Alkylphosphonium carboxylate ionic liquids with tuned microscopic structures and properties.

Eleven pure alkylphosphonium carboxylate ionic liquids (ILs) were synthesised following a reliable and accessible route. Tetrabutylphosphonium and tetradecyltrihexylphosphonium cations were associated to a variety of [R-COO]- anions with R varying from shorter to longer linear alkyl chains; smaller to bulkier branched alkyl chains; cyclic saturated aliphatic and aromatic moieties; and one heterocyclic aromatic ring containing nitrogen. A combined experimental and molecular simulation study allowed the full characterization of the physico-chemical properties, the structure and the thermal stability of the synthesized ILs. Although slightly more viscous than their imidazolium counterparts, the viscosities of the prepared salts decrease dramatically with temperature and are comparable to other ILs above 50 °C, a manageable temperature as they are thermally stable up to temperatures above 250 °C, even under an oxidizing atmosphere. The microscopic structure of the phophonium ILs is rich and has been studied both experimentally using SAXS and by molecular dynamics simulation using state of the art polarizable force fields whose parameters were determined when necessary. Unique and surprising anion-anion correlations were found for the tetrazolate-based IL allowing to explain some of the unique physical-chemical properties of this phosphonium salt.

Euscorpius (Scorpiones, Euscorpiidae): three cases of stings in northwestern Italy

In the period between June 2008 and August 2009, three cases of stings of Euscorpius scorpions indigenous to Italy were treated at two different emergency departments (ED) in hospitals of the Piedmont region, northwest Italy: Santa Croce e Carle General Hospital in Cuneo, and Santissima Annunziata Hospital in Savigliano. Scorpion stings in Italy are rare and not well documented in the literature; this situation may raise doubts among medical personnel as to how such lesions are best treated. Analysis of the incidents confirms that the venom of Euscorpius do not provokes systemic poisoning in humans and in these cases even dermatological reactions were not significant.(AU)

Outcome of a conservative approach in severe ulcerative colitis.

BACKGROUND: Severe ulcerative colitis is potentially life threatening even though a policy of intensive medical management and early colectomy in recent years reduced mortality to almost zero. However, colectomy, with or without ileal-anal anastomosis, has its own problems (morbidity, pouchitis, cuffitis) and no reliable prognostic index of surgical outcome has been developed. Intravenous steroids are still the mainstay of medical therapy but their maximal duration before stating a 'treatment failure' has not been defined. AIM OF THE STUDY: To evaluate the effectiveness, safety and outcome of an intensive medical approach in a series of patients with severe ulcerative colitis. PATIENTS AND METHODS: One hundred and forty-nine episodes of severe ulcerative colitis in 115 patients admitted to a Gastroenterology Unit in a 7-year period were retrospectively evaluated. Intravenous glucocorticosteroids--methylprednisolone 1 mg/kg/day--and topical steroids were administered, and supportive treatments with intensive monitoring were extended to all the patients. Second-line strategies for steroid-refractoriness were prolonged glucocorticosteroids treatment, oral ciclosporin, infliximab or surgery. RESULTS: The median number of Truelove criteria at admission was 3 (range 2-5), median CRP 34 mg/l (range 10-196). Median follow-up after discharge was 49 months. In 84 (57%) episodes an early response was noted, while 65 (43%) did not respond within 10 days to the standard steroid treatment. In the non-responders group, 28 patients went into remission with a prolonged steroid treatment (slow responders); 15 patients were treated with ciclosporin (eight responders) and 6 with infliximab (four responders). A total of 24 colectomies was performed in this group of patients (in 21 cases within 30 days from admission). Slow responders showed lower albumin levels (P = 0.02), higher cumulative dose of glucocorticosteroids in the year prior to admission (P = 0.02) and higher age (P = 0.03), in comparison with early responders. Major complications were noted in four episodes which responded to medical treatment. Disease-related mortality was zero. CONCLUSIONS: Medical treatment and use of second-line therapies were effective in the present series of patients. A group of slow responders has been identified and, if an intensive medical monitoring is guaranteed, steroids can be safely prolonged after the first 10 days of treatment. Cumulatively, about 80% of the patients responded to short-term medical treatment, only 5% of the patients underwent colectomy in the follow-up period. Major adverse events were recorded in four patients, who had recovered completely after adequate medical treatment.

Review article: Crohn's disease: monitoring disease activity.

A global measurement of Crohn's disease activity, comprising clinical, endoscopic, biochemical and pathological features is not available yet and perhaps is unobtainable. In this review we analyse the most used and validated clinical indices (Crohn's Disease Activity Index [CDAI], Perianal Disease Activity Index [PDAI], fistula drainage assessment), quality of life scores (Inflammatory Bowel Disease Questionnaire [IBDQ]), sub-clinical markers (C-reactive protein, faecal calprotectin, intestinal permeability) and endoscopic indices (Crohn's Disease Endoscopic Index of Severity [CDEIS]/Simple Endoscopic Score for Crohn's Disease [SES-CD], Rutgeeerts' score for postsurgical recurrence). We also review the main advantages and disadvantages of each of these scoring systems. All these indices are rather complex and time-consuming, therefore their use is limited to clinical trials. In everyday clinical practice most gastroenterologists rely on their global clinical judgement, which is less reproducible, but simpler for decision-making.

Review article: medical treatment of severe ulcerative colitis.

Approximately 15% of patients with ulcerative colitis have a severe attack requiring hospitalization at some time during their illness. This treatment leads to a remission in 60-80% of patients and non-responders may require a total colectomy. Mortality in severe episodes of ulcerative colitis decreased from 31-61% in the 1950s to 5-9% in the 1960s thanks to the introduction of steroids and to a policy of early colectomy. Recently, some new drugs have been shown to be effective in the treatment of severe steroid-refractory ulcerative colitis. This review concentrates on the clinical evaluation, prognostic factors and new developments in medical therapy in severe ulcerative colitis. A retrospective evaluation of a consecutive series of patients with severe ulcerative colitis admitted to a Gastroenterology Department in Torino, Italy, is also reported.

Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders.

BACKGROUND AND AIMS: Duration of gluten exposure seems to predispose adolescents with coeliac disease to autoimmune diseases. In a retrospective cohort study, we assessed the relationship between autoimmune disorders and actual gluten exposure in patients in whom coeliac disease was diagnosed in adult life (> or = 16 years). METHODS: We screened for the presence of autoimmunity in 605 controls (16-84 years) and 422 patients (16-84 years), all of whom had been on gluten withdrawal for at least one year (median follow up 9.5 years). A logistic regression analysis, setting the prevalence of autoimmunity as the dependent variable, was employed to control for independent covariates as predictors of the risk of autoimmunity. RESULTS: The prevalence of autoimmunity was threefold higher (p < 0.00001) in patients than in controls. Mean duration of gluten exposure was 31.2 and 32.6 years for patients with or without autoimmunity. Logistic regression showed that increased age at diagnosis of coeliac disease was related to the prevalence of autoimmune disease while "actual gluten exposure" which takes into account diet compliance, follow up, and age at diagnosis of autoimmune disorders were not predictive for the risk of developing autoimmune diseases (odds ratio 0.82 per year). CONCLUSION: The prevalence of autoimmune diseases in patients with a late coeliac disease diagnosis does not correlate with duration of gluten intake. Early exposure to gluten may modify the immunological response. Gluten withdrawal does not protect patients with a late diagnosis from autoimmune diseases.

A novel method for detecting IgA endomysial antibodies by using human umbilical vein endothelial cells.

BACKGROUND: Although tissue transglutaminase was recently identified as the main autoantigen recognized by endomysial antibodies in coeliac patients, anti-endomysium antibody detection still persists as the gold standard for coeliac disease screening and diagnosis. OBJECTIVES: (1) To evaluate human umbilical vein cells (HUVEC) as an alternative source of endomysial antigen and to assess their suitability in the diagnosis of coeliac disease. (2) To verify whether tissue transglutaminase is one target antigen eliciting the endomysial antibody fraction of coeliac serum IgA. SETTING: University teaching hospital. PATIENTS AND METHODS: Sera from 123 untreated adults with biopsy-proven coeliac disease and 84 controls (40 healthy and 44 diseased) were assessed by indirect immunofluorescence, using HUVEC on glass slides prepared by cytocentrifugation and permeabilized by using Triton X (0.5%). Indirect immunofluorescence was performed: (1) using coeliac disease serum samples on HUVEC with or without prior incubation with tissue transglutaminase; and (2) incubating both HUVEC and monkey oesophagus with goat anti-guinea pig tissue transglutaminase antibody. RESULTS: All the coeliac patients, who were also positive on monkey oesophagus, showed the typical fluorescent homogeneous cytoplasmic stain on HUVEC. All control sera were negative both on HUVEC and on monkey oesophagus. IgA antibodies did not react with non-permeabilized cells, with intact membrane. Preincubation of coeliac sera with tissue transglutaminase abolished the typical fluorescent pattern. The incubation of anti-tissue transglutaminase antibody with monkey oesophagus and HUVEC resulted in an immunofluorescence staining pattern identical to that obtained with positive coeliac sera. CONCLUSIONS: (1) As a substrate for anti-endomysial antibody, HUVEC may provide the same diagnostic accuracy as monkey oesophagus, thus bypassing economical and ethical problems. The HUVEC antigen reacting with IgA from coeliac disease sera is an intracellular rather than a cell-surface antigen, as IgA antibodies reacted only with permeabilized cells. (2) Pretreatment of untreated coeliac sera with tissue transglutaminase abolished almost completely the specific staining; incubation with anti-tissue transglutaminase antibody elicited the characteristic fluorescent pattern, thus confirming that tissue transglutaminase represents the prominent autoantigen in coeliac disease.

Simplified gram stain interpretive method for diagnosis of bacterial vaginosis.

OBJECTIVE: Two methods which only consider bacterial morphotypes and require counting various types of bacteria, for interpreting Gram stains of vaginal secretions for the purpose of diagnosing bacterial vaginosis were previously described. A new interpretative method, which combines clue cells with bacterial morphotypes as diagnostic markers, is offered. STUDY DESIGN: One hundred twenty patients were tested with the new interpretative method and clinical criteria of bacterial vaginosis as the reference standard. RESULTS: The new method was found comparable to older methods when all were compared with clinical diagnostic methods. The sensitivity of the clue cell method was 86.1% and the specificity was 92.8%. The predictive value of a positive test was 83.7% for a population with a prevalence of bacterial vaginosis of 30%. The negative predictive value was 94.0%. CONCLUSION: If clue cells are present and the nonlactobacilli morphotypes exceed lactobacilli morphotypes, bacterial vaginosis can be diagnosed without the need for exact bacterial counts.

Bacterial vaginosis: current review with indications for asymptomatic therapy.

Bacterial vaginosis is a definable clinical entity whose exact origin is unknown. A shift in normal vaginal flora from aerobic, predominantly but not exclusively lactobacilli, to a predominantly anaerobic flora characterizes the condition. More than one half of all women with bacterial vaginosis have no symptoms. The condition is not entirely benign. The potentially pathogenic bacteria present in the vagina in large numbers place these women at risk for postoperative morbidity and adverse obstetric outcome. Sexual transmission has not been proved, but therapeutic cures sometimes require that patient and partner be treated simultaneously. Recommended therapy is with metronidazole or clindamycin and must be given for 7 days for maximal effectiveness. Recurrence of disease can be a problem.

PIP: Bacterial vaginosis, the most common infectious cause of vaginitis, is characterized by a shift in normal vaginal flora from predominantly aerobic to mainly anaerobic flora. Incidence rates in various studies have ranged from 1-0-45%. Unclear are both the pathophysiology of the observed reduction in lactobacilli and whether bacterial vaginosis is sexually transmitted. Evidence for sexual transmission is provided by a significantly greater incidence of bacterial vaginosis in women with more than 5 sexual partners compared to those in a lifelong monogamous relationship, while bacterial detection in virgins and the failure to demonstrate benefits of partner treatment argue against sexual transmission. Use of an IUD does appear to be a risk factor. The only symptom consistently reported by women with bacterial vaginosis is a malodorous vaginal discharge; however, over half of women with this condition are asymptomatic. The standard criterion for diagnosis includes the presence of 3 of the following signs: the clue cell, homogeneous discharge that adheres to but is easily wiped off the vaginal wall, an elevated vaginal pH, and the potassium hydroxide test for volatile amines. Of concern is the potential for serious sequelae. The abnormal bacterial flora associated with vaginosis significantly impede the white blood cell response to infection. Gynecologic-obstetric sequelae include pelvic inflammatory disease, endometritis, postoperative vaginal cuff infections, preterm labor, premature rupture of membranes, and chorioamnionitis. Metronidazole and clindamycin are the most effective treatment agents. Given the long-term risks associated with bacterial vaginosis, a full course of antibiotics should be considered in both obstetric patients with this condition and women undergoing outpatient ambulatory invasive surgical procedures.

Terconazole for the treatment of vulvovaginal candidiasis.

A double-blind, randomized trial was conducted to evaluate the efficacy and safety of terconazole for vulvovaginal candidiasis. Treatment consisted of daily intravaginal application of one of the following regimens: 80-mg terconazole suppositories for 3 days, miconazole nitrate suppositories for 7 days or placebo suppositories for 7 days. The terconazole and miconazole nitrate groups had significantly higher therapeutic cure rates than did the placebo group. Evaluation of vaginal secretions with microscopic examination showed no evidence of leukocyte proliferation. Proline aminopeptidase activity, present in patients who have bacterial vaginosis, could not be detected in the vaginal secretions from patients with yeast vulvovaginitis.