Stroke and the need for immediate assistance at the place of onset: the future of mandatory training for lay people in Italy.

Introduction: Lay training is essential to manage emergencies properly, although patients or bystanders need increased recognition of medical urgencies such as strokes. In Italy, as defined by Legislative Decree 81/08, all companies must train employees responsible for correctly recognizing and managing medical emergencies. Our study aims to evaluate the characteristics of medical emergencies concerning patients with a possible stroke in the Lombardy Region. Methods: A retrospective observational study was conducted. All missions performed by Regional Agency for Emergencies and Urgencies (Agenzia Regionale Emergenza Urgenza - AREU) in which the patient presented a possible stroke, recorded in the SAS-Areu database, were analyzed. The study period was from January 1, 2019, to December 31, 2019. Results: 10,201 patients with possible stroke were rescued, of whom only 540 (5.3%) occurred in workplaces. In workplaces, the percentage of males with a possible stroke was higher (62.2% vs 45.2%; p<0.01) and the mean age of rescued patients was lower (64.7 vs 77.5; p<0.01). Conclusions: A stroke occurs less frequently in the workplace, while most events occur at home. Man-datory training on early stroke recognition should be extended to schools and conveyed through a media information campaign. Lay training is the first point in the chain of survival; redefining training is critical for the future.

Pregnancy in women with Hereditary Angioedema due to C1-inhibitor deficiency: Results from the ITACA cohort study on outcome of mothers and children with in utero exposure to plasma-derived C1-inhibitor.

Background: In women with Hereditary Angioedema (HAE) due to C1-inhibitor (C1INH) deficiency (C1INH-HAE), pregnancy counseling and treatment can be challenging. Despite the evidence of the immediate favorable outcome and safety of plasma-derived (pd)C1INH concentrate, there are no data regarding any difference among women who underwent or not pdC1INH during pregnancy or on children with in utero exposure to pdC1INH. The present interview study aimed at analyzing outcome of C1INH-HAE mothers and children according to pdC1INH-exposure during pregnancies. Methods: C1INH-HAE women who experienced at least 1 pregnancy were included from seven centers of the Italian Network for Hereditary and Acquired Angioedema (ITACA). The interview study retrospectively analyzed pregnancies who underwent (group 1) or not (group 2) pdC1INH. The overall goals of the study included immediate and long-term outcomes, in terms of outcomes in the time interval between pregnancy and survey. Results: A total of 168 pregnancies from 87 included women were analyzed. At term delivery (>37 gestation-week, GW) has been registered in 73.8% of cases, while spontaneous abortion (SA) occurred in 14.2% of cases with a mean GW 7 ± 2. The group 1 including pdC1INH-treated pregnancies comprised a third of the cohort (51/168, time interval 1.5 ± 10.4 yrs), while the group 2 represented 69.6% (117/168, time interval 32.8 ± 14 yrs). The same prevalence of SA occurred when comparing group 1 (11.7%) with group 2 (15.4%) with a similar GW at SA. The group 1 was older at the pregnancy time and younger at the interview than the group 2 (P < 0.01 for both); moreover, the group 1 showed a higher prevalence of cesarean delivery (P < 0.0001). The overall prevalence of obstetrical syndromes was similar between two groups: however, gestational diabetes was described only in pdC1INH-untreated pregnancies. In utero pdC1INH-exposed children (n = 45) did not show differences compared with unexposed ones (n = 99) in neonatal short-term outcomes. Conclusion: Through appropriate management and counseling, most of C1INH-HAE women undergo successful pregnancy and delivery. For pregnant C1INH-HAE women being treated with pdC1INH, our findings are reassuring and might lead to an improvement of both the knowledge about treatments and the experience of HAE itself.

Public health impact of the COVID-19 pandemic on the emergency healthcare system.

BACKGROUND: The Lombardy region has been the Italian region most affected by the coronavirus disease 2019 (COVID-19) pandemic in 2020. The emergency healthcare system was under deep stress throughout the past year due to the admission of COVID-19 patients to the emergency department (ED) and had to be thoroughly reorganized. METHODS: We performed a retrospective descriptive analysis of patients admitted into the ED recorded in the Lombardy online regional portal called EUOL (Emergenza e Urgenza OnLine). We compared the data registered in the EUOL with the patients admitted to the EDs from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. RESULTS: The number of admissions to the ED decreased by 32.5% in 2020 compared with 2019, reaching the lowest number in March and April. However, the percentage of patients hospitalized after ED significantly increased in 2020 compared with 2019 (P < 0.0001), reflecting the management of patients with a more severe clinical condition. More patients arrived at the ED by ambulance in 2020 (21.7% in 2020 versus 15.1% in 2019; P < 0.0001), particularly during March and April. CONCLUSIONS: This analysis showed the importance of monitoring the pandemic's evolution in order to treat more critically ill patients, despite a lower number of patients.

Subclinical atherosclerosis and endothelial dysfunction in patients with polymyalgia rheumatica: a pilot study.

Objective: The aim of the study was to investigate endothelial function in treatment-naïve polymyalgia rheumatica (PMR) patients and its modification during steroid therapy, in relation to changes in clinical and laboratory parameters.Method: This prospective observational study involved patients with a new diagnosis of PMR according to provisional American College of Rheumatology/European League Against Rheumatism 2012 criteria, who were naïve to steroid therapy, and control subjects matched for age, gender, and comorbidities. All participants underwent clinical and vascular ultrasound evaluations at baseline and after 1, 3, 6, and 12 months of steroid therapy. For the study of endothelial function, we evaluated the brachial artery reactivity, which has emerged as the most well-established technique used in adults, by assessing flow-mediated dilatation (FMD), which measures the endothelium-dependent vasodilatation.Results: Sixteen newly diagnosed PMR patients were compared with a population of 16 matched controls. FMD values in all subjects showed an inverse correlation with the values of erythrocyte sedimentation rate and C-reactive protein. At baseline, the FMD of PMR patients was significantly lower than controls and remained significantly lower with respect to controls until the sixth month of therapy, despite a clinical improvement already being evident after 1 month of therapy.Conclusions: PMR is characterized by an important chronic subclinical inflammatory component. This pilot study demonstrates that affected patients show endothelial dysfunction that slowly responds to steroid therapy. Further studies are needed to investigate the clinical relevance of these observations and, in particular, to monitor the cardiovascular risk profile of PMR patients.

Preserved cardiorespiratory function and NT-proBNP levels before and during exercise in patients with recent onset of rheumatoid arthritis: the clinical challenge of stratifying the patient cardiovascular risks.

Rheumatoid arthritis (RA) is associated with an increased risk of myocardial infarction and congestive heart failure. In RA patients, elevated NT-proBNP levels have been reported to be a prognostic marker of left ventricular dysfunction. In this study, we evaluated cardiorespiratory functional capacity and NT-proBNP levels before and during cardiopulmonary exercise test in early RA (ERA) patients. Twenty ERA patients and 10 healthy controls were studied by color Doppler echocardiography to evaluate ventricular systolic and diastolic function. Arterial stiffness and wave reflections were quantified non-invasively using applanation tonometry of the radial artery. Cardiopulmonary treadmill test was performed to measure peak VO2 and VE/VCO2 parameters. NT-proBNP plasma levels were measured before and at the exercise peak during cardiopulmonary exercise. The peak oxygen uptake [VO2 (ml/min/kg)], the ventilatory equivalents for carbon dioxide (EqCO2), respiratory exchange ratio and arterial stiffness were similar between patients and controls during cardiopulmonary exercise test. Basal and peak cardiopulmonary exercise NT-proBNP plasma levels were comparable in ERA patients with respect to healthy controls. When we analyzed patients according to disease characteristics and cardiovascular risk factors, ERA patients with high disease activity, BMI > 25 kg/m2 and ACPA positivity presented significantly higher baseline and exercise peak NT-proBNP levels. Cardiorespiratory function is preserved in patients with recent onset of rheumatoid arthritis. The increased basal and exercise peak NT-proBNP plasma levels in patients with negative disease prognostic factors represent a possible marker to stratify the cardiovascular risk in patients with early rheumatoid arthritis.

Assessment of reproductive and growth performances of pig breeds in the peri-urban area of Douala (Equatorial Zone).

The aim of this study was to evaluate the reproductive and growth performances of pig breeds in Douala, Cameroon. The reproductive performance of gilts and multiparous sows (38 per group) from 8 selected farms were monitored and controlled. Thereafter, piglets were controlled from birth to weaning age. The age at first service (AFS), fertility index (FI), fecundity, age at first farrowing (AFF), weight at first farrowing (WtFF) and litter size (LS) of gilts were 179.97 ± 25.40 days; 1.76 ± 0.77; 100 ± 0.00; 350.47 ± 40.58 days; 107.26 ± 31.85 kg and 7.18 ± 1.93 piglets, respectively. In sows, the FI, fecundity, LS and farrowing interval (FarI) were 1.13 ± 0.34; 100 ± 0.00; 9.03 ± 2.14 piglets and 179.63 ± 25.14 days, respectively. FI and LS were better in sows compared to gilts (P = 0.000). The sex ratio was 0.63. Local breed animals reared in semi-modern farms and fed mixed feed showed the lowest WtFF. In piglets, the average birth weight (kg), the average weaning weight (kg), age at weaning (days) and survival rate (%) until weaning were 1.32 ± 0.20, 10.60 ± 1.41, 56.86 ± 8.24 and 48.43, respectively. These results indicated that reproductive performance is strongly influenced by breed, feed and farm type.

Evaluation of bovine (Bos indicus) ovarian potential for in vitro embryo production in the Adamawa plateau (Cameroon).

An abattoir study was conducted to evaluate the ovarian potential of 201 local zebu cattle from Ngaoundere, Adamawa region (Cameroon) for in vitro embryo production (IVEP). The ovaries were excised, submerged in normal saline solution (0.9%) and transported to the laboratory for a detailed evaluation. Follicles on each ovary were counted, their diameters (Φ) measured and were grouped into 3 categories: small (Φ < 3 mm), medium (3 ≥ Φ ≤ 8 mm) and large (Φ > 8 mm). Each ovary was then sliced into a petri dish; the oocytes were recovered in Dulbecco's phosphate buffered saline, examined under a stereoscope (x10) and graded into four groups based on the morphology of cumulus oophorus cells and cytoplasmic changes of the oocytes. Grade I (GI): oocytes with more than 4 layers of bunch of compact cumulus cells mass with evenly granulated cytoplasm; grade II (GII): oocyte with at least 2-4 layers of compact cumulus cell mass with evenly granulated cytoplasm; grade III (GIII): oocyte with at least one layer of compact cumulus cell mass with evenly granulated cytoplasm; grade IV (GIV): denuded oocyte with no cumulus cells or incomplete layer of cumulus cell or expanded cells and having dark or unevenly granulated cytoplasm. The effects of both ovarian (ovarian localization, corpus luteum, size and weight of ovary) and non-ovarian factors (breed, age, body condition score (BCS) and pregnancy status of cow) on the follicular population and oocyte recovery rate were determined. There were an average of 16.75±0.83 follicles per ovary. The small, medium and large follicles were 8.39±0.60, 8.14±0.43 and 0.21±0.02 respectively. Oocyte recovery was 10.97±0.43 per ovary (65%). Oocytes graded I, II, III and IV were 3.53±0.19 (32.21%), 2.72±0.15 (24.82%), 2.24±0.15 (20.43%) and 2.47±0.20 (22.54%) respectively. The oocyte quality index was 2.26. Younger non pregnant cows having BCS of 3 and large ovaries presented higher number of follicles and oocyte quality (P < 0.05) compared with other animals. Oocytes with quality (grade I and II) acceptable for IVEP constituted 57.15% of the harvest. This study indicated that factors such as age, pregnancy status, BCS and ovarian size must be taken into account to increase the potential of the ovary for IVEP.

Systematic review of the literature and a case report informing biopsy-proven giant cell arteritis (GCA) with normal C-reactive protein.

Giant cell arteritis (GCA) is a vasculitis of large- vessels. A markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are characteristics of GCA, although temporal artery biopsy remains the gold standard for the diagnosis. We describe a case of biopsy-proven GCA showing a heavy infiltration of CD68 macrophages and CD3 T cells and with normal ESR and CRP levels at diagnosis. Key points (1) GCA may occur with normal ESR in a percentage of about 4 to 15 % (although the American College of Rheumatology classification criteria for giant cell arteritis include an ESR of 50 mm/h or more), while it can occur with normal ESR and normal CRP in a percentage of about 0.8 %. So, the clinical suspicion must be confirmed with a positive biopsy. (2) GCA patients with ESR >40 mm/h are characterized by higher incidence of headache and jaw claudication compared to patients with normal ESR. In our case, it occurred with normal ESR. (3) Color duplex ultrasonography is a noninvasive, easy, and inexpensive method for supporting a diagnosis of TA, with a high sensitivity and specificity. It can predict which patient will need TAB.

Proton pump inhibitors in rheumatic diseases: clinical practice, drug interactions, bone fractures and risk of infections.

Platelet activation and aggregation are key elements of the pathogenesis of acute coronary syndromes, of endothelial damage in chronic inflammatory and connective tissue disease (i.e. systemic sclerosis-SSc). Patients affected by chronic inflammatory diseases as well as by connective tissue diseases such as systemic sclerosis, often have the need to take anti-platelet therapy (e.g. ASA or clopidogrel). Current consensus recommendations state that patients prescribed clopidogrel plus aspirin should receive a proton pump inhibitor (PPI) to reduce gastrointestinal bleeding. Although each single PPI has similar efficacy in many cases, differences between them should be considered when choosing a treatment regimen. Many studies show PPI and clopidogrel drug interaction, with clopidogrel non-responsiveness in about 25% of the population. Only pantoprazole, which does not inhibit CYP P450 2C19, doesn't seem to have interaction with clopidogrel or other drugs. Patients affected by systemic sclerosis have high frequency of oesophageal mucosal abnormalities and should take long-term PPI therapy. When addressing long-term therapy safety data are clearly needed. Two recent studies have reported increased hip fracture rates with long-term PPI use, raising concerns about adverse effects of this class of drugs on mineral metabolism. The use of PPIs is also associated with an increase in the risk of development of Clostridium difficile infection (CDI) and the use of PPIs during CDI treatment is associated with an increased risk of recurrence. In order to achieve the desired results and, as with all medications, PPIs should always be used appropriately taking care never to exceed correct dosage and duration. When necessary use of pantoprazole arises as one of the best possible choices.

MR imaging of atlantoaxial joint in early rheumatoid arthritis.

PURPOSE: This study was done to assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis and evaluate the role of magnetic resonance (MR) imaging in depicting this early joint involvement. MATERIALS AND METHODS: Twenty patients (16 women and four men, mean age 55.0±12.9 years) with clinical and laboratory evidence of early rheumatoid arthritis (mean disease duration <12 months) were included in our study. MR imaging of the atlantoaxial joint was performed in all patients within 3 months from diagnosis. The MR features were correlated with clinical and biochemical variables. RESULTS: Five (25.0%) of the 20 patients exhibited enhancement of the periodontoid synovial spaces after gadolinium administration due to inflammatory synovitis. Compared with patients without cervical involvement, these five patients showed significantly higher values of erythrocyte sedimentation rate [median 77.0 mm/h (range 25th and 75th percentile 69.0-86.0) vs median 33.0 mm/h (range 25th and 75th percentile: 9.2-52) (p=0.007)]; significantly higher C-reactive protein values [median 53.6 mg/l (range 25th and 75th percentile 21.9-81.9) vs median 14.0 mg/l (range 25th and 75th percentile 0.8-20) (p=0.03)]; higher disease activity score [median 4.2 (range 25th and 75th percentile 3.9-5.4) vs median 3.2 (range 25th and 75th percentile 2.8-3.8) (p=0.03)]. Four (80%) of these five patients presented anti-citrulline antibodies (anti-CCP) and rheumatoid factor at laboratory testing. The latter was positive in 12 of the 20 patients (66%), and anti-CCP were positive in 15 (83%). CONCLUSIONS: MR imaging showed an atlantoaxial inflammatory synovitis in 25% of patients with early rheumatoid arthritis. Our results indicate that patients with higher disease activity are likely to be at higher risk of presenting early involvement of the atlantoaxial joint. MR imaging of the cervical spine is an excellent tool for assessing the early manifestations of rheumatoid arthritis before any destructive changes occur. Therefore, MR imaging should be included in the diagnostic workup in order to provide reliable guidance for treatment choices.

Antibody responses to the host-protective Taenia solium oncosphere protein TSOL18 in pigs are directed against conformational epitopes.

TSOL18 is a recombinant protein that has been shown in repeated experimental trials to be capable of protecting pigs against challenge infection with the cestode parasite Taenia solium. Antibodies raised by the vaccine are capable of killing the parasite in an in vitro culture and it is believed that antibody and complement-mediated killing of invading parasites is the major protective immune mechanism induced by vaccination with TSOL18. Investigations were undertaken to characterize whether the principal antibody specificities raised by TSOL18 in pigs were against linear or conformational determinants. TSOL18 was expressed in two truncated forms representing either the amino terminal portion or the carboxy terminal portion, with the two truncations overlapping in sequence by 25 amino acids. The original protein (designated TSOL18N(-)) and the two truncations (TSOL18N(-)-1 and TSOL18N(-)-2) were used in inhibition ELISA. TSOL18N(-) was shown to be capable of completely inhibiting the binding of pig anti-TSOL18N(-) antibodies to TSOL18N(-) in ELISA. However, neither TSOL18N(-)-1 nor TSOL18N(-)-2, either alone or when combined together, was capable of inhibiting any detectable amount of reactivity of pig anti-TSOL18N(-) antibodies with TSOL18N(-). It is concluded that the dominant antibody specificities, and probably the host-protective specificities, of TSOL18 are conformational epitopes.

Pig-farming systems and porcine cysticercosis in the north of Cameroon.

A survey was conducted in 150 households owning 1756 pigs in the rural areas of Mayo-Danay division in the north of Cameroon. A questionnaire survey was carried out to collect information on the pig-farming system and to identify potential risk factors for Taenia solium cysticercosis infection in pigs. Blood samples were collected from 398 pigs with the aim of estimating the seroprevalence of T. solium cysticercosis. The results showed that 90.7% of the pigs are free roaming during the dry season and that 42.7% of households keeping pigs in the rural areas have no latrine facility. Seventy-six per cent of the interviewed pig owners confirmed that members of the household used open-field defecation. Enzyme-linked immunosorbent assay (ELISA) for antigen and antibody detection showed an apparent prevalence of cysticercosis of 24.6% and 32.2%, respectively. A Bayesian approach, using the conditional dependence between the two diagnostic tests, indicated that the true seroprevalence of cysticercosis in Mayo-Danay was 26.6%. Binary logistic regression analysis indicated that a lack of knowledge of the taeniasis-cysticercosis complex and the absence of a pig pen in the household were associated with pig cysticercosis.

Immunologic and genetic links between spondylarthropathies and inflammatory bowel diseases.

BACKGROUND AND OBJECTIVE: Spondyloarthritis (SpA) is a well recognized extraintestinal manifestation of Inflammatory Bowel Diseases (IBDs), either Crohn's Disease(CD) or Ulcerative Colitis (UC). A much larger percentage of SpA patients have subclinical gut inflammation manifested either by endoscopic findings or by histology. The aim of the present article is to review clinical and experimental evidences regarding the immunological and genetic links between gut and joint inflammation in IBDs and SpA. EVIDENCE AND INFORMATION SOURCES: A systematic review using PubMed database entering IBD and SpA as key words was performed. STATE OF THE ART: The association with HLA-B27 is less strong in IBD-associated SpA than in Idiopathic Ankylosing Spondylitis (AS) and there is some evidence for an association between gut inflammation in SpA and CD related CARD15 mutations. A common inflammatory pathogenic pathway has been suggested in gut and joint inflammation in IBD. Treatment of SpA associated with IBD has gained major advances in recent years with the advent of anti-TNF-alpha therapy. PERSPECTIVES: The adaptive immune response in IBD is thought to be strictly differentiated between Th1 and Th2 in CD and UC respectively. Recent findings, however, suggest that novel effector pathways could drive tissue damage. The most important pathway now emerging is the IL-23/IL-17 axis. CONCLUSIONS: Present and future advancements of knowledge on mechanisms of inflammation will likely lead to new therapeutic targets.

A paraneoplastic retroperitoneal fibrosis resistant to corticosteroids treated with tamoxifen.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by an inflammatory proliferative fibrosing process occurring in the retroperitoneum, often causing urinary tract obstruction. Medical therapy is not well-defined, but glucocorticoids have been the mainstay of therapy. Recently, positive response to tamoxifen, an antiestrogen drug, has been reported among patients with RPF. We report the case of a 65-year-old male with a renal cell carcinoma in the upper pole of the right kidney showing acute renal failure due to a biopsy-confirmed RPF determining bilateral hydronephrosis. After polar resection of the right kidney, a high-dose oral steroid therapy did not modify the hydronephrosis. At 6 months, therapy with tamoxifen determined the retroperitoneal fibrotic mass regression and resolved the ureteral obstruction, that persists at the 13th month of follow-up. Tamoxifen can be considered as an effective alternative to corticosteroids and immunosuppressors in treating RPF.

Seasonal distribution and abundance of tsetse flies (Glossina spp.) in the Faro and Deo Division of the Adamaoua Plateau in Cameroon.

Ten years after the large-scale tsetse control campaigns in the important cattle rearing areas of the Faro and Deo Division of the Adamaoua Plateau in Cameroon, the seasonal distribution and abundance of tsetse flies (Glossina spp.) were determined. During a period of 12 consecutive months (January-December 2005), the tsetse population was monitored along four trap transects consisting of a total of 32 traps and two flyround transects traversing the study area, which comprised the tsetse-infested valley, a buffer zone and the supposedly tsetse-free plateau. Throughout the study period, a total of 2195 Glossina morsitans submorsitans and 23 Glossina tachinoides were captured in the traps and 1007 G. m. submorsitans (78.8% male flies) were captured along the flyround transects. All G. tachinoides and almost all G. m. submorsitans were captured in the valley. Five G. m. submorsitans were captured in traps located in the buffer zone, whereas no flies were captured in traps located on the plateau. The index of apparent abundance (IAA) of G. m. submorsitans was substantially higher in the areas close to game reserves. In the remaining part of the valley, where wildlife is scarce and cattle are present during transhumance (dry season), the IAA of tsetse was substantially lower. In this part of the valley, the abundance of tsetse seemed to be associated with the presence of cattle, with the highest IAA during transhumance when cattle are present and the lowest apparent abundance during the rainy season when cattle have moved to the plateau. It is concluded that the distribution of tsetse in a large part of the valley undergoes substantial seasonal changes depending on the presence or absence of cattle. The repercussions of those findings for the control of tsetse in the valley and the probability of reinvasion of the plateau are discussed.

Assessment of the occurrence of trypanocidal drug resistance in trypanosomes of naturally infected cattle in the Adamaoua region of Cameroon using the standard mouse test and molecular tools.

From May to November 2005, a study was carried out to assess the occurrence of trypanocidal drug resistance (DR) in trypanosomes of naturally infected cattle of the Adamaoua region of Cameroon. Two distinct Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) procedures were used together with an Allele specific-PCR (AS-PCR) and the standardized single-dose mouse test. Using the mouse test, 3 of the 13 Trypanosoma brucei isolates and all 14 tested Trypanosoma congolense isolates were resistant to ISM. However, only 11 of the 25 T. congolense isolates were diagnosed as resistant to ISM using the MboII-PCR-RFLP. Resistance to DA was identified in 1 of the 13 T. brucei isolates and all 11 T. congolense isolates which were tested with the mouse test. Using the AS-PCR or BclI-PCR-RFLP, 3 of the 13 T. brucei isolates and all 25 T. congolense isolates respectively were found resistant. The data presented in this study prove that DR is widespread in the Adamaoua Department of Cameroon. The problem appears to be more serious in T. congolense than in T. brucei. Appropriate measures need to be taken in order to control bovine trypanosomosis in this area.

Prevalence and incidence of bovine trypanosomosis on the Adamaoua plateau in Cameroon 10 years after the tsetse eradication campaign.

Between March 2004 and February 2005, the monthly incidence of trypanosome infections was measured in cattle from nine sentinel herds in the Adamaoua province of Cameroon. Three herds of 20 cattle each were kept on the plateau which has been cleared from tsetse flies about 10 years ago, three other herds were grazing in the tsetse infested valley whereas the last three were herded in the buffer zone. The cross-sectional study showed that the initial trypanosomosis prevalence was 1.8, 5.2 and 2.0% on the plateau, in the buffer zone and the valley, respectively. During the longitudinal study, the trypanosomosis incidence was high in the valley (3.7-20%) and the buffer zone (1.8-13.4%), whereas it was significantly lower (0-2.1%) on the plateau. Tsetse flies, mainly Glossina morsitans submorsitans and a few G. tachinoides, were caught in the valley and the buffer zone, but none on the plateau. The data indicate a low trypanosomosis risk on the plateau. Further entomological studies, however, are required to clarify the origin of the trypanosome infections on the plateau.

Antibody responses and epitope specificities to the Taenia solium cysticercosis vaccines TSOL18 and TSOL45-1A.

Taenia solium is a cestode parasite that causes cysticercosis in humans and pigs. This study examined the antibody responses in pigs immunized with the TSOL18 and TSOL45-1A recombinant vaccines against T. solium cysticercosis. Immunization with these proteins induced specific, complement-fixing antibodies against the recombinant antigens that are believed to be associated with vaccine-induced protection against T. solium infection. Sera from immunized pigs were used to define the linear B-cell epitopes of TSOL18 and TSOL45-1A. Prominent reactivity was revealed to one linear epitope on TSOL18 and two linear epitopes on TSOL45-1A. These, and oncosphere antigens from other taeniid cestodes, contain a protein sequence motif suggesting that they may show a tertiary structure similar to the fibronectin type III domain (FnIII). Comparison of the location of linear antigenic epitopes in TSOL18 and TSOL45-1A within the proposed FnIII structure to those within related cestode vaccine antigens reveals conservation in the positioning of the epitopes between oncosphere antigens from different taeniid species.

Pulmonary involvement in systemic sclerosis due to therapy and as a complication.

Lung involvement frequently occurs in systemic sclerosis (SS), similar to other connective tissue diseases. Sometimes lung disease may be a side effect of antirheumathic drugs. We report a case of a patient affected by SS, with isolated pulmonary hypertension, who developed bronchiolitis secondary to penicillamine. The latter was treated by withdraw of the drug without increasing the steroids. After one month, the patient's clinical conditions appeared improved.