Thalassemia-associated osteoporosis: a systematic review on treatment and brief overview of the disease.

Thalassemia-associated osteoporosis constitutes a major complication in patients with thalassemia. This review presents the existing studies on the treatment of thalassemia-associated osteoporosis and discusses the management of this debilitating complication. A brief presentation of the disease characteristics and pathogenetic mechanisms is also provided. The life expectancy of patients with thalassemia has increased markedly in recent years resulting in the aging of the population and the emergence of new comorbidities. The majority of patients with thalassemia have low bone mineral density and experience lifelong fracture rates as high as 71 %. The pathogenesis of thalassemia-associated osteoporosis (TAO) is multifactorial with anemia and iron overload playing crucial role in its development. Data concerning the prevention and treatment of TAO are extremely limited. We performed a literature research in Pubmed and Scopus to identify interventional studies evaluating the effects of various agents on TAO. Seventeen studies were retrieved. We present the results of these studies as well as a brief overview of TAO including presentation, pathogenesis, and management. Most of the studies identified are of poor quality, are not randomized controlled, and include small number of participants. There are no data concerning effects on fracture rates. Bisphosphonates are the most widely studied agents and among them zoledronic acid is the most well studied. Hormone replacement treatment (HRT) shows beneficial but small effects. Denosumab and strontium ranelate have each been evaluated in only a single study, while there are no data about the effects of anabolic agents. Given the increased life expectancy and the increase in fracture rates with age, more data about the management of TAO are warranted. Moreover, due to the need for lifelong management starting at young age, careful treatment plans which may include sequential treatment may often be required. However, currently, there are no relevant data available.

Fungal flora of Nigerian currency notes in circulation in Benin City, Nigeria.

A mycological survey of Nigerian currency (naira) notes in circulation in Benin City was undertaken to determine the fungal species present, so as to bring to light the health implications of their presence. A total of 84 naira notes comprising 20, 50, 100, 200 and 500 naira denominations were obtained randomly from a bank, commuter bus, food canteen, and open market. Four-day old Potato Dextrose Agar cultures of diluted water diffusate of the currency notes were examined under the microscope and fungi were isolated and identified. The isolated fungi and their frequencies of isolation were A. flavus (90.5), A. fumigatus (42.9), A. terreus (57.1), A. flavipes (26.2) A. niger (59.5), Candida albicans (92.3), Rhizopus sp (2.7), Penicillium sp (4.0), Fusarium sp (12.8), and Saccharomyces cerevisae (16.1%). The frequencies of fungi isolated from the various denominations varied significantly at 0.05 probability. While the 50 naira denomination had the highest colony count (mean of means = 41 colonies/ml) the 500 naira had the lowest colony count (mean of means =8.3 colonies/ml). The high occurrence of fungi in the currency notes is of public health concern.

Gastric carcinoma detected by cervical cytology.

This paper is a report on a case of gastric carcinoma of diffuse type in a young female patient aged 38. The patient was still asymptomatic at hospital admission, her only pathological sign being the finding of malignant cells of indeterminate origin at a routine Pap-test examination. Subsequent investigations showed the presence of a poorly differentiated gastric carcinoma, with metastatic diffusion to uterus, ovaries and peritoneum. Only a few cases of gastric carcinomas without cervical localization, detected by Pap-test, are reported in literature. A few other cases with cervical localization have been described. The aim of this work is to point out that a Pap-test smear may reveal the presence of extragenital tumors still unappreciated.

[Cloacal exstrophy, ultrasonic diagnosis]. / Estrofia della cloaca, diagnosi ecografica.

This study aims to underline the importance of transvaginal ultrasonography in the first three months of pregnancy. The authors report a case which was referred to their attention for preliminary tests performed prior to amniocentesis, recommended by the general physician because of the mother's age. The primapara woman and father of the fetus were healthy and the family history excluded hereditary diseases or congenital pathologies. Transvaginal ultrasonography permitted the diagnosis at the start of the fourth month of pregnancy of a polymalformed fetus with cloacal exstrophy, sacral myelomeningocele, clubfoot, single umbilical artery. In this case, the mother decided to undergo eugenic abortion in view of the severity of the pathology.

[Lipoprotein(a), parameters of lipid metabolism and hemostasis in obese patients]. / Lipoproteina(a), parametri del metabolismo lipidico e dell'emostasi in pazienti obesi.

BACKGROUND: The prevalence of obesity is increasing in the population of industrialized countries and this condition is today considered a risk factor for cardiovascular diseases because, at least partly, it represents a prothrombotic state. METHODS: For this reason we have studied plasma lipid concentrations (C, TG, HDL-C), Lp(a) and some parameters of haemostasis (PAI-1, t-PA, D-dimer) in 41 non diabetic obese patients (38 females and 3 males) and in 36 healthy normal weight subjects. RESULTS: Lipid pattern has resulted in overlapping both in the two studied populations and in the two subgroups of pre- and postmenopausal women, while greater concentrations of Lp(a), (p < 0.001) and t-PA (p < 0.05) have been found in obese populations vs controls, but not different between the two subgroups; in particular, Lp(a) has resulted > 30 mg/dl in 34.14% of obese patients and in no case in the control group. Finally, Lp(a) concentrations have been found for the first time to be positively related to C and negatively to HDL-C in the obese population. CONCLUSIONS: As Lp(a) is believed to be a pathogenetic linkage between atherogenesis and thrombosis and can be affected by weight loss, the efficacy of the reduction of high plasma levels of Lp(a) needs to be considered with longitudinal studies.

[Selective episiotomy. Comparison of two suture technics]. / Episiotomia selettiva. Due tecniche di sutura a confronto.

AIMS: The study aimed to highlight any differences between the sequelae of episiorrhaphy performed using the Blair-Donatti and Guilmen-Pontonnier techniques. METHODS: A total of 202 pregnant women were recruited in the Obstetrics Ward of Codogno Civic Hospital in 1994 and 1995. Subjects were randomly divided into two groups matched for socioeconomic status, age and parity (group A: Guilmen-Pontonnier suture, group B: Blair-Donatti suture). The following parameters were evaluated: pain twenty-four hours, sixty-six hours and one, two and three months after labour, pain during sexual relations, the onset of infection, hematoma, dehiscence of the wound, and lastly the cosmetic results. RESULTS: No significant differences were found between the parameters examined in both groups, barring the improved cosmetic result in group A.

[A clinical study of the use of a combination of glucomannan with lactulose in the constipation of pregnancy]. / Studio clinico dell'impiego di una associazione di glucomannano con lattulosio nella stipsi gravidica.

RATIONALE: Constipation is a problem frequently encountered during pregnancy as is excessive weight gain. Treatments of common use to control constipation are endowed with some drawbacks and they are not active in controlling weight increase. A preparation of lactulose and glucomannan in previous studies proved very effective and well tolerated in patients affected by stypsis and evidentiated also activity both in controlling excessive food intake and in correcting some metabolic imbalances regarding lipids and urea. MATERIAL AND METHODS: 50 pregnant females affected by constipation were treated with sachets containing a preparation of glucomannan (1.45 g) and lactulose (4.2 g) in a posology of 2 (1-4) sachets a day for 1-3 months. RESULTS: Treatment induced a return to normal frequency of weekly number of evacuations (4.9-5.8/week) and a parallel control of weight gain (within 20% of initial body weight). The latter finding seems to be related to hunger control induced by glucomannan at the gastric level which prevents an excessive food intake.

[Blood glucose and insulin responses to oral glucose in hyperthyroidism]. / Risposta glicemica ed insulinemica al glucosio orale nell'ipertiroidismo.

Because thyroid hyperfunction "per sè" can induce impaired glucose tolerance in 2-57% of patients, we have studied glycaemic and insulinaemic response to oral glucose load (OGTT) in this condition. Glycaemic and insulinaemic curves after oral glucose (100 g), the respective secretory areas (AUC-G and AUC-IRI) have been determined in 13 hyperthyroid patients (8 Graves disease, 4 multinodular toxic goiters and 1 Plummer's adenoma) and in 16 healthy control subjects. AUC-G, AUC-IRI and median values of G and IRI in most of considered times have resulted significantly greater in hyperthyroid patients. This study has confirmed the impact of thyroid hyperfunction on carbohydrate metabolism, but has not proved an impaired insulin secretion as previously reported in Literature. In conclusion, we believe that: a) hyperthyroidism is associated with greater circulating levels of G and IRI, b) hyperinsulinaemia in addition to hyperglycaemia suggests that insulin-resistance is underlying in this condition.

[Histopathologic findings in CD1 albino mice infected with Plasmodium berghei in pregnancy. Experimental model for pathology of the feto- placental unit in malaria]. / Riscontri istopatologici in topi albini CD1 infettati in gravidanza con plasmodium berghei. Modello sperimentale per la patologia della unità fetoplacentare nella malaria.

Three study groups of pregnant CD1 albino mice were inoculated intraperitoneally with Plasmodium berghei on the 6th (Group I), 13th (Group II) and 18th (Group III) day of gestation. Two control Groups were included, one of non pregnant mice (Group IV) and the other of pregnant non inoculated mice. Group IV was inoculated in the same day of group I. All mice of these two Groups died. Of the 20 mice in Group II 8 died, 7 delivered prematurely and 5 gave birth of low birth weight offspring. The 15 mice in Group III delivered normally with only 4 low birth weight offspring and no deaths. Histological examination revealed total placental necrosis, resorption of the products of conception and widespread foci of hepatic necrosis, malarial pigment accumulation in Group I. Such changes were also present in 8 mice of Group II, but the remainder of the Group retained the product of conception, had marked morphological changes in the placenta and moderate focal hepatic necrosis and malarial pigment accumulation. Group III had mild placental changes and moderate pigment accumulation. The products of conception displayed marked hepatic hematopoiesis in Group II while it was moderate in Group III. No parasitized red cells were observed in the fetal circulation. The stage of gestation at which the malarial infection was contracted was decisive. Malarial infection does not cross the placental barrier so its pathogenetic effects are felt in the maternal circulation with variable effects on the products of conception.

[Hydronephrosis in pregnancy. Ultrasonographic study]. / Idronefrosi della gravidanza. Studio ecografico.

Hydronephrosis is a common pathology during pregnancy and according to some authors affects between 80 and 90% of women in the third trimester. The right side is most frequently affected. Moreover, there appears to be no relation between parity and hydronephrosis or between previous infections of the urinary tract and hydronephrosis; however its presence, especially if severe, is associated with urinary infections with a frequency which is significantly greater than in patients with a urinary tract within normal limits. There are two pathogenetic hypotheses: one identifies the inhibitory effect of progesterone and prostaglandins on muscular tone and the peristalsis of smooth ureteral muscle, with consequent dilatation and anfractuosity of the excretory tract above the pelvic brim; the other is the mechanical hypothesis based on the possible compression of the ureter caused by the pregnant womb at the level of the pelvic brim at the intersection with the ilial and ovarian vessels. One hypothesis does not exclude the other, but on the contrary they complement each other and give added plausibility to a multifactorial pathogenesis. The study of hydronephrosis in pregnancy has made considerable progress since the introduction of echotomography in image diagnosis, a low-cost method which is easy to use and does not harm the product of conception. Echographs with 3.5 MHz probes were used to carry out a prospective study by examining the kidneys and excretory tract in 370 asymptomatic pregnant women during the first, second and third trimesters of gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ultrasonic evaluation of the uterus during puerperium]. / Valutazione ecografica dell'utero in puerperio.

The aim of this study was to evaluate morphological and volumetric changes in the uterus during the first eight days postpartum in a sample of 229 patients using ultrasonography. Both pregnancies and postpartum were physiological in all the women examined. Fifty patients underwent cesarean section. A sectorial 3.5 MHz probe was used to measure the longitudinal, antero-posterior and latero-lateral diameter of the uterus and its volume. Involution was gradual both in relation to the diameters and uterine volume up until day 8 and was most evident during days 1-4. Longitudinal and antero-posterior diameter reduced more quickly in relation to the latero-lateral diameter. Uterine volume, calculated by considering the uterus as an ellipsoid, diminished 42% from 730 cc to 421 cc. No differences were observed between uterine diameters in primiparas and those in pluriparas, nor between patients undergoing cesarean section and those after normal childbirth. However, there was a clear difference between those patients who breastfed immediately after birth and those who resorted to artificial methods; uterine volume diminished more rapidly in the former, especially between days 1-4, confirming that early breastfeeding plays an important role in uterine involution in the very early days of postpartum. The physiological characteristics of the postpartum uterus were useful in formulating a medical or surgical treatment strategy in the few cases of postpartum metrorrhagia observed during the study.

[Morphometric evaluation and AgNOR number in c-erbB-2 positive and negative breast carcinoma: absence of correlation]. / Valutazione morfometrica e determinazione del numero di AgNOR in carcinomi mammari c-erbB-2 positivi e negativi: assenza di correlazione.

A total of 722 nuclei from 22 fine needle aspirates (FNA) of breast carcinomas have been subjected to quantitative nuclear analysis. Form Factor, Nuclear Area and Nuclear Major Diameter were determined for each case. An equal number of nuclei from as many aspirates from benign breast nodules was used as control. The aim of the study was to evaluate the predictive value of these parameters on the result of the immunohistochemical determination of the c-erb B-2 antigen in the tumour mass, since 6 of the 22 carcinomas were positive to this antigen. None of these parameters singly or in combination proved of any value in predicting the positive or negative result of the c-erb B-2 antigen determination. Nuclei both positive and negative for the antigen were located within the large cell carcinomas. Nucleolar Organizer Regions were also determined on the histologic sections of both groups to assess any statistically significant difference not only between controls and carcinomas, but also between c-erb B-2 positive and negative cases. Both NOR mean numbers and NOR cytograms were of no use, since no difference was found between c-erb B-2 positive and negative cases.

[Intestinal volvulus in pregnancy]. / Volvolo intestinale in gravidanza.

Intestinal occlusion is a rare pathologic event during pregnancy occurring mostly in the second and third trimenon when increased volume of the uterus and the consequent displacement of abdominal organs cause complications of pathologies which would otherwise escape notice, such as intestinal adhesions, to become manifest. Diagnosis is difficult for a number of reasons. Vomiting during the first trimenon and mild abdominal pain during the third are often neglected or considered to be part of the normal course of pregnancy; pain is sometimes referred to atypical sites due to the displacement of abdominal organs; in other cases, the high endorphin tonus is apt to reduce the customary defence reaction. All this should not cause time to be lost, and whenever intestinal occlusion is suspected all the necessary diagnostic procedures must at once be carried out and appropriate therapy must speedily be started so as to reduce the risk of mortality and morbidity for mother and fetus. Management of ileus in pregnancy is identical to that for the non pregnant woman, except for the need to empty the uterus in cases in which it prevents treatment or if the fetus has reached a sufficient degree of pulmonary maturity. The paper describes a case of ileal volvulus and revisits the literature analyzing the diagnostic and therapeutic options suggested.

Value of AgNOR counts in cervical pathology.

Nucleolar organizer regions (NORs) were counted on normal tissue, condylomata, CIN 1, 2 and 3, to verify the possibility of a differentiation between the various grades of CIN and between them and condylomata. Counts were performed on the full thickness of the tissue, layer by layer (stratified counts). A significant difference (p < 0.05) was found between the mean of normal tissue in relation to condylomata and CIN 2 and 3 and between CIN 1, and CIN 2 and 3. There was no significance (p > 0.05) between normal tissue and CIN 1, between CIN 2 and 3 and between condylomata and CIN 2 and 3. The range of variations in the counts was associated with overlapping between the various cases. Our data showed also a progressive rise in mean NOR values from normal tissue to CIN 3. The stratified counts showed in all the groups a rise from basal to parabasal cells. Counts on parabasal and intermediate layers distinguished two groups of cases. In one there was either the same number of dots or a further rise while in the other a definite decrease was seen. The former pattern may be related to a potential for malignant evolution of the lesion. NORs should be counted in all cases of CIN and condylomata to treat more aggressively those lesions which present the patterns of a progressive rise of NORs from basal to intermediate cells.