Hypertension in childhood.

Hypertension is a growing health problem in children, and it is an important parameter of cardiovascular risk for adults. It is classified as primary (influenced by obesity, sedentary lifestyles and poor-quality food) or secondary to underlying causes. The AAP 2017 guidelines recommend measuring blood pressure every year from the age of three and in children under the age of three only if they have known risk factors. The measurement of infantile hypertension is relatively complicated and instable and, for this reason, ambulatory blood pressure monitoring (ABPM) and multiple office BP measurement (mOBPM), especially in infants who are not collaborating are indicated. High blood pressure may have an adverse effect on the heart, the vessels, the kidney, and the central nervous system so it is important recognize it and act promptly. Hypertension is initially treated with lifestyle changes such as weight loss, a healthy diet, and regular exercise, but, if non-pharmacological interventions have failed, a pharmacological treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, thiazide diuretics and/or beta blocker may be indicated.

[Drivers' random controls and population's recent drug use monitoring]. / I controlli casuali dei conducenti di veicoli a motore quale base per il monitoraggio dell'uso recente di droghe nella popolazione.

Substance abuse, particularly among young people, does not seem to have the tendency to decrease. Our knowledges on this phenomenon are manifold and they validly compete to address the actions of contrast. Nevertheless, it would seem profit to be able to have further informations, to place side by side to those already existing, with the aim to improve the surveillance of the phenomenon. For this purpose, in the present paper we propose a monitoring model based on the results of random controls on road, carried out by the Police (or by the Hospital) in relationship to the road safety. The representativeness of the data that we could get this way appears elevated as an hight percentage of the population own the driver's licence. As it is shown, these controls could be both individual and related to drivers' pools of biological samples. This last approach would seem to be more practicable since problems relating to the drivers' privacy would be avoided.

[Impact of increasing number of road alcohol controls on the prevalence of driving under the influence in Italy]. / L'aumento del numero dei controlli alcolemici su strada e i suoi effetti sulla prevalenza della guida in stato di ebbrezza in Italia.

In Italy the number of road controls for the driving under the influence of alcohol is significantly grown in the last years. In 2006 these controls have been around 250,000; in 2007, around 800,000. On the grounds of the data currently available one can estimate around 1,500,000 controls in 2008. At the same time a lowering percentage of drivers with blood alcohol concentration greather than the legal limit (equal to 0.5 g/l in Italy) has been recorded. Aforesaid percentage amounted to 15% and 6% in 2006 and 2007 respectively, with a lessening of 9 percent points. This reduction could plausibly be the outcome of the increased controls number on the italian roads. Likely, increased perception to be checked by the police has induced to a greater caution the drivers. However the controls are not random controls, but based on a 'well-founded suspicion', that is when the police is right to hold by their behavior that the drivers can be in state of drunkenness. This procedure prevents us from properly estimating the true effect. Therefore, carry out a suitable number of random controls besides the well-founded controls seems needed to quantify in accurate statistical way the proportion of drivers in state of drunkenness as well as its temporal trend.

[Measuring blood alcohol concentration on the road as a tool for early identification of subjects with alcohol-related problems]. / I controlli alcolemici su strada quale strumento per l'identificazione precoce di soggetti con problemi alcol-correlati.

This paper deals with some considerations showing the phenomenon 'alcohol and driving' doesn't have primary character. Instead, it springs from the individual's state leading him to drink over and over again too much alcoholic beverages. The fact that such a subject will drive in state of drunkenness afterwards is accidental, even if frequent. Therefore, to improve the road safety, as well as the social safety, action on the individual as regards its excessive alcohol consumption is needed. Nevertheless, for different reasons (bad information, underestimation of the risk, social reproval), who has problems with alcohol tends to hide himself; therefore problematic subjects are not easy to be identified. To get round this impediment, we propose to use BAC (Blood Alcohol Concentration) drivers' controls on the road to identify such as subjects, taking as cutoff a BAC greater than 1.5 g/l, or at least twice overcoming the legal limit (0.5 g/l), apart from the BAC value in itself In this way it would be possible to offer an early chance of specialistic assistance beforehand to help them to settle their own problem with the alcohol. This approach could be a successful strategy since among the subjects that would come so identified many are clearly in acceptable psycophysical state (as they can drive); many are young people (therefore subjects at the beginning of drinker's career); practically all have a good grounds for solving their problem (to get driving licence back). Of course, if this program had to have put into effect it would be necessary to strengthen the specialised Alcohol Services and therefore to bear the cost of it. Nevertheless, the outcomes would have significant spin-off not only on the road safety but, in more broad terms, on the social safety too.

[A method to estimate one's own blood alcohol concentration when the ministerial tables are not avaible]. / Un metodo per stimare la propria alcolemia quando non si disponga delle tabelle ministeriali.

To reduce the prevalence of driving under the influence, tables allowing to estimate one's own blood alcohol concentration (BAC) by type and quantity of alcoholic drinks intake have been enacted by decree in Italy. Such tables, based on a modified Widmark's formula, are now put up in all public concerns serving alcoholic beverages. Aim of this initiative is to try to get subjects which consume alcoholics and then will drive a vehicle take in account their own estimated BAC and, on this base, put into effect, if needed, suitable actions (to avoid or to limit a further consumption, to wait more time before driving, to leave driving a sober subject). Nevertheless, many occasions exist in which these tables are not available. To allow anybody to rough estimate his own BAC in these cases too, a proper method has been developed. Briefly, the weight (in grams) of consumed alcohol has to be divided by half her own weight, if female drunk on an empty stomach (by the 90% of her own weight, if she drunk on a full stomach); by 70% of his own weight, if male drunk on an empty stomach (by 120% of his own weight, if he drunk in a full stomach). Consistency between BAC values estimated by the proposed method and those shown in the ministerial tables is very narrow: they differ in a few hundredth of grams/liter. Unlike the ministerial tables, the proposed method needs to compute the grams of ingested alcohol. This maybe involves some difficulties that, nevertheless, can be overcome easily. In our opinion, the skillfulness in computing the grams of assumed alcohol is of great significance since it provides the subject with a strong signal not only in road safety terms, but also in health terms. The ministerial tables and the proposed method should be part of teaching to issue the driving licence and to recovery of driving licence taken away points. In broad terms, the school should teach youngs to calculate alcohol quantities assumed by drink to acquaint them with the risks paving the way for a more aware drinking when they will come age.

The urgency of establishing a rapid monitoring system for mortality due to traffic accidents (as well as for all mortality due to violence and accidents).

The data regarding the number of deaths from road accidents per year in Italy is presently available only after extensive time, in the range of years. This situation originates from problems related to data collection as well as to the subsequent management of the information. The two sources which allow the quantification of this mortality are: statistic of "Road Accidents documented by the Police Force", consisting in accidents reported by the Police and involving deceased or injured victims; general mortality statistics The first source presents problems related to quality and completeness; the second, problems related to dimensions: reports of mortality due to traffic accidents (presently about 6000 reports per year) end up, as they should, in the flow of general mortality (more than 560,000 reports per year), which necessarily lengthens response time. This excessive time interval between notification of deaths from traffic accidents and their actual availability in terms of statistics has, as of today, a negative impact not only on the prompt knowledge of the phenomenon, but also on the necessary appraisal in light of reaching the objectives proposed by the European Union by 2010 (reduction of 50% health consequences of traffic accidents). This article aims to show that it would be easy to set up a Rapid Monitoring System for deaths due to traffic accidents by creating an appropriate sub-flow of the general mortality statistics. Based on reported appraisals, we aim to show that it seems highly practicable (and convenient) to extend this system to all accidental and violent mortality, inclusive of drug-related mortality (presently underestimated). The authors feel that the System herein described could, in a matter of months, provide, at very low costs, useful and reliable information regarding health and social issues. It is worthwhile pointing out that what hereby proposed does not interfere in any way with the flow of general mortality currently in use and may also be used for parallel collection of data which is currently not being recorded.

Antibody assay for measles virus: comparisons of immune-adherence haemagglutination, single radial haemolysis, enzyme immunoassay and haemagglutination inhibition.

Immune-adherence haemagglutination (IAHA); single radial haemolysis and enzyme immunoassay (ELISA) versus haemagglutination inhibition (HAI) for detecting antibodies to measles virus were evaluated. The rank correlation computed according to Spearman for the sera of healthy individuals gave values of 0.66, 0.73, 0.72, respectively, for HAI-IAHA, HAI-single radial haemolysis (SRH) and HAI-ELISA. High percentages of accordance were observed as regards sera from both healthy and vaccinated individuals. In the case of vaccinated individuals the discordance analysis showed significant differences between HAI and IAHA, HAI and SRH, SRH and ELISA. The discordances indicate higher sensitivity of HAI and ELISA for the detection of seroconversion.

Mitochondrial aspartate aminotransferase isoenzyme: a biochemical marker for the clinical management of alcoholics?

Serum mitochondrial and total aspartate aminotransferase activity was quantified by a characterized immunochemical method in 126 subjects, 44 healthy controls and 82 chronic alcoholics (51 outpatients and 31 monitored through 15 days). The monitored alcoholics were divided into actual abstinents (n = 21) and drinkers (n = 10) by blood ethanol concentration performed daily. The aims of the present study were: (a) to compare the diagnostic diagnostic usefulness of the mitochondrial isoenzyme and the mitochondrial/total aspartate aminotransferase ratio to detect problematic drinkers; (b) to evaluate the suitability of these indices to monitor abstinence, a difficulty not yet solved in the clinical management of alcoholics. The results demonstrated the mitochondrial isoenzyme to be more suitable to discriminate between controls and alcoholics (Kruskal and Wallis ANOVA, Bonferroni test, P < 10(-5) and mostly between actual drinkers and other alcoholics (P < 0.041). So acute alcohol consumption may be a significant, suggestive and until now inadequately examined factor in evaluating the suitability of mAST as a marker. The results, showing that mAST peaks quickly appear in the presence of a new alcohol intake, should indicate mAST as a possible marker of acute alcohol intake useful in checking self-claimed abstinence.

Neuroendocrine correlates of depression in abstinent heroin-dependent subjects.

The functions of the central alpha-adrenergic, serotoninergic and dopaminergic systems were investigated in 28 heroin-dependent subjects 6-8 weeks after detoxification, and in 22 healthy control subjects (group C). Fourteen heroin-dependent subjects with depressive comorbidity (group A), and 14 heroin-dependent subjects without other Axis I and II pathologies (group B) were included among abstinent substance abusers. Norepinephrine (NE) function was evaluated by growth hormone (GH) responses to acute stimulation with clonidine (clon); serotonin (5-HT) function by prolactin (PRL) and cortisol (CORT) responses to acute stimulation with D-fenfluramine (D-fen) and dopamine (DA) function by GH and PRL responses to acute administration of bromocriptine (brom). Central NE activity, as measured by the GH-clon test, seems to be well preserved both in A and B subjects. PRL and CORT responses to D-fen were significantly blunted both in A subjects and in B subjects, in comparison with control subjects (C); the PRL response in A subjects was significantly lower than in B subjects. The DA system of B subjects was found unimpaired; in contrast, a significantly higher GH response to brom in A subjects (depressed) could express D2 post-synaptic receptor hypersensitivity and, therefore, decreased pre-synaptic DA release. In sum, the study of central monoamine function revealed an alteration only of the 5-HT system in detoxified heroin-dependent subjects without psychiatric comorbidity, which might be a trait character of these subjects, possibly involved in the pathogenesis of the disorder. A more significant impairment of 5-HT function and the hypersensitivity of post-synaptic DA receptors in A subjects suggests that specific biological correlates of psychiatric comorbidity may characterize substance abuser subtypes.

Ethanol in biological fluids: headspace GC measurement.

The present study evaluates the suitability of headspace gas chromatography (GC) with a capillary column as a method for determining the ethanol content in different biological fluids. This procedure allows the use of headspace GC not only as a reference method but also in routine diagnostics and monitoring work. The recent literature reviewed reports no standardized methodology that is at the same time suitable for ethanol determination in all routinely available biological fluids (blood, serum, plasma, urine, and saliva). The proposed procedure seems to be a good solution to the problem. The reproducibility study for the biological fluids tested resulted in coefficients of variation that ranged from 0.8 to 2.9% and recoveries that averaged 99%. Linearity was verified in the range of 0.01-20 g/L of ethanol in aqueous solutions. Sensitivity was determined to be 0.01 g/L. Ethanol measurement by this method is easy, simple, and highly reliable, and only a small sample volume (0.1 mL) is required. An internal standard and sample manipulation are not necessary. The obtained results suggest that the use of headspace GC could be extended from confirmatory analyses to routine application in many biomedical fields.

[Characterization of an analytical method, comparison between two methods and electronic elaboration of data (author's transl)]. / Alcune considerazioni sulla caratterizzazione di un metodo di analisi e sul confronto tra metodi per la messa a punto della procedura per la elaborazione elettronica dei dati.

An experimental scheme for the evaluation of two parameters of validity of an analytical method, precision and accuracy, has been reported. Particular emphasis has been given to the problem of comparison between two methods. In the description a validity limit of the scheme has been given and certain critical points, commonly encountered in the measurement of the above mentioned parameters during the preparatory as well as the experimental phase, has been underlined. Further, with the help of tables and graphs, an example for electronic elaboration of the data obtained during the course of standardization of an automatic method for the determination of uric acid in serum according to the above scheme, has been given.

[Evaluation of smoke consumption by the determination of serum thiocyanate (author's transl)]. / Valutazione obiettiva dell'assunzione di fumo tramite la determinazione del tiocianato sierico.

The method of Butts and Coll. for determination of serum thiocyanate--parameter correlated to smoke assumption--has been modified in order to improve sensibility and has been characterized as regards precision and accuracy. The improved method has been successively utilized for determination of serum thiocyanate of 493 subjects during a screening for prevention from coronary heart disease. A linear correlation (r = 0,916) between the number of smoked cigarettes and serum thiocyanate has been found. Assuming 40 mumol/l as a cut-off point to distinguish cigarette smokers and non smokers, 1,8% false positive and 5% false negative resulted.

Cocaine misuse in selected areas: Rome.

Dramatic increases in seizures of cocaine and, perhaps, in its use, are recording in Italy and in many European Countries. This should mean that heavy health problems have to be expected in a middle time (3-4 years), as already in USA where there is spreading of clinically relevant in-patients. The most cocaine users form the unseen part of the iceberg, so it is difficult to contact with it and to verify in extent. We report data, observations and comments on the suitability of the used "Snowball" sampling technique and, mostly, on its supplementary perspectives. This research was carried out in Rome area (September-December 1987) in the frame of the first pilot multi-center study, promoted by the Commission of the European Communities, on cocaine prevalence and incidence (Munich, Rome and Rotterdam). Results about the patterns and the characters of the 83 questioned users random selected (according to "Snowball" sampling technique), 32 females and 51 males (from 25 to 51 years), are reported. Some peculiar points emerged, as the differences by sex referred to: educational level (less than 50% of the males primary/middle school, greater than 70% of the females high school/university); civil status (almost 50% of the males are single, less than 20% of the females live with partner); median length of time of use (males 8 years, females 6 years); referred cocaine amount weekly used (1-7 grams); associations with other abuse substances (50% with alcohol); drug related problems (police, work, family); tendency to start use long before (teen-agers too) and to increase it with time.(ABSTRACT TRUNCATED AT 250 WORDS)

[Automatic determination of triglyceride, cholesterol, glucose and serum uric acid in the screening for preventive medicine (author's transl)]. / Determinazione automatica di trigliceridi, colesterolo, glucosio, acido urico: prospettive d'impiego in screening di medicina preventiva.

A centrifuge speed analyzer, used for triglyceride, cholesterol, glucose and serum uric acid determinations, was tested as to linearity, precision, steadiness and accuracy requirements. The results were compared to those obtained by other techniques. Automatic techniques were proved to comply with reliability and practicability requirements, necessary during the screenings for preventive medicine. The centrifuge speed analyzer seems to be particularly fit for the primary prevention trials of coronary heart disease, since the follow-up studies require repeated laboratory examinations.