The general purpose of the known research, is to reveal the way of developing the trials of acquisition of professional competence of the nursing student. The revealing results of the summative yearly and final evaluations, considering... more
The general purpose of the known research, is to reveal the way of developing the trials of acquisition of professional competence of the nursing student. The revealing results of the summative yearly and final evaluations, considering important steps of valuated process, therefore the student is considered an active part of his or her own education process. However, it is revealed in a partial use or fragmented use of an evaluation method. The chosen procedures are more orientated at a reading of the technical performance than that of an observation of a communication competence.
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Research Interests: Obesity, Adolescent, Humans, Child, Blood Pressure, and 4 moreFemale, Male, Heart rate, and Lung Volume Measurements
Research Interests: Obesity, Humans, Child, Glucose, Hyperglycemia, and 7 moreInsulin, Glucagon, Female, Male, Hypoglycemia, Age Factors, and Glucose Tolerance Test
Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Specific immunotherapy modifies this arrangement restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early... more
Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Specific immunotherapy modifies this arrangement restoring a physiologic Th1 profile. Sublingual immunotherapy (SLIT) is widely prescribed, but there is no early marker of response. The aim of this study is to investigate possible marker of SLIT effectiveness. Thirty children with mite allergy were studied: 15 were treated with drugs alone, 15 with SLIT and drugs on demand. The study lasted 2 years. Visual analogue scale (VAS) for symptoms and medication score were evaluated. Serum cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, IFN-gamma, MCP-1, and TNF-alpha) were assessed by ELISA before and after 1 and 2 year SLIT. SLIT-treated children obtained a significant improvement of symptoms and a reduction of drug use, whereas children treated with a drug alone did not obtained any change. IL-10 significantly increased, whereas Th2-dependent and pro-inflammatory cytokines significantly decreased. In conclusion, the pres...
Research Interests: Cytokines, Adolescent, Humans, Child, Female, and 6 moreAnimals, Male, Immunoglobulin E, Clinical Sciences, Mites, and Hypersensitivity
Food allergy may be clinically expressed by a variety of respiratory symptoms, which can be provoked either by IgE- or cellular mediated reactions. Among the diagnostic procedures, newly introduced atopy patch test seems to be important... more
Food allergy may be clinically expressed by a variety of respiratory symptoms, which can be provoked either by IgE- or cellular mediated reactions. Among the diagnostic procedures, newly introduced atopy patch test seems to be important for diagnosis of cellular, delayed immune reactions. We studied the prevalence of positive atopy patch tests with food and inhalant allergens and the correlation between the positivity of atopy patch tests and questionnaire derived atopic and nonatopic espiratory symptoms and diseases in an unselected children population. We found a correlation between the positive patch test result with wheat and cough after physical effort, allergic rhino-conjunctivitis, and bronchitis recidivans. The subjects with positive skin reaction to egg suffered from allergic rhino-conjunctivitis and bronchial asthma. Food and inhalant allergens play an important role in the induction and exacerbation of some respiratory allergic diseases. The positive correlation of positi...
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To evaluate non-rapid eye movement sleep instability (NREM), as measured by the cyclic alternating pattern (CAP), in a cohort of children with attention-deficit/hyperactivity disorder (ADHD) and normal controls. Prospective study. Sleep... more
To evaluate non-rapid eye movement sleep instability (NREM), as measured by the cyclic alternating pattern (CAP), in a cohort of children with attention-deficit/hyperactivity disorder (ADHD) and normal controls. Prospective study. Sleep laboratory. Twenty consecutive outpatients with ADHD (18 boys and 2 girls; age range 6-13 years, mean age 9.3 years) and 20 normal children matched for age and socioeconomic status underwent polysomnographic recordings for 2 consecutive nights in a standard laboratory setting. Sleep was visually scored for sleep macrostructure and CAP, according to standard criteria. Children with ADHD showed significantly reduced sleep duration and increased rate of stage shifts. All children with ADHD had an apnea-hypopnea index less than 1. Those with ADHD presented lower total CAP rates and lower CAP rates during sleep stage 2 than did normal controls. Moreover, in children with ADHD, we found a lower number of CAP sequences and a reduced total A1 index, mainly i...
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Bronchial reactivity was studied via carbachol testing in 46 patients affected by type 1 diabetes mellitus and in 30 control subjects and via exercise testing in 55 diabetic patients and 60 control subjects. In all subjects, reactivity to... more
Bronchial reactivity was studied via carbachol testing in 46 patients affected by type 1 diabetes mellitus and in 30 control subjects and via exercise testing in 55 diabetic patients and 60 control subjects. In all subjects, reactivity to skin allergen tests, the existence of atopic illnesses, and family history for these diseases were evaluated. Diabetic patients were less affected by asthma than control subjects, although their family history of atopy is greater. Bronchial reactivity, as expressed by the results of carbachol testing, was lower in diabetic patients than in control subjects. Furthermore, the duration of disease in diabetic patients was positively correlated with the results of carbachol testing. Reduced bronchial reactivity might be an indication of initial damage to the autonomic nervous system, which would thus appear to be both a complication and a protective factor.
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To describe the ictal polysomnographic features of a patient with Panayiotopoulos syndrome, a peculiar epileptic syndrome characterized by infrequent, often single, prolonged, nocturnal, focal seizures comprising an unusual constellation... more
To describe the ictal polysomnographic features of a patient with Panayiotopoulos syndrome, a peculiar epileptic syndrome characterized by infrequent, often single, prolonged, nocturnal, focal seizures comprising an unusual constellation of autonomic symptoms (malaise, nausea, pallor, tachycardia, vomiting) and unilateral deviation of the eyes at the onset of seizures. These clinical, ictal manifestations are rarely followed by post-ictal headache. In the literature, there is little information on the ictal EEG characteristics of Panayiotopoulos syndrome and, in particular, on certain autonomic manifestations, such as tachycardia, as the sole ictal phenomena at the onset of seizures. One, all-night videopolysomnography, during which one seizure was recorded. Video-EEG data were evaluated visually and by means of quantitative spectral analysis. The spectral analysis of the recorded seizure showed a complex ictal pattern of cortical involvement with focal onset in the right occipital ...
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1 Department of Pediatrics; II Faculty S. Andrea University of Rome La Sapienza 2 Biomedical Engineering Laboratory, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy {Barbaro, Bartolin, Giovanni.Calcagnini,... more
1 Department of Pediatrics; II Faculty S. Andrea University of Rome La Sapienza 2 Biomedical Engineering Laboratory, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy {Barbaro, Bartolin, Giovanni.Calcagnini, Censi}@iss.it 3 Department of Information and ...
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ABSTRACT
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Although it has been experimentally proved that thyroid hormones stimulate beta 2 receptor activity and tissue responsiveness to catecholamines, previous studies have established that asthma and nonspecific bronchial reactivity (NSBR) can... more
Although it has been experimentally proved that thyroid hormones stimulate beta 2 receptor activity and tissue responsiveness to catecholamines, previous studies have established that asthma and nonspecific bronchial reactivity (NSBR) can worsen if complicated by hyperthyroidism. Our study is an effort toward the analysis of this contradiction. In 20 congenitally hypothyroid children, substitutive opotherapy was completely withdrawn for 1 month, resumed in the original dosage for 2 months, and then increased by 20% from day 91 to day 110. Mean NSBR, expressed in carbachol-related PD20-FEV1 and PD25-V25, was significantly increased by day 30, remained significantly elevated by day 90, and returned to initial values by day 110. These results suggest that thyroid hormones per se in nonasthmatic subjects decrease bronchial reactivity. This observation should be taken into consideration when attempting to explain the worsening condition of asthmatics who became affected with hypothyroidism. Bronchial reactivity appears to be under the control of many factors (including thyroid hormone levels). Once it is altered, a period of time seems necessary to restore the original bronchomotor tone (2 months in our study).
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Because signs of nocturnal seizures can overlap with sleep respiratory events, clinicians can have difficulty distinguishing abnormal events related to sleep disorders from epileptic seizures. We describe the case of a 3-year-old child... more
Because signs of nocturnal seizures can overlap with sleep respiratory events, clinicians can have difficulty distinguishing abnormal events related to sleep disorders from epileptic seizures. We describe the case of a 3-year-old child presenting with ictal electroencephalographic (EEG) activity associated with a particular form of atypical obstructive sleep apnea, characterized by increased respiratory rate, paradoxical breathing, desaturations, and tonic-dystonic posture associated with movement artifacts. Following cardiorespiratory polysomnography, the patient was initially misdiagnosed as having severe obstructive sleep apnea syndrome.
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In a retrospective analysis of the history of 1,700 asthmatic children, 167 (9.8%) were found to have had bronchiolitis during the first 2 years of life. These 167 cases with asthma and bronchiolitis were matched against 215 selected... more
In a retrospective analysis of the history of 1,700 asthmatic children, 167 (9.8%) were found to have had bronchiolitis during the first 2 years of life. These 167 cases with asthma and bronchiolitis were matched against 215 selected cases of asthma without bronchiolitis. Both groups attended our Ambulatory Care Unit for Asthma. Data were collected from the clinical cards of the children. Asthmatics who had bronchiolitis were found to have an earlier onset of asthma (p less than 0.001), earlier resolution of symptoms (p less than 0.05 total; p less than 0.01 females), and less evidence of atopy (p less than 0.005). It is suggested therefore that the bronchial hyperreactivity in asthma following bronchiolitis may have different underlying mechanisms than in the typical atopic case, without preceding bronchiolitis. Long-term follow-up studies in infants with bronchiolitis are still necessary in order to clarify the process by which bronchiolitis predisposes to bronchial hyperreactivity and asthma. The consequences of the viral infection itself may lead to pathophysiological processes that promote bronchial hyperreactivity. On the contrary, an underlying condition of bronchial hyperreactivity could be the "primum movens" of the bronchiolitis itself.
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Research Interests: Genetics, Asthma, Air pollution, Adolescent, Environmental Pollution, and 17 moreFamily history, Rome, Students, Humans, Child, Primary School, Female, Childhood asthma, Male, Incidence, Sex Factors, Age Factors, Urban Population, Cross Sectional Studies, Age Groups, Urban Area, and Socioeconomic Factors
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The clinical investigation of occupational asthma is currently based on the demonstration of functional changes after exposure to occupational agents, but it does not yet include any monitoring of airway inflammation, one of the hallmarks... more
The clinical investigation of occupational asthma is currently based on the demonstration of functional changes after exposure to occupational agents, but it does not yet include any monitoring of airway inflammation, one of the hallmarks of this disease. Methods permitting a non-invasive assessment of airway inflammation, such as induced sputum and exhaled nitric oxide, are currently under investigation for research purposes in occupational asthma. Their role in clinical practice has not yet been established. The advantages and limitations of these methods for occupational airway diseases, and more particularly occupational asthma, are discussed in this review.
Research Interests: Immunology, Inflammation, Asthma, Oxidative Stress, Humans, and 18 moreCarbon Monoxide, Smoking, Nitric oxide, Vehicle Emissions, Male, Lung Diseases, Disease Severity, New South Wales, Middle Aged, Adult, Occupational Exposure, Success Rate, Bronchitis, Ships, Biological markers, Gases, Sputum, and Occupational Diseases
Differing or increasing prevalence of positive allergen skin-prick tests observed in Europe could at least in part be explained by population changes in histamine skin reactivity. These changes would also alter the relationship between... more
Differing or increasing prevalence of positive allergen skin-prick tests observed in Europe could at least in part be explained by population changes in histamine skin reactivity. These changes would also alter the relationship between positive allergen skin-prick tests and serum IgE. To assess changes in histamine reactivity, allergen skin-prick tests and serum IgE in our geographical setting. We compared the outcome of two epidemiological surveys conducted 16 years apart in unselected 9-year-old schoolchildren (170 in 1983 and 176 in 1999) from a semi-rural region in central Italy. Outcome measures were skin-prick tests with two histamine concentrations (10 and 1 mg/mL) and 11 locally relevant allergens; serum total and specific IgE for positive allergens. The two histamine concentrations induced significantly larger mean weal diameters in 1999 than in 1983 (10 mg/mL: 5.28+/-0.82 mm vs. 3.25+/-0.97 mm; P<0.001). Whereas the prevalence of subjects with at least one positive allergen-induced weal reaction (>or=3 mm) increased over the 16 years (from 15.3% in 1983 to 25.6% in 1999), the prevalence of positive skin-prick tests, expressed as the allergen/ histamine weal ratio, remained almost unchanged. A given allergen weal diameter yielded less total (P<0.05 by Student's t-test for cumulative weals <8 mm) and specific (P<0.01 by Student's t-test for weals <3 mm, P<0.05 by Kruskal-Wallis test) serum IgE in 1999 than in 1983. Although the causes and mechanisms remain unclear, the increased histamine skin reactivity over time is associated with an increase in positive allergen skin-prick tests. In the presence of increased tissue and organ susceptibility to histamine, minute amounts of specific IgE could have important biological consequences.
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Power spectrum analysis of heart rate variability (HRV) is a noninvasive technique that provides a quantitative assessment of cardiovascular neural control. Using this technique, we studied the autonomic nervous system changes induced by... more
Power spectrum analysis of heart rate variability (HRV) is a noninvasive technique that provides a quantitative assessment of cardiovascular neural control. Using this technique, we studied the autonomic nervous system changes induced by sleep in 14 healthy subjects: 7 infants (mean age, 9.40 +/- 2.32 months) and 7 children (mean age, 8.93 +/- 0.65 years) during a standard all-night polysomnographic recording. Our primary aim was to assess the effect of sleep stage and age on short-term HRV during sleep in healthy infants and children. Power spectral density was estimated by autoregressive modeling over 250 consecutive R-R intervals. In this study, we mainly considered two spectral components: the high-frequency (HF) component (0.15 to 0.40 Hz), which reflects parasympathetic cardiovascular modulation; and the low-frequency (LF) component (0.04 to 0.15 Hz), generally considered due to both parasympathetic and sympathetic modulation. Heart rate was higher (p < 0.01 in all sleep stages) and total power lower (p < 0. 02) in infants than in children. HF power was higher in children than in infants (p < 0.05). In infants and children, the ratio between LF and HF powers changed with the various sleep stages (p < 0.02 in infants; p < 0.01 in children): it decreased during deep sleep and increased during rapid eye movement sleep. However, it was invariably lower in children than in infants. These findings show that the sleep stage and age both significantly influence short-term HRV during sleep in healthy infants and children. Hence, to provide unbiased results, HRV studies investigating the effects of age on autonomic nervous system activity should segment sleep into the five stages. In addition, despite a relatively small study sample, our data confirm greater parasympathetic control during sleep in children than in infants.
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The current criterion standard for measuring inspiratory effort, esophageal manometry, is an invasive procedure that young patients find intolerable. Inspiratory effort can also be assessed noninvasively by measuring the pulse transit... more
The current criterion standard for measuring inspiratory effort, esophageal manometry, is an invasive procedure that young patients find intolerable. Inspiratory effort can also be assessed noninvasively by measuring the pulse transit time (PTT). PTT is the time the pulse wave (PW) takes to travel between two arterial sites (normally heart to finger). The speed at which the PW travels is directly proportional to arterial BP. When BP rises, PTT shortens. Conversely, when BP falls, PTT lengthens. In this study, we investigated PTT as a measure for evaluating inspiratory effort in children. We studied 15 healthy children (age range, 5 to 12 years; mean age [+/- SD], 8.3 +/- 2.74; 9 male children) selected from patients referred to our pediatric center for routine assessment. We assessed changes in the PTT during breathing against known resistances in awake children. Resistance was applied to the nose and mouth with a modified, two-way, nonrebreathing facemask. Our data show a good correlation between the induced inspiratory effort and the amplitude of PTT variations. PTT should be a useful method for quantifying changes in inspiratory effort due to augmented upper airway resistance in awake children.
Research Interests: Humans, Child, Female, Male, Clinical Sciences, and 4 moreInhalation, Time Factors, Pulse, and Chest
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To determine the predominant abnormality of pulmonary function in patients with thalassemia major (TM), we evaluated 29 patients with TM who were receiving hypertransfusion therapy and chelation with desferrioxamine (DFO), and who ranged... more
To determine the predominant abnormality of pulmonary function in patients with thalassemia major (TM), we evaluated 29 patients with TM who were receiving hypertransfusion therapy and chelation with desferrioxamine (DFO), and who ranged in age from 6 to 40 yr (mean 19.8 +/- 8.5 yr). A reduction in the total lung capacity (TLC) was the most striking abnormality, found in 21 of 29 patients (79%). Fourteen of these patients (67%) had a moderate or severe reduction in TLC. Expiratory flow rates, FEV1, and FEF25-75 were decreased below predicted values in 48 and 17% of the patients, respectively, but no patients had pure obstructive disease. Significant hypoxemia (oxygen saturation of less than 95%) was observed in only one patient. There was a significant inverse correlation between TLC and patient age (p < 0.003), transfusional iron burden (p < 0.003) and DFO ratio (p < 0.024). Restrictive disease is the predominant abnormality of pulmonary function in TM, with a mixed restrictive-obstructive pattern in a small number of patients. The restrictive disease becomes more severe with increasing age, and the degree and duration of iron overload appear to be important in its pathogenesis. The role of DFO therapy in preventing the pulmonary complications associated with TM requires further study.