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Castagno E, Balbo M, Procacci A, Parisi A, Paglia F, Bergese I, Versace A, Bondone C. [Early warning scores of clinical deterioration in pediatric patients: a literature review]. Assist Inferm Ric 2023; 42:137-151. [PMID: 37721339 DOI: 10.1702/4095.40918] [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: 09/19/2023]
Abstract
. Early warning scores for clinical deterioration in pediatric patients: a literature review. INTRODUCTION An early recognition of clinical worsening (the manifestation of signs and symptoms resulting in physiological instability) in pediatric inpatients may prevent the evolution towards cardiorespiratory arrest. In recent decades, several tools known as PEWS (Pediatric Early Warning Scores), have been developed, aiming to reduce in-hospital morbidity and mortality. OBJECTIVE To describe efficacy, sensitivity and specificity of the available tools for early detection of clinical worsening in children, based on literature review. METHODS Systematic review through the consultation of PubMed and Google Scholar, cross-combining Mesh terms and free text words. RESULTS Out of 266 analysed papers, 34 were included in this review: 23 retrospective observational studies, 8 reviews, 1 reliability study, and 2 pilot studies. Overall, 23 main PEWS with sufficient evidence of efficacy were described (11 track and trigger and 12 aggregate). Ranges of sensibility and specificity were available only for 18 PEWS. It is not possible to recognize a gold standard, however, some PEWS are better in terms of validity and efficacy in different clinical settings. Internationally, the BPEWS (Brighton Pediatric Early Warning Score) is the most commonly adopted tool, able to identify clinical worsening of in-hospital children almost 11 hours before cardiac arrest. CONCLUSIONS Although with limited evidence, validated PEWS have shown good ability to prevent the risk of clinical worsening by reducing adverse events. Further studies and greater standardization according to the clinical context are still needed.
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Affiliation(s)
- Emanuele Castagno
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Margherita Balbo
- Corso di Laurea Infermieristica, Università Cattolica del Sacro Cuore, Presidio Ospedale Cottolengo, Torino, Italia
| | - Arianna Procacci
- Corso di Laurea Infermieristica, Università Cattolica del Sacro Cuore, Presidio Ospedale Cottolengo, Torino, Italia
| | - Alessandro Parisi
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Federica Paglia
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Ilaria Bergese
- S.C. Rianimazione 5 Pediatrica, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Antonia Versace
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
| | - Claudia Bondone
- S.C. Pediatria d'Urgenza, Ospedale Infantile Regina Margherita, A.O.U. Città della Salute e della Scienza di Torino, Italia
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Tonna M, Ottoni R, Paglia F, De Panfilis C, marchesi C. “Pseudoneurotic Schizophrenia” Revisited: The role of obsessive-compulsive symptoms in low-level disorganization psychosishosiser. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptom (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.MethodSeventy-five patients affected by schizophrenia were administered the SCID-IV, the PANSS, the YBOCS and the SOFAS.The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high).ResultsIn both groups, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at higher levels of disorganization (Figure 1).ConclusionData suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS. Particularly, mild OCS contributes to higher levels of functioning in patients with psychosis at low levels of disorganization. In keeping with the historical concept of “pseudoneurotic schizophrenia”, we speculate that obsessive dimension might have a pathoplastic influence in milder forms of schizophrenia spectrum disorders, balancing the effect of underlying low disorganization symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Celestini A, Paglia F. The Wellens' Syndrome in the management of acute coronary syndromes. Intern Emerg Med 2012; 7 Suppl 1:S19-20. [PMID: 21365465 DOI: 10.1007/s11739-011-0546-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
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Celestini A, Paglia F, Dell’ Unto O, Guarisco R, Puoti C. Rare splenic complications and specific serology: decisive diagnostic tools in two cases of visceral leishmaniasis. Ital J Med 2012. [DOI: 10.4081/itjm.2011.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Visceral leishmaniasis (VL) is a major endemic vector-borne disease in Southern Europe. We present two cases of VL, both characterized by splenic complications. Methods and results: Case 1: A 47-year-old female presented with effort angina, hepatosplenomegaly and pancytopenia. The clinical course was complicated by splenic infarction. Although bone marrow biopsy failed to show amastigotes, diagnosis was performed by a fast agglutinating screening test (FAST) and confirmed by a direct agglutinating test (DAT). The patient was treated successfully with AmBisome. Case 2: A 22-year-old male who had undergone a splenectomy to treat splenic rupture related to a minor trauma four months earlier presented with fever, nocturnal sweats and weight loss. The lack of pancytopenia was due to the absence of the spleen. The first biopsy did not identify parasites, but because the FAST had been positive, another bone marrow biopsy was performed, which demonstrated leishmaniasis. This patient was treated with the same schedule of AmBisome infusion. Discussion: 1) The clinical presentation of VL can be atypical, 2) splenic complications can characterize this disease, and 3) specific serology may be an important tool to reach a diagnosis.
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Puoti C, Bellis L, Guarisco R, Costanza OM, Felici R, Spilabotti L, Paglia F, Galossi A, Dell' Unto O. Quantitation of tissue polypeptide antigen (TPA) in hepatic and systemic circulation in patients with chronic liver diseases. J Gastroenterol Hepatol 2009; 24:1847-51. [PMID: 19686414 DOI: 10.1111/j.1440-1746.2009.05916.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/14/2022]
Abstract
BACKGROUND AND AIM Abnormal serum tissue polypeptide antigen (TPA) values are commonly found in patients with chronic liver damage and liver cirrhosis even in the absence of malignancies. The aim of this study was to compare serum TPA levels in patients with cirrhosis, to examine correlations between TPA levels and the degree of portal hypertension, and to evaluate TPA concentrations in paired hepatic and peripheral blood samples. METHODS A total of 128 patients with chronic liver disease of various severity were studied prospectively. TPA concentrations in hepatic vein and peripheral blood were determined, and Hepatic Vein Pressure Gradient (HVPG) was measured. RESULTS TPA levels were significantly higher in patients with cirrhosis than in those with chronic hepatitis, and in systemic circulation than in hepatic vein blood. Peripheral but not hepatic TPA levels did correlate with the HVPG. Subjects with clinically significant portal hypertension (HVPG > 10 mmHg) showed significantly higher peripheral TPA levels than those with HVPG < 10 mmHg. CONCLUSIONS Our data suggest that the increased TPA levels observed in cirrhotic patients and the high systemic-to-hepatic blood TPA gradient are probably due to the presence of portal-systemic shunts rather than to hepatic necro-inflammatory activity. In clinical practice, TPA determination could help us to identify and to follow up cirrhotic patients with more severe portal hypertension.
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Affiliation(s)
- Claudio Puoti
- Department of Internal Medicine and Liver Unit, Marino General Hospital, Rome, Italy.
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Puoti C, Pellicelli AM, Romano M, Mecenate F, Guarisco R, Barbarini G, Mazzoni E, Spilabotti L, Bellis L, Paglia F, Barlattani A, Picardi A, Paffetti A, Bonaventura ME, Nosotti L, Mitidieri O, Dell'Unto O, Villani R, Dell'Unto C, Morrone A, Soccorsi F. Treatment of hepatitis C virus carriers with persistently normal alanine aminotransferase levels with peginterferon alpha-2a and ribavirin: a multicentric study. Liver Int 2009; 29:1479-84. [PMID: 19422478 DOI: 10.1111/j.1478-3231.2009.02042.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 12/22/2022]
Abstract
BACKGROUND/AIMS To evaluate, in clinical practice, the efficacy and safety of combined antiviral treatment in hepatitis C virus (HCV) carriers with normal alanine aminotransferase (ALT) levels. METHODS Eighty-eight HCV carriers with persistently normal ALT levels were enrolled. All patients received peginterferon (PEG-IFN) alpha-2a 180 microg once weekly plus ribavirin (RBV) 800 mg/day for 24 weeks (HCV-2 and -3) or 1000-1200 mg/day for 48 weeks (HCV-1). RESULTS Rapid virological response (RVR) was seen in 66/88 patients (75%): 19/32 HCV-1 (59%), 40/46 HCV-2 (87%) and 7/10 HCV-3 patients. Younger patients, leaner subjects and patients with non-1 genotype or lower baseline HCV RNA levels were more likely to achieve an RVR. Sustained virological response (SVR) was seen in 69/88 patients (78%): 20/32 HCV-1 patients (62%), 41/46 HCV-2 patients (89%) and 8/10 (80%) HCV-3 patients. The overall SVR rate was 88% in patients with RVR (58/66) and 50% in those without RVR. CONCLUSIONS The combination of PEG-IFN alpha-2a and RBV produces, in patients with normal ALT, virological response rates that are comparable or even higher than those obtained in patients with elevated ALT levels. Thus, we suggest that in selected cases immediate therapy might be preferred to a 'wait-and-see' policy.
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Affiliation(s)
- Claudio Puoti
- Department of Internal Medicine and Liver Unit, Marino Hospital, Rome, Italy.
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Carnevale V, Scillitani A, Vecci E, D'Erasmo E, Romagnoli E, Paglia F, Pepe J, Baldini V, Santori C, De Geronimo S, Minisola S. Dehydroepiandrosterone sulfate and bone resorption rates as reflected by serum levels of C-terminal telopeptide of type I collagen: a study in healthy men. J Endocrinol Invest 2005; 28:102-5. [PMID: 15887853 DOI: 10.1007/bf03345350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sex steroid hormones contribute to the physiological regulation of bone turnover in males. To address this issue, we investigated serum estradiol (E2), total testosterone (T), and DHEAS concentrations, along with serum levels of carboxy-terminal telopeptide of type I collagen (sCTx), in a sample of 76 healthy men aged 23 to 87. The concentration of sCTx declined with age. Both T and DHEAS, at variance with E2, showed a significant age-related decline. T, DHEAS and sCTx significantly (p<0.01) correlated with each other. DHEAS and T were significantly associated after correcting for age (r=0.35, p=0.002) or body mass index (r=0.65, p<0.0001). DHEAS, but not T, significantly correlated with sCTx after correcting for age (r=0.26, p=0.026, and r=0.20, p=0.08, respectively). Stepwise multiple regression analysis showed that only DHEAS (but not T or E2) was a significant independent predictor of sCTx (p=0.0001). Our results show that adrenal androgens play a crucial role in regulating bone resorption in aging men.
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Affiliation(s)
- V Carnevale
- Department of Internal Medicine, Casa Sollievo della Sofferenza Hospital IRCCS, San Giovanni Rotondo (FG), Italy.
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Romagnoli E, Carnevale V, Nofroni I, D'Erasmo E, Paglia F, De Geronimo S, Pepe J, Raejntroph N, Maranghi M, Minisola S. Quality of life in ambulatory postmenopausal women: the impact of reduced bone mineral density and subclinical vertebral fractures. Osteoporos Int 2004; 15:975-80. [PMID: 15118812 DOI: 10.1007/s00198-004-1633-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 03/15/2004] [Indexed: 10/26/2022]
Abstract
Health-related quality of life (HRQOL) in postmenopausal women with osteoporosis has hitherto been mainly assessed in patients with clinically recognized vertebral fractures. Our study aimed to investigate the QOL perception in 361 asymptomatic ambulant postmenopausal women who came to our center for an osteoporosis screening program planned with their general practitioners. The Quality of Life Questionnaire of the European Foundation for Osteoporosis (QUALEFFO) was administered to all subjects. The participants underwent bone mineral density (BMD) measurements by DXA of either the lumbar spine and/or the femoral neck, as well as X-ray examination of the thoracolumbar spine to identify subclinical vertebral fractures. According to the WHO definition, where subjects are subdivided by BMD values into three groups (women with normal BMD, osteopenia, and osteoporosis), a significant difference was found only for the domains which explore general health perception (p<0.01 by ANOVA) and mental function (p<0.001 by ANOVA). When we segregated both osteopenic and osteoporotic women according to whether or not they had vertebral fractures, a significant difference was found only in osteoporotic patients for domains which explore physical function (p<0.001), social function (p<0.001), general health perception (p<0.02), and total QUALEFFO score (p<0.01). Stepwise multiple logistic regression analysis of the whole sample showed that both vertebral fractures and a low femoral BMD impairs QOL perception, while age did not exert a significant influence. ROC curves analysis demonstrated a low discriminating capacity of individual domains and total QUALEFFO score for both vertebral deformities and BMD categorization. Our results showed that QUALEFFO is not able to discriminate between patients with or without subclinical vertebral fractures. However, some aspects of QOL appear to be impaired in patients with subclinical vertebral fractures or reduced BMD.
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Affiliation(s)
- Elisabetta Romagnoli
- Department of Clinical Sciences, University La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy.
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Carnevale V, Dionisi S, Nofroni I, Romagnoli E, Paglia F, De Geronimo S, Pepe J, Clemente G, Tonnarini G, Minisola S. Potential Clinical Utility of a New IRMA for Parathyroid Hormone in Postmenopausal Patients with Primary Hyperparathyroidism. Clin Chem 2004; 50:626-31. [PMID: 14718396 DOI: 10.1373/clinchem.2003.026328] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: A new commercially available (so-called second-generation) IRMA for parathyroid hormone (PTH) separately detects intact PTH and its N-truncated fragments; however, no studies have compared the first- and second-generation IRMAs for PTH in patients with primary hyperparathyroidism (PHPT) to assess their respective diagnostic accuracies.
Methods: We concomitantly investigated 39 postmenopausal patients with PHPT and a control group of 70 healthy postmenopausal women matched for age, renal function, and vitamin D status. In all individuals, PTH was measured with a classic IRMA (PTH-S; DiaSorin Inc.), which uses antibodies directed against epitopes 1–34 and 39–84, and a new method (Scantibodies Laboratory. Inc.), which uses antibodies against epitopes 1–4 and 39–84 (PTH-W) and epitopes 7–34 and 39–84 (PTH-T). We also assayed serum PTH in 10 PHPT patients every 24 h for 5 days after successful surgery.
Results: The different assays gave serum PTH values that were >2 SD higher than values for the control population in 59% (PTH-S), 77% (PTH-W), and 82% (PTH-T) of patients with PHPT. However, ROC curve analysis showed no significant differences among the three PTH assays, demonstrating overlapping diagnostic sensitivities. In PHPT patients, the correlation among the assays was highly significant (r = 0.91–0.92; P <0.001). The ratio PTH-W:PTH-T × 100 showed a gaussian distribution in both PHPT patients and controls, whose mean (SD) values [63.4 (13.3)% vs 64.5 (9.5)%, respectively] did not differ significantly. After parathyroidectomy, the mean percentages of variation in PTH detected with all of the assays were quite similar.
Conclusions: The distribution of the PTH-W:PTH-T ratio in patients and controls suggests that PHPT does not markedly influence the rate at which biologically inactive fragments are generated by central or peripheral cleavage of PTH. The similar postoperative curves seem to contradict the hypothesized effect of acute hypocalcemia in modulating the central secretion of hormonal fragments. Our results indicate that the three investigated assays have similar diagnostic sensitivities in PHPT.
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Affiliation(s)
- Vincenzo Carnevale
- Department of Internal Medicine, Casa Sollievo della Sofferenza Hospital, IRCCS, Viale dei Cappuccini, San Giovanni Rotondo, FG, Italy
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Carnevale V, Manfredi G, Romagnoli E, De Geronimo S, Paglia F, Pepe J, Scillitani A, D'Erasmo E, Minisola S. Vitamin D status in female patients with primary hyperparathyroidism: does it play a role in skeletal damage? Clin Endocrinol (Oxf) 2004; 60:81-6. [PMID: 14678292 DOI: 10.1111/j.1365-2265.2004.01946.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vitamin D deficiency, even subclinical, has been considered to worsen the skeletal damage in primary hyperparathyroidism (PHPT). Our study aimed to investigate the impact of vitamin D status on skeletal involvement in PHPT. DESIGN AND MEASUREMENTS A cross-sectional study was designed involving 62 female patients with PHPT. Serum total calcium (tCa), phosphate (P), creatinine (Cr) and total alkaline phosphatase activity (AP), together with 24-h (uCa 24 h) and spot fasting (uCa/Cr) urinary calcium, were measured by autoanalyser; ionized calcium (iCa) was assessed by an ion-specific electrode; intact parathyroid hormone (PTH) was measured by immunoradiometric assay (IRMA) and 25-hydroxyvitamin D (25-OHD) by radioimmunoassay (RIA). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DXA) at lumbar spine in 58 patients, and at femoral neck, Ward's triangle, greater trochanter, intertrochanteric line and total hip in 56 patients. The associations of all variables with age, 25-OHD, body mass index (BMI) and PTH were studied by linear multiple regression analysis, using progressively restricted models. RESULTS The model including age, 25-OHD, PTH and BMI showed significant regression with BMD values. PTH, age and BMI exerted a leading role in determining such a significance, while no significant regression was found between the parameters studied and 25-OHD; this was confirmed by Pearson's linear correlation analysis. The progressively restricted models showed significant regression of BMD at femoral neck, femoral intertrochanteric line and total hip with age, BMI and PTH. BMD measured at the Ward's triangle and greater trochanter showed significant regression with age and BMI, and that measured at lumbar spine with age. CONCLUSIONS Our data indicate that in primary hyperparathyroidism patients the influence of 25-hydroxyvitamin D levels on bone mineral density, if any, was overwhelmed by the effects of parathyroid hormone excess, age and body mass index. The latter unequally affected bone mineral density of various measured sites with different composition.
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Affiliation(s)
- Vincenzo Carnevale
- Divisioni di Medicina Interna, Ospedale 'Casa Sollievo della Sofferenza' IRCCS, San Giovanni Rotondo (FG), Rome, Italy
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Romagnoli E, Paglia F, Dionisi S, De Geronimo S, Pepe J, Di Virgilio R, Minisola S. [Male osteoporosis: current treatments and future options]. Clin Ter 2003; 154:49-53. [PMID: 12854284] [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: 03/03/2023]
Abstract
PURPOSE To provide indications for currently approved treatments and future options for male osteoporosis, based on the pathogenetic mechanisms of bone loss in the male sex. DESIGN Review of the most significant data reported in the literature. RESULTS Unhealthy lifestyle habits should be modified. Testosterone replacement is indicated only in patients with diagnosis of hypogonadism. Based on the demonstrated pathogenetic role of estrogen lack in bone loss in men, either low doses of this hormone or selective androgen receptor modulators have been proposed for the treatment of male osteoporosis. Bisphosphonates are the only medications approved by Food and Drug Administration for idiopathic and glucocorticoid-induced osteoporosis in men. As far as anabolic treatments are concerned, there is not agreement on clinical utility of sodium fluoride. Short-term treatment with parathyroid hormone (PTH) seems to be safe and effective in patients with idiopathic osteoporosis, due to its anabolic action. Therapeutic use of growth hormone (GH) and insulin-like growth factor type I (IGF-I), both considered as potential anabolic agents, is still limited because of the high incidence of side effects and relatively transient efficacy, particularly of IGF-I. CONCLUSIONS Treatments should be selected on the basis of anti-fracture efficacy of various medications, which has been demonstrated so far only for alendronate and risedronate. Although anabolic agents produce noticeable increase of bone mineral density, is still debated if they also reduce fracture incidence in males with osteoporosis.
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Affiliation(s)
- E Romagnoli
- Ospedale San Giovanni Battista, Università La Sapienza, Roma, Italia
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Romagnoli E, De Geronimo S, Pepe J, Dionisi S, Tonnarini G, Celi M, Ragno A, Di Virgilio R, Paglia F, Minisola S. [Clinical aspects of osteoporosis]. Recenti Prog Med 2002; 93:484-8. [PMID: 12355987] [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: 02/26/2023]
Abstract
The main clinical presentation of osteoporosis is fracture and its consequences. However a number of diseases and factors can induce bone loss and increase the risk of fracture. Therefore the clinical approach should be initially directed to exclude secondary osteoporosis. Vertebral fractures are the most common osteoporotic fractures; they are characterized by back pain, typical physical changes such as kyphosis and height loss, functional impairment and social decline. On the other hand, hip fracture is the most severe consequence of osteoporosis, because of its higher morbility and mortality. The main pathogenetic determinants of hip fracture are represented by both bone loss and several factors contributing to fall in the elderly. Moreover, a number of conditions are responsible for the high mortality rate following hip fracture. Colles' fracture is rarely hospitalized; however, most patients complain a complex algodystrophic syndrome which impairs the quality of life.
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Dionisi S, Minisola S, Pepe J, De Geronimo S, Paglia F, Memeo L, Fitzpatrick LA. Concurrent parathyroid adenomas and carcinoma in the setting of multiple endocrine neoplasia type 1: presentation as hypercalcemic crisis. Mayo Clin Proc 2002; 77:866-9. [PMID: 12173721 DOI: 10.4065/77.8.866] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We describe a patient with multiple endocrine neoplasia type 1 characterized by the simultaneous occurrence of parathyroid cancer, parathyroid adenomas, and pancreatic gastrinoma, who presented with an episode of acute hypercalcemia. The rapid parathyroid hormone assay provided a basis for the diagnosis of parathyroid hyperfunction. Mediastinal metastasis of the parathyroid carcinoma was found at autopsy. However, the staining of pancreatic and gastric tissue for parathyroid hormone-related protein does not make it possible to exclude completely the contribution of this peptide in mediating the hypercalcemia. To our knowledge, this is the first reported case of parathyroid carcinoma as part of the multiple endocrine neoplasia type 1 syndrome.
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Affiliation(s)
- Simona Dionisi
- Department of Clinical Sciences, University of Rome La Sapienza, Italy
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Minisola S, Rosso R, Romagnoli E, Pepe J, De Geronimo S, Dionisi S, Paglia F, Raejntroph N, Aliberti G, Mazzuoli GF. Uneven deficits in vertebral bone density in postmenopausal patients with primary hyperparathyroidism as evaluated by posterior-anterior and lateral dual-energy absorptiometry. Osteoporos Int 2002; 13:618-23. [PMID: 12181619 DOI: 10.1007/s001980200083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This investigation was undertaken to determine whether the preservation of bone mass in patients with mild primary hyperparathyroidism (PHPT) could be detected when measuring spine density in the lateral projection. We compared the bone mineral density (BMD) of L2-L4 utilizing the posterior-anterior (PA) and lateral projections in postmenopausal patients with PHPT and in a group of 27 postmenopausal normal women. Thirty-three consecutive postmenopausal patients with PHPT were studied; 25 were asymptomatic whereas the remaining 8 suffered complications related to the disease. Based upon the criteria established by the Consensus Conference on the Management of Asymptomatic PHPT, only 10 of the 25 asymptomatic patients could be considered affected by mild disease; the remaining patients were classified as having moderate disease. Patients with mild disease had mean lateral total BMD values (0.682 +/- 0.113 g/cm(2)) significantly higher than normal women (0.588 +/- 0.076, p<0.02) and patients with moderate disease (0.599 +/- 0.077, p<0.05). There were significant differences among the three groups in both PA L2-L4 and L1-L4 levels: patients with mild disease had significantly higher mean BMD values than patients with moderate disease and normal women, when either three or four vertebrae were considered. Interestingly, at this latter site, patients with moderate disease had significantly ( p<0.05) lower values than normal women. Our results indicate that patients with mild PHPT have a preservation of vertebral mass when compared with the other hyperparathyroid patients and normal women, when taking into account both the mainly trabecular portion and the whole vertebra. The finding that when the PA projection was assessed, BMD values of patients with moderate disease were significantly lower than those of normal women, might be attributed to the detrimental effect of raised parathyroid hormone levels on the cortical component of the vertebral body.
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Affiliation(s)
- S Minisola
- Dipartimento di Scienze Cliniche, Università La Sapienza, Rome.
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Minisola S, Dionisi S, Pacitti MT, Paglia F, Carnevale V, Scillitani A, Mazzaferro S, De GS, Pepe J, Derasmo E, Romagnoli E. Gender differences in serum markers of bone resorption in healthy subjects and patients with disorders affecting bone. Osteoporos Int 2002; 13:171-5. [PMID: 11905526 DOI: 10.1007/s001980200009] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To assess how two different serum markers of bone resorption may reflect changes in bone turnover, we compared age- and sex-related changes in serum C-terminal telopeptide of type I collagen (betaCTx) and tartrate-resistant acid phosphatase activity (TRAP) in 136 healthy men and 184 normal women. Serum levels of the two markers were also assessed in several groups of patients of both sexes presenting with the most common metabolic and endocrine bone diseases: established osteoporosis (n = 77), primary hyperparathyroidism (n = 44), glucocorticoid excess (n = 17), chronic renal failure (n = 39), active Paget's disease of bone (n = 5), humoral hypercalcemia of malignancy (n = 3), osteomalacia (n = 3), hyperthyroidism (n = 10), post-surgical hypoparathyroidism (n = 10), acromegaly (active disease, n = 8) and Cushing's syndrome (n = 10). In men the regression of betaCTx with age showed an initial decrease in bone resorption followed by an increase thereafter, starting from the sixth decade of life. No age-related change in serum TRAP activity was observed. In women, by contrast, a slight but significant linear correlation of both serum betaCTx and TRAP with age (r = 0.223, p<0.003 and r = 0.333, p<0.0001, respectively) was found, the two markers being positively correlated (r = 0.238, p<0.002). In each class of patients the mean Z-scores of betaCTx were significantly higher than those of TRAP activity. Moreover, compared with normal subjects, serum betaCTx seems to be characterized by a superior sensitivity relative to TRAP measurement, at least in the disorders studied.
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Affiliation(s)
- S Minisola
- Department of Clinical Sciences, University of Rome La Sapienza, Italy.
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Carnevale V, Pacitti MT, Pileri M, Paglia F, Scillitani A, Dionisi S, Caravella P, Romagnoli E, Minisola S. Short-term effects of surgery in post-menopausal patients with primary hyperparathyroidism and normal bone turnover. J Endocrinol Invest 2001; 24:575-9. [PMID: 11686539 DOI: 10.1007/bf03343897] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The most common clinical presentation of primary hyperparathyroidism (PHPT) is nowadays characterized by a slight skeletal involvement. We studied 5 consecutive female patients with PHPT presenting with bone turnover marker levels within the reference range of our Center and whose bone mineral density values were above the usual fracture risk threshold. In each patient we measured, both in basal conditions and daily, for the first 5 days after surgery, the following indexes: serum total (T-ALP) and bone-specific (B-ALP) alkaline phosphatase activity, osteocalcin (BGP, by two different assays), together with the 24-hour urinary excretions of total pyridinoline (Pyr/Cr) and deoxypyridinoline (DPyr/Cr), free deoxypyridinoline (FD-Pyr/Cr), cross-linked N-telopeptide of type I collagen (NTx/Cr), and type I C-telopeptide (CTx/Cr). The markers of both bone formation and resorption significantly decreased after surgery (p<0.001 by multiple ANOVA). Individual post-surgical markers changes were all significant but T-ALP and FD-Pyr, the most pronounced percent reductions being shown by NTx and CTx. The time-course of such variations substantially differed among the various indexes. These results show that bone formation and resorption markers are up-regulated also in PHPT patients with mild skeletal involvement; acute removal of parathyroid hormone excess differently affected the markers of bone turnover in terms of both entity and time-course.
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Affiliation(s)
- V Carnevale
- Department of Internal Medicine, Ospedale Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo, FG, Italy
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Paglia F, Dionisi S, De Geronimo S, Rosso R, Romagnoli E, Raejntroph N, Ragno A, Celi M, Pepe J, D'Erasmo E, Minisola S, Raejentroph N. Biomarkers of bone turnover after a short period of steroid therapy in elderly men. Clin Chem 2001; 47:1314-6. [PMID: 11427468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- F Paglia
- Dipartimento di Scienze Cliniche, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy
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Paglia F, Dionisi S, De Geronimo S, Rosso R, Romagnoli E, Raejentroph N, Ragno A, Celi M, Pepe J, D’Erasmo E, Minisola S. Biomarkers of Bone Turnover after a Short Period of Steroid Therapy in Elderly Men. Clin Chem 2001. [DOI: 10.1093/clinchem/47.7.1314] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Federica Paglia
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Simona Dionisi
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Simona De Geronimo
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Rossana Rosso
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Elisabetta Romagnoli
- Ospedale “Casa Sollievo della Sofferenza” IRCCS, San Giovanni 71013 Rotondo (FG), Italy
| | - Natalia Raejentroph
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Alessandro Ragno
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Massimiliano Celi
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Jessica Pepe
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Emilio D’Erasmo
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
| | - Salvatore Minisola
- Dipartimento di Scienze Cliniche, Università di Roma “La Sapienza”, 00161 Rome, Italy
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Romagnoli E, Minisola G, Pacitti MT, Rosso R, Paglia F, Dionisi S, Aliberti G, Minisola S. Exogenous glucocorticoids affect in different way the various phases of bone formation in postmenopausal patients. MINERVA ENDOCRINOL 2000; 25:69-73. [PMID: 11338398] [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: 02/20/2023]
Abstract
BACKGROUND To determine the effect of glucocorticoid excess on the most important circulating markers of bone formation in postmenopausal treated patients. METHODS The study included 15 postmenopausal women taking glucocorticoids for various medical conditions and two groups of 30 healthy premenopausal and 28 age-matched postmenopausal women as controls. Osteoblastic activity was assessed by measuring both serum levels of osteocalcin (BGP) (N-tact Osteo SP, Incstar Co.) and the bone-specific isoenzyme of alkaline phosphatase (BAP) (Alkphase-B, Metra Biosystems). RESULTS The mean values of serum BGP found in patients taking steroids were significantly reduced as compared to those found in both fertile and postmenopausal women (p < 0.0001). The mean serum levels of BAP were significantly increased in treated patients as compared to premenopausal women (p < 0.0001), while no significant difference was found between patients and age-matched postmenopausal women. Similar results were also obtained when individual values of both serum BAP and BGP were expressed as standard units in comparison to values obtained in fertile subjects (T-score) or postmenopausal subjects (Z-score). CONCLUSIONS Steroid therapy in postmenopausal patients differentially affects the various phases of bone formation. Measurement of serum BGP may represent a reliable parameter for monitoring bone formation in postmenopausal treated patients.
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Affiliation(s)
- E Romagnoli
- Presidio Ospedaliero Villa Betania, Ospedale San Giovanni Battista (ACISMOM), Italy
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Paglia F, Hivet M, Poilleux J. [Atheromatous occlusion of the celiac trunk]. Ateneo Parmense 1 1971; 41:41-7. [PMID: 5154089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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