-
[show abstract]
[hide abstract]
ABSTRACT: Surfactant inactivation is present in neonatal pneumonia.
One hundred thirty-nine preterm babies with Birth Weight (BW) < or = 1250 grams were studied and subdivided in two groups: RDS Group, with a diagnosis of "simple" RDS (N 80) and RDS with Pneumonia Group, consisting of babies with a diagnosis of RDS and a positive BALF culture in the first 24-48 h of life (N 59).
Surfactant administration seems less effective in the latter group, because a significantly higher number of infants needed a second dose of surfactant, compared to the patients suffering from RDS alone. (www.actabiomedica.it).
Acta bio-medica: Atenei Parmensis 01/2012; 83 Suppl 1:33-6.
-
[show abstract]
[hide abstract]
ABSTRACT: In clinical practice, one of the major problems in optimizing recruitment or lung volume during HFOV in preterm infants is the inability to accurately measure direct changes in lung volume at bedside.
To evaluate changes in lung volume during the recruitment phase of elective HFOV in preterm infants with RDS using respiratory inductive plethysmography.
The preliminary results of an observational prospective study were reported. Newborns with GA ≤ 27 weeks requiring elective HFOV for a diagnosis of RDS were studied within the first 6 hours of life using RIP technology, before surfactant instillation. HFOV was performed with Draeger Babylog 8000 plus ventilator with "optimum lung volume strategy "(continuous distending pressure (CDP) increased step-by-step until FiO(2) ≤ 0.25 was reached). Data on ventilator settings, gas exchange and RIP volume were collected and analyzed. The analysis package used in this study visualizes measured data from the Bicore-II device (CareFusion), Pulse Oximeter Masimo, AX300 FiO(2) monitor device and TCM4 shuttle (TCM4, Radiometer, Copenaghen, Denmark).
Four preterm infants (two females) with mean ± SD gestational age of 26.5 ± 1.0 weeks and mean ± SD birth weight of 978 ± 188 grams were studied. Relative FRC slightly increased during the first steps of the recruitment phase, while deeply decreased at higher CDP values (≥ 15 cm H(2)O). Notwithstanding FiO(2) decreased until 0.25 in all the newborns except one.
Because RIP cannot differentiate between changes in lung fluid or intrathoracic gas, we hypothesized that as CDP increases and total lung capacity is approached, pulmonary vascular resistance increases as a consequence of the compression of intra-alveolar vessels. This increases right ventricular afterload which, combined with re-establishment of right-to left shunting, results in decreased pulmonary blood flow and then decreased lung volume. Caution should then be used when using high CDP values during the recruitment procedure.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 09/2011; 24 Suppl 1:159-62. · 1.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There is no agreement to define the target FiO2 to adopt in the lung recruitment phase during HFOV in preterm infants. We report our experience of an optimal lung volume strategy (OLVS), defined as FiO2≤0.25 during the recruitment phase, in a cohort of neonates with gestational age (GA) ≤27 weeks treated with elective HFOV for respiratory distress syndrome (RDS) between July 2006 and September 2008.
FiO2 used during the recruitment phase was different according to physician' evaluation. 51 newborns were then divided into two groups: patients reaching FiO2≤0.25 (OLVS Group, N.=28), and patients reaching FiO2>0.25 (No-OLVS Group, N.=23).
Prior to surfactant administration OLVS Group, respect to No-OLVS Group, received a significantly higher continuous distending pressure (CDP): 12.8±1.1 cmH2O vs 11.2±1.3 cmH2O (P<0.0001) and a significantly lower FiO2: 0.25±0.01 vs 0.35±0.06 (P<0.0001). A multivariate modeling approach confirmed that OLVS was significantly associated to the need for less surfactant doses (OR 0.19[95% CI 0.05-0.84]), a decreased risk of ductus arteriosus surgically ligated (OR 0.13[95% CI 0.02-0.86]) and to a lower number of ventilation hours before extubation: -152 (95% CI -284- -20).
OLVS to fully recruit the lungs achieving FiO2≤0.25 during elective HFOV is associated with better short-term pulmonary outcomes respect to a strategy where the patients received a FiO2>0.25 during the recruitment phase. Utilizing HFOV in this way provides a more effective means to recruit and protect acutely injured lungs.
Minerva anestesiologica 06/2011; 78(2):151-9. · 2.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A wide array of options are now available for migraine prophylaxis. Conventional treatments include beta-blockers, anticonvulsants, antidepressants, calcium antagonists and antiserotoninergic drugs. Emerging medications such as ACE inhibitors, sartans and nutritional supplements are gaining favour for migraine prophylaxis. Botulinum toxin type A is a promising therapeutic tool for chronic migraine. Tonabersat is likely to be a step forward for the treatment of migraine with aura. However, much work is needed to identify predictive clinical features of successful responsiveness and to better define the duration of prophylaxis.
Neurological Sciences 05/2011; 32 Suppl 1:S111-5. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Progression of episodic migraine to chronic migraine may be related to comorbid medical conditions. In this study, we focused on the role played by arterial hypertension in migraine transformation. Several studies reveal that hypertension is associated with chronic migraine and may induce migraine chronification. Hypertension probably amplifies the effects of migraine on the vascular wall further enhancing the endothelial dysfunction in cerebral vasculature. Consequently, monitoring of blood pressure is recommended in migraineurs showing an otherwise unexplained increase in attack frequency. Studies are needed to verify if prophylactic treatment with drugs improving endothelial function (e.g. calcium channel blockers, beta blockers, calcium inhibitors, ACE inhibitors and sartans) may selectively ameliorate the course of migraine in these patients.
Neurological Sciences 06/2010; 31 Suppl 1:S41-3. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Antimicrobial peptides plays an important role in the host innate defence network, even in humans. Recent studies demonstrated the capacity of human airways epithelial cells to synthesize antimicrobial peptides, and their multifunctional role in the primary immunity. The presence of ct-defensins in bronchoalveolar lavage fluid (BALF) was investigated in a cohort of preterm newborns with gestational age (GA) < or =30 weeks. BALF samples were analysed by High Performance Liquid Chromatography Electrospray Ionization Mass Spectrometer. Our data show that preterm newborns, also at the lower GA, are able to produce defenses, underlining that their innate defence system is already active before the at-term delivery date.
Minerva pediatrica 06/2010; 62(3 Suppl 1):47-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Migraine patients often complain of sleepiness, a problem that manifests both during and outside an attack, may impair the quality of life and can lead to potentially harmful situations. Findings from an uncontrolled study suggest that a high percentage of migraineurs experience excessive daytime sleepiness (EDS). We investigated EDS in a case-control study on 100 patients with episodic migraine and 100 age- and sex-matched healthy controls and also assessed sleep quality, anxiety and depression. Although it was found that EDS was more frequent in migraineurs than in controls (14% vs. 5%; odds ratio 3.1; 95% confidence interval 1.1-8.9), the frequency was lower than previously reported. EDS correlated with migraine disability, sleep problems and anxiety. EDS in patients with migraine probably stems from the full constellation of headache-sleep-affective symptoms resulting from the complex clinical burden of the disease.
Cephalalgia 11/2007; 27(10):1115-9. · 3.43 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Excessive daytime somnolence (EDS) and quality of sleep were studied in 25 parkinsonian patients at baseline, when they had not yet received any antiparkinsonian medication, and after 1 year of treatment with dopaminergic drugs. EDS was measured by the Epworth Sleepiness Scale (ESS) and sleep quality by the Pittsburgh Sleep Quality Index (PSQI). At baseline, the ESS score was not different from that of age-matched healthy controls. The mean ESS score increased significantly after 1 year of follow-up, being more than 10 in 12 patients. The mean PSQI also increased significantly after 1 year of treatment, but there were no differences in the number of "bad sleepers" at baseline and at follow-up. In conclusion, EDS seems to emerge during the course of the illness, at least in a proportion of PD patients, and could represent another clinical correlate of the interaction between the ongoing neurodegenerative process and the side effects of drugs.
Neurological Sciences 11/2003; 24(3):178-9. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Excessive daytime somnolence (EDS) and quality of sleep
were studied in 25 parkinsonian patients at baseline, when they
had not yet received any antiparkinsonian medication, and after
1 year of treatment with dopaminergic drugs. EDS was measured by
the Epworth Sleepiness Scale (ESS) and sleep quality by the
Pittsburgh Sleep Quality Index (PSQI). At baseline, the ESS
score was not different from that of agematched healthy
controls. The mean ESS score increased significantly after 1
year of follow-up, being more than 10 in 12 patients. The mean
PSQI also increased significantly after 1 year of treatment, but
there were no differences in the number of bad sleepers at
baseline and at follow-up. In conclusion, EDS seems to emerge
during the course of the illness, at least in a proportion of PD
patients, and could represent another clinical correlate of the
interaction between the ongoing neurodegenerative process and
the side effects of drugs.
Neurological Sciences 09/2003; 24(3):178-179. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: As cholinergic mechanisms may be at least partially responsible for hallucinations and delusions in Parkinson's disease (PD), we conducted an open study in 8 PD patients to assess the efficacy and tolerability of the cholinesterase inhibitor donepezil, 5 mg at bedtime for two months, in the treatment of these complications. Hallucinations and delusions improved significantly in all patients. Donezepil was overall well tolerated, but a deterioration in motor disability was noted in 2 out of 8 patients.
Neurological Sciences 05/2002; 23(1):41-3. · 1.32 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The progressive ageing of the population will produce an increase of those neuropsychiatric disturbances (late onset psychosis, behavioural disturbances of dementia, psychosis in Parkinson's disease) which may require treatment with antipsychotics. However, aged individuals are at higher risk for the development of adverse events from these drugs, namely extrapyramidal disturbances and tardive dyskinesias (TD). TD are a complex disorder, and despite much work done both in basic science and in clinical studies, many issues are still unresolved, such as risk factors, natural history and response to treatment. Although TD may be a mild disorder, it may become debilitating in a proportion of patients. As treatment is often quite disappointing, efforts are directed to its prevention. In this respect, atypical antipsychotics, with their peculiar mixed dopamine-serotonin antagonism, present a clear advantage over classic neuroleptics in young schizophrenic patients, with a lower incidence of TD during chronic treatment. Data are accumulating to show that this is likely to be true also in older patients.
International Journal of Geriatric Psychiatry 01/2002; 16 Suppl 1:S19-23. · 2.42 Impact Factor
