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Iatrogenic hypothyroidism and acute psychosis

Lucrezia Islam, Anna Maria Masu, Silvio Scarone, Orsola Gambini
2013 Open Journal of Psychiatry  
We present the case of a 39 years old woman who was referred to our day hospital unit because of anxiety. The patient didn't endorse any past psychiatric symptoms except for an acute psychotic episode in August 2010. In June 2010 she was diagnosed with hypothyroidism (likely due to Hashimoto's thyroiditis) and was started on Methilmazole 30 mg. Shortly after that she reported persecutory ideation and hallucinations which quickly progressed, until she was hospitalized in a psychiatric facility.
more » ... pon admittance her lab work revealed severe hypothyroidism. Methilmazole was suspended, she was started on Haloperidol, and the symptoms went into remission after four days. Despite the fact that she self discontinued Haloperidol shortly after discharge, she showed no sign of psychotic symptoms. While it is widely accepted that hypothyroidism can cause depressive symptoms, to the best of our knowledge very few cases of psychotic symptoms associated with this condition have been described. Based on the patient's clinical history, on the rapid onset and remission of symptoms, on the lab values and on the doses of medication that were prescribed, we hypothesize that our patient's psychotic episode was caused by iatrogenic hypothyroidism.
doi:10.4236/ojpsych.2013.33028 fatcat:6e4hbjglvvcnpb63xj5lqa6fay

Male bilateral risk-reducing mastectomy: Report of a case

Francesca Combi, Elisabetta Razzaboni, Angela Toss, Anna Gambini, Simona Papi, Laura Cortesi, Giovanni Tazzioli
2020 The Breast Journal  
Breast J. 2020;00:1-2. | 1 Keywords: BRCA-2 mutation, male breast cancer, psychological counseling, risk-reducing surgery cancerophobia, low adherence to surveillance programs, or significant family history may sometimes influence the choice between surveillance and risk-reducing surgery. In literature, male prophylactic mastectomy is described only in sporadic cases and always performed in men with BRCA mutation with a contralateral breast cancer diagnosis.
more » ... 8 Despite the absence of a survival benefit, 9 the use of contralateral prophylactic mastectomy for men who received a diagnosis of unilateral breast cancer has substantially increased over time. 8 The same trend is recognized in women population. 10 This may suggest that patient's personal choice is becoming more and more important in genetic counseling. Health care professionals have the role to educate patients on benefits, risks, and implications of surveillance programs versus risk-reducing strategies, and to flank the patient to reach shared decisions. This case may suggest that we need to tailor counseling and decision-making process for males carrying BRCA mutation and take into consideration risk-reduction surgery when wished and strongly motivated by the consultant or in the presence of multiple risk factors in addition to gene mutation. In our experience, the involvement of family members in the counseling process is also greatly important.
doi:10.1111/tbj.13928 pmid:32519448 fatcat:bmppatofmzevjezwxlmlvbgvdu

Marchiafava-Bignami disease: longitudinal MR imaging and MR spectroscopy study

Anna Gambini, Andrea Falini, Lucia Moiola, Giancarlo Comi, Giuseppe Scotti
2003 American Journal of Neuroradiology  
A case of Marchiafava-Bignami disease was serially evaluated with MR imaging and MR spectroscopy at 1, 2, 4, and 11 months after the onset of symptoms. The first MR imaging study showed extensive abnormal signal intensity of the corpus callosum without macroscopic changes; a diagnosis of Marchiafava-Bignami disease was made, and vitamin therapy was initiated. Follow-up studies showed progressive reduction of signal intensity abnormalities and residual callosal atrophy. MR spectroscopy revealed
more » ... rogressive reduction of the N-acetylaspartate:creatine ratio, with partial recovery in the last study, and a normalization of the choline:creatine ratio, which was initially slightly increased. Lactate was detectable during the subacute phase and was replaced by lipids after 4 months. This study confirmed the role of MR imaging in diagnosing Marchiafava-Bignami disease and particularly the value of MR spectroscopy in focusing the pathogenesis of the disease, monitoring its evolution and changes related to therapy.
pmid:12591642 pmcid:PMC7974142 fatcat:l4tphod5pjan3g3hvra6xd5vtq

Male mammary myofibroblastoma: Two case reports and brief review of literature

Marta Venturelli, Angela Toss, Laura Cortesi, Anna Gambini, Alessia Andreotti, Stefano Cascinu, Giovanni Tazzioli, Luca Moscetti
2020 Molecular and clinical oncology  
Myofibroblastoma of the breast is a rare benign stromal tumor that occurs in both sexes with a higher prevalence in male breast of older populations. Furthermore, myofibroblastoma can arise in extra mammary sites, along the milk-line. A variety of morphological variants in addition to the classic type have been identified. The differential diagnosis includes both benign and malignant entities that, through the use of clinical and radiological imaging, is difficult to characterize.
more » ... cal examination and immunohistochemistry are fundamental in the establishment of appropriate management of the disease and avoidance of overtreatment. The present study focuses on two cases of male mammary myofibroblastoma, with a short literature review.
doi:10.3892/mco.2020.2038 pmid:32454973 pmcid:PMC7241234 fatcat:wdhntudjnzfkhcghwqf6m4g4wa

Inhibitory Motor Control at Five Years as a Function of Prenatal Cocaine Exposure

2003 Journal of Developmental and Behavioral Pediatrics  
This study examined children's (n = 140, age 5 years) ability to inhibit a motor response as a function of prenatal cocaine exposure. We hypothesized that cocaine-exposed children would perform worse than unexposed children on the Contrary Tapping task. Results indicated that cocaine exposure, high environmental risk, male gender, and low child IQ each were related to poorer inhibitory control. An interaction indicated that cocaine effects were specific to children who lived in relatively
more » ... sk environments. Cocaine-exposed children made an error sooner than unexposed children if they lived in low-risk environments but not if they lived in high-risk environments. Potential underlying mechanisms and the importance of examining cocaine exposure effects in the context of children's existing environment are discussed. Index terms cocaine exposure; inhibitory control; impulsivity The effects of cocaine on human development have received much attention in the last 20 years since "crack" became available and large numbers of children have been exposed to it during gestation. 1 There is accumulating evidence that the development of emotional and regulatory functions is likely to be affected by prenatal cocaine exposure. 2-8 This is consistent with the mechanism of effect of cocaine on the developing central nervous system. Prenatal exposure to cocaine is likely to affect regulatory control through its action on the monoaminergic neurotransmitter systems, in particular the dopamine (DA) system in the mesolimbic and midprefrontal cortices. 9-13 These brain regions are believed to provide the neuronal substrates Address for reprints: Michael Lewis, Ph.D., Robert Wood Johnson Medical School, 97 Paterson Street, New Brunswick, NJ 08903.. This study explores whether prenatal cocaine exposure alters one aspect of behavioral control-the ability to inhibit a response under changing circumstances, part of the array of abilities under executive functioning. It is refreshing to see a report investigating mental functioning in this group of youngsters that goes beyond standard measures of global intelligence. The authors have highlighted the contribution of the postnatal environment to a child's abilities in this area, something that comes as no surprise to anyone working with a population in which drug use is a factor in children's lives. Children in low-risk environments do better than children who remain in high-risk circumstances. The analytic model is innovative but solid, according to our statistical reviewers, taking into account the interactional nature and non-normally distributed feature of these data. The effect size of these factors is small, so let the reader exercise caution in generalizing the results. -Editor NIH Public Access
doi:10.1097/00004703-200310000-00005 pmid:14578695 pmcid:PMC1522056 fatcat:r4yxz2sntrfmvaxu6prdc7bnwi

Brief Psychotic Disorder during the national lockdown in Italy: an emerging clinical phenomenon of the coronavirus pandemic

Armando D'Agostino, Simone D'Angelo, Barbara Giordano, Anna Chiara Cigognini, Margherita Lorenza Chirico, Cristiana Redaelli, Orsola Gambini
2020 Schizophrenia Bulletin  
The impact of the COVID–19 pandemic on psychosis remains to be established. Here, we report six cases (3 Male; 3 Female) of First Episode Psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full–blown psychosis (BPRS = 53,3 ± 15,6). Blood tests, toxicological urine
more » ... g and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (Male, 73 years). All patients were negative for SARS-CoV-2 throughout their stay but three presented the somatic delusion of being infected. Of note, all six cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53,3 ± 15,6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13,8 ± 6,9) with remission of symptoms (BPRS = 27,5 ± 3,1) and satisfactory insight were possible after relatively low–dose antipsychotic treatment (Olanzapine–equivalents = 10,6 ± 5,4 mg). Brief Psychotic Disorder (BPD) / Acute and Transient Psychotic Disorder (ATPD) diagnoses were confirmed during follow–up visits in all six cases. The youngest patient (Female, 23 years) also satisfied available criteria for Brief Limited Intermittent Psychotic Symptoms (BLIPS). Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.
doi:10.1093/schbul/sbaa112 pmid:32761196 pmcid:PMC7454891 fatcat:ysnsroxbzngebctovsg5fayeme

Sleep endophenotypes of schizophrenia: slow waves and sleep spindles in unaffected first-degree relatives

Armando D'Agostino, Anna Castelnovo, Simone Cavallotti, Cecilia Casetta, Matteo Marcatili, Orsola Gambini, Mariapaola Canevini, Giulio Tononi, Brady Riedner, Fabio Ferrarelli, Simone Sarasso
2018 npj Schizophrenia  
Sleep spindles and slow waves are the main brain oscillations occurring in non-REM sleep. Several lines of evidence suggest that spindles are initiated within the thalamus, whereas slow waves are generated and modulated in the cortex. A decrease in sleep spindle activity has been described in Schizophrenia (SCZ), including chronic, early course, and early onset patients. In contrast, slow waves have been inconsistently found to be reduced in SCZ, possibly due to confounds like duration of
more » ... s and antipsychotic medication exposure. Nontheless, the implication of sleep spindles and slow waves in the neurobiology of SCZ and related disorders, including their heritability, remains largely unknown. Unaffected first-degree relatives (FDRs) share a similar genetic background and several neurophysiological and cognitive deficits with SCZ patients, and allow testing whether some of these measures are candidate endophenotypes. In this study, we performed sleep high-density EEG recordings to characterise the spatiotemporal features of sleep spindles and slow waves in FDRs of SCZ probands and healthy subjects (HS) with no family history of SCZ. We found a significant reduction of integrated spindle activity (ISAs) in FDRs relative to HS, whereas spindle density and spindle duration were not different between groups. FDRs also had decreased slow wave amplitude and slopes. Altogether, our results suggest that ISAs deficits might represent a candidate endophenotype for SCZ. Furthermore, given the slow wave deficits observed in FDRs, we propose that disrupted cortical synchronisation increases the risk for SCZ, but thalamic dysfunction is necessary for the disorder to fully develop.
doi:10.1038/s41537-018-0045-9 pmid:29426848 pmcid:PMC5807540 fatcat:marvowqvdbgvbmixrilxwlkaj4

Orthogonal diffusion-weighted MRI measures distinguish region-specific degeneration in cerebellar ataxia subtypes

Sarah H. Ying, Bennett A. Landman, Shwetadwip Chowdhury, Alexander H. Sinofsky, Anna Gambini, Susumu Mori, David S. Zee, Jerry L. Prince
2009 Journal of Neurology  
The cerebellar peduncles are excellent candidates for composite indicators of regional degeneration in posterior fossa structures, as the peduncles show histopathological changes in degenerative ataxia. We postulate that magnetic resonance imaging will reveal evidence of disease specific peduncle degeneration through macro-structural (cross-sectional area) and microstructural (fractional anisotropy, mean diffusivity) measures. This study presents a "proof of principle" using orthogonal
more » ... tensor imaging cross-sections of the cerebellar peduncles to distinguish categories of cerebellar disease.
doi:10.1007/s00415-009-5269-1 pmid:19653028 pmcid:PMC2789274 fatcat:65agifae45cgja5obizbvruwtq

Phenotypic and functional characterization of switch memory B cells from patients with oligoarticular juvenile idiopathic arthritis

Anna Corcione, Francesca Ferlito, Marco Gattorno, Andrea Gregorio, Angela Pistorio, Roberto Gastaldi, Claudio Gambini, Alberto Martini, Elisabetta Traggiai, Vito Pistoia
2009 Arthritis Research & Therapy  
Introduction In chronic inflammatory disorders, B cells can contribute to tissue damage by autoantibody production and antigen presentation to T cells. Here, we have characterized synovial fluid and tissue B-cell subsets in patients with oligoarticular juvenile idiopathic arthritis (JIA), an issue not addressed before in detail. Methods B cells from synovial fluid (SF) and peripheral blood (PB) of 25 JIA patients, as well as from PB of 20 controls of comparable age, were characterized by
more » ... lor flow cytometry. Immunoglobulin-secreting cells were detected by ELISPOT. Immunohistochemical analyses of synovial tissue from three JIA patients were performed. Results JIA SF B cells were enriched in CD27 + and CD27switch memory B cells, but not in CD27 + IgM memory B cells, compared with patient and control PB. Plasma blasts were more abundant in SF and secreted higher amounts of IgG. Lymphoid aggregates not organized in follicle-like structures were detected in synovial tissue sections and were surrounded by CD138 + plasma cells. Finally, transitional B cells were significantly increased in JIA PB versus SF or control PB. CCR5, CCR8, CXCR2, and CXCR3 were upregulated, whereas CCR6, CCR7, and CXCR5 were downregulated on SF CD27 + and CD27switch memory B cells compared with their circulating counterparts. SF CD27 + and CD27switch memory B cells expressed at high levels the costimulatory molecule CD86 and the activation marker CD69. Conclusions This study demonstrates for the first time an expansion of activated switch memory B cells and of IgGsecreting plasma blasts in the SF from oligoarticular JIA patients. Memory B cells belonged to either the CD27 + or the CD27subsets and expressed CD86, suggesting their involvement in antigen presentation to T cells. Patterns of chemokines-receptor expression on CD27 + and CD27switch memory B cells delineated potential mechanisms for their recruitment to the inflamed joints.
doi:10.1186/ar2824 pmid:19804628 pmcid:PMC2787263 fatcat:56x4kltqzrfdjnv65xah3brbiy

CX3CR1 Is Expressed by Human B Lymphocytes and Meditates CX3CL1 Driven Chemotaxis of Tonsil Centrocytes

Anna Corcione, Elisa Ferretti, Maria Bertolotto, Franco Fais, Lizzia Raffaghello, Andrea Gregorio, Claudya Tenca, Luciano Ottonello, Claudio Gambini, Glaucia Furtado, Sergio Lira, Vito Pistoia (+1 others)
2009 PLoS ONE  
Fractalkine/CX 3 CL1, a surface chemokine, binds to CX 3 CR1 expressed by different lymphocyte subsets. Since CX 3 CL1 has been detected in the germinal centres of secondary lymphoid tissue, in this study we have investigated CX 3 CR1 expression and function in human naïve, germinal centre and memory B cells isolated from tonsil or peripheral blood. Methodology/Principal Findings: We demonstrate unambiguously that highly purified human B cells from tonsil and peripheral blood expressed CX 3 CR1
more » ... at mRNA and protein levels as assessed by quantitative PCR, flow cytometry and competition binding assays. In particular, naïve, germinal centre and memory B cells expressed CX 3 CR1 but only germinal centre B cells were attracted by soluble CX 3 CL1 in a transwell assay. CX 3 CL1 signalling in germinal centre B cells involved PI3K, Erk1/2, p38, and Src phosphorylation, as assessed by Western blot experiments. CX 3 CR1 + germinal centre B cells were devoid of centroblasts and enriched for centrocytes that migrated to soluble CX 3 CL1. ELISA assay showed that soluble CX 3 CL1 was secreted constitutively by follicular dendritic cells and T follicular helper cells, two cell populations homing in the germinal centre light zone as centrocytes. At variance with that observed in humans, soluble CX 3 CL1 did not attract spleen B cells from wild type mice. OVA immunized CX 3 CR1 2 / 2 or CX 3 CL1 2 / 2 mice showed significantly decreased specific IgG production compared to wild type mice. Conclusion/Significance: We propose a model whereby human follicular dendritic cells and T follicular helper cells release in the light zone of germinal centre soluble CX 3 CL1 that attracts centrocytes. The functional implications of these results warrant further investigation.
doi:10.1371/journal.pone.0008485 pmid:20041188 pmcid:PMC2793522 fatcat:tfsw6nhi7rfivmqw3wber2suji

Application of OSNA Nomogram in Patients With Macrometastatic Sentinel Lymph Node: A Retrospective Assessment of Accuracy

Francesca Combi, Alessia Andreotti, Anna Gambini, Enza Palma, Simona Papi, Alice Biroli, Stefania Zaccarelli, Guido Ficarra, Giovanni Tazzioli
2021 Breast Cancer: Basic and Clinical Research  
Almost 50% to 70% of patients who undergo axillary lymph node dissection (ALND) because of a single metastatic sentinel lymph node (SLN) have no further metastatic nodes at the axillary histology. On these grounds, the one-step nucleic acid amplification (OSNA) nomogram was designed and validated. As a mathematical model, calculated through tumor size (expressed in millimeters) and CK19 mRNA copy number, it is thought to predict nonsentinel lymph node (NSLN) status. The aim of the study is to
more » ... rify the diagnostic accuracy of the OSNA nomogram in a group of patients with macrometastatic SLN, with a retrospective analysis. Methods: The OSNA nomogram was retrospectively applied to a group of 66 patients with macrometastatic SLN who underwent ALND. The result of the final histology of the axillary cavity was compared to the nomogram prediction. We calculated the prevalence of NSLN metastasis in patients who underwent ALND, sensitivity and specificity, negative and positive predictive value of the nomogram. Results: In patients with macrometastasis in SLN, the prevalence of patients with metastatic NSLN was 45%. The sensitivity of the nomogram was excellent (90%). The specificity was low (36%). Positive predictive value amounted to 54%, while negative predictive value was good (81%). Conclusions: These results suggest that the OSNA nomogram is a valid instrument that can help choose the best surgical strategy for the treatment of axillary cavity. The mathematical model is useful to avoid surgery in a selected group of patients because it accurately predicts NSLN status.
doi:10.1177/11782234211014796 pmid:33994790 pmcid:PMC8113365 fatcat:jl2fqesjfrf6xdjmgzqukeojnm

Survivin Expression and Prognostic Significance in Pediatric Malignant Peripheral Nerve Sheath Tumors (MPNST)

Rita Alaggio, Riccardo Turrini, Daniela Boldrin, Anna Merlo, Claudio Gambini, Andrea Ferrari, Patrizia Dall'Igna, Cheryl M. Coffin, Annalisa Martines, Laura Bonaldi, Gian Luca De Salvo, Paola Zanovello (+2 others)
2013 PLoS ONE  
Malignant peripheral nerve sheath tumors (MPNST) are very aggressive malignancies comprising approximately 5-10% of all soft tissue sarcomas. In this study, we focused on pediatric MPNST arising in the first 2 decades of life, as they represent one the most frequent non-rhabdomyosarcomatous soft tissue sarcomas in children. In MPNST, several genetic alterations affect the chromosomal region 17q encompassing the BIRC5/SURVIVIN gene. As cancer-specific expression of survivin has been found to be
more » ... n effective marker for cancer detection and outcome prediction, we analyzed survivin expression in 35 tumor samples derived from young patients affected by sporadic and neurofibromatosis type 1-associated MPNST. Survivin mRNA and protein expression were assessed by Real-Time PCR and immunohistochemical staining, respectively, while gene amplification was analyzed by FISH. Data were correlated with the clinicopathological characteristics of patients. Survivin mRNA was overexpressed in pediatric MPNST and associated to a copy number gain of BIRC5; furthermore, increased levels of transcripts correlated with a higher FNCLCC tumor grade (grade 1 and 2 vs. 3, p = 0.0067), and with a lower survival probability (Log-rank test, p = 0.0038). Overall, these data support the concept that survivin can be regarded as a useful prognostic marker for pediatric MPNST and a promising target for therapeutic interventions.
doi:10.1371/journal.pone.0080456 pmid:24303016 pmcid:PMC3841247 fatcat:ip6tpwfgpvgj7jdr5gtzfhfzd4

Sildenafil attenuates hypoxic pulmonary remodelling by inhibiting bone marrow progenitor cells

Shirley Favre, Elisa Gambini, Patrizia Nigro, Alessandro Scopece, Paola Bianciardi, Anna Caretti, Giulio Pompilio, Antonio F. Corno, Giuseppe Vassalli, Ludwig K. von Segesser, Michele Samaja, Giuseppina Milano
2016 Journal of Cellular and Molecular Medicine  
The recruitment of bone marrow (BM)-derived progenitor cells to the lung is related to pulmonary remodelling and the pathogenesis of pulmonary hypertension (PH). Although sildenafil is a known target in PH treatment, the underlying molecular mechanism is still elusive. To test the hypothesis that the therapeutic effect of sildenafil is linked to the reduced recruitment of BM-derived progenitor cells, we induced pulmonary remodelling in rats by two-week exposure to chronic hypoxia (CH, 10%
more » ... ), a trigger of BM-derived progenitor cells. Rats were treated with either placebo (saline) or sildenafil (1.4 mg/kg/day ip) during CH. Control rats were kept in room air (21% oxygen) with no treatment. As expected, sildenafil attenuated the CH-induced increase in right ventricular systolic pressure and right ventricular hypertrophy. However, sildenafil suppressed the CH-induced increase in c-kit + cells in the adventitia of pulmonary arteries. Moreover, sildenafil reduced the number of c-kit + cells that colocalize with tyrosine kinase receptor 2 (VEGF-R2) and CD68 (a marker for macrophages), indicating a positive effect on moderating hypoxia-induced smooth muscle cell proliferation and inflammation without affecting the pulmonary levels of hypoxia-inducible factor (HIF)-1a. Furthermore, sildenafil depressed the number of CXCR4 + cells. Collectively, these findings indicate that the improvement in pulmonary haemodynamic by sildenafil is linked to decreased recruitment of BMderived c-kit + cells in the pulmonary tissue. The attenuation of the recruitment of BM-derived c-kit + cells by sildenafil may provide novel therapeutic insights into the control of pulmonary remodelling.
doi:10.1111/jcmm.13026 pmid:27860185 pmcid:PMC5387166 fatcat:sdeofwyo7vfmfnpqn73idumc5e

Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the "Life-ON" project

Simone Baiardi, Fabio Cirignotta, Alessandro Cicolin, Corrado Garbazza, Armando D'Agostino, Orsola Gambini, Alessandra Giordano, Mariapaola Canevini, Elena Zambrelli, Anna Maria Marconi, Susanna Mondini, Stefan Borgwardt (+3 others)
2016 BMC Psychiatry  
Perinatal depression (PND) has an overall estimated prevalence of roughly 12 %. Untreated PND has significant negative consequences not only on the health of the mothers, but also on the physical, emotional and cognitive development of their children. No certain risk factors are known to predict PND and no completely safe drug treatments are available during pregnancy and breastfeeding. Sleep and depression are strongly related to each other because of a solid reciprocal causal relationship.
more » ... ght light therapy (BLT) is a well-tested and safe treatment, effective in both depression and circadian/sleep disorders. Methods: In a 3-year longitudinal, observational, multicentre study, about 500 women will be recruited and followed-up from early pregnancy (10-15 gestational week) until 12 months after delivery. The primary aim of the present study is to systematically explore and characterize risk factors for PND by prospective sleep assessment (using wrist actigraphy, polysomnography and various sleep questionnaires) and bloodbased analysis of potential markers during the perinatal period (Life-ON study). Secondary aims are to explore the relationship between specific genetic polymorphisms and PND (substudy Life-ON1), to investigate the effectiveness of BLT in treating PND (substudy Life-ON2) and to test whether a short term trial of BLT during pregnancy can prevent PND (substudy Life-ON3). Discussion: The characterization of specific predictive and risk factors for PND may substantially contribute to improve preventive medical and social strategies for the affected women. The study results are expected to promote a better understanding of the relationship between sleep disorders and the development of PND and to confirm, in a large sample of women, the safety and efficacy of BLT both in prevention and treatment of PND.
doi:10.1186/s12888-016-1086-0 pmid:27814712 pmcid:PMC5225570 fatcat:gsqjrl2wlnfqjlpdzyxm4poxf4

Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis

Alberto Berardi, Anna Maria Buffagni, Cecilia Rossi, Eleonora Vaccina, Chiara Cattelani, Lucia Gambini, Federica Baccilieri, Francesca Varioli, Fabrizio Ferrari
2016 World Journal of Clinical Pediatrics  
AIM To investigate whether serial physical examinations (SPEs) are a safe tool for managing neonates at risk for early-onset sepsis (EOS). METHODS This is a retrospective cohort study of neonates (≥ 34 wks' gestation) delivered in three high-volume level Ⅲ birthing centres in Emilia-Romagna (Italy) during a 4-mo period (from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and
more » ... ns. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals (at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data (gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk (or not) for EOS were evaluated. 5|Issue 4| WJCP| Berardi A et al . SPEs for EOS RESULTS There were 2092 live births and 1 culture-proven EOS (Haemophilus i ) (incidence rates of 0.48/1000 live births). Most newborns with signs of illness (51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics (17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness (51 out of 1442 vs 40 out of 650, P = 0.009) or have a sepsis workup (25 out of 1442 vs 28 out of 650, P < 0.001). However, they were not less likely to receive empirical antibiotics (17 out of 1442 vs 12 out of 650, P = 0.3). Thirty-two neonates were exposed to intrapartum fever or chorioamnionitis: 62.5% (n = 20) had a sepsis workup and 21.9% (n = 7) were given empirical antibiotics. Among 216 neonates managed through the SPEs strategy, only 5.6% (n = 12) had subsequently a sepsis workup and only 1.9% (n = 4) were given empirical antibiotics. All neonates managed through SPEs had a normal outcome. Among 2092 neonates, only 1.6% (n = 34) received antibiotics; 1.4% (n = 29) were ill and 0.2% (n = 5) were asymptomatic (they were treated because of risk factors for EOS). CONCLUSION The SPEs strategy reduces unnecessary laboratory evaluations and antibiotics, and apparently does not worsen the outcome of neonates at-risk or neonates with mild, equivocal, transient symptoms.
doi:10.5409/wjcp.v5.i4.358 pmid:27872823 pmcid:PMC5099587 fatcat:qjo2a3ium5dijakr7tfhmka5aa
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