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Messina R, de Gennaro L, De Robertis M, Pop R, Chibbaro S, Severac F, Blagia M, Balducci MT, Bozzi MT, Signorelli F. Cerebrospinal Fluid Lactate and Glucose Levels as Predictors of Symptomatic Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2023; 170:e596-e602. [PMID: 36403937 DOI: 10.1016/j.wneu.2022.11.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a complex neurovascular syndrome with profound systemic effects associated with high rates of disability and mortality. Delayed cerebral ischemia (DCI), which encompasses all neurobiological events occurring in the subacute-late stage after aSAH, has a complex pathogenesis and can occur in the absence of instrumental vasospasm. Our aim was to assess the correlation between cerebrospinal fluid (CSF) lactate and glucose levels measured on the second or third day after aSAH with clinical deterioration caused by DCI and with 3-month functional outcome. METHODS This prospective study included all aSAH patients admitted between January 2020 and December 2021 who underwent external ventricular drain placement and CSF lactate and glucose measurement. RESULTS Among 133 aSAH patients, 48 had an external ventricular drain placed and early CSF lactate and glucose assessment. Independent predictors of symptomatic DCI were World Federation of Neurosurgical Societies grade IV-V (adjusted odds ratio [aOR] 25.8, 95% confidence interval [CI] 2.9-649.2, P = 0.012), elevated CSF glucose (aOR 28.8, 95% CI 3.3-775.2, P = 0.010), and elevated CSF lactate (aOR 14.7, 95% CI 1.9-205.7, P = 0.018). The only independent predictor of 3-month functional outcome was occurrence of symptomatic DCI (aOR 0.02, 95% CI 0.0-0.2, P = 0.01). CONCLUSIONS Elevated CSF lactate and glucose levels in the first 3 days following aSAH were independent predictors of subsequent DCI-related neurological impairment; the presence of instrumental vasospasm was not significantly correlated with DCI after multivariate adjustment. CSF lactate and glucose monitoring may represent a point-of-care test, which could potentially improve prediction of subacute neurological worsening and guide therapeutic choices. Further research with larger prospective cohorts is warranted.
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Affiliation(s)
- Raffaella Messina
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University "Aldo Moro" of Bari, Bari, Italy
| | - Luigi de Gennaro
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University "Aldo Moro" of Bari, Bari, Italy
| | - Mario De Robertis
- Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy
| | - Raoul Pop
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France; Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France
| | - Salvatore Chibbaro
- Neurosurgery Department, Strasbourg University Hospitals, Strasbourg, France
| | - François Severac
- Public Healthcare Department, Strasbourg University Hospitals, Strasbourg, France
| | - Maria Blagia
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University "Aldo Moro" of Bari, Bari, Italy
| | | | - Maria Teresa Bozzi
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University "Aldo Moro" of Bari, Bari, Italy
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Translational Biomedicine and Neurosciences (DiBraiN), University "Aldo Moro" of Bari, Bari, Italy.
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Nigri P, Corsello G, Nigri L, Bali D, Kuli-Lito G, Plesca D, Pop TL, Carrasco-Sanz A, Namazova-Baranova L, Mestrovic J, Vural M, Giardino I, Losonczi L, Somekh E, Balducci MT, Pettoello-Mantovani M, Ferrara P. Prevention and contrast of child abuse and neglect in the practice of European paediatricians: a multi-national pilot study. Ital J Pediatr 2021; 47:105. [PMID: 33941234 PMCID: PMC8094489 DOI: 10.1186/s13052-021-01055-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background Child abuse and neglect, or maltreatment, is a serious public health problem, which may cause long-term effects on children’s health and wellbeing and expose them to further adulthood vulnerabilities. Studies on child maltreatment performed in Europe are scarce, and the number of participants enrolled relatively small. The aim of this multi-national European pilot study, was to evaluate the level of understanding and perception of the concepts of child abuse and neglect by European paediatricians working in different medical settings, and the attitude toward these forms of maltreatment in their practice. Methods The study was performed by a cross-sectional, descriptive, online survey, made available online to European paediatricians members of 50 national paediatric, who belonged to four different medical settings: hospital, family care, university centres and private practice. The questionnaire, designed as a multiple choice questions survey, with a single answer option consisted of 22 questions/statements. Frequency analyses were applied. Most of the data were described using univariate analysis and Chi-squared tests were used to compare the respondents and answers and a significance level of p ≤ 0.05 applied. Results Findings show that European paediatricians consider the training on child maltreatment currently provided by medical school curricula and paediatric residency courses to be largely insufficient and continuing education courses were considered of great importance to cover educational gaps. Physical violence was recognized by paediatricians mostly during occasional visits with a significant correlation between detecting abuse during an occasional visit and being a primary care paediatrician. Results also showed a reluctance by paediatricians to report cases of maltreatment to the competent judicial authorities. Conclusions Data of this study may provide useful contribution to the current limited knowledge about the familiarity of European paediatricians with child maltreatment and their skills to recognize, manage and contrast abusive childhood experiences in their practice. Finally, they could provide local legislators and health authorities with information useful to further improve public health approaches and rules able to effectively address shared risk and protective factors, which could prevent child abuse and neglect from ever occurring.
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Affiliation(s)
- Paola Nigri
- Campus Bio-Medico University Medical School, Rome, Italy
| | - Giovanni Corsello
- Italian Society of Pediatrics, Rome, Italy.,Institute of Pediatrics, University of Palermo, Palermo, Italy
| | - Luigi Nigri
- Italian Federation of Pediatricians, Rome, Italy
| | | | | | - Doina Plesca
- Romanian Society of Paediatrics, Bucharest, Romania
| | | | | | | | | | | | - Ida Giardino
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Laszlo Losonczi
- Association of Hungarian Primary Care Paediatrician, Budapest, Hungary
| | - Eli Somekh
- Department of Pediatrics, Mayanei Hayeshuah Medical Center, Bnei Brak, Israel
| | | | - Massimo Pettoello-Mantovani
- European Paediatric Association, Union of National European Pediatric Societies and Associations, Berlin, Germany.
| | - Pietro Ferrara
- Campus Bio-Medico University Medical School, Rome, Italy.,Italian Society of Pediatrics, Rome, Italy
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Pizzi E, Spinelli A, Battilomo S, Azzarito C, Balducci MT, Bettinelli ME, Campostrini S, Germinario C, Mazzarella G, Mignuoli AD, Morbidoni M, Porchia S, Simeoni L, Speri L. [The health determinants in young children: testing a new surveillance system in Italy]. Epidemiol Prev 2019; 43:66-70. [PMID: 31111715 DOI: 10.19191/ep19.1.p66.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, the scientific community has stressed the need to invest in the first 1,000 days of life - the time spanning between conception and the 2nd birthday - because it is during this period that the foundations of health are laid and whose effects will be present throughout the life and may influence the next generation. Taking this into account, in 2013 the National Centre for Disease Prevention and Control (CCM) of the Italian Ministry of Health promoted and financed a project to test a surveillance system of the main determinants of health concerning the child between the conception period and the 2nd years of life which are included in the National Programme "GenitoriPiù": folic acid before and during pregnancy, abstention from tobacco and alcohol during pregnancy and lactation, breastfeeding, infant sleep position, vaccination attitude, and early reading. The Project, started in January 2014 and ended in August 2016, has piloted the design, testing, and evaluation of the surveillance system with the view to national extension and the repeatability over time. The surveillance system has been designed to collect data through a questionnaire compiled by mothers in vaccination centres, in order to produce indicators which will enable territorial and intertemporal comparisons to be made. The project has shown the feasibility of this system, identifying favourable conditions and possible difficulties, and its ability to collect important information on children's health.
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Affiliation(s)
- Enrica Pizzi
- Centro nazionale per la prevenzione delle malattie e la Promozione della salute, Istituto superiore di sanità, Roma;
| | - Angela Spinelli
- Centro nazionale per la prevenzione delle malattie e la Promozione della salute, Istituto superiore di sanità, Roma
| | - Serena Battilomo
- Direzione generale della prevenzione sanitaria, Ministero della salute, Roma
| | | | | | | | | | | | - Gianfranco Mazzarella
- Direzione generale per la tutela della salute e coordinamento del Sistema sanitario regionale, Regione Campania, Napoli
| | | | - Marco Morbidoni
- Unità operativa complessa ambiente e salute, ASUR Area Vasta 2, Ancona
| | | | - Lara Simeoni
- Dipartimento di prevenzione, AULSS 9 Scaligera, Verona
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Germinario C, Tafuri S, Napoli C, Montagna MT, Balducci MT, Fortunato F, Martinelli D, Prato R. Young-adult carriers ofNeisseria meningitidisin Puglia (Italy): Will the pattern of circulating meningococci change following the introduction of meningococcal serogroup C conjugate vaccines? Human Vaccines 2014; 6:1025-7. [DOI: 10.4161/hv.6.12.13145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Galeone G, Spadavecchia R, Balducci MT, Pagliarulo V. [The role of Proxelan in the treatment of chronic prostatitis. Results of a randomized trial]. MINERVA UROL NEFROL 2012; 64:135-141. [PMID: 22617307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Inflammatory diseases of the prostate are one of the most difficult problems to manage in the fertile male aged between 20 and 50. Antibiotics are the gold standard for the treatment of both bacterial (category II-NIH) and non bacterial prostatitis (category III-NIH). However, antibiotics need to be associated with other therapies focused on reducing symptoms and providing a better quality of life. In the present study we sought to test the effectiveness of antibiotics and the medical device Proxelan suppositories taken together. METHODS Starting in January 2011, we conducted a randomized controlled trial involving 60 subjects with bacterial and non bacterial chronic prostatitis, who were divided into two groups. Subjects allocated in group A received only antibiotics for 28 days; subjects in group B received antibiotics + Proxelan, for 28 days as well. Before randomization all subjects underwent Meares-Stamey test, IPSS and NIH-CPSI questionnairs. All of those were repeated 60 and 120 days after randomization. Microbiological and clinical efficacy were compared using specific statistical analyses. RESULTS Data were obtained from 29 subjects allocated in group A and 31 in group B. Minor side effects were observed which did not cause study interruption in any case. Of the total population, 68,3% resulted positive to the Meares-Stamey test at study start. Proxelan was not better than antibiotics alone under a microbiological point of view (OR)=0.9; (IR) 0.3-2.8; P=0.46. According to the answers provided at the NIH-CPSI questionnaire, subjects in the group B obtained a better score compared to group A, either after 2 months (OR:2.8; 95%IC 1.2-4.1; P=0.017) and after 4 months (OR:1.67; 95%IC 0.9-2.9; P=0.04). With regards to the IPSS questionnaire, 2 months after treatment start, subjects in the group A had a probability of having urinary symptoms 2 times higher compared to subjects in group B (OR:1.9; 95%IC 1.0-3.5; P=0.028). Although Proxelan seems to improve IPSS also after 4 months, the difference does not reach the level of statistical significance. CONCLUSION Compared to antibiotics alone, the combination of antibiotics and Proxelan improve both symptoms associated to chronic prostatitis and urinary symptoms, however microbiological results are not different. Future studies may be required to confirm our results and to explain the mechanism of action of Proxelan.
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Affiliation(s)
- G Galeone
- Dipartimento delle Emergenze e Trapianti di Organi, Università di Bari Aldo Moro, Bari, Italia
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Tafuri S, Martinelli D, Melpignano L, Balducci MT, Calvario A, Bozzi A, Prato R, Germinario C. High level immunity against poliomyelitis in African and Asian refugees in southern Italy. J Travel Med 2010; 17:203-5. [PMID: 20536893 DOI: 10.1111/j.1708-8305.2009.00392.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the level of poliomyelitis immunization in refugees residing in the Asylum Seeker Center in Bari. The study was carried out during 2008 and involved 573 refugees. An antibody titer >or=1:8 was found in 99.6% for poliovirus 1, in 99.8% for poliovirus 2, and in 99.5% for poliovirus 3.
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Affiliation(s)
- Silvio Tafuri
- Department of Biomedical Sciences, Hygiene Section, University of Bari, Puglia Regional Epidemiological Observatory, Bari, Italy
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Tafuri S, Martinelli D, Caputi G, Balducci MT, Germinario C, Prato R. Simultaneous administration of vaccines in immunization protocols: an audit in healthcare workers in the Puglia region of Italy. Hum Vaccin 2009; 5:745-7. [PMID: 19684482 DOI: 10.4161/hv.5.11.9438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Through a standardized questionnaire, this study investigated the opinions and attitudes of Vaccine Service staff in the Puglia Region of Italy regarding simultaneous administration of vaccines. Co-administration was practiced by 89.4%, and the staff's positive opinions were that it is important for work organization (80.8%) and as an opportunity to increase vaccine take-up (59.9%). Negative opinions were that it increases the risk of adverse reactions or undesired effects (11.3%) and can engender fear of such reactions in parents (31.1%).
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Affiliation(s)
- Silvio Tafuri
- Department of Biomedical Sciences, Hygiene Section, University of Bari, Apulia Regional Epidemiological Observatory, Bari, Italy
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Tafuri S, Martinelli D, Balducci MT, Fortunato F, Prato R, Germinario C. [Epidemiology of femoral neck fractures in Puglia (Italy): an analysis of existing data]. Ig Sanita Pubbl 2008; 64:623-636. [PMID: 19188938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of this study was to describe the epidemiology of femoral neck fractures in Puglia (Italy) by analysing hospital discharge records from 1998 to 2005 and mortality data from 1998 to 2003. In total, 41,354 admissions for femoral neck fractures were recorded, 75% of which in females. The mean age of patients was 78 years (73 in males, 79 in females). Approximately 70% of patients below 50 years of age were male, while above age 50, only 23% of patients were male. Yearly admission rates increased from 1998 to 2005. Mortality records recorded 1,031 deaths due to femoral neck fracture with a decreasing trend in mortality rates in the years considered. Fractures in males were most commonly associated with work related accidents and motor vehicle accidents. In females most fractures were related to home accidents. These results may be used to guide prevention strategies.
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Affiliation(s)
- S Tafuri
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Bari, Osservatorio Epidemiologico Regione Puglia, Bari
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Germinario C, Balducci MT, Picoco F, Semisa D, Martinelli D, Mincuzzi A, Battista T, Prato R. [Quality of life evaluation in residential facilities for the mentally ill in Puglia (Italy). Phase 2: evaluation of quality of care]. Ig Sanita Pubbl 2007; 63:525-542. [PMID: 18416026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Cinzia Germinario
- Sezione di Igiene e Medicina Preventiva, Universita degli Studi di Bari, Bari, Italy.
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Ciancio BC, Di Renzi M, Binkin N, Perra A, Prato R, Bella A, Niutta P, Rossi F, Germinario C, Balducci MT, Caputi G, Fusco A. [Risk factors for mortality during a heat-wave in Bari (Italy), summer 2005.]. Ig Sanita Pubbl 2007; 63:113-125. [PMID: 18223698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The Italian Heat Health Watch Warning System (HHWWS) was set up following the over 3000 excess deaths which occurred in Italy during the heat wave of 2003, In June 2005 the warning system issued a heat warning in various Italian cities. METHODS A case control study was performed in one of these cities (Bari) in order to identify individual and environmental risk factors as well as preventive strategies for reducing mortality during future heat waves. Cases were defined as subjects aged <65 years who had died during the heat wave and whose death certificate listed one of the following as the cause of death: heat, cardiovascular or cerebrovascular disorders, neurocognitive disorders, dehydration or fever/infection not otherwise specified. For each case, three age-matched controls were randomly selected among individuals followed by the same general practitioner as the case. All variables significantly associated with mortality (<0.1) in the univariate analysis were entered into a conditional logistic regression model and the population attributable fraction (PAF) was calculated for significant variables (at p<0.05). RESULTS Twenty cases and sixty controls were included in the study. In 17 cases (89%) death had occurred at home and 11(55%) of these were cardiovascular- related deaths. At the multivariate analysis, the factors significantly associated with mortality risk during the heat wave were: having a functioning air conditioner at home [OR:0.09(95% CI 0.01-1.00)], having an Activities of Daily Living score <2 [OR:21.0(95%CI 1.81-242.47)] and having been hospitalized the year preceding death [OR:18.1(95%CI 2.04-160.51)]. CONCLUSIONS Public health interventions during heat waves should include the provision of access to an air conditioned environment. Subjects with impaired health (especially if recently hospitalized) and with significant limitations in their activities of daily living are probably at higher risk during heat waves.
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Affiliation(s)
- Bruno Christian Ciancio
- European Programme for Intervention Epidemiology Training (EPIET) Health Protection Agency Centre for Infection, London, UK
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