RESUMO
Objective: Immunoglobulin G4-related disease (IgG4-RD) is considered a chronic condition with insidious presentation, but clinical experience suggests that disease onset prompts admission to the emergency department (ED) in a sizeable proportion of patients. We assessed the prevalence of acute manifestations associated with IgG4-RD onset requiring referral to the ED. Method: We revised our database and identified patients admitted to the ED because of symptoms latterly attributed to IgG4-RD onset (Group 1) and those who were referred to our outpatient clinic without previous urgent manifestations (Group 2). Acute manifestations were clustered based on the anatomical region affected by IgG4-RD. Epidemiological, clinical, and serological features of Groups 1 and 2 were compared. Results: The study included 141 patients with IgG4-RD. Of these, 76 (54%) presented to the ED at disease onset. The most common clinical manifestations requiring admission to the ED were jaundice (53%), abdominal pain (41%), and fever (10%). Gastrointestinal involvement was the most frequent cause of referral to the ED (71% of cases), followed by involvement of the retroperitoneum (14.5%) and the nervous system (6.6%). Pancreatobiliary involvement was significantly more frequent in Group 1 than in Group 2. Head and neck, and salivary and lacrimal gland involvement was more frequent in Group 2 than in Group 1. The diagnostic delay was significantly shorter in Group 1 than in Group 2. Conclusion: Clinical manifestations associated with IgG4-RD onset require referral to the ED in most cases. This finding contrasts with the general view of IgG4-RD as a condition with non-acute presentation.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Doença Relacionada a Imunoglobulina G4/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/sangue , Doença Relacionada a Imunoglobulina G4/diagnóstico , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
The aim of this study was to investigate the role of IL-18, a member of the IL-1 family, in group B Streptococcus (GBS) infection. Both in a neonatal and adult model of GBS infection, IL-18-deficient animals were significantly more susceptible to infection than WT animals. The lack of IL18 was associated with a marked reduction in IFN-γ-levels after bacterial stimulation but did not play a significant role in the recruitment of PMN to sites of GBS infection. Collectively, our data document a fundamental function of IL-18 signaling in boosting the host immune responses against GBS infection.
Assuntos
Interleucina-18/imunologia , Infecções Estreptocócicas/imunologia , Streptococcus agalactiae/fisiologia , Animais , Feminino , Humanos , Interferon gama/genética , Interferon gama/imunologia , Interleucina-18/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Neutrófilos/imunologia , Infecções Estreptocócicas/genética , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/genética , Streptococcus agalactiae/isolamento & purificaçãoRESUMO
Recent studies have demonstrated that the outline shapes of deciduous upper and lower second molars and the deciduous upper first molar are useful for diagnosing hominin taxa-especially Homo neanderthalensis and Homo sapiens. Building on these studies, we use geometric morphometric methods to assess the taxonomic significance of the crown outline of the lower first deciduous molar (dm1). We test whether the crown shape of the dm1 distinguishes H. neanderthalensis from H. sapiens and explore whether dm1 crown shape can be used to accurately assign individuals to taxa. Our fossil sample includes 3 early H. sapiens, 7 Upper Paleolithic H. sapiens, and 13 H. neanderthalensis individuals. Our recent human sample includes 103 individuals from Africa, Australia, Europe, South America, and South Asia. Our results indicate that H. neanderthalensis dm1s cluster fairly tightly and separate well from those of Upper Paleolithic H. sapiens. However, we also found that the range of shapes in the recent human sample completely overlaps the ranges of all fossil samples. Consequently, results of the quadratic discriminant analysis based on the first 8 principal components (PCs) representing more than 90% of the variation were mixed. Lower dm1s were correctly classified in 87.3% of the individuals; the combined H. sapiens sample had greater success (90.2%) in assigning individuals than did the H. neanderthalensis sample (61.5%). When the analysis was run removing the highly variable recent human sample, accuracy increased to 84.6% for H. neanderthalensis, and 57.1% of Upper Paleolithic H. sapiens were classified correctly by using the first 4 PCs (70.3%). We conclude that caution is warranted when assigning isolated dm1 crowns to taxa; while an assignment to H. neanderthalensis has a high probability of being correct, assignment to Upper Paleolithic H. sapiens is less certain.
Assuntos
Dente Molar/anatomia & histologia , Homem de Neandertal/classificação , Coroa do Dente/anatomia & histologia , Dente Decíduo/anatomia & histologia , Animais , Fósseis , Humanos , Homem de Neandertal/anatomia & histologiaRESUMO
PURPOSE: Hyperhomocysteinemia is a known cardiovascular risk factor and a key player in the inflammatory activation of autoimmune diseases. Hashimoto's thyroiditis (HT) is the leading cause of hypothyroidism which, in itself, has been associated with a significant raise of homocysteine (Hcy) levels and increased cardiovascular risk. Our aim was to assess the impact of HT on Hcy levels in patients with acute hypothyroidism. METHODS: We prospectively enrolled 121 patients (mean age: 46 years, F/M = 102/19) with acute post-surgical hypothyroidism. Based on the presence of anti-thyroid antibodies and the histological description of an inflammatory infiltrate, 26 and 95 patients were classified as HT and non-HT, respectively. Several parameters including thyroid-stimulating hormone (TSH), levels of serum free T3 and free T4, weight, glucose levels, total cholesterol, creatinine, vitamin B12, ferritin and erythrocyte sedimentation rate were obtained from all patients and correlated with Hcy levels. RESULTS: Median Hcy level in the whole cohort was 16.8 µmol/L (normal values: < 12 µmol/l). Among all parameters analysed, only Hcy levels were significantly different between HT and non-HT patients (median Hcy = 19.7 vs 16.2 µmol/L, respectively; p = 0.018, Mann-Whitney U test). Analysis of covariance showed the presence of HT to be the strongest predictor of Hcy levels (coefficient = 0.25534, p = 0.001). Serum TSH was not significantly associated with Hcy levels (p = 0.943). CONCLUSION: In patients with iatrogenic hypothyroidism, those with HT have significantly higher Hcy levels than those without HT. The increase of Hcy levels appears to be mainly determined by the HT-related immune-inflammatory condition.
Assuntos
Autoimunidade , Hiper-Homocisteinemia/etiologia , Hipotireoidismo/complicações , Glândula Tireoide/imunologia , Doença Aguda , Adulto , Feminino , Doença de Hashimoto/complicações , Doença de Hashimoto/epidemiologia , Doença de Hashimoto/imunologia , Doença de Hashimoto/cirurgia , Humanos , Hiper-Homocisteinemia/epidemiologia , Hiper-Homocisteinemia/imunologia , Hipotireoidismo/epidemiologia , Hipotireoidismo/imunologia , Doença Iatrogênica/epidemiologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Glândula Tireoide/efeitos da radiaçãoRESUMO
INTRODUCTION: The repair of large incisional hernias may occasionally lead to a substantial increase in intra-abdominal pressure (IAP), and rarely to abdominal compartmental syndrome (ACS) with subsequent respiratory, vascular, and visceral complications. Measurement of the IAP has recently become a common practice in monitoring critical patients, even though such measurements were obtained in the early 1900s. PATIENTS AND METHODS: A prospective study involving 54 patients undergoing elective abdominal wall gap repair (mean length, 17.4 cm) with a tension-free technique after incisional hernia was conducted. The purpose of the study was to determine whether or not urinary pressure for indirect IAP measurement is a reliable method for the early identification of patients with a higher risk of developing ACS. IAP measurements were performed using a Foley catheter connected to a HOLTECH® medical manometer. IAP values were determined preoperatively, after anesthetic induction, upon patient awakening, upon patient arrival in the ward after surgery, and 24 h after surgery before removing the catheter. All patients were treated by the same surgical team using a prosthetic composite mesh (PARIETEX®). RESULTS: Incisional hernia repair caused an increase in the mean IAP score of 2.68 mmHg in 47 of 54 patients (87.04%); the IAP was decreased in two patients (3.7%) and remained equal in five patients before and 24 h after surgery (9.26%). FEV-1, measured 24 h after surgery, increased in 50 patients (92.6%), remained stable in two patients (3.7%), and decreased in two patients (3.7%). The mean increase in FEV-1 was 0.0676 L (maximum increase = 0.42 L and minimum increase = 0.01 L) in any patient who developed ACS. CONCLUSIONS: Measurement of urinary bladder pressure has been shown to be easy to perform and free of complications. Measurement of urinary bladder pressure can also be a useful tool to identify patients with a higher risk of developing ACS.
Assuntos
Cavidade Abdominal , Herniorrafia , Hérnia Incisional/cirurgia , Hipertensão Intra-Abdominal/prevenção & controle , Manometria/métodos , Assistência Perioperatória/métodos , Bexiga Urinária , Cateterismo Urinário/métodos , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Manometria/instrumentação , Pessoa de Meia-Idade , Assistência Perioperatória/instrumentação , Pressão , Estudos Prospectivos , Telas CirúrgicasRESUMO
Previous studies have indicated that group B streptococcus (GBS), a frequent human pathogen, potently induces the release of interleukin-1ß (IL-1ß), an important mediator of inflammatory responses. Since little is known about the role of this cytokine in GBS disease, we analyzed the outcome of infection in IL-1ß-deficient mice. These animals were markedly sensitive to GBS infection, with most of them dying under challenge conditions that caused no deaths in wild-type control mice. Lethality was due to the inability of the IL-1ß-deficient mice to control local GBS replication and dissemination to target organs, such as the brain and the kidneys. Moreover, in a model of inflammation induced by the intraperitoneal injection of killed GBS, a lack of IL-1ß was associated with selective impairment in the production of the neutrophil chemokines CXCL1 and CXCL2 and in neutrophil recruitment to the peritoneal cavity. Decreased blood neutrophil counts and impaired neutrophil recruitment to the brain and kidneys were also observed during GBS infection in IL-1ß-deficient mice concomitantly with a reduction in CXCL1 and CXCL2 tissue levels. Notably, the hypersusceptibility to GBS infection observed in the immune-deficient animals was recapitulated by neutrophil depletion with anti-Gr1 antibodies. Collectively, our data identify a cytokine circuit that involves IL-1ß-induced production of CXCL1 and CXCL2 and leads the recruitment of neutrophils to GBS infection sites. Moreover, our data point to an essential role of these cells in controlling the progression and outcome of GBS disease.
Assuntos
Quimiocina CXCL1/metabolismo , Quimiocina CXCL2/metabolismo , Interleucina-1beta/metabolismo , Neutrófilos/fisiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/imunologia , Animais , Quimiocina CXCL1/genética , Quimiocina CXCL2/genética , Feminino , Humanos , Interleucina-1beta/genética , Camundongos , Camundongos Knockout , Peritonite/imunologia , Peritonite/microbiologia , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/farmacologia , Infecções Estreptocócicas/imunologiaRESUMO
Human immunodeficiency virus (HIV) infection has historically been related to the development of specific cancers, some of which are so closely linked to the infection, such as Kaposi's Sarcoma (KS), that they have earned the name Acquired Immuno-Deficiency Syndrome (AIDS)-defining cancers (ADCs). While the development of antiretroviral therapy (ART) has decreased the incidence of AIDS-defining cancers, the resulting aging of people living with HIV (PLWH) highlighted an increased occurrence of other forms of cancer. At the "Gaetano Martino" hospital in Messina, we developed a multidisciplinary approach by creating a bridge between the Oncology Unit and the Infectious Diseases Unit to carry out screening and a more rapid diagnostic and therapeutic journey for cancers in PLWH. The goal is to improve the diagnosis of various types of cancer by involving other professionals, such as gastroenterologists and gynecologists, to ensure faster access to treatment and, therefore, a greater chance of survival. In addition, our multidisciplinary approach has also included vaccine screening, offered by the "Gaetano Martino" hospital and useful for preventing the development of specific forms of cancer in the entire population and particularly in PLWH.
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Neoplasias , Sarcoma de Kaposi , Humanos , Detecção Precoce de Câncer , Fatores de Risco , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Sarcoma de Kaposi/epidemiologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , HospitaisRESUMO
Von Willebrand disease (VWD) is an inherited bleeding disorder caused by the quantitative or qualitative deficiency of von Willebrand factor (VWF). Replacement therapy with plasma-derived VWF/factor VIII (FVIII) concentrates is required in patients unresponsive to desmopressin. To assess the efficacy, safety and ease of use of a new, volume-reduced (VR) formulation of VWF/FVIII concentrate Haemate(®) P in patients requiring treatment for bleeding or prophylaxis for recurrent bleeding or for invasive procedures. Pharmacoeconomic variables were also recorded. Data were analysed using descriptive statistics. This was a multicentre, prospective, observational study. Consecutively enrolled patients received Haemate(®) P VR according to their needs, and were followed for 24 months. Of the 121 patients enrolled, 25.6% had type 3 VWD and more than 40% had severe disease. All patients were followed for 2 years, for a total of 521 visits. On-demand treatment was given to 61.9% of patients, secondary long-term prophylaxis to 25.6% and prophylaxis for surgery, dental or invasive procedures to 45.5%. The response to treatment was rated as good to excellent in >93-99% of interventions. The new formulation was well tolerated by all patients with no report of drug-related adverse events. The switch to volume-reduced Haemate(®) P was easy to perform and infusion duration was decreased twofold compared with the previous formulation. Volume-reduced Haemate(®) P was at least as effective and well-tolerated as the previous formulation.
Assuntos
Anticoagulantes/uso terapêutico , Fator VIII/uso terapêutico , Doenças de von Willebrand/tratamento farmacológico , Fator de von Willebrand/uso terapêutico , Adolescente , Adulto , Idoso , Anticoagulantes/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Substituição de Medicamentos , Fator VIII/efeitos adversos , Feminino , Hemorragia/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pasteurização , Estudos Prospectivos , Adulto Jovem , Fator de von Willebrand/efeitos adversosRESUMO
BACKGROUND: Infections caused by extracellular Gram positive bacteria are still a major health problems. Better understanding of the mechanisms underlying immune responses to these organisms is key to develop pharmacological agents, including vaccines, to control these infections. OBJECTIVE AND PERSPECTIVES: The objective of this review is to highlight the importance of nucleic acid-sensing, intracellular Toll-like receptors in innate immune recognition and in host defenses against extracellular bacteria. CONCLUSIONS: Toll-like receptors 7 and 9 have a major role in inducing host-protective type I interferon responses in conventional dendritic cells in response to streptococci and other extracellular gram positive bacteria. Moreover an as yet unidentified MyD88-dependent receptor is likely responsible for proinflammatory cytokine induction in response to these pathogens.
Assuntos
Bactérias Gram-Positivas/imunologia , Receptores Toll-Like/imunologia , Animais , Endossomos/imunologia , Transdução de SinaisRESUMO
BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome that is often fatal despite treatment. It is caused by a dysregulation in natural killer T-cell function, resulting in activation and proliferation of histiocytes with uncontrolled hemophagocytosis and cytokines overproduction. The syndrome is characterized by fever, hepatosplenomegaly, cytopenias, liver dysfunction, and hyperferritinemia. HLH can be either primary, with a genetic aetiology, or secondary, associated with malignancies, autoimmune diseases, or infections. AIM: To focus on secondary HLH complicating zoonotic diseases. MATERIALS AND METHODS: PubMed search of human cases of HLH occurring during zoonotic diseases was performed combining the terms (haemophagocytic or haemophagocytosis or hemophagocytosis or hemophagocytic or erythrophagocytosis or macrophage activation syndrome) with each one of the etiological agents of zoonoses. RESULTS: Among bacterial diseases, most papers reported cases occurring during brucellosis, rickettsial diseases and Q fever. Regarding viral diseases, most of the cases were reported in patients with avian influenza A subtype H5N1. Among the protozoan zoonoses, most of the cases were reported in patients with visceral leishmaniasis. Regarding zoonotic fungi, most of the cases were reported in AIDS patient with histoplasmosis. No cases of secondary HLH were reported in patient with zoonotic helminthes. CONCLUSIONS: Zoonotic diseases are an important cause of HLH. Secondary HLH can delay the correct diagnosis of the zoonotic disease, and can contribute to an adverse outcome.
Assuntos
Linfo-Histiocitose Hemofagocítica/etiologia , Zoonoses/transmissão , Animais , Comorbidade , Humanos , Linfo-Histiocitose Hemofagocítica/terapiaRESUMO
OBJECTIVE: The objective of this narrative review is to present a summary of current knowledge of host-fungal pathogen interaction focusing on the importance of the innate immune system in host defense against invasive fungal infections. In addition, the emergence of drug resistance in the treatment of invasive fungal infections has also been highlighted. MATERIALS AND METHODS: A literature review was conducted to identify articles documenting the role of the host innate immune system against fungal pathogen and the emergence of drug resistance in the treatment of invasive fungal infections. RESULTS: In this review, we provide an update from the most recent studies on the role of the host innate immune system against fungal pathogen and we also highlight the mechanisms that these pathogens use to evade the innate immune system. CONCLUSIONS: This review highlights the existence of different cellular mechanisms that, following the recognition of fungal PAMPS, induce the production of different sets of defense factors. The development of new diagnostic methods and antifungal drugs along with a better understanding of the host immune response are key approaches to controlling invasive fungal infections.
Assuntos
Infecções Fúngicas Invasivas , Micoses , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Interações Hospedeiro-Patógeno , Humanos , Sistema Imunitário , Imunidade Inata , Micoses/microbiologiaRESUMO
INTRODUCTION: Aspergilloma is a non-invasive form of pulmonary aspergillosis usually presenting as a clump of mold in pre-existing cavitary lung disease. Aspergillus related lung diseases have been classified into four types, whose manifestation is often related to previous lung diseases and host immunologic status. CASE REPORT: Cases of cavitary pulmonary aspergillosis without any evidence of pre-existing cavities, are rarely reported. We present here a case of pulmonary aspergillosis in which cavity formation appeared apparently after the establishment of infection. CONCLUSIONS: The occurrence of atypical presentations and the importance of recognizing these unusual cases of pulmonary aspergilloma is discussed.
Assuntos
Aspergilose Pulmonar , Aspergillus , Humanos , Contagem de Leucócitos , Pulmão , Aspergilose Pulmonar/diagnósticoRESUMO
Providing comprehensive care, counselling and support to haemophilic patients, and their parents have always been quite complex for haemophilia treatment centres. Nowadays, starting with recent developments in genetic counselling, prenatal diagnosis and carrier testing, the psychological burden on patients and parents might possibly have increased, compared with even the recent past. The emotional strains and worries associated with a possibly affected newborn and his care through childhood and adolescence may also have a grievous impact on couple dynamics and marital relationship. The impact may be even higher in families in which haemophilia is newly diagnosed. The main psychological problems faced by parents and then by affected individuals are herein chronologically reviewed, starting from genetic counselling before conception through childhood, adolescence and adulthood. Aware of the psychosocial burden on patients and their families associated with haemophilia, from prenatal diagnosis and carrier testing until later stages of life of the affected individual, a board of Italian haemophilia specialists and psychologists is designing and organizing an innovative network of psychological support services in some Italian haemophilia centres and promoting specific educational programmes in this setting.
Assuntos
Adaptação Psicológica , Hemofilia A/psicologia , Pais/psicologia , Adolescente , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Aconselhamento , Família/psicologia , Feminino , Aconselhamento Genético , Hemofilia A/diagnóstico , Hemofilia A/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Adesão à Medicação/psicologia , Gravidez , Diagnóstico Pré-NatalRESUMO
We investigated whether immunization with recombinant anti-idiotypic antibody fragments mimicking the conformation of the capsular antigen can protect against infection by group B streptococcus, an important neonatal pathogen. Single-chain fragment-variable anti-idiotypes competed with the type III carbohydrate for binding to type-specific antibodies and elicited, in mice, the production of protective immunoglobulins reacting against the type III polysaccharide. Moreover, maternal immunization with soluble or phage-displayed fragments protected neonatal mice against streptococcal infection. These data indicate that recombinant anti-idiotypic antibodies may be useful in developing protein images of relevant carbohydrate epitopes and, ultimately, in preventing infections by encapsulated bacteria.
Assuntos
Anticorpos Anti-Idiotípicos/imunologia , Imunidade Materno-Adquirida/imunologia , Infecções Estreptocócicas/imunologia , Streptococcus agalactiae , Vacinas de DNA/imunologia , Aglutinação/efeitos dos fármacos , Testes de Aglutinação , Animais , Animais Recém-Nascidos , Anticorpos Anti-Idiotípicos/administração & dosagem , Anticorpos Anti-Idiotípicos/genética , Formação de Anticorpos/efeitos dos fármacos , Formação de Anticorpos/imunologia , Feminino , Fragmentos de Imunoglobulinas/administração & dosagem , Fragmentos de Imunoglobulinas/imunologia , Região Variável de Imunoglobulina/administração & dosagem , Região Variável de Imunoglobulina/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Infecções Estreptocócicas/prevenção & controle , Vacinação , Vacinas de DNA/genéticaRESUMO
The aim of the study was to determine the burden of Toxoplasma gondii-infections in sheep in Sicily, southern Italy and the risk factors for infection. Sera from 1961 sheep were collected just before slaughtering from 62 farms located in 8 out of 9 Sicilian administrative districts. The sera were analysed for Toxoplasma-specific IgG antibodies using commercially available enzyme-linked immunosorbent assay. Sheep less than 4 weeks old were further analysed by ELISA for Toxoplasma-specific IgM-antibodies. Data on farm size and location were obtained from slaughterhouse sanitary reports and through structured telephone interviews of the veterinary officers from public health districts. The overall seroprevalence of Toxoplasma-specific IgG-antibodies were 49.9% (937/1876) by ELISA. Eighty-seven (54/62) percent of the farms had at least one Toxoplasma-positive animal. All the farms fed the animals outdoor on pasture and only one was claiming organic farming. Having cats on the farm, age of the animals, farm size and the use of surface water sources for drinking were all significantly associated with T. gondii-infected animals on the farm. T. gondii infection in mutton used for human consumption is very prevalent, and eating unprocessed sheep and lamb meat has a high risk of transmitting infections to humans. The presence of cats on the farm, farm size and using surface water as drinking water for the animals were risk factors for infection in sheep, with age as a significant confounder.
Assuntos
Doenças dos Ovinos/epidemiologia , Toxoplasma , Toxoplasmose Animal/epidemiologia , Envelhecimento , Agricultura , Animais , Anticorpos Antiprotozoários/sangue , Imunoglobulina G/sangue , Itália/epidemiologia , Fatores de Risco , Estudos Soroepidemiológicos , Ovinos , Doenças dos Ovinos/sangue , Toxoplasma/imunologia , Toxoplasma/isolamento & purificação , Toxoplasmose Animal/sangueRESUMO
To evaluate the usefulness of conventional serological methods with western blot assay (WB) in congenital toxoplasmosis diagnosis, we prospectively enrolled in a clinical and serological follow-up all pregnant women with Toxoplasma gondii infection and their offspring, referred to us from October 2004. Western blot and standard serological test were performed on sera collected from mother during pregnancy and from mother and child at birth, at postpartum month 1-3-6-9 and 12. At this point in time, 22 pregnant women and 14 infants have completed the follow-up. 4 newborns were infected and 2 had specific toxoplasmosis anomalies at the birth. In mothers without seroconversion, the WB performed during pregnancy demonstrates the highest accordance with postnatal follow-up whereas in 1 case the negative result of PCR analysis was not confirmed by postnatal observation. The detection of anti-T gondii IgG against 8 kDa accessory antigenic band and against the accessory band included between 35 and 40 kDa band in immunoblot assay was useful for diagnosis of acute phase but did not improve the evaluation of comparative postnatal profile. Althougth few infants have concluded the postnatal follow-up, the preliminary results showed a greater value of using a IgM and IgA WB test than other standard method for the early diagnosis of toxoplasmosis at birth also in child born to treated mothers. The comparative anti-T gondii IgG immunoblot profile of mother and child permitted us to reduce the time of ruling out infection in newborns born to mothers with probable or possible infection and/or when prenatal diagnosis is negative or not performed.
Assuntos
Anticorpos Antiprotozoários/sangue , Doenças Fetais/diagnóstico , Técnicas Imunoenzimáticas/métodos , Complicações Infecciosas na Gravidez/diagnóstico , Diagnóstico Pré-Natal/métodos , Toxoplasmose Congênita/diagnóstico , Toxoplasmose/diagnóstico , Adulto , Animais , Anticorpos Antiprotozoários/imunologia , Antígenos de Protozoários/imunologia , Western Blotting , Feminino , Doenças Fetais/epidemiologia , Doenças Fetais/parasitologia , Seguimentos , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Prospectivos , Estudos Soroepidemiológicos , Sicília/epidemiologia , Toxoplasma/imunologia , Toxoplasmose/epidemiologia , Toxoplasmose Congênita/embriologia , Toxoplasmose Congênita/epidemiologiaRESUMO
AIM: A multicenter randomized open-label crossover prospective trial was designed to compare the efficacy, safety, and cost of standard and high dosages of recombinant factor VIIa (rFVIIa) for home treatment of hemarthroses in hemophiliacs with inhibitors. METHODS: Patients were instructed to treat, within 6 h from the onset of bleeding, four consecutive hemarthroses of ankles, knees, or elbows, either with the rFVIIa standard dose of 90 microg kg(-1) (repeated as necessary every 3 h) or with a single high dose of 270 microg kg(-1). Patients who did not achieve a clinical success within 9 h continued rFVIIa treatment with repeated standard doses. Response to treatment was assessed for up to 48 h by patients/caregivers, who reported on a Visual Analogue Scale (VAS) graded from 0 to 100 the improvement in symptoms and also rated the responses as effective, partially effective or ineffective. Success was defined a treatment course rated as effective and with a VAS score > or =70 and failure a treatment course rated as ineffective and VAS score < or =30, whereas treatment courses that did not fulfill these criteria were considered partial responses. RESULTS: Twenty hemophiliacs with inhibitors were originally enrolled (median age: 27 years), 18 of them treated 32 hemarthroses assigned to the standard-dosage and 36 to the high-dosage regimen, during the study period of 18 months. Forty-eight hemarthroses (71%) occurred in target joints. Success rates for standard- and high-dosage regimens were similar: 31% and 25% at 9 h, 53% and 50% at 24 h, 66% and 64% at 48 h, the end point for outcome assessment. The median number of rFVIIa infusions needed to achieve a successful course was significantly greater for the standard-dosage (n = 3) than for the high-dosage regimen (n = 1), and the median amount of rFVIIa ultimately used per successful course was identical (270 microg kg(-1)). CONCLUSION: Our results indicate that a high-dosage regimen with rFVIIa for home treatment of hemarthroses is effective, safe, does not imply an increased consumption of rFVIIa and requires the infusion of a smaller number of rFVIIa doses. Its convenience is particularly relevant in cases with difficult venous access and in hemorrhages into target joints.
Assuntos
Fator VIIa/uso terapêutico , Hemartrose/tratamento farmacológico , Hemartrose/etiologia , Hemofilia A/tratamento farmacológico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Cross-Over , Fator VIIa/administração & dosagem , Fator VIIa/efeitos adversos , Fator VIIa/antagonistas & inibidores , Hemofilia A/complicações , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêutico , SegurançaRESUMO
The 'dynias' are a group of chronic focal pain syndromes with a predilection for orocervical or urogenital regions. Only exceptionally do they involve both sites in the same patient. Here, we report a case of simultaneous occurrence of dysaesthetic peno/scroto dynia and stomatodynia.
Assuntos
Síndrome da Ardência Bucal/complicações , Doenças dos Genitais Masculinos/complicações , Síndrome da Ardência Bucal/tratamento farmacológico , Doenças dos Genitais Masculinos/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To estimate survival trends for persons with haemophilia and HIV/AIDS. DESIGN AND METHODS: Survival analysis conducted among the cohort of HIV-positive haemophiliacs with AIDS at the Italian Haemophilia Registry. Kaplan-Meier method was used to estimate survival times, stratifying for demographic and clinical covariates. Cox proportional hazards model was applied in order to identify factors independently associated with survival. RESULTS: Median survival from the first AIDS diagnosis to death was estimated to be 17.0 months for 176 individuals with AIDS. Median survival after AIDS diagnosis increased from 12.0 months in December 1983-December 1988 to 17.0 months in January 1989-May 1990 and to 25.0 months in June 1990-December 1991. Median survival times were significantly (P < 0.001) lower for individuals diagnosed with non-infective AIDS indicator diseases (lymphoma, AIDS-associated neurological disease, Kaposi's sarcoma, wasting syndrome: 4.0 months), in comparison with haemophiliacs diagnosed with Pneumocystis carinii pneumonia (PCP; 18.0 months) or other infections (35.0 months). Antiretroviral treatment after AIDS diagnosis was associated with a longer survival than that estimated for individuals with no treatment after AIDS; the same was true for PCP prophylaxis. Younger age at HIV seroconversion and at AIDS diagnosis were associated with a longer survival. Multivariate analysis showed that factors independently associated with survival were type of AIDS indicator disease and antiretroviral administration after AIDS diagnosis. CONCLUSIONS: This study indicates an increasing survival from AIDS diagnosis to death over time, also as a result of the introduction of antiretroviral therapy. Survival trends are similar to those reported among homosexual men and intravenous drug users with AIDS, suggesting a similar access to the health-care system for individuals with AIDS. Survival studies may improve our understanding of the natural history of HIV infection and may indicate the impact of preventive measures.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Hemofilia A/complicações , Síndrome da Imunodeficiência Adquirida/epidemiologia , Estudos de Coortes , Estudos de Avaliação como Assunto , Hemofilia A/epidemiologia , Humanos , Itália/epidemiologia , Estudos Longitudinais , Análise Multivariada , Análise de SobrevidaRESUMO
Human platelets may hydrolyze externally added NAD+ yielding ADPR and nicotinamide. The extent of hydrolysis is significantly higher when the platelets are stimulated. The presence of external NAD+ strongly inhibits the aggregation induced by every agonist used. It seems that adenosine or ADPR itself generated by NAD+ hydrolysis may be responsible for the inhibition of aggregation. Evidence is given that some of the NAD+ hydrolysis product is taken up by stimulated platelets.