Hepatitis C virus outbreak in a haemodialysis unit: learning from failures.

The investigation of an outbreak of hepatitis C virus in an Italian haemodialysis (HD) centre showed that three patients acquired infection with the same strain, affecting a chronically hepatitis C virus (HCV)-infected patient receiving HD in the same room and during the same shifts. Through our observational analysis many possible modes of transmission were identified, but none could be definitively identified as the route of HCV spread in this small cluster. This outbreak confirms that repeated opportunities for nosocomial HCV transmission may occur among HD patients due to several breaches in the standard precautions for bloodborne infections by healthcare staff.

Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country.

A contact investigation following a case of infectious tuberculosis (TB) reported in a call centre in Milan (Italy) led to the identification of three additional cases that had occurred in employees of the same workplace during the previous 5 years, one of whom was the probable source case. Thirty-three latent infections were also identified. At the time of diagnosis, the source case, because of fear of stigma related to TB, claimed to be unemployed and a contact investigation was not performed in the workplace. Cases were linked through genotyping of Mycobacterium tuberculosis. TB stigma has been described frequently, mainly in high-incidence settings, and is known to influence health-seeking behaviours and treatment adherence. The findings in this report highlight that TB-associated stigma may also lead to incomplete contact investigations. Little is known about the causes and impact of TB-related stigma in low-incidence countries and this warrants further exploration. Research is also needed to evaluate the effectiveness of specific interviewing techniques and training interventions for staff in reducing feelings of stigma in TB patients. Finally, the outbreak emphasizes the importance of integrating routine contact investigations with genotyping.

Steroidogenesis, proliferation and apoptosis in bovine granulosa cells: role of tumour necrosis factor-alpha and its possible signalling mechanisms.

This study was designed to investigate the presence of bioactive tumour necrosis factor-alpha (TNF-alpha) in bovine fluid collected from small (<5 mm) and large (>8 mm) follicles, as well as the production of the cytokine by the granulosa cells collected from the same type of follicles. Moreover, the effectiveness of 10, 1 and 0.1 ng mL(-1) of human TNF-alpha (hTNF-alpha) in affecting the main parameters of granulosa cell function, progesterone (P4) and oestradiol-17beta (E2) production, cell proliferation and apoptosis, was tested. In addition, the study aimed to determine whether the signalling mechanisms of TNF-alpha in these cells involve cAMP, nitric oxide or prostaglandin E2 (PGE2) and F2alpha (PGF2alpha). It emerged that bioactive TNF-alpha is present in follicular fluid from both types of follicles and can be measured in media conditioned by granulosa cells from large follicles. As for the effects of hTNF-alpha, it inhibits P4 production in cells from both types of follicles and stimulates E2 output in those from small follicles; it does not affect proliferation, but it stimulates granulosa cell apoptosis. Finally, the effects of hTNF-alpha on bovine granulosa cells are not mediated by nitric oxide or cAMP, as neither of these substances were affected by treatment with the cytokine; however, in some way, they could be mediated through PGE2 and PGF2alpha, the production of which was inhibited by TNF-alpha in cells from small follicles.

Cerebral effects of hyperbaric oxygen breathing: a CBF SPECT study on professional divers.

We investigated the effects on cerebral blood flow (CBF) of pure oxygen breathing exposure during dives in a group of professional divers, in both the normobaric (NBO) and the hyperbaric oxygen (HBO) breathing conditions. Using single photon emission computerized tomography (SPECT) and Tc-99m hexamethylpropylenamine oxime (HM-PAO), we studied 10 young divers and six normal volunteers. Divers were studied by SPECT in the NBO and HBO conditions, in two different sessions. The HBO state was obtained in a hyperbaric chamber at 2.8 ATA for 15 min. By ANOVA, we did not observe any significant difference in CBF distribution between controls and divers in both NBO and HBO conditions. By individual analysis, divers showed a decreased CBF in a total of 33 regions of interest (ROIs) during NBO and 46 ROIs during HBO with respect to control values. In particular, two divers showed a remarkable increase in the number of hypoperfused ROIs during HBO (+7 and +5 ROIs, respectively). Pure oxygen breathing exposure in young divers is associated with a patchy distribution of brain areas of hypoperfusion. This phenomenon is more pronounced in the HBO state than in the NBO state. Further studies on CBF are needed to help identify divers potentially prone to harmful oxygen effects.

Leptin regulates GH gene expression and secretion and nitric oxide production in pig pituitary cells.

The aim of this study was to investigate the direct effect of leptin on GH gene expression and secretion and the role of nitric oxide as a possible mediator in pig anterior pituitary cells. Pituitary cells from adult sows were treated for 4 or 24 h with rhleptin (from 0.1 nM to 1 microM) alone or in association with GHRH (10 nM) or hexarelin (10 nM). At the end of incubation, medium was collected for GH and nitric oxide determination by ELISA and Griess test, respectively. Total RNA was collected from cells, and GH gene expression was measured by RT-PCR. Leptin significantly (P < 0.001) stimulated GH secretion in both incubation periods. The maximum response was induced by 10 nM leptin; furthermore, a significant interaction (P < 0.002) between leptin and GHRH (P < 0.03) and between leptin and hexarelin was observed when the molecules were used in association. GH gene expression was significantly increased (at least P < 0.05) by hexarelin, GHRH, and leptin (1000 and 100 nM) after 24 h of treatment. Leptin (10 nM and 1 microM) significantly (P < 0.05) increased nitric oxide production, whereas S-nitroso-N-acetyl-penicillamine (from 0.01-1000 nM) significantly (P < 0.05) stimulated GH secretion. These data demonstrate that leptin directly influences GH regulation at the pituitary level, and nitric oxide may be involved in this function.

IGF-I, IGFBP-2 and -3 but not GH concentrations are different in normal and poor growing piglets.

In this study we investigated the somatotropic axis in piglets with evident growth delay. Female Suffolk crossbred piglets (30 days old; N = 12) were divided into normal weight (10 +/- 0.9 kg) and poor growing subjects (7 +/- 0.5 kg) and bled for growth hormone (GH), Insulin-like growth factor-I (IGF-I), Insulin-like growth factor binding protein 2 and 3 (IGFBP-2 and -3) determination. Basal and induced-GH levels were not different in the groups. Plasma IGF-I concentrations were significantly different (p < 0.001): 101.8 +/- 9.8 ng x mL(-1) (normal weight group) and 39.5 +/- 4.0 ng x mL(-1) (poor growing group). IGFBP-2 and -3 concentrations were significantly (p < 0.001) lower in poor growing than in normal piglets. Piglet weight was positively correlated (r = 0.98, p < 0.001) with IGF-I and IGFBP-2 or -3 concentrations. Our data indicate that growth rate was not correlated to basal or secretagogue-induced GH secretion.

Analysis of cerebral bioelectrical activity during the compression phase of a saturation dive.

Considering previous studies on EEG brain mapping in the course of saturation dives, the authors studied the same standards of EEG performance during the compression phase of a saturation dive reaching -250 m. An increase of theta and beta rhythms was observed, especially in the midline anterior regions of the brain, during the entire compression period, while an increase of delta activity was noted only at -100 m. These results confirm our hypothesis that the compression profile is physiologically correct, because the EEG modifications decreased during the stay at maximum depth.

[Influence of the early mother-infant contact in the delivery room on short or long term breast feeding]. / Influenza del contatto precoce madre-figlio in sala parto sull'allattamento al seno a breve e lungo termine.

Two groups of mothers and their children were followed up in order to assess the influence of early mother-child contact on breast-feeding; a first control was carried out at discharge from the nursery and a follow-up 6 months later. All the mothers were in good health and pregnancy was physiological with uncomplicated eutocic delivery; none of the babies presented pathologies during the period of their stay in the nursery and in the subsequent 6 months. Group A comprised 126 mothers who had had contact with their babies in the delivery room for at least one hour; group B comprised 109 mothers whose first contact with their baby was only 3-6 hours after birth. Significant differences between the 2 groups were observed as early as the first control which took place at discharge from the nursery: 69.1% of the babies in group A against 51.3% in group B had taken mother's milk exclusively (p < 0.01). Equally significant differences emerged from the subsequent control at 6 months: 70 babies out of 116 (60.4%) were breast fed exclusively or partially, against 42 out of 101 (42.4%) in group B (p < 0.01). Furthermore, important data emerged from the duration of breast-feeding, whether this was exclusive or otherwise, in the first 6 months of life: group A differed significantly from group B (p < 0.002). Our figures suggest a positive influence of early mother-child contact on breast-feeding and on its duration. Notwithstanding the fact that there is no unanimous confirmation in the literature, it is considered that such behaviour will bring benefits to both mother and child.

Fetoneonatal hydrops from human parvovirus B19. Case report.

Authors report the case of a newborn who died just a few hours after the birth as a result of intrauterine Parvovirus B19 infection. Diagnosis of fetal hydrops was made by ultrasound examination at the 25th week of pregnancy. Etiology was established on the basis of specific antibody findings in the serum of the mother, the fetus (by cordocentesis), and the neonate; B19 virus was then observed in the fetus and the neonate tissues after death using the dot-blot hybridization assay and the polymerase chain reaction technique for viral DNA. The severe fetal anemia was treated with intrauterine transfusions, but achieved poor results. The pathogenesis of fetal hydrops and advisability of intrauterine treatment in such cases are discussed.

[Acute fetofetal transfusion in dichorionic twins: a clinical case report]. / Transfusione feto-fetale acuta in gemelli bicoriali: descrizione di un caso clinico.

Fetofetal transfusion is due to the twin to twin blood shunt caused by vascular anastomoses. It has been suggested that two types of FFT exist: a chronic form existing during pregnancy, and an acute form occurring only during parturition. Cross-circulation may be demonstrated in monochorionic as well as dichorionic placentas. However, such communications were found in 85-100% of monochorionic placentas, compared with one of 68 dichorionic fused placentas. Authors describe one case of acute feto-fetal transfusion in dichorionic twins.

[Double hydatid cyst of the liver, one of them with a fistula and causing stenosis of the pyloric canal associated with calculous cholecystitis]. / Cisti di echinococco duplice del fegato, una fistolizzata e provocante stenosi del canale pilorico ed associazione di colecistite calcolosa.

A case of double hydatid cyst of the liver (one fistulised into the pyloric canal where it had caused stenosis) and its association with calculous cholecystitis is reported. The therapy chosen to treat this rare phenomenon had a very satisfactory outcome in view of the complexity of the case given the need to perform several operations in contemporary (enucleation of the cyst, gastric resection and cholecystectomy) and the age of the patient.

[Treatment of acute cholecystitis and its complications]. / Terapia della colecistite acuta e delle sue complicazioni.

Forty cases of acute cholecystitis and its complications have been reviewed. Examination of the literature and a study of the personal series leads to a discussion on the need or otherwise for early surgery, particularly in those patients in whom a more unfavourable course for the clinical picture can be objectively presumed.

Further steps toward a neonatal chronocardiology.

The study of 53 series of blood pressures at half-hour intervals from clinically healthy full-term newborns during the first days of life reveals various classifiers correlating with a history of high blood pressure: the circadian amplitude of diastolic blood pressure, the 50% range of systolic blood pressure and the standard deviation of heart rate.

Circadian variability of blood pressure and heart rate in newborns and cardiovascular chronorisk.

At present, neonates are being given screening tests for relatively rare diseases, such as phenylketonuria. The time has come to give emphasis to assessing the risk for major handicapping diseases, such as coronary heart disease, stroke, and certain diseases of the kidney. Modern technology for blood pressure and heart rate monitoring and data analysis provides noninvasive means to determine when preventive measures are indicated.

Glycosilated fetal hemoglobin in neonates of diabetic mothers.

In diabetic patients, the correlation between glycosilated adult hemoglobin (HbA1c) levels and average glucose concentration over the preceding weeks is well known. We have, therefore, sought the possibility to identify newborns at risk measuring cord blood levels of fetal glycosilated hemoglobin (HbF1) in neonates of diabetic mothers. HbF1 was tested by the isoelectrofocusing method. Mean values of HbF1 have been proven to be higher in in infants born to diabetic mothers as compared to normal newborns. The highest levels were encountered in those babies whose mothers had shown a poor glycemic control during the last few weeks of pregnancy.