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V Fanos

Publications and source records attributed to V Fanos.

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

C-reactive protein and serum amyloid A protein in neonatal infections.

In this study, we examine C-reactive protein (CRP) and serum amyloid protein A (SAA). Although the former is the best known and most commonly used indicator of inflammation, certain considerations underline the inadequacy of CRP determination alone for the early diagnosis of infection. In fact symptoms often precede the CRP elevation. SAA protein comprises a family of polymorphic apolipoproteins produced mainly by the liver, and several studies have stressed its importance in the diagnosis and monitoring of various diseases. Pathological SAA values are often detected in association with normal CRP concentrations. SAA rises earlier and more sharply than CRP. Finally, contrary to CRP, SAA presents the same trend in viral as well as bacterial infections. Although the data available on SAA in neonates are currently very limited, it is possible to postulate a role of primary importance for SAA in the management of neonatal infections.

C-Reactive Protein↗
PubMed2000

Pyelectasis and hydronephrosis in the newborn and infant.

UNLABELLED: The aim of this review is to describe the present status of prenatally diagnosed pyelectasis and hydronephrosis. Ultrasonographic definitions are presented, along with guidelines for the management of urinary tract dilatations. Isolated pyelectasis without caliceal involvement rarely constitutes a pathological situation and does not require any particular diagnostic or therapeutic measures. Obstructive dilatation is characterized by an obstacle to normal urinary flow situated at any level in the urinary tract, with consequent stagnation of urine and dilatation upstream of the obstruction. If the obstruction is not correctly treated it can cause a progressive deterioration of renal function. The presence of ureterectasia plays a crucial role in the diagnostic algorithm and a micturitional cystourethrography is necessary to look for a vesicoureteric reflux (VUR). The significance of urinary tract dilatation is discussed in detail. CONCLUSION: In newborns with pyelectasis or hydronephrosis the paediatrician's goal should be to strike the right balance between excessive medical intervention and sufficient intervention for the diagnosis of potentially dangerous conditions.

Dilatation, Pathologic↗
PubMed2000

Antibiotic prophylaxis in children with relapsing urinary tract infections: review.

Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.

Anti-Infective Agents↗
PubMed2000

Fluoroquinolones in pediatrics and their nephrotoxicity in adults: minireview.

In recent years there is increasing pressure to use fluoroquinolones in pediatric patients but relatively few data have been published in the literature. Therefore this paper reviews the available information about the pharmacokinetics of fluoroquinolones in children and their use in pediatric urinary tract infections, taking into account their potential as nephrotoxic agents. From the available data it seems reasonable to suggest that there is no risk of quinolone-induced nephrotoxicity and that this class of antibiotics may therefore be considered as potential candidates in urinary tract infections in children. Nevertheless adequate pharmacokinetic investigations and further studies on long-term monitoring for potential toxicity need to be conducted in pediatric populations.

Adult↗
PubMed2000

Amphotericin B-induced nephrotoxicity: a review.

Amphotericin B is the gold standard for antifungal treatment for the most severe mycoses. However, adverse effects are common, with nephrotoxicity being the most serious, occurring early in the course of treatment, and usually being reversible in most patients. Tubular damage is a well known problem associated with amphotericin B therapy but acute renal failure is the most serious complication. Recent studies have examined ways to ameliorate the well-known toxicities of amphotericin B. A new approach has been to complex the drug with lipids or entrap it in liposomes. This review will concern amphotericin B-induced nephrotoxicity, whose mechanisms are not completely clear. Nephrotoxicity seems related to direct amphotericin B action on the renal tubules as well as to drug-induced renal vasoconstriction. The main mechanisms of nephrotoxicity suggested in the literature are presented. The clinical picture at different ages (adults, children, newborns), interactions of clinical significance, strategies for prevention of amphotericin B-induced nephrotoxicity are summarized. To provide optimal patient care, it is imperative that the clinician understand the etiology of and the signs and symptoms associated with nephrotoxicity, as well as interventions to prevent nephrotoxicity in patients receiving amphotericin B.

Age Factors↗
PubMed2000

Megaureter: classification, pathophysiology, and management.

The term megaureter does not define a specific pathological condition, because it can be due to different underlying abnormalities. The most used classification includes three groups: refluxing megaureter, associated with vesicoureteral reflux (VUR); obstructive megaureter, associated with urine flow impairment at the vesicoureteral junction; non-refluxing non-obstructive megaureter, if neither obstruction nor reflux can be identified. Each group can be divided into two subgroups: primary megaureter; secondary megaureter. With the advent of antenatal ultrasound an increased number of cases are identified prior to the onset of symptoms. The common used investigation are: urinary tract ultrasound, voiding cystourethrography, urography, serial diuretic renography and pressure-perfusion studies (Whitaker test). The advent of prenatal and neonatal echography has modified the natural history of megaureter. Nowadays non operative management is preferred. Operative intervention is indicated only in these cases: significant impairment to urine flow; worsening renal function during the observation time; recurrent UTI in spite of adequate antibiotic prophylaxis.

Child↗
PubMed2000

[Leonardo da Vinci and his studies on the human fetus and the placenta].

OBJECTIVE: To review the accuracy of Leonardo's anatomical studies of the female external genitalia and the foetus, particularly those concerning the umbilical cord with its blood vessels. BACKGROUND: The anatomical drawings of Leonardo da Vinci which are now stored in the Windors Castle near London were reviewed and the accuracy of the details of the genital apparatus and foetus was evaluated. A written comment characterizes many of his drawings. RESULTS: He described accurately the position of the uterine blood vessels and the relationship between the pelvic organs. However his drawing and description of the female external genitalia and human placenta was incorrect because his understanding of it was inadequate. He believed that the human placenta had cotyledons like that of the ungulate uterus (drown side A of sheet 19). At the top of that sheet some Leonardo's details of the anatomic relationship are shown. CONCLUSIONS: In our opinion, Leonardo's misunderstanding is probably because he was only able to perform one anatomical dissection of a pregnant women and foetus and therefore his knowledge was limited. The resulting documentation of the pregnant women and foetus was therefore heavily supplemented with his enormous experience in animal anatomy.

Famous Persons↗
PubMed2000

[Neonatal resuscitation: a fascinating story!].

Over the past thousands of years many examples can be found of the treatment given for asphyxia in the apparently dead subject. The resuscitation procedures were applied alike both in adults and in newborn babies. The first reference made to the mouth-to-mouth method was in the Kings'. In the second half of the 1800 many Authors proposed a method to resuscitate the asphyxiated newborn infant, which were still practiced up until the 1930 s. Many other different methods of air and 02 administration to the airway and stomach of an apparently dead newborn were well known and used in the 1800 s and still used in the 1950 s. Other methods used involved the dilatation of the rectum; the immersion in alternating warm and cold water and the use of a larynx tube developed by Chaussier which was then modified by other Authors. The use of tight fitting tracheal tubes and direct tracheal 02 administration after the clearing of the oropharynx using fingers and finally the mouth to mask and mouth to endotracheal tube breathing. All these examples are indicative of the approach taken in the resuscitation of the apparently dead infant. The science of resuscitation and its history continue to evolve....

History, 18th Century↗
PubMed1999

46, XY, del (3) (pter-->p25) syndrome: further delineation of the clinical phenotype.

A boy with monosomy for the distal part of the short arm of chromosome 3 is described. The clinical features this patient has in common with the previously reported cases include pre- and post-natal growth delay, microcephaly, craniofacial dysmorphism and mental retardation. In addition, minor abnormalities not previously reported were observed, such as snapping thumbs, dorsiflected big toes, connecting anterior and posterior fontanelles at birth, nasolacrimal duct stenosis and double urethral meatus. Conclusion These five new clinical findings may help in further delineation of the syndrome and allow its early recognition. A complete revision of clinical findings published in literature is reported.

Abnormalities, Multiple↗
PubMed1999

Transient hyperechogenicity of the renal medullary pyramids: incidence in the healthy term newborn.

A screening program was performed on 1881 clinically healthy term newborns, aimed at detecting eventual pathological conditions not diagnosed during pregnancy. Seventy-three cases of transient hyperechogenicity of the renal medullary pyramids were observed, involving one or both kidneys with either sectorial or diffuse pattern. None of the neonates examined had evidence of renal dysfunction and follow-up ultrasound scans demonstrated complete resolution of the sonographic picture. Medullary hyperechogenicity is not rare in healthy term newborns (3.9%); it presents rapid resolution and should be considered in differential diagnosis of pathological conditions.

Female↗
PubMed1999

Cystatin C in healthy women at term pregnancy and in their infant newborns: relationship between maternal and neonatal serum levels and reference values.

Human cystatin C, a basic low molecular mass protein with 120 amino acid residues, is freely filtered by the glomerulus and almost completely reabsorbed and catabolized by the proximal tubular cells. Cystatin C has been recently proposed as a new sensitive endogenous serum marker for the early assessment of changes in the glomerular filtration rate. To define a reference basis for future clinical investigations in the perinatal period, we investigated the relationship between maternal and neonatal serum cystatin C in comparison with that of creatinine. We also defined reference values in healthy women at full-term pregnancy and in full-term newborns over the first 5 days of life. Seventy-eight women with uncomplicated pregnancy, aged between 19 and 40 years, and their infant newborns (43 males, 35 females) were enrolled in the study. The gestational age ranged from 37 to 43 weeks, and the birth weight from 2.50 to 4.15 kg. Blood samples were taken from all the women immediately before delivery and from their newborns at birth, 72 and 96 h after birth. Maternal and neonatal renal function was evaluated by standards parameters and by calculating creatinine clearance. In all serum samples, we measured cystatin C, creatinine, and urea. At term gestation, serum cystatin C ranged from 0.64 to 2.30 mg/L. At birth, serum cystatin C values ranged from 1.17 to 3.06 mg/L, significantly decreasing after 3 and 5 days of life. No correlation was found between maternal and neonatal serum cystatin C values (r = 0.09). As cystatin C serum levels in newborns are not significantly correlated with the respective maternal levels, neonatal serum cystatin C may originate almost exclusively in the neonate.

Adult↗
PubMed1999

Antimicrobial survey of urinary tract isolates from a pediatric department.

The epidemiology of urinary tract colonization/infection in children admitted during 1996 to the Pediatric Department of the University of Verona has been studied; 501/1959 urine cultures were positive (25.57%). 584 microorganisms (64.89% Gram-negative, 24.82% Gram-positive, 10.27% fungi) were isolated. The highest rate of Gram-negative isolation (80.0%) was observed in infants, while the highest rate of Gram-positive isolation (29.6%) was found in newborns admitted to the neonatal intensive care unit. Escherichia coli was the most frequently isolated microorganism in infants and children, but not in newborns. A 3-fold increase in resistant E. coli strains to cotrimoxazole/sulfamethoxazole and amoxicillin/clavulanic acid was documented during the last 3 years in this pediatric population. Our observations underline the importance of the survey of microbial maps in pediatric departments in order to optimize therapeutic and preventive choices.

Anti-Bacterial Agents↗
PubMed1999

Candida infections in newborns: a review.

Despite adequate treatment, nosocomial fungal infections have become an increasingly important cause of morbidity, extended hospitalization, and mortality in critically ill newborn babies. Furthermore, the high incidence of central nervous system involvement in septic newborns frequently results in serious neurological damage and psychomotorial sequelae. The prevention of fungal colonization in the population at risk, together with prompt diagnosis and treatment, are an efficient combination which lead to a better outcome of neonatal fungal infections. New drugs characterized by great efficacy and tolerance have recently been employed in clinical practice. This article summarizes certain aspects of Candida spp. infections in the neonatal period with regard to multisystemic presentation and involvement.

Candidiasis↗
PubMed1999

Antibacterial-induced nephrotoxicity in the newborn.

Antibacterials are the primary cause of drug-induced kidney disease in all age groups and these agents bring about renal damage by 2 main mechanisms, namely, direct and immunologically mediated. For some antibacterials (aminoglycosides and vancomycin) nephrotoxicity is very frequent but generally reversible upon discontinuation of the drug. However, the development of acute renal failure with these agents is possible and its incidence in the newborn seems to be increasing. Antibacterials are very often used in the neonatal period especially in very low birthweight neonates. The role of neonatal age in developing nephrotoxicity has still to be defined. Since the traditional laboratory parameters of nephrotoxicity are abnormal only in the presence of substantial renal damage, the identification of early non-invasive markers of the renal damage (urinary microglobulins, enzymes and growth factors) is of importance. Aminoglycosides and glycopeptides are still frequently used, either alone or in combination, despite their low therapeutic index. Numerous factors intervene in bringing about the kidney damage induced by these 2 classes of antibacterials, such as factors related to the antibacterial itself and others related to the associated pathology as well as pharmacological factors. Nephrotoxicity can be caused by the beta-lactams and related compounds. Their potential to cause nephrotoxicity decreases in the order: carbapenems > cephalosporins > penicillins > monobactams. Third generation cephalosporins are frequently used in neonates. However, they are well tolerated compounds at the renal level. The nephrotoxicity of other classes of antibacterials is not discussed either because they are only used in neonates in exceptional circumstances, for example, chloramphenicol and cotrimoxazole (trimethoprim-sulfamethoxazole) or are not associated with significant nephrotoxicity, for example macrolides, clindamicin, quinolones, rifampicin (rifampin) and metronidazole. Antibacterial-induced nephrotoxicity is an important parameter to be considered when treating the newborn and this is particularly true when use of a combination of different antibacterials and/or drugs with a nephrotoxic potential is being considered. However, other parameters, such as antibacterial spectrum, pharmacokinetics, post-antibacterial effect, clinical efficacy, general adverse effect profile and cost, must also be considered in the choice of antibacterial therapy in the neonate. Knowledge of the renal safety of antibacterials and the correct approach to therapeutic drug monitoring may be useful elements for preventing iatrogenic renal disorders.

Aminoglycosides↗
PubMed1999

Antibiotics in neonatal infections: a review.

The bacteria most commonly responsible for early-onset (materno-fetal) infections in neonates are group B streptococci, enterococci, Enterobacteriaceae and Listeria monocytogenes. Coagulase-negative staphylococci, particularly Staphylococcus epidermidis, are the main pathogens in late-onset (nosocomial) infections, especially in high-risk patients such as those with very low birthweight, umbilical or central venous catheters or undergoing prolonged ventilation. The primary objective of the paediatrician is to identity all potential cases of bacterial disease quickly and begin antibacterial treatment immediately after the appropriate cultures have been obtained. Combination therapy is recommended for initial empirical treatment in the neonate. In early-onset infections, an effective first-line empirical therapy is ampicillin plus an aminoglycoside (duration of treatment 10 days). An alternative is ampicillin plus a third-generation cephalosporin such as cefotaxime, a combination particularly useful in neonatal meningitis (mean duration of treatment 14 to 21 days), in patients at risk of nephrotoxicity and/or when therapeutic monitoring of aminoglycosides is not possible. Another potential substitute for the aminoglycoside is aztreonam. Triple combination therapy (such as amoxicillin plus cefotaxime and an aminoglycoside) could also be used for the first 2 to 3 days of life, followed by dual therapy after the microbiological results. In late-onset infections the combination oxacillin plus an aminoglycoside is widely recommended. However, vancomycin plus ceftazidime (+/- an aminoglycoside for the first 2 to 3 days) may be a better choice. Teicoplanin may be a substitute for vancomycin. However, the initial approach should always be modified by knowledge of the local bacterial epidemiology. After the microbiological results, treatment should be switched to narrower spectrum agents if a specific organism has been identified, and should be discontinued if cultures are negative and the neonate is in good clinical condition. Penicillins and third-generation cephalosporins are generally well tolerated in neonates. There is controversy regarding whether therapeutic drug monitoring of aminoglycosides will decrease toxicity (particularly renal damage) in neonates, and on the efficacy and safety of a single daily dose versus multiple daily doses of these drugs. Toxic effects caused by vancomycin are uncommon, but debate still exists over the need for therapeutic drug monitoring of this agent. When antibacterials are used in neonates, accurate determination of dosage is required, particularly for compounds with a low therapeutic index and in patients with renal failure. Very low birthweight infants are also particularly prone to antibacterial-induced toxicity.

Anti-Bacterial Agents↗
PubMed1999

Cystatin C in paediatric nephrology. Present situation and prospects.

Cystatin C is a small basic protein with a MW of 13,359 Daltons, consisting of a non-glycosylated polypeptide chain containing 120 amino-acid residues. Cystatin C is produced in all the nucleated cells of the human body and its output rate is constant. The kidney is the main catabolic site of cystatin C, since the protein, by virtue of its low MW and its positive charge at normal pH, is freely filtered by the glomerulus and almost completely reabsorbed, catabolised and broken down in the cells of the proximal convoluted tubule. It is practically entirely filtered via the glomerular membrane, without any significant tubular secretion. The constant production rate of cystatin C in all the tissues, its elimination via the glomerular filter and its non-dependence on many extrinsic factors, including sex, age, diet, inflammation, are potentially ideal conditions for an endogenous biochemical marker of glomerular filtration. A recent method for determining cystatin C, is based on an immune reaction, could increase its clinical application. Not many studies have been conducted to date on cystatin C in children. The cystatin C concentration was higher during the first few days of life (range: 1.64-2.59 mg/L) with a rapid reduction during the first 4 months. Beyond the first year of life, cystatin C concentration became constant, with a reference range of 0.7-1.38 mg/L. On the basis of the data currently available, neonatal serum cystatin C would appear to derive from the newborn itself. In fact no correlations were found between maternal and neonatal serum cystatin C values. Cystatin C determination appears to be at least equivalent to serum creatinine measurement for the assessment of glomerular filtration rate in children. Further extended studies are needed to investigate these aspects more thoroughly in neonates.

Adolescent↗
PubMed1998

Renal tolerability of teicoplanin in a case of neonatal overdose.

The literature does not contain reports regarding teicoplanin overdose in newborns. In a neonate with a history of recent postasphyctic acute renal failure which recovered within 7 days of life, antibiotic therapy with teicoplanin was started for sepsis due to Staphylococcus hominis. However, for 5 days the dosage was excessive (20 mg/kg twice daily instead of an initial dose of 16 mg/kg and then doses of 8 mg/kg once daily). Once this error had been noted, therapy was immediately suspended. Clinically the newborn had improved and blood culture at the end of the therapy was negative. Biohumoral tests revealed constantly normal levels of serum creatinine, serum cystatin C and blood nitrogen. Urinary parameters of tubulotoxicity were also within normal values. Urinary epidermal growth factor was increased. Teicoplanin was well tolerated at the renal level in the newborn even in this case of excessive dosage.

Acute Kidney Injury↗