Fifteen Years of Iodine Prophylaxis in Italy: Results of a Nationwide Surveillance (Period 2015-2019)

CONTEXT

In 2005, a nationwide program of iodine prophylaxis on a voluntary basis was implemented in Italy by law. However, recent data on iodine status are lacking.

OBJECTIVE

The aim of this study was to evaluate efficiency, effectiveness, and possible adverse effects (increased occurrence of thyroid autoimmunity and hyperthyroidism) of the Italian iodine prophylaxis program.

METHODS

From 2015 to 2019, a nationwide survey was performed. The use of iodized salt was evaluated in a sample of 164 593 adults and in 998 school canteens. A sample of 4233 schoolchildren (aged 11-13 years) was recruited to assess urinary iodine concentration, prevalence of goiter, and thyroid hypoechogenicity on ultrasound, with the latter being an indirect indicator of thyroid autoimmunity. Neonatal TSH values of 197 677 infants screened in regions representative of Northern, Central, and Southern Italy were analyzed to investigate the percentage of TSH values >5.0 mIU/L. Data on methimazole prescriptions were analyzed as indirect indicators of new cases of hyperthyroidism.

RESULTS

The prevalence of the use of iodized salt was 71.5% in adult population and 78% in school canteens. A median urinary iodine concentration of 124 μg/L, a prevalence of goiter of 2.2%, and a prevalence of thyroid hypoechogenicity of 5.7% were observed in schoolchildren. The percentage of neonatal TSH values >5.0 mIU/L resulted still higher (5.1%) than the World Health Organization threshold of 3.0%, whereas the prescriptions of methimazole showed a reduction of 13.5%.

CONCLUSION

Fifteen years of iodine prophylaxis have led to iodine sufficiency in Italy, although there still is concern about iodine nutritional status during pregnancy.

The Burden of Obesity in Type 1 Diabetic Subjects: A Sex-specific Analysis From the AMD Annals Initiative

OBJECTIVE

Obesity is a growing emergency in type 1 diabetes (T1D). Sex differences in obesity prevalence and its clinical consequences in adult T1D subjects have been poorly investigated. The aim of this study was to investigate the prevalence of obesity and severe obesity, clinical correlates, and potential sex differences in a large cohort of T1D subjects participating to the AMD (Associazione Medici Diabetologi) Annals Initiative in Italy.

RESEARCH DESIGN AND METHODS

The prevalence of obesity [body mass index(BMI) ≥30 kg/m2] and severe obesity (BMI ≥ 35 kg/m2) according to sex and age, as well as obesity-associated clinical variables, long-term diabetes complications, pharmacological treatment, process indicators and outcomes, and overall quality of care (Q-score) were evaluated in 37 436 T1D subjects (45.3% women) attending 282 Italian diabetes clinics during 2019.

RESULTS

Overall, the prevalence of obesity was similar in the 2 sexes (13.0% in men and 13.9% in women; mean age 50 years), and it increased with age, affecting 1 out of 6 subjects ages >65 years. Only severe obesity (BMI >35 kg/m2) was more prevalent among women, who showed a 45% higher risk of severe obesity, compared with men at multivariate analysis. Cardiovascular disease risk factors (lipid profile, glucose, and blood pressure control), and the overall quality of diabetes care were worse in obese subjects, with no major sex-related differences. Also, micro- and macrovascular complications were more frequent among obese than nonobese T1D men and women.

CONCLUSIONS

Obesity is a frequent finding in T1D adult subjects, and it is associated with a higher burden of cardiovascular disease risk factors, micro- and macrovascular complications, and a lower quality of care, with no major sex differences. T1D women are at higher risk of severe obesity.

Diagnostic imaging of hepatic tuberculosis: case series

BACKGROUND

Hepatic tuberculosis (TB) shows non-specific symptoms, and liver imaging may provide diagnostic clues. Here we describe a series of patients with hepatic TB showing characteristic radiological findings.

METHODS

Single-centre retrospective evaluation of patients with hepatic TB diagnosed over a period of 16 years who underwent ultrasound, computed tomography (CT) and/or magnetic resonance imaging (MRI). Hepatic lesions were classified as miliary, nodular, serohepatic or cholangitis.

RESULTS

Of 14 patients with hepatic TB, five were co-infected with the human immunodeficiency virus. All patients had additional extrahepatic TB localisations. An interferon-gamma release assay was performed in 11/14 patients, ultrasound and CT were available for all patients and MRI for four. Observed patterns were miliary (n = 6) with multiple nodules < 2 cm; nodular (n = 5), characterised by a variable number of nodules (2-7 cm); and serohepatic (n = 3), with multiple nodular subcapsular lesions with a thin, smooth wall. Shared findings were hypoechoic lesions on ultrasound, hypodense lesions with ring enhancement on CT, while MRI lesions were hypointense on T1- and hyperintense on T2-weighted images.

CONCLUSIONS

Ultrasound, CT and MRI can independently contribute to detection of hepatic TB. While a miliary pattern or calcifications are characteristic, no pattern is completely pathognomonic and the diagnosis depends on microbiological evidence. Particularly in risk groups, characteristic radiological findings may prompt targeted diagnostic work-up.

Last-male sperm precedence in Rhynchophorus ferrugineus (Olivier): observations in laboratory mating experiments with irradiated males

The Red Palm Weevil (RPW) Rhynchophorus ferrugineus (Olivier 1790) is an invasive pest from southeastern Asia and Melanesia that in the last 30 years has spread widely in the Middle East and Mediterranean Basin. Its stem-boring larvae cause great damage to several palm species of the Arecaceae family, many of which are economically important for agricultural and ornamental purposes. Therefore, great attention has recently been focused in studying this species to identify sustainable and effective eradication strategies, such as sterile insect technique (SIT). The rapid spread of RPW is associated with its high reproductive success. To evaluate the suitability of a SIT strategy, particular physiological and behavioral aspects of RPW reproduction, such as the presence of polyandry and post-copulatory sperm selection mechanisms, were investigated. To determine paternity of progeny from multiply mated females, double-crossing experiments were carried out confining individual females with either a wild-type male or a γ-irradiated male (Co-60). Fecundity and fertility of females were scored to evaluate post-copulatory sperm selection. Results showed that progeny were almost exclusively produced by the sperm of the second male, suggesting that a last-male sperm precedence is expressed at high levels in this species, and providing interesting insights for an area-wide RPW management strategy such as the SIT.

Genetic and morphological studies of Trichosirocalus species introduced to North America, Australia and New Zealand for the biological control of thistles

Trichosirocalus horridus sensu lato has been used as a biological control agent of several invasive thistles (Carduus spp., Cirsium spp. and Onopordum spp.) since 1974. It has been recognized as a single species until 2002, when it was split into three species based on morphological characters: T. horridus, Trichosirocalus briesei and Trichosirocalus mortadelo, each purported to have different host plants. Because of this taxonomic change, uncertainty exists as to which species were released in various countries; furthermore, there appears to be some exceptions to the purported host plants of some of these species. To resolve these questions, we conducted an integrative taxonomic study of the T. horridus species complex using molecular genetic and morphological analyses of specimens from three continents. Both mitochondrial cytochrome c oxidase subunit I and nuclear elongation factor 1α markers clearly indicate that there are only two distinct species, T. horridus and T. briesei. Molecular evidence, morphological analysis and host plant associations support the synonymy of T. horridus (Panzer, 1801) and T. mortadelo Alonso-Zarazaga & Sánchez-Ruiz, 2002. We determine that T. horridus has been established in Canada, USA, New Zealand and Australia and that T. briesei is established in Australia. The former species was collected from Carduus, Cirsium and Onopordum spp. in the field, whereas the latter appears to be specific to Onopordum.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

The ALPPS procedure for hepatocellular carcinoma

BACKGROUND

The main limiting factor to major hepatic resections is the amount of the future liver remnant (FLR). Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS) is a procedure which induces a rapid hypertrophy of the FLR in patients with non-resectable liver tumours.

METHODS

ALPPS is a surgical technique of in-situ splitting of the liver along the main portal scissura or the right side of the falciform ligament, in association with portal vein ligation in order to induce a rapid hypertrophy of the left FLR.

RESULTS

The median FLR volume increase was 18.7% within one week after the first step and 38.6% after the second step. At the first step the median operating time was 300 min, blood transfusions were not required in any case, median blood loss was 150 cc. At the second step median operating time was 180 min, median blood loss was 50 cc, none of the patients required intra-operative blood. All patients are alive at a median follow up of 9 months.

CONCLUSIONS

This novel strategy seems to be feasible even in the context of a cirrhotic liver, and demonstrates the capacity to reach a sufficient FLR within a shorter interval of time.

Appropriateness: analysis of outpatient radiology requests

PURPOSE

This study assessed radiology requests and the influence of previous radiological procedures on their specificity and appropriateness, evaluated diagnostic outcomes and recorded the economic impact of inappropriate examinations.

MATERIALS AND METHODS

We prospectively analysed 4,018 outpatient requests, the appropriateness of which was assessed using an evaluation form. Economic analysis was based on costs listed in the Italian National Health Services (NHS) national tariff as established by the Ministerial Decree of 22 July 1996. Statistical analysis was carried out using Pearson's test and univariate and multivariate logistic regression models.

RESULTS

Of 4,018 outpatient requests, 57% were not included in a follow-up protocol and 56% were found to be appropriate. The diagnostic question was confirmed in 66% of cases considered appropriate (p<0.001). The existence of previous investigations had a significant impact on appropriateness and diagnostic outcome (p<0.001). The total cost of the requests was 257,317 euro, with inappropriate requests accounting for 94,012 euro (36.5%).

CONCLUSIONS

We found a 56% rate of appropriate requests and demonstrated that appropriate prescriptions provided with a specific clinical question led to significantly higher confirmation rates of the diagnostic hypothesis. In addition, inappropriate requests had a major negative economic impact.

Natural history studies for the preliminary evaluation of Larinus filiformis (Coleoptera: Curculionidae) as a prospective biological control agent of yellow starthistle

We studied the life history, geographic distribution, behavior, and ecology of Larinus filiformis Petri (Coleoptera: Curculionidae) in its native range to determine whether it is worthy of further evaluation as a classical biological control agent of yellow starthistle, Centaurea solstitialis (Asteraceae: Cardueae). Larinus filiformis occurs in Armenia, Azerbaijan, Turkey, and Bulgaria and has been reared only from C. solstitialis. At field sites in central and eastern Turkey, adults were well synchronized with the plant, being active from mid-May to late July and ovipositing in capitula (flowerheads) of C. solstitialis from mid-June to mid-July. Larvae destroy all the seeds in a capitulum. The insect is univoltine in Turkey, and adults hibernate from mid-September to mid-May. In the spring, before adults begin ovipositing, they feed on the immature flower buds of C. solstitialis, causing them to die. The weevil destroyed 25-75% of capitula at natural field sites, depending on the sample date. Preliminary host specificity experiments on adult feeding indicate that the weevil seems to be restricted to a relatively small number of plants within the Cardueae. Approximately 57% of larvae or pupae collected late in the summer were parasitized by hymenopterans [Bracon urinator, B. tshitsherini (Braconidae) and Exeristes roborator (Ichneumonidae), Aprostocetus sp. (Eulophidae), and unidentified species of Eurytomidae and Ormyridae]. This weevil may be a better choice than the other capitula insects already established in the United States, particularly in colder parts of the plant's range.

Effects of a neem extract on blood feeding, oviposition and oocyte ultrastructure in Anopheles stephensi Liston (Diptera: Culicidae)

Secondary metabolites of the neem tree (Azadirachta indica A. Juss., Meliaceae) exhibit a wide range of biological activities in insects. However, few studies have addressed the effects of neem extracts or compounds in arthropods of medical importance. In this study, a laboratory strain of Anopheles stephensi was used to assess the effects of a commercial formulation (Neem Azal) (NA)), containing azadirachtin A at 34%, on blood feeding, oviposition and oocyte ultrastructure. Oral administration of Neem Azal) to A. stephensi females through artificial blood meals did impair blood intake and oviposition in a concentration dependent manner. Similar results were obtained on females, which had consumed Neem Azal) in sucrose solution before taking a blood meal of plain blood. Neem treated females displayed a delay in oocyte development in both the phase of vitellogenesis and the phase of choriogenesis. The ultrastructural studies on ovaries from Neem Azal) treated females revealed distinct structural modifications indicative of: (i) a complete block of oogenesis, (ii) impairment of vitellogenesis and vitelline envelope formation, (iii) a severe degeneration of follicle cells. In agreement with results obtained in other insects, this study indicates that Neem Azal) impairs hormone control of oogenesis and exerts a cytotoxic effect on both follicular cells and oocytes of the Asian malaria vector A. stephensi.

Laboratory evaluation of the bioinsecticide Spinosad for mosquito control

Spinosad, a naturally occurring product of the fermentation of the bacterium Saccharopolyspora spinosa, is a highly effective bioinsecticide against a broad range of agriculturally important insect pests, and this agent has an excellent environmental and mammalian toxicological profile. In this study the efficacy of a Spinosad-based product (Laser 4.8% emulsifiable concentrate) was evaluated in laboratory bioassays against laboratory-reared mosquito strains of 3 species of medical importance: Aedes aegypti, Anopheles stephensi, and Culex pipiens. Spinosad was particularly effective against larval Aedes and Culex, with a less marked activity against anophelines (24-h median lethal concentration = 0.0096, 0.0064, and 0.039 mg/liter, respectively), showing a persistence of the insecticide action of about 6 wk in laboratory containers. The activity of the Spinosad-based product against adult mosquitoes (toxicity by ingestion and a possible irritant or repellent effect on gravid females) also was evaluated. Results are discussed and compared with those available in the literature.

[Comparison between estimates of radiological workload]

OBJECTIVE

To comparise three methods for assessing the productivity of radiological services: a) simple count of radiological examinations, b) method proposed by SNR-SAGO-SIRM, c) method used by Regione Emilia Romagna (RER) to evalutate the characteristics of these methods and to find a common method of estimate.

MATERIAL AND METHODS

On the radiological examinations performed at our unit over a period of 12 months were recorded. The different types of examinations were clustered into five homogenous groups (general radiology, ultrasound, barium examinations, CT, MRI). The data were assessed by a) number of examinations/hour per radiologist, b) score/hour according to the SNR-SAGO-SIRM method and c) score/hour according to the RER method, and then compared for the percentage of the single aggregates.

RESULTS

a) The total number of examinations was 26,776 with 40% being accounted for by general radiology; mean numbers of examinations our ranged from 2.43 (August) to 4.20 (March). b) The total score according to the SNR-SAGO-SIRM method was 67,054. The radiologist weight per hour ranged from 6.37 (August) to 9.67 (May). Ultrasound was the most relevant examination in the unit accounting for 43% of total weight. c) The total score according to the RER method was 1,850,780. The radiologist weight per hour ranged from 159 (August) to 316 (April). CT was the most relevant examination (51% of total weight).

CONCLUSION

According to the simple count of examinations, general radiology and ultrasound were the most relevant examinations together accounting for 75% of examinations, i.e. 40% and 35% respectively, whereas by SNR-SAGO-SIRM standards the two techniques represent 19% and 45% respectively. The simple count method therefore fails to give adequate weight to technologically advanced imaging technique. The SNR-SAGO-SIRM method adequately takes into account the combination of patient-number and patient weight. The RER method gives excessive weight costly technology as it considers the total weight of the examination and not only the radiologist's activity.

Non-hodgkin's lymphoma of the liver in patients with AIDS: sonographic, CT, and MRI findings

PURPOSE

We analyzed the sonographic, CT, and MRI findings in acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) of the liver to evaluate the role of sonography in the diagnosis of this disease.

METHODS

We retrospectively reviewed sonograms and CT scans on 26 patients who had human immunodeficiency virus with liver lymphoma, either primary (10 cases) or secondary (16 cases), from 1992 to 1999. We also reviewed MR images on 12 of the patients. All patients had pathologically proven NHL; all imaging studies were obtained within 2 weeks of sonographically guided fine-needle aspiration biopsies. Lymphoma was the initial AIDS-defining illness in 38% of the patients.

RESULTS

NHL occurred as multiple lesions in most cases of both primary (7 of 10 cases) and secondary (15 of 16 cases) liver lymphoma. No imaging finding was specific for the diagnosis of hepatic lymphoma. The hepatic lesions were hypoechoic in 25 of 26 cases; in the remaining case, there was a large isoechoic mass. On unenhanced and contrast-enhanced CT, the lesions were hypodense in all cases, with a thin enhancing rim in 6 patients. On MRI, the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images.

CONCLUSIONS

Sonography may be helpful in the diagnosis of focal hepatic lymphoma in patients with human immunodeficiency virus. Sonographically guided fine-needle aspiration biopsy provides a definitive diagnosis. CT was crucial in the staging of lymphoma. MRI appears appropriate for studying liver NHL in selected cases.

[Diagnostic imaging of current pulmonary tuberculosis. Clinical significance of the presentation patterns and particular aspects in HIV-positive and HIV-negative subjects]

PURPOSE

We compared two groups of risk patients to try to identify different radiologic patterns in pulmonary tuberculosis.

MATERIALS AND METHODS

74 subjects, divided into two groups (HIV+:27; HIV-:47) were included since 1993. The patients were examined with chest X-ray (CXR) and CT.

RESULTS

In the HIV+ group we observed 40 radiologic alterations, with 6 cases of bilateral lung involvement and 9 of atypical localizations; particularly: 11 consolidations, 8 cavitations, 5 miliary diseases, 9 hilar or mediastinal adenopathies, 3 extrapulmonary localizations and 4 negative CXRs. In the HIV- group we found 53 radiologic alterations, with 6 cases of bilateral lung involvement and 3 of atypical localizations; particularly: 12 consolidations, 25 cavitations, 5 nodular patterns, 1 miliary disease, 5 nodal disease, 4 pleural diseases and 1 negative CRX.

DISCUSSION AND CONCLUSIONS

In HIV- patients lung consolidations and tysiogen patterns are significantly prevalent, while miliary diseases, mediastinal diseases and atypical localizations and negative CRXs are more frequent in HIV+ patients. We found miliary diseases, mediastinal diseases and extrapulmonary localizations also in HIV- patients with heavily impaired social, economic and sanitary conditions. This alterations indicate compromised host resistance, independent of the causes and modalities of immunodeficiency. The distinction between primary and secondary tuberculosis is currently not mandatory.

[Lung tuberculosis in HIV positive patients. Clinico-radiologic correlations]

We investigated the radiologic features of pulmonary tuberculosis in HIV+ patients.

SUBJECTS AND METHODS

24 cases of pulmonary tuberculosis in HIV+ patients were studied (17 men and 7 women, average age: 38 years). The study includes 19 drug addicts, 3 homosexuals, 1 polytransfused subject and 1 patient not belonging to the categories considered at risk). Three subgroups were identified by the CD4/mm3 cell count (< 200, 200-500, > 500).

RESULTS

In our 24 patients, we identified 37 radiologic manifestations (in 13 cases associated in the same patient), with 6 cases of bilateral pulmonary and 9 atypical localizations. In detail: 10 consolidations, 7 productive (miliary) cavitations, 8 mediastinal lymphadenitis, 3 extrapulmonary forms and 4 cases with no chest X-ray alterations. There is a major frequency of consolidations and cavitations in the patients with CD4 > 200 and a major frequency of productive forms, lymphadenitis and extrapulmonary localizations in the subjects with CD4 < 200. We observed no cases of tuberculosis in patients with CD4 > 500. The medical therapy is usually more effective in the more immunocompetent subjects and, anyway, in the exudative forms, improving in 35% of cases, than in the productive and disseminated forms improving in 6% of cases only.

DISCUSSION AND CONCLUSIONS

Only the severely immunodeficient HIV+ patients (CD4 < 500) are affected with tuberculosis. There exists a significant rate of parenchymal consolidations and tisiogenic forms in subjects with CD4 > 200 and a high rate of miliary forms, lymphadenitis and extrapulmonary localizations in patients with low cell count (< 200). The medical therapy is more effective in the more immunocompetent subjects and, anyway, in the exudative forms, than in the productive and disseminated forms. Finally, atypical localization of pulmonary tuberculosis are frequent in HIV patients.

[Lymphocyte subpopulations and the soluble interleukin-2 receptor in Hashimoto's thyroiditis and subacute thyroiditis]

There are no univocal experimental data in literature about T cell clone alterations in the peripheral blood during Hashimoto's thyroiditis (TH), autoimmune disease, and during subacute thyroiditis (TSA), an inflammatory thyroid lesion with possibility of "self-perpetuation". The object of our research was to examine the T cell clones, soluble fraction of interleukin 2 receptor and HLA-DR modifications in patients with TH and TSA compared with healthy population. Our results show significant increase of sIL-2r in the TSA compared with normal subjects and with patients TH, where on the contrary, a constant increase of HLA-DR was observed.

[Immunologic and cytologic aspects of Hashimoto's thyroiditis during therapy with thymopentin]

Hashimoto's thyroiditis is an autoimmune disease characterized by the presence of thyroid autoantibodies and frequent coexistence of other autoimmune disorders. The object of our research was to examine the peripheral blood and fine-needle cytology modifications in patients with this disease during therapy with Timopentina. Our results suggested a possible therapeutic effect of Timopentina, as an alternative to traditional cortisone treatment.

[Changes in the thyroid function during treatment of psychiatric disorders using lithium salts]

Lithium, a monovalent cation used mainly in the management of certain psychiatric disorders, appears to act on thyroid function and to interfere with T3 and T4 secretion. The authors have followed 10 patients treated with lithium salts for two years and have monitored some parameters of thyroid function. Clinical and laboratory signs of hypothyroidism appeared in one case and subsided after withdrawal of lithium treatment.