Hepatitis B vaccination in haemodialysis patients: an underestimated problem. Factors influencing immune responses in ten years of observation in an Italian haemodialysis centre and literature review.

OBJECTIVES: Despite universal infection control precautions, the risk of hepatitis B virus (HBV) infection in patients on chronic haemodialysis (HD) remains high. For this reason anti-HBV vaccination is recommended in these subjects. In hemodialyzed patients vaccinal response is often suboptimal and it's not clear what factors may influence it. STUDY DESIGN: The aim of our study is to assess the influence of some clinical and laboratory factors on seroconversion rate after anti HBV vaccination in a cohort of patients on maintenance HD. METHODS: We analysed 60 patients on regular HD, 40 men and 20 women (age 64±12 years, range 40-88 years), immunized with Engerix B ® vaccine, followed for an average time of 62 month (12-120 months). For each patient the following data were collected: age, serum albumin (sAlb), Blood urea nitrogen before HD session (BUN), age at vaccination, dialysis vintage, presence of systemic disease, type of vascular access, dialysis modality. Correlation between these factors and anti Hbs titer was estimated with multiple regression analysis. RESULTS: Anti-Hbs seroconversion rate ( Anti Hbs > 10 IU/l) was 77%. Better rate of seroconversion (86%) was observed in patients with arteriovenous fistula (AVF) and serum albumin > 3,5 g/dL (93%), while higher rate of not responders (50%) in patients with systemic diseases. The only parameter correlated to anti Hbs titer was sAlb (p =0,0012). sAlb was correlated to age in all patients (p=0,01) and age was correlated to higher anti Hbs titer in the responder group (p=0,018). DISCUSSION: In our experience an early vaccination, when patients on chronic HD are younger and in better nutritional conditions, improves anti-HBV response.

Immunomodulating treatment with low dose interleukin-4, interleukin-10 and interleukin-11 in psoriasis vulgaris.

Psoriasis is a chronic inflammatory skin disease affecting approximately 2-3 percent of the world population; it is characterised by hyperproliferation and hyperplasia of the superficial layers of the epidermis. Inappropriate signals released by the immune system determine an altered keratinocyte differentiation, resulting in the formation of desquamating, thickened, inflamed and erythematous plaques. The aim of this investigation was to study the pharmacological activity and safety of three low dose cytokines, Guna-Interleukin 4, Guna-Interleukin 10 and Guna-Interleukin 11 at the concentration of 10 fg/ml in patients affected by moderate to slight psoriasis vulgaris. The multicenter, double-blind, randomized, placebo-controlled clinical trial involved 48 patients who were enrolled and followed up according to a 8-month experimental project. All patients received, according to a cross-over model, either the experimental treatment or placebo, alternatively. Globally, in the 41 evaluated patients it was observed a PASI significant reduction (Friedman test: p=0.00960). The DLQI too decreased significantly in all subjects compared to baseline (Friedman test: p=0.00007). The safety of the treatment with three low dose cytokines administered simultaneously was proved; no adverse event was reported during the whole trial.

[Study on the activity of a therapeutic bacterial combination in intestinal motility disorders in the aged]. / Studio sull'attività di un'associazione batterioterapica nei disturbi dell'alvo dell'anziano.

The possible beneficial effects and changes in the histology of the duodenojejunal and colonic mucosa brought about by oral bacterial therapy were studied in 60 elderly patients (mean age +/- SD: 76.6 +/- 5.3 years) with bowel disorders mainly represented by diarrhea accompanied by abdominal pain and meteorism. All patients were submitted to a 7-day washout followed by treatment with 6 capsules daily, each capsule containing live, lyophilized Lactobacillus acidophilus (10(9) CFU/ml). The clinical course was observed in 50 patients while the remaining 10 were hospitalized and submitted to esophago-gastro-duodenoscopy and colonoscopy both before and after treatment for withdrawal of duodenal secretion and fragments of duodenojejunal and colonic mucosa biopsies. Duodenal secretion was examined bacteriologically, and after treatment an increase of the anaerobic flora at the expense of the aerobic one was found together with improved quality of the former. Histologic examination showed reduction of the inflammatory infiltration by lymphocytes and plasma cells and increased muciparous activity of the glands. Clinically, a marked improvement of the symptoms was observed in all 60 patients.

[Food allergy in asthma. Diagnostic significance of peripheral eosinophils]. / Allergia alimentare nell'asma. Significato diagnostico degli eosinofili periferici.

Thirty one patients with suspicion of asthma due to food allergy (lack of correlation between allergic sensitivity and asthmatic attacks, association of clinical features suggestive of food allergy, no response to the pharmacological treatment) received an elimination diet. A second group (control group) of 51 asthmatic patients were enrolled in the study for a better evaluation of the diagnostic significance of blood eosinophil counts in food-induced asthma. 29-31 patients who took a variable oligoallergenic diet had a baseline blood eosinophilia greater than 600/mm3 (range 600-2100/mm3). Eosinophil count after an appropriate diet showed an early significant fall which preceded the improvement of symptoms. Only 10 patients had not a valuable improvement from the diet. The post diet change of spirometric values was significant. There was no significant difference between subjects with an eosinophil count greater than 1000/mm3 vs. less than 1000/mm3 with regard to both inhalant and food skin prick tests. On the other hand, the group with blood eosinophilia greater than 1000/mm3 had a significant correlation with the presence of persistent asthma (persistent alteration of forced expiratory volumes verified in asymptomatic phases of the disease) as with the anamnestic or actual report of eczema or other clinical manifestations of food allergy. Blood eosinophil count showed to be essential in the management of patients with a suspicion of asthma due to food allergy.

Continuous subcutaneous insulin infusion: a long-term study.

The authors report data obtained from a 3-year study of CSII and humanized insulin (semi-synthetic human insulin) administered to 18 insulin-dependent subjects in the outpatient clinic. The aim of this study was to evaluate the validity of insulin pumps in long-term treatment. Metabolic parameters were significantly improved (p less than 0.001) in the first month and remained so with only slight alterations throughout treatment. The authors underline some metabolic problems (ketosis) caused by malfunctioning of the insulin pumps, by the difficulties with the infusion system or by nodular skin lesions at the infusion site. Only these lesions called for treatment to be discontinued in 4 patients. The highest incidence of nodular skin lesions was seen after one year's uninterrupted treatment and they seem connected to the duration of treatment rather than to the patients' negligence (inadequate hygiene, delayed needle substitution). The authors conclude that CSII treatment is valid over short-term periods, whereas it presents drawbacks over long-term administration.

Diabetes in the elderly: remarks from an epidemiological study carried out in a town in south-eastern Sicily (Militello V.C.).

Longer mean life span and life expectancy of diabetics and increased factors that favor onset of type II diabetes have determined greater prevalence of diabetes in the elderly population. According to HANES II, it is 17% in the elderly in U.S.A. We carried out an epidemiological study on the over 65 year olds in Militello V.C. and examined 910 elderly subjects (72.05% of the total elderly population). All were tested for peripheral fasting blood glucose, body weight and height and filled out a questionnaire with general and diabetological questions. The values recommended by the NDDG were used to diagnose diabetes. One hundred and sixty-one diabetics (25 newly diagnosed) were observed (17.69%). Onset had occurred before age 65 (aged diabetics) in 72 cases and after 65 in 89 (senile diabetics). Mean blood glucose was 152.91 +/- 55.56 mg/dl. Our results indicated that sulfonylureas and/or biguanides are first choice treatment. By grouping the diabetics on the basis of age at onset and duration of disease, a fall in the number of cases treated with diet alone and hypoglycemic drugs and an increase in patients on insulin were seen in aged diabetics as the disease evolves. On the contrary, there was a rise in the number of senile diabetics on hypoglycemic drugs.

A case-control study of Salmonella gastrointestinal infection in Italian children.

A case-control study of 85 cases with non-typhoid Salmonella gastroenteritis, 85 outpatient controls and 79 inpatient controls was conducted among children in Monfalcone, north-east Italy, between June 1989 and June 1994. Logistic regression was used to evaluate the effect of demographic and socio-economic characteristics, duration of breastfeeding, history of intestinal illnesses and household diarrhoea, and the recent use of antimicrobials. Breastfeeding was the single most important factor associated with a 5-fold decreased risk of Salmonella infection. In addition, children who were treated with antimicrobials before onset of gastroenteritis had a 3-fold increased risk. Low social class and history of other chronic non-infectious intestinal diseases were also directly associated with illness.

Cisapride and gastric emptying of a solid meal in dyspeptic diabetics without autonomic neuropathy and in healthy volunteers.

Gastric emptying was studied in 10 insulin-treated, long-standing, diabetic out-patients with upper gastrointestinal, dyspeptic symptoms. Autonomic neuropathy, mucosal lesions and chloropeptic hyposecretion were excluded. Gastric emptying of a labelled solid meal (99mTc-sulphur colloid-infiltrated chicken liver) was clearly delayed by comparison with normal subjects: the mean gastric emptying half-time was almost 5-times longer (245.6 vs 52.5 min), and the gastric emptying rate at 120 min was 75% slower. Cisapride 10 mg i.v. significantly accelerated both parameters, and placebo had no effect upon them. In conclusion, gastroparesis may be present in diabetics without autonomic neuropathy, and cisapride may improve gastric emptying in such patients.