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Biomedical subjects

Federico Marchetti

Publications and source records attributed to Federico Marchetti.

32 records · Page 2Linked to original sources
PubMed2004

Color Doppler ultrasound in renal transplant: role of resistive index versus renal cortical ratio in the evaluation of renal transplant diseases.

BACKGROUND/AIMS: Ultrasound (US) and color Doppler are not sensitive enough to detect anomalies in cortical perfusion, which is affected in most graft dysfunctions. The renal cortical ratio (RCR) is a variation in the resistive index (RI) values from the renal artery to cortical vessels, expressed in percent. The aim of this study was to compare the RI and RCR in the differentiation of normal and pathological grafts, to assess the positive predictive value of RCR and show that RCR enables earlier diagnosis than RI. METHODS: Based on clinical, biochemical and histological examinations, 494 renal allografts were divided into 3 groups (normal grafts, acute and chronic pathologies). All patients underwent US color Doppler. RI was measured and RCR calculated. Follow-up confirmed the initial division in groups. Statistical significance was calculated using the two-tailed Student's t test. The positive predictive value was calculated for each group. RESULTS: 24 h after transplant, RCR differentiated normal grafts from acute dysfunctions despite confusing biochemical values and clinical symptoms. In chronic patients, RCR variations occurred later but always before the serum creatinine level increased. CONCLUSION: RCR presented a higher positive predictive value than RI. RCR curves were already altered in the early stages of transplant pathologies. RCR calculation is easy and makes a significant contribution towards a correct early diagnosis.

Adolescent↗
PubMed2003

Deep sedation with propofol by nonanesthesiologists: a prospective pediatric experience.

BACKGROUND: The need to perform procedural sedation for children has increased in recent years, and so has the experience of nonanesthesiologists in this field. The use of propofol increases the success of satisfactory deep sedation, but it can produce rapid and profound decreases in level of consciousness and cardiorespiratory function. Data are needed to assess the safety of this drug outside an anesthesiology setting. OBJECTIVE: To assess safety and efficacy of procedural sedation with propofol in a pediatric ward of a tertiary-care pediatric teaching hospital with trained personnel and monitoring facilities. METHODS: Patients admitted to the hospital who needed invasive procedures underwent procedural sedation by the pediatric sedation unit with intravenous propofol. A training protocol was developed to educate nurses and residents. RESULTS: We performed 1059 procedures. Sedation was achieved in all procedures, and all but 1 were successfully performed. No patient required intubation. Transient desaturation resolving spontaneously occurred in 134 (12.7%) of 1059 patients. Major desaturation requiring a short course of ventilation occurred in 4 (0.8%) of 483 patients undergoing upper endoscopies, in 1 (0.3%) of 287 patients undergoing painful procedures, and in none of the 289 patients undergoing colonoscopies. Laryngospasm occurred in 10 (2.1%) of 483 patients undergoing upper endoscopies. CONCLUSIONS: In this experience, the use of propofol with concurrent oxygen administration allowed sedations in children with no significant complications for colonoscopies and painful procedures. Complications in the group of upper endoscopies appear too high for recommending propofol in a sedation unit with residents in attendance. This protocol of procedural sedation by nonanesthesiologists allowed a significant increase in the number of procedures performed with sedation and saved anesthesiology resources.

Adolescent↗
PubMed2003

Levofloxacin and ciprofloxacin in vitro activities against 4,003 clinical bacterial isolates collected in 24 Italian laboratories.

Levofloxacin showed comparable in vitro susceptibility to ciprofloxacin among Enterobacteriaceae, Pseudomonas aeruginosa, enterococci, and Staphylococcus aureus, while greater susceptibility was observed in Stenotrophomonas maltophilia and Staphylococcus epidermidis, mainly when oxacillin resistant. The susceptibility of Streptococcus pneumoniae to levofloxacin reached 99%.

Anti-Infective Agents↗
PubMed2003

[Multicentric study for evaluation of levofloxacin in the treatment of complicated urinary tract infections].

OBJECTIVES: The objective of this open-label, single-arm, multicenter study was to assess the efficacy and safety of levofloxacin in the treatment of complicated urinary tract infections. MATERIALS AND METHODS: A total of 72 outpatients with symptoms/signs of urinary tract infection and underlying anatomic or functional abnormality of the urinary tract was enrolled to receive levofloxacin 250 mg orally once daily for 10 days. Return visits were scheduled at 3-5 days (early follow-up visit) and 4-6 weeks after completion of therapy (long-term follow-up). At each visit symptoms and signs were assessed, possible adverse events were recorded and a urine specimen was obtained for culture. RESULTS: At 3-5 days post-therapy clinical success rate was 94% and the overall microbiological eradication rate of pathogens was 94%. Microbiological eradication rate with respect to patients was 86%. Treatment failed in 4 patients and 2 patients had superinfections with pathogens still susceptible to levofloxacin. At long-term follow-up visit 3 reinfections were observed in patients previously cured at early follow-up. Drug-related adverse events were reported by 2 patients. CONCLUSION: These study results indicate that levofloxacin 250 mg orally once daily for 10 days is an effective and well tolerated treatment of complicated urinary tract infections.

Anti-Infective Agents↗
PubMed2003

[A prospective descriptive study on the practice of management of urinary tract infections by general practitioners in Italy: epidemiology (Part I)].

OBJECTIVES: The aim of this prospective descriptive study was to draw the picture of the diagnostic and therapeutic pathways of general practitioners (GPs) in the practice of management of urinary tract infections (UTIs) in Italy. The study results are published in two separate papers. We report here the epidemiological data collected on the prevalence of UTIs and their etiology. MATERIALS AND METHODS: A total of 2.696 GPs were requested to fulfill a questionnaire on their perception of the prevalence of UTIs and their habits in the management of patients either before (IVU1 study, 1.111 GPs) or after (IVU2 study, 1.585 GPs) a specific training course. Epidemiological data from both studies were merged and analyzed. RESULTS: The perceived prevalence of UTIs among the GPs was 1.7% ambulatory-related patients/GP/month, leading to an average of 18.7 UTIs cases/GP/month. UTIs were higher among women (75%) with respect to men (25%), being acute uncomplicated cystitis in women the more prevalent (nearly 50% of female ambulatory-related patients). E. coli was considered the most frequently isolated bacterial pathogen in urine. CONCLUSION: The epidemiological results of this study contribute to assess the prevalence and etiology of UTIs among Italian outpatients. These data may be helpful for urologists in the management of community-acquired UTIs.

Data Collection↗
PubMed2003

[A prospective, descriptive study on the practice of management of urinary tract infections by general practitioners in Italy: clinical pathways (Part II)].

OBJECTIVES: The aim of this prospective, descriptive study was to draw the picture of the diagnostic and therapeutic pathways of general practitioners (GPs) in the practice of management of urinary tract infections (UTIs) in Italy. The study results are published in two separate papers. We report here the clinical pathways followed by GPs to diagnose and treat UTIs. MATERIALS AND METHODS: A total of 2.696 GPs were requested to fulfill a questionnaire on their perception of the prevalence of UTIs and their habits in the management of patients either before (IVU1 study, 1.111 GPs) or after (IVU2 study, 1.585 GPs) a specific training course. The clinical management pathway was analysed. RESULTS: GPs turned out to share an appropriate management of UTIs, even though some discrepancies between the clinical habits and UTIs guidelines were focused. After the training course the discrepancies were partly amended (IVU2 study). Urinalysis and urine culture are nearly always requested by GPs, frequently including blood examinations. Older and newer fluoroquinolones are mostly prescribed for UTIs, followed by fosfomycin tromoetamol. Lifestyle recommendations for UTIs containment and prevention are released to patients by GPs. CONCLUSION: The clinical results of this study contribute to assess the habits of Italian GPs in diagnosing and treating UTIs. These data may be helpful for urologists in the management of community-acquired UTIs.

Adult↗
PubMedDate not supplied

Maturity-onset diabetes of the young with necrobiosis lipoidica and granuloma annulare.

We describe a 12-year-old white girl with granuloma annulare localized to both ankles since she was five, necrobiosis lipoidica in the left pretibial region since she was ten, and a recent history of weakness, migraine, and weight loss. After initial evaluation, high fasting blood glucose levels and high hemoglobin A1c were found. The family history for non-insulin-dependent diabetes was suggestive of maturity-onset diabetes of the young. Coexistence of necrobiosis lipoidica and granuloma annulare, together with a family history of non-insulin-dependent diabetes, the age of onset, and the absence of ketosis, are specific features making possible, a clinical diagnosis. Genetic confirmation may not be so easily accessible or necessary.

Child↗
PubMedDate not supplied

[Hospitalisation associated with Rotavirus gastroenteritis in Italy, 2001-2003, evaluated by means of ICD9-CM diagnostic codes].

Rotaviruses (RV) are the most common etiological agents in acute gastroenteritis (GE) in children in the first years of life. Data from the national scientific literature show that RV is responsible of 26% of all cases of hospitalisation for diarrea in children, resulting the most frequently identified agent. The Italian database of hospital discharge, freely available from the web site of the national Ministry of Health, was searched to investigate the epidemiology of RV gastroenteritis. The mean number of hospitalisation for RV enteritis in children in the first 4 years of live was 4.758 in the years 2001, 2002 and 2003, representing 84% of viral enteritis. RV was identified as agent in 17% of all intestinal infectious diseases in this age group. This percentage shows the important role of RV in severe gastrointestinal infections; it is however much lower than the value expected from specifically performed surveys. This underestimation may be attributed to the high number of undefined gastroenteritis found in the database (54%), to the scarce sensitivity of the hospital discharge code, and to the fact that the analysis was performed using only the principal diagnosis. A specific immunisation strategy, safe, effective, cost-effective and easy to perform, could have a great impact on the incidence of the disease and on the associated costs.

Acute Disease↗