Possible role of vitamin D in Covid-19 infection in pediatric population.

PURPOSE: Covid-19 is a pandemic of unprecedented proportion, whose understanding and management is still under way. In the emergency setting new or available therapies to contrast the spread of COVID-19 are urgently needed. Elderly males, especially those affected by previous diseases or with comorbidities, are more prone to develop interstitial pneumonia that can deteriorate evolving to ARDS (acute respiratory distress syndrome) that require hospitalization in Intensive Care Units (ICUs). Even children and young patients are not spared by SARS-CoV 2 infection, yet they seem to develop a milder form of disease. In this setting the immunomodulatory role of Vitamin D, should be further investigated. METHODS: We reviewed the literature about the immunomodulatory role of Vitamin D collecting data from the databases Medline and Embase. RESULTS: Vitamin D proved to interact both with the innate immune system, by activating Toll-like receptors (TLRs) or increasing the levels of cathelicidins and ß-defensins, and adaptive immune system, by reducing immunoglobulin secretion by plasma cells and pro-inflammatory cytokines production, thus modulating T cells function. Promising results have been extensively described as regards the supplementation of vitamin D in respiratory tract infections, autoimmune diseases and even pulmonary fibrosis. CONCLUSIONS: In this review, we suggest that vitamin D supplementation might play a role in the prevention and/or treatment to SARS-CoV-2 infection disease, by modulating the immune response to the virus both in the adult and pediatric population.

Psychopathological chronic sequelae of the 2009 earthquake in L'Aquila, Italy.

BACKGROUND: To date, there are no data available among the general adult population on the long-term psychological sequelae of the earthquake that occurred in the town of L'Aquila, Italy in 2009. We investigated the prevalence of post-traumatic stress disorder (PTSD) and major depression (MD) and identified risk factors for these disorders among adult survivors more than one year after the earthquake. METHODS: Telephone interviews were conducted among a random sample of 957 resident adults. The interviews were performed using a questionnaire on exposure to the earthquake, the Mini-International Neuropsychiatric Interview for PTSD, and the Patient Health Questionnaire 8 for MD. Univariate and multivariate logistic regression analyses were conducted to assess potential risk factors. RESULTS: The prevalence rates of PTSD and MD were 4.1% (95% CI=3.0-5.5) and 5.8% (95% CI=4.5-7.5), respectively. The risk factors for PTSD were economic difficulties not necessarily related to the earthquake, chronic disease, death of a relative or friend, and serious economic difficulties as consequence of the earthquake, whereas those for MD were female gender, economic difficulties not necessarily related to the earthquake, not having a permanent job and living in L'Aquila. LIMITATIONS: The major limitations were the cross sectional design and the uncertain accuracy of the diagnoses compared with clinical diagnoses. CONCLUSIONS: Psychological symptoms are frequent even 14-19 months after the L'Aquila earthquake. The mental health care providers in the area of L'Aquila should be aware of the possibility of PTSD or MD among their users.

Italy: the first European country to forbid smoking in closed spaces. First results.

Second-hand smoke is a well-known risk factor for several diseases, including lung cancer, chronic obstructive pulmonary disease, asthma. Evidence exists that smoke-free policies have an effect on reducing or eliminating the exposure to second-hand smoke, decreasing the prevalence of smokers, encouraging smokers to quit or preventing the initiation of smoking, and reducing cigarettes consumption among smokers. Italy has been the first European country to forbid smoking in closed places, also in working areas not open to the public, as protection to the health of the entire population. This article describes the first results obtained from the application of this new law, the positive effects and unexpected modifications in the behaviour and social habits of the Italian people, thus, revealing itself an important instrument to protect public health.

[Vaccine coverage survey of the elderly in 11 Italian regions]. / Indagine sulle coperture vaccinali nella popolazione anziana di undici regioni Italiane.

In 2002, a sample survey of the population > or =65 years of age was conducted in 11 Italian regions that included information on the influenza, pneumococcal, and tetanus vaccination status. In each region, cluster sampling was used to select 210 individuals. In the Campania region, a separate random sample of 100 individuals was selected for Naples. Information on vaccination status was collected via an interview conducted in the participants' homes. A total of 2299 persons participated in the survey. During the 2001--2002 influenza season, 61% of the population reported that they had been vaccinated (regional range 39%-70%). The proportion of the population that had received an influenza vaccine increased with age and was higher than those with underlying diseases and conditions (70% of those > or =75 years of age with underlying problems). The percentage of those who reported having been vaccinated against tetanus was 54% (regional range 11% to 79%); coverage was higher among males and decreased with age. Only 24% of the sample reported having been adequately vaccinated (at least 3 doses, of which the last was administered during the last 10 years). Five percent had been vaccinated against pneumococcus, and none of the regions had a coverage higher than 15%. The elderly represent a segment of the population that is especially vulnerable to infectious diseases and often have problems with access to health services. These findings underline the need to improve vaccine coverage using strategies specifically targeted for this age group.

The role of vaccine in controlling hepatitis A epidemics.

We report the conduct and results of a review of recent literature to describe various types of epidemics and outbreaks in Italy or countries with similar epidemiological profiles and to assess vaccine use in outbreak situations. We identified three scenarios most likely to occur in Italy: outbreaks occurring in small closed communities (nursery or a primary school), outbreaks in communities of limited dimensions (small towns or villages) and open community settings in which epidemics occur at regular intervals (person-to-person transmission). In closed communities we recommend vaccination of family members and school personnel living or working in close proximity to the index case as well as classmates. We also recommend vaccination when there is a proof of secondary transmission within the community. In small open communities we recommend vaccination of more susceptible age groups such as children and adolescents. For large open communities the only practicable alternative strategy is vaccination of close family contacts of acute cases couple with non-immunity boosting control measures.

Influenza vaccination coverage in elderly people, Campania (Italy), 1999.

A study on the coverage of influenza vaccination among elderly people was carried out. Fity-six per cent of those interviewed had been vaccinated (weighted coverage 50%), compared with the target of 75%, but higher rates were reported in those older than 74 years and those with chronic diseases.

Fatal pulmonary infection due to multidrug-resistant Mycobacterium abscessus in a patient with cystic fibrosis.

We report a case of fatal pulmonary infection caused by Mycobacterium abscessus in a young patient with cystic fibrosis, who underwent bipulmonary transplantation after a 1-year history of severe lung disease. Fifteen days after surgery he developed septic fever with progressive deterioration in lung function. M. abscessus, initially isolated from a pleural fluid specimen, was then recovered from repeated blood samples, suggesting a disseminated nature of the mycobacterial disease. Drug susceptibility testing assay, performed on two sequential isolates of the microorganism, showed a pattern of multidrug resistance. Despite aggressive therapy with several antimycobacterial drugs, including clarithromycin, the infection persisted, and the patient died.

Hepatitis C virus infection and alanine transaminase levels in the general population: a survey in a southern Italian town.

BACKGROUND/AIM: The aim of the study was to estimate the prevalence, risk factors and genotype distribution of hepatitis C virus (HCV) in the general population older than 5 years of age in a southern Italian town. The positive predictive value of alanine transaminase (ALT) screening in identifying HCV positive subjects was also assessed. METHODS: Cluster random sampling from the census of the general population was used. ELISA and RIBA tests assessed the presence of anti-HCV; nested reverse transcription polymerase chain reaction (RT-PCR) was used to identify HCV-RNA; genotyping was performed by INNO-LIPA III. The association linking anti-HCV seropositivity with potential risk factors was assessed by multiple logistic regression analysis. RESULTS: Among the 488 subjects enrolled, 79 (16.2%) were anti-HCV positive. The prevalence increased from 1.2% in subjects 6-29 years of age to 42.1% in those > or = 60 years. Forty percent of these positive subjects also had abnormal ALT level and 54.4% were HCV RNA positive by PCR. The positive predictive value of the ALT test in identifying anti-HCV positive subjects was 65%; however, it was 46.7% in subjects younger than 60 years of age and 90.5% in those 60 or older. Genotype 1b was detected in 74% of subjects, type 2c in 23.3%, and type 1a in 2.3%. The only two variables significantly associated with HCV seropositivity in multivariate analysis were age older than 45 years (O.R. 8.5; CI 95%=3.0-24.1) and past use of glass syringes (O.R. 3.4; CI 95%=1.5-7.6). CONCLUSIONS: These findings confirm that HCV infection is endemic in southern Italy, particularly among the elderly. Percutaneous exposure, such as injections with nondisposable, multiple-use, glass syringes used in the past for medical purposes may have played a major role in the spread of HCV infection. ALT screening is not useful in detecting HCV positive subjects in the general population, particularly among subjects who could benefit from antiviral therapy.

Fatal disseminated Nocardia farcinica infection in a renal transplant recipient.

Six years after a renal cadaver transplant, a 20-year-old girl developed multiple painful cutaneous abscesses and bilateral pneumonia secondary to Nocardia farcinica infection. Despite broad in vitro sensitivity to several antibiotic agents and aggressive medical treatment, the patient failed to respond and died after 10 weeks of therapy. We conclude that Nocardia farcinica is a very aggressive organism in immunocompromised patients and is often resistant to antimicrobial agents.

Histopathologic interobserver agreement on the diagnosis of melanocytic skin lesions with equivocal dermoscopic features: a pilot study.

AIMS AND BACKGROUND: Dermoscopy (dermatoscopy, skin surface microscopy, epiluminescence microscopy) has been increasingly employed in recent years for the preoperative detection of cutaneous melanoma, and dermatoscopic features of pigmented skin lesions have been previously defined using histopathology (HP) as the "key to the code". The aim of the present study was to evaluate the interobserver agreement on the HP diagnosis in a series of epiluminescence microscopy equivocal melanocytic skin lesions. STUDY DESIGN: Ten melanocytic skin lesions were selected on the basis of diagnostic disagreement of at least 2 out of 9 epiluminescence microscopy observers. The histologic specimens from the 10 lesions were examined by 9 HP observers. The agreement of the HP diagnoses was calculated by means of Fleiss' k statistics. RESULTS: The overall HP agreement was less than excellent (k = 0.5). When considering the prevailing epiluminescence microscopic and HP diagnoses, 2 cases were shown to be epiluminescence microscopy false-negative melanomas. Virtually no agreement was found among epiluminescence microscopy observers in 4 cases (40%) or among HP observers in 3 cases (30%). However, only one pigmented skin lesion remained unclassifiable on epiluminescence microscopy as well as HP. CONCLUSIONS: When at least 2 epiluminescence microscopy experts disagree in the evaluation of a given melanocytic skin lesion, even HP consultations may give equivocal results. The need to establish more reliable epiluminescence microscopic and HP criteria by performing an improved and meticulous clinicopathologic correlation, e.g. by using telecommunication via Internet, is emphasized.

Influenza vaccination among the elderly in Italy.

This article surveys the attitudes and perceptions of a random sample of the elderly population in three regions of Italy on the use and efficacy of influenza vaccine. The data were collected by direct interviews using a standard questionnaire. The results show that vaccination coverage against influenza is inadequate (26-48.6%). The major reasons for nonvaccination were lack of faith in the vaccine and disbelief that influenza is a dangerous illness. These data emphasize the need for a systematic education programme targeted at the elderly and the provision of influenza vaccination, with the increased cooperation of general practitioners.

An outbreak of Salmonella enteritidis infection associated with iced cake.

Several people developed severe symptoms of gastroenteritis after attending a first holy communion banquet in Benevento, a town of 60 000 inhabitants in southern Italy. About 60 people had attended the banquet, held on 14 June 1998, between 1400 and 1800

Characterization of the T-cell receptor V-beta repertoire in Kawasaki disease.

Kawasaki disease (KD) is a paediatric multisystem necrotizing vasculitis constituting the most frequent cause of acquired heart disease in childhood. Conflicting data have been reported regarding expanded T-cell populations using particular T-cell receptor (TCR) beta-chain variable (BV) gene segments, suggesting either a superantigen- or a conventional antigen-mediated immune response in this disease. In order to further investigate the role of T lymphocytes, cells were stained with an extensive panel of 21 different TCRBV specific monoclonal antibodies (MoAbs) covering almost 70% of all T-cells. Flow cytometry was employed to analyse the expression of the TCRBV repertoire in the CD4+ and CD8+ subsets separately, and of activation markers, in freshly isolated peripheral blood lymphocytes of 25 Kawasaki disease patients during the acute and convalescent phases of the disease. No abnormal usage of any TCRBV family was found, neither acutely nor during convalescence, compared with a control group of healthy children. However, a significant increase in interleukin-2 receptor (IL-2R)-expressing T lymphocytes restricted to the CD4+ subset was observed in KD patients. Our data confirm a strong immune activation in KD that might be of importance in the pathogenesis of the disease.

Shellfish consumption and awareness of risk of acquiring hepatitis A among Neapolitan families - Italy 1997.

In 1996, about 15% of all reported cases of hepatitis A (n=8651) in Italy were from the Campania region, with Naples reporting the region s highest incidence (34.9/100 000). Almost a half of all cases were between 15 and 24 years of age. In recent years,