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Biomedical subjects

P Coppo

Publications and source records attributed to P Coppo.

18 recordsLinked to original sources

Pseudoverrucous papules: an aspect of incontinence in children.

Pseudoverrucous papules and nodules can be observed on skin surrounding urostomies and colostomies. These lesions appear to be uncommon, and sometimes can be misdiagnosed, even leading to surgical removal. We report the case of a 12-year-old boy whose lesions appeared in crops in an area subjected to urine leakage and spontaneously regressed in time. In this patient, anogenital warts had to be ruled out, but many skin diseases must be considered in the differential diagnosis of these misunderstood lesions. We stress the importance of a skin examination by a trained professional aware of these problems to avoid unnecessary investigations and treatments.

Biopsy, Needle↗

Inflammatory myositis associated with anti-U1-small nuclear ribonucleoprotein antibodies: a subset of myositis associated with a favourable outcome.

OBJECTIVES: Inflammatory myositides are rare chronic disorders which may be either isolated or associated with other conditions such as connective tissue diseases or neoplasia. A large variety of autoantibodies can be detected in patients with myositis, some of which have a diagnostic and/or a prognostic value. Myositis associated with anti-U1-small nuclear ribonucleoprotein antibodies (anti-U1-snRNP Abs) are usually considered as overlapping syndromes, mainly mixed connective tissue diseases (MCTD) in which muscle symptoms occur insidiously during the disease course and are characterized by a favourable outcome. METHODS: The clinical, biological, immunological and pathological findings as well as the outcome of five patients with anti-U1-snRNP-associated myositis were retrospectively analysed. RESULTS: Patients were mainly black females. In all five patients, myositis was the predominant manifestation at presentation. Associated conditions consisted of interstitial lung disease (ILD) (three), arthritis (three) and neurological symptoms (two). No patient presented Raynaud's phenomenon nor met criteria for MCTD. Biological inflammatory features, rheumatoid factor and polyclonal hypergammaglobulinaemia were present in all cases. Besides anti-U1-snRNP Abs, one patient had anti-Ro/SSA and anti-La/SSB Abs at presentation and one additional patient developed anti-double-stranded-DNA and anti-Sm Abs after a follow-up of more than 4 yr. No patient had anti-PM/sclerosis (Scl) nor anti-aminoacyl-tRNA synthetase Abs. All patients dramatically improved with steroids, and reached complete remission (CR) within 3 weeks. Two patients relapsed 18 months after CR. They both reached rapidly second CR using steroids associated or not with oral methotrexate. CONCLUSION: Our data suggest that anti-U1-snRNP Abs may define a subset of myositis characterized by a favourable outcome, though often associated with ILD and/or neurological manifestations.

Adult↗

Photoinduced, ionic Meerwein arylation of olefins.

Irradiation of 4-chloroaniline or of its N,N-dimethyl derivative in polar solvents generates the corresponding triplet phenyl cations. These are trapped by alkenes yielding arylated products in medium to good yields. B3LYP calculations show that the triplet cation slides with negligible activation energy to a bonded adduct with ethylene, whereas it forms only a marginally stabilized CT complex with water (chosen as a representative sigma nucleophile). The structure of the final products depends on the preferred path from the adduct cation with the alkene. In the case of aryl olefins, this deprotonates to stilbene derivatives, while, from 2,3-dimethyl-2-butene and allytrimethylsilane, allylanilines are obtained by elimination of an electrofugal group in gamma. In the case of mono- and disubstituted alkenes the cation adds chloride rather than eliminating and beta-chloroalkylanilines are obtained. The regio- and sterochemistry of the addition across the alkene are best understood with a phenonium ion structure for the adduct. The nucleophile entering in beta can be varied under conditions in which the adduct cation is trapped more efficiently than the starting phenyl cation. Thus, beta-methoxyalkylanilines are formed when the irradiation is carried out in methanol. beta-Iodoalkylanilines are obtained in acetonitrile containing iodide and unsubstituted alkylanilines in the presence of sodium borohydride. A case of intramolecular nucleophilic trapping is found with 4-pentenoic acid. The reaction is a wide-scope ionic analogue of the radicalic Meerwin arylation of olefins.

Journal Article↗

Effectiveness of platelet transfusions after plasma exchange in adult thrombotic thrombocytopenic purpura: a report of two cases.

Plasma infusion (PI) and plasma exchange (PE) are the most efficient treatment of thrombotic thrombocytopenic purpura (TTP), allowing achievement of complete remission in 60 to 90% of cases. Life-threatening bleeding, related to severe thrombocytopenia, is one of the main complications of the disease. Thrombocytopenia may also preclude invasive procedures such as splenectomy, which may be required during the management of TTP. Platelet concentrates transfusions are usually thought to worsen the disease, especially if not associated with the appropriate treatment of this latter, and thus should be avoided. We report hereon 2 patients with TTP who experienced a surgical procedure i.e., a cholecystectomy for a cholecystitis, and a splenectomy for a refractory TTP. In both patients, the surgical procedure was preceded by a 60 mL/kg plasma exchange with solvent/detergent treated plasma as replacement fluid, followed by platelet transfusion, with a corrected count increment of 57.1% (Patient 1) and 69.3% (Patient 2). Using this sequential treatment, the patients did not experience any deterioration of their status. Both patients had a favorable outcome after surgery. However, until such a procedure will be validated on a larger series of patients, it should be restricted to patients presenting with a refractory life-threatening thrombocytopenia and/or requiring surgery or any kind of invasive procedure. Am. J. Hematol. 68:198-201, 2001. Published 2001 Wiley-Liss, Inc.

Adult↗

Allogenic bone marrow transplantation with a donor presenting with an acute hepatitis A.

We report the unique occurrence of an allogenic bone marrow transplantation performed as the donor was suffering from an acute hepatitis A. The bone marrow was contaminated at the time of collection, as demonstrated by hepatitis A virus (HAV) RNA detected by RT-PCR. Hepatitis A virus infection in such a situation could have resulted in a severe liver disease in the recipient. However, although we could demonstrate that the recipient had been infected, he did not develop a symptomatic hepatitis A but only minor disturbances of liver function tests between days 35 and 55. Both the postponement of the transplantation and the use of intravenous polyvalent immunoglobulins have probably played a key role in decreasing the viral load and allowing a rapid clearance of the virus. A possible role of the grafted immune system might also be envisaged, as suggested by the de novo synthesis of IgM in the recipient.

Acute Disease↗

Astrovirus enteritis in a chronic lymphocytic leukemia patient treated with fludarabine monophosphate.

We report on a case of severe astrovirus gastroenteritis in a chronic lymphocytic leukemia (CLL) patient treated with fludarabine monophosphate (FAMP). Astrovirus was detected in stools using both an immunoenzymatic assay and an electronic microscopy analysis. Treatment consisted in symptomatic care and the outcome was favorable. Astrovirus infection might constitute a common etiology of gastroenteritis in patients with hematologic malignancies that have been severely immunocompromised with FAMP or other purine analogues, and therefore should be more systematically investigated.

Antimetabolites, Antineoplastic↗

Psychopathology in the Dogon Plateau: an assessment using the QDSM and principal components analysis.

BACKGROUND: The present paper reports the findings of principal components analysis performed on the basis of answers to the Questionnaire pour le Depistage en Santé Mentale (QDSM) administered to subjects from the Bandiagara plateau (Mali), who had been evaluated in a previously published report. METHODS: The study sample was made up of 466 subjects (253 males, 213 females), 273 of whom belonged to the Dogon ethnic group, 163 were Peul and the remaining 30 belonged to other groups (Sonrai, Bozo, Tuareg, Bambara). All subjects were submitted to QDSM, a structured interview derived from the Self Reporting Questionnaire. Data obtained were processed by means of principal components analysis, in order to obtain syndromic aggregations. RESULTS: Eight factors with an Eigen value greater than 1 were extracted, which provided sufficient explanation for the overall variance observed among the 23 items. These factors may be termed as follows: Sadness (factor 1); Dysphoria (factor 2); Nightmares (factor 3); Persecution (factor 4); Somatic symptoms (factor 5); Special powers (factor 6); Hopelessness (factor 7); Loss of Interest (factor 8). CONCLUSIONS: The findings from this study support the hypothesis of an independence of "psychosomatic" from depressive symptoms. In particular, contrary to some evidence derived from other African studies, the present research appears to suggest a possible counterposition of these two ways of expressing depression, commonly considered as autonomous.

Adolescent↗

Progressive multifocal leucoencephalopathy with peripheral demyelinating neuropathy after autologous bone marrow transplantation for acute myeloblastic leukemia (FAB5).

Progressive multifocal leucoencephalopathy is an opportunistic JC virus-related pathology occurring in immunocompromised patients. We report a case of severe cellular immunodeficiency in a patient who underwent autologous bone marrow transplantation for acute myeloblastic leukemia, and who subsequently developed progressive multifocal leucoencephalopathy, an unusual pathology in this context. Progressive multifocal leucoencephalopathy was preceded by a peripheral demyelinating neuropathy. We discuss the possible link between these two neuropathies, the possible aggravation or activation from CMV infection, as well as the possible contribution of bone marrow purging in the resultant cellular immunodeficiency.

Adult↗

Mental disorders and health care seeking in Bandiagara: a community survey in the Dogon Plateau.

A two-level community study was carried out among the Peul and Dogon populations of the Bandiagara plateau (Mali). For the purpose of the study the Questionnaire pour le depistage en santé mentale (QDSM), a 23-item screening questionnaire derived from the Self-Reporting Questionnaire (SRQ), was adapted and validated; internal consistency and accuracy were evaluated. In the first phase of the study, 466 subjects randomly selected on a residential basis were evaluated by means of the QDSM. In the second phase all subjects who were "positive" at the screening, as well as a sample who were "negative", were examined by means of a semistructured interview. When necessary, clinical and laboratory investigations were performed. The estimated prevalence of psychiatric cases was 6.4%. A significant risk was associated with age and education. Somatic diseases frequently associated with psychiatric disorders were genitourinary tract disorders, tuberculosis and disabling cardiopathies. The main factor determining the seeking of medical help either through traditional of conventional health systems was the presence of a somatic disorder. The presence of a true minor psychiatric disorder, however, was often associated with divining practices.

Adolescent↗

Perceived morbidity and health behaviour in a Dogon community.

The episodes of morbidity over a 6 month period were recorded at 179 households comprising 1715 people living in the district of Bandiagara (Mali). This population was subdivided into groups according to their distances from the nearest district health centre and educational services, their scholarization, socio-economic and hygiene levels. The subjects interviewed were asked to report illnesses using their vernacular names, the type of therapy selected, the decision process, the time-lapse between onset and remedial action, the treatment undergone and its effect. Subsequent analysis of the data recorded indicates that the frequency of morbidity episodes is inversely proportionate to the household's level of hygiene. It also appears that factors such as the household's hygienic, socio-economic and educational levels along with the type of illness and its duration, are more decisive when resorting (or not resorting) to treatment than is the proximity factor. This seems particularly true in the case of traditional medicine, chosen even where cosmopolitan resources are available and by people with a relatively high socio-economic, hygienic and educational level. In the specific situation under study this paper indicates those areas for further study with a view to improving public health education.

Adolescent↗

Prevalence of mental disorders in Tuscany: a community study in Lari (Pisa).

A number of population studies of mental disorders has been carried out using standardized diagnostic tools. We performed a study of this type in the small town of Lari (Pisa) with the objectives of estimating the prevalence of mental disorders, including "minor" disorders, and of comparing our estimates with similar studies carried out in UK and Greece using identical methods (PSE-IX and CATEGO). The prevalence of individuals with mental disorders in our study population was 15.4% similar to that observed in Greece (16%) and higher than that observed in London (10%). Prevalence of "obsessive neurosis" was higher in London as compared to Lari and Athens, while the opposite was true for "generalized anxiety".

Adolescent↗

Depression and social change. From transcultural psychiatry to a constructivist model.

Based on the findings of previous studies carried out by our group, which will be briefly summarised, the present paper puts forward several hypotheses to account for the evolution of depressive symptoms and the possible increase observed in risk of depression subsequent to social changes. The particular mood disorders presented by Senegalese emigrants and several protective factors which appear to determine a low risk in these populations, such as a strong social support, will be examined. Based on a previous investigation carried out by our group, which seems to indicate the presence of depressive pictures among poorly westernised populations such as the Peul nomads or Dogon farmers from the Sub-Saharian regions, the hypothesis that "westernalisation" (considered as the loss at an individual level of traditional ways of life, working habits, cultural patterns and languages in favour of different attitudes influenced by western culture) may represent a risk factor for depressive illness, in its clinical expressions commonly observed in western contexts, has been considered. In these populations, with the exception of educated individuals, the albeit rare depressive symptoms appear to be secondary to serious somatic disorders. Research performed identified two well-defined means of clinical expression, which has been termed, respectively, "western style" or "guilty" and "traditional" or "dislocation from the group". Further studies carried out in rapidly changing areas seem to indicate how environmental factors are able to influence the evolution of depressive symptoms from the first form to the latter and to modify the threshold of onset of emotive, behavioural and depressive patterns. It has been hypothesised that rapid changes in the social organisation tend to exacerbate attitudes of "compulsive hyper-responsibilisation", a cognitive set of basic assumptions which may be considered at the same time both as a product of "westernalization" at an individual level and a risk factor for depression. Individuals who possess these basic characteristics, subsequent to the opportunities afforded by the social changes, tend to develop new complex systems of interpreting reality, causality, controlling of events and ways of expressing emotions. Accordingly, we herewith propose a reviewal of the entire threshold concept and provide a means of interpreting the transformation in depressive phenomena in view of the fact that, although the new levels of knowledge and learning better equip subjects to face the new situations, they also render them more vulnerable to depression.

Adult↗

[Ethnopsychiatric observations apropos of the ritualization of deviation].

The author compares certain aspects of "conventional" and "traditional" psychiatry, on the basis of observations carried out within different traditional African cultures, particularly referring to ritual practices that have as object the treatment of mental disorders. The author underlines the importance of the attitude of the traditional healer. Nevertheless he stresses the major role played by the social structure that represents the frame of any therapeutic action.

Africa↗