Multiple gut-liver axis abnormalities in children with obesity with and without hepatic involvement.

BACKGROUND: Gut-liver axis (GLA) dysfunction appears to play a role in obesity and obesity-related hepatic complications. OBJECTIVES: This study sought to concurrently explore several GLA components in a paediatric obese population with/without liver disease. METHODS: Thirty-two children (mean age 11.2 years) were enrolled: nine controls with normal weight and 23 patients with obesity (OB+). Of the 23 patients OB(+), 12 had not steatosis (ST-), and 11 had steatosis (ST+) (associated [n = 8] or not [n = 3] with hypertransaminasaemia [ALT +/-]). Subjects were characterized by using auxologic, ultrasonographic and laboratory parameters. A glucose hydrogen breath test was performed to test for small intestinal bacterial overgrowth, a urinary lactulose/mannitol ratio (LMR) was obtained to assess intestinal permeability, and tests for transaminases, blood endogenous ethanol, endotoxin and faecal calprotectin were also conducted. RESULTS: Eleven out of 23 patients OB(+) (p < 0.05) exhibited pathological (>90th percentile of the control group values) LMR, with values paralleling the grade of liver involvement (normal weight < OB[+] < OB[+]ST[+]ALT[-] < OB[+)]ST[+]ALT[+] [p < 0.05]). LMR significantly correlated with ethanolaemia (r = 0.38, p = 0.05) and endotoxaemia (r = 0.48, p = 0.015) concentrations. Increased permeability was a risk factor for the development of steatosis (p < 0.002). SIBO was present only in patients with obesity. Faecal calprotectin concentrations were within normal limits in all subjects. CONCLUSIONS: Increased permeability, endogenous ethanol and systemic endotoxin concentrations reflect some GLA dysfunction in obesity and its hepatic complications. Pending further results to establish their potential causative roles, the modulation of the GLA appears to represent a possible target for the prevention and treatment of these conditions.

Bruxism and health related quality of life in southern Italy's prison inmates.

OBJECTIVE: The aim of this study was to determine the prevalence of self-assessed bruxism, the level of Health Related Quality of Life (HRQoL) and their relationship in a group of male inmates. BASIC RESEARCH DESIGN, SETTING: The present study was cross-sectional, its setting was two penal institutions in Italy. PARTICIPANTS: A sample of 280 male prisoners (mean age 39.7 years). Due to the very small number of female prisoners, it was not possible to study both genders. INTERVENTIONS AND MAIN OUTCOME MEASURES: Subjects were administered a questionnaire with items investigating demographic data, self-assessed bruxism and HRQoL using EuroQoL EQ-5D instrument. RESULTS: Bruxism was present in 29.7% of inmates. Results for EQ-5D (in brackets are data for the general population age and gender matched) were: EQ-index 1.3 (0.8), EQ-VAS 62 (80). Percentage reporting a problem for each dimension: Mobility (MO): 7.5 (9.6), Self Care (SC): 6.1 (4.3), Usual Activities (UA): 17.9 (10.1), Pain/discomfort (PD): 43.9 (40.8), Anxiety/depression (AD): 54.6 (31.9). There was a strong correlation between bruxism and EQ-index, showing concordance and dependence and, as expected, discordance and dependence between bruxism and EQ-VAS. CONCLUSION: Bruxism prevalence is higher and HRQoL is worse in the prison population than in the general population; the presence of bruxism is correlated with lower HRQoL levels, and correlation is stronger for subjects at first prison experience and for higher education levels, thus suggesting higher effect of stress on these subjects.

Laryngeal tube as airway rescue device from prehospital tracheostomy: a case report.

Airway management is a priority for the critically ill patient. The insertion of a cuffed tracheal tube is the best practice to obtain an airway control; however, it is associated with many practical problems in prehospital trauma care. When this common procedure is not available, it can be substituted by an extraglottic airway. We report the case of a 54-year-old victim of a multi-vehicle collision brought to the Emergency Department of a Level One Trauma Center by Emergency Medical Service. Initial evaluation revealed a Glasgow Coma Scale score of 8 and a fixed and midriatic right pupil, suggesting a severe head injury. The patient did not show any predictable sign of difficult intubation. After oxygen administration and cervical spine immobilization a rapid sequence induction was carried out and intubation failed after three attempts. Then a laryngeal tube (LT) was successfully placed and connected with a transport ventilator. The transfer to the hospital took 20 minutes with SpO(2) level of 99% and end tidal carbon dioxide not above 42 mmHg. The patient was properly ventilated by the LT during the computed tomography scan investigations. Due to the impossibility of endotracheal intubation the patient underwent surgical tracheostomy as suggested by the ear nose throat surgeon consultant. This case suggests that LT could be an important alternative device for airway management in trauma patients after a failed tracheal intubation. LT is a precious tool to achieve good ventilation and oxygenation from the field to the operatory theatre.

Pathologic findings in synovial tissue of the musculoskeletal system: role of MRI in therapeutic clinic assessment.

OBJECTIVES: The clinical diagnosis of synovial lesions is difficult and radiographic findings may establish a confident diagnosis only in some cases. MR imaging has become the technique of choice in evaluating these lesions, because a presumptive diagnosis can be made in most cases. The purpose of this study was to evaluate the joint synovial disease through intravenous contrast MRI examination and the following histological validation. MATERIALS AND METHODS: Forty-eight patients were considered, twenty-seven women and twenty-one men, with pain relief or collectively determined by a known joint synovial disease, who underwent MRI at our institution between 2000 and the second half of 2010. All patients underwent magnetic resonance imaging using a low field magnet (0.2 Tesla) or high field magnet (1,5Tesla). RESULTS: Only nine patients were diagnosed with an inflammatory arthropathy, in the remaining cases non-inflammatory arthropathy of which the most frequent form was pigmented villonodular synovitis (PVNS) was diagnosed. CONCLUSIONS: MRI is able to provide an accurate representation of all the pathological changes involved in the joint space following acute or chronic inflammation and to define the characteristic features useful in differential diagnosis.

Cytokine expression in dogs with natural Leishmania infantum infection.

The aim of this study was to evaluate cytokine expression in 22 Leishmania infantum naturally infected dogs, in order to correlate this parameter with the clinical status of infected animals. After 4 and 8 months from the first diagnosis of Leishmania infection, clinical and laboratory examination of dogs was performed and peripheral blood mononuclear cells (PBMC) were isolated. The cytokine profile was analysed in terms of IFN-gamma, IL-4, IL-10 and TNF-alpha mRNA expression in cultured PBMC by a semi-quantitative reverse transcriptase-PCR. Thirteen out of 22 Leishmania-infected dogs remained asymptomatic in the follow-up, while 9 showed clinical signs of leishmaniasis. IL-4, IL-10, TNF-alpha and IFN-gamma mRNA levels were not significantly different in asymptomatic compared to symptomatic animals 4 months from the diagnosis of Leishmania infection, but were significantly higher in symptomatic versus asymptomatic dogs after 8 months from diagnosis. In addition, IL-4, IL-10 and TNF-alpha mRNA levels significantly increased only in symptomatic dogs at 8 months, in comparison to the levels found at 4 months. These results show a mixed Th1 and Th2 cytokine response in Leishmania-infected dogs, with higher cytokine expression in dogs with manifest clinical disease, during the second follow-up after 8 months from the first diagnosis of infection.

Surveillance of nosocomial infections: a preliminary study on yeast carriage on hands of healthcare workers.

Hospital-acquired fungal infection is increasing. The aim of this preliminary study was to evaluate the frequency and distribution of yeast carriage on the hands of healthcare workers (HCW) from different departments. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynaecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcare workers were randomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The plate with yeast was counted and Candida species were identified. Risk factors for hand contamination were determined. Hand carriage of yeast and Candida species in the three departments were found in the following percentages: Surgery (50% and 49%); Intensive Care Unit (61% and 57%); Obstetrics and Gynaecology (65% and 59%). No significant difference in the frequency or distribution of yeast and Candida sp. recovered in the three departments was ascertained by comparing every two months' data, the hand carriage of yeast and Candida species found in the three departments; this varied - min to max - according to the following percentages: Surgery [(45%-54%) and (42%-58%)]; Intensive Care Unit [(53%-66%) and (56%-59%)]; Obstetrics and Gynaecology [(62%-69%) and (57%-63%)]. The only factor associated with yeast carriage on the hands of healthcare workers was the absence of gloving during healthcare procedure (p = 0.0192). We conclude that in our study yeast carriage on the HCWs' hands is common in the three departments investigated, but its causes are unclear. Careful use of gloving may reduce pathogenic yeast on hands.

The first cosmetic treatise of history. A female point of view.

The Schola Medica Salernitana was an early medieval medical school in the south Italian city of Salerno and the most important native source of medical knowledge in Europe at the time. The school achieved its splendour between the 10th and 13th centuries, during the final decades of Longobard kingdom. In the school, women were involved as both teachers and students for medical learning. Among these women, there was Trotula de Ruggiero (11th century), a teacher whose main interest was to alleviate suffering of women. She was the author of many medical works, the most notable being De Passionibus Mulierum Curandarum (about women's diseases), also known as Trotula Major. Another important work she wrote was De Ornatu Mulierum (about women's cosmetics), also known as Trotula Minor, in which she teaches women to conserve and improve their beauty and treat skin diseases through a series of precepts, advices and natural remedies. She gives lessons about make-up, suggests the way to be unwrinkled, remove puffiness from face and eyes, remove unwanted hair from the body, lighten the skin, hide blemishes and freckles, wash teeth and take away bad breath, dying hair, wax, treat lips and gums chaps.

Modeling of granulocyte cytoskeletal responses following fMLP challenging.

Formyl peptides released from Gram-negative bacteria ligate a group of specific mammalian receptors, expressed mainly on granulocytes, monocytes, and macrophages. Receptor ligation activates different transduction cascades, eventually leading to the release of reactive oxygen species and other bactericidal chemical species, and the activation of the actin cytoskeleton with extension of lamellipodia and migration toward the sites of maximal formyl peptide concentration. In vitro, under conditions of nongradient formyl peptide concentrations, lamellipodia form all around the cell contour (chemokinesis). In granulocytes challenged under these conditions with N-formyl-methionyl-leucyl-phenylalanine, (i) the power spectrum of the contour of activated cells shows a peak at a specific periodicity, indicating that the lamellipodial extension is not completely random but stochastically conforms to a deterministic scheme, and (ii) the morphological response (percent of cells exhibiting chemokinesis) tends to reach a maximum at certain drug concentrations, then declining at higher concentrations. Accordingly, the logarithm of the drug concentration-polarizing effect curve is bell-shaped. Herein we illustrate theoretical models for the simulation of these two components of the chemokinetic responses. We show that the main traits of the general morphology and arrangement of lamellipodia may be simulated by an algorithm that starting from a situation of random distribution of active receptors on the cell membrane, encompasses in the successive calculation cycles both a local autocatalytic enhancement of the actin polymerization and a relative inhibition of the actin polymerization at some distance from the more active polymerization foci. In addition, a drug log concentration-polarizing effect bell-shaped curve may be simulated by assuming that the N-formyl-methionyl-leucyl-phenylalanine, while binding with high affinity to the specific receptor, is also able to bind to another lower affinity receptor that may effect depolarizing actions or, more generally, metabolic blocking effects. Under these conditions, at low drug concentrations the polarizing effect brought about by the ligation of the specific receptor is largely predominant. However, as the drug concentration increases and the specific receptors approach saturation, the inhibitory effects become more and more powerful and the net polarizing effect is reduced.

Surveillance of nosocomial infections: a preliminary study on hand hygiene compliance of healthcare workers.

The observance of hand hygiene compliance is important to reduce cross-infection by micro-organisms. The aim of this preliminary study was to evaluate the level of hand hygiene in healthcare workers from different departments, with particular emphasis on transient flora. The study was conducted in three departments (Surgery, Intensive Care Unit, Obstetrics and Gynecology) of a hospital in Campania, southern Italy. Over a six-month period, 50 healthcare workers were randomly tested. Imprints of palms and fingertips were taken monthly during the morning shift. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Total flora was found in the following CFU means per palm and per five fingertips (95% CI): Obstetrics and Gynecology [palms 130 CFUs (95% CI 85-180); fingertips 125 CFUs (95% CI 92-160)]; ICU [palms 80 CFUs (95% CI 58-99); fingertips 62 CFUs (95% CI 45-82)]; Surgery [palms 75 CFUs (95% CI 41-120); fingertips 70 CFUs (95% CI 52-90)] Transient flora was found on 39% of healthcare workers' hands. The only factor associated with hand contamination by transient flora was the absence of gloving during healthcare procedure (P = 0.02).

Two-years surveillance of fungal contamination in three hospital departments in Campania region.

A two-years (2003-2005) fungal environmental surveillance was carried out in three departments of a hospital in Campania region (Surgery, Intensive Care Unit, Obstetrics and Gynaecology). Four operating theatres rooms and their relative areas of service and support, 4 patient rooms of intensive care unit, 1 delivery room, 1 labour room and 1 nursery of Obstetrics and Gynaecology were checked. A total of 12,120 surfaces and 2,904 air samples were collected in 24 monthly determinations. A seasonal variation in the fungal development was observed, in particular the lowest level of air and surface fungi contamination was found in winter and autumn whereas it was higher in spring and summer. In this study 30 fungal species were identified and, among these, the most frequent specie isolated was the Aspergillus spp. The results show an air contamination, expressed in percentage of positive determinations for Aspergillus spp, and the other fungi in the following percentages: Obstetrics and Gynaecology (25% and 33,3%); Intensive Care Unit (17% and 25%); Surgery (12.5% and 21%). For surfaces contamination it was found: Obstetrics and Gynaecology (67% and 75%); Intensive Care Unit (63% and 71%); Surgery (58.3% and 67%). This study shows that in the departments observed environmental fungi contamination is always present and therefore it would be necessary to apply environmental surveillance procedure and monitor the effectiveness.

Giardia cysts and Cryptosporidium oocysts in membrane-filtered municipal wastewater used for irrigation.

A wastewater tertiary treatment system based on membrane ultrafiltration and fed with secondary-treated municipal wastewater was evaluated for its Giardia cyst and Cryptosporidium oocyst removal efficiency. Giardia duodenalis (assemblages A and B) and Cryptosporidium parvum were identified in feed water but were found in filtered water only during occasional failure of the filtration system.

In vitro antibacterial activity of moxifloxacin against hospital isolates: a multicentre study.

OBJECTIVE: To evaluate the in vitro antibacterial activity of moxifloxacinin in comparison to that of other fluoroquinolones (ciprofloxacin, ofloxacin and trovafloxacin). METHODS: A total of 2,196 strains was collected in 11 French hospitals in 1998. Minimum inhibitory concentrations (MICs) (mg/L) were determined by agar dilution and agar diffusion was performed with 5-microg discs. Internal quality control was carried out with genetically defined strains. RESULTS: MIC50s and MIC90s of moxifloxacin against nalidixic acid (NAL)-susceptible Enterobacteriaceae (n = 663) were 0.12 and 0.5. As for other quinolones, the activity of moxifloxacin (4-32) was reduced against NAL-intermediate and NAL-resistant strains (n = 222). MIC50s and MIC90s of moxifloxacin were 2 and 4 for ciprofloxacin-susceptible P. aeruginosa (n = 128); moxifloxacin had no activity against ciprofloxacin-resistant strains (n = 56). The activity of moxifloxacin was maintained against NAL-susceptible A. baumannii (n = 11; 0.032-0.125), but reduced against NAL-resistant strains (n = 30; 16-32). H. influenzae (n = 97) and M. catarrhalis (n = 40) were inhibited by low concentrations (0.03-0.06 and 0.06-0.25, respectively). Moxifloxacin had better activity (0.06-0.12) than other tested quinolones against methicillin-susceptible S. aureus strains (n = 110); ciprofloxacin-resistant strains (n = 85) (2-8) were usually methicillin-resistant. Moxifloxacin was moderately active against enterococci (n = 149) (E. faecalis: 0.5-16; E. faecium: 2-4). Streptococci (n = 194) and pneumococci (n = 136), including 70 penicillin G-intermediate or G-resistant strains, were inhibited by low concentrations (0.25-0.5 for each species). Based on the regression curve, tentative zone diameter breakpoints could be > or =21 and <18 mm for MIC breakpoints of < or =1 and >2 mg/L, respectively. CONCLUSIONS: While retaining activity against Enterobacteriaceae, moxifloxacin was moderately active against P. aeruginosa. Its activity was inferior to that of ciprofloxacin for these species. This study confirmed the comparatively high in vitro activity of moxifloxacin against Gram-positive cocci and other pathogens isolated from community-acquired respiratory tract infections.

Adherence to disease-modifying therapy in multiple sclerosis: Part I.

Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure. However, the recent introduction of injectable immunomodulating agents has made it possible to reduce the frequency of relapsing episodes and to possibly slow its progression. The use of these agents is recommended by the National MS Society, however, their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Because MS is unpredictable, and treatments can produce side effects, ensuring adherence to the recommended therapy is a complex and challenging issue. A better understanding of the obstacles to adherence, and the identification of possible solutions, should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. This article, which is in two parts, describes the particular problems of treatment adherence, and proposes that the transtheoretical model of behavior change can be useful in achieving treatment goals in MS and in other chronic disease states. This model is based upon the concept that a patient's "readiness for change" is crucial, and that attempts at intervention should be sensitive to the patient's changing conditions and state of mind. Nurses who work with patients with MS and other chronic diseases can apply the model to help their patients accept and adhere to the demands of ongoing treatment.

Adherence to disease-modifying therapy in multiple sclerosis: Part II.

Multiple sclerosis (MS) is a chronic, debilitating disease for which there is no cure; however, the recent introduction of injectable immunomodulating agents has reduced the rate of relapsing episodes and possibly slowed the progression of the disease. These disease-modifying agents are recommended by the National MS Society, but their true potential cannot be realized if patients do not accept them and healthcare professionals do not promote them. Since MS has an unpredictable course, and treatments can produce side effects, adherence to the recommended therapy is a complex and challenging issue. Improved understanding of the obstacles to adherence and the identification of possible solutions should be of value to nurses, who have numerous opportunities to encourage patients to initiate and continue therapy. Part I of this article, published in the September/October 2001 issue of Rehabilitation Nursing, described the particular problems of treatment adherence in MS. Part II proposes that the transtheoretical model of behavior change can be a useful tool in achieving both patient acceptance and treatment goals. This model is founded upon the concept that readiness for change is crucial, and that attempts at intervention should be sensitive to the patients' changing conditions and states of mind.

Attitudes toward physician-assisted suicide among persons with multiple sclerosis.

This study was conducted to estimate the level of interest in assisted suicide among persons with multiple sclerosis (MS), the hypothetical conditions under which they would consider assisted suicide, and the factors associated with such interest. The sample of 511 members drawn from the Oregon and Michigan chapters of the National Multiple Sclerosis Society (NMSS) completed a mail questionnaire indicating whether they had ever considered assisted suicide, under what conditions they would consider it, and the correlates of considering assisted suicide. Close to one third of persons with MS in this study had thought about assisted suicide as an option for themselves. One quarter to one half would consider assisted suicide in five hypothetical circumstances, including experiencing unbearable pain, being unable to do things that made them happy, causing financial burden to caregivers or family members, or experiencing extreme emotional distress. Religiosity, social support, depressive symptomatology, MS symptoms, NMSS chapter, years since diagnosis, and gender were associated with some or all of the responses to the hypothetical conditions. The clinical and policy implications of these findings are discussed.

[Comparison of two treatment models in type-II diabetic patients with poor metabolic control: Preformed combination of glibenclamide 2,5 mg + metformin 400 mg or mono-therapy with sulfonylurea at maximal doses? An evaluation at six months]. / Confronto tra due modelli di trattamento in pazienti diabetici di tipo II con cattivo controllo glicometabolico: l'associazione precostituita glibenclamide 2.5+metformina 400 mg oppure la monoterapia con sola sulfanilurea a dosaggi posologici massimali? Valutazione a 6 mesi.

Both glibenclamide and metformin have been used alone or in association for many years. In the treatment of type 2 or non-insulin-dependent diabetes (NIDDM). Glibenclamide stimulates insulin release by pancreatic beta cells (pancreatic attachment point), while metformin acts at a peripheral level by increasing glucose absorption in muscular, fatty and hepatic tissues, thus considerably reducing insulin resistance (extra-pancreatic attachment point). The aim of this study was to evaluate the therapeutic efficacy of the pre-formed association of glibenclamide 2.5 mg+metformin 400 mg (treatment group 1) compared to treatment with glibenclamide 5 mg alone (treatment group 2) at almost double therapeutic doses compared to those contained in the association. A total of 40 NIDDM patients were examined (24 females and 16 males) with a mean age of 55.86 years, a mean duration of disease of 9.37 years, generally obese or overweight. From the final results of the study it was found that the associative therapy of glibenclamide 2.5 mg+metformin 400 mg was very advantageous, leading to a significant improvement in the glycometabolic control (HbA1c and fasting plasma glucose) compared to patients treated using single drug therapy who maintained almost stable control of the disease.

EEG diagnostic and predictive value on HIV infection in childhood.

This prospective study evaluated the electroencephalographic (EEG) diagnostic and prognostic value in childhood HIV infection. It was carried out on 125 subjects and included all Piemonte's seropositive children. The EEG was repeated every three months during the first 15 months of life, and then, at least, annually in the P1 and P2 group. Data of group P2 was compared blindly to that of the seroconverted control group of the same age and risk. EEG results were normal in P0, P1 and control patients. In group P2, EEG was abnormal in 35.5% of subjects, of these 54.6% developed an encephalopathy with a delay of 2.5 months to 2 years 11 months. EEG is therefore useful to evaluate early CNS damage and to identify onset features and evolution of encephalopathy in P2 patients.

Sexuality and multiple sclerosis.

This article addresses sexuality within the context of living with multiple sclerosis (MS). A discussion of MS-related dysfunction is followed by assessment tips and a range of interventions. Psychosocial and societal issues are reviewed as well as practice implications for health professionals.