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Biomedical subjects

R Zannolli

Publications and source records attributed to R Zannolli.

18 recordsLinked to original sources
PubMed2000

Vagal and hypoglossal Bell's palsy.

A 7-year-old boy was referred because of a sudden change to nasal speech, dysarthria for words with explosive consonants in speech, and nasal regurgitation of fluids. The symptoms arose over 1 week following a capricious episode of acute asthmatic bronchitis. Physical and neurologic examinations were normal except for a left deviation of the uvula, accompanied by a "curtain" movement of the posterior pharyngeal wall against the opposite side, and a left deviation of the protruded tongue. No vascular, traumatic, infectious, neoplastic, or neurologic causes could be identified. No therapy was administered. Full recovery occurred 4 months later. The diagnosis was idiopathic vagal and right hypoglossal nerve palsy (Bell's palsy).

Bell Palsy↗
PubMed1999

Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies.

OBJECTIVE: In epidemiological studies, weight loss is usually associated with increased mortality rate. Contrarily, among obese people, weight loss reduces other risk factors for disease and death. We hypothesised that this paradox could exist because weight is used as an implicit adiposity index. No study has considered the independent effects of weight loss and fat loss on mortality rate. We studied mortality rate as a function of weight loss and fat loss. DESIGN: Analysis of 'time to death' in two prospective population-based cohort studies, the Tecumseh Community Health Study (1890 subjects; 321 deaths within 16y of follow-up) and the Framingham Heart Study (2731 subjects; 507 deaths within 8y of follow-up), in which weight and fat (via skinfolds) loss were assessable. RESULTS: In both studies, regardless of the statistical approach, weight loss was associated with an increased, and fat loss with a decreased, mortality rate (P < 0.05). Each standard deviation (s.d.) of weight loss (4.6 kg in Tecumseh, 6.7 kg in Framingham) was estimated to increase the hazard rate by 29% (95% confidence interval CI), (14%, 47%, respectively) and 39% (95% CI, 25%, 54% respectively), in the two samples. Contrarily, each s.d. of fat loss (10.0 mm in Tecumseh, 4.8 mm in Framingham) was estimated to reduce the hazard rate 15% (95% CI, 4%, 25%) and 17% (95% CI, 8%, 25%) in Tecumseh and Framingham, respectively. Generalisability of these results to severely (that is, body mass index BMI) > or = 34) obese individuals is unclear. CONCLUSIONS: Among individuals that are not severely obese, weight loss is associated with increased mortality rate and fat loss with decreased mortality rate.

Adipose Tissue↗
PubMed1999

Testing the robustness of the likelihood-ratio test in a variance-component quantitative-trait loci-mapping procedure.

Detection of linkage to genes for quantitative traits remains a challenging task. Recently, variance components (VC) techniques have emerged as among the more powerful of available methods. As often implemented, such techniques require assumptions about the phenotypic distribution. Usually, multivariate normality is assumed. However, several factors may lead to markedly nonnormal phenotypic data, including (a) the presence of a major gene (not necessarily linked to the markers under study), (b) some types of gene x environment interaction, (c) use of a dichotomous phenotype (i.e., affected vs. unaffected), (d) nonnormality of the population within-genotype (residual) distribution, and (e) selective (extreme) sampling. Using simulation, we have investigated, for sib-pair studies, the robustness of the likelihood-ratio test for a VC quantitative-trait locus-detection procedure to violations of normality that are due to these factors. Results showed (a) that some types of nonnormality, such as leptokurtosis, produced type I error rates in excess of the nominal, or alpha, levels whereas others did not; and (b) that the degree of type I error-rate inflation appears to be directly related to the residual sibling correlation. Potential solutions to this problem are discussed. Investigators contemplating use of this VC procedure are encouraged to provide evidence that their trait data are normally distributed, to employ a procedure that allows for nonnormal data, or to consider implementation of permutation tests.

Analysis of Variance↗
PubMed1999

The direct health care costs of obesity in the United States.

OBJECTIVES: Recent estimates suggest that obesity accounts for 5.7% of US total direct health care costs, but these estimates have not accounted for the increased death rate among obese people. This article examines whether the estimated direct health care costs attributable to obesity are offset by the increased mortality rate among obese individuals. METHODS: Data on death rates, relative risks of death with obesity, and health care costs at different ages were used to estimate direct health care costs of obesity from 20 to 85 years of age with and without accounting for increased death rates associated with obesity. Sensitivity analyses used different values of relative risk of death, given obesity, and allowed the relative costs due to obesity per unit of time to vary with age. RESULTS: Direct health care costs from 20 to 85 years of age were estimated to be approximately 25% lower when differential mortality was taken into account. Sensitivity analyses suggested that direct health care costs of obesity are unlikely to exceed 4.32% or to be lower than 0.89%. CONCLUSIONS: Increased mortality among obese people should be accounted for in order not to overestimate health care costs.

Adult↗
PubMed1997

Does puberty interfere with asthma?

This study reviews whether, to date, scientific evidence exists that puberty interferes with the occurrence of asthma. This question was triggered by three points: (a) clinical experience with asthma as a relatively benign disease that children often 'grow out of'; (b) observations implying that asthma can change during fluctuations of sexual steroid hormones; and (c) knowledge that puberty is an age of deep hormonal changes. No scientific evidence was found that pubertal changes interfere with the occurrence of asthma. Nevertheless, there is a general agreement about the influence of age and sex on its outcome. The overall occurrence of the disease, which is highest in childhood, declines with age. In the wane phenomena, puberty does not seem to be more important than previous ages. Furthermore, the pattern of occurrence is different in the two sexes. Boys have more asthma before 10 years of age or the mid-teens. Girls then overtake boys and have more asthma up to the years of sexual maturity. During the fifth or sixth decade, asthma again seems to become slightly more prevalent in men than women, or at least the difference between the sexes disappears. It is concluded that the risk of asthma is not influenced by puberty. Age and sex seem to be more important factors, although the reason for this is unknown.

Adolescent↗
PubMed1997

Hepatitis B vaccine: current issues.

OBJECTIVE: To review two main issues concerning the hepatitis B vaccine: (1) the management of unresponsive subjects and (2) the need for routine booster doses. DATA SOURCES: Pertinent literature identified via MEDLINE (1980-1996) search as well as references cited in published articles. DATA SYNTHESIS: The optimal procedure for management of subjects unresponsive to hepatitis B vaccine has not been well established. Most unresponsive subjects are not absolute nonresponders, since most of them can develop protective concentrations of antibodies to hepatitis B surface antigen (anti-HBsAg) after hepatitis B revaccination, consisting of a fourth or a fifth dose or a new complete course of immunization. In subjects who do not respond to the hepatitis B vaccine after four or more injections, the benefits of the combination of cytokines (e.g., interferon-alfa, interleukin-2 [aldesleukin]) and vaccine have not been clearly shown. There are two main opinions regarding the need for routine booster doses. Experts from the US, claiming long-term protection from immunologic memory, suggest delaying booster doses for at least a decade after vaccination in subjects with normal immune status. Furthermore, postvaccination antibody testing should be restricted only to high-risk subjects. Once a vaccinated subject has responded satisfactorily, further antibody tests are unnecessary. Only hemodialysis patients should be tested annually for adequate antibody concentrations and the booster dose administered when concentrations decline to less than 10 IU/L. Experts from Europe suggest that vaccine-induced antibody responses should be assessed in all subjects and booster doses administered at intervals, with the theory being that protection correlates with the presence of antibody. However, indications about appropriate timing for booster doses and target titers of anti-HBsAg remain controversial. CONCLUSIONS: It is possible to obtain seroconversion in nonresponders by using variations in vaccination strategies (i.e., > 3 doses, double amounts of HBsAg). Adjuvants such as interferon-alfa or aldesleukin are of limited use. The opinions of American experts regarding routine booster doses, as expressed by the statement of the Immunization Practices Advisory Committee, seem to be well defined and helpful to clinicians trying to resolve controversies for individual patients. The opinions of the European experts are not unanimous and are sometimes impractical. A consensus conference is needed.

Antibodies, Viral↗
PubMed1996

Waist percentiles: a simple test for atherogenic disease?

OBJECTIVE: To give standards for quantification of the magnitude of waist circumference in children. METHODS: We calculated the percentiles of waist circumference by age and sex from a sample of 2858 subjects (1440 males and 1418 females, aged 6-14 years). Data were from a population survey of 15,000 school-children in Pescara, a town in Abruzzo, a region of Central Italy. RESULTS: We reported the values of the calculated percentiles by age and sex and gave the smoothed percentile curves. CONCLUSIONS: Some recent studies in adults have indicated that measuring waist circumference seems to be the simplest way to estimate obesity and the risk of cardiovascular disease. In children, similar evidence is emerging. To date, no example of calculating standards has been published for quantitating the magnitude of waist circumference in children; therefore, our example of standard waist measurements could be used as a practical model for selecting subjects with a value of < or = or > 2 SD from the mean. The metabolic status should then be checked by complementary laboratory examination.

Abdomen↗
PubMed1996

The varicella vaccine. An evolving mosaic of information.

The Oka strain of live attenuated varicella vaccine has been under evaluation for license for many years. Nevertheless, despite more than 20 years of research efforts, only few countries, up-to-day, licensed this vaccine. Notwithstanding numerous studies have indicated that the vaccine is safe, immunogenic and highly protective against severe varicella in healthy children and adults and in certain immunocompromised patients, including children with leukemia, there are some controversial aspects that could explain the lacking diffusion of the vaccine. In this study, some main question have been reviewed: 1) how the vaccine should be used; 2) how much the vaccine is powerful; 3) how we should manage the immunodeficient patient: 4) how much the vaccine virus could be dangerous for the disease transmission; 5) why the vaccine is better than the immune-globulins; 6) which is the best timing for immunization; 7) why we are still waiting to start the universal immunization.

Adult↗
PubMed1995

New pathogens, and diseases old and new. I) Afipia felis and Rochalimaea. II) Parvovirus B 19. III) herpesvirus 6.

The paper describes events that in the last fifteen years, have led to the identification of the aetiological agents of three widely known diseases: cat scratch disease, erythema infectiosum and exanthem subitum. The particular features of Afipia felis and Rochalimaea, Parvovirus B 19 and Herpesvirus 6 are presented. The paternity of new diseases (i.e. bacillary angiomatosis, bacillary peliosis hepatitis, LES-like syndrome, chronic fatigue syndrome, petechial glove and sock syndrome, etc.) has also been attributed to some of these pathogens as has the paternity of some older ones (i.e. aplastic crisis, erythroblastosis fetalis, trench fever, hepatitis, opportunistic infection, etc.). It has been argued that the same pathogen can cause different diseases depending on the immunogenic state of the subject. To date, persisting difficulties in isolating the pathogen or differentiating between latent or active infection, still in some cases raises doubts concerning the attribution of the disease to a specific agent. New immunological or molecular techniques, allowing the direct detection of in vivo replication, are still needed in order to establish a sure connection between some of these agents and some of these diseases. Progress here will both give more accurate data about the epidemiology of some diseases and allow us to apply more appropriate treatment and prevention techniques.

Bartonella henselae↗
PubMed1994

[Body mass index, weight and height in school children in central Italy].

AIM: To study the pattern of distribution for body-mass index, weight and height in children of the Abruzzo region and to compare them with commonly used standards. STUDY DESIGN: Weight, height and body-mass index (BMI, weight/height2) were reported from 2858 school children (6 to 14 years old) of a town of Central Italy (Pescara). Data were detected in 1991. The conventional percentiles were calculated. Then we considered the first (25%), the median (50%) and the third (75%) quartile of all obtained data. Those of the BMI were superimposed on France (Rolland-cachera MF, Eur J Clin Nutr 1991;45:13) and USA (Hammer LD, Am J Dis Child 1991;145:259) standards. Those of weight and height were superimposed on the respective Tanner standards (Tanner JM, Arch Dis Child 1966;41:613). RESULTS: The percentiles are shown. The central point of distribution (quartiles) appear slid over. The nearer standard for BMI to our sample seems to be represented by France standards, in front of which our values result slid quite exactly of one quartile over. The comparison with USA standards shows an increase of our findings, but the slope of the curves is different (overall in the advanced ages). Both weight and height, compared with Tanner standards, show an increase of values. CONCLUSIONS: 1) Different growth patterns are observed in the studied sample; 2) to calculate the prevalence of wasting and fattening conditions using values of cutoff points from not own standards could load to not appropriate estimates.

Adolescent↗
PubMed1993

Hyperinsulinism as a marker in obese children.

OBJECTIVE: To determine the relationship between insulin and the metabolic profile and eventual weight loss in obese children. DESIGN: We first attempted to define the metabolic profile for 18 obese children; we then studied weight loss in this group longitudinally. SETTING: Department of Pediatrics in a university hospital. PARTICIPANTS: Eighteen randomly selected, young, obese male subjects from 5 to 16 years of age. INTERVENTIONS: (1) Metabolic screening at the outset, including insulinemia and glycemia after the oral glucose tolerance test and plasma levels of total cholesterol, high-density lipoprotein cholesterol, and triglycerides, and (2) weight loss treatment. RESULTS: We divided the sample into "normoinsulinemic" and "hyperinsulinemic" groups, similar for all the variables tested except for weight loss and plasma triglyceride levels. A direct relationship between weight loss results and duration of treatment was found for the entire group. The "hyperinsulinemic" group had a lower percentage reduction in excess weight, and the results in this group were not dependent on the duration of treatment. CONCLUSIONS: The effort to keep "normoinsulinemic" obese children in treatment may be useful; it is advisable to study "hyperinsulinemic" children more in depth.

Adolescent↗
PubMed1989

[Neonatal hyperthyroidism with early onset and protracted course].

Neonatal hyperthyroidism has often been described as a rare, transient disorder in which the mother has hyperthyroidism during her pregnancy. We have found 99 cases mentioned in recent literature, but not in all reports the clinical characteristics were described. This survey has shown that the prolonged clinical course, though less common than the transient one, is to be taken into account. A case of a female child who had signs of hyperthyroidism soon after the birth is presented. Now, at the age of 7.8 years, she continues to have hyperthyroidism with several problems in treatment.

Child↗
PubMed1989

[Methodologic approach to the therapeutic problem of infant and childhood obesity. Review of the literature and personal experience].

Notwithstanding the high prevalence and morbidity, current knowledge of obesity is rather rudimentary. Nevertheless recent findings have enabled us to surmount anachronistic nosographic generalizations whereby excess weight was attributed only to inappropriate and excessive food intake and the lack of physical exercise. Various studies indicate that there are complex interactions in determining weight excess: genetic, psychosocial, cultural but also biochemical factors are incriminated and it is now recognised that the aetiology of obesity is multifactorial and that, consequently, there are different types of obesity. However, in most studies concerning the therapeutic approach, it is noted that the same type of treatment is applied to groups of subjects that are probably highly heterogeneous for type of obesity. No easy or final solution to the problem is proposed as for the moment no ideal treatment exists. What is suggested is the need to attempt to identify possible factors linked to weight excess before commencing the therapeutic approach. For each single case, this could permit the use of the most appropriate treatment and make therapeutic results less frustrating.

Adolescent↗
PubMedDate not supplied

Influence of age, sex, and BMI on waist-to-thigh circumference ratio in children.

In adults the distribution of body fat towards the central region seems a good predictor of disease and mortality. Central fat deposition tends to increase with age; sex and obesity further influence this trend. In children the distribution of adiposity to the central region is not well known. Recently, using circumferences of waist and thigh, we computed the percentile curves of the waist to thigh circumference ratio (WTR) from 2858 subjects (1440 males, 1418 females), 6-14-years-old (Zannolli, R., Chiarelli, F., and Morgese, G., 1993, International Journal of Obesity, 17 (Supplement 2), 60). In the present study, using the same sample of data, we showed that in lean, average or fat subjects, WTR is only weakly (< 5% of variance) explained by age, sex and body-mass index (in spite of the 'statistical significance' of sex and body-mass index in some groups). Hence, some subjects, among the lean, average and fat groups, could have a high (i.e. > 2 SD over the mean) WTR, independent of age, sex or weight. We therefore propose that the values of WTR should be checked against appropriate standards. Those with a WTR value greater than 2 SD from the mean, independent of age, sex or weight, should be studied more carefully, using anthropometry, so as to give early warning of those who are more prone to degenerative disease.

Abdomen↗
PubMedDate not supplied

Distribution of BMI in children: prevalence of wasting and fattening conditions.

This paper reports a study of body-mass index (weight/height2) frequency distribution in 2858 schoolchildren (1440 males, 1418 females), 6-14 years old: (a) not taking into account the degree of skewness (z-score) and (b) taking it into account (LMS method by Cole). The z-score detected no evident problems of severe wasting conditions, but did detect the presence of severe fattening conditions. The LMS method gave a more balanced distribution. Methods that do not take into account the degree of skewness should be avoided in estimates concerning prevalence of wasting and stunting conditions.

Adolescent↗