTRACT: this paper reports an association between an increased Nuchal Translucency (NT) and Osteogenesis Imperfecta (OI), a type of skeletal dysplasia. Measurement of fetal NT at 10-14 weeks of gestation is a sensitive and effective screening method for chromosomal abnormalities. a 35-year- old Caucasian woman in her fourth pregnancy was referred to our clinic for an ultrasound scan at 12 weeks of gestation, that confirmed increased Nuchal Translucency. Chorionic villi sampling was performed, showing a normal karyotype. The patient was evaluated by a team of experienced ultra sonographers for pregnancy follow-up at our Department, that is a tertiary center. in our case the ultrasound scan at 12 week of gestation revealed only an increased NT (3 mm). Cytogenetic analysis on chorionic villi demonstrated a normal male karyotype. US follow-up, performed every 3-4 weeks, confirmed normal anthropometric parameters except for shortening of both femurs, but at 23 weeks an incorrect attitude of the feet was revealed. A clinical and radiographic diagnosis of OI type III was made only at birth, and through follow-up continuing to date. NT screening was successful for chromosomal abnormalities at 11-14 weeks of gestation. An increased NT thickness is also associated with numerous fetal anomalies and genetic syndromes in a chromosomally normal fetus. In our case there were no sonographic signs of imperfect osteogenesis in the first trimester, although there was an increased NT with a normal karyotype. currently, in literature, there are not other cases of OI type III associated with an increased NT. Our report is the first to suggest an association between an increased nuchal translucency, short femur length and osteogenesis imperfecta type III.
    Journal of prenatal medicine. 01/2013; 7(1):5-8.
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    ABSTRACT: Objective The accuracy of current formulae for the sonographic estimation of fetal weight (EFW) is compromised by significant intra‐ and interobserver variability of biometrical measurements, particularly circumferences. The aim of this study was to assess the reliability of the linear measurement of mid‐thigh soft‐tissue thickness (STT) and to derive a novel formula for EFW.Methods This was a prospective study involving 388 singleton uncomplicated pregnancies. There were three consecutive phases: (1) to verify the relationship between STT and birth weight, (2) to derive a novel formula for EFW using femur length and STT only, and (3) to test the accuracy of the new equation. Only the 290 patients who delivered within 48 h of measurement were considered for the analysis. A comparison with other formulae was performed.ResultsSTT was significantly correlated with both abdominal circumference and birth weight (r2 = 0.36 and 0.46, respectively; P Conclusions Our findings confirm the potential of the linear measurement of mid‐thigh STT as a valuable parameter for the sonographic assessment of fetal growth and EFW. Our new equation is apparently at least as reliable as the most widely used formulae for EFW. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
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    ABSTRACT: PURPOSE: This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery. MATERIALS AND METHODS: A total of 143 patients (mean age 34.3±5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3-10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard. RESULTS: Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67-100%, 85-100%, 83-100%, 84-100% and 84-100%, respectively, in recognising lesions located in different pelvic sites. CONSLUCIONS: MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement.
    La radiologia medica 06/2012; · 1.46 Impact Factor
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    ABSTRACT: Aim:  A common anatomical consequence of low-segment cesarean section is the presence of a pouch on the anterior uterine wall that can be detected by sonography or hysteroscopy. Different suturing techniques have been compared (single vs double layer) and showed no substantial differences. This prospective longitudinal study was aimed at evaluating the outcome of the cesarean scar, comparing two different types of single-layer sutures by transvaginal ultrasound and hysteroscopy. Material and Methods:  The study sample consisted of two groups of 30 singleton primiparae at term who delivered by elective low segment cesarean section. In the first group, uterine closure was done with locked continuous single-layer sutures and in the second group, with single-layer interrupted sutures. Patients were assessed by transvaginal ultrasound and hysteroscopy, between the 6th and the 12th month after delivery, and again at the 24th month. Ultrasound measurements were made of the pouch area, if present. Results:  A bell-shaped uterine wall defect was seen at ultrasound in 36 (85.71%) of 42 patients who completed the follow up at the 24th month. It was larger in the group of patients with closure by continuous sutures (6.2 [2.1-14.7] mm(2) ) as compared to interrupted sutures (4.6 [1.9-8.2] mm(2) , P = 0.03). Hysteroscopy confirmed the presence of the wall defect in all 36 cases, but different hysteroscopic outcomes were observed. Conclusion:  Locked continuous sutures seem to cause a larger defect as compared to interrupted sutures, probably due to a greater ischemic effect exerted on the uterine tissue.
    Journal of Obstetrics and Gynaecology Research 05/2012; · 0.84 Impact Factor
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    ABSTRACT: Objectives: The aim of this study was to investigate the accuracy of transvaginal sonography (TVS) and contrast-enhanced magnetic resonance-colonography (CE-MR-C) for the pre-surgical assessment of deep infiltrating endometriosis (DIE). Methods Ninety women were prospectively enrolled for a suspicion of DIE. All patients underwent a TVS and a CE-MR-C performed blindly, before laparoscopy. The sites of DIE examined by both imaging techniques were: recto-vaginal septum, pouch of Douglas, utero-sacral ligaments, vesico-uterine pouch, bowel, bladder and vagina. The presence of adhesions, the involvement of adnexa and of a previous abdominal scar, in case of a clinical suspicion, were also evaluated. TVS and CE-MR-C findings were compared with laparoscopic and histological results. Results Endometriosis was confirmed by laparoscopy in 95.6% of cases (86//90). In 82.2% (74/90) of patients there was DIE. The global accuracy, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios and negative likelihood ratios were 89.2%, 81.1%, 94.2%, 89.6%, 89.0%, 13.9 and 0.2 for TVS, 87.2%, 71.1%, 97.1%, 93.7%, 84.6%, 24.4 and 0.3 for CE-MR-C. CE-MR-C allowed to diagnose all cases of bowel involvement; the accuracy for infiltration and stenosis was 100%. The accuracy of TVS for recto-sigmoid nodules and infiltration was 91.1% and 88.9%. Conclusions Both techniques showed satisfactory results. TVS appears a powerful, simple, feasible, cost effective tool for preoperative staging of DIE. CE-MR-C is an "X Ray free" technique, which could be reserved for cases with deep infiltrating rectosigmoid lesions, for the prediction of stenosis and involvement of the upper part of colon and small intestine. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
    Ultrasound in Obstetrics and Gynecology 04/2012; · 3.56 Impact Factor
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    ABSTRACT: to compare ultrasound (US) and autopsy findings of fetal malformations in second trimester terminations of pregnancy to evaluate the degree of agreement between US and fetal autopsy. in this study, all second trimester termination of pregnancy between 2003-2010 were considered. US and autopsy findings were compared and all cases were classified into five categories according to the degree of agreement between US and pathology (A1: full agreement between US and autopsy; A2: autopsy confirmed all US findings but revealed additional anomalies 'rarely detectable' prenatally; B: autopsy demonstrated all US findings but revealed additional anomalies 'detectable' prenatally; C: US findings were only partially demonstrated at fetal autopsy; D: total disagreement between US and autopsy). 144 cases were selected. In 49% of cases there was total agreement between US and autopsy diagnosis (A1). In 22% of cases additional information were about anomalies 'not detectable' by US (A2). In 12% of cases autopsy provided additional information about anomalies not observed but 'detectable' by US (B). In 13% of cases some anomalies revealed at US, such as valve insufficiencies, pericardial and pleural effusions, were not verified at autopsy (C). Total lack of agreement was noted only in 4% of cases (D). Main areas of disagreement concerned cardiovascular, CNS and complex malformations. The degree of agreement was higher if malformations were diagnosed in a tertiary center. this study shows an overall high degree of agreement between definitive US and autopsy findings in second trimester termination of pregnancy for fetal malformations. Autopsy reveals to be the best tool to diagnose malformations and often showed other abnormalities of clinical importance not detected by US, but sometimes also US could provide additional information about functional anomalies because US is a dynamic examination.
    Journal of prenatal medicine. 04/2012; 6(2):13-7.
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    Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2011; 38(S1). · 3.56 Impact Factor
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    ABSTRACT: Pregnancy has been associated with a low risk of HIV disease progression. Most pregnancies with HIV currently involve women who have not experienced AIDS-defining events, and are clinically classified as Centers for Disease Control and Prevention (CDC) groups A or B. We evaluated the main maternal outcomes among pregnant women with more advanced HIV disease, defined by CDC-C disease stage. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. A total of 566 HIV-infected mothers, 515 in stage A or B (CDC-AB group) and 51 in stage C (CDC-C group) were evaluated. The two groups had similar baseline characteristics. No differences were found in the main maternal and neonatal outcomes. Most of the women achieved viral suppression at end of pregnancy (>1000 copies per milliliter: CDC-C: 17.2%; CDC-AB: 13.7%). One year after delivery, HIV replication (HIV-RNA >1000 copies per milliliter) was present in 11.5% of CDC-AB women and 30.0% CDC-C women. Despite lower initial CD4 counts (300 versus 481 cells per microliter), CDC-C women maintained stable CD4 levels during pregnancy, and 1 year after delivery, a significant increase in CD4 count from preconception values was observed in both groups (CDC-C: +72 cells per microliter, p=0.031; CDC-AB: +43 cells per microliter, p<0.001). Only one AIDS event occurred in a woman with a previous diagnosis of AIDS. In CDC-C women, pregnancy is not associated with an increased rate of adverse maternal or neonatal outcomes, and a good immunovirologic response can be expected. During postpartum care, women with more advanced HIV infection should receive particular care to prevent loss of virologic suppression.
    AIDS patient care and STDs 09/2011; 25(11):639-45. · 2.68 Impact Factor
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    ABSTRACT: To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis. One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years' experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded. MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen's K test). CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.
    European Radiology 02/2011; 21(7):1553-63. · 4.34 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):281. · 3.56 Impact Factor
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    ABSTRACT: We assessed recent trends in hepatitis C virus (HCV) prevalence in pregnant women with HIV using data from a large national study. Based on 1240 pregnancies, we observed a 3.4-fold decline in HCV seroprevalence in pregnant women with HIV between 2001 (29.3%) and 2008 (8.6%). This decline was the net result of two components: a progressively declining HCV seroprevalence in non-African women (from 35.7% in 2001 to 16.7% in 2008), sustained by a parallel reduction in history of injecting drug use (IDU) in this population, and a significantly growing presence (from 21.2% in 2001 to 48.6% in 2008) of women of African origin, at very low risk of being HCV-infected [average HCV prevalence 1%, adjusted odds ratio (aOR) for HCV 0.09, 95% CI 0.03-0.29]. Previous IDU was the stronger determinant of HCV co-infection in pregnant women with HIV (aOR 30.9, 95% CI 18.8-51.1). The observed trend is expected to translate into a reduced number of cases of vertical HCV transmission.
    Epidemiology and Infection 09/2010; 138(9):1317-21. · 2.87 Impact Factor
  • Journal of Minimally Invasive Gynecology 11/2009; 16(6). · 1.61 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2009; 34(S1):201. · 3.56 Impact Factor
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    ABSTRACT: This study was to evaluate the impact of mode of delivery and timing of caesarean section in extremely preterm births, below 28 weeks of gestation, on long-term survival and psychomotor outcomes. This was a single-centre retrospective cohort study of 84 cases of extremely low birth weight infants with complete maternal, obstetrical and neonatological information. Mortality and survival with neurological disabilities at 18 months of life were considered outcome measures. Forty percent of deliveries were at or less than 25 weeks of gestation and birth weight was <or=500 g in 14% of all infants. The overall survival rate was 54.8% with a prevalence of neuromotor impairment with disability among the survivors of 26.1%. After adjustment using multiple logistic regression, only extreme prematurity (<or=25 weeks) and birth weight below 500 g had significant effects on survival (p<0.05), regardless of mode and timing of delivery. Mode of delivery and labour seem not to play a significant role in adverse neonatal outcomes, either mortality or neuro-developmental impairment, in extremely low birth weight infants.
    European journal of obstetrics, gynecology, and reproductive biology 05/2009; 145(2):154-7. · 1.97 Impact Factor

Publication Stats

801 Citations
273.75 Total Impact Points

Institutions

  • 1994–2013
    • Università degli Studi di Bari Aldo Moro
      • Sezione di Ginecologia ed Ostetricia
      Bari, Apulia, Italy
  • 2003
    • Università degli studi di Foggia
      Foggia, Apulia, Italy
  • 2001
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 1996–1999
    • Università degli Studi del Sannio
      Benevento, Campania, Italy