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Biomedical subjects

G Antonucci

Publications and source records attributed to G Antonucci.

At least 37 records · Page 2Linked to original sources
PubMed2000

Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection.

OBJECTIVE: To assess the association between use of different antiretroviral regimens and incidence of tuberculosis among HIV-infected individuals. DESIGN: Observational, multicenter, prospective cohort study. SETTING AND PATIENTS: Twenty-eight infectious diseases hospital units in Italy. A total of 2160 HIV-infected persons were considered for enrolment in a study on the implementation of tuberculosis preventive therapy between 1 May 1995 and 30 April 1996. The 1360 subjects who completed tuberculin screening at base-line were included in this analysis. Information on the use of antiretroviral therapies over time was collected. The median duration of follow-up was 104 weeks and 997 subjects (73.3%) completed the study. MAIN OUTCOME MEASURE: Incidence of active tuberculosis according to different types of antiretroviral therapy. RESULTS: Eighteen cases of tuberculosis were observed with an overall incidence rate of 0.79 per 100 person-years of observation [95% confidence interval (CI), 0.51-1.31]. Tuberculin positivity and low CD4+ lymphocyte count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 took triple combination therapy. After adjusting for base-line characteristics of enrolled individuals, the relative hazard of tuberculosis was 0.16 (95% CI, 0.03-0.74) for double combination therapy and 0.08 (95% CI, 0.01-0.88) for triple combination therapy compared with no therapy or monotherapy. CONCLUSIONS: Combination antiretroviral therapy significantly reduced the risk of tuberculosis in HIV-infected persons. In industrialized countries, the widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, possibly contributing to a reduction in the overall incidence of tuberculosis.

Adolescent↗
PubMed2000

Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy.

OBJECTIVE: To assess the specific influence of onset-admission interval (OAI) on rehabilitation results. DESIGN: A case-control study in consecutive stroke inpatients, enrolled in homogeneous subgroups, matched for age (within 1 year) and Barthel Index (BI) score at admission, and different for OAI to the rehabilitation ward. The short OAI group began rehabilitation treatment within the first 20 days from stroke, medium OAI group between days 21 and 40, and long OAI between days 41 and 60. SETTING: Rehabilitation hospital. PATIENTS: One hundred forty-five patients with sequelae of first stroke. MAIN OUTCOME MEASURES: Efficiency (average increase in BI per day), effectiveness (proportion of potential improvement achieved during rehabilitation) of treatment, and percentage of low- and high-response patients, calculated on BI, were evaluated. Odds ratios (ORs) of dropouts and of poor and excellent therapeutic response were also quantified. RESULTS: The short OAI subgroup had significantly higher effectiveness of treatment than did the medium (p < .05) and the long OAI groups (p < .005). Beginning treatment within the first 20 days was associated with a significantly high probability of excellent therapeutic response (OR = 6.11; 95% confidence interval [CI], 2.03-18.36), and beginning later was associated with a similar risk of poor response (OR = 5.18; 95% CI, 1.07-25.00). On the other hand, early intervention was associated with a five times greater risk of dropout than that of patients with delayed start of treatment (OR = 4.99; 95% CI, 1.38-18.03). The three subgroups were significantly (p < .05) different regarding the percentage of low and high responders. CONCLUSION: Our results showed a strong association between OAI and functional outcome.

Aged↗
PubMed2000

Processing of illusion of length in spatial hemineglect: a study of line bisection.

Bisection of horizontal lines and of the Brentano form of the Müller-Lyer illusion was investigated in six right brain-damaged patients with left spatial hemineglect, and in six control subjects. Patients bisected the lines to the right of the objective mid-point. Comparable illusory effects on line bisection were however found in both patients and control subjects. Relative to the baseline condition, in both groups the subjective midpoint was displaced towards the side expanded by the illusion, both leftwards and rightwards. By contrast, line length and spatial position of the stimulus had differential effects. In neglect patients, the rightward bisection error increased disproportionately with line length, and when the stimulus was located in the left, neglected, side of egocentric space. Control subjects showed no such effects. The suggestion is made that the visual, non-egocentric, processes underlying these illusory effects of length may be spared in patients with left spatial neglect. The possible neural basis of this dissociation is discussed.

Aged↗
PubMed1999

Poststroke depression and its role in rehabilitation of inpatients.

OBJECTIVES: To identify the prevalence of poststroke depression (PSD) in a population of patients admitted for rehabilitation of neurologic sequelae of their first stroke, to recognize reliable prognostic factors associated with the occurrence of PSD, and to evaluate the impact of PSD on the results of rehabilitation treatment. METHODS: In a prospective study of 470 of 508 consecutive patients admitted to a rehabilitation hospital for sequelae of their first stroke, the relation between 23 independent variables and the development of depression was assessed by using a logistic regression analysis (forward stepwise). In addition, the impact of PSD on basal disability and on rehabilitation results was assessed by multiple measures (length of stay, efficiency, effectiveness, and percent of low responders on activities of daily living [ADL] and mobility). RESULTS: PSD occurred in 129 patients (27.4%). Being female and having more than 8 years of schooling were associated with a higher probability of developing depression (odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.27-2.96, and OR = 1.61, 95% CI = 1.04-2.48, respectively). No association was found with site or side of cerebral lesion. In a logistic model, depression was a significant independent predictor (OR = 1.99, 95% CI = 1.14-3.46) of low response on ADL in spite of treatment. CONCLUSIONS: PSD occurs especially in female patients and in patients with a high level of education and, even if treated, may affect rehabilitation results. No association was found between brain lesion location and PSD.

Activities of Daily Living↗
PubMed1999

Hierarchical organisation in perception of orientation.

According to Rock [1990, in The Legacy of Solomon Asch (Hillsdale, NJ: Lawrence Erlbaum Associates)], hierarchical organisation of perception describes cases in which the orientation of an object is affected by the immediately surrounding elements in the visual field. Various experiments were performed to study the hierarchical organisation of orientation perception. In most of them the rod-and-frame-illusion (RFI: change of the apparent vertical measured on a central rod surrounded by a tilted frame) was measured in the presence/absence of a second inner frame. The first three experiments showed that, when the inner frame is vertical, the direction and size of the illusion are consistent with expectancies based on the hierarchical organisation hypothesis. An analysis of published and unpublished data collected on a large number of subjects showed that orientational hierarchical effects are independent from the absolute size of the RFI. In experiments 4 to 7 we examined the perceptual conditions of the inner stimulus (enclosure, orientation, and presence of luminance borders) critical for obtaining a hierarchical organisation effect. Although an inner vertical square was effective in reducing the illusion (experiment 3), an inner circle enclosing the rod was ineffective (experiment 4). This indicates that definite orientation is necessary to modulate the illusion. However, orientational information provided by a vertical or horizontal rectangle presented near the rod, but not enclosing it, did not modulate the RFI (experiment 5). This suggests that the presence of a figure with oriented contours enclosing the rod is critical. In experiments 6 and 7 we studied whether the presence of luminance borders is important or whether the inner upright square might be effective also if made of subjective contours. When the subjective contour figure was salient and the observers perceived it clearly, its effectiveness in modulating the RFI was comparable to that observed with luminance borders.

Adult↗
PubMed1999

Experimental infection by Vibrio anguillarum in mice and guinea pigs.

The fish pathogen Vibrio anguillarum causes a lethal infection in farmed fish characterized by hemorrhagic septicemia. There are no reports of experimental laboratory infections in warm-blooded animals. We investigated the effects of an intraperitoneal infection with different doses of a V. anguillarum suspension in mice and guinea pigs. The infection caused a 95-100% of mortality in 24-48 h. Hemorrhagic septicemia was observed at necropsy and confirmed by histological and hematological examination. Immunohistochemically positive bacterial clumps were detected exclusively in vessel lumen in all examined organs, including brain, and V. anguillarum was reisolated in pure culture from all organs, particularly from the kidney. Blood analysis showed erythropenia and leukopenia with granulocytosis in mice, platelet reduction and leukopenia with lymphocytosis in guinea pigs.

Animals↗
PubMed1998

A possible correlation between the blood leukocyte formula and the use of glucocorticoids as growth promoters in beef cattle.

Clinical analyses designed to set welfare parameters were performed on blood drawn from the caudal vein of 14 groups of cattle (young bulls and heifers) (n = 10) from 480 to 550 kg b.w., each group representative of a different farm. The leukocyte formula exhibited a lymphocytopenia in four groups compared with the values from a control group (n = 50). This finding was related to the possible illicit use of corticoids as growth promoters in meat production. The individual plasmas tested negative by two different ELISA kits for corticosteroids, but chemical analyses by LC-MS/APCI (detection limit 0.5 ng/ml) on the pooled plasma of each of the 14 groups revealed the presence of beclomethasone and fluocinolone acetonide in 3 of the 4 suspect farms. These corticosteroids are not always efficiently screened by commercially available immunoassays. The epidemiological reliability of blood analysis as a screening test for such drugs is discussed in the light of the need for quality certification of the whole meat production processes 'from farm to fork', and for enhanced animal welfare.

Animals↗
PubMed1998

Changes in functional outcome in inpatient stroke rehabilitation resulting from new health policy regulations in Italy.

This study was designed to assess whether enforcement of new health policy regulations in Italy limiting fully paid hospital stay to 60 days has actually caused a decrease in rehabilitation outcomes of stroke patients. Final sample included 370 out of 398 consecutive patients hospitalized between 1993 and 1996 for first stroke sequelae. Rehabilitation results were compared between subgroups of patients admitted before and after new Italian regulations. Length of stay was significantly (p < 0.001) shorter in 1996 than in previous years. However, between 1993 and 1996 a significant (p < 0.05) decrease in effectiveness on mobility and a significant (p < 0.05) increase in "low responders" on both daily living activities and mobility was observed. Moreover, in 1995-96 the precocious discharge of patients compromised stabilization of recovery with subsequent functional worsening. After discharge, outpatient rehabilitation treatment was able to conserve achieved mobility status, but not functional status on daily living activities. We suggest revising the present regulation for medical rehabilitation services to one based on FRGs (functional related groups), so that the appropriate treatment can be carried out for each patient.

Journal Article↗
PubMed1998

Role of human immunodeficiency virus in primary pulmonary hypertension--case reports.

Previous cases of pulmonary hypertension (PH) in human immunodeficiency virus (HIV) infection have been reported in the literature. The role of HIV in PH is still debatable. The purpose of this report was to analyze whether HIV plays a direct or indirect role in PH pathogenesis. Between February and November 1997, 56 HIV-infected patients with cardiac symptoms and signs were studied by serial color Doppler echocardiography. In four patients (7.1%), PH not related to other well-known associated conditions, was disclosed. In spite of a low serum HIV RNA viral load and a high-efficacy antiretroviral therapy, including a protease inhibitor in two patients, PH developed and worsened. It could be hypothesized that in some patients with an individual immunogenetic predisposition, a high secretion of cytokines and endothelin-1 stimulated by an unidentified pathogen different from HIV could lead to PH. Antiretroviral therapy seems not to prevent or reduce right ventricle pressure gradient in PH.

Adult↗
PubMed1998

Detection of bovine mitochondrial DNA in ruminant feeds: a molecular approach to test for the presence of bovine-derived materials.

A ban on ruminant-derived proteins in ruminant feeds has been introduced as a preventive measure to avoid the spread of bovine spongiform encephalopathy (BSE), as well as to minimize any potential risk of BSE transmission from bovines to humans. In the absence of commercially available efficient methods for identification of bovine-derived proteins in animal feeds, we developed a rapid and sensitive polymerase chain reaction (PCR)-based assay which allows detection and identification of a bovine-specific mitochondrial DNA sequence from feedstuffs. The amplified product encodes for the whole ATPase subunit 8 and the amino-terminal portion of the ATPase subunit 6 proteins, which are known to exhibit a relatively low degree of conservation among vertebrates. The specific amplification of such a bovine mitochondrial sequence from reference feedstuff samples was demonstrated by means of both direct sequencing and single-strand conformational analysis of the PCR product. Specificity was also confirmed by the absence of detectable homologous PCR product when using reference feedstuff samples lacking bovine-derived meat and bonemeals, or genomic DNA samples from vertebrates whose offals are commonly included in animal feeds. This method allows detection of the presence of bovine mitochondrial DNA in feedstuffs containing less than 0.125% of bovine-derived meat and bonemeals. Furthermore, it does not appear to be considerably affected by prolonged heat treatment. DpnII and SspI restriction endonuclease digestions of the unpurified PCR product may be used routinely to confirm the bovine origin of the amplified sequence. Since this method is specific, rapid, and sensitive, it could be successfully utilized as a routine control assay to evaluate the presence of bovine-derived meat and bonemeals in ruminant feeds.

Adenosine Triphosphatases↗
PubMed1997

Association of tuberculosis risk with the degree of tuberculin reaction in HIV-infected patients. The Gruppo Italiano di Studio Tubercolosi e AIDS.

BACKGROUND: The risk of developing active tuberculosis associated with a different size of induration to purified protein derivative (PPD) has not been prospectively assessed among individuals infected with human immunodeficiency virus (HIV). The quantification of this risk is important to more appropriately identify candidates for preventive therapy for tuberculosis. METHODS: A prospective, multicenter, cohort study on tuberculosis in HIV-infected patients was conducted in 23 infectious disease units in public hospitals in Italy. Two thousand six hundred ninety-five HIV-infected patients were enrolled in the study. Of these, 1054 patients who were nonanergic at the time of entry were included in the present analysis. The median duration of follow-up was 102 weeks. The main outcome measure was a diagnosis of active tuberculosis confirmed by the isolation of Mycobacterium tuberculosis in culture. RESULTS: Among the 252 patients with PPD reactivity, patients with an induration to PPD of 2 to 4 mm had a median CD4+ lymphocyte count of 0.34 x 10(9)/L (interquartile [IQ] range, 0.14 x 10(9)-0.56 x 10(9)), those with a response of 5 to 9 mm had a median count of 0.38 x 10(9)/L (IQ range, 0.24 x 10(9)-0.56 x 10(9)), and those with a response of 10 mm or higher had a median count of 0.37 x 10(9)/L (IQ range, 0.23 x 10(9)-0.52 x 10(9)) (P = .38). Compared with the 802 nonanergic PPD-negative patients, hazard ratios of tuberculosis were 2.1 (95% confidence interval [CI], 0.2-18.3) among the 55 patients with a response to PPD of 2 to 4 mm, 5.7 (95% CI, 1.6-19.8) among the 128 patients with a response to PPD of 5 to 9 mm, and 23.1 (95% CI, 7.8-68.6) among the 69 patients with a response to PPD of 10 mm or higher. CONCLUSIONS: Among nonanergic HIV-infected patients, the degree of response to tuberculin does not appear to reflect the degree of immunosuppression and is strongly correlated with the subsequent incidence of tuberculosis. To identify HIV-infected patients who are at an increased risk of tuberculosis and may benefit from preventive therapy, a response to PPD of 5 mm appears to be an appropriate cutoff point.

AIDS-Related Opportunistic Infections↗
PubMed1997

Frame-of-reference and hierarchical-organisation effects in the rod-and-frame illusion.

Two hypotheses proposed as alternatives by Rock--frame of reference and hierarchical organisation of perception--were tested in a series of experiments with the use of the rod-and-frame illusion. This illusion produces errors in the apparent vertical due to the presence of a tilted frame surrounding the test rod. The apparent vertical is shifted in the direction of the frame tilt. When an upright square was added inside the tilted frame, rod-setting errors varied according to the visual characteristics of the display. In the case of a large display presented in the dark (experiment 1), there continued to be large errors in the direction of the outer-square tilt. This finding supports the frame-of-reference hypothesis, which proposes that the orientation of all objects in the visual field is dominated by the most peripheral reference. In the case of a small display presented in a lit environment (experiments 2 and 3), the direction of errors was the opposite. This latter finding was taken to indicate that the rod was set with reference to the perceived tilt of the inner upright square. Thus, according to a hierarchical-organisation hypothesis, the orientation of an object in the visual field is influenced by objects in the immediate surroundings not by outermost reference. Overall, the results confirm the presence of two qualitatively different classes of orientational phenomena: one is concerned with the definition of egocentric coordinates and one with an object-centred visual representation.

Adult↗
PubMed1996

Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross-over study.

A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

Cerebrovascular Disorders↗
PubMed1996

Beyond unilateral neglect.

When required to set the endpoints of an imaginary horizontal line of a given length on the basis of its midpoint printed on a sheet of paper, left neglect patients most frequently misplaced endpoints leftwards. Though giving rise to the very same disproportion usually found with these patients on canonical line bisection tasks, this behaviour cannot be accommodated by current explanations of unilateral neglect. When the task was executed during leftward optokinetic stimulation (OKS), a manoeuvre known temporarily to improve neglect symptoms, the disproportion increased instead of vanishing. We therefore suggest that unilateral neglect is a manifestation of a disorder primarily implying a horizontal anisometry of space representation and that manipulations such as OKS may remove neglect without normalizing the representational medium itself.

Adult↗
PubMed1996

Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causative strains.

Over the years 1983-1994, Candida parapsilosis causes 35 or 138 fungemic episodes (24 of 69 candidemias in the last quadriennium) in patients with hematologic malignancies who were being treated at a large university hospital in Italy. The central venous catheter was usually the source of bloodstream invasion; in most cases, the resolution of fungemia in patients receiving antifungal therapy required catheter removal. In seven cases, C. parapsilosis fungemia evolved to five proven (two cases with endocarditis) and two probable deep-seated infections; three of these seven patients died of deep-seated infections. Deep seated infection was associated with the detection of a circulating mannoprotein antigen of C. parapsilosis but not with in vitro resistance to antifungal agents. Almost all fungal isolates produced slime in vitro, but only 34% were pathogenic in a model of bloodstream infection in neutropenic mice. The four isolates associated with endocarditis or persistent fungemia with multiorgan failure were among the most virulent in the model of infection. Overall, our findings highlight the role of C. parapsilosis as an agent of fungemia in patients with malignant hemopathies.

Adolescent↗