Glomerular filtration rate is associated with trabecular bone score in patients with type 2 diabetes mellitus.

AIMS: The present study aimed to evaluate the trabecular and cortical bone components using Trabecular Bone Score (TBS) and its association with estimated-Glomerular Filtration Rate (e-GFR) in T2DM patients. METHODS: An assessment both of bone mineral density (BMD) and vertebral bone microarchitecture was performed in all patients using TBS iNsight® software version 3.0.2.0. Furthermore, the total population was divided into two groups based on the value of the eGFR (eGFR < o > at 60 ml/min/1.73 m2). RESULTS: TBS value was lower in patients with low e-GFR than that in patients with higher e-GFR (1.246 ± 0.125 vs 1.337 ± 0.115, respectively, p = 0.013 adjusted by gender and age) while there was no difference in total BMD value between two groups. In the multivariate model taking into account several possible confounders, such as age, gender, duration of diabetes, BMI, LDL cholesterol, serum calcium and HbA1c, the correlation between e-GFR and TBS remained significant (p: 0.046). CONCLUSIONS: In individuals with T2DM and reduced kidney function, TBS provides information independent of BMD, age and gender. TBS may be a useful additional tool to predict fracture risk in this unique population.

[Hospital care for acute stroke at the Palestrina hospital: comparison of cost and quality of care with an "hospital at home" care model]. / Analisi dei ricoveri ospedalieri per patologia cerebrovascolare nell'Ospedale di Palestrina (RM): confronto dei costi e della qualità assistenziale con un modello di Ospedalizzazione Domiciliare.

INTRODUCTION: In the Lazio Region (Central Italy) the Emergency Care network has been recently re-arranged in order to improve the effectiveness of care. The aim of this paper is to assess the impact of stroke patient care on both cost and organization of the hospital of Palestrina (Lazio Region). METHODOLOGY: An analysis of cost and path of care of all stroke patients (239) with stroke attending the hospital in 2010 has been carried out. RESULTS: The care was more expensive than the one offered to the stroke patients attending the "Hospital at Home" service managed by the San Giovanni Battista Hospital in Turin; moreover the care was incomplete because of the lack of rehabilitation services in the hospital catchment area. CONCLUSION: The care model offered to stroke patient hit by stroke in Palestrina needs to be deeply revised.

Autonomic dysfunction and neuropeptide Y in fibromyalgia.

OBJECTIVES: Fibromyalgia (FM) is a syndrome associated with widespread pain and various other signs and symptoms. Several of these multisystem features could be explained on the basis of autonomic nervous system (ANS) dysfunction. METHODS: The aim of the present study was to evaluate ANS dysfunction in FM based on time-domain heart rate variability (HRV) analysis and serum neuropeptide Y (NPY) levels in 51 patients with FM, 25 patients with systemic sclerosis (SSc), and 15 healthy controls (NHS). RESULTS: Compared with the SSc and NHS groups, the FM group had significantly higher NPY levels, and in the FM subgroup subjected to HRV analysis (25/51 patients, 49%), certain HRV indices were significantly reduced. In this subgroup, NPY was significantly correlated with the SDANN index and the NN50, but neither NPY or HRV parameters showed any significant correlation with clinical aspects of the FM. CONCLUSION: These findings suggest that autonomic dysfunction and NPY are crucial elements in the pathophysiology of FM. Additional studies are necessary to define the complex roles played by NPY and ANS in modulating pain and immunological functions of different diseases.

Desloratadine in combination with montelukast in the treatment of chronic urticaria: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Chronic urticaria (CU) is a common skin condition. It is frequently a disabling disease due to the persistency of clinical symptoms, the unpredictable course and negative influence on the quality of life. OBJECTIVE: The aim of this study is to determine whether montelukast, a LTD4 receptor antagonist, plus desloratadine, is more efficacious than desloratadine alone in the treatment of chronic urticaria. MATERIALS: A randomized, double-blind, placebo-controlled study was conducted on 81 patients with a diagnosis of CU. A 1-week single-blind placebo run-in period (baseline) was followed by a 6-weeks double blind active treatment period. The patients were randomized to receive the following treatment once daily: (a) oral desloratadine (5 mg) plus placebo; (b) desloratadine (5 mg) plus montelukast (10 mg); (c) oral placebo alone. The study ended after another 1-week single-blind placebo washout period. RESULTS: The evaluable population thus consisted of 76 patients. Both desloratadine alone and desloratadine plus montelukast administered once daily yielded improvements with respect to the baseline assessment as regards pruritus, number of separate episodes, size and number of weals, visual analogue score and patients' quality of life and with respect to the placebo group both in the active treatment period and in the run-out period. However, desloratadine plus montelukast was shown to improve the symptoms and patients' quality of life significantly more than desloratadine alone, although it did not have a significant effect on the number of urticarial episodes. CONCLUSION: The combination of desloratadine plus montelukast is effective in the treatment of CU. It may therefore be a valid alternative in patients with relatively mild CU, in view of its efficacy and the lack of adverse events.

Tissue damage and haematophagia due to praniza larvae (Isopoda: Gnathiidae) in some aquarium seawater teleosts.

Over a 5 yr period, severe infestations due to Gnathia vorax larvae affecting different teleosts have been registered at the Civic Aquarium of Messina, Italy. Here, the damage caused by these parasites is evaluated from a macroscopical and histopathological point of view. We also attempt to evaluate the amount of blood sucked up by a single parasite and make some observations about the haematophagia. The histopathological changes confirm mucosal electrolytic failure as the main problem, even though the mean value of blood sucked up by a single parasite, about 1.9 mg, suggests that haematophagia may play an important role in the pathogenesis of such infestation. In conclusion, it was found that the G. vorax larvae caused 2-fold damage that was responsible for the death of the fish. Little by little, the parasitic problem was successfully removed by washing the tank, using fresh water rather than costly and dangerous chemotherapeutans.

Erectile dysfunction after kidney transplantation: our 22 years of experience.

AIM: To evaluate the results of treatment of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil. MATERIALS AND METHODS: From 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. Before sildenafil use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases. RESULTS: From 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response to sildenafil (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects of sildenafil and PGE1 therapy were similar to those reported in the literature. CONCLUSIONS: ED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with sildenafil citrate and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases.

Results of standard series patch testing in patients with occupational allergic contact dermatitis.

BACKGROUND: In the workplace, the skin is at high risk of exposure to chemicals and other contaminants, and occupational dermatitis is an important field of study. METHODS: We evaluated 230 patients referred to our clinic because they were affected by dermatitis suspected to be of occupational and allergic origin. They were tested with the allergens of the GIRDCA standard series, and with supplementary series when indicated. RESULTS: Among the 230 subjects, 49 were positive only to supplementary series (26.3% of all allergic contact dermatitis), while 130 (69.9% of all allergic contact dermatitis) were considered to have an occupational allergic contact dermatitis diagnosed by the standard series alone. The most frequent occupations of the patients were health care workers and hairdressers/beauticians. The most common agents responsible for occupational allergic contact dermatitis were metals and para-phenylenediamine. CONCLUSIONS: As the standard series detected a relatively low proportion of occupational allergic contact dermatitis, it is not adequate to recognize an occupational allergic contact dermatitis, certain supplementary series should also to be tested. However, even if such occupational series are used, we remain likely to continue to underestimate the frequency of occupational allergic contact dermatitis, because workers come into contact with a large number of substances that are often unknown.

Light and scanning electron microscopy observations on Gnathia vorax (Isopoda: Gnathiidae) larvae.

A large population of gnathid isopods (Crustacea) has been observed on sea water teleost fishes coming from the Civic Aquarium of Messina (Italy). Gnathiidae are parasite of fishes only at the stage of praniza, while adults are free living. Several teleosts, reared in captivity at the Civic Aquarium of Messina were sent for parasitological examination over a period of three years. Numerous parasites, identified as pranizae of Gnathiidae, were found on dorsum, on dorsal, pectoral and caudal fins, as well as in oro-pharyngeal cavity and gills of the affected fishes. The cranial part of an exuvie of adult male belonging to Gnathia sp. was also found on the floor of the tank. Because adult parasites are rarely detected in the sand bottom, the taxonomic identification is based on the morphological characteristics of larvae, even if it is very hard to show interspecific differences among gnathiids. For this reason, the morphological study was performed also by SEM to better show the surface details with taxonomic meaning. One to five mm long pranizae had a flattened body characterised by a head followed by 5 thoracic and 6 abdominal segments and a caudal plate with two biarticulated uropods. In the oral part of the head there was a ventrally oriented and smooth trapezoidal rostrum. Oral appendages, not clearly visible by light microscopy, were: a) two jaws with denticulate internal sides longer than the rostrum; b) a single ipostoma apically divided into two long appendixes; c) long and thin maxillae, with denticulate distal margins; d) two paired maxillipedes showing ciliate internal side that reaches the extremity of buccal cone; e) two big gnatopods with apical nail. Flagellum of antennulae had 7 articles. Telson was triangularly shaped, longer than large, with truncated apex having two apical bristles. Uropods were short with rounded internal angle and were provided by smooth and plumose setae; endopod was larger than exopod. The jaw of the adult gnathiid male, studied only by light microscopy, was solid, with oblique and denticulated blade; long and thin apex; rounded internal lobe; prominent external spur. Morphological characteristics of the jaw of the adult male and the shape of larvae permitted us to identify our specimens as Gnathia vorax (Lucas, 1850).

Unitubulotestis sardae (Trematoda: Didymozoidae) infection in Atlantic bonito Sarda sarda (Perciformes: Scomberomoridae) in the Ionian and Tyrrhenian Seas: histopathological and SEM investigations.

Nematobothrinae are trematoda digenea that usually live in cysts in fish tissues. They have been reported in different teleost species although the host-parasite relationships remain to be elucidated. This report is aimed at analysing the presence of Unitubulotestis sardae in the Atlantic bonito (Sarda sarda) populations fished in the Straits of Messina. The histopathological change reported in literature in similar cases is an aneurisma verminosa saccata, whereas, in the specimens here described, we show neovascularisation and at the same time, hyperplasia of the gill epithelium, leading to the formation of a bistratified cystic wall. The SEM examination of the parasitic cysts gave us a better understanding of the surface microanatomical details of the cystic walls. The external surface appeared to be constituted by a pluristratified covering epithelium of the gill arch. The internal layer was constituted by a net of blood vessels richly anastomosed with those originating from the gill arch arteries. This could be in agreement with data reported by Grabda (1947) on the localisation of the juvenile stages of the parasite in this blood vessel, but the evolution in cysts formation does not show similarities with the formation of an aneurisma.

Prevalence and clinical features of skin diseases in chronic HCV infection. A prospective study in 96 patients.

BACKGROUND: Between extra-hepatic manifestations of hepatitis C virus (HCV) infection particular interest is focused on some dermatological diseases such as: leukocytoclastic vasculitis, oral lichen planus, pruritus-urticaria, psoriasis, etc. The aim of this study was to determine the prevalence of some dermatoses in our population of patients with HCV infection and describe the more characteristics clinical pictures. METHODS: Ninety-six patients (36 men and 60 women) aged from 35 to 74 years with HCV documented by 3rd generation ELISA and RIBA tests were prospectively examined for 3 years to determine the prevalence of some skin disorders, reported as associated with HCV infection. All patients were also studied for presence and quantification of HCV-RNA by polymerase chain reaction and genotyping when possible. Eighty-one underwent a liver biopsy. Routine laboratory tests and some immunological investigations (ANA, AMA, SMA, LKM, ANCA, ICC, crioglobulins) were performed using standard procedures and indirect immunofluorescence, nephelometric, RIA methods. RESULTS: Twelve of 96 patients (12.5%) presented skin disorders in progress of chronic virus C hepatitis: 5 cases of leukocytoclastic vasculitis (LCV) by mixed cryoglobulinemia, 1 case of pruritus, 2 cases of oral lichen planus (OLP), 2 cases of alopecia areata, 1 case of urticaria, 1 case of psoriasis. CONCLUSIONS: Our findings show a calculated prevalence of clinical dermatoses in HCV infected patients around 12.5%. These findings confirm however the importance of liver examination in presence of skin diseases not related to other pathogenetic mechanisms.

[Rationale for the use of renin-angiotensin inhibitors in the treatment of arterial hypertension and correlated organ damage]. / Razionale per l'uso degli inibitori del sistema renina-angiotensina nella terapia dell'ipertensione arteriosa e del danno d'organo correlato.

The treatment of hypertension has evolved in recent years. Blood pressure lowering per se is no longer a sufficient parameter to evaluate its beneficial effects on end-organ damage. Drugs must be considered on the basis of their effects on cellular level and structural alterations that occur in the vasculature, heart and kidney. Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, two classes of drugs that inhibit angiotensin II effects, may protect target organs from damage and thereby improve outcomes. The mechanisms of action are different even if both counteract all noxious effects of angiotensin II. Angiotensin II receptor blockers selectively inhibit AT1 receptors whose stimulation mediates the hypertensive and proliferative effects of angiotensin II while do not interfere with AT2 receptors. These last ones have a role not well established but it has been postulated that they have antihypertensive and antiproliferative effects. A review will be made on the cellular mechanisms of angiotensin II activity and the effects of AT receptor antagonists.

What visual perception tells us about mind and brain.

Recent studies of visual perception have begun to reveal the connection between neuronal activity in the brain and conscious visual experience. Transcranial magnetic stimulation of the human occipital lobe disrupts the normal perception of objects in ways suggesting that important aspects of visual perception are based on activity in early visual cortical areas. Recordings made with microelectrodes in animals suggest that the perception of the lightness and depth of visual surfaces develops through computations performed across multiple brain areas. Activity in earlier areas is more tightly correlated with the physical properties of objects whereas neurons in later areas respond in a manner more similar to visual perception.

Lightness constancy in primary visual cortex.

When the illumination of a visual scene changes, the quantity of light reflected from objects is altered. Despite this, the perceived lightness of the objects generally remains constant. This perceptual lightness constancy is thought to be important behaviorally for object recognition. Here we show that interactions from outside the classical receptive fields of neurons in primary visual cortex modulate neural responses in a way that makes them immune to changes in illumination, as is perception. This finding is consistent with the hypothesis that the responses of neurons in primary visual cortex carry information about surface lightness in addition to information about form. It also suggests that lightness constancy, which is sometimes thought to involve "higher-level" processes, is manifest at the first stage of visual cortical processing.

Evaluation of myocardial involvement in systemic lupus erythematosus by signal-averaged electrocardiography and echocardiography.

OBJECTIVE: The myocardial involvement in systemic lupus erythematosus (SLE) patients, frequently found at autopsy or at endomyocardial biopsy, is less easily detected clinically. The myocardial lesions are characterized by an increase in interstitial connective tissue and myocardial scarring. Signal-averaged electrocardiography (ECG-SA) is currently used for recording ventricular late potentials which are the expression of slowed and disorganized conduction through zones of myocardial scarring. M-mode, two-dimensional and Doppler echocardiography (ECHO) represent relatively simple methods for evaluating the left ventricular function. This study was aimed to evaluate by ECG-SA and ECHO the myocardial involvement of SLE patients without clinical and electrocardiographic evidence of cardiac disease. METHODS AND RESULTS: Twenty outpatients with SLE were studied and compared with 18 normal controls. Late potentials were recorded in 20% of SLE patients and in 5.5% of controls. A significant increase of abnormal left ventricular diastolic filling was found in the SLE patients, characterized by reduced E/A (p = 0.018), a lower deceleration rate of early diastolic flow velocity (p = 0.048) and a prolonged isovolumic relaxation time (p = 0.001). SLE patients had diastolic dysfunction of various degrees although the depolarization abnormalities detected by ECG-SA were found only in a few subjects. CONCLUSIONS: The depolarization abnormalities, revealed by ECG-SA, probably reflect a longer extent of myocardial fibrosis in SLE patients with ECHO evidence of abnormal left ventricular filling. The simultaneous occurrence of ECHO and ECG-SA alterations could be a marker of subclinical myocardial involvement.

Diastolic function abnormalities in rheumatoid arthritis. Evaluation By echo Doppler transmitral flow and pulmonary venous flow: relation with duration of disease.

OBJECTIVE: The aim of this study was to evaluate left ventricular filling in patients with rheumatoid arthritis (RA), analysing transmitral flow and pulmonary venous flow, with special regard to age and disease duration. METHODS: 32 patients affected by RA according to ARA criteria were selected, without evidence of cardiac disease, and compared with matched control subjects. All patients and the control group were submitted to M-mode, two dimensional, Doppler and colour Doppler (continuous and pulsed wave) echocardiography. The following diastolic parameters were evaluated: transmitralic flow (E/A ratio), pulmonary venous flow (S/D ratio), a-Pw, IVRT and DT. RESULTS: In RA patients left ventricular filling abnormalities were found characterised by a reduced E/A ratio (mean (SD) 1.16 (0.31) v. controls 1.37 (0.32); p = 0.02) and an increased S/D ratio (1.43 (0.40) v. controls 1.22 (0.29); p = 0.017). In the group of patients a relation was found between E/A ratio and disease duration (r= 0.40, p = 0.01 Spearman rank correlation). CONCLUSIONS: At present, it is concluded that RA patients, in absence of clinical evidence of heart disease, show diastolic dysfunction characterised by impaired E/A and S/D ratio. The relation between transmitral flow alteration and disease duration suggests a sub-clinical myocardial involvement.