Neuropsychological profiles in children and young adults with spina bifida.

PURPOSE: A total of 43 Italian children, aged between 6 and 16 years, diagnosed with spina bifida, myelomeningocele, and shunted hydrocephalus have been described clinically and completed a neuropsychological battery in order to evaluate their cognitive, personality, and behavior profile. METHODS: Enrolled children underwent cognitive assessment by means of the Weschler WISC-IV cognitive test and assessment of the attention sustained through the LEITER test. In addition, parents were asked, in order to obtain a personality and behavior profile of the children, to fill in a "CBCL 6-18 years" questionnaire and to fill in a Barthel Index questionnaire. RESULTS: Processing Speed Index of the WISC-IV QI scale was statistically significant (p = 0.027), with the highest value presented by autonomous patients (95.8 ± 12.8) and the lowest by patients using a wheelchair (75.5 ± 19). WISC-IV QI mean value is 98 (±15.7) for lipoma patients and 78.7 (±17.6) for LMMC and MMC patients (p = 0.001). In more detail, Perceptual Reasoning (p < 0.0005), Working Memory (p = 0.01), and Processing Speed Index (p = 0.001) highlighted a significant difference between the groups. The attention sustained subscale of the LEITER presented a mean of 6.9 (±3.1) for lipoma patients and a men value of 4.6 (±3.1) for LMMC and MMC patients (p = 0.024). Patients with hydrocephalus had statistically significant worse cognition and autonomy (Barthel Index) score (p < 0.001) compared with those without hydrocephalus, and normal scores regarding attention and depression scales. CONCLUSION: These results can be useful in planning dedicated therapeutic protocols such as suitable rehabilitation treatments, speech therapy, psychomotor skills, and cognitive enhancement and to develop prevention protocols particularly tailored for children with hydrocephalus who appear to have the more deficient skills.

[Guide for follow-up of patients with SARS-CoV-2 pneumonia. Management proposals developed by the French-language Respiratory Medicine Society. Version of 10 May 2020]. / Guide pour le suivi respiratoire des patients ayant présenté une pneumonie à SARS-CoV-2. Propositions de prise en charge élaborées par la Société de pneumologie de langue française. Version du 10 mai 2020.

The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.

The PML/RARalpha fusion protein inhibits tumor necrosis factor-alpha-induced apoptosis in U937 cells and acute promyelocytic leukemia blasts.

We investigated the effect of the acute promyelocytic leukemia (APL) specific PML/RARalpha fusion protein on the sensitivity to TNF-alpha-mediated apoptosis. The U937 leukemia cell line was transduced with PML/RARalpha cDNA. PML/RARalpha expression caused a markedly reduced sensitivity to TNF-alpha, even if apoptosis was triggered by agonistic antibodies to TNF-alpha receptors I and II (TNF-alphaRI, II). PML/RARalpha induced a 10-20-fold decrease of the TNF-alpha-binding capacity via downmodulation of both TNF-alphaRI and TNF-alphaRII: this may mediate at least in part the reduced sensitivity to TNF-alpha. Furthermore, the fusion protein did not modify Fas expression (CD95) or sensitivity to Fas-mediated apoptosis. The pathophysiological significance of these findings is supported by two series of observations. (a) Fresh APL blasts exhibit no TNF-alpha binding and are resistant to TNF-alpha-mediated apoptosis. Conversely, normal myeloblasts-promyelocytes show marked TNF-alphaR expression and are moderately sensitive to TNF-alpha-mediated cytotoxicity. Similarly, blasts from other types of acute myeloid leukemia (AML M1, M2, and M4 FAB types) show an elevated TNF-alpha binding. (b) The NB4 APL cell line, which is PML/RARalpha+, shows low TNF-alphaR expression capacity and is resistant to TNF-alpha-triggered apoptosis; conversely a PML/RARalpha- NB4 subclone (NB4.306) exhibits detectable TNF-alpha-binding capacity and is sensitive to TNF-alpha-mediated cytotoxicity. These studies indicate that the PML/RARalpha fusion protein protects against TNF-alpha-induced apoptosis, at least in part via downmodulation of TNF-alphaRI/II: this phenomenon may play a significant role in APL, which is characterized by prolonged survival of leukemic blasts.

The use of hyperbaric oxygen therapy in the treatment of sickle cell hyphema.

Eyes of adult albino rabbits were injected intracamerally with either normal saline or anticoagulated human sickle cell blood to study the effect of hyperbaric oxygen administration on sickle cell hyphema. The administration of two atmospheres of 100% oxygen for 2 hr to the rabbits raised the pO2 of the aqueous humor from a baseline value of 63.5 +/- 12.3 mmHg (mean +/- SD) to 620 +/- 133 mmHg in saline-injected eyes and 503.7 +/- 89.1 mmHg in eyes injected with human sickle cell blood. This rise in pO2 was highly significant (P less than 0.0001). The percentage of sickled cells in the anterior chamber 2 hr after injection decreased from 35.7 +/- 32.4% in rabbits breathing room air to 4.1 +/- 2.8% in rabbits exposed to hyperbaric oxygen for 2 hr. Hyperbaric oxygen can thus significantly raise aqueous humor pO2 values and decrease the sickling of erythrocytes in the anterior chamber and may be of value in patients with sickle cell hyphema.

Hyperbaric and transcorneal delivery of oxygen to the rabbit and monkey anterior segment.

When delivered to the corneal surface of rabbits for 30 minutes, 100% oxygen can significantly increase the mean (+/- SD) partial pressure of oxygen (PO2) in the aqueous humor (from 63.5 +/- 12.3 mm Hg [n = 12] to 139.5 +/- 32.4 mm Hg [n = 8]). Similar elevations were seen in monkeys. Under hyperbaric conditions (2 atm) for 30 minutes the aqueous PO2 in rabbits breathing room air can be increased to 295.2 +/- 132.4 mm Hg (n = 7) by exposing the rabbit cornea to 100% oxygen for 30 minutes. The high PO2 under these hyperbaric conditions is mediated by both vascular and transcorneal delivery of oxygen. The increase of PO2 in the rabbit aqueous can prevent or reverse sickling of intracameral human erythrocytes containing sickle hemoglobin. The exposure of rabbit eyes to 100% oxygen at the corneal surface is followed by autoregulation (constriction) of the iris vasculature. Transcorneal or vascular delivery of oxygen to the eye under normobaric or hyperbaric conditions may possibly benefit patients with hypoxic diseases of the anterior segment such as anterior segment necrosis, rubeosis iridis, or sickle cell hyphema.

Efficacy and duration of action of procaterol, a new bronchodilator.

Procaterol, a new beta-adrenergic agonist, was tested in two different doses in patients with reversible airway obstruction. Single oral doses of 0.05 or 0.1 mg produce an increase in measured expiratory flow rates, and the peak and duration of action are both dose related. Side effects reported during this one-day study were similar to those described with other compounds of this class; they were considered to be mild by the patients and the investigator. From these results, further investigation of this agent in bronchoconstrictive disease appears warranted.

Susceptibility of healthcare workers to measles, mumps rubella and varicella.

Susceptible healthcare workers are at risk of acquiring and transmitting measles, mumps, rubella and varicella to or from patients. We tested 333 employees at Padova University Hospital, for specific IgG. Of the workers tested, 98.2% were positive for measles, 85.9% for mumps, 97.6% for rubella and 97.9% for varicella. Eventhough participants born before 1957 were not all positive, they had a higher prevalence of immunity. We suggest serological screening in high-risk areas (paediatrics, oncology, radiotherapy, infectious diseases, maternity and the laboratory) and vaccination of susceptible employees.

Effect of vaccination and the immunomodulators "bacillus of Calmette-Guérin, avridine and Propionibacterium acnes" on rabies in mice.

Responses of vaccination and treatment to immunomodulators against rabies in mice were evaluated through macrophage inhibition factor (MIF), intra-pad inoculation (IPI) and serum neutralization (SN) tests and by the detection of gamma-interferon (IFN-gamma). Onco-BCG, Avridine and Propionibacterium acnes were administered to groups of mice. Higher survival rates were found in animals treated with P. acnes. Lower levels of IFN-gamma were observed in the groups of infected and vaccinated mice. The IPI was not effective on detecting the response of delayed-type hypersensitivity. Vaccine induced in the infected animals a more intense response to MIF reaction.

Short duration of neutralizing antibody titers after pre-exposure rabies vaccination with suckling mouse brain vaccine.

The human anti-rabies pre-exposure treatment currently used in Brazil, employing a 1-ml dose of suckling mouse brain vaccine (SMBV) administered on days 0, 2, 4 and 28, was compared to an alternative treatment with two 1 ml-doses on day 0, and one 1 ml-dose injected on days 7 and 21. The latter induced higher virus-neutralizing antibody (VNA) titers on day 21. Both Brazilian rabies vaccines produced with PV or CVS rabies virus strains were tested. Two additional volunteer vaccine groups, receiving the pre-exposure and the abbreviated post-exposure schedules recommended by the WHO using cell-culture vaccine (CCV) produced with PM rabies virus strain, were included as reference. The VNA were measured against both PV and CVS strains on days 21, 42 and 180 by the cell-culture neutralization microtest. The PV-SMBV elicited higher seroconversion rates and VNA by day 21 than the CVS-SMBV. Both, however, failed to induce a long-term immunity, since VNA titers were < 0.5 IU/ml on day 180, regardless of the schedule used. Cell-culture vaccine always elicited very high VNA on all days of collection. When serum samples from people receiving mouse brain tissue were titrated against the PV and CVS strains, the VNA obtained were similar, regardless of the vaccinal strain and the virus used in the neutralization test. These results contrast with those obtained with sera from people receiving PM-CCV, whose VNA were significantly higher when tested against the CVS strain.

Diagnostic cytology in breast cancer screening.

In the period 1977-1978, 245 solid or cystic breast tumors and 134 nipple secretions were evaluated cytologically at the Trieste Cancer Institute. The results are discussed in the light of literature reports, and the high incidence of unsatisfactory smears observed in the group of malignant lesions (14,7%) is attributed to incorrect technique in specimen collection. The incidence of false positives and false negatives was 0,2% and 2,9%, respectively. The data reported are insufficient for significant statistical conclusion, but nevertheless confirm further the diagnostic importance of breast cytology whose routine practice in patient study protocols for breast cancer is highly recommended.

[An error in the administration of rabies serum vaccination. The use of an improvised schedule and its evaluation: report of a case]. / Engano na administração de soro-vacinação para raiva. Emprego de esquema improvisado e sua avaliação: apresentação de um caso.

We report on a female patient attacked by a dog that died 4 days later, who sought treatment 11 days after the accident. A serum vaccination schedule was indicated, to be started immediately with the administration of anti-rabies serum (9 ml, corresponding to 40 IU/Kg body weight) and a series of 10 doses of vaccine applied on consecutive days plus 3 booster doses applied at 10-day intervals, according to the regulations of the Health Secretariat of the State of São Paulo. However, due to an error, 9 vaccine doses were initially applied at 3 different anatomical sites. The error was immediately discovered and it was decided to interrupt treatment for a few days and to restart and complete it later; this was done only 8 days later. Serologic follow-up by the serum-neutralization test in cell culture revealed a fully satisfactory response greatly exceeding WHO recommendations in terms of levels, precocity and duration. The patient continued to be healthy by the 240th day after the accident, when she was observed for the last time before this publication.

Simplification of immune adherence hemagglutination test for detection of rabies antibodies in human serum.

In the present work the immune adherence hemagglutination test (IAHA) was standardized in a simplified procedure. This test showed good reproducibility, better than the classical mice serum neutralization test (SN). The tests showed high correlation degree: high titers in one test corresponded to high titers in the other one, and the same occurred with low titers. The IAHA test is extremely simple, fast to perform, and of low cost when compared to tests such as SN or indirect immunofluorescence (IIF). It also proved to be useful in less sophisticated laboratories or even as a screening test for the titration of rabies antibodies.

Studies on human anti-rabies immunization in Brazil. I--Evaluation of the 3 + 1 pre-exposure vaccination schedule under field conditions.

The currently used pre-exposure anti-rabies immunization schedule in Brazil is the one called 3+1, employing suckling mouse brain vaccine (3 doses on alternate days and the last one on day 30). Although satisfactory results were obtained in well controlled experimental groups using this immunization schedule, in our routine practice, VNA levels lower than 0.5 IU/ml are frequently found. We studied the pre-exposure 3+1 schedule under field conditions in different cities on the State of São Paulo, Brazil, under variable and sometimes adverse circumstances, such as the use of different batches of vaccine with different titers, delivered, stored and administered under local conditions. Fifty out of 256 serum samples (19.5%) showed VNA titers lower than 0.5 IU/ml, but they were not distributed homogeneously among the localities studied. While in some cities the results were completely satisfactory, in others almost 40% did not attain the minimum VNA titer required. The results presented here, considered separately, question our currently used procedures for human pre-exposure anti-rabies immunization. The reasons determining this situation are discussed.

Immunomodulatory effect of glucan on the response to experimental antirabies vaccination.

The objective of the present study was to determine the stimulatory response to antirabies vaccination promoted by glucan in mice. Glucan increased both resistance to infection and antibody titres and this effect was more evident when glucan was used at dose of 0.5 mg, administered intraperitoneally before, during and after immunization and when the challenge virus was applied to the foot-pad.

Simplified fluorescent inhibition microtest for the titration of rabies neutralizing antibodies.

A simplified fluorescence inhibition microtest (SFIMT) was standardized for the evaluation of antirabies serum neutralizing antibodies based on the rapid fluorescent focus inhibition test (RFFIT) and the fluorescence inhibition microtest (FIMT). The simplified test showed reproducibility similar to that of the FIMT with advantages as easier executation and quicker reading. A simple pre-treatment of Brazilian microplates produced for immune enzymatic assays (PROSIL) gave equivalent results and substantial coast reduction, in relation to imported plates (DIFCO). The simplified test can be easily implemented in less sophisticated laboratories, as alternative to the mouse serum neutralization test, still the most largely employed in Brazil, or even to others as RFFIT and FIMT.

An ELISA suitable for the detection of rabies virus antibodies in serum samples from human vaccinated with either cell-culture vaccine or suckling-mouse-brain vaccine.

An indirect ELISA for determination of post-vaccination rabies antibody was applied. Purified rabies virus was used as antigen to coat plates, and staphylococcal protein A linked with horseradish peroxidase was used for detecting IgG antibody in human sera. Sera from humans, vaccinated with cell-culture vaccine or suckling-mouse-brain vaccine, were examined. ELISA results were compared to those obtained from the virus neutralization test. The mean and standard deviation of OD were determined for 126 negative sera (pre-vaccination) and for 73 sera from vaccinated persons showing antibody titers lower than 0.5 IU/ml. Results were defined as ELISA -positive, -negative or -doubtful. Establishment of a doubtful region reduced the number of sera otherwise classified as positive (false-positive sera). In this way, the sensitivity, specificity and agreement values were respectively 87.5%, 92.4% and 88.5%. No significant differences were observed in these values when the group vaccinated with cell-culture vaccine and the group vaccinated with suckling-mouse-brain vaccine were compared. It was shown that much of the disagreement between the values obtained by neutralization test and ELISA occurred in sera obtained at the beginning of the immunization process, and was probably due to the presence of IgM in the serum samples, detected only by the former test. This ELISA method can be used as a screening test in rabies laboratories regardless of the kind of vaccine used for immunization.

Reduced schedule of human antirabies immunization with Fuenzalida & Palacios vaccine.

The present study evaluates the humoral and cellular immune responses in 35 volunteers submitted to short antirabies vaccination schedules with the Fuenzalida & Palacios vaccine based on the administration of doses on non consecutive days. The volunteers were divided into two groups. The first group received a total number of five doses given on days 0, 4, 7, 20 and 35. The other group received four doses, the first one being a double dose given on day 0 and than three other single doses on days 7, 20 and 35. The evaluation of humoral immune response was carried out by serum neutralization (SN) and indirect immunofluorescence (IIF) tests, while the cellular immune response was evaluated by lymphoblastic transformation assay (LTA) and skin test (ST). According to our results these reduced schedules elicited early and effective humoral and cellular immune responses to rabies antigen suggesting that new reduced schedules should be extensively studied in order to give the proper bases to the proposition of changes in the current long-term schedule.

Antibody response in cattle after vaccination with inactivated and attenuated rabies vaccines.

Despite the absence of current official reports showing the number of cattle infected by rabies, it is estimated that nearly 30,000 bovines are lost each year in Brazil. In order to minimize the important economic losses, control of the disease is achieved by eliminating bat colonies and by herd vaccination. In this study, we compare the antibody response in cattle elicited by vaccination with an attenuated ERA vaccine (AEvac) and an inactivated-adjuvanted PV (IPVvac) vaccine. The antibody titers were appraised by cell-culture neutralization test and ELISA, and the percentage of seropositivity was ascertained for a period of 180 days. IPVvac elicited complete seropositivity rates from day 30 to day 150, and even on day 180, 87% of the sera showed virus-neutralizing antibody titers (VNA) higher than 0.5IU/ml. There were no significant differences between the VNA titers and seropositivity rates obtained with IPVvac in the two methods tested. AEvac, however, elicited significantly lower titers than those observed in the group receiving inactivated vaccine. In addition, the profiles of antirabies IgG antibodies, evaluated by ELISA, and VNA, appraised by cell-culture neutralization test, were slightly different, when both vaccines were compared.

Reduced schedule of human anti-rabies immunization with Fuenzalida & Palacios vaccine. Additional data.

It was reevaluated a reduced schedule for anti-rabies post-exposure immunization with newborn mice nervous tissue vaccine (Fuenzalida & Palacios) in a group of 30 non exposed volunteers. The vaccine was administered by intramuscular injections on days zero, 2, 4, 16 and 27, in the deltoid area. Antibody levels were determinated by a simplified serum neutralization microtest on days zero, 16 and 37. On days 16 and 37 the antibody levels of the whole group was > or = 0.5 IU/ml and > or = 1.0 IU/ml, respectively. The cell mediated immunity was precociously detected (on day 4) by the delayed type hypersensitivity skin test. Our results show that this reduced schedule elicited an early and effective humoral and cellular immune response. However it is necessary other studies with larger groups of vaccinees in order to obtain definitive conclusion.