Trends in perinatal care in developing countries.
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Biomedical subjects
Publications and source records attributed to G P Chiaffoni.
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Bacterial ecology was studied in 1114 newborns (355 at term, 759 preterm) admitted to a neonatal intensive care unit (NICU) during a three year period. Bacterial samples were taken in each newborn from external ear canal, pharynx and eyes in all patients, and from endotracheal tube, umbilical catheter and blood in selected patients. The predominant flora was characterized by gram-positive microorganisms (63.53%), Staphylococcus epidermidis representing 34.68% of all isolated strains. S. epidermidis isolation increased significantly with time (p < 0.002) and was highest in summer. The percentage of S. epidermidis resistant strains to oxacillin (63.8%) and to amikacin (17.8%) was high. This is the antimicrobial combination we commonly employ as empirical treatment of suspected bacterial infection in our NICU. Knowledge of characteristics of local microbial flora seems important in order to optimize preventive and therapeutic policies for neonatal infections.
Bilateral polycystic kidneys were detected by ultrasound at 23 weeks gestation in a male fetus. Bilateral renal cysts were subsequently also found in the asymptomatic propositus' mother and grandmother, suggesting the diagnosis of autosomal dominant polycystic kidney disease (ADPKD). The renal ultrasonograms showed cortical cysts with normal or decreased-sized kidneys. Renal function was normal. Seven available members of the family were genotyped for flanking DNA markers tightly linked to the PKD1 gene on chromosome 16p, and for a polymorphism close to a second putative disease gene (PKD2) on chromosome 2. The genetic linkage approach allowed us to detect with a high degree of accuracy the ADPKD1 at risk chromosome in the three patients, as well as in a 28-year-old unaffected female. This report illustrates the feasibility and the usefulness of recent molecular genetic strategies for diagnostic purposes in ADPKD, especially when clinical and radiological data are atypical. Furthermore, it also confirms that early or very early onset forms of the disease are not uncommon, and should be considered in the differential diagnosis of childhood cystic disease.
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We report a case of an unusual prenatal presentation of polycystic kidneys associated with multiple skeletal limb defects, including polydactyly, syndactyly, bilateral agenesis of the tibia, and club foot. The ultrasonographic picture was consistent with a diagnosis of polycystic kidney disease, either the adult onset autosomal dominant type (ADPKD) or the early onset autosomal recessive form (ARPKD). However, there was a positive family history for ADPKD. Linkage analysis was performed in 10 family members, of whom four were affected, using six flanking DNA markers tightly linked to the PKD1 locus on chromosome 16p, and one marker linked to the putative PKD2 locus on chromosome 2p. Lod score determinations indicated that the affected gene in the family is most likely PKD1. The patient inherited the disease linked haplotype from his affected mother.
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Ceftazidime pharmacokinetics were studied in 13 preterm newborns requiring antibiotic treatment, following intramuscular administration of a 50 mg/kg dose in the first 24 hours of life. The main pharmacokinetic parameters (peak concentration, time to reach peak, plasma half-life, area under the curve, elimination constant, distribution volume and plasma clearance) were determined directly from the serum concentrations observed. The clinical and bacteriological response to ceftazidime treatment was good; no side effects or alterations of biohumoral parameters were noted.
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