Piperacillin/tazobactam (Tazocin™) seems to be no longer responsible for false-positive results of the galactomannan assay.

OBJECTIVES: Galactomannan (GM) testing is extremely useful for diagnosing invasive aspergillosis in high-risk patients, but false-positive results have been reported in patients treated with piperacillin/tazobactam. The aims of this study are to test if the recent piperacillin/tazobactam (Tazocin™; Pfizer) preparation still contains GM, and if serum GM positivity in haematopoietic stem cell transplant (HSCT) recipients receiving piperacillin/tazobactam can be attributed to this treatment. PATIENTS AND METHODS: Serum samples obtained from 1 October 2009 to 31 October 2010 from HSCT recipients for GM testing were analysed. The difference in the rate of positive results (defined as GM ≥ 0.5) in patients receiving and not receiving piperacillin/tazobactam was evaluated. Piperacillin/tazobactam vials from randomly selected batches were tested. RESULTS: Of 1606 samples drawn in the absence of piperacillin/tazobactam therapy, 25 (1.6%) tested positive for GM versus 10 of 394 samples (2.5%) drawn while on piperacillin/tazobactam (P = 0.18). The median GM result of samples drawn on piperacillin/tazobactam was slightly higher than that of samples drawn in the absence of piperacillin/tazobactam (0.141 versus 0.122; P < 0.001). All 90 piperacillin/tazobactam vials from 30 randomly selected batches tested negative for GM, with a median GM value of 0.057 (range: 0.011-0.320). CONCLUSIONS: Although some residual GM might still be present in piperacillin/tazobactam, currently available brand piperacillin/tazobactam preparations seem no longer responsible for false-positive GM results.

Therapeutical aspects and outcome of HIV/HCV coinfected patients treated with pegylated interferon plus ribavirin in an Italian cohort.

BACKGROUND: One-third of HIV-infected individuals suffer from chronic hepatitis C virus infection (HCV) in Europe. Recommendations from HCV-HIV International Panel advise current treatment with pegylated interferon plus ribavirin. We assessed the impact of interferon and ribavirin combination in 43 patients between 2002 and 2006. PATIENTS AND METHODS: All coinfected patients treated for HCV during the 5-year period were included in retrospective data collection. CD4+ T-lymphocyte count, HAART discontinuation, reasons for treatment interruption and factors correlated to sustained virological response (SVR) were monitored. RESULTS: The mean age was 41 +/- 6.7 years; the risk factor for coinfection was intravenous drug abuse in 32/43 (74%). The baseline CD4+ T-lymphocytes cell count was > 500 in 51% (22/43). Genotype 3a represented 51% (22/43); 37% were on HAART at baseline (16/43) and half of patients showed high HCV RNA levels (> 800,000 IU/ml). High rates of treatment discontinuation were observed (27/43, 63%), caused by voluntary interruptions in 52% (14/27) and virological failure in 26% (7/27). The overall population had an SVR of 30%; genotypes 3a and 1 had SVR of 38% and 24%, respectively. The SVR was significantly lower in three groups: high HCV RNA viral load (chi2 = 6, p < 0.0025), CD4+ T-lymphocyte historical nadir <350 cells/mm3 (chi2 = 3.26, p < 0.01) and genotype 1 with high viral load (chi2 = 4.8, p < 0.005). CONCLUSIONS: Although factors such as HCV viral load rates and genotype 1 have been confirmed to threaten the response to therapy, we observed a significant response rate when patients had a history of CD4+ T-lymphocyte nadir >350 per mm3. The high dropout rates due to voluntary discontinuations complicated the patients' case management.

Soft-tissue infection with Absidia corymbifera and kidney complications in an AIDS patient.

We describe a case of primary cutaneous Absidia corymbifera infection in an AIDS patient with renal complications. The Sensititre YeastOne panel was adopted to determine antifungal susceptibility and liposomial amphotericin B was used which initially produced a significant clinical response.

Plasma levels of amyloid beta-protein 42 are increased in women with mild cognitive impairment.

BACKGROUND: Accumulation in the brain of small aggregates of amyloid beta-protein 42 (Abeta42) is the major pathogenic event of Alzheimer disease (AD). In familial early-onset AD this event is likely the result of Abeta42 overproduction; in the most common sporadic late-onset form of the disease the mechanisms of Abeta42 accumulation are unknown. METHODS: To address this issue the authors analyzed plasma levels of Abeta42 in 88 elderly patients with amnestic mild cognitive impairment (MCI), chosen as paradigm of preclinical sporadic AD. RESULTS: The authors found a significant increase of Abeta42 plasma levels in women with MCI, in comparison to the affected men and 72 cognitively normal age-matched subjects. The levels were independent of variables in education, apolipoprotein E genotype, cholesterol, and creatinine plasma concentrations, as well as hemoglobin content. CONCLUSIONS: The elevation of Abeta42 plasma levels in women with MCI may represent a biologic explanation for the sex-dependent increased incidence of late-onset AD in women identified by epidemiologic studies.

Contaminacion de un suelo urbano afectado por residuos solidos

Existe muy poca informacion acerca de los problemas de los suelos urbanos,en trabajos previos se detectaron contaminacion del suelo en la zona norte del Gran Buenos y tambien elevado contenido de plomo,aunque en profundidad en un area de suelos urbanos en la zona de Costanera Sur de la ciudad de Buenos Aires.El presente estudio se planteo por una demanda del persona de una guarderia infantil,que requeria la utilizacion de un terreno para realizar una huerta para alimentacion de niños y vecinos.Tomando como hipotesis de trabajo la presuncion de que se trataba de un suelo potencialmente contaminado se evaluaron dos aspectos de las muestras del suelo 1)Condiciones de fertilidad para la implantacion de cultivos horticolas 2)Determinacion de contaminantes inorganicos por posibles riesgos ambientales que hicieran peligrosa la implantacion e ingesta de cultivos de dicha area

Contaminacion de un suelo urbano afectado por residuos solidos

Existe muy poca informacion acerca de los problemas de los suelos urbanos,en trabajos previos se detectaron contaminacion del suelo en la zona norte del Gran Buenos y tambien elevado contenido de plomo,aunque en profundidad en un area de suelos urbanos en la zona de Costanera Sur de la ciudad de Buenos Aires.El presente estudio se planteo por una demanda del persona de una guarderia infantil,que requeria la utilizacion de un terreno para realizar una huerta para alimentacion de niños y vecinos.Tomando como hipotesis de trabajo la presuncion de que se trataba de un suelo potencialmente contaminado se evaluaron dos aspectos de las muestras del suelo 1)Condiciones de fertilidad para la implantacion de cultivos horticolas 2)Determinacion de contaminantes inorganicos por posibles riesgos ambientales que hicieran peligrosa la implantacion e ingesta de cultivos de dicha area

Calidad de suelos antropicos en espacios verdes urbanos

En terrenos pertenecientes a la Reserva Ecológica se realizaron observaciones de variables edáficas y se midieron niveles de metales oesados relacionados con la salud de la población ante la presunción de la existencia de niveles considerados de polución. En el área estudiada los valores de metales pesados fueron bajos y el resto de las propiedades medidas no atentan contra la calidad y salud de la población capaz de disfrutar de este espacio recreativo

Calidad de suelos antropicos en espacios verdes urbanos

En terrenos pertenecientes a la Reserva Ecológica se realizaron observaciones de variables edáficas y se midieron niveles de metales oesados relacionados con la salud de la población ante la presunción de la existencia de niveles considerados de polución. En el área estudiada los valores de metales pesados fueron bajos y el resto de las propiedades medidas no atentan contra la calidad y salud de la población capaz de disfrutar de este espacio recreativo

CD4+ T-lymphocyte lines developed from HIV-1-seropositive patients recognize different epitopes within the V3 loop.

To define the epitopes present within the V3 loop sequence recognized by five HIV-1 envelope-specific T-cell lines, a panel of V3 LAI peptides bearing sequential truncations from both the N- and C-terminus was synthesized and tested for their ability to induce proliferation. Each individual T-cell line had a different pattern of response against the truncated V3 peptides, demonstrating the presence of a cluster of CD4+ T-cell epitopes within the V3 loop. To assess the ability of these envelope-specific T-cell lines to recognize and proliferate in response to V3 loops of different viral strains, they were tested against a panel of heterologous V3 loop peptides derived from different viral genotypes within and outside of HIV-1 clade B. There was no proliferative response against heterologous V3 loops by any of the lines, demonstrating that recognition of the V3 epitopes is highly strain specific. One of the defined epitopes was shown to elicit a cytotoxic response as well, suggesting the multifaceted role that the CD4+ T cell might play in HIV-1 disease.

Establishment and characterization of human immunodeficiency virus type 1 (HIV-1) envelope-specific CD4+ T lymphocyte lines from HIV-1-seropositive patients.

Human immunodeficiency virus type 1 (HIV-1) gp160-, gp120-, and tetanus toxoid-specific CD4+ T lymphocyte lines were developed from 11 HIV-1-seropositive volunteers enrolled in a vaccine therapy trial. Of the 20 HIV-1 envelope-specific T cell lines, 9 were challenged with a panel of overlapping peptides spanning the gp120LAI sequence. The most frequently recognized regions were amino acids 74-105 in the C1 region and 306-328 in the V3 region. When tested against a panel of divergent HIV-1 envelopes, 55% of the envelope-specific lines were able to recognize gp120MN, while only 22% recognized gp120SF2. Cytotoxicity testing with HIV-1 envelope antigen or peptides demonstrated killing by all 3 envelope-specific lines tested. Supernatants from 2 of 9 lines had high titers of p24 gag antigen, which did not seem to interfere with functional properties.

Consequences of stable transduction and antigen-inducible expression of the human interleukin-7 gene on tetanus-toxoid-specific T cells.

Interleukin-7 (IL-7) has previously been shown to increase antigen-specific immune responses; the effect of IL-7 on human antigen-specific T cell lines has not directly been addressed. A tetanus-toxoid (TT)-specific T cell line exhibited increased proliferation in the presence of exogenous IL-7, suggesting that IL-7 may be useful in the potentiation of immune responses to defined microbial antigens. Murine retroviral vectors encoding the human IL-7 gene and the neomycin phosphotransferase gene (neoR) were packaged into murine retroviral particles, and supernatants containing these retroviral vectors were used to infect a CD4+ lymphoblastoid cell line. Stable integration of the retroviral vector and constitutive expression of the IL-7 gene were observed. Successful IL-7 gene transduction into TT-specific T cells was also accomplished. Detection of neoR DNA sequences and expression of IL-7-specific mRNA increased with selection in geneticin. Production of IL-7 in these cells was induced by exposure to TT. Production of IL-4, IL-6, and interferon-gamma (IFN-gamma) was detected after antigenic stimulation; there was, however, no effect of IL-7 on the pattern or kinetics of cytokine production by these cells. Human IL-7 transduced cells showed greater proliferation to TT than control T cells, particularly at subthreshold TT concentrations. These dta imply that genetic modification of antigen-specific T cells may be a plausible strategy for the study and manipulation of the immune responses to microbial pathogens.

[Tuberculosis of the spine in children. Personal experience]. / Tubercolosi della colonna vertebrale in età pediatrica. Nostra esperienza.

We are currently witnessing a worldwide return of tuberculosis. An extremely rare form is tuberculosis of the spine which is reported above all in extra-European studies. The authors report a case of Pott's disease in a child aged 3 years and 3 months who was referred to their attention due to the appearance of left inguinal swelling, fever and anemia. Diagnostic tests (ETG, CT, MR) showed an abscess involving the L5-S1 intersomatic space, the intervertebral disc and osteolytic lesions of S1, with impairment of the left psoas muscle and diffusion as far as the inguinal region. Chemotherapy was commenced using isoniazid, ethambutol, rifampicin, and streptomycin and lasted 24 months associated with drainage of the ileopsoas abscess. Conservative orthopedic treatment lasting for one year initially took the form of decubitus in bed with hyperdistension of the vertebral column, followed by the creation of a plaster-cast cot on the back and lastly a glass-reinforced resin orthopedic jacket. The follow-up of 2 years and 10 months showed recovery with reconstruction of the vertebral elements and the preservation of intervertebral space.

Variability among geriatricians in the evaluation of functional disabilities and rehabilitation needs of the elderly.

A formal variability study has been carried out in a geriatric hospital in Genoa, Italy, in order to estimate the degree of agreement between geriatricians in disability and functional assessment, recommendation for rehabilitation treatments, need for mobility and daily activities aids, and decisions about optimal place of treatment (own home, sheltered housing, old peoples' home, nursing home). Sixteen long-stay geriatric patients, average age 83 years, were visited by eight geriatricians, a patient receiving from two to five visits. The participating physicians could visit the patients at their leisure, had access to clinical records and could interview a nurse well acquainted with the patient. A marked variability was observed for most items, e.g. the agreement concerning the recommendation for individual physiotherapy was only 52%. The results of this study may not be generalized to other situations and to actual practice; however, variability studies of this kind, that assess diagnosis habits, treatment and managerial decisions at the same time, may be useful to pinpoint the most important problems and to stimulate professionals' participation in proper Quality Assurance projects.

Impaired habituation of long-latency stretch reflexes of the wrist muscles in Huntington's disease.

Electromyographic responses to sudden wrist extension were recorded from the forearm and finger flexor muscles in 10 patients with Huntington's disease (HD) and in 10 normal controls. Stretch reflexes were characterized by a short-latency (SL) and a long-latency (LL) component both in patients and controls. Latency, duration, and size of the SL component were not different in the two groups, whereas the LL component was delayed in latency and reduced in size in HD patients. Increasing the stretch repetition rate from 0.1 to 0.4 cycles/s did not affect the SL component of either group, whereas the LL stretch reflex was reduced in size and duration in normal controls, but not in HD patients. These findings suggest an impairment of the "gain" mechanisms of the sole LL component, responsible for a desaturation of this component. This study supports the hypothesis that LL stretch reflexes are mediated by a transcortical long loop, possibly damaged in HD.

[Recurrent Salmonella dublin infections]. / Infections récidivantes par Salmonella dublin.

A recurrent septicemia in a 8-year old child is reported. Blood and lymphnode tissue cultures permitte the isolation of Salmonella dublin. Despite the in vitro susceptibility of the isolated bacteria and the prolonged antimicrobial therapy, sepsis had a protracted course with relapses.

Do muscle afferents contribute to the cervical response evoked by electrical stimulation of the median nerve in man?

The possible contribution of low threshold muscle afferents to the postsynaptic component (N13) of the cervical response evoked by electrical stimulation of the median nerve (MN) was investigated in normal subjects. Electroneurographic (ENG) and electromyographic (EMG) correlates of the reflex motoneuronal discharge (RMND) were recorded simultaneously. A. No reflex activity could be elicited by stimulation of the MN at the wrist, at least in the resting subjects, while well developed ENG (P2 efferent volley) and EMG (H reflex) monosynaptic responses occurred following stimulation of the MN at the elbow at suitable strengths. In neither case could a surface correlate of interneuronal activity evoked by muscle afferents be demonstrated. B. Recruitment curves showed that at stimulus intensities above maximal for the H reflex both P2 and H responses started to decrease until they completely disappeared, while N13 showed further enhancement. C. Subthreshold conditioning stimulation of the MN enhanced both P2 and H responses, while vibratory muscle stimuli provoked a clearcut suppression of these two responses. In contrast, N13 was completely unaffected by either manoeuvre. D. No cervical evoked activity could be detected following tendon tapping of the anterior forearm muscles in spite of the appearance of well developed cortical responses and the ENG and EMG correlates of the T reflex. E. Conditioning volleys elicited by tendon taps of the anterior forearm muscles suppressed both P2 and H responses following stimulation of the MN at the elbow without affecting the related N13 component. Conditioning supramaximal stimulation of the MN at the wrist suppressed the N13 component of the cervical response evoked by stimulation of the MN at the elbow without affecting the related reflex responses. No component chronologically related to the RMND could be recorded at the posterior neck region during suppression of N13, thus ruling out the possibility that failure to detect the RMND (as well as its interneuronal concomitants) with cervical electrodes is due to a masking effect of the N13 component. G. Conditioning tendon taps of anterior forearm muscles provoked a clearcut reduction of the primary cortical response to finger stimulation without affecting the postsynaptic component of the related cervical response. It is concluded that neither segmental (motoneuronal or interneuronal in origin) nor ascending postsynaptic impulses generated in the spinal cord by stimulation of low threshold muscle afferents contribute to N13, the latter being probably due to activation of both short and long axoned spinal neurons by cutaneous afferents.

Experimental studies on peripheral nerve repair following early or delayed suture.

Early suture of the sciatic nerve in rats was compared with delayed suture performed after 2 weeks. The distal tract of the nerve was studied morphologically using semifine sections and computerised measurements of the number and diameters of regenerated fibres, and electrophysiologically by the measurement of nerve velocity conduction. The morphological examination did not reveal any substantial difference, while the velocity conduction tests showed better reinnervation following early suture.