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Biomedical subjects

A Avanzini

Publications and source records attributed to A Avanzini.

At least 19 recordsLinked to original sources
PubMed2004

Assessing mortality risk in very low birthweight infants: a comparison of CRIB, CRIB-II, and SNAPPE-II.

BACKGROUND: Illness severity scores are increasingly used for risk adjustment in clinical research and quality assessment. Recently, a simplified version of the score for neonatal acute physiology (SNAPPE-II) and a revised clinical risk index for babies (CRIB-II) score have been published. AIM: To compare the discriminatory ability and goodness of fit of CRIB, CRIB-II, and SNAPPE-II in a cohort of neonates < 1500 g birth weight (VLBWI). METHODS: Data from 720 VLBWI, admitted to 12 neonatal units in Lombardy (Northern Italy) participating in a regional network, were analysed. The discriminatory ability of the scores was assessed measuring the area under the receiver operating characteristic curve (AUC). Outcome measure was in-hospital death. RESULTS: CRIB and CRIB-II showed greater discrimination than SNAPPE-II (AUC 0.90 and 0.91 v 0.84, p < 0.0004), partly because of the poor quality of some of the data required for the SNAPPE-II calculation-for example, urine output-but also because of the relative weight given to some items. In addition to each score, several variables significantly influenced survival in logistic regression models. Antenatal steroid prophylaxis, singleton birth, absence of congenital anomalies, and gestational age were independent predictors of survival for all scores, in addition to caesarean section and not being small for gestation (for SNAPPE-II) and a five minute Apgar score of > or = 7 (for SNAPPE-II and CRIB). CONCLUSIONS: CRIB and CRIB-II had greater discriminatory ability than SNAPPE-II. Risk adjustment using all scores is imperfect, and other perinatal factors significantly influence VLBWI survival. CRIB-II seems to be less confounded by these factors.

Epidemiologic Methods↗
PubMed2001

Sleep apnea and respiratory dysfunction in congenital myotonic dystrophy.

A case of neonatal Myotonic Dystrophy (MD) is presented. A 35 week old 3570 g baby was born to a mother affected by MD and pregnancy-induced unstable diabetes. Soon after birth, he developed apnea, severe hypoglycemia, hypocalcemia, hypotonia and mild respiratory distress. His clinical course improved during the following days, but persistent episodes of desaturation and/or cyanosis did not subside; hypotonia was mild. A polysomnographic recording showed mixed central and obstructive apnea. DNA testing showed trinucleotide repeat expansion mutations diagnostic of MD. The baby was discharged with home-sleep monitoring and breast-feeding. Recurrent apnea/bradycardia was the main clinical feature in this case of congenital MD, with increased risk of an acute life-threatening event.

Humans↗
PubMed1998

Revaccination against hepatitis B virus of non-responding and low-responding infants immunised at birth. A parallel evaluation of rubella and tetanus vaccine.

The aim of the present study was to identify the true extent of the non-responsiveness in infants born from HBsAg-negative mothers, vaccinated against Hepatitis B Virus (HBV) at birth. Sixty-four non- and low-responding infants, selected from an initial cohort of 2009, were given two additional doses of recombinant HBV vaccine between the tenth and the twelfth month of age. A parallel evaluation was conducted on the response to anti-rubella and anti-tetanus vaccine. Only two infants remained non-responders, whereas 68% of the non-responders and 94% of the low responders after the primary vaccination schedule developed antibody titres over 100 mIU ml-1. No significant relationship between the specific antibody level against HBV and against rubella or tetanus 1 month after vaccination was observed.

Hepatitis B↗
PubMed1997

Amniotic fluid index variations after amniocentesis, amnioinfusion and amnioreduction: preliminary data.

We studied the relationship between the ultrasonographically measurable variations in the amniotic fluid index (AFI) and actual changes in the amniotic fluid volume induced by three differing invasive procedures: genetic amniocentesis, amnioinfusion and amnioreduction. We examined 50 patients, all between the 15th and 34th weeks of pregnancy, subdivided into three groups. The first group consisted of 33 women who underwent genetic amniocentesis, the second was of 11 patients submitted to amnioinfusion for oligohydramnios (AFI < 5 cm), and the third was composed of 6 patients affected by hydramnios (AFI > 20 cm) and treated with amnioreduction. In all cases AFI was measured before and after the invasive procedures and their variations (delta AFI) were correlated to the actual quantities of liquid infused or extracted. All the procedures gave rise to statistically significant AFI changes. After genetic amniocentesis, the mean change was from 12.0 to 10.9 cm (p < 0.005), after amnioinfusion from 3.1 to 10.6 cm (p < 0.0001) and after amnioreduction from 33.1 to 22.0 cm. (p < 0.005). However, a significant linear correlation between delta AFI and the fluid volume variations actually induced was found for amnioinfusion (y = 0.236537 + 0.031465x; R2 = 44.4%; p < 0.05) and for amnioreduction (y = -0.0584294 + 0.012008x; R2 = 89.8%. p < 0.00001). Only for amnioreduction is it possible, as proved by a multiple regression analysis, to improve the predictability of delta AFI, taking into consideration together with the quantity of fluid aspirated, the value of the preprocedure AFI (R2 = 92%; p < 0.05).

Amniocentesis↗
PubMed1993

An attempt at real prophylaxis of primary dysmenorrhea: comparison between meclofenamate sodium and naproxen sodium.

Dysmenorrhea is a widespread phenomenon, affecting mainly young nulliparous women, often inducing difficulties in study or in work. Its pathogenesis involves a release of local vasoconstrictors like Prostaglandins and Leukotrienes. Modern therapy is based firstly on the administration of prostaglandin-Synthetase Inhibitors or Contraceptive Pills, with the aim of reducing the menstrual excess of pain inducing substances. In order to achieve more efficacy, on the basis of the already proven effectiveness of the Non Steroid Anti-Inflammatory Drugs (NSAID)s in this field, we recently set out to prevent dysmenorrhea in a double-blind randomized study with Meclofenamate Sorium and Naproxen Sodium. Through the observation of the drop in Basal Body Temperature which usually precedes menstrual flow, we were able to instruct our patients in the earlier recognition of impending menstrual onset, leading to earlier prevention of Prostaglandin and Leukotriene release. Meclofenamate Sodium in particular led to considerable pain reduction, with very good patient compliance and without significant complications, probably of its additional receptor effect.

Adolescent↗
PubMed1992

IgG subclasses compared in maternal and cord serum and breast milk.

Total and specific IgG subclass antibodies against 14 pneumococcal capsular polysaccharide antigens on the cord serum from 11 healthy term infants at birth and on serum from their mothers at delivery were evaluated. The same evaluation was performed five days after delivery on the serum and the milk obtained from the six mothers who were breast feeding their infants. Mean neonatal: maternal serum ratio of total IgG1 was significantly higher than the ratios of total IgG2, IgG3, and IgG4 and higher than the ratios of pneumococcal IgG subclass antibodies. Total IgG3 and IgG4 ratios were higher than the specific antibody ratios of the same IgG subclass. Type 1 and type 14 IgG1 antibodies were the highest antipneumococcal ratios. Although the maternal milk:serum ratios of total IgG subclasses were very low, significant amounts of specific antibodies were found in the milk, at about half the concentration observed in mother's serum.

Adolescent↗
PubMed1992

Immunodeficiency, growth hormone deficiency and central nervous system involvement in a girl.

We describe a mentally retarded 12-year-old girl with ataxia in whom diagnostic evaluation for short stature revealed isolated growth hormone (GH) deficiency and multiple central nervous system (CNS) lesions. Assessment of immunologic status, performed because of the persistence of recurrent respiratory tract infections, showed associated deficiencies of IgG2-IgG4 and specific antibody response; in addition, in vitro lymphocyte response to mitogens was low, in vitro production of interleukin-2 and of IgM was absent, and natural killer activity was decreased. The possibility that association of the CNS lesions, GH deficiency and immune defects could be due to alterations of the neuro-immuno-endocrine network secondary to a disturbance of neurotransmitters induced by precocious CNS damage of a viral or ischemic nature is discussed.

Brain Diseases↗
PubMed1991

[Persistent bradycardia and apnea due to hypothyroidism in a very low-weight newborn infant].

Alterations in thyroid function are quite heterogeneous in VLBW preterm neonates. The case of a 1160-g newborn is reported, affected by severe RDS and persistent bradycardia during the first week of life, who later developed symptoms and signs of low-output cardiac failure. ECG showed low QRS. Echocardiography revealed small pericardial effusion. Therapy with L-thyroxine led to rapid improvement of clinical conditions and to normalization of ECG and echocardiographic pattern. Levels of thyroid hormones should be monitored in VLBW infants, since their deficiency may play a role in compromised clinical conditions.

Apnea↗
PubMed1990

[Neonatal screening and follow-up of congenital hip luxation using echography. Review of the literature and personal contribution on 1421 newborns].

US screening for hip dysplasia was performed on 1421 full-term newborns. The study was aimed at: 1) evaluating US feasibility in an unselected maternity ward population; 2) determining the frequency of the different types of hips, and correlating ours with literature data; 3) evaluating the efficacy of both an early prevention and treatment. All US examinations were performed within the first week of life and the 2842 hips classified according to Graf. At birth, normal hips (Ia, Ib) were 2064 (72.6%) (group I); physiologically immature hips (IIa) were 721 (25.4%) (group II); pathological hips (group III) were: 43 (1.5%) IIc, 8 (0.3%) IId, 6 (0.2%) III. Hips in group B were checked at 3 months: 502 were normal, 51 were type IIb, and 1 was type IId: the latter 52 hips were treated and normalized in the following months. Hips in group C (types IIc, IId, and III = 57 hips) were treated and checked every seventh week until normalization. Our experience confirms US value in the evaluation of hip dysplasia in the newborn. In our opinion, the use of this method should be encouraged, although US screening of all newborns remains controversial on a cost-benefit ratio. Multicentric studies will better define US sensitivity, specificity and reliability. The correlation of our results with literature data was difficult, because study populations are not always homogeneous. As for therapy, we found the plastic splint very effective and easy to use. In 2 cases, Milgram devices were used for a few months.

Female↗
PubMed1988

Algae as possible sources of antitumoural agents. Preliminary evaluation of the "in vitro" cytostatic activity of crude extracts.

Aqueous, ethanolic and chloroformic extracts of 13 algae from the Gulf of Trieste (North Adriatic Sea) were assayed in vitro against human tumour established cell line (KB). Some of them exhibit a noteworthy cytostatic activity, in particular Dictyopteris membranacea (Stackh.) Batt., which significantly inhibits the growth of the cell cultures in all the three different crude extracts, was quantitatively screened in different periods of the year for the presence of cytostatic compound(s).

Antineoplastic Agents↗
PubMed1988

Immunoglobulin subclass deficiency.

IgG subclass deficiency was first noted in 1968. Subnormal levels of one or two, occasionally three IgG subclasses may be relatively common. It has not been determined, however, at what level below the normal range the IgG subclass deficiency is of clinical relevance. It remains important to clarify this point because certain subclass deficiencies may be without relevance of their own. Because patients with decreases of various IgG subclasses often present with a number of diseases, the low immunoglobulin levels may signify the presence of other abnormalities of more biologic significance. IgG subclass deficiency has been noted in about 25% of patients with well-defined food allergy and in patients with asthma, diabetes mellitus, Henoch-Schönlein's purpura, Bechterew's disease, intractable epilepsy of childhood, Friedreich's ataxia and autoimmune cytopenias. Most commonly they have increased frequency of infections especially in the respiratory tract, including sinusitis, otitis media and bronchopneumonia, but also osteomyelitis, meningitis, septicemia and various skin infections. Low levels of various subclasses have been noted in connection with other immunodeficiencies such as ataxia-telangiectasia. In common variable immunodeficiency there is an obvious imbalance in the IgG subclasses. Furthermore IgG subclass deficiency can be seen in relatives of patients with common variable immunodeficiency and in IgA deficiency. They also occur in relatives of patients with systemic lupus erythematosus, diabetes mellitus type 1 and C2 deficiency. In a few cases of subclass deficiency gene deletions have been shown. Subnormal levels of IgG subclasses make a remarkable change in sex distribution around puberty from 3/1 in boys and girls to the reverse sex ratio among adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Immunoglobulin G subclass deficiencies.

Low levels of single or multiple serum immunoglobulin G (IgG) subclasses is a common finding among patients with increased susceptibility to infections. In this investigation we summarize data from studies of 503 subclass-deficient individuals. Low IgG2 levels was the most common deficiency among children, and boys were more often deficient than girls. From the age of 16, females dominated, and the most frequent finding was low IgG3 levels. In vitro T or B lymphocyte dysfunction was demonstrated in 75% of the individuals, suggesting that low subclass levels may be indicators of an underlying defect at the B cell or possibly T cell level. Vaccinations and mucosal biopsies were performed to evaluate which patients may be helped by immunoglobulin substitution therapy.

Adult↗
PubMed1984

Serum IgG levels and complement activity in hypogammaglobulinaemic patients under substitution therapy.

Haemolytic activity of the classical and alternative pathways of complement as well as serum levels of C1q, Factor B, Factor H, C3, C4, C3d,g and IgG were determined in 15 hypogammaglobulinaemic patients on immunoglobulin replacement therapy. Alternative pathway activity (AP) and C1q were defective in the presence of low IgG levels and normalized on achievement of normal IgG levels; for both variables the correlation with serum IgG was highly significant. Classical pathway activity (CP), C3, C4 and Factor H serum levels were normal independently of IgG levels; Factor B and C3d, g serum levels were elevated in hypogammaglobulinaemic patients regardless of IgG levels. The present report supports the hypothesis that IgG serum levels influence complement function.

Adolescent↗
PubMed1983

IgM and IgD concentrations in the serum and secretions of children with selective IgA deficiency.

Serum IgG and serum and secretory IgM, IgA and IgD levels were determined in 14 children with selective IgA deficiency and in 12 age and sex matched healthy controls. IgD was determined using a highly sensitive ELISA technique. In the healthy controls serum IgG, IgA and IgM were all in the age normal range, and serum IgA was significantly higher than secretory IgA with IgA in nasal secretions being significantly higher than in saliva. In the IgA deficient children serum IgG and IgM and secretory IgM were present in higher concentrations than in the controls but the difference was statistically significant only for serum IgG and salivary IgM. IgD was detectable in the serum and secretions of all patients and all but one control subject. Like IgM, serum IgD levels were significantly higher than secretory IgD levels and IgD was present in greater concentrations in nasal secretions than in saliva both in the patients and the controls, with no difference between the two groups. Thus, the data of this study show that while serum and secretory IgM levels are elevated in children with selective IgA deficiency, serum and secretory IgD are present in normal concentrations, supporting the hypothesis of a compensatory increase in IgM but not in IgD in such patients.

Adolescent↗
PubMed1982

Evaluation of the supertransfusion regimen in homozygous beta-thalassaemia children.

The maintenance of physiological levels of haemoglobin is beneficial in the management of patients with thalassaemia major since it leads to better tissue oxygenation, reduction of blood volume, and reduced intestinal absorption of iron. We have studied 11 patients with thalassaemia major while treating them for 4-12 months with a standard transfusion regimen (mean pre-transfusion Hb 10.2 g/dl) and then for a second period of 7-18 months with a supertransfusion regimen (mean pre-transfusion Hb 12.3 g/dl). Blood consumption was 16.71 +/- 2.0 ml/kg/month in the first period; it rose to 20.30 +/- 3.5 ml/kg/month in the first 5 months of the second period, and then returned to the values of the first period (16.53 +/0 2.0 ml/kg/month). There were no significant differences in blood consumption between the two transfusion regimens, after the 5-month equilibration period.

Adolescent↗
PubMed1982

Early iron overload in beta-thalassaemia major: when to start chelation therapy?

Twenty-eight children with beta-thalassaemia major aged between 11 and 48 months were given intensive transfusions. Serum iron, transferrin saturation, serum ferritin, non-transferrin iron, and subcutaneous desferrioxamine-induced urinary iron excretion were measured. The results showed that even children with a limited number of transfusions had severe iron overload as indicated, in particular, by the raised serum ferritin levels and the high excretion rates after subcutaneous infusion of desferrioxamine. The desferrioxamine test was useful, even in very young children, in assessing response to chelation therapy thus enabling such treatment to be started early to prevent harm from iron overload.

Child, Preschool↗