Pregnancy in patients with thalassemia major: a cohort study and conclusions for an adequate care management approach.

An improvement in quality of life and survival occurred among thalassemia major (TM) patients: pregnancy in such patients has become a reality. Safe pregnancy and delivery require efforts to ensure the best outcomes. Between 2007 and 2016, 30 TM patients had 37 pregnancies. We analyzed the hematological parameters before, during, and after pregnancies and in 19 patients a cardiovascular magnetic resonance (CMR) T2* was performed. The mean age at first pregnancy was 30 ± 4 years; the current mean age is 35 ± 5 years. Twenty-four patients (80%) had a single pregnancy, five patients (17%) had two pregnancies, and one patient (3%) became pregnant three times. Seventeen pregnancies (46%) were spontaneous, 20 (64%) needed gonadotrophin-induced ovulation and/or reproductive technologies. All pregnancies resulted in live births. Seven were twin pregnancies (19%). The mean gestational hemoglobin was 9.2 ± 0.5 g/dl, lower than pre- and postpregnancy (9.8 ± 1 g/dl, p = ns and 9.6 ± 1 g/dl, p = 0.02, respectively). Median ferritin levels increased progressively (1071, range 409-5724 ng/ml, before pregnancy vs 2231, range 836-6918 ng/ml, after pregnancy, p < 0.0001). CMR before pregnancy showed a normal cardiac T2* (mean 35.34 ± 8.90 ms) and a mean liver iron concentration (LIC) of 3.37 ± 2.11 mg/g dry weight (dw). After pregnancy, the mean cardiac T2* was 31.06 ± 13.26 ms and the mean LIC was significantly increased (9.06 ± 5.75 mg/g dw, p = 0.0001). Pregnancy is possible and safe in thalassemia major. During pregnancy, iron accumulates, especially in the liver; a prompt resumption of chelation after delivery is mandatory.

Unusual presentation of large B cell lymphoma: a case report and review of literature.

Diffuse large B cell lymphoma (DLBCL) is the largest subtype of non-Hodgkin's lymphomas (NHLs) and is characterized by relatively frequent extranodal presentation. In these cases, the most common extranodal localizations are stomach, CNS, bone, testis and liver. Simultaneous detection of multiple extranodal involvement at presentation is quite uncommon, with the majority of these cases characterized by gastric or intestinal disease localization. Retrospective analysis concerning multifocal extranodal NHLs never pointed out disease features such as those described here. We report a patient with an unusual presentation of DLBCL, characterized by adrenal and renal involvement, associated with symptoms and signs of the cold agglutinin disease and a hypercoagulable state. Subsequently, computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning disclosed a rapidly extensive spread to nodes and bones. Cytofluorimetric analysis of a renal specimen showed medium-to-large lympho-monocytoid elements positive for CD20 with monoclonal expression of immunoglobulin kappa light chain. Histopathological examination confirmed a renal CD20 positive DLBCL localization.

Psychopathological and cognitive features in subclinical hypothyroidism.

1. To evaluate effective and cognitive dysfunctions in subjects with a marginal form of thyroid hypofunction the authors studied a population of female goiter patients, divided in two groups on the basis of thyroid function: euthyroidism and subclinical hypothyroidism (SCH). 2. The SCH patients were treated with levothyroxine (LT4) in order to obtain euthyroidism, as demonstrated by normalization of the hormonal pattern. 3. Both groups were evaluated with a wide range of psychometric tests (Wechsler memory test, scribble test, reaction times) and psychopathological rating scales (Hamilton rating scales for depression and anxiety, brief psychiatric rating scale) at admission and after 3 months. 4. At admission, a significant decrease in logical memory was found in SCH patients; no differences in affectivity ratings were found between the groups. 5. After LT4 treatment, SCH patients showed a significant improvement in some items of memory performance. 6. In conclusion, when interfering factors relating to the perception of disease were excluded by employing euthyroid goiter patients as a comparison group, SCH appeared associated only with memory impairment, while the impairment of affective functions described in previous studies comparing SCH patients with normal controls was not confirmed. A significant improvement of memory skills was induced by LT4 treatment in SCH patients.

[Urine culture and analysis of data using a computer]. / L'urinocoltura, analisi dei dati mediante computer.

A computerized investigation of microbiological data concerning 7042 culture exams of urines has been carried out. Interesting data from the epidemiological point of view came out: positivity percentages in relation to the different months of the year, strains frequency, incidence of the urinary pathology in relation to sexes. It is also interesting the analysis of positivity percentages in relation to the derivation of samples, since it is clear a significant negativity of non-hospital samples. The use of computerized analysis of data in the microbiological laboratory is discussed and is a well considered the need to use computer not only to identify microorganisms and to determine the sensibility of antibiotics, but also for data management especially from the epidemiological point of view. Therefore the use of computer as file is desired in order to obtain by the statistic analysis, evidence of epidemiological character, plannings, work plans finalized to a more efficient answer to the growing need of culture exams.

[Dynamics of the production of staphylococcal enterotoxin and thermonuclease in foods responsible for outbreaks of food poisoning]. / Dinamica della produzione di enterotossine e termonucleasi stafilococciche in alimenti responsabili di episodi di tossinfezioni alimentari.

The behaviour of staphylococcal growth, thermonuclease and enterotoxin production in foods responsible of different food poisoning outbreaks is described. The significance of thermonuclease estimation, as a simple laboratory test for evaluating the hygienic status of foods in different steps of their commercial life, is discussed.

[Comparison of the MPN method and direct counting on specific selective media for bacteriological examination of surface and waste waters]. / Confronto tra metodo MPN e conteggio diretto su terreni selettivi specifici per l'esame batteriologico delle acque superficiali e di scarico.

A tentative procedure, with solid plated selective-differential media, for enumeration of total and fecal coliforms and enterococci in surface and waste waters is described. Results obtained with such techniques appear to be satisfactory in comparison with the traditional official procedure (MPN) for fecal coliforms (E. coli). The procedure and cultural media proposed is not satisfactory for total coliforms counting and it is only partially satisfactory for enterococci direct enumeration. We then propose the direct enumeration technique on mFC agar for fecal coliforms estimation. Further experiments for improving counting procedures for the other microbiological parameters are in progress.

[Research of the RNA-coliphages, in comparison with usual microbial and chemical indexes of biological pollution, for hygienic and sanitary evaluations of coast-waters (author's transl)]. / La ricerca dei colifagi-RNA, in rapporto ai tradizionali indici microbici e chimici di inquinamento biologico, ai fini della valutazione igienico-sanitaria delle acque costiere.

Hygienic significance of the usual microbial (E. coli, Enterococci, Clostridia) and chemical (COD, NH3, NO2) indexes of sea-water biological pollution was investigated, in comparison with RNA-coliphages assay. E. coli was confirmed as an easily measurable and significant index of biological pollution (at least for routinary investigations), while the other microbial and chemical parameters do not significantly increase the hygienic selectivity of the E. coli assay. RNA-coliphages assay, on the contrary, is able to increase the hygienic selectivity of sanitary investigations, particularly in lowly polluted coast-water. This behaviour of RNA-coliphages is in accordance with their great persistance in sea-water, due to their survival-time, closely comparable with human viruses. RNA-coliphages assay is therefore proposed as a simple and useful index of "viral pollution" for a complete hygienic evaluation of sea-water environment in addition to routinary E. coli assay.

[Simple and rapid method for direct coliform analysis in seawater]. / Metodo semplice e rapido per la colimetria fecale diretta in acque marine

A simple and rapid test for the fecal coliform analysis in seawaters by means of the direct seeding on selective-differential m-FC agar medium is described. The data set fourth show a good yield for the test insofar as test sensitivity, specificity and reliability are concerned. Consequently, its use is proposed along with, or at variance with, the traditional techniques MPN and FM which are not always of practical and easy carrying out, under particular operative conditions (need to customarily analyse a high number of samples).