Direct-acting antivirals used in HCV-related liver disease do not affect thyroid function and autoimmunity.

PURPOSE: It is well known that interferon-α (IFN-α), used for long time as the main therapy for HCV-related disease, induces thyroid alterations, but the impact of the new direct-acting antivirals (DAAs) on thyroid is not established. Aim of this prospective study was to evaluate if DAAs therapy may induce thyroid alterations. METHODS: A total of 113 HCV patients, subdivided at the time of the enrollment in naïve group (n = 64) and in IFN-α group (n = 49) previously treated with pegylated interferon-α and ribavirin, were evaluated for thyroid function and autoimmunity before and after 20-32 weeks of DAAs. RESULTS: Before starting DAAs, a total of 8/113 (7.1%) patients showed Hashimoto's thyroiditis (HT) all belonging to IFN-α group (8/49, 16.3%), while no HT cases were found in the naïve group. Overall, 7/113 (6.2%) patients were hypothyroid: 3/64 (4.7%) belonging to naïve group and 4/49 (8.2%) to IFN-α group. Furthermore, a total of 8/113 patients (7.1%) showed subclinical hyperthyroidism: 2/64 (3.1%) were from naïve group and 6/49 (12.2%) from IFN-α group. Interestingly, after DAAs therapy, no new cases of HT, hypothyroidism and hyperthyroidism was found in all series, while 6/11 (54.5%) patients with non-autoimmune subclinical thyroid dysfunction became euthyroid. Finally, the only association between viral genotypes and thyroid alterations was genotype 1 and hypothyroidism. CONCLUSIONS: This study supports evidence that DAAs have a limited or missing influence on thyroid in patients with HCV-related diseases. Moreover, it provides preliminary evidence that subclinical non-autoimmune thyroid dysfunction may improve after HCV infection resolution obtained by DAAs.

Multi analytical technique study of human bones from an archaeological discovery.

In 1953, during the building restoration of San Michele church (Bono, Sardinia, 16th-19th Century), a high number of disarticulated skeletons were recovered. From a group of 412 hip bones, two of these, affected by several pathological lesions, were analysed. The two coxal bones can be referred to the same individual, an adult man. A multi-analytical study, started with the purpose of investigating the bone pathology, was extended to characterize the mineral components of a large representative set of bones from the same ossuary, all attributed to adult men who lived in the region four-two centuries ago. A quantitative ICP-AES analysis for Ca, Fe, Mg, Mn, Na, Pb and Zn was executed, and a chemometric investigation on the results was performed. This approach gave evidence of the effects of diagenesis, allowed some hypothesis of the incidence of the known dietary habits on bone composition, and completely differentiated the pathological bones from those of a normal population on the basis of the mineral composition. Moreover, porosity, crystallinity and FT-IR analysis were conducted on both non- and pathological sample.

Insulin-like growth factor-I (IGF-1), IGF-binding protein-3 (IGFBP-3) and mammographic features.

INTRODUCTION: The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status. PATIENTS AND METHODS: A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density. RESULTS: The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio compared to breast density after stratification of the study population by menopausal status (premenopausal and postmenopausal) showed that there was no association between the plasma of growth factors and breast density, neither in premenopausal nor in postmenopausal patients. Multivariate analysis showed that only nulliparity, premenopausal status and body mass index (BMI) are determinants of breast density. CONCLUSIONS: Our study provides a strong evidence of a crude association between breast density and plasma levels of IGF-1 and molar ratio. On the basis of our results, it is reasonable to assume that the role of IGF-1 and molar ratio in the pathogenesis of breast cancer might be mediated through mammographic density. IGF-1 and molar ratio might thus increase the risk of cancer by increasing mammographic density.

[Phlegmons of the neck: our experience with 7 cases]. / Flemmoni del collo: nostra esperienza su 7 casi clinici.

Phlegmons of the neck originate from infectious diseases of head and neck. Odontogeneous inflammation of the oral cavity is most frquently primary lesion, followed by sinusitis, otitis, as well as radiation therapy and surgical procedures. Phlegmons of head and neck can drain into the spaces among the muscles, aponevrosis, organs inside the neck like sublingual space, lateral pharyngeal space, retro-pharyngeal space or pre-vertebral space. We hereby report our experience with 7 patients treated from 2001 to 2005.

[Identification of Legionella spp. by means of cultural and molecular methods in a public hospital]. / Isolamento di Legionella spp. mediante metodi colturali e tecniche molecolari in matrici ambientali prelevate in una struttura ospedaliera pubblica.

An epidemiologic study on the isolation of Legionella spp from the sanitary water of a public Hospital in Cagliari (Italy) has been performed. The aim of the study was the comparison between the isolation of various Legionella spp from different hospital sources and the real hazard of Legionella infection of the inpatients. Two test methods were used for Legionella detection: a) the culture on selective media, that has the disadvantage of being quite time-consuming and of isolating also other bacterial species. Furthermore, the culture method often fails the isolation of vital but not culturable bacteria (VBNC); b) the PCR molecular method, which is rapid and precise and recognizes also VBNC cells. The most relevant result of this work was that, in spite of the isolation of a considerable number of Legionella spp (even Legionella pneumophila), no case of infection was detected in the Hospital during the period of the study.

[Monolateral adenopathy of the axilla due to sarcoid-type granulomata: idiopathic granulomatous disease or sarcoidosis? A case report]. / Linfoadenopatie ascellari monolaterali da granulomi di tipo sarcoidosico: malattia granulomatosa idiopatica o sarcoidosi? Caso clinico.

The presence of sarcoid-type granulomata in peripheral lymph nodes, with no evidence of other typical lesions, doesn't allow to diagnose sarcoidosis. In fact, sarcoidosis is a systemic disease and two or more organs must be affected to reach a definitive diagnosis. However this involvement could happen even several years later, thus making a correct diagnosis really difficult. In the absence of other organ involvement, an "idiopathic granulomatous disease" of peripheral lymph nodes is identified. Patients must anyway undergo a careful, long-term follow-up in order to detect clinical or radiologic variations that may confirm a diagnosis of sarcoidosis. After presenting a case-report of monolateral adenopathy of the axilla as an idiopathic granulomatous disease, the Authors review the international literature about sarcoidosis and its extra-pulmonar presentation, underlining the importance of considering sarcoidosis among possible diagnosis when peripheral adenopathies occur.

[A case of recurrent pharyngocele: treatment and literature review]. / Un caso di faringocele bilaterale recidivato come mediano e rioperato con successo.

Congenital or acquired pharyngocele is a rare disease characterized by a herniation of the pharyngeal mucosa through a "locus minoris resistentiae" of the lateral wall of the pharynx. Generally the pharyngocele does not present specific clinical signs or symptoms which makes it necessary to resort to radiological examination for the diagnosis. Our case is particular for primitive bilaterality and the single and median recurrence eight years later. After surgical excision the symptoms completely disappeared. The radiological examinations following surgery were negative.

[A case of lymphoepithelial cyst (branchial cyst) in an elderly patient: diagnosis differential, treatment and literature review]. / Un caso di cisti linfoepiteliale (branchiale) in un paziente anziano: diagnosi differenziale, trattamento e revisione della letteratura.

We present a case of lateral cervical cyst stressing the difficulties about the diagnosis. The international guidelines for the management of lateral neck cysts in the over 40s' age group are taken in consideration. Our case is a 74 years old male patient with a 6 month history of a cervical swelling. We consider this case rare for the age of patient and the absence of malignancy.

Measurement of environmental trace-metal levels in Mediterranean coastal areas with transplanted mussels and DGT techniques.

Mussels (Mytilus galloprovincialis) and diffusive gradients in thin films (DGT) devices were deployed together for three one-month periods in coastal waters of Sardinia (Italy), in order to assess the levels of Cd, Cu, Ni, and Pb in areas differently affected by anthropogenic activities. DGT devices were more sensitive than mussels in detecting differences in metal concentrations between sites, while interpretation of the biomonitoring data revealed difficulties related to the biotic and abiotic factors that can influence the measurements. Regression analysis showed a significant correlation between Cd and Pb concentrations measured in the mussel tissues and bioavailable metal levels in seawater. Moreover transplanted mussels did not accumulate Cu and Ni following pre-exposure, although DGT showed significant concentrations of bioavailable forms of these metals in seawater. The results provided an estimate of the water quality with respect to dissolved metals and pointed out the usefulness of a combination of biomonitoring and DGT techniques for a better understanding of trace metal availability in coastal waters.

[G6PD phenotype and red blood cell sensitivity to the oxidising action of chlorites in drinking water]. / Fenotipo G6PD e sensibilità degli eritrociti all'azione ossidante dei cloriti nelle acque potabili.

Chlorine dioxide is widely used to replace sodium hypochlorite in the disinfection of surface waters for human consumption, in order to avoid or reduce the formation of organohalogenated compounds with mutagenic and carcinogenic activity. However, chlorine dioxide may lead to the formation of by-products, such as chlorites and chlorates, that have an oxidative effect on the blood corpuscled fraction. In this investigation, blood crasis was assessed in relation to the G6PD phenotype and the consumption of tap water, disinfected with chlorine dioxide, or bottled mineral water from non-disinfected underground sources. The results show that the effect of oxidative stress resulting from the uptake of chlorites with drinking water is not additive to the effect due to G6PD deficiency. The observed change in haematological parameters, including those related to the G6PD polymorphism, is always within the normal range. However, it is still possible that more relevant changes would follow exposure to chlorites concentrations greater than that observed in the present study.

[Trihalomethanes and chlorites in finished drinking water in Sardinia (Italy) and possible health effects]. / Trialometani e cloriti dalla disinfezione delle acque in Sardegna: valutazioni igienico-sanitarie.

A five years monitoring was carried out in central and southern Sardinia (Italy) to assess the levels of two disinfection by-products (DBPs)--total thrialomethanes (TTHMs) and chlorites--in drinking water Between 1997 and 2002, about 1900 drinking water samples were analysed for both of them. The results showed that TTHMs exceeded very often the maximum admissible concentration. Chlorite concentration was found rising in all the distribution networks since the utilization of chlorine dioxide as disinfectant in 1999, exceeding the maximum contaminant level goals suggested by the World Health Organization. These results are relevant for epidemiological studies on health effects from DBPs exposure.

Computerized cardiotocography in the management of intrauterine growth restriction associated with Doppler velocimetry alterations.

OBJECTIVE: To verify the reliability of computerized cardiotocography (cCTG) in the prediction of the oxygen metabolism status of fetuses with growth restriction and Doppler velocimetry alterations. METHODS: From 24 third-trimester cesarean section performed because of intrauterine growth restriction (IUGR) and Doppler velocimetry alterations, there were 11 cases of fetal heart rate alterations (Dawes-Redman criteria were not satisfied) and 13 cases of reactive cCTG. Fetal lung maturity was detected by amniocentesis and blood samples for umbilical blood gas analysis (UBGA) were collected before the first neonatal breath from the umbilical artery in a double-clamped segment of the cord. RESULTS: Umbilical cord gas analysis showed arterial cord blood pH to be 7.20 or less in 11 newborns (45.8%), 7.10 or less in 6 (25%), and 7.00 or less in 3 (12.5%). Linear regression analysis showed short-term variation (STV) in the fetal heart rate to be significantly correlated with umbilical artery pH (r = 0.49; P = 0.01) and pCO2 (r = -0.50; P = 0.01). There were no significant correlations between cCTG and the other UBGA parameters considered. Receiver operator curves permitted to calculate the STV values at which pathological neonatal UBGA values can be expected (pH < 7.00 and pCO2 > 80 mmHg). A short-term variation less than 4.5 ms was found to predict acidemia with a sensitivity of 100% and a specificity of 70% (positive predictive value, 33%; negative predictive value, 100%), and hypercarbia with a sensitivity of 100% and a specificity of 77.8% (positive predictive value, 55.6%; negative predictive value, 100%). CONCLUSION: In view of the results of this study, 4.5 ms for STV may be a threshold below which timing of delivery should be decided in cases of fetal growth restriction.

The effect of physical activities of various intensities on the energy expenditure of type 2 diabetic men.

Interventions that focus on changing lifestyles through the combined use of dietary management, weight reduction, and increased physical activity are essential for managing type 2 diabetes mellitus (T2DM). The objective of the present study was to examine mildly obese T2DM patients [ n=10; mean age (+/-SD), 51.29+/-6.80 years; body mass index (BMI), 30.26+/-6.19 kg/m(2); and glycosylated haemoglobin (HbA(1c)), 8.16+/-1.16%)] and to compare them with normoglycaemic persons ( n=10; age, 53.00+/-9.48 years; BMI, 27.63+/-3.33 kg/m(2), and HbA(1c), 5.85+/-0.56%) in terms of energy expenditure while performing physical activities of various intensities (i. e. light, moderate, and heavy). The resting metabolic rate for T2DM patients was significantly higher than that for healthy controls (2200+/-354 kcal/day vs. 1628+/-176 kcal/day, respectively; p<0.0001). The values of energy expenditure at all three levels of physical activity were comparable between the two groups. Physical activity seems to have various beneficial effects on mildly obese T2DM patients because it increases the plasma glucose consumption, resulting in similar energy expenditure in comparison with normoglycaemic individuals.

[Controlled release vaginal dinoprostone for the induction of labour]. / Induzione del travaglio di parto con dinoprostone vaginale a rilascio controllato.

AIM: To study the efficacy and safety of controlled release dinoprostone (PGE2) for the induction of labour. METHODS: From March 2001 to August 2002, a total of 173 patients hospitalized for postdate pregnancy, maternal hypertension, intrauterine delayed growth, reduction of amniotic fluid, were studied. In 33 of these patients, a hydrogel strip containing 10 mg dinoprostone, inserted into the posterior fornix of the vagina and release PGE2 at constant rate of 0.3-0.4 mg/h was used. RESULTS: Indications for induction, mode and time of delivery, maternal, fetal and neonatal parameters anomalies are evaluated. In 23 patients dinoprostone was used for postdate pregnancy, in 4 for maternal hypertension, in 4 for oligohydramnios and in 2 for intrauterine delayed growth. In 2 cases, the vaginal insert was removed for hyperstimulation in 1 case and for abnormal fetal heart rate in the other case. After vaginal delivery, Apgar scores and umbilical artery pH values were evaluated without anomalies. Vaginal delivery within 24 hours occurred in 51.6% of patients and medium time to delivery was 17.5 (nulliparous) and 12.3 (multiparous) hours. Only one case of uterine hyperstimulation to PGE2 was recorded, and the induction was suspended. The cesarean section rate was 12% and vaginal delivery after 24 hours was 38.7%. CONCLUSION: The continuous release of PGE2 from the vaginal insert permits a controlled and safe induction of labour, minimal risk of hyperstimulation, fast and easy removal of drugs in cases of fetal or maternal anomalies, easy accetability for patients, but high cost.

[Coliphages as indicators of fecal contamination in sea water]. / I colifagi come indice di contaminazione fecale nelle acque marine.

Assessment of water quality has traditionally relied on faecal indicator organisms, which however do not necessarily correlate well with the presence of pathogenic organisms. Coliphages are regarded as possible alternative indicators. Although they can be detected in water by rapid, simple and reliable procedures, any agreement about a standard method has not yet been reached. Moreover guidelines for the levels of bacteriophages have not yet been set as for coliform bacteria, making difficult to evaluate results. In this work both bacteriophages anti E. coli and traditional indicators of fecal contamination were detected on 274 seawater samples taken from 23 sampling stations located along the coast of southern Sardinia (Italy). The results confirm the usefulness of coliphages as indicators of fecal contamination and suggest a level which could be considered a guideline value for their presence in seawater.

Aluminum fractions in drinking water from reservoirs.

To provide insight into aluminum speciation in raw and in finished water and to investigate the factors that can affect it, specific aluminum fractions have been isolated and analyzed in water samples from three drinking water reservoirs in Sardinia (Italy) and at the outlet of their treatment plants. All water treatment plants employed polyaluminum chloride as coagulant. The results demonstrate that the treatment of raw water with the aluminum-based coagulant did not increase the concentration of the metal in the finished water. Aluminum fractions were quite different in raw water and in finished water. More than 80% of the aluminum in raw water was in the particulate form. In the dissolved fraction, organic forms were present at higher concentrations in the raw water, while following water treatment (coagulation, flocculation, filtration) most of the aluminum was in the inorganic form. Most of the dissolved Al in raw water was strongly bound or polymeric colloidal, while percentages of monomeric Al ranging from 40 to 62% were present in the finished water.

[Evaluation of the effectiveness and tolerability of MED 15 vs. piroxicam in patients with acute epicondylitis]. / Valutazione dell'efficacia e tollerabilità di MED 15 verso piroxicam in pazienti affetti da epicondilite acuta.

In this trial we studied 30 patients with acute epicondylitis: 15 were treated with Med 15, a new non-steroidal anti-inflammatory drug, and 15 with piroxicam. Med 15 was administered orally for 15 days: the first 2 days 2 tablets daily (1.200 mg) and the following 13 days 1 tablet daily (600 mg). Piroxicam was administered 2 tablets the first 2 days and 1 tablet daily the following 13 days. It was demonstrated that the new compound is significantly more active and better tolerated than the reference drug.

[Iris vascular anomalies: angiographic aspects]. / Anomalies vasculaires iriennes: aspects angiographiques.

The authors report five cases of abnormal iris vessels observed in patients, without evident local or systemic pathology. These vessels, are dilated channels. On iris fluorescein angiography their filling appeared earlier than in normal stromal vasculature and was synchronous with that of conjunctival vessels. No dye leakage was present. Two functional angiographic pictures are observable: 1) vessels with abnormal diameter and path, approximately following normal iris vessel arrangement (case 1 and 2); 2) atypical vessels with wide communicating shunt between artery and vein without collaterals (cases 3, 4 and 5). These vessels are very tortuous and do not show any abnormality. The authors suggest to consider these anomalous vessels as anatomic abnormalities comparable with the arterio-venous communications of the retina.