1
|
Rossini L, Bonardi CM, Bresolin S, Trevisson E, Marzollo A. Severe Herpes Simplex Encephalitis: an Unusual Presentation of IPEX. J Clin Immunol 2024; 44:100. [PMID: 38625673 DOI: 10.1007/s10875-024-01702-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Linda Rossini
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital of Padova, Padova, Italy
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, Via Giustiniani, 3, 35128, Padova, Italy.
| | - Silvia Bresolin
- Onco-Hematology, Stem Cell Transplant and Gene Therapy, Istituto di Ricerca Pediatrica Foundation - Città della Speranza, Padova, Italy
| | - Eva Trevisson
- Clinical Genetics Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Antonio Marzollo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, University Hospital of Padova, Padova, Italy
| |
Collapse
|
2
|
Bonardi CM, Nosadini M, Lorenzoni G, Tessari A, Santoro L, Pettenazzo A, Gregori D, Sartori S, Amigoni A. PICU Admission of Children for Status Epilepticus: Is There a Different Approach Between Referral and Second-Level Hospitals in an Italian Region? Clin Pediatr (Phila) 2023:99228231220174. [PMID: 38142368 DOI: 10.1177/00099228231220174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2023]
Abstract
Appropriate status epilepticus (SE) management is key to minimize admission to the pediatric intensive care unit (PICU). We retrospectively describe 115 children admitted to the PICU of the tertiary-care referral hospital of Padova for seizures, SE, and SE-related complications (59% from second-level hospitals, 41% from the referral hospital) and compare SE management among hospitals. Compared with the referral center, in second-level hospitals, anesthetics were more often administered as first/second drug (P < .001), and intubation was more frequent (P < .001). Intubation was significantly associated with SE onset at home (P = .045) and benzodiazepine-associated respiratory depression (P = .044). There was no association between intubation and SE duration, etiology, PICU length of stay, and morbidity at discharge. In conclusion, adherence to treatment protocols on SE management after the first-line drug differs between referral center and second-level hospitals. Lack of association with SE characteristics and patient's outcome suggests PICU admission could be due to inappropriate invasive management.
Collapse
Affiliation(s)
| | | | | | - Anna Tessari
- Azienda Ospedale Università Padova, Padova, Italy
| | | | | | | | | | | |
Collapse
|
3
|
Ancora C, Marchi M, Bonardi CM, Sartori G, Lopreiato R, Zuccarello D, D'Errico I, Nosadini M, Sartori S, Boniver C, Toldo I, Salviati L. Electroclinical Features in Two Novel STRADA Patients and a Functional Yeast Assay for the Validation of Missense STRADA Mutations. Pediatr Neurol 2023; 148:152-156. [PMID: 37722301 DOI: 10.1016/j.pediatrneurol.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023]
Abstract
Loss of function of the STRADA gene, an upstream mTOR inhibitor, causes a rare neurodevelopmental disorder characterized by polyhydramnios, megalencephaly, and symptomatic epilepsy (PMSE syndrome). Patients display a homogeneous phenotype including early-onset drug-resistant epilepsy, severe psychomotor delay, multisystemic comorbidities, and increased risk of premature death. The administration of sirolimus, an mTOR inhibitor, is helpful in controlling seizures in this syndrome. We report the electroclinical phenotype of two novel patients and the development of a yeast model to validate the pathogenicity of missense variants. Patient 1 harbored a missense STRADA variant and had a peculiar electroclinical phenotype with a relatively mild epilepsy course. Patient 2 harbored a truncating STRADA variant and showed a typical PMSE phenotype and a favorable response to early treatment with sirolimus. When we modeled the p.(Ser264Arg) STRADA change in its yeast homolog SPS1, it impaired SPS1 function. The results underlie the importance of a timely molecular diagnosis in these patients and show that yeast is a simple yet effective model to validate the pathogenicity of missense variants.
Collapse
Affiliation(s)
- Caterina Ancora
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Marchi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy; Clinical Genetics Lab, Città della Speranza Pediatric Research Institute, Padua, Italy
| | - Claudia Maria Bonardi
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Geppo Sartori
- Department of Biomedical Sciences, University of Padua, Padua, Italy
| | | | - Daniela Zuccarello
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Margherita Nosadini
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Stefano Sartori
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Clementina Boniver
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Leonardo Salviati
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy; Clinical Genetics Lab, Città della Speranza Pediatric Research Institute, Padua, Italy
| |
Collapse
|
4
|
Paolin C, Zanetto L, Frison S, Boscolo Mela F, Tessari A, Amigoni A, Daverio M, Bonardi CM. Apneas requiring respiratory support in young infants with COVID-19: a case series and literature review. Eur J Pediatr 2023; 182:2089-2094. [PMID: 36912961 PMCID: PMC10009862 DOI: 10.1007/s00431-023-04856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
The objective of this study is to describe the clinical features of young infants with apneas as a clinical sign of COVID-19. We reported the cases of 4 infants who needed respiratory support in our PICU for a severe course of COVID-19 complicated with recurrent apneas. Moreover, we conducted a review of the literature about COVID-19 and apneas in infants ≤ 2 months of corrected age. A total of 17 young infants were included. Overall, in most of the cases (88%), apnea was an initial symptom of COVID-19, and in two cases, it recurred after 3-4 weeks. Regarding neurological workup, most children underwent a cranial ultrasound, while a minority underwent electroencephalography registration, neuroimaging, and lumbar punctures. One child showed signs of encephalopathy on electroencephalogram, with further neurological workup resulting normal. SARS-CoV-2 was never found in the cerebrospinal fluid. Ten children required intensive care unit admission, with five of them needing intubation and three non-invasive ventilation. A less invasive respiratory support was sufficient for the remaining children. Eight children were treated with caffeine. All patients had a complete recovery. Conclusion: Young infants with recurrent apneas during COVID-19 usually need respiratory support and undergo a wide clinical work-up. They usually show complete recovery even when admitted to the intensive care unit. Further studies are needed to better define diagnostic and therapeutic strategies for these patients. What is Known: • Although the course of COVID-19 in infants is usually mild, some of them may develop a more severe disease needing intensive care support. Apneas may be a clinical sign in COVID-19. What is New: • Infants with apneas during COVID-19 may require intensive care support, but they usually show a benign course of the disease and full recovery.
Collapse
Affiliation(s)
- Chiara Paolin
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Lorenzo Zanetto
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Sara Frison
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Federica Boscolo Mela
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Anna Tessari
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy.
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University Hospital of Padova, via Giustiniani 3, 35128, Padua, Italy
| |
Collapse
|
5
|
Bonardi CM, Furlanis GM, Toldo I, Guarrera B, Luisi C, Pettenazzo A, Nosadini M, Boniver C, Sartori S, Landi A. Myoclonic super-refractory status epilepticus with favourable evolution in a teenager with FIRES: Is the association of vagus nerve stimulation and cannabidiol effective? Brain Dev 2023; 45:293-299. [PMID: 36725381 DOI: 10.1016/j.braindev.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Febrile infection-related epilepsy syndrome (FIRES) is a rare and catastrophic clinical syndrome occurring in previously healthy patients. Aetiology is still unknown and outcome usually poor. We describe a case of myoclonic prolonged super refractory status epilepticus (P-SRSE) in FIRES in a patient admitted to the paediatric intensive care unit of Padova, Italy. CASE REPORT A previously healthy 14-year-old girl with onset of myoclonic status epilepticus after a mild febrile illness was admitted to our hospital with a diagnosis of FIRES. Extensive diagnostic work-up was inconclusive. Status epilepticus and electroclinical seizures recurred every time weaning from anaesthetic agents was attempted. Eventually, a vagal nerve stimulator (VNS) was implanted and cannabidiol (CBD) administered, 43 days and 70 days after P-SRSE onset, respectively. Two days after CBD introduction, status epilepticus weaned and the girl rapidly regained complete consciousness showing a brilliant and unexpected recovery. At last follow-up, 12 months later, she is 8-months seizure free on multiple antiseizure medications, has only mild neuropsychological impairment with no neurological and intellective deficit. CONCLUSIONS To our knowledge, this represents a unique case with an extremely favourable evolution with a possible effect of the association of VNS and CBD to traditional antiseizure medications.
Collapse
Affiliation(s)
- Claudia Maria Bonardi
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | | | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Brando Guarrera
- Paediatric and Functional Neurosurgery Unit, Padua University Hospital, Padua, Italy
| | - Concetta Luisi
- Department of Neurosciences (DNS), University of Padua, Padua, Italy; Rare and Complex Epilepsy Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Full Member of European Reference Network EpiCARE, Rome, Italy
| | - Andrea Pettenazzo
- Paediatric Intensive Care Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Clementina Boniver
- Paediatric Neurology and Neurophysiology Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Woman's and Child's Health, Padua University Hospital, Padua, Italy; Department of Neurosciences (DNS), University of Padua, Padua, Italy.
| | - Andrea Landi
- Paediatric and Functional Neurosurgery Unit, Padua University Hospital, Padua, Italy; Department of Neurosciences (DNS), University of Padua, Padua, Italy
| |
Collapse
|
6
|
Poletto E, Cavagnero F, Pettenazzo M, Visentin D, Zanatta L, Zoppelletto F, Pettenazzo A, Daverio M, Bonardi CM. Corrigendum on: Ventilation weaning and extubation readiness in children in pediatric intensive care unit: A review. Front Pediatr 2022; 10:1044681. [PMID: 36313866 PMCID: PMC9616164 DOI: 10.3389/fped.2022.1044681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 12/02/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.867739.].
Collapse
Affiliation(s)
- Elisa Poletto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Francesca Cavagnero
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marco Pettenazzo
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Davide Visentin
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Laura Zanatta
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Fabrizio Zoppelletto
- Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Andrea Pettenazzo
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| | - Claudia Maria Bonardi
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy
| |
Collapse
|
7
|
Sfriso F, Bonardi CM, Viaggi F, Sartori S, Boniver C, Martinolli F, Da Dalt L, Frigo AC, Mazza A, Amigoni A. Dexmedetomidine for EEG sedation in children with behavioral disorders. Acta Neurol Scand 2020; 142:493-500. [PMID: 32501525 DOI: 10.1111/ane.13293] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/13/2020] [Revised: 05/17/2020] [Accepted: 05/31/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of sedation with dexmedetomidine, a highly selective α2-agonist with sedative effect, for EEG recording in children with behavioral disorders. MATERIAL AND METHODS Prospective observational study on children with behavioral disorders undergoing EEG at the Pediatric Hospital in Padova, Italy. A 2 mcg/kg intravenous bolus of dexmedetomidine was administered, followed by a 1-2 mcg/kg/h infusion. If necessary, bolus was repeated up to 3 times to reach the target level of sedation, assessed by Pediatric Sedation State Scale. Patients were fully monitored before, during and after the procedure until complete recovery. EEG recording quality, and caregivers' satisfaction were collected. Any adverse effect was registered using SIVA score. RESULTS For this preliminary study, 19 patients were enrolled. EEG was successfully completed in all of them. Mean total dose of dexmedetomidine was 3.7 ± 1.7 mcg/kg. Adequate sedation was achieved within 11.9 ± 8 minutes. Mean time to first awakening was 30.9 ± 36.9 minutes and time to complete recovery 113.3 ± 92.7 minutes. Adverse effects (hypotension, bradycardia) were reported in 10 patients, all classified as "minor." EEG recording quality was good or excellent. Parents' satisfaction was high in all the interviewed families. CONCLUSIONS Intravenous dexmedetomidine as a single drug showed an excellent efficacy and good safety profile for EEG recording in children with behavioral disorders.
Collapse
Affiliation(s)
- Francesca Sfriso
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Claudia Maria Bonardi
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Viaggi
- Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Clementina Boniver
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Francesco Martinolli
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Biostatistics, Epidemiology and Public Health Unit, Padova University School of Medicine, Padova, Italy
| | - Alessandro Mazza
- Pediatric Emergency Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | - Angela Amigoni
- Pediatric Intensive Care Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| |
Collapse
|
8
|
Toldo I, Bonardi CM, Bettella E, Polli R, Talenti G, Burlina A, Sartori S, Murgia A. Brain malformations associated to Aldh7a1 gene mutations: Report of a novel homozygous mutation and literature review. Eur J Paediatr Neurol 2018; 22:1042-1053. [PMID: 30005813 DOI: 10.1016/j.ejpn.2018.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND The ALDH7A1 gene is known to be responsible for autosomal recessive pyridoxine-dependent epilepsy (OMIM 266100). The phenotypic spectrum of ALDH7A1 mutations is very heterogeneous ranging from refractory epilepsy and neurodevelopmental delay, to multisystem neonatal disorder. AIM The present study aims at describing the phenotype associated with a novel homozygous ALDH7A1 mutation and the spectrum of brain malformations associated with pyridoxine-dependent epilepsy. METHODS We conducted a literature review on the Internet database Pubmed (up to November 2017) searching for ALDH7A1 mutations associated with brain malformations and brain MRI findings. RESULTS We present the case of two siblings, children of related parents. The proband presented neonatal focal seizures not responding to conventional antiepileptic drugs. Electroencephalography showed a suppression burst pattern and several multifocal ictal patterns, responsive to pyridoxine. Brain MRI was normal. Molecular analysis by targeted next-generation sequencing panel for epileptic encephalopathy disclosed a homozygous missense mutation of ALDH7A1. The same mutation was then found in a stored sample of DNA from peripheral blood of an older sister dead 3 years earlier. This girl presented a complex brain malformation diagnosed with a foetal MRI and had neonatal refractory seizures with suppression burst pattern. She died at 6 months of age. LITERATURE REVIEW The brain abnormalities most frequently reported in pyridoxine-dependent epilepsy include: agenesia/hypoplasia of the corpus callosum, not specific white matter abnormalities, large cisterna magna, ventriculomegaly, haemorrhages, cerebellum hypoplasia/dysplasia, and, more rarely, dysplasia of the brainstem and hydrocephalus. DISCUSSION AND CONCLUSIONS ALDH7A1 mutations have been associated to different brain abnormalities, documented by MRI only in few cases. The study cases expand the clinical spectrum of ALDH7A1 associated conditions, suggesting to look for ALDH7A1 mutations not only in classical phenotypes but also in patients with brain malformations, mainly if there is a response to a pyridoxine trial.
Collapse
Affiliation(s)
- Irene Toldo
- Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | | | - Elisa Bettella
- Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | - Roberta Polli
- Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | - Giacomo Talenti
- Department of Neurosciences, University Hospital of Padua, Italy.
| | - Alberto Burlina
- Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | - Stefano Sartori
- Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | | |
Collapse
|
9
|
Giacomet V, Penagini F, Trabattoni D, Viganò A, Rainone V, Bernazzani G, Bonardi CM, Clerici M, Bedogni G, Zuccotti GV. Safety and immunogenicity of a quadrivalent human papillomavirus vaccine in HIV-infected and HIV-negative adolescents and young adults. Vaccine 2014; 32:5657-61. [PMID: 25149430 DOI: 10.1016/j.vaccine.2014.08.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 12/18/2022]
Abstract
Human papillomavirus (HPV) infection is highly prevalent and can lead to cancer; the development of safe and efficacious vaccines for HPV is a major public health concern. The two licensed HPV vaccines contain recombinant virus-like particles of HPV 16 and 18; one of such vaccines also protects against HPV types 6 and 11 which cause genital warts. We determined safety and immunogenicity of quadrivalent HPV vaccine in HIV-infected and HIV-negative adolescents and young adults, aged 13-27 years. The seroconversion rate, assessed by antibody titers, 1 month after the administration of the third vaccine dose was 0.85 (95% CI 0.75-0.95) in the HIV-infected group and 0.91 (0.83-0.99) in the HIV-negative subjects (p=0.52). The vaccine was generally safe and well tolerated; the most common side effect was local pain and the most frequent systemic side effect was headache. This is the first report on response to HPV vaccination in both female and male HIV-infected adolescents and young adults and highlights that this population may benefit from HPV immunoprophylaxis. Further studies are needed to examine the long term efficacy of this vaccine in HIV-infected individuals.
Collapse
Affiliation(s)
- Vania Giacomet
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | - Daria Trabattoni
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy
| | - Alessandra Viganò
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy.
| | - Veronica Rainone
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy
| | - Giada Bernazzani
- Department of Pediatrics, Luigi Sacco Hospital, University of Milan, Italy
| | | | - Mario Clerici
- Department of Immunology, Luigi Sacco Hospital, University of Milan, Italy; Don C Gnocchi Foundation, IRCCS, Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy
| | | |
Collapse
|
10
|
Abstract
The amygdala is considered to be a critical neural substrate underlying the formation of stimulus-reward associations, and is known to receive substantial innervation from dopaminergic neurons located within the ventral mesencephalon. However, relatively little is known about the function of the mesoamygdaloid dopamine projection in stimulus-reward learning. Recently, we have found post-session intra-amygdala microinjections of d-amphetamine to enhance appetitive Pavlovian conditioning as assessed in a discriminative approach task. In the present study, we have examined the effects of dopamine receptor agonists possessing relative selectivity for the D1, D2 and D3 receptor subtypes in order to examine more fully the role of the mesoamygdaloid dopamine projection in stimulus-reward learning. Thus, subjects were trained to associated an initially neutral stimulus (CS+) with 10% sucrose reward (US). A second, control stimulus (CS-) was also presented but never paired with sucrose reward. In order to measure specifically the conditioned response to CS+/CS- presentation, responding during CS and US presentations was measured separately. Immediately following each training session, subjects received bilateral intra-amygdala infusion of 0.1, 1 or 10 nmol/side of SKF-38393, quinpirole or 7-OH-DPAT. Infusions of SKF-38393 or quinpirole were without effect on CS+ approach. However, post-session intra-amygdala infusions of 7-OH-DPAT enhanced selectively CS+ approach in a dose-dependent fashion. No dose of any drug affected CS- approach, US behaviours, or measures of extraneous behaviour. Subsequent acquisition of a novel conditioned instrumental response was also unaffected. Thus, the present data indicate a selective involvement of the D3 dopamine receptor subtype in the modulation of stimulus-reward learning by the mesoamygdaloid dopamine projection.
Collapse
MESH Headings
- 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine/administration & dosage
- 2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-benzazepine/pharmacology
- Amygdala/anatomy & histology
- Amygdala/physiology
- Animals
- Conditioning, Operant/drug effects
- Discrimination Learning/drug effects
- Dopamine Agonists/administration & dosage
- Dopamine Agonists/pharmacology
- Injections
- Male
- Photic Stimulation
- Quinpirole/administration & dosage
- Quinpirole/pharmacology
- Rats
- Receptors, Dopamine D2/agonists
- Receptors, Dopamine D3
- Reward
- Tetrahydronaphthalenes/administration & dosage
- Tetrahydronaphthalenes/pharmacology
Collapse
Affiliation(s)
- P K Hitchcott
- Department of Psychology, University of York, Heslington, UK
| | | | | |
Collapse
|