Distinguished Career Award of the American Society of Pediatric Hematology/Oncology for 2000.
Explore the source record for details and available documents.
Awards and Prizes↗
Biomedical subjects
C Manno
Publications and source records attributed to C Manno.
Primary renal lymphoma does exist: case report and review of the literature.
Primary renal lymphoma (PRL) is a controversial and rare disease and there is still no agreement on its existence. Many cases have been reported in the literature, but clear diagnostic criteria have not yet been established. Most of the reported cases are questionable because of incomplete staging or the presence of extrarenal disease. Here we report a new case and a review of the literature based on a critical examination of the diagnostic procedure. Thus, probably only 29 cases, ours included, should be recognized as PRL, because only these cases fulfil the three diagnostic criteria and underwent complete diagnostic screening, including renal biopsy, bone marrow biopsy and thoraco-abdominal computerised tomography (CT).
Acute Kidney Injury↗
Prospective randomized controlled multicenter trial on steroids plus ramipril in proteinuric IgA nephropathy.
Recent studies have shown that steroids improve renal survival and reduce proteinuria in IgA nephropathy (IgAN) patients with moderate urinary protein excretion and normal renal function. However, this effect seems to diminish over time. Moreover, it has been demonstrated that long-term use of ramipril reduces the risk of end-stage renal disease in proteinuric diabetic and non-diabetic chronic nephropathies. We have planned a long-term unblinded, prospective, centrally randomized, controlled, multicentric trial to assess whether combined treatment of steroids and ramipril is superior to ramipril alone in patients with progressive IgAN disease. A minimum of 134 patients with biopsy-proven IgAN, grade G3 or G4, daily proteinuria > 1.0 g and creatinine clearance > 50 mL/min will be enrolled during a 2-year recruitment period. The patients will be allocated randomly to receive a six-month course of oral prednisone (1.0 mg/Kg/day for 2 months, tapered by 0.2 mg/Kg/day every month) plus ramipril (2.5 mg/day for one month, increased by 1.25 mg/day every month to achieve and maintain a blood pressure less than 120-80 mm Hg and/or to reduce daily proteinuria to 1.0 g or less or by at least 50%) in the experimental group or ramipril alone in the control group. Ramipril will be administered during the whole 5-year follow-up period in both groups. The primary endpoint will be renal survival estimated by 50% increase in baseline serum creatinine; the secondary endpoints will be urinary protein and cytokine excretion and side-effects. Analyses will be done by intention to treat. A p <0.05 will be taken as significant.
Angiotensin-Converting Enzyme Inhibitors↗
[Randomized controlled trials: a controversial past and a future of regulation and rejection].
The quality of randomized controlled clinical trials has a pivotal role in their external validity. There are no definite protocols to evaluate the quality of already published studies, whereas international guidelines for the preparation of randomized controlled trials are available. This review outlines some milestones in the development of guidelines for randomized controlled trials and presents the Revised Consort Statement which includes 22 items, sub divided into sections (title and abstract, introduction, methods, results and discussion) and a flow chart. The aim of this analysis is to provide clinical researchers with a valuable working tool. Finally, future guidelines for systematic reviews of randomized controlled studies are presented according to the Cochrane Collaboration model.
Double-Blind Method↗
[Prevalence of malnutrition in uremic patients undergoing hemodialysis therapy in Puglia and Lucania].
BACKGROUND: Calorie-protein malnutrition is associated with increased morbidity and mortality in hemodialysis patients. The aim of this study was to evaluate the prevalence of malnutrition in uremic patients treated with hemodialysis in two areas of Southern Italy. METHODS: A questionnaire was sent out to all Dialysis Centers in the two regions to select and enrol eligible patients by considering these parameters: Body Mass Index (BMI), serum albumin, serum creatinine, urea, calcium, phosphate, triglycerides, cholesterol, body weight. Enrolment criteria were patients on dialysis for at least six months and BMI less than 21 kg/m2. The dialytic dose was evaluated by reporting the hours of dialysis and filter surfaces. The number of weekly sessions (n. 3) remained unchanged over time. RESULTS: Twenty-three Dialysis Centers in the two Regions replied to our questionnaire and 149 patients were enrolled in the study out of the 1546 patients examined. The overall prevalence of calorie-protein malnutrition was observed in 9.6% of the patients. The prevalence of malnutrition was found to be higher in males and in patients on dialysis for longer time. We observed no correlation with the hypoproteic diet administered in the pre-dialysis phase. Malnourished patients showing progressive weight loss were older and had undergone dialysis for a longer time. CONCLUSIONS: This retrospective study indicates low prevalence of malnutrition in the two regions examined. The lack of correlation between the hypoproteic diet and dialytic dose suggests the need for further studies to evaluate if increased dialytic dose or early start of dialysis could improve the nutritional status and quality of life in elderly patients.
Adult↗
[Prevalence of pre-obesity and obesity in uremic hemodialysis patients from Puglia and Lucania].
BACKGROUND: Obesity is a well-known cause of increased morbidity and mortality in the general population, while its influence on the hemodialysis population is yet to be defined. Obesity probably has a protective effect on survival in hemodialysis. In this study, we evaluated the prevalence of obesity in the hemodialysis population of Puglia and Lucania, two regions of Southern Italy, by using simple and easily accessible parameters collected by the participating centres. METHODS: One thousand five hundred and forty-six patients on stable hemodialysis for at least 6 months from 23 Centres were studied. One hundred and sixty patients had a body mass index (BMI) more than 25 kg/m2; "preobesity" was defined as a BMI ranging between 25 and 30 kg/mq, while "obesity" as a BMI > 30. All data regarding the underlying renal disease, the use of low-protein diet before beginning hemodialysis, weight and height at the beginning of treatment and the different kinds of treatment were collected. A careful analysis of the last dialysis treatment by means of biochemical data was carried out. RESULTS: The prevalence of preobesity and obesity was 3.1 and 7.3%, respectively. Eighty-three percent of patients in the preobesity group and seventy-two percent in the obesity group were female (p<0.001). The prevalence of diabetes was 19 and 24% in the preobesity and obesity groups, respectively, while it was 8% in patient with normal BMI (p<0.0001). Age and duration of low-protein diet were similar to those observed in the general population, while dialytic age was greater in preobesity group (p<0.01). Conclusions. Our study has shown that the prevalence of obese people undergoing hemodialysis is increasing. It is therefore necessary to introduce new measures to obtain a good nutritional status in end stage renal disease patients; in particular fat free mass is to be increased, since an improvement in the patient's nutritional status acts as a protecting factor against morbidity and mortality.
Adult↗
[Chorea in hemodialysis: Is chorea just a neurological syndrome or is it related to uremia or dialysis?].
Chronic renal failure and haemodialysis patients are prone to develop encephalopathy. The causes of encephalopathy are often unclear. Clinical signs of encephalopathy in the uraemic patient often overlap with several other affections causing neurological disorders. Whenever basal ganglia are anatomically involved, movement disorders arise, including chorea. Some acute and chronic neurological syndromes associated with chronic uraemia have consistently been reported (uraemic encephalopathy, dialysis disequilibrium syndrome, dialysis dementia, nephroangiosclerosis neuropathy and ageing neuropathy). Other clinical conditions in which neurological involvement exists are not so frequent in both haemodialysis patients and in the general population (Wernicke's encefalopathy, Creutzfeldt-Jacob disease). Because of the non specific symptoms and the very heterogeneous aetiology, a careful physical examination should be performed in haemodialysis patients with clinical signs of encephalopathy and the main metabolic alterations should be sought; moreover, central nervous system imaging examination is often appropriate. In case of basal ganglia anatomical involvement, supported by findings of imaging techniques, it is necessary to evaluate individual causes of encephalopathy by means of more accurate tests including analysis of cerebro-spinal fluid, measurement of plasma levels of vitamin B components and laboratory tests searching for more uncommon diseases such as Huntington's chorea and Wilson's disease.
Aged↗
[Nephrology evidence and guidelines: current tools and several still open questions].
BACKGROUND: It is widely accepted that decision making should be based on evidence. Although nephrology is a relatively young discipline of internal medicine that should be quick to adopt evidence-based decision making policies, several problems are slowing the progress to an era of evidence-based nephrology. These problems may be identified as: a) an inadequate knowledge-base for problems related to the utilization of evidence-based research resources; b) the unavailability of adequate evidence sources in nephrology; and c) the small investment and funding for clinical research. METHODS: This review outlines the major problems of evidence-based nephrology and looks particularly at the strengths and weaknesses of study designs for evidence-based nephrology. The primary guidelines for evidence-based preparation are presented together with possible strategies to meet the challenge of adopting evidence-based policies in nephrology. CONCLUSIONS: This challenge is particularly important now; after several years of extraordinary basic science research, we face the problem of improving clinical practice by applying this same progress in basic science. This transition has failed because of the small investment provided for clinical research.
Evidence-Based Medicine↗
[Causality in nephrology: study design and objectives of future research].
BACKGROUND: Causality has to be assessed by randomised controlled trials. However, since these are not always ethically or technically possible, other study designs such as cohort studies, case-control and cross-sectional analytic studies may be used. METHODS: In this review, we focus on the strengths and limitations of epidemiological studies whose aim is to identify the causal relationship between study factor and outcome (cohort studies, case-control studies, cross-sectional analytic studies). We also introduce the absolute and non-absolute parameters useful in determining the causal relationship in epidemiological studies. RESULTS: To establish a causal relationship between a factor and an outcome, exposure must precede the outcome, the association must not be due to chance, bias, confounding or misclassification. It is important when reading this kind of research papers that all these factors are properly considered. Studies in which strong associations are documented, whereby a dose-effect relationship exists, and those which are consistent with the results of previous epidemiological studies and document biologically plausible associations are generally stronger evidence than those in which these criteria are not found. CONCLUSIONS: The design and conduct of valid cohort, case-control and other type of studies, when randomised trials are unfeasible or unethical to answer causality and intervention questions, is a challenge for the nephrology community, presently lacking valid clinical evidence and adequate answers to many questions.
Biomedical Research↗
[Critical appraisal of systematic reviews of randomised trials in nephrology: theory and practice for interpreting level I evidence].
INTRODUCTION: Systematic reviews represent the primary level of evidence (level I evidence) and an excellent answer to causality questions. They should be based upon high quality standards and the critical appraisal of such study design is fundamental. METHODS: In this review we introduce the primary indicators of quality and guide our readers through the process of critical appraisal of systematic reviews. RESULTS: The main criteria in critically appraising systematic reviews in nephrology are the adequate presentation of a research question, adequate selection of studies, comprehensiveness of search strategies, the quality assessment of included studies, the fact that all procedures have been performed independently by at least 2 investigators, the exploration of heterogeneity, the type of results and their applicability. In nephrology we still lack a large number of systematic reviews because of the lack of randomised trials. CONCLUSIONS: Preparing a large number of systematic reviews is an important challenge for the nephrology community. This community should prepare more randomised trials to answer intervention questions and should make an effort to synthesise the evidence in the form of systematic reviews. It is essential that available systematic reviews be critically appraised and their results implemented in the clinical practice whenever they are based on high methodological standards.
Nephrology↗
[Quality guide in nephrology and dialysis].
The Quality Guide, a strategic tool for any nephrologist wishing to initiate a quality policy in his own renal unit, describes to the organisation of total quality management. This article gives a short description of a Quality Guide in Nephrology and Dialysis. According to ISO 9004:2000 Norms, the Quality Guide can be subdivided into four sections: Managerial Accountability, Resource Management; Implementation of Services; Analysis, Evaluation and Continuous Quality Improvement. The quality cycle begins by identifying the customers, who added to the resources constitute the input that will be transformed by the service into output (results). By measuring customer satisfaction the results will be evaluated and analyzed to allow continuous improvement of the service. In conclusion, the drafting of the Guide by all staff members involved has a twofold value: it organizes the quality management within the renal unit and certifies the quality level guaranteed to the customer.
Ambulatory Care Facilities↗
[Search strategies for nephrology knowledge and evidence].
The informatic techniques for searching biomedical literature have been one of the fundamental advantages of the era of information explosion. In this review, we focus on some methodologies for searching biomedical literature with particular focus on nephrology and describe the use of PubMed and the techniques for understanding and using the Medical Subject Heading (MeSH) to search Medline and other databases. Search strategies take advantages of simple search engines which generate informatic algorithms to find relevant articles; alternatively, a set of rules is to be known and represents a more powerful means for identification of selected publications. The latter technique is more useful for researchers seeking relevant information in the literature to prepare systematic reviews. Informatic techniques for searching biomedical literature have represented a fundamental advantage in science. Additional advantage will derive from the use of structured formats in research reporting, with better and quicker readability of retrieved published information, and from the effort of researchers in synthetizing the available published literature.
Databases, Bibliographic↗
[Evidence-based guidelines in nephrology].
INTRODUCTION: The preparation of evidence-based guidelines by the Nephrology Societies is fundamental to improve long-term outcomes of patients with chronic kidney diseases. However, this is a complex process and requires the interaction of clinicians and experts in epidemiology methods, and researchers and research enterprises. METHODS: In this review, we present the potential structure of a body for the coordination and development of evidence-based guidelines in a nephrology society and we address the major problems that can arise in this process describing strategies that could be used to overcome them. RESULTS: The development of evidence-based nephrology guidelines requires a structure; this should consist of a coordinating center and a number of working groups. The working groups is to identify specific research questions and to develop and synthetize the evidence in answer to the questions proposed. This shall be done in collaboration with the coordinating center. Draft guidelines produced by this process should be peer reviewed, disseminated and implemented. CONCLUSIONS: The development of evidence-based nephrology guidelines is a challenge for individual nephrology societies. These guidelines are different from typical research publications in that their success does not lie in the final publication, but in the actual dissemination and implementation, which is in the improvement of patient outcomes and its measurement.
Evidence-Based Medicine↗
[Update of the Italian Society of Nephrology Project No. 1 of the 2004-2006 SIN programme].
In the last few years the Italian Society of Nephrology has addressed many technical-scientific and management aspects to better patient satisfaction. Project No. 1 of the 2004-2006 programme on 'Quality and Accreditation of National Renal Units' focuses on four essential points. The first is the questionnaire mailed to all the Presidents and Regional Delegates on the relationship between Nephrology units, Local Government Health-System and the Regional Healthcare Agency. The results evidence that the 'political' decision-making power of nephrologists decreases in the absence of a national strategy. The second point, in collaboration with the National Census Group, includes the quality analysis and the standardization of resources (human and structural) and management of the Renal Units. The third point is based on 'Educational Courses for Quality and Accreditation' held in Rome (3-5 October 2005: L'Accreditamento all'Eccellenza dell'Unita' Operativa di Nefrologia, Dialisi e Trapianto; 17-19 October 2005: Il Manuale di Accreditamento della Specialità di Nefrologia). The courses aim at training members responsible for each region to hold courses in their specific region to create a network including each single Renal Unit to create an acceptable homogenous language on the models of analysis and on the correct use of 'The Guide for Excellence Accreditation'. The fourth point concerns both the on-line Guide for Excellence Accreditation and 'Peer Review Accreditation' and the NEQUASY (Nephrology Quality System) project. The manual must be 'user friendly' allowing each Centre to self-evaluate using national and regional standards.
Accreditation↗
[The Italian Society of Nephrology Guidelines (3rd Edition): principles and methods].
Scientific Societies at both a local and international level are making big effort to prepare their clinical practice guidelines. The Italian Society of Nephrology has already published in two previous editions a series of guidelines relating to various aspects of management and diagnosis of different renal diseases. In this review we present the criteria of the 3(rd) edition of the Italian Society of Nephrology guidelines. This 3(rd) edition of guidelines will be based on the availability of scientific evidence in different areas of nephrology, dialysis and transplantation. Ten key intervention questions have been identified, based on the availability of systematic reviews of randomized trials or individual randomized address them. Systematic reviews and randomized trials are the optimal study design to address intervention questions. These have been summarized based upon rigid methodological criteria and strictly reflect the evidence basis. The different phases of development and publication of the 3(rd) edition of the Italian Society of Nephrology guidelines are presented.
Italy↗
Plasma fibronectin concentrations in hemodialyzed patients. Influence of different dialyzers.
Explore the source record for details and available documents.
Blood↗
[Relation between immune complexes, anti-DNA antibodies and complement in lupus nephropathy].
Explore the source record for details and available documents.
Antigen-Antibody Complex↗
[Immunological and clinical aspects of pre-eclampsia].
Explore the source record for details and available documents.
Adult↗