Biological and clinical effects of anti-TNFalpha treatment.

Tumor necrosis factor alpha (TNFalpha) is implicated in the pathogenesis of many chronic inflammatory diseases such as rheumatoid arthritis (RA), psoriasis and psoriatic arthritis (PsA), ankylosing spondylitis (AS), Crohn's disease, ulcerative colitis and uveitis. The availability of new pharmacological agents (infliximab, etanercept, adalimumab), able to selectively block the TNFalpha, has recently offered new opportunity for the treatment of these diseases. TNFalpha antagonists are different in the mechanism of action and are all effective agents in the treatment of RA and several chronic inflammatory diseases as a large number of controlled clinical trials have shown. Among biological effects of TNFalpha antagonists, the production of autoantibodies has been emphasized. This phenomenon is not correlated with the disease background, since anti-nuclear antibodies (ANA) and anti-double stranded-DNA antibodies (anti-dsDNA) induction is observed in RA as well as in spondyloarthritis (SpA) patients. Nonetheless, recent studies had reported a significant reduction in the serum titre of rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide antibodies (anti-CCP) during anti-TNFalpha therapy. The TNFalpha antagonists represent a significant advance in the therapy of active RA and other chronic inflammatory diseases. However, they have distinct biological, clinical, and pharmacological properties that must be considered when selecting a drug for therapy.

Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders.

BACKGROUND AND AIMS: Though low levels of insulin-like growth factor-1 (IGF-1) have been repeatedly reported in patients with eating disorders, the nutritional significance of IGF-1 has not been evaluated. The study aimed to assess the utility of IGF-1 for screening malnutrition and for monitoring nutrition intervention in patients with eating disorders. METHODS: IGF-1 and nutritional status were evaluated in 82 patients, 59 with anorexia nervosa (AN), and 23 with bulimia nervosa (BN). Nutritional assessment included the evaluation of body mass index (BMI), body fat (FAT) and muscle mass (MM), assessed by skinfold anthropometry, serum albumin, transthyretin and retinol-binding protein, energy and protein intake. IGF-1 and nutritional parameters were reevaluated in the early phase of refeeding (2-4 weeks) in 20 AN patients who entered a refeeding program. RESULTS: Mean IGF-1 z-score was -1.74+/-0.74 in AN, and -0.74+/-0.91 in BN. Serum proteins were reduced in only a minority of patients. IGF-1 correlated with BMI (r=0.64), FAT (r=0.57), MAMC (mid-arm muscle circumference) (r=0.58) and MM (r=0.66) (P<0.001), while it did not correlate with serum proteins. In the early phase of nutritional repletion serum proteins and anthropometric parameters did not vary significantly, while a prompt and marked increase (73.9%) of IGF-1 was observed. CONCLUSIONS: IGF-1 represents a biochemical marker of malnutrition and a sensitive index of nutritional repletion in patients with eating disorders.

Nutrition and survival in patients with liver cirrhosis.

Although the effect of malnutrition on survival has been demonstrated by a number of studies, it is not clear whether malnutrition represents an independent risk factor in patients with liver disease. We studied 212 hospitalized patients with liver cirrhosis who were followed clinically for 2 y or until death. Body fat and muscle mass were evaluated by triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC), respectively. Multivariate analysis according to Cox's model assessed the predictive power of nutritional parameters on survival. Thirty-four percent of patients had severe malnutrition as determined by MAMC and/or TSF below the 5th percentile and 20% had moderate malnutrition (MAMC and/or TSF < 10th percentile). Twenty-six percent of patients were overnourished (MAMC and/or TSF > 75th percentile). Severely and moderately malnourished patients had lower survival rates than normal and overnourished patients. When analyzed with Cox's regression analysis, severe depletion of muscle mass and body fat were found to be independent predictors of survival. The inclusion of MAMC and TSF in the Child-Pugh score, the prognostic score used most with liver disease, improved its prognostic accuracy. The prognostic power of MAMC was higher than that of TSF. These data demonstrate that malnutrition is an independent predictor of survival in patients with liver cirrhosis. The inclusion of anthropometric measures in the assessment of these patients might provide better prognostic information.

Ofloxacin: in vitro activity against recently isolated gram-negative bacterial strains.

The activity of ofloxacin was determined against 117 Enterobacteriaceae, 13 Acinetobacter var, anitratus, 124 Pseudomonas aeruginosa in comparison with other antibiotics. Its activity was very high: against Enterobacteriaceae the minimum inhibitory concentration (MIC)50 was 0.125 micrograms/ml, the MIC90 1 micrograms/ml, and the geometric mean (GM) was 0.4 micrograms/ml against Acinetobacter var. anitratus the MIC50 1 micrograms/ml, MIC90 4 micrograms/ml, GM 1.7 micrograms/ml. Unlike other authors we found that the activity of ofloxacin was influenced by the selection of P. aeruginosa resistant to carbenicillin and gentamicin.

Comparative in vitro activity of eight antibiotics against Pseudomonas aeruginosa and infrequently isolated gram-negative bacilli.

Seventy-eight Gram-negative non-fermentative bacilli have been tested against eight antimicrobial agents (wide spectrum penicillins, newer generation cephalosporins and aminoglycosides). Minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of each compound were determined by microdilution technique. Ceftazidime showed higher antibacterial activity against all bacterial strains.

[Comparison of three anti-nucleus antibody detection methods in different pathologies (author's transl)]. / Confronto di tre metodi nella ricerca di anticorpi anti-nucleo in diverse forme morbose.

Anti-nucleus antibodies were detected in the blood sera of 232 patients of different pathologies by three diverse methods: a morphological method, and indirect immunofluorescent method and a radioimmunologic method. The results demonstrated the importance of the radioimmunologic method since this method displays anti-DNA antibodies which are specific in the active stage of lupus erythematosus (LE). Forthermore, the immunofluorescent method proved to be highly sensitive; and the morphological method can reveal different aspects of the LE phenomenon (such as nucleus phagocytosis) which can be indicative of an auto-aggressive process. Our survey indicates that simultaneous use of the three methods is advisable.

[Comparison of AMS and MS-2 in the identification and antibiotic sensitivity of clinically isolated bacterial strains]. / Confronto tra AMS e MS-2 nell'identificazione e nella sensibilità agli antibiotici su ceppi batterici di isolamento clinico.

282 clinical bacterial strains have been identified with AMS and MS-2. Among biochemical tests only lysine, adhonitol , glucose did not show significant differences. The overall correlation has been 86.3%. The results of the susceptibility to antimicrobial agents on 98 bacterial strains revealed an overall agreement of 79.3%, an essential agreement of 91%.

Patterns of haemagglutinating activity of Escherichia coli.

MR and MS adhesins on 169 strains of Escherichia coli subjected to different cultural conditions were detected. Haemagglutination Test (static settling test in plastic microtiter trays) was used and several species of red blood cells were employed. The results confirm that different media can influence the expression of the adhesins and that using as many species of red blood cells as possible one can detect different adhesins.

Fusarium peritonitis in peritoneal dialysis: report of two cases.

This report describes two cases of peritoneal dialysis-related peritonitis caused by Fusarium species which have been incriminated in a variety of disease conditions. Treatment with 5-Fluorocytosine was unsuccessful, but removal of the catheter resulted in a rapid resolution of the infections.

[Detection of bacteremia by biphasic and radiometric methods]. / Rilevamento di batteriemia con metodo bifasico e radiometrico.

During one year period our laboratory carried out 859 hemocultures. These have been evaluated with two methods: a conventional biphasic method (Castaneda bottles), and the automated radiometric method (Bactec System). 185 cultures were obtained with one or both methods. Of these 3.5% were considered contaminated, therefore the clinically significant isolation rate was 16.2%. Of these 86.4% was recovered by biphasic system and 79.8% by Bactec System. The recovery time to positivity and spectrum of isolates were similar for the two methods. Although there were substantially more contaminants isolated in the Vacutainer-Bactec System.

Preliminary evaluation of sensititre system for identifying gram-negative bacilli.

The automated microdilution Sensititre System (Sensititre, LtD.) was evaluated for the identification of 120 clinically isolated fermenter and non-fermenter Gram negative bacilli and of 12 ATCC reference strains (American Type Culture Collection). Daily and overnight (5 and 18 hours) identifications were performed according to the manufacturer. In both cases, the results were compared with those obtained with the overnight API 20E (API System, La Balme les Grottes, Montalieu Vercieu) used as reference method. Concordance between the results obtained after 5 hrs of incubation and those obtained with API 20E was found in 65% of cases (acceptable identification criteria with probability over 80%). When results were determined after 18 hrs of incubation (identification criteria with probably over 80%) concordance was found in 82.5%. Reproducibility obtained by repeated (10 times) identification with four different strains was 100% both at 5 hrs and 18 hrs. Identification accuracy of the 12 ATCC strains was 8/12 (66.6%) after 5 hrs and 12/12 (100%) after 18 hrs.

[Comparative evaluation of 3 miniaturized systems (API 20E, Enterotube II, Sensititre AP60) commonly used in clinical microbiology laboratories]. / Valutazione comparativa di tre sistemi miniaturizzati (API 20E, Enterotube II, Sensititre AP60) largamente in uso nei laboratori di microbiologia clinica.

API 20E, Enterotube II, Sensititre AP60 have been evaluated. Some biochemical tests (lysine, ornithine, VP, H2S, adonitol , arabinose, citrate) have revealed significative differences among three systems. The total correlations about bacterial identifications have been very similar. The repetibility of identifications of strains isolated from clinical specimens has been 98.7% for Enterotube and API 20E, 95.5% for Sensititre . The biochemical tests have revealed repetibility greater than or equal to 94%, citrate repetibility instead has been 91%.