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Abankwa A, Sansone S, Aligbe O, Hickner A, Segal S. The Role of Ureaplasma and Mycoplasma Species in Recurrent Lower Urinary Tract Infection in Females: A Scoping Review. Reprod Sci 2024:10.1007/s43032-024-01513-y. [PMID: 38509400 DOI: 10.1007/s43032-024-01513-y] [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: 11/30/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
It is unknown if recurrent urinary tract infection in the gynecologic population is associated with Mycoplasma and Ureaplasma genitourinary infections. The purpose of this scoping review is to highlight the literature surrounding Mycoplasma and Ureaplasma infections in the setting of recurrent urinary tract infections in the gynecologic population. MEDLINE ALL and Embase were searched to retrieve articles published in or after 1950 through 2024. Studies included were those with adults over age 18, non-pregnant, diagnosed with recurrent urinary tract infection and concurrent genitourinary infection with Ureaplasma or Mycoplasma published in English. Study designs eligible were quantitative, qualitative, and mixed methods studies. Publication types were also extended to conference abstracts and unpublished data. 2 independent investigators systematically performed title/abstract screening and full-text review using standardized inclusion criteria. For disagreements in either title and abstracts or full-text articles, consensus was reached through discussion by the 2 screeners and/or a 3rd final adjudicator. Screening and data extraction were performed on Covidence, a web-based platform for systematic review management. There were 1170 studies identified before title and abstract screening. 26 full-text articles were reviewed for eligibility. Of these, 23 full-text studies were excluded. 3 studies met full inclusion criteria and data extraction was performed on these 3 studies. There were 2 additional studies included after identification via other methods. There is a need for more recent and robust studies examining the role of Ureaplasma and Mycoplasma genitourinary infections amongst gynecologic patients with recurrent urinary tract infections.
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Affiliation(s)
- A Abankwa
- Department of Obstetrics and Gynecology and Department of Urology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - S Sansone
- Department of Obstetrics and Gynecology, Hackensack Meridian Jersey Shore Medical Center, Neptune, NJ, USA
| | - O Aligbe
- Department of Obstetrics and Gynecology and Department of Urology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - A Hickner
- Weill Cornell Medicine - Samuel J. Wood Library & C.V. Starr Biomedical Information Center, New York, NY, USA
| | - S Segal
- Department of Obstetrics and Gynecology and Department of Urology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA.
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Sansone S, Ramos Y, Segal S, Asfaw TS, Morales DK. Uncovering Surface Penetration by Enterococci From Urinary Tract Infection Patients. Urogynecology (Phila) 2024; 30:320-329. [PMID: 38484249 DOI: 10.1097/spv.0000000000001476] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE The relationship between Enterococcus faecalis vaginal colonization and urinary tract infections (UTIs) remains uncertain. OBJECTIVE We aimed to evaluate the surface invasion capability of E faecalis isolates from patients with and without UTIs as a potential readout of pathogenicity. STUDY DESIGN Participants were females from urogynecology clinics, comprising symptomatic UTI and asymptomatic non-UTI patients, categorized by the presence or absence of E faecalis-positive cultures identified via standard urine culture techniques. Vaginal and urine samples from patients were plated on enterococci selective medium, and E faecalis isolates detected in both cohorts were species specific identified using 16S rRNA sequencing. Clinical isolates were inoculated on semisolid media, and both external colonies and underneath colony prints formed by agar-penetrating enterococci were imaged. External growth and invasiveness were quantified by determining colony-forming units of the noninvading and agar-penetrating cells and compared with the E faecalis OG1RF. RESULTS We selected E faecalis isolates from urine and vaginal samples of 4 patients with and 4 patients without UTIs. Assays demonstrated that most isolates formed similarly sized external colonies with comparable colony-forming unit. Surface invasion differed across patients and isolation sites compared with OG1RF. The vaginal isolate from UTI patient 1, who had the most recurrences, exhibited significantly greater agar-invading capacity compared with OG1RF. CONCLUSIONS Our pilot study indicates that ex vivo invasion assays may unveil virulence traits in E faecalis from UTI patients. Enhanced enterococcal surface penetration could increase urogenital invasion risk. Further research is needed to correlate penetration with disease severity in a larger patient group.
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Affiliation(s)
- Stephanie Sansone
- From the Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY
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Dabic S, Sze C, Sansone S, Chughtai B. Rare complications of pessary use: A systematic review of case reports. BJUI Compass 2022; 3:415-423. [PMID: 36267197 PMCID: PMC9579882 DOI: 10.1002/bco2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Pessaries are desirable for its overall safety profiles. Serious complications have been reported; however, there is little summative evidence. This systematic review aimed to consolidate all reported serious outcomes from pessaries usage to better identify and counsel patients who might be at higher risk of developing these adverse events. Methods We performed a systematic literature review using search terms such as ‘prolapse’, ‘stress urinary incontinence’ and ‘pessary or pessaries or pessarium’ on PubMed, Embase and CINAHL. A total of 36 articles were identified. Patient‐level data were extracted from case reports to further describe complications on an individual level. Results Overall median age of the patients was 82 years (range 62–98). The most frequent complications were vesicovaginal fistula (25%, n = 9/36), rectovaginal fistula (19%, n = 7/36), vaginal impaction (11%, n = 4/36) and vaginal evisceration of small bowel through vaginal vault (8%, n = 3/36). In the vesicovaginal fistula cohort, none of the patients had a history of radiation, and two had histories of total abdominal hysterectomy (22%). In the rectovaginal fistula cohort, one patient had a history of pelvic radiation for rectal squamous cell carcinoma, and another had a history of chronic steroid use for rheumatoid arthritis. No other risk factors were reported in the other groups. Ring and Gellhorn were the most represented pessary types among the studies, 16 (44%) and 12 (33%), respectively. No complications were reported with surgical and non‐surgical treatment of the complications. Conclusion Pessaries are a reasonable and durable treatment for POP with exceedingly rare reports of severe adverse complications. The ideal candidate for pessary should have a good self‐care index. Studies to determine causative factors of the more serious adverse events are needed; however, this may be difficult given the long follow‐up that is required.
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Affiliation(s)
- Stefan Dabic
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Christina Sze
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Stephanie Sansone
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
| | - Bilal Chughtai
- Department of Urology Weill Cornell Medicine/New York Presbyterian New York New York USA
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Sansone S, Lu J, Drangsholt S, Asfaw TS, Segal S. No pelvic exam, no problem: patient satisfaction following the integration of comprehensive urogynecology telemedicine. Int Urogynecol J 2022; 33:2401-2407. [PMID: 35238948 PMCID: PMC8892397 DOI: 10.1007/s00192-022-05104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/15/2022] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis The COVID-19 pandemic revolutionized the practice of medicine, requiring rapid adoption of telemedicine. However, patient satisfaction has not been well characterized for telemedicine visits for a broad range of urogynecologic conditions. Methods We performed a cross-sectional survey study following a retrospective review of all urogynecologic telemedicine visits from March 1, 2020, to March 31, 2021, at a tertiary care center. The survey queried patient satisfaction using the Likert scale. Descriptive statistics and Fisher’s exact analyses were performed. Results There were 256 telemedicine visits at our institution during the study period, and 88 patients (34% unadjusted response rate) completed the survey. The average age of study participants was 55 (SD 17; 24, 84) years old. The majority of patients were white (69%), lived within the five boroughs of NYC (81%), and had higher levels of education (72% with a bachelor’s or professional degree). Most visits were for urinary complaints (68%), with those patients reporting greater fulfillment of urogynecologic needs compared to patients presenting with pelvic complaints (p = 0.02). There were no significant differences in satisfaction among other demographics (p > 0.05). Altogether, high satisfaction rates were noted for scheduling (99%), technology (90%), provider interaction (96%), fulfillment of personal needs (91%), and overall satisfaction (94%). Conclusions We demonstrate high patient satisfaction for telemedicine visits in a tertiary urogynecology clinic for a variety of indications, with greater fulfillment of urogynecologic needs observed for those visits which may not necessitate an in-person exam (e.g., urinary complaint).
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Affiliation(s)
- Stephanie Sansone
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA.
- Department of Urology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, 10065, USA.
| | - Jessica Lu
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
| | - Siri Drangsholt
- Department of Urology, New York Medical College, Valhalla, NY, USA
- Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA
| | - Tirsit S Asfaw
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
| | - Saya Segal
- Department of Obstetrics & Gynecology, NewYork-Presbyterian/Weill Cornell Medicine, 525 E 68th St, J130, New York, NY, 10065, USA
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Lee ITL, Sansone S, Irfan M, Copp T, Beidas R, Dokras A. Implementation of International Guidelines for Polycystic Ovary Syndrome: Barriers and Facilitators Among Gynecologists and Primary Care Providers. F S Rep 2022; 3:94-101. [PMID: 35789712 PMCID: PMC9250120 DOI: 10.1016/j.xfre.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/16/2021] [Accepted: 01/19/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To identify barriers and facilitators to the implementation of evidence-based guidelines among gynecologists and primary care physicians (PCPs) caring for women with polycystic ovary syndrome (PCOS). Design Qualitative semi-structured interview study. Setting Academic medical center. Patients None. Interventions None. Main Outcome Measures Barriers and facilitators in the diagnosis and management of PCOS. Results We interviewed 10 gynecologists and 8 PCPs to reach thematic saturation using a thematic analysis approach. Four themes were identified: diagnostic considerations, treatment of symptoms of PCOS, screening for long-term complications of PCOS, and counseling on long-term complications. Many gynecologists did not perform the recommended metabolic screening and were uncomfortable managing metabolic complications of PCOS. They uniformly counseled patients on the risk of endometrial hyperplasia and infertility. PCPs expressed the lack of familiarity with diagnostic criteria and often did not complete a comprehensive workup before making a diagnosis of PCOS. However, they routinely counseled patients on cardiometabolic risk and were familiar with managing the related long-term complications. Common barriers to comprehensive care delivery included the lack of knowledge and inadequate time and resources. Important facilitators included the overlap between the management of PCOS and other conditions such as obesity and abnormal uterine bleeding. Conclusions Our study highlights the need for interventions that target the barriers identified among gynecologists and PCPs in implementing guidelines for diagnosing and managing PCOS. In conjunction with prior studies, our findings support a multidisciplinary care model for women with PCOS. Future studies should focus on implementation strategies to facilitate evidence-based care.
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Affiliation(s)
- Iris Tien-Lynn Lee
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Reprint requests: Iris Tien-Lynn Lee, M.D., Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3701 Market Street, Suite 800, Philadelphia, Pennsylvania 19104.
| | - Stephanie Sansone
- Department of Urology, Weill Cornell Medicine, New York City, New York
| | - Maryam Irfan
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tessa Copp
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Implementation Science Center (PISCE@LDI), Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Anuja Dokras
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND Task force statements support the use of cognitive behavioral therapy (CBT) and motivational interviewing (MI) to promote self-care in chronic heart failure (CHF) patients. Digital counseling interventions have the potential to complement conventional programs. However, therapeutic components of digital programs associated with improved outcomes are not clearly established. OBJECTIVE Identify therapeutic components of the Canadian e-Platform to Promote Behavioral Self-Management in Chronic Heart Failure (CHF-CePPORT) protocol that were associated with improved health-related quality of life (HRQL). MATERIALS AND METHODS Ordinal logistic regression was used to identify therapeutic components of the CHF-CePPORT protocol. The primary outcome was the 12-month Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) tertile. Logistic regressions determined the association between 12-month KCCQ-OS tertile, using logon hours for key segments of the protocol, modality of content delivery, and clinical themes. RESULTS A total of 117 patients were enrolled in the e-Counseling arm of the CHF-CePPORT trial. Median age was 60 years (IQR 52-69). Total logon hours in the initial 4-month segment of CHF-CePPORT (Sessions 1-16) was associated with increased 12-month KCCQ-OS tertile (Odds Ratio, OR = 1.31, 95% CI, 1.1-1.5, P = 0.001). Within sessions 1-16, improved KCCQ-OS was associated with logon hours for self-assessment tools/trackers (OR = 1.49, 95% CI, 1.1-2.0, P = 0.007), and videos (OR = 1.57, 95% CI, 1.03-2.4, P = 0.04), but not for CHF information pages. CONCLUSION This study highlights the importance of using evidence-based guidelines from CBT and MI as core components of digital counseling, delivered through videos and interactive tools/trackers, to improve HRQL with CHF.
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Affiliation(s)
- Gabriel C Fezza
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Health, York University, Toronto, ON, Canada
| | - Stephanie Sansone
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Health, York University, Toronto, ON, Canada
| | - Robert P Nolan
- Behavioral Cardiology Research Unit, University Health Network (UHN), Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Peter Munk Cardiac Centre, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Fezza GC, Sansone S, Nolan RP. Therapeutic components of an automated digital counselling intervention for chronic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Task force statements advocate digital health interventions to promote self-care behaviour and health-related quality of life (HRQL) in patients with chronic heart failure (CHF). There is a need to identify therapeutic components of digital interventions to improve the efficacy and replicability of these CHF interventions.
Purpose
The Canadian e-Platform to PrOmote BehavioRal Self-ManagemenT in Chronic Heart Failure trial (CHF-CePPORT) evaluated the efficacy of automated digital counseling to improve HRQL at 12 months, using the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS). Our aim was to identify therapeutic components of the CHF-CePPORT protocol that were independently associated with KCCQ-OS endpoint.
Methods
CHF-CePPORT was a multicenter, randomized controlled trial with a 2-parallel group, double blind design, and assessments at baseline, 4- and 12-months. This substudy focused on patients randomized to the automated digital counseling arm of CHF-CePPORT. Ordinal logistic regression was used to identify components of the protocol that predicted higher KCCQ-OS tertile at 12-months, according to schedule of automated digital contact, modality of content, and clinical content theme – see Figure.
Results
From the sample enrolled in CHF-CePPORT (n=230), 117 patients were included in this substudy: female, n=24 (20.5%), median age=60 years (IQR, 52, 69), New York Heart Association Class 1, n=45 (38.5%), Class 2, n=48 (41.0%), and Class 3, n=16 (13.7%). Baseline KCCQ-OS was median=82.3 (IQR, 67, 93). Patient engagement with the digital counseling platform over 12 months was as follows: Median (IQR) total logons = 79 (24, 133), Total logon time = 5.8 hours (1.6, 9.8).
Total logon time during the initial phase of the trial (sessions 1–16), with weekly scheduled sessions was independently associated with a higher 12-month KCCQ-OS tertile score (p=0.003). Subsequent sections (sessions 17–24, and 25–28) were not independently associated with the 12-month KCCQ-OS (p=0.56 and p=0.91 respectively). Within sessions 1–16, the 12-month KCCQ-OS was associated with the use of counseling and dramatic videos (p=0.04) and e-tools/trackers (p=0.007), but not conventional information/education pages (p=0.80). Content themes associated with the 12-month KCCQ-OS included motivational counseling (sessions 5–8) with self-assessment tools and trackers (p=0.04). Cognitive behavioural guidelines for HF self-care were also associated with 12-month KCCQ-OS tertiles when presented by expert and dramatic videos (p=0.02) as well as self-assessment etools/etrackers (p=0.02). Self-assessment tools and trackers for HRQL (sessions 15–16) were also associated with higher KCCQ tertiles at 12 months (p=0.01) – see Table.
Conclusion(s)
The results of this study confirm the importance of using key components from evidence-based, clinically organized protocols of behavioural counseling to promote HRQL for patients with CHF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
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Affiliation(s)
- G C Fezza
- York University, Faculty of Health, Toronto, Canada
| | - S Sansone
- York University, Faculty of Science, Toronto, Canada
| | - R P Nolan
- Peter Munk Cardiac Centre, University Health Network, Behavioural Cardiology Research Unit, Toronto, Canada
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Affiliation(s)
- Yusibeska Ramos
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States of America
| | - Stephanie Sansone
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States of America
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | - Diana K. Morales
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York, United States of America
- * E-mail:
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Arora E, Soriano A, Sansone S, Arya L, Andy U. 41: Contaminated mid-stream urine specimens in women with pelvic organ prolapse. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kadam-Halani P, Sansone S, Arya L, Harvie H, Andy U. 15: Dietary patterns and defecatory symptoms in women undergoing surgery for pelvic organ prolapse. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sansone S, Ryles H, Arya L, Harvie H. 71: Relationship between anterior vaginal wall prolapse and detrusor contractility. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hessl D, Harvey D, Sansone S, Crestodina C, Chin J, Joshi R, Hagerman RJ, Berry‐Kravis E. Effects of mavoglurant on visual attention and pupil reactivity while viewing photographs of faces in Fragile X Syndrome. PLoS One 2019; 14:e0209984. [PMID: 30653533 PMCID: PMC6336311 DOI: 10.1371/journal.pone.0209984] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background Numerous preclinical studies have supported the theory that enhanced activation of mGluR5 signaling, due to the absence or reduction of the FMR1 protein, contributes to cognitive and behavioral deficits in patients with fragile X syndrome (FXS). However multiple phase 2 controlled trials in patients with FXS have failed to demonstrate efficacy of compounds that negatively modulate mGluR5, including two phase 2b randomized controlled trials (RCT) of mavoglurant (AFQ056, Novartis Pharma AG), when the primary measures of interest were behavioral ratings. This has cast some doubt onto the translation of the mGluR5 theory from animal models to humans with the disorder. Methods We evaluated social gaze behavior–a key phenotypic feature of the disorder—and sympathetic nervous system influence on pupil size using a previously-validated eye tracking paradigm as a biobehavioral probe, in 57 adolescent or adult patients with FXS at baseline and following three months of blinded treatment with one of three doses of mavoglurant or placebo, within the context of the AFQ056 RCTs. Results Patients with FXS treated with mavoglurant demonstrated increased total absolute looking time and number of fixations to the eye region while viewing human faces relative to baseline, and compared to those treated with placebo. In addition, patients had greater pupil reactivity to faces relative to baseline following mavoglurant treatment compared to placebo. Discussion The study shows that negative modulation of mGluR5 activity improves eye gaze behavior and alters sympathetically-driven reactivity to faces in patients with FXS, providing preliminary evidence of this drug’s impact on behavior in humans with the disorder.
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Affiliation(s)
- David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, United States of America
- * E-mail:
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, United States of America
| | - Stephanie Sansone
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Crystal Crestodina
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Jamie Chin
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Reshma Joshi
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
| | - Randi J. Hagerman
- MIND Institute, University of California Davis Medical Center, Sacramento, California, United States of America
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, United States of America
| | - Elizabeth Berry‐Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States of America
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, United States of America
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Fezza G, Sansone S, Surikova J, Ross H, Nolan R. Patient Engagement with an Ecounseling Platform is Enhanced Over 12 Months in the CHF-CePPORT Trial. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Sullivan-Pyke C, Sansone S, Jou J, Koelper N, Stentz N, Takacs P, Speicher D, Sammel M, Senapati S, Barnhart K. Small non-coding RNA as a serum biomarker for non-viable and ectopic pregnancy. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gossett A, Sansone S, Schneider A, Johnston C, Hagerman R, Tassone F, Rivera SM, Seritan AL, Hessl D. Psychiatric disorders among women with the fragile X premutation without children affected by fragile X syndrome. Am J Med Genet B Neuropsychiatr Genet 2016; 171:1139-1147. [PMID: 27615674 PMCID: PMC6907071 DOI: 10.1002/ajmg.b.32496] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/19/2016] [Indexed: 11/07/2022]
Abstract
Several studies have demonstrated increased rates of anxiety and depressive disorders among female carriers of the fragile X premutation. However, the majority of these studies focused on mothers of children with fragile X syndrome, who experience higher rates of parenting stress that may contribute to the emergence of these disorders. The present study compared psychiatric symptom presentation (utilizing measures of current symptoms and lifetime DSM-IV Axis I disorders) in 24 female carriers without affected children (mean age = 32.1 years) to 26 non-carrier women from the community (mean age = 30.5 years). We also examined the association between CGG repeat size (adjusted for X activation ratio) and mRNA, with severity of psychiatric symptoms. Women with the premutation reported significantly elevated symptoms of anxiety, depression, interpersonal sensitivity, obsessive-compulsiveness, and somatization relative to controls during the past week. Carriers had significantly higher rates of lifetime social phobia (42.3%) compared to controls (12.5%); however, this comparison did not remain significant after multiple comparison adjustment. Rates of other psychiatric disorders were not significantly elevated relative to controls, though it should be noted that lifetime rates among controls were much higher than previously published population estimates. Although the sample is relatively small, the study of this unique cohort suggests the premutation confers risk for mood and anxiety disorders independent of the stress of parenting children with FXS. Screening for psychiatric disorders in women with the premutation, even before they become parents, is important and highly encouraged. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Amy Gossett
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychology, California School of Professional Psychology, Alliant International University, Sacramento, California
| | - Stephanie Sansone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Cindy Johnston
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, California
| | - Susan M. Rivera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychology, University of California Davis, Davis, California
- Center for Mind and Brain, University of California Davis, Davis, California
| | - Andreea L. Seritan
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
| | - David Hessl
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Medical Center, Sacramento, California
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California
- Correspondence to: David Hessl, Ph.D., Department of Psychiatry and Behavioral Sciences, MIND Institute, UC Davis, 2825 50th St., Sacramento, CA 95817.
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Schneider A, Johnston C, Tassone F, Sansone S, Hagerman RJ, Ferrer E, Rivera SM, Hessl D. Broad autism spectrum and obsessive-compulsive symptoms in adults with the fragile X premutation. Clin Neuropsychol 2016; 30:929-43. [PMID: 27355445 DOI: 10.1080/13854046.2016.1189536] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Clinical observations and a limited number of research studies provide evidence that the fragile X premutation may confer risk for autism, executive dysfunction, and psychopathology. The link to autism spectrum symptoms and social cognition deficits with the premutation remains uncertain, and thus was the focus of the present investigation. METHOD Our sample included 131 individuals, 42 men/22 women with the FMR1 premutation (mean age = 31.83 ± 8.59 years) with a normal neurological exam, and 48 men/19 women healthy age-matched controls (mean age = 29.48 ± 7.29 years). Individuals completed a comprehensive neuropsychological battery with additional assessments for social cognition, broad autism spectrum, and obsessive-compulsive (OC) symptoms. RESULTS Premutation carriers self-reported higher rates of autism-related symptoms (Autism Quotient; p = .001). Among males only, premutation carriers showed more atypical social interaction (p < .001) and stereotyped behavior (p = .014) during standardized clinical examination on the Autism Diagnostic Observation Schedule (ADOS) relative to controls. Female premutation carriers reported significantly higher rates of OC symptoms compared to control females (p = .012). Molecular measures defining the expanded premutation (FMR1 CGG repeat length and/or mRNA) were significantly associated with a measure of theory of mind (Reading the Mind in the Eyes Task). CONCLUSIONS The results of this study indicate a higher rate of broad autism spectrum symptoms in some males with the premutation and provide evidence for an obsessive-compulsive subtype in female premutation carriers.
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Affiliation(s)
- A Schneider
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,c Department of Pediatrics , UC Davis School of Medicine , Sacramento , CA , USA
| | - C Johnston
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,b Department of Psychiatry and Behavioral Sciences , UC Davis School of Medicine , Sacramento , CA , USA
| | - F Tassone
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,f Department of Biochemistry and Molecular Medicine , UC Davis , Davis , CA , USA
| | - S Sansone
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,g Department of Human Development , UC Davis , Davis , CA , USA
| | - R J Hagerman
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,c Department of Pediatrics , UC Davis School of Medicine , Sacramento , CA , USA
| | - E Ferrer
- d Department of Psychology , UC Davis , Davis , CA , USA
| | - S M Rivera
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,d Department of Psychology , UC Davis , Davis , CA , USA.,e Center for Mind and Brain, UC Davis , Davis , CA , USA
| | - D Hessl
- a MIND Institute, UC Davis Medical Center , Sacramento , CA , USA.,b Department of Psychiatry and Behavioral Sciences , UC Davis School of Medicine , Sacramento , CA , USA
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Affiliation(s)
| | - Elizabeth Cowell
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Milna Rufin
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Stephanie Sansone
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Yoon Kang
- Department of Medicine, Weill Cornell Medical College, New York, USA.
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Brusciano L, Limongelli P, del Genio G, Di Stazio C, Rossetti G, Sansone S, Tolone S, Lucido F, D'Alessandro A, Docimo G, Docimo L. Short-term outcomes after rehabilitation treatment in patients selected by a novel rehabilitation score system (Brusciano score) with or without previous stapled transanal rectal resection (STARR) for rectal outlet obstruction. Int J Colorectal Dis 2013; 28:783-93. [PMID: 22983757 DOI: 10.1007/s00384-012-1565-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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] [Accepted: 08/14/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to examine short-term outcomes of rehabilitation treatment in patients with or without previous stapled transanal resection (STARR) for rectal outlet obstruction by using a novel rehabilitation score system (Brusciano score). METHODS This is a retrospective cohort study conducted at a single tertiary referral institution including all patients with chronic functional constipation admitted to the outpatient unit from 2004 to 2009. RESULTS Among 330 consecutive patients, 247 (74.8 %) (204 females and 43 males) showing a significantly higher rehabilitation score (mean of 15.7 ± 1.8; range, 7-25) than healthy controls (mean, 3.2 ± 1.2; range 2-6) (p < .0001) were selected for rehabilitation. Of the 247 patients evaluated, group A (no previous surgery) consisted of 170 patients (53 males; mean age, 44.8 ± 12.9 years; range, 19-80) of which 38 presented mixed constipation, whereas group B (previous surgery) consisted of 77 patients (18 males; mean age, 47.0 ± 11.2 years; range, 22-81). The Brusciano score, Agachan-Wexner score and quality of life improved in both groups of patients after treatment. Better improvements of Brusciano and Agachan-Wexner scores were observed in patients with previous STARR (group B). CONCLUSIONS The rehabilitation score system employed in this study seems to be a useful tool in selecting and assessing the outcome of patients who might benefit from rehabilitation treatment. Constipation and quality of life were significantly improved by the rehabilitation treatment. Further studies are needed to clarify either the impact of rehabilitation treatment on long-term outcome of patients treated for rectal outlet obstruction or its role in those who develop problems over time.
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Affiliation(s)
- L Brusciano
- XI Division of General and Obesity Surgery, Second University of Naples, Naples, Italy.
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19
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Morisco F, Castiglione F, Rispo A, Stroffolini T, Sansone S, Vitale R, Guarino M, Biancone L, Caruso A, D'Inca R, Marmo R, Orlando A, Riegler G, Donnarumma L, Camera S, Zorzi F, Renna S, Bove V, Tontini G, Vecchi M, Caporaso N. Effect of immunosuppressive therapy on patients with inflammatory bowel diseases and hepatitis B or C virus infection. J Viral Hepat 2013; 20:200-8. [PMID: 23383659 DOI: 10.1111/j.1365-2893.2012.01643.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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] [Received: 04/02/2012] [Accepted: 05/29/2012] [Indexed: 12/16/2022]
Abstract
Viral hepatitis reactivation has been widely reported in patients undergoing immunosuppressive therapy; however, few data are available about the risk of HBV and HCV reactivation in patients with inflammatory bowel disease, receiving immunosuppressive drugs. The aim of our study was to assess the prevalence of HBV and HCV infection in a consecutive series of patients with inflammatory bowel disease and to value the effects of immunosuppressive therapy during the course of the infection. Retrospective observational multicenter study included all consecutive patients with inflammatory bowel disease who have attended seven Italian tertiary referral hospitals in the last decade. A total of 5096 patients were consecutively included: 2485 Crohn's disease and 2611 Ulcerative Colitis. 30.5% and 29.7% of the patients were investigated for HBV and HCV infection. A total of 30 HBsAg positive, 17 isolated anti-HBc and 60 anti-HCV-positive patients were identified. In all, 20 patients with HBV or HCV infection received immunosuppressive therapy (six HBsAg+; four isolated anti-HBc+ and 10 anti-HCV+). One of six patients showed HBsAg+ and one of four isolated anti-HBc+ experienced reactivation of hepatitis. Two of six HBsAg patients received prophylactic therapy with lamivudine. Only one of 10 anti-HCV+ patients showed mild increase in viral load and ALT elevation. Screening procedures for HBV and HCV infection at diagnosis have been underused in patients with inflammatory bowel disease. We confirm the role of immunosuppressive therapy in HBV reactivation, but the impact on clinical course seems to be less relevant than previous reported.
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Affiliation(s)
- F Morisco
- Clinical and Experimental Medicine, Gastroenterology Unit, University of Naples Federico II, Naples, Italy.
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20
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Shin J, Epperson K, Yanjanin NM, Albus J, Borgenheimer L, Bott N, Brennan E, Castellanos D, Cheng M, Clark M, Devany M, Ensslin C, Farivari N, Fernando S, Gabriel L, Gallardo R, Castleman M, Gutierrez O, Herschel A, Hodge S, Horst A, Howard M, James E, Jones L, Kearns M, Kelly M, Kim C, Kiser K, Klazura G, Knoedler C, Kolbus E, Lange L, Lee J, Li E, Lu W, Luttrell A, Ly E, McKeough K, McSorley B, Miller C, Mitchell S, Moon A, Moser K, O'Brien S, Olivieri P, Patzwahl A, Pereira M, Pymento C, Ramelb E, Ramos B, Raya T, Riney S, Roberts G, Robertshaw M, Rudolf F, Rund S, Sansone S, Schwartz L, Shay R, Siu E, Spear T, Tan C, Truong M, Uddin M, VanTrieste J, Veloz O, White E, Porter FD, Haldar K. Defining natural history: assessment of the ability of college students to aid in characterizing clinical progression of Niemann-Pick disease, type C. PLoS One 2011; 6:e23666. [PMID: 21984891 PMCID: PMC3184943 DOI: 10.1371/journal.pone.0023666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/25/2011] [Indexed: 11/19/2022] Open
Abstract
Niemann-Pick Disease, type C (NPC) is a fatal, neurodegenerative, lysosomal storage disorder. It is a rare disease with broad phenotypic spectrum and variable age of onset. These issues make it difficult to develop a universally accepted clinical outcome measure to assess urgently needed therapies. To this end, clinical investigators have defined emerging, disease severity scales. The average time from initial symptom to diagnosis is approximately 4 years. Further, some patients may not travel to specialized clinical centers even after diagnosis. We were therefore interested in investigating whether appropriately trained, community-based assessment of patient records could assist in defining disease progression using clinical severity scores. In this study we evolved a secure, step wise process to show that pre-existing medical records may be correctly assessed by non-clinical practitioners trained to quantify disease progression. Sixty-four undergraduate students at the University of Notre Dame were expertly trained in clinical disease assessment and recognition of major and minor symptoms of NPC. Seven clinical records, randomly selected from a total of thirty seven used to establish a leading clinical severity scale, were correctly assessed to show expected characteristics of linear disease progression. Student assessment of two new records donated by NPC families to our study also revealed linear progression of disease, but both showed accelerated disease progression, relative to the current severity scale, especially at the later stages. Together, these data suggest that college students may be trained in assessment of patient records, and thus provide insight into the natural history of a disease.
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Affiliation(s)
- Jenny Shin
- Center for Rare and Neglected Diseases, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Katrina Epperson
- Center for Rare and Neglected Diseases, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Nicole M. Yanjanin
- Program in Developmental Endocrinology and Genetics, NICHD, National Institutes of Health, DHHS, Bethesda, Maryland, United States of America
| | - Jennifer Albus
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Laura Borgenheimer
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Natalie Bott
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Erin Brennan
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Daniel Castellanos
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Melissa Cheng
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Michael Clark
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Margaret Devany
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Courtney Ensslin
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Nina Farivari
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Shanik Fernando
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Lauren Gabriel
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Rani Gallardo
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Moriah Castleman
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Olimpia Gutierrez
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Allison Herschel
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Sarah Hodge
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Anne Horst
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Mary Howard
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Evan James
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Lindsey Jones
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Mary Kearns
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Mary Kelly
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Christine Kim
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Kinzie Kiser
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Gregory Klazura
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Chris Knoedler
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Emily Kolbus
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Lauren Lange
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Joan Lee
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Eileena Li
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Wei Lu
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Andrew Luttrell
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Emily Ly
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Katherine McKeough
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Brianna McSorley
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Catherine Miller
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Sean Mitchell
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Abbey Moon
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Kevin Moser
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Shane O'Brien
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Paula Olivieri
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Aaron Patzwahl
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Marie Pereira
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Craig Pymento
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Erin Ramelb
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Bryce Ramos
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Teresa Raya
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Stephen Riney
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Geoff Roberts
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Mark Robertshaw
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Frannie Rudolf
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Samuel Rund
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Stephanie Sansone
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Lindsay Schwartz
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Ryan Shay
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Edwin Siu
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Timothy Spear
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Catherine Tan
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Marisa Truong
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Mairaj Uddin
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Jennifer VanTrieste
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Omar Veloz
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Elizabeth White
- NPC Consortium for Community-Based Assessment of Patient Records, Cape Town, South Africa
| | - Forbes D. Porter
- Program in Developmental Endocrinology and Genetics, NICHD, National Institutes of Health, DHHS, Bethesda, Maryland, United States of America
| | - Kasturi Haldar
- Center for Rare and Neglected Diseases, University of Notre Dame, Notre Dame, Indiana, United States of America
- * E-mail:
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Currò Dossi R, Roscia G, Turri E, Dall'ora E, Sansone S, Stockner I, Wiedermann CJ. Acute ischemic stroke complicating carotid sinus massage in the absence of carotid artery disease and failure of thrombolytic therapy. Minerva Med 2010; 101:193. [PMID: 20562806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Cipolletta L, Bianco MA, Garofano ML, Meucci C, Piscopo R, Cipolletta F, Salerno R, Sansone S, Rotondano G. A randomised study of hydro-jet vs. needle injection for lifting colorectal lesions prior to endoscopic resection. Dig Liver Dis 2010; 42:127-30. [PMID: 19596616 DOI: 10.1016/j.dld.2009.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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] [Received: 04/20/2009] [Revised: 05/29/2009] [Accepted: 06/10/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Submucosal lifting of lesions prior to endoscopic resection is crucial to reduce complications and improve the technical feasibility of the procedure. AIM To compare a self-assembled hydro-jet system vs. standard needle injection for tissue elevation prior to endoscopic resection of colorectal lesions. METHODS Randomised study performed at a single tertiary care institution. Consecutive patients with colonoscopic diagnosis of sessile polyps or non-polypoid lesions >5 mm or laterally spreading tumours. OUTCOME MEASURES successful elevation, time to proper elevation, completeness of excision, cautery damage, and general histological diagnostic quality (blinded pathologic assessment). RESULTS 79 patients were randomised to hydro-jet (40 patients, group A) and needle (39 patients, group B) elevation. Successful elevation was achieved in 97.5% and 94.8%, respectively. Time to proper elevation was 8+/-5 s vs. 18+/-3 s (p<0.05). In group A, histology showed selective accumulation of fluid in the submucosa with intact collagen fibres. Damage to muscularis mucosa was never noted in the specimens of group A and in 7 cases of group B (p<0.01). Artefacts from "cautery effect" were very limited. Radial margins of resection could be adequately evaluated in all cases and were negative. CONCLUSIONS The hydro-jet system is as effective and safe as standard needle injection for tissue elevation prior to endoscopic resection of colorectal lesions, but it is significantly faster.
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Affiliation(s)
- L Cipolletta
- Division of Gastroenterology-Hospital "A. Maresca", Torre del Greco, Italy.
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Gravina AG, Iacono A, Alagia I, D'Armiento FP, Sansone S, Romano M. Gastric xanthomatosis associated with gastric intestinal metaplasia in a dyspeptic patient. Dig Liver Dis 2009; 41:765. [PMID: 18829401 DOI: 10.1016/j.dld.2008.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 08/12/2008] [Indexed: 12/11/2022]
Affiliation(s)
- A G Gravina
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale-Gastroenterologia, Seconda Università di Napoli and Centro Interuniversitario per la Ricerca su Alimenti ed Apparato Digerente, II Policlinico Edificio 3, IV Piano, Italy
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Brusciano L, Limongelli P, del Genio G, Rossetti G, Sansone S, Healey A, Maffettone V, Napolitano V, Pizza F, Tolone S, del Genio A. Clinical and instrumental parameters in patients with constipation and incontinence: their potential implications in the functional aspects of these disorders. Int J Colorectal Dis 2009; 24:961-7. [PMID: 19271224 DOI: 10.1007/s00384-009-0678-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [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] [Accepted: 02/19/2009] [Indexed: 02/04/2023]
Abstract
PURPOSE The aims of this study were to evaluate several clinical and instrumental parameters in a large number of patients with constipation and incontinence as well as in healthy controls and discuss their potential implications in the functional aspects of these disorders. METHODS Eighty-four constipated and 38 incontinent patients and 45 healthy controls were submitted to a protocol based on proctologic examination, clinico-physiatric assessment, and instrumental evaluation. RESULTS Constipated and incontinent patients had significantly worse lumbar lordosis as well as lower rate in the presence of perineal defense reflex than controls. Constipated but not incontinent patients had a lower rate of puborectalis relaxation than controls. Furthermore, worse pubococcygeal tests and a higher rate of muscle synergies presence, either agonist or antagonist, were observed in both constipated and incontinent patients compared to controls. CONCLUSIONS This study has demonstrated strong correlations between physiatric disorders and the symptoms of constipation and incontinence. Further studies designed to demonstrate a causal relationship between these parameters and the success of a specific treatment of the physiatric disorders on the proctology symptoms are warranted.
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Affiliation(s)
- L Brusciano
- First Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy.
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Sansone S, Aschbacher R, Staffler M, Bombonato M, Girardi F, Larcher C, Wiedermann CJ. Nosocomial diarrhoea in adult medical patients: the role of Clostridium difficile in a North Italian acute care teaching hospital. J Prev Med Hyg 2009; 50:117-120. [PMID: 20099443] [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: 05/28/2023]
Abstract
BACKGROUND The number of patients with severe Clostridium difficile-associated diarrhoea (CDAD) increases. Health care facilities are requested to establish rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. OBJECTIVE Aim of the single-center surveillance project was to establish local prevalence rates of N-CDAD in adult acute care medical patients. METHODS For a period of at least one year, all diarrhoeal stools from inpatients of a general internal medicine ward were tested for Clostridium difficile toxin A. Case record files were retrospectively analysed and questionnaires were completed for patients with positive stool assays who met the case definitions. RESULTS AND DISCUSSION During the surveillance period, 2,610 medical patients had been acutely hospitalized. Stools had been submitted to the hospital laboratory from 163 patients (6.2%) because of diarrhoea and were screened for Clostridium difficile cytotoxin. Complete data sets were available for analysis from 150 patients. Of 137 identified potential cases, 77 (56.2%) met the case definitions for nosocomial diarrhoea. Thirteen of the patients with nosocomial diarrhoea (16.9%) were detected positive by the Clostridium difficile toxin A assay. The overall prevalence of N-CDAD among inpatients was 8.7 cases/100 diarrhoeal stools. The mean number ofN-CDAD cases was 62.3 cases/100,000 patient days and 5 cases/1,000 patient admissions. The mean age of N-CDAD patients was 79.4 years (range 71 to 92). All patients were given broad-spectrum antibiotics before acute diarrhoea developed. Four patients died for reasons not directly related to N-CDAD which confirms increased disease severity as an important risk factor. CONCLUSIONS This single-center surveillance project, which established N-CDAD rates at frequencies currently reported from international surveys, is useful as benchmark and will help in understanding patterns and impact of N-CDAD at the regional level.
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Affiliation(s)
- S Sansone
- Department of Medicine, Central Hospital of Bolzano, Italy
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26
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Brusciano L, Limongelli P, del Genio G, Sansone S, Rossetti G, Maffettone V, Napoletano V, Sagnelli C, Amoroso A, Russo G, Pizza F, Del Genio A. Useful parameters helping proctologists to identify patients with defaecatory disorders that may be treated with pelvic floor rehabilitation. Tech Coloproctol 2007; 11:45-50. [PMID: 17357866 DOI: 10.1007/s10151-007-0324-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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] [Received: 08/29/2006] [Accepted: 09/07/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND No studies have specifically reported on the use of a diagnostic tool based on physiatric assessment of constipated or incontinent patients METHODS Sixty-seven constipated and 37 incontinent patients were submitted to a standard protocol based on proctologic examination, clinico-physiatric assessment (puborectalis contraction, pubococcygeal test, perineal defence reflex, muscular synergies, postural examination) and instrumental evaluation (anorectal manometry, anal US and dynamic defaecography). Patients were offered pelvic floor rehabilitation (thoraco-abdominoperineal muscle coordination training, biofeedback, electrical stimulation and volumetric rehabilitation). RESULTS After rehabilitation treatment, decreases of Wexner constipation score (p=0.0001) and Pescatori incontinence score (p=0.0001) were observed. CONCLUSION This diagnostic protocol might improve the selection of patients with defaecatory disorders amenable for rehabilitation treatment.
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Affiliation(s)
- L Brusciano
- First Division of General and Gastrointestinal Surgery, Second University of Naples, Naples, Italy.
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Parkinson H, Sarkans U, Shojatalab M, Abeygunawardena N, Contrino S, Coulson R, Farne A, Lara GG, Holloway E, Kapushesky M, Lilja P, Mukherjee G, Oezcimen A, Rayner T, Rocca-Serra P, Sharma A, Sansone S, Brazma A. ArrayExpress--a public repository for microarray gene expression data at the EBI. Nucleic Acids Res 2005; 33:D553-5. [PMID: 15608260 PMCID: PMC540010 DOI: 10.1093/nar/gki056] [Citation(s) in RCA: 215] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
ArrayExpress is a public repository for microarray data that supports the MIAME (Minimum Information About a Microarray Experiment) requirements and stores well-annotated raw and normalized data. As of November 2004, ArrayExpress contains data from approximately 12,000 hybridizations covering 35 species. Data can be submitted online or directly from local databases or LIMS in a standard format, and password-protected access to prepublication data is provided for reviewers and authors. The data can be retrieved by accession number or queried by various parameters such as species, author and array platform. A facility to query experiments by gene and sample properties is provided for a growing subset of curated data that is loaded in to the ArrayExpress data warehouse. Data can be visualized and analysed using Expression Profiler, the integrated data analysis tool. ArrayExpress is available at http://www.ebi.ac.uk/arrayexpress.
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Affiliation(s)
- H Parkinson
- European Bioinformatics Institute, EMBL-EBI Wellcome Trust Genome Campus, Hinxton CB10 1SD, UK.
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Abstract
The question discussed in the two following experiments concerns the effect of facial expressions on face recognition. Famous and unknown faces with neutral or smiling expression were presented for different inspection durations (15 ms vs 1000 ms). Subjects had to categorize these faces as famous or unknown (Experiment 1), or estimate their degree of familiarity on a rating scale (Experiment 2). Results showed that the smile increased ratings of familiarity for unfamiliar faces (Experiments 1 and 2) and for famous faces (Experiment 2). These data are discussed in the framework of current face-recognition models and are interpreted in terms of social value of the smile. It is proposed that the smiling bias found here acts at the level of the decision process.
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Affiliation(s)
- J Y Baudouin
- Institut des Sciences Cognitives, Equipe Cognition et Mémoire, Bron, France.
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Pancera P, Presciuttini B, Sansone S, Montagna L, Paluani F, Covi G, Lechi A. Effect of losartan on heart rate and blood pressure variability during tilt test and trinitroglycerine vasodilation. J Hypertens 1999; 17:513-21. [PMID: 10404953 DOI: 10.1097/00004872-199917040-00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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: 11/25/2022]
Abstract
OBJECTIVE To define the changes in variability of heart rate and of blood pressure during vasodilation in a group of hypertensive patients treated with an angiotensin II type I (AT1) receptor inhibitor. DESIGN Losartan (50 mg/day at 0800 h) or placebo were administered for 3 weeks according to a single blind, crossover, randomized protocol, to 18 hypertensive patients (16 men and two women, mean age 42 + 3.6 years). Continuous ECG recording and beat-to-beat blood pressure monitoring were carried out with subjects in the supine position and during a head-up tilt test, as well as after sublingual administration of trinitroglycerine. The elaboration of ECG traces in the frequency domain, was carried out using an autoregressive method and measured using the autoregressive moving average technique. RESULTS Orthostatic stimulus, both during treatment with losartan and with placebo, caused a significant decrease in the heart rate high frequency power; on the other hand, the low frequency power appeared unchanged after placebo and was significantly reduced with losartan. Five minutes after the administration of trinitroglycerine, the low frequency power with placebo showed a significant increase (817 -+ 221 versus 465 + 101 ms2, P < 0.03). No change was recorded in total power nor in low frequency or high frequency power during losartan therapy. The ratio of low frequency to high frequency powers showed a sympathetic prevalence during vasodilation only during placebo treatment, whereas a mainly unchanged balance was maintained during losartan treatment Blood pressure variability showed a sympathetic prevalence after upright and trinitroglycerine stimulation only in placebo-treated subjects. CONCLUSIONS Our study demonstrated that vasodilation is not able to evoke an unbalancing of the autonomic modulation in hypertensive patients treated with an AT1 receptor inhibitor, but permits the maintenance of a significant vagal component, thus highlighting the favorable profile of this drug in the autonomic control of circulation.
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Pancera P, Sansone S, Presciuttini B, Montagna L, Cerù S, Lunardi C, Lechi A. Autonomic nervous system dysfunction in sclerodermic and primary Raynaud's phenomenon. Clin Sci (Lond) 1999; 96:49-57. [PMID: 9857106] [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: 02/09/2023]
Abstract
Our aim was to investigate the sympathetic hyperactivity of systemic sclerosis that may lead to greater morbidity and mortality from cardiovascular events. We analysed the sympathetic (low-frequency) and vagal (high-frequency) components of heart rate variability, in supine and upright positions, in 10 patients with systemic sclerosis, 12 patients with primary Raynaud's phenomenon and 14 controls. We also analysed lung function in order to evaluate a possible link between heart rate variability and ventilation parameters. Heart rate variability was reduced in the supine position in subjects with systemic sclerosis both in comparison with primary Raynaud's phenomenon (total power: 1103+/-156 versus 3302+/-486 ms2, P<0.004) and control subjects (3148+/-422 ms2, P<0.002). Low-frequency power was higher in patients with systemic sclerosis than in the controls (54.5+/-4.5 versus 42.5+/-3.5 normalized units, P<0.01). During tilt, the change in heart rate was +44% in controls, +24% in subjects with primary Raynaud's phenomenon, and only +17% in the patients with systemic sclerosis (P<0.01 versus controls). In patients with systemic sclerosis we found a significant correlation between high-frequency power and the indices of lung function (residual volume: r2=0.5143, P<0.01; total lung capacity: r2=0.5142, P<0.01, vital capacity: r2=0.3789, P<0.05). Heart rate variability was reduced and sympathetic output increased in patients with systemic sclerosis. Subjects with primary Raynaud's phenomenon were characterized by normal heart rate variability and by some degree of sympathetic hyperactivity. During tilting, subjects with systemic sclerosis maintained an unmodified heart rate variability, thus suggesting an impaired baroceptor modulation of the autonomic control. The negative correlation between high-frequency power and indices of respiratory insufficiency in patients with systemic sclerosis suggests that the pulmonary structure plays an important role in the modulation of heart rate variability.
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Affiliation(s)
- P Pancera
- Istituto di Clinica Medica, Ospedale Policlinico, 37134 Verona, Italy
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Pancera P, Sansone S, Secchi S, Covi G, Lechi A. The effects of thromboxane A2 inhibition (picotamide) and angiotensin II receptor blockade (losartan) in primary Raynaud's phenomenon. J Intern Med 1997; 242:373-6. [PMID: 9408065 DOI: 10.1046/j.1365-2796.1997.00219.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [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: 02/05/2023]
Abstract
OBJECTIVES To assess the role of thromboxane A2 and of angiotensin II in patients with primary Raynaud's phenomenon. DESIGN After an eight-day run-in period, the patients were enrolled in a single-blind, cross-over, study. SETTING Patients were examined at the Ambulatory for Microcirculatory Diseases of the Clinic of Internal Medicine, University Hospital, Verona. SUBJECTS Fifteen subjects affected by primary Raynaud's phenomenon were included. MAIN OUTCOME MEASURES A piezoelectric plethysmography to evaluate the distensibility of the digital arteries as the ratio between peak time (PT) and total time (TT), and an oscillometric blood pressure recorder were used after the run-in period, and after a two-week course of picotamide (300 mg b.i.d., i.e. two times daily) or losartan (12.5 mg once daily) with an interval of a week of placebo between the active treatments. The tests were performed after every treatment in basal condition and during mental stress. The patients reported in a diary the number and the severity (from 0 to 4 +) of the vasospastic crises. RESULTS The change in TP/TT ratio appeared statistically significant only after losartan treatment, both in basal condition and during mathematical stress. Both pharmacological treatments, with respect to placebo, showed an improvement of the scores, derived from the number and severity of vasospastic attacks, but only the therapy with losartan determined a statistically significant improvement. CONCLUSIONS The inhibition of the type 1 receptor for angiotensin II seems highly effective in the reduction of the vasospastic crises in the subjects with primary Raynaud's phenomenon. According to our experience, losartan could be used more extensively in the treatment of these patients besides arterial hypertension.
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Affiliation(s)
- P Pancera
- Clinic of Internal Medicine, University of Verona, Italy
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Ceru S, Pancera P, Sansone S, Sfondrini G, Codella O, De Sandre G, Lechi A, Lunardi C. Effects of five-day versus one-day infusion of iloprost on the peripheral microcirculation in patients with systemic sclerosis. Clin Exp Rheumatol 1997; 15:381-5. [PMID: 9272298] [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: 02/05/2023]
Abstract
OBJECTIVE To evaluate the effects of iloprost infusion on the microcirculation in patients suffering from severe Raynaud's phenomenon secondary to systemic sclerosis. METHODS Eight patients received a 7-hour infusion of iloprost for five consecutive days and then for one day 3 months later. The effects on vascular distensibility were evaluated by piezoelectric plethysmography before and after the treatment and at 2, 4 and 6 weeks. RESULTS The beneficial effects on the peripheral microcirculation were statistically significant after five days of infusion (distensibility index: 0.18 +/- 0.01 vs 0.23 +/- 0.01, p < 0.002) and lasted for less than four weeks, whereas no difference (0.22 +/- 0.04 vs 0.24 +/- 0.02, p: ns) was seen after one day of treatment. One patient suffered from typical angina pectoris with electrocardiographic changes of the ST wave detected during the infusion. CONCLUSION Our results show that a five-day infusion of iloprost has an effect which lasts from two to four weeks; after four weeks the distensibility index returned to the baseline value. The one-day infusion had no effect on the vascular bed, studied by the piezoelectric pletysmographic method. Treatment with five consecutive days of infusion every four weeks is an impracticable scheme to adopt, however. We have therefore instituted a treatment schedule of a single daily infusion every four weeks with the aim of maintaining the effects induced by the initial five-day infusion. The preliminary results obtained with this schedule are reported.
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Affiliation(s)
- S Ceru
- Institute of Internal Medicine, Policlinico Borgo Roma, University of Verona, Italy
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