Bosentan treatment for Raynauds phenomenon and skin fibrosis in patients with Systemic Sclerosis and pulmonary arterial hypertension: an open-label, observational, retrospective study.

Raynaud?s phenomenon (RP) and cutaneous fibrosis are the distinctive manifestations of scleroderma, in which Endothelin-1 plays a fundamental pathogenetic role. Bosentan, an Endothelin-1 receptor antagonist used for the treatment of pulmonary arterial hypertension, retards the beginning of new sclerodermic digital ulcers (DU). This open-label, observational, retrospective study verified the effect of Bosentan on RP and skin fibrosis in sclerodermic outpatients affected by pulmonary arterial hypertension without DU. Fourteen subjects (13 women, 1 man; mean age 60 ± 7.5 years; ten with limited and four with diffuse scleroderma) were observed at baseline (T0) and after four (T1), twelve (T2), twenty-four (T3) and forty-eight (T4) weeks during treatment with Bosentan. They were evaluated for daily quantity and duration of RP attacks and skin thickness (using modified Rodnan total skin score, MRSS). Videocapillaroscopic evaluation was performed at T0 and T4. Bosentan decreased significantly the number and duration of RP attacks, beginning at T2 (p<0.05). Videocapillaroscopy showed significant improvement of microcirculatory patterns at T4 (p<0.05). MRSS decreased throughout the study, reaching the statistical significance at T3 and T4 (p<0.01) in the whole cohort. The present data suggest that Bosentan is effective in stabilizing the microcirculation involvement and in improving skin fibrosis irrespective of scleroderma patterns.

Intestinal microsporidiosis in Italian individuals with AIDS.

A survey on microsporidiosis in individuals with AIDS presenting chronic diarrhoea was carried out in Italy, over a four-year period (1992-1995). Three out of 72 (4.2%) individuals were found positive, on intestinal biopsies, for Enterocytozoon bieneusi by light microscopy and transmission electron microscopy (TEM). Sixteen individuals with AIDS, from a second group of subjects, were confirmed positive, by TEM, for intestinal microsporidiosis due to Enterocytozoon bieneusi. Of these 19 cases, 10 (52.6%) were homosexual men. Two of these individuals, under albendazole treatment, showed also spores with unusual features. The prevalence of intestinal microsporidiosis (12-50%) reported in European countries, Australia and North America, where homosexuality is the major HIV risk factor (63-77%), is higher than in Italy, where homosexual men represent only 16% of the total number of AIDS cases.

Purification and characterization of the staphylococcal slime-associated antigen and its occurrence among Staphylococcus epidermis clinical isolates.

The Staphylococcus epidermidis slime-associated antigen (SAA) was purified and characterized. N-Acetyl-glucosamine accounted for 70% of the dry weight of SAA, which was immunolocalized on the ruthenium red-positive material produced by slime-positive strains. A total of 59% of slime-producing S. epidermidis clinical isolates expressed SAA, while the phenotype slime- SAA+ was never recovered.

Malaria transmission in a central area of Futa Djalon (Guinea): results of a parasitological survey during the 1989 rainy season.

A malaria survey based on household surveys and dispensary visits without notice was carried out during the rainy season of 1989 in three selected areas of central Futa Djalon (Republic of Guinea). Preliminary entomological evidence showed that Anopheles gambiae was the main vector in the area with a CS positive rate of 7.6% and a human blood index of 78% in August 1989. Indoor resting densities were highest in the rural village, lowest in Labé and intermediate in the town of Timbi Madina (median density per room of 18, 2 and 4.5, respectively). The household survey showed different parasite rates in the three areas: 78.2% of children had parasitaemia in Sombili, 45.8% in Timbi Madina and 16.7% in the urban sector of Labé. Prevalence and levels of P. falciparum antisporozoite antibodies were lowest in the urban area (seroprevalence of 51.9% and median titre of 2.4 arbitrary units), intermediate in the town (70.1% and 5.2) and highest in the rural village (78.9% and 5.8). Serological findings produced by dispensary visits were similar to those obtained with the household surveys except in the rural area, while parasitological data obtained with the two sampling methods were different both in rural and in urban areas. Routine malaria diagnosis made on a presumptive basis in the health services in the survey period was able to detect 30.1% of cases with parasitaemia and 53.2% of cases with hyperparasitaemia (sensitivity) and malaria was correctly not suspected in 82.8% of non parasitized people (specificity).

Endocrine, hematological and immunological changes in surgical patients undergoing general anesthesia.

Some hematological endocrine, and immunological reactions in surgical patients under general anesthesia were studied. While serum cortisol, fT4, T4, rT3 levels increased, TBG, TSH, fT3 and T3 decreased. Cortisol increase and T3 and fT3 decrease were still significant three days after surgery. TSH and T3 decrease was significantly related to cortisol increase. CD4 (helper-inducer) cells dropped, rosettes, CD 5, CD 8, CD 16 (NK) and T HLA-DR (activated) number of cells did not change significantly. The decrease in CD 4 subset was significantly related to cortisol increase. Thus surgery was followed by a reduced thyroid function and decreased CD 4 subset. However this was observed also in the few patients in whom the serum cortisol level did not change. These reactions may represent immunosuppression occurring in the postoperative period.

Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in relation to vaginal delivery.

The aim of this study was to evaluate the effect of vaginal delivery on both ACTH and catecholamines (DA, NE, E) secretion in the mother, the fetus (umbilical artery) and the newborn. Blood samples were obtained from 19 normal pregnant women and the corresponding umbilical cords, and from the newborns. Seventeen normal nonpregnant women, matched for age and parity, were also included in the study as "nonpregnant controls". The results demonstrate that in the mother, plasma catecholamines (CA) concentrations during labor and delivery are elevated above the values reported for normal nonpregnant women and there is a predominant E response. The concentrations of CA in umbilical arteries are very high compared to those in the corresponding mother and they fall rapidly after birth. Unlike that in the mother, the predominant CA response to parturition in the fetus and newborn infant is NE. The extraction rate of DA, NE and E from placenta is approximately 60%. The peripheral plasma levels of ACTH in pregnant women during labor are twice and 10 times as high as those observed in the corresponding umbilical arteries and in nonpregnant women respectively. At delivery they increase further. No significant differences are found between the values measured in the arterial cord blood and those in the venous cord blood and in the newborns. A way of explaining the prevalence of E and the higher ACTH/E ratio found in the mother in comparison with the fetus could be that in the mother the stress response to parturition is regulated mainly by the pituitary-adrenal axis, whereas in the fetus there is a prevalent stimulation of the sympathetic nervous system.