Use of oclacitinib as antipruritic drug during sarcoptic mange infestation treatment.

Sarcoptic mange is a parasitic disease causing severe pruritus, self-induced skin lesions and secondary infections. In many cases, an antipruritic treatment is useful to decrease clinical signs of the disease. Oclacitinib is a synthetic janus kinase-1 (JAK1) inhibitor, that selectively inhibits cytokines involved in inflammation and pruritus. The aim of this retrospective study was to evaluate efficacy of oclacitinib in alleviating pruritus and inflammation in dogs affected by scabies. Forty-four clinical records of dogs containing the words sarcoptes and oclacitinib were selected among dermatologic cases recorded within the last 5 years (2014-2019). Thirty-one of 44 cases with confirmed sarcoptic mange infestation were included. All dogs were treated at day (D)0 with systemic antiparasitic drugs (e.g. moxidectin, sarolaner, afoxolaner) in association with oclacitinib at 0.5 mg/kg by mouth every 12 hours for 14 days followed by oclacitinib administration every 24 hours for another 14 days. Visual Analogic Scale (VAS) was recorded at D0 and D30. Selected cases were 16 females and 15 males, median age was 4.5 years, majority were crossbred dogs. Mean VAS recorded at D0 was nine, and after onemonth decreased to three. Telephone follow up information, collected seven days after discharge, reported a significative decrease in pruritus within 24 hours. Our results suggest that the association of oclacitinib inhibition of JAK1 dependent cytokines (allergic and inflammatory associated IL2, IL4, IL6, IL13 and pruritogenic associated IL31) with conventional antiparasitic treatment, may be useful to provide quick relief from pruritus and decrease inflammation in dogs with sarcoptic mange.

Knowledge and behaviour of nursing students on the prevention of healthcare associated infections.

INTRODUCTION: Hospital infections, or "healthcare associated infections" (HAI) represent the most common and serious complications of healthcare. Adoption of safe care practices able to prevent or control the transmission of infections, both in hospitals and in other healthcare settings is crucial. The aim of the study is to assess the awareness about the risk factors and the most effective measures of prevention of HAI in the University of Ferrara nursing school students, giving particular attention to the hand hygiene practices and the use of standard precautions. METHODS: 339 students attending all the three years of course of the same academic year were enrolled. An anonymous questionnaire was administered in order to investigate the knowledge about three specific areas: infections associated with healthcare practices (HAI), standard precautions (SP) and hand hygiene (HH). RESULTS: A sufficient level of knowledge by all the three groups of students was observed only in the SP area. A barely sufficient score was reached only by the third year students with regard to the proper HH. The level of knowledge about HAI was inadequate. CONCLUSIONS: A periodically check of nursing students' knowledge would be advisable in order to fill any gaps, improve training, reduce HAI and increase prevention measures compliance.

Risk perception of sexually transmitted diseases and teenage sexual behaviour: attitudes towards in a sample of Italian adolescents.

The aim of the study is to determine awareness about sexually transmitted diseases (STDs) and their prevention in people aged 14-19 of Ferrara and province. The study was carried out using a self-administered standardised anonymous questionnaire in a sample of students attending to three upper secondary schools. Total number of collected questionnaires was 2695, the average age of interviewed was 17.1. Only 52.3% of respondents correctly recognized STD definition. Over 95% of subjects identified acquired immune deficiency syndrome (AIDS), while properly classification of Hepatitis B increased with age and lowest degree of knowledge concerned herpes infection and Candidiasis. Sex without condom (95.97%) and needle exchange in drugs abusers (94.9%) are considered high risk behaviours. 80.3% of interviewed, without distinction of school attendance, sex, and age considered lack of information as a situation of high risk. Condoms are not used by 46.4% of the subjects in case of sex with a regular partner and by 9.5% with casual partner. Majority of students declared condoms very safe in preventing STDs but an important percentage indicated also contraception methods; correct answers were higher among females and increased with age. Main sources of information were TV (21.6%), school (21.1%) and friends (14.8%) and a few sought information from family doctor (7.4%) and web (4.8%). The study suggests, as priority, to improve teenagers' awareness about risk behaviours and prevention of STDs. School can play an important role in reinforcement of sexual education programmes and directing young people to general practitioners and primary sexual health care services.

[Epidemiological, social and public health aspects of tuberculosis in Ferrara in the 19th century]. / Aspetti epidemiologicie socio-sanitari dellatubercolosi a Ferrara nell'800.

Our first study of tuberculosis in Ferrara during the nineteenth century, whose results have been recently published, focused on disease treatment. Here we present the descriptive analysis of mortality, with the following results being attained: two behavioural patterns are detected with regard to the onset of disease, before and after 1850; TB is a specific disease that affects all parts of the body in all age groups: childhood, and active and passive populations; there are no significant differences with regard to gender; as regards the occupations performed by the deceased, those related to industry and agriculture and to various other activities and services are those with the highest mortality; tuberculosis has a seasonal pattern; summer and autumn are the periods of greatest prevalence (hot weather and humidity are factors that affect the respiratory system); among the forms of tuberculosis it can be observed that up to the year 1850 people died in Ferrara either of pulmonary tuberculosis or TB localised in other areas; from 1851 onward there appears to have been a dramatic change, with a decrease in unspecific diagnosis but the appearance of disease manifestations in its various clinical forms.

Molecular analysis of the fragile histidine triad (FHIT) tumor suppressor gene in vesical tumors of cattle with chronic enzootic hematuria (CEH).

The FHIT (fragile histidine triad) gene is a tumor suppressor gene known to be inactivated in many tumors including bladder tumors and is spanning FRA3B, a very active common fragile site in the human genome. We have recently isolated the bovine gene, and the aim of this study was to test whether FHIT presents altered expression patterns in vesical tumors of cattle with CEH (chronic enzootic hematuria). CEH is a common syndrome affecting Mediterranean cattle: clastogenic, mutagenic and cancerogenic substances released by the bracken fern (Pteridium spp) grazed by animals induce the formation of neoplastic lesions, among which bladder tumors have a high incidence. We analysed FHIT in 23 bladder tumors of CEH cattle looking at: 1) the methylation status of the CpG island comprising the promoter and part of exon 1; 2) the presence of altered FHIT transcripts; 3) the mRNA expression levels measured with a quantitative real time PCR (QRT-PCR) approach. Our results suggest that unlike in human tumors, FHIT in vesical tumors of CEH cattle is largely unmethylated. Furthermore, the same mRNA isoforms of FHIT were detected in tumors and in healthy tissues, including a novel isoform that was found in this study. Finally, QRT-PCR data did not reveal significantly altered expression profiles of FHIT transcripts. Further studies and larger sets of cases will be useful to confirm this finding, but the data seem to suggest that epigenetic modifications of FHIT and altered expression profiles are not a hallmark of bovine vesical tumors like they are in human tumors.

Effect of familial hypertension on glomerular hemodynamics and tubulo-glomerular feedback after uninephrectomy.

Familial hypertension, glomerular hemodynamic alterations, and dysregulation of tubulo-glomerular feedback (TGFB) have all been associated with the development of chronic renal failure. In the present study we evaluated renal and glomerular hemodynamics and TGFB responses in healthy kidney donors either with or without familial hypertension, before and after nephrectomy. Para-amino-hippurate plasma clearance (CPAH) and inulin plasma clearance (CInu) were measured in 15 kidney donors before and 1 year after nephrectomy. All subjects were normotensive and were kept in a sodium-replete state. Both clearances were measured after 40 min of constant infusion of PAH and Inu, as well as 20, 30, 50, and 60 min after the intravenous administration of acetazolamide (5 mg/kg). Glomerular hemodynamics were calculated by means of the Gomez formulae. Nephrectomy caused the expected decreases in CPAH and CInu and increase in the filtration fraction (all P < .0001). The decrease in renal resistances of the remaining kidney was greater at the afferent (-24%, P = .0075) than at the efferent arteriolar level (-17%, P < .0001). The TGFB activation was not altered by nephrectomy or by familial hypertension. Effective renal plasma flow (ERPF) decrease after TGFB activation appeared earlier than glomerular filtration rate (GFR) decrease before (P = .01), but not after, nephrectomy (P = .48). The presence of familial hypertension was associated with increased glomerular pressure (P = .0004). This study suggests that uninephrectomy in healthy human subjects causes a greater decrease in afferent arteriolar resistances, but that TGFB responses are not quantitatively altered. Familial hypertension is associated with a tendency toward higher glomerular pressures.

Donor and recipient family histories of hypertension influence renal impairment and blood pressure during acute rejections.

A previous historical prospective observational study, double blinded for knowledge of kidney donors' family history of hypertension, included 85 transplanted patients with stable renal function, not treated with cyclosporine, who were followed-up for an average of 8 yr and carefully characterized for the presence or absence of hypertension in the donor and recipient families. The recipients without a family history of hypertension, but grafted with a kidney coming from a "hypertensive" family, developed hypertension much more frequently than recipients grafted with a kidney coming from a "normotensive" family, or recipients with familial hypertension in whom the origin of the kidney did not influence the prevalence of hypertension after transplantation. In this second study of the same patients, it was found that these recipients with a "normotensive" family and a "hypertensive" kidney showed a greater increase of diastolic BP (P = 0.005) and a greater degree of acute renal damage (P = 0.004) during acute rejections than all of the other recipients. This extension study shows that a grafted kidney can transmit not only chronic hypertension, but also susceptibility to a greater rise in BP and more severe kidney impairment after an acute insult.

Which urinary proteins are decreased after angiotensin converting--enzyme inhibition?

It is believed that angiotensin converting-enzyme (ACE) inhibitors lower proteinuria by acting on glomerular hemodynamics. This hypothesis predicts that the urinary excretion of a tubular protein should be unaffected by ACE inhibition. In the present study we have compared the excretion of albumin and Tamm-Horsfall Glycoprotein (THGP), a protein secreted only by renal tubules, before and after ACE inhibition. Urinary protein excretion was measured with the Phast System, a method based on SDS polyacrylamide gel electrophoresis followed by silver staining, in 15 essential hypertensives, after at least 4 weeks of wash-out from any drug and after 2 months of ACE inhibition with oral Quinapril. After 2 months of ACE inhibition, blood pressure (BP), body weight, urinary output, heart rate, plasma glucose, plasma and urinary creatinine, urate and electrolytes, and creatinine clearance, were not different from baseline values. Plasma ACE activity decreased from 76 +/- 7 to 10 +/- 4 U/mL (mean +/- SEM, 2 tails paired t test, p = 0.0001). Both albumin and THP urinary excretions decreased from 51 +/- 6 to 43 +/- 4 mg/ 24 h (p = 0.05) and from 19 +/- 3 to 12 +/- 1 mg/24 h (p = 0.02), respectively. This unexpected result suggests that ACE inhibitors may act also at the level of renal tubular cells.

ACE Inhibitors and Renal Vascular Responses in the Spontaneously Hypertensive Rat.

BACKGROUND: Substantial evidence has accumulated for the intrarenal generation of functionally important quantities of angiotensin II (Ang II). To assess the possibility that Ang II generation occurs beyond a barrier to diffusion from the vascular compartment, six angiotensin-converting enzyme (ACE) inhibitors varying widely in their lipid solubility were employed in the spontaneously hypertensive rat (SHR) and their normotensive controls (WKY). The biological end points were renal blood flow and its response to Ang II. RESULTS: Two ACE inhibitors, ramipril and captopril, induced a larger increase in renal blood flow and enhanced the renal vascular response to Ang II substantially more than did enalapril and lisinopril. The two prodrugs, enalapril and ramipril, which are substantially more lipophilic than the respective active drugs, enalaprilat and ramiprilat, showed equivalent responses. The partial agonist saralasin virtually abolished the renal vasodilator response to ramipril. The pattern of response was similar in WKY, but the responses were substantially smaller. CONCLUSIONS: The results support the concept that a functionally important compartment for intrarenal Ang II formation exists in the healthy rat and that this process is amplified in the SHR.

Salvage surgery for lateral tennis elbow.

We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were performed between 1979 and 1994. Each patient's non-operative and operative history was recorded before our salvage revision surgery. At revision surgery, findings included residual tendinosis of the extensor carpi radialis brevis tendon in 34 of 35 elbows. In 27 elbows, the pathologic changes in the extensor carpi radialis brevis tendon had not been previously addressed at all, and in 7 elbows the damaged tissue had not been completely excised. Salvage surgery included excision of pathologic tissue in the extensor carpi radialis brevis tendon origin combined with excision of excessive scar tissue and repair of the extensor aponeurosis when necessary. Based on a 40-point functional rating scale proposed here, 83% of the elbows (29 of 35) had good or excellent results at an average followup of 64 months (range, 17 months to 17 years). To prevent failure of surgical treatment for tennis elbow, the pathologic tissue usually present in the extensor carpi radialis brevis tendon should be resected. Release operations, which weaken the extensor aponeurosis but fail to address the pathoanatomic changes, are not recommended.

Accuracy of the urinary albumin titrator stick 'Micral-Test' in kidney-disease patients.

BACKGROUND: A quick, accurate, and easy measurement of microalbuminuria can be useful for the management of many patients. The Micral-Test stick (Boehringer Mannheim, Germany) gives a semiquantitative estimation of urinary albumin concentration at discrete readings of 0, 10, 20, 50 or 100 mg/l. The purpose of this study was to test its accuracy. METHODS: From 46 non-diabetic patients, 491 urinary samples were analysed both with Micral-Test and with immunochemical nephelometry. RESULTS: Of 491 samples, 308 were from non-proteinuric patients (urinary albumin < 300 mg/day). In these patients the correlation coefficient of nephelometric values versus the stick readings was 0.79: 120/123 samples from non-microalbuminuric (< or = 30 mg/24 h) and 164/185 from microalbuminuric patients were correctly identified by the stick, giving an 89% sensitivity and a 98% specificity. The readings around the threshold for microalbuminuria (20 and 50 mg/l patches) were the most reliable ones. Analysis of the correct/uncorrect readings' ratio for every patch in the 245 samples in the 0-150 mg/l range shows a relative uniformity (chi2 = 8.5, P = 0.07), while analysis of the over/correct/underreadings for the 10, 20 and 50 patches, shows that incorrect responses tend to be underestimations for the 10 patch and overestimations for the 20 and 50 mg/l patches (chi2 = 10.5, P = 0.03). CONCLUSIONS: The Micral-Test stick is useful for screening, but less reliable for follow-up, unless considerable changes in albumin excretion are expected.

Hypertension may be transplanted with the kidney in humans: a long-term historical prospective follow-up of recipients grafted with kidneys coming from donors with or without hypertension in their families.

In several genetic hypertensive rat strains, transplantation studies have established that the kidney carries at least a portion of the genetic message for hypertension. In man it has, of course, been more difficult to obtain clearcut results. This historical prospective observational study, double-blinded for knowledge of donors' and recipients' family history for hypertension, concerns 85 transplanted patients, not treated with cyclosporine and with stable renal function, followed up for an average of 8 yr. Both the donors' and the recipients' families were carefully characterized for presence or absence of hypertension. After transplantation, in recipients without hypertension in their own families, a kidney coming from a "hypertensive" family determines less withdrawal and more introduction of antihypertensive therapy (AHT) than a kidney from a "normotensive" family (odds ratio for AHT introduction 5.0, confidence interval, 1.4 to 17.8; P = 0.017). In recipients with familial hypertension, the origin of the kidney does not influence the prevalence of hypertension after transplantation. More detailed analyses show that, in recipients without familial hypertension, the transplantation of a "hypertensive" kidney determines a tenfold larger increase in the requirement of antihypertensive therapy than the transplantation of a "normotensive" kidney, to obtain a similar blood pressure control (P = 0.003). This results is confirmed by the analysis of time-profile trends for antihypertensive therapy, adjusted for missing data, in the most clinically stable period (2nd to 10th yr after transplantation). The transmission of familial hypertension with the kidney is thus seen only in recipients coming from "normotensive" families, because a familial tendency for hypertension blunts the effect of receiving a "hypertensive" kidney.

Evaluation of the tubuloglomerular feedback system in human subjects.

It has been shown in animals that GFR decreases after administration of a carbonic anhydrase inhibitor (CAI) because of activation of the tubuloglomerular feedback. However, the magnitude of this response has never been studied in healthy subjects, nor has the possibility of inhibiting tubuloglomerular feedback with frusemide (FRU). Changes in CCr, V, CNa, CCl, CH2O, CLi were studied before and after acute administration of acetazolamide (ACZ) to 11 normal subjects or FRU to 9 normal subjects. Both ACZ and FRU increased V, CNa, CCl and CLi. Only FRU decreased CH2O. ACZ but not FRU decreased CCr, despite lesser increases of V, CLi and CH2O+CCl (rough indexes of distal delivery). The magnitude of the GFR decrease after comparable increases in distal delivery varied greatly between subjects. There was a tendency for the subjects with lower basal GFRs to show tubuloglomerular feedback responses of lesser magnitude than those with higher GFRs. These results show that it is possible to study tubuloglomerular feedback and its sensitivity in humans using CAIs. FRU blocks the tubuloglomerular feedback response. Its sensitivity appears to vary widely in normal subjects.

Anatomy and examination of the elbow.

The treatment of elbow injuries necessitates establishment of a proper diagnosis. An understanding of anatomic relationships serves as the basis for clinical evaluation. The history must ascertain the details of specific injury as well as identify intrinsic and extrinsic risk factors. Physical examination includes inspection, range of motion testing, palpation, provocative testing, and neuromuscular testing. Radiologic and ancillary testing supplement the clinical evaluation.