Latent tuberculous infection among foreign-born individuals applying to shelters in the metropolitan area of Milan.

SETTING: Screening for latent tuberculous infection (LTBI) of groups at high risk of active tuberculosis (TB) is a key component of the End TB Strategy. OBJECTIVE: To conduct a retrospective descriptive analysis of LTBI rates among foreign-born individuals applying to shelters in the metropolitan area of Milan, Italy. DESIGN: All foreign-born individuals registering for accommodation centres in the city of Milan from November 2009 to April 2017 were screened for active TB and LTBI. Individuals aged <36 years with a tuberculin skin test (TST) induration of >10 mm were offered confirmatory testing with QuantiFERON®-TB Gold In-Tube (QFT-GIT). RESULTS: Of the 2666 TST-positive migrants aged <36 years who underwent LTBI confirmation testing, 1322 (49.6%) tested negative, 1339 (50.2%) were positive and five (0.2%) had indeterminate results. In the multivariate analysis, TB incidence in the country of origin and age were significantly associated with QFT-GIT positivity. Although estimated TB incidence in Eritrea, Morocco and Romania was 100/100 000 person-years (py), the probability of being QFT-GIT-positive in individuals from these countries were not statistically significantly different from individuals from countries with TB incidence > 250/100 000 person-years. CONCLUSION: Our data showed a high proportion of LTBI among individuals coming from intermediate TB burden countries.

Effects of moderate Sicilian red wine consumption on inflammatory biomarkers of atherosclerosis.

OBJECTIVE: The aim of the study is to evaluate the effect of moderate Sicilian red wine consumption on cardiovascular risk factors and, in particular, on some inflammatory biomarkers. METHODS: A total of 48 subjects of both sexes who were nondrinkers or rare drinkers of moderate red wine were selected and randomly subdivided into two groups assigned to receive with a crossover design a Sicilian red wine (Nero d'Avola or Etna Torrepalino) during meals: Group A (n = 24), in whom the diet was supplemented for 4 weeks with 250 ml/day of red wine, followed by 4 weeks when they returned to their usual wine intake; and Group B (n = 24), in whom the usual wine intake was maintained for 4 weeks, followed by 4 weeks when the diet was supplemented with 250 ml/day of red wine. The following were values measured in all tests: blood glucose, total and HDL-cholesterol and triglycerides, LDL-cholesterol, LDL/HDL ratio, apolipoproteins A1 and B, Lp(a), plasma C-reactive protein, TGFbeta1, D-Dimer, Factor VII , PAl Ag, t-PA Ag, fibrinogen, oxidized LDL Ab, total plasma antioxidant capacity. RESULTS: At the end of the red wine intake period, LDL/HDL, fibrinogen, factor VII, plasma C-reactive protein and oxidized LDL Ab were significantly decreased, while HDL-C, Apo A1,TGFbeta1, t-PA, PAI and total plasma antioxidant capacity were significantly increased. CONCLUSIONS: Our results show a positive effect of two Sicilian red wines on many risk factors and on some inflammatory biomarkers, suggesting that a moderate consumption of red wine in the adult population is a positive component of the Mediterranean diet.

One-year atorvastatin treatment in hypercholesterolemic patients with or without carotid artery disease.

AIM: Statins are the drugs of choice in heterozygous familial hypercholesterolemia (FH), which has a high risk of premature cardiovascular events including myocardial infarction, stroke, and surgical revascularization. METHODS: A 1-year open-label study was conducted to test the efficacy and tolerability of Atorvastatin titrated to the target, in proven FH patients and to evaluate certain inflammatory parameters. One hundred and two FH patients (44 men and 58 women; mean age 58.7+/-3.6 years) were included in the study. After evaluation using the B-mode duplex scanning system of extracranial carotid arteries, the patients were divided into two groups: Group 1 (15 men, 25 women) with carotid plaques or intima-media thickness (IMT) greater than 0.95 mm and Group 2 (30 men, 32 women) without carotid plaques or IMT less than 0.95 mm. After a 6-week hypolipemic diet phase all the patients were treated with atorvastatin titrated to achieve a low density lipoprotein (LDL-C) <100 mg/dL. Patients with carotid lesions were also submitted to an oral fixed dose of aspirin 100 mg/day. RESULTS: In patients without and with carotid lesions, atorvastatin treatment (mean dosage: 23.5 mg/day) reduced triglycerides by 8.7% (P<0.005) and 10.6% (P<0.005), total cholesterol by 41.5% (P<0.005) and 42.6% (P<0.005), LDL-C by 55.8% (P<0.005) and 57.3% (P<0.005) and apolipoprotein B by 38.3% (P<0.005) and 37.2% (P<0.005) respectively, and increased the mean levels of high density lipoprotein cholesterol (HDL-C) by 8.7% (P<0.005) and 11% (P<0.005), and apolipoprotein A-I by 3.2% (P<0.05) and 3.3%, respectively. In both groups of patients the mean decrease (52 weeks) of fibrinogen was 19.8% (P<0.005) and 10.4% (P<0.005), respectively and of high sensitivity C-reactive protein (hs-CRP), 36.2% (P<0.005) and 38.2% (P<0.005), respectively. No variation of the parameters of safety and clinical tolerability of the drugs administered was observed. No variation in hematocrit in the patients taking ASA treatment was observed. CONCLUSIONS: In FH patients, 1-year atorvastatin treatment titrated to the target (LDL-C <100 mg/dL) was well tolerated and improved serum lipid levels and inflammatory parameters.

Liver disease in early syphilis.

Atypical manifestations of early syphilis, although uncommon, may represent diagnostic difficulties and delay therapy. We describe two cases of hepatitis complicating early syphilis. Clues to the diagnosis of early syphilitic hepatitis include the presence of perianal lesions and disproportionate increases in the serum alkaline phosphatase level. Biopsy results were nonspecific. The major differential diagnostic consideration is hepatitis B with false-positive serologic findings. The abnormalities of liver function respond to standard therapy for secondary syphilis. Follow-up of patients and their contacts is essential.

Evidence for soluble and nuclear site I binding of estrogens in human aorta.

The purpose of this study was to establish the estrogen receptor (ER) expression and content in human aorta fragments removed at the time of by-pass surgery. To this end, we adopted a radioligand binding assay to evaluate either soluble (S) or nuclear (N) ER using dextran-coated charcoal (DCC) and filtration methods, respectively. To better define the intratissular distribution and content of ER, we also measured the presence of a 27 kDa heat shock protein (HSP27), a well established ER-associated protein, using D5 monoclonal antibody. Finally, we analysed the different molecular isoforms of both S and N ER using size exclusion-high performance liquid chromatography (SE-HPLC). High affinity (type I) sites of estrogen binding were detected in 17 out of 19 samples in either S or N fraction, although only 9 out of 19 cases displayed site 1 ER in both cell compartments. ER levels in aortic tissues, detected by radioligand method, compare well with those we have found in other hormone-sensitive human cancer tissues and cells. SE-HPLC analysis revealed two main receptor isoforms in the soluble fraction, having 65 kDa and 18 kDa molecular mass, while a minor component of 29 kDa was also found; the nuclear fraction displayed again two major components of 38 and 23 kDa. Using the HSP27 immunohistochemistry we observed a major staining occurring in smooth muscle cells (SMC), with an increasing intensity towards the lumen. All samples, including the ER negative ones, exhibited some degree of histochemical staining. Using an arbitrary cut-off value, 7 out of 12 samples displayed a highly positive staining, 6 of which showed nuclear ER. Furthermore, SE-HPLC separation indicated the presence of a 64.9 kDa component in the soluble fraction, according to the well known relative molecular mass of ER. Following HSP27 immunohistochemistry, the overall staining intensity in aortic SMC approaches that seen in endometrial and breast epithelia, whilst the muscle ER content is generally lower. Although our data are compatible with a direct role of estrogens in arterial function, the extent of the link with arterial disease remains to be established.

Relationship between O2 delivery and O2 consumption in the adult respiratory distress syndrome.

We evaluated the relationship between O2 delivery and oxygen consumption (VO2) in ten patients with the adult respiratory distress syndrome (ARDS) over the course of their illness (mean 7 +/- 5 days) while they were receiving positive mechanical ventilation with varying levels of positive end-expiratory pressure (PEEP). Mean values and standard deviations for O2 delivery and VO2 were 15.2 +/- 4.8 ml/min/kg and 4.1 +/- 1.2 ml/min/kg, respectively. In our ten patients, below an O2 delivery of 21 ml/min/kg, VO2 was linearly related to O2 delivery (VO2 = 0.32 X O2 delivery--0.53, n = 83, r = 0.76). However, at an O2 delivery rate higher than 21 ml/min/kg, there was no correlation between VO2 and O2 delivery. Mixed venous O2 content (CvO2) and arteriovenous oxygen content difference (C(a-v)O2) did not correlate with O2 delivery, nor was there a significant correlation between cardiac output (Qt) and mixed venous O2 tension (PvO2) or saturation (SvO2). We conclude that in patients with ARDS on mechanical ventilation with PEEP, VO2 and O2 delivery are linearly related except at high levels of O2 delivery. PvO2 and (C(a-v)O2) do not correlate with O2 delivery and are not sensitive indicators of tissue oxygenation in ARDS.

Elevated levels of lipoprotein (a) in patients suffering from myocardial infarction with carotid atherosclerotic lesions.

The aim of the present study was to evaluate metabolic, coagulation and fibrinolytic parameters in 45 patients [31 men, 14 women, aged 56.5 +/- 3.5 years (mean +/- SD)] who had suffered myocardial infarction more than 6 months earlier, with or without carotid atherosclerotic lesions. After the extracranial carotid arteries had been evaluated using a B-mode Duplex scanning system, patients were subdivided into two groups: group 1 (n = 20) with carotid plaques or measurable intima-media thickness; and group 2 (n = 25) without carotid plaques or measurable intima-media thickness. Twenty-two age- and sex-matched subjects were recruited as controls (group 3). Groups 1 and 2 displayed significantly higher levels of total cholesterol, apolipoprotein B, human autoantibodies against oxidised low-density lipoprotein and the c fraction of the third component system, and significantly lower levels of high-density lipoprotein cholesterol and apolipoprotein A1 than group 3. However, serum levels of triglyceride and lipoprotein (a) were significantly higher in group 1 than in the control group. Moreover, groups 1 and 2 displayed significantly higher levels of factor VII, fibrinogen, fragment 1+2, thrombin-antithrombin complex and plasminogen activator inhibitor after venous occlusion, and significantly lower levels of tissue-type plasminogen activator after venous occlusion than group 3. Significantly higher levels of tissue-type plasminogen activator and plasminogen activator inhibitor before venous occlusion were observed in groups 1 and 2 and significantly lower levels of antithrombin III, protein C and protein S were observed in group 1 compared with the controls. Patients were also analysed according to levels of lipoprotein (a). The lowest levels of tissue-type plasminogen activator after venous occlusion and the highest levels fragment 1 + 2, the c fraction of the third component system, and plasminogen activator inhibitor after venous occlusion were observed in patients with the highest levels of lipoprotein (a). Our data demonstrate an activation of coagulation and deficient fibrinolysis in survivors of myocardial infarction, particularly in those with associated carotid atherosclerotic lesions. We speculate that this thrombophilic state may play a key role in the pathogenesis of atherosclerotic vascular disease and thromboembolic complications.

Specificity and sensitivity of 3rd generation EIA for detection of HCV antibodies among intravenous drug-users.

Serum samples from 487 ambulatory I.V. drug users were screened for HIV and HCV antibodies to determine the prevalence of coinfection in this high risk group for AIDS. For anti-HCV antibody screening we first used a 3rd generation EIA using, as antigen synthetic peptides which were not subjected to false positive results due to antibodies against superoxide dismutase or against yeast proteins (which may copurify with the recombinant proteins employed in the first and second generation test). The specimens that were positive in the screening test were confirmed by a more specific EIA system that detect antibodies to proteins encoded by structural (HCV-st EIA) and non structural (HCV-nst-EIA) regions of the HCV genome. A second confirmation assay was also performed: sera were run in presence or absence of blocking reagents which inhibits antibodies to C200 and C22 HCV epitopes for binding to the solid phase. The sensitivity of the HCV EIA screening for human HCV antibody detection revealed a 100% positivity for HCV infection. The confirmatory strategy presented in this paper revealed an HCV EIA specificity of 98.6%. In this work we demonstrated a significantly higher prevalence (p < 0.001) of HCV exposure in HIV infected individuals compared to the general population. Our experimental data also confirmed that HBV infection in drug-users at high risk for HIV infection was significantly associated with HCV infection (p < 0.001). In contrast, the acquisition of HIV by sexual contact was not a statistically significant risk factor for HCV coinfection.

[Serum levels of 17-beta-estradiol and progesterone in atherosclerotic subjects before and after HCG tests]. / Valori di 17 beta estradiolo e progesterone in soggetti aterosclerotici prima e dopo test con HCG.

In this work the Authors describe the results of 17 plasmatic beta estradiol and plasmatic progesterone in a group of 10 arteriosclerotic patients before and after a test with HCG. The data proved that this drug doesn't modify statistically the plasmatic values of the mentioned steroids. These data cannot explain the mechanism of the therapeutic action of the HCG through a stimulus of the gonads.

[Levels of prolactin in atherosclerotic subjects before and after HCG tests]. / Valori di prolattina in soggetti aterosclerotici prima e dopo test con HCG.

Among the researches concerning the therapeutic mechanism of HCG in the arteriosclerotic disease, in this work the Authors report the values of prolactin before and after a stimulus with HCG in a group of 10 arteriosclerotic patients. The prolactin values are not modified by HCG and would not confirm the eventual direct or indirect mediation of the hypophysis in the above mentioned therapeutic action.

Oestrogen binding sites in fresh human aortic tissue.

Biopsies of aortic tissue were obtained from patients undergoing heart surgery, and were tested for oestrogen binding sites. Tests were carried out using a 7 + 1-point dextran-coated charcoal method, and receptors were quantified both in the cytoplasmic and in the nuclear fractions using Scatchard plot analyses. Tests yielded positive results in 8 cases out of 13 (cytosol fraction) and in 10 cases out of 13 (nuclear fraction). Receptors showed high affinity for oestrogens, the Kd values ranging from 10(-11) M to 10(-10) M. These findings therefore suggest the occurrence of oestrogen receptors in human blood-vessels.

Effects of L-carnitine on adriamycin-induced cardiomyopathy in rabbit.

The authors conducted an investigation in order to ascertain whether or not L-carnitine, by promoting the utilization of FFA for energy and neutralizing FFA toxicity occurring after ischaemia, could prevent or confine adriamycin-induced cardiotoxicity in rabbits. The results show that L-carnitine determines a higher survival rate and reduced onset of cardiomyopathy. Histopathological examination of myocardial tissue under light and electron microscopy revealed a marked decrease in mitochondrial lesions.

The spatial components of demographic change.

"In recent years, fertility in developed countries has drastically fallen towards replacement levels, so that further changes play an increasing role in determining the dynamics of population systems. In this paper, the dynamics of multiregional populations are analyzed when occasional perturbations resulting from changes in social and economic conditions exist. A perturbation theory for population models is introduced and the increasing effect of changes in demographic rates in determining the spatial component of the multiregional population growth is shown." The author outlines the critical situations in which perturbations produce drastic demographic changes. Data for Italy are used to show the theory's usefulness in analyzing both short- and long-term effects of changes in vital rates.

[Evaluation of the effects of verapamil, flunarizine, diltiazem, nimodipine and placebo in the prevention of hemicrania. A double-blind randomized cross-over study]. / Valutazione degli effetti indotti dall'uso di verapamile, flunarizina, diltiazem, nimodipina e placebo nella profilassi dell'emicrania. Studio a doppio cieco randomizzato cross-over.

Notwithstanding progress in the prophylactic treatment of migraine, the available therapies are often inefficient and unsatisfactory. In this study, 50 patients suffering for at least one year from the classic or common type migraine and treated with calcium-antagonists: Verapamil, Flunarizine, Diltiazem, Nimodipine, as well as placebo, were studied. 34 patients completed the study. All of the calcium-antagonists studied resulted efficacious in the prophylaxis of migraine; however, more attention should be paid to Flunarizine since this substance, in addition to its therapeutic efficacy, also has the advantages of a single daily dose which makes it the drug of choice in the prophylaxis of vasomotor migraine.

[Telethermographic evaluation of the intra-articular administration of thymopentin in rheumatoid arthritis of the knee]. / Valutazione teletermografica dell'impiego della timopentina per via intraarticolare nell'artrite reumatoide del ginocchio.

Fifteen subjects with rheumatoid arthritis defined as "classical" or "definite" according to A.R.A. criteria and classified according to Steinbrocker as stages I to III were submitted to knee joint infiltration (bilateral where both knees were involved) with 50 mg thymopentin in 1 ml, once a week for five weeks. Telethermographic examination was performed in all cases in order to evaluate the thermal inflammatory component before the first and 48 hours after the last infiltration. In none of the patients with the exception of only one case, did the drug lead to a significant change of the thermal index. This evaluation does not take into account any other objective and subjective parameters the study of which was beyond the scope of the above research.

[The evaluation of the time of gastric radio-isotopic emptying in subjects with non-insulin dependent diabetes mellitus]. / Valutazione dei tempi di svuotamento gastrico radio-isotopico in soggetti con NIDDM in terapia con cisapride.

Abnormal gastro-intestinal motility is a well-recognized complication of autonomic neuropathy in diabetics; delayed gastric emptying is frequently documented. Various pharmacologic agents have been used to treat this complication such as cisapride. We have evaluated the effects of cisapride on gastric emptying in nine diabetic patients with autonomic neuropathy through radio-scintigraphic method. Gastric emptying diabetic patients was significantly prolonged compared control subjects (p < 0.01). In our study cisapride increased gastric emptying, but this did not reach statistical significance. We concluded that cisapride may be considered as a good alternative in cases where limited efficacy or side effects preclude the use of metoclopramide.

[A rare case of cryptococcal meningitis unrelated to AIDS]. / Un raro caso di meningite criptococcica non correlata ad AIDS.

It is presented the clinical case of a man 60 years old, heterosexual, suffering from chronic bronchopathy from old date, inveterate smoker, with previous diskotomy, herniotomy, who presents a symptomatology characterized from recurrent fever, productive cough, dyspnea, asthenia and headache for 6 month. He was admitted to hospital for fever and for a sensory slightly obnubilated. A series of investigations for typhus fever, cytomegalovirus, all with negative results were performed. He resulted negative also to the test to PPD as well as to markers of B and C hepatitis and the test for HIV. The study of the principal cancer markers also gave negative results, while the blood smears displayed leukopenia with monocytosis. The magnetic nuclear resonance of the brain showed the presence of multiple lesions of the brain and along the meninges: the examination of the liquor underlines the presence of the Cryptococcus neoformans, making to set the diagnostic of cryptococcal meningitis. The immunological study showed low values of CD4 in presence of normal values of CD8 and of a normal natural killer function. The exitus happened at 64th day. The interest of the case consists in the fact that in the medical Italian literature, unlike the international one, are not described cases of cryptococcal meningitis in patients not infected by HIV.

Regional water quality patterns in an alluvial aquifer: direct and indirect influences of rivers.

The influence of rivers on the groundwater quality in alluvial aquifers can be twofold: direct and indirect. Rivers can have a direct influence via recharge and an indirect one by controlling the distribution of fine-grained, organic-carbon rich flood deposits that induce reducing conditions. These direct and indirect influences were quantified for a large alluvial aquifer on the Swiss Plateau (50km(2)) in interaction with an Alpine river using nitrate as an example. The hydrochemistry and stable isotope composition of water were characterized using a network of 115 piezometers and pumping stations covering the entire aquifer. Aquifer properties, land use and recharge zones were evaluated as well. This information provided detailed insight into the factors that control the spatial variability of groundwater quality. Three main factors were identified: (1) diffuse agricultural pollution sources; (2) dilution processes resulting from river water infiltrations, revealed by the δ(18)OH2O and δ(2)HH2O contents of groundwater; and (3) denitrification processes, controlled by the spatial variability of flood deposits governed by fluvial depositional processes. It was possible to quantify the dependence of the nitrate concentration on these three factors at any sampling point of the aquifer using an end-member mixing model, where the average nitrate concentration in recharge from the agricultural area was evaluated at 52mg/L, and the nitrate concentration of infiltrating river at approximately 6mg/L. The study shows the importance of considering the indirect and direct impacts of rivers on alluvial aquifers and provides a methodological framework to evaluate aquifer scale water quality patterns.

Efficacy and safety of long-term ezetimibe/simvastatin treatment in patients with familial hypercholesterolemia.

AIM: Patients with heterozygous familial hypercholesterolemia (FH) have an increased risk of premature myocardial infarction, stroke, and surgical revascularization, and an increased rate of progression of carotid intima-media thickness (IMT). The most commonly used drugs for cholesterol lowering, statins, have a limited action in these patients. Ezetimibe, a novel compound, selectively inhibits cholesterol uptake and when associated with statins has an additional low-density lipoprotein cholesterol (LDL-C) reducing effect. The aim of this study is to evaluate the effects of long-term combined Ezetimibe/Simvastatin (EZE/SIMVA) therapy (30 months) on the lipidic pattern, inflammatory markers, and carotid IMT in patients with FH subdivided into two groups: one with a history of acute myocardial infarction (IMA) and the other with carotid atherosclerotic plaques but no history of cardiovascular events. METHODS: All patients enrolled in this study (group A: patients with a history of IMA; group B, patients with carotid lesions but no history of cardiovascular events) were submitted to a 6-week period of isocaloric diet and to a 4-week lipid-lowering wash-out period before study entry. After the wash-out period at baseline (time 0) and then every two months total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and apolipoprotein B and A1 were determined. LDL-C levels were calculated. Fibrinogen and hs-CRP at baseline and at 6, 18, and 30 months were determined. All patients were submitted to an ultrasonographic evaluation of the carotid intima-media thickness at baseline, 18 and 30 months. The scheduled duration time of the study was 30 months. At the beginning of the study all patients were assigned to receive the combined EZE/SIMVA treatment 10/20 mg per day. After two months, patients who had not reached the respective LDL-C targets proposed by NCEP ATPIII (<70 mg/dL for patients with a history of IMA and <100 mg/dL for patients with carotid lesions) were assigned to receive EZE/SIMVA 10/40 mg per day and, after four months, patients who had not reached the respective LDL-C targets were assigned to receive EZE/SIMVA 10/80 mg per day. RESULTS: At the end-point, significant reductions (P<0.001) of about 70% in LDL-C, of 57% in total cholesterol (TC), of 46% in Apo-B, and of 46% in hs-C-reactive protein (hs-CRP) were observed in both groups compared to baseline. Also, triglyceride and fibrinogen levels were significantly (P<0.01) reduced, respectively by 26% and 15% compared to baseline. The EZE/SIMVA association resulted in significant increases in HDL-C (P<0.01) of 11% and in Apo-A1 (P<0.05) by 9% and in significant (P<0.001) reductions of the mean of the carotid IMT in both groups. The EZE/SIMVA treatment was generally well-tolerated, with a safety profile on laboratory parameters. During the 30-month scheduled period of the study, no patient in either group presented any further cardiovascular events. CONCLUSION: In patients with FH, combined EZE/SIMVA treatment resulted in a significant LDL-C lowering, achieving the goals proposed by NCEP ATP III, in a significant improvement of all the lipidic and inflammatory patterns, and above all in a progressive decrease of the carotid IMT. Although the results of ongoing randomized controlled trials are required before making any definitive conclusions, our results support the hypothesis of stabilizing effect of EZE/SIMVA on the atherosclerotic disease both in primary and in secondary prevention.