PubMed Health⌕ Search

Biomedical subjects

R Micciolo

Publications and source records attributed to R Micciolo.

At least 19 recordsLinked to original sources
PubMed2006

The prescription of psychotropic drugs in psychiatric residential facilities: a national survey in Italy.

OBJECTIVE: This paper reports the prescriptions of psychotropic drugs made to 2962 patients living in 265 residential facilities (RFs) in Italy. METHOD: Structured interviews were administered to RF managers and staff to obtain data on patients' sociodemographic and clinical characteristics; information about current drug prescriptions were obtained from clinical records. RESULTS: Polypharmacy was common: on average, each treated patient was taking 2.7 drugs (+/-1.1). The association of one atypical antipsychotic with one benzodiazepine represented the most common prescription profile. The variable most consistently associated with a higher likelihood of receiving polypharmacy was a history of admission to an acute general hospital psychiatric ward in the previous 12 months. Many prescriptions were loosely related to specific diagnoses. CONCLUSION: Psychotropic drug prescription patterns for severe patients living in RFs are characterized by substantial rates of polypharmacy. Specific guidelines may be helpful for long-stay patients living in RFs, who exhibit complex care needs.

Adult↗
PubMed2002

The combination of single-dose montelukast and loratadine on exercise-induced bronchospasm in children.

The aim of the study was to evaluate the protective effect of single-dose, combination treatment comprising montelukast (5 mg) and loratadine (10 mg), on exercise-induced bronchoconstriction in asthmatic children. The combination was compared to placebo, loratadine and montelukast alone. Nineteen children were enrolled in a double-blind randomised, single-dose, crossover study. For each treatment patients undertook two treadmill exercise tests, 2 and 12 h respectively after single-dose administration. No significant differences were seen in the maximum fall in forced expiratory volume in one second (FEV1) 2 h after treatment and placebo. Whereas significant differences in maximum fall in FEV1 were observed between treatment groups 12 h after administration. Loratadine alone did not show any significant protection or any additional effect in comparison with montelukast alone. Single doses of montelukast and montelukast plus loratadine were significantly more effective than loratadine at 12 h. The present study, performed using single-dose treatments, demonstrated that maximal protective effect by montelukast was obtained 12 h after dosing and that montelukast plus loratadine did not result in significant additive bronchoprotective effects on exercise-induced bronchoconstriction.

Acetates↗
PubMed2002

Residential care in Italy. National survey of non-hospital facilities.

BACKGROUND: In Italy, where all mental hospitals have been gradually phased out since 1978, psychiatric patients requiring long-term care are being treated in non-hospital residential facilities (NHRFs). However, detailed data on these facilities are sparse. AIMS: The Progetto Residenze (PROGRES) residential care project is a three-phase study, the first phase of which aims to survey the main characteristics of all Italian NHRFs. METHOD: Structured interviews were conducted with the manager of each NHRF. RESULTS: On 31 May 2000 there were 1370 NHRFs with 17 138 beds; an average of 12.5 beds each and a rate of 2.98 beds per 10 000 inhabitants. Residential provision varied ten-fold between regions and discharge rates were very low. Most had 24-hour staffing with 1.42 patients per full-time worker. CONCLUSIONS: There is marked variability in the provision of residential places between different regions; discharge rates are generally low.

Adult↗
PubMed2000

Postabsorptive resting metabolic rate and thermic effect of food in relation to body composition and adipose tissue distribution.

One hundred thirty subjects were studied to investigate relationships between the body composition and fat distribution as evaluated by computed tomography and the resting metabolic rate (RMR) as evaluated by indirect calorimetry: 82 premenopausal women (age, 18 to 52 years; body mass index [BMI], 27 to 52 kg/m2), 27 postmenopausal women (46 to 71 years; 28 to 49 kg/m2), and 21 men (18 to 70 years; 31 to 43 kg/m2). The thermic effect of food (TEF) was evaluated in all men and in 2 subgroups of 55 and 19 women. The best-fitting equations for predicting RMR, obtained by multiple regression, included the following as covariates: fat-free mass and both subcutaneous and visceral adipose tissue in premenopausal women (R2 = .55, P = .0001), fat-free mass and visceral adipose tissue in postmenopausal women (R2 = .58, P = .001), and age, with minus sign, and visceral adipose tissue in men (R2 = .44, P = .0051). Fasting insulin and fat-free mass, with minus sign, and both visceral and subcutaneous adipose tissue were the predictors of the TEF (R2 = .25, P = .0055) in premenopausal women. This study demonstrates that visceral fat distribution is important in determining the RMR in postmenopausal women and men. In premenopausal women, total adipose tissue is a main determinant of both the RMR and TEF This last effect could be counterbalanced by insulin resistance.

Adipose Tissue↗
PubMed2000

Comparative study of clinical, pathological and biological characteristics of symptomatic versus asymptomatic breast cancers.

BACKGROUND: It is well known that mammographic screening reduces breast cancer mortality. One possible explanation for this effect is that screening makes it possible to detect smaller breast cancers with fewer involved nodes, but another hypothesis is that some screening-detected tumors are in a pathologically and biologically different phase of evolution from those that are detected clinically. The aim of the present study was to compare the biological, pathological and clinical characteristics of symptomatic vs. asymptomatic breast cancers. PATIENTS AND METHODS: The study considers a series of 1916 consecutive patients who underwent surgery for stage I and II infiltrating breast cancer at Verona hospitals after having undergone ultrasound and mammography (at least one of which was positive). They were divided into two groups on the basis of why they decided to undergo the imaging examinations: group A refers to the 1247 patients with a palpable lump, and group B to the 616 who were asymptomatic. RESULTS: The patients in group A were older, and had larger tumors and a higher percentage of positive nodes than those in group B; they also had significantly higher grade tumors, higher Ki-67 levels, and a higher percentage of ER and PgR negative and c-erbB-2 positive tumors (all of the P-values were significant). A logistic regression analysis adjusted for tumor diameter and age showed a reduction in the significance of each of the considered variables, but all of them remained significantly associated with the modality of diagnosis except ER, PgR and c-erbB-2. CONCLUSIONS: Our results suggest that asymptomatic tumors are biologically different from their clinically presenting counterparts, thus confirming the hypothesis that progression towards greater malignancy may occur during the natural history of breast cancer.

Adult↗
PubMed2000

Spectral and bidirectional filters give different results for signal-averaged ECG analysis in patients with postmyocardial infarction. GISSI-3 Arrhythmias Substudy Investigators.

This study aims at assessing the specific effects of bidirectional filters (BF) and spectral filters (SF) on signal-averaged ECG (SAECG) analysis. The GISSI-3 Arrhythmias Substudy collected SAECGs of 598 patients 10 +/- 4 days after myocardial infarction (MI) from 20 Italian coronary care units. BF and SF were applied on 340 and 258 patients, respectively. QRS duration (QRSD), low amplitude signal duration (LAS40), and root mean-square-voltage (RMS40) were measured with filters set at 40 to 250 Hz. For ventricular late potentials (VLP) detection filter-specific criteria were adopted: QRSD > 114 ms, LAS40 > 38 ms, RMS40 < 20 microV for BF and QRSD > 120 ms, LAS40 > 38 ms, RMS40 < 20 microV for SF. VLP were considered present if any 2 of the criteria were met. The QRSD obtained by BF (100.6 +/- 13 ms) was shorter (P < .0001) than that obtained by SF (109.1 +/- 12 ms). Nevertheless, a higher prevalence of VLP for patients with BF than for patients with SF was found (23.8% vs 16.7%; P < .04). Indeed, filter-specific criteria were able to avoid any differences in the prevalence of abnormal QRSD and LAS40, but not of RMS40 (25.6% vs 17.1%, P < .02). Finally, the difference of VLP prevalence was mainly owing to the higher number of abnormal pairs of RMS40 + LAS40 (58% vs 44%) for BF than for SF. This multicentric study suggests that after MI, BF and SF produce discordant results on low-amplitude signals of filtered QRS that are not avoided by adopting filter-specific criteria. On the contrary, specific criteria seem to be suitable for comparison of QRSD between different SAECG devices in post-MI patients.

Action Potentials↗
PubMed2000

Digital epiluminescence microscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions. A statistical comparison between visual and computer inspection.

Epiluminescence light microscopy (ELM) has been confirmed to be a useful tool for the diagnosis of pigmented skin lesions. The application of digital systems to epiluminescence represents the latest attempt to improve the diagnosis of cutaneous melanoma. The aim of this study was to compare the diagnostic accuracy of one of these systems, the DB-Dermo MIPS, with the accuracy of well-trained dermatologists using the ELM technique in order to establish the real usefulness of this instrument and to verify how much it can help the clinician make a diagnosis in a clinical setting. During a campaign for the early diagnosis of cutaneous melanoma, 311 patients with non-melanocytic lesions, common naevi, dysplastic naevi and melanomas underwent clinical diagnosis using ELM, computerized evaluation with DB-Dermo MIPS and skin biopsy. Sensitivity, specificity, true and negative predictive value were evaluated for epiluminescence and digital epiluminescence. Our study revealed that the inspection of pigmented skin lesions by digital epiluminescence has a better diagnostic accuracy than that of a trained dermatologist using the epiluminescence technique only. In our experience, this computerized system can play an essential role in the detection of early melanomas.

Diagnosis, Computer-Assisted↗
PubMed2000

Cough threshold in reflux oesophagitis: influence of acid and of laryngeal and oesophageal damage.

BACKGROUND: Gastro-oesophageal reflux is often associated with cough. Patients with reflux show an enhanced tussive response to bronchial irritants, even in the absence of respiratory symptoms. AIM: To investigate the effect of mucosal damage (either oesophageal or laryngeal) and of oesophageal acid flooding on cough threshold in reflux patients. PATIENTS: We studied 21 patients with reflux oesophagitis and digestive symptoms. Respiratory diseases, smoking, and use of drugs influencing cough were considered exclusion criteria. METHODS: Patients underwent pH monitoring, manometry, digestive endoscopy, laryngoscopy, and methacholine challenge. We evaluated the cough response to inhaled capsaicin (expressed as PD5, the dose producing five coughs) before therapy, after five days of omeprazole therapy, and when oesophageal and laryngeal damage had healed. RESULTS: In all patients spirometry and methacholine challenge were normal. Thirteen patients had posterior laryngitis and eight complained of coughing. Twenty patients showed an enhanced cough response (basal PD5 0.92 (0.47) nM; mean (SEM)) which improved after five and 60 days (2.87 (0.82) and 5.88 (0.85) nM; p<0.0001). The severity of oesophagitis did not influence PD5 variation. On the contrary, the response to treatment was significantly different in patients with and without laryngitis (p = 0.038). In patients with no laryngitis, the cough threshold improved after five days with no further change thereafter. In patients with laryngitis, the cough threshold improved after five days and improved further after 60 days. Proximal and distal oesophageal acid exposure did not influence PD5. Heartburn disappeared during the first five days but the decrease in cough and throat clearing were slower. CONCLUSIONS: Patients with reflux oesophagitis have a decreased cough threshold. This is related to both laryngeal inflammation and acid flooding of the oesophagus but not to the severity of oesophagitis. Omeprazole improves not only respiratory and gastro-oesophageal symptoms but also the cough threshold.

Adult↗
PubMed1999

CD4(+) T cell clones producing both interferon-gamma and interleukin-10 predominate in bronchoalveolar lavages of active pulmonary tuberculosis patients.

The pattern of cytokine production in T cell clones derived from bronchoalveolar lavages (BAL) of active pulmonary tuberculosis (TB) patients was analyzed in clones obtained by limiting dilution procedures which expand with high efficiency either total T lymphocytes, independently of their antigen-recognition specificity, or Mycobacterium tuberculosis-specific T cells. BAL-derived clones, representative of CD4(+) cells from five patients with active TB, produced significantly higher amounts of IFN-gamma than BAL-derived CD4(+) clones from three inactive TB donors or four controls (with unrelated, noninfectious pathology). Average IL-4 and IL-10 production did not differ significantly in the three groups. Although these data suggest a predominant Th1 response to M. tuberculosis infection in the lungs, the majority of BAL-derived CD4(+) clones produced both IFN-gamma and IL-10 and the percentage of clones with this pattern of cytokine production was significantly higher in clones derived from BAL of active TB patients than from controls. Only rare clones derived from peripheral blood (PB)-derived CD45RO(+) CD4(+) T cells of both patients (nine cases) and controls (four cases) produced both IFN-gamma and IL-10; instead, the IL-10-producing clones derived from PB T cells most often also produced IL-4, displaying a typical Th2 phenotype. Higher average amounts of IFN-gamma and IL-10 were produced by BAL-derived CD8(+) clones of four active TB patients than of four controls, although the frequency of CD8(+) clones producing both IFN-gamma and IL-10 was lower than that of CD4(+) clones. The M. tuberculosis-specific BAL-derived T cell clones from three active TB patients were almost exclusively CD4(+) and produced consistently high levels of IFN-gamma often in association with IL-10, but very rarely with IL-4. Unlike the BAL-derived clones, the M. tuberculosis-specific clones derived from PB CD45RO(+) CD4(+) T cells of three different active TB patients and two healthy donors showed large individual variability in cytokine production as well as in the proportion of CD4(+), CD8(+), or TCR gamma/delta(+) clones. These results indicate the predominance of CD4(+) T cells producing both the proinflammatory cytokine IFN-gamma and the anti-inflammatory cytokine IL-10 in BAL of patients with active TB.

Antigens, Bacterial↗
PubMed1999

One-year weight follow-up in anorexia nervosa after inpatient psycho-nutritional rehabilitative treatment.

Many inpatient treatments have been proposed for anorexia nervosa (AN) in the past, but few weight outcomes are available today. The criteria for outcome evaluation have always considered body weight. The fifty-three women with AN [26 restrictive (ANR) and 27 bulimic (ANB), studied in this paper were all those discharged in 1996 after an inpatient psycho-nutritional rehabilitation programme. Body weight and BMI were significantly increased between admission and discharge and this increase was maintained at the one-year follow-up. Mean weight in ANR and ANB were similar both at admission and on discharge, but showed significant differences at the follow-up. Follow-up weight was stable (+/- 5%) in 31%, decreased in 15% and increased in 54% of ANR, compared with 44%, 33% and 23% respectively in ANB. There were no differences in age and illness duration. It is very difficult to study presence or absence of menses because many patients were on estro-progestins. Furthermore, only 28% of patients with menses presented BMI higher than 17.5. Only the ANR group showed a significant weight increase at the follow-up. Their BMI was acceptable in 65% compared with 33% in the ANB group. Bulimic behaviour seems to be itself a negative prognostic factor for weight recovery.

Adolescent↗
PubMed1999

Variables associated with the hospitalization of psychiatric emergencies evaluated in the community.

We investigated hospitalization factors in acutely ill patients visited by psychiatrists at home. A series of 100 consecutive calls for psychiatric emergencies of a community mental health centre were investigated with a structured evaluation of psychiatric symptoms and aggressiveness (IEF, GAS, and VSAS). First order interactions were tested, and selected variables were tested with logistic regression analysis. Admission was significantly associated with GAS scores (low scores were found in 92.6% of admitted patients vs. 43.8% of patients not admitted), paranoid delusions (66.7 vs. 39.7%), and lack of social support (70.4 vs. 30.1%). Multivariate analysis confirmed a significant independent effect only for low GAS score and lack of social support. The study replicated some findings from research on hospitalization in emergency wards, while other factors, such as 'diagnosis' and 'suicide risk', were not significant.

Acute Disease↗
PubMed1999

Bone marrow micrometastases in breast cancer patients.

The presence of epithelial cells in bone marrow may be a prognostic factor in breast cancer, and so we evaluated their evolution in treated and untreated patients. A first bone marrow aspirate was obtained from 125 stage I/II breast cancer patients at diagnosis and repeated every 6-8 months; the samples were processed for leukocyte separation, used to prepare cytospin slides, stained with a pool of monoclonal antibodies (MoAb) recognising epithelial antigens, and immunocytochemically processed. The median follow-up was 48 months (range 15-82); 23 patients relapsed, and 14 died. MoAb positive cells were observed in 31.2% of first, 24.3% of second, and 27.8% of third aspirates. In 68/100 pairs of successive aspirates, bone marrow status remained unchanged; in 20 it became negative, and in 12 positive (not statistically significant even after adjusting for adjuvant therapy). An analysis based on Mantel and Byar's approach to time-dependent covariates using all 225 aspirates found no statistically significant prognostic difference between the patients with negative and positive bone marrow. Bone marrow status changed over time in about 1/3 of the patients; adjuvant therapy did not affect the probability of its becoming negative or positive. No significant association was found between bone marrow evolution and relapse or death, but the relatively high probability of a change in status over time cannot exclude the possibility that a positive aspirate during the course of breast cancer may be a negative prognostic factor.

Antibodies, Monoclonal↗
PubMed1999

A case of intra-abdominal multiple lymphangiomas in an adult in whom the immunological evaluation supported the diagnosis.

A 60-year-old patient with intra-abdominal lymphangiomatosis is described. He presented with anaemia due to enteric haemorrhage, hypoproteinaemia with heavy hypogammaglobulinaemia and T-cell lymphopenia. Duodenal biopsy showed lymphangiectasia while a small bowel study revealed several filling defects in the terminal ileum. On exploratory laparotomy, numerous inoperable lymphangio-haemangiomata were found, involving the small and large intestine, appendix, mesenterium, gallbladder and main biliary tract. The importance of T-cell lymphopenia and hypogammaglobulinaemia in the diagnosis of intra-abdominal lymphangiomatosis with lymphangiectasia is stressed.

Abdominal Neoplasms↗
PubMed1999

The relationship between body composition and physical performance in older women.

BACKGROUND: The relationship between age-associated change in body composition and physical disability is still unknown. Skeletal muscle mass declines with age in both sexes; however, since women have less muscle mass per unit of weight than men, these changes may be more debilitating in women. OBJECTIVE: To evaluate the relationship between body composition and physical performance. DESIGN: A cross-sectional study. PARTICIPANTS: 144 women aged 68 to 75 were selected randomly from the general population of Verona. MEASUREMENTS: Body composition was evaluated using dual energy X-ray absorptiometry and bioimpedance. Physical performance was evaluated using a modified version of the Activities of Daily Living scale. Distance walked in 6 minutes was calculated, and isometric knee strength was tested. RESULTS: Normal women had a significantly lower body mass index (BMI) and percent body fat. These women also had a higher ratio of body cell mass (BCM) and total fat free mass (FFM) than women with physical impairments. After adjusting for BMI, women in the lowest tertile of muscle strength had significantly lower BCM than those in the highest tertile. CONCLUSIONS: These cross-sectional data show that although muscle strength is related to fat-free mass, disability in older women is associated with heavier BMI and with a higher percentage of body fat.

Absorptiometry, Photon↗
PubMed1998

Unplanned first contact as a predictor of future intensive use of mental health services.

The scheduled appointment system, widely used in most mental health services, has never been evaluated. This study attempts such an evaluation within a community-based mental health service that permits unplanned access to specialist care, by comparing further service use of first-episode patients who come unannounced to seek psychiatric care with that of patients with a planned (scheduled) initial appointment. All patients with first lifetime psychiatric contact who contacted psychiatric services reporting to the South-Verona Psychiatric Case Register between 1 January 1982 and 31 December 1989 (n = 1261) were identified. A total of 1056 patients entered the study and were followed for 2 years. Poisson regression with the generalised estimating equation (GEE) method (to take into account both overdispersion of contacts between subjects and correlation between contacts within subjects) was used to evaluate the effects of the type of first-ever contact (defined as planned or unplanned according to whether or not a regular appointment was previously arranged) and of other selected variables, including sociodemographic characteristics, on the annual rate of planned and unplanned care in the follow-up period. Thirty-six percent of first-ever contacts were unplanned. Patients who began with unplanned contact, as compared with others, were more often widowed, separated or divorced, unemployed and with a diagnosis of schizophrenia or organic psychosis. Moreover, they had, in the following 2 years, significantly higher rates of both unplanned and planned community care, as well as more in-patient care (higher admission rate and a longer mean length of stay). These results at follow-up were confirmed when the rates for the type of first-ever contact were adjusted for all other clinical and sociodemographic variables at initial contact. Step-down Poisson multiple regression analysis showed that the rates of both unplanned and planned contacts in the follow-up period were significantly and independently associated with: type of first-ever contact, diagnosis and type of service first contacted. Unplanned cases at initial contact require particular attention and are confirmed as at risk for placing higher demands on mental health services in the following 2 years. The results of the present study may also have implications for other, non-psychiatric health services.

Adolescent↗
PubMed1998

Intralymphocyte free magnesium and calcium and insulin tolerance test in a group of essential hypertensive patients.

In order to assess the links which are claimed to exist between peripheral insulin resistance and intracellular magnesium and calcium concentrations, we measured free intralymphocyte magnesium (Mg(i)) and calcium (Ca(i)) concentrations as well as the rate constant of plasma glucose disappearance (K(itt)) after insulin injection (insulin tolerance test: ITT) in a group of 16 normotensive control subjects (NC) and 34 essential hypertensive subjects (EH). Mg(i) and Ca(i) were measured in triplicate by means of a fluorimetric technique based on the dyes furaptra and fura-2 respectively. K(itt) values proved significantly reduced in EH as compared to NC (M +/- SD, EH: 4.49 +/- 1.31 vs 5.28 +/- 1.19, P <0.05; 95% confidence limits: 0.23-1.5). Mg(i) and Ca(i) were not statistically different in EH as compared to NC subjects (Mg(i), NC: 266 +/- 20 micromol/l; EH: 245 +/- 50 micromol/l; Ca(i), NC: 47 +/- 9 nmol/l EH: 46 +/- 13 nmol/l). We found a statistically significant inverse correlation in the whole study group between K(itt) and body mass index (R= -0.363, P<0.01) and a statistically significant positive correlation between K(itt) and Mg(i) (R=0.347, P=0.013) was found. In a step-up multivariate regression analysis including blood pressure, plasma lipids, BMI, plasma magnesium, fasting insulin, fasting glucose, Mg(i) and Ca(i), the dependent variable K(itt) is statistically significantly correlated with body mass index and Mg(i). In a first attempt to study the relationships between insulin resistance, Mg(i) and Ca(i) in nucleated cells, the chosen index of peripheral resistance seems to be linked to intracellular free magnesium.

Adult↗
PubMed1998

The haemochromatosis mutations do not modify the clinical picture of thalassaemia major in patients regularly transfused and chelated.

Iron overload is the main cause of morbidity and mortality in patients with thalassaemia major. In order to establish if the presence of the mutations recently described in the haemochromatosis gene affects the severity of iron overload in thalassaemia patients, we compared the prevalence of mutations C282Y and H63D in 216 young adults regularly transfused and chelated in North-Eastern Italy with the frequency found in a group of blood donors from the same area. For each patient, mean serum ferritin over the last 3 years, liver iron concentration, and the presence of diabetes, hypogonadism and heart disease, were considered. The frequency of the C282Y allele was 1.9% in patients with thalassaemia major and 2.3% in blood donors (P=ns). The frequency of the H63D allele was 16.2% in patients with thalassaemia major and 15.3% in blood donors (P=ns). When age, liver iron concentration and mean yearly serum ferritin levels were compared in patients with and without mutations C282Y and H63D, no significant differences were found. Also, the prevalence of iron-induced complications was not significantly different between patients carrying or not carrying the mutations. The presence of the HH mutations does not seem to influence the degree of iron overload and its consequences in regularly transfused and chelated patients with thalassaemia major.

Adolescent↗