The World Organisation for Animal Health: notification of animal diseases

In a globalised world, accurate, complete and timely notification of the presence of animal diseases plays a crucial role in international trade. It allows countries at risk to take appropriate action to prevent the spread of transboundary diseases or minimise their impact, and thus mitigate the associated risks to animal and public health. In this context, the World Organisation for Animal Health (OIE) is responsible for rapidly and transparently sharing accurate and complete information on the global animal health situation. To do so, it collects, verifies, validates and disseminates the animal health information provided by its Members. Information on animal diseases, including zoonoses, is notified to the OIE in compliance with legally binding instruments between the OIE and its Members. Since the creation of the OIE in 1924, the type of animal disease information to be notified and the communication channels for its subsequent distribution to Members have been standardised and improved over time, taking advantage of the available tools and methods of mass dissemination of information. The continuous improvement of the OIE disease notification process has had positive effects, both in terms of animal disease prevention, control and eradication at a global level, and by facilitating the international trade of animals, their products and by-products.

The incidence of neuropathic pain after intercostal cryoablation during the Nuss procedure

PURPOSE

Intercostal nerve cryoblation during the Nuss procedure for pectus excavatum decreases pain, opiate requirement, and hospital length of stay (LOS) compared to thoracic epidural analgesia. However, long-term complications of cryoablation, including neuropathic pain development, are not well studied.

METHODS

We conducted a multi-institutional retrospective review of patients following intercostal nerve cryoablation during Nuss bar insertion (11/2015-7/2018). Patients completed the Leeds Assessment of Neuropathic Symptoms and Signs, a validated questionnaire for detecting neuropathic symptoms. Primary outcome was neuropathic pain development. Secondary outcomes included duration of chest numbness and LOS. T test was performed; p < 0.05 is significant.

RESULTS

43 patients underwent intercostal cryoablation during the Nuss procedure. Ages at repair ranged 11-47 years (median 16). Patients were grouped by age: ≤ 21 years (30 patients) or older (13 patients). Mean LOS was shorter for the younger group, 2.0 versus 3.9 days (p = 0.03). No patients in the younger group, and three in the older, experienced neuropathic pain. Mean time to numbness resolution was shorter for the younger group, 3.4 versus 10.8 months (p = 0.003).

CONCLUSION

In pediatric patients, intercostal cryoablation provides effective analgesia following the Nuss procedure with minimal risk of post-operative neuropathic pain. Adult patients are at greater risk of experiencing neuropathic pain and prolonged numbness.

Widespread Occurrence of Black-Orange-Black Color Pattern in Hymenoptera

Certain color patterns in insects show convergent evolution reflecting potentially important biological functions, for example, aposematism and mimicry. This phenomenon has been most frequently documented in Lepidoptera and Coleoptera, but has been less well investigated in Hymenoptera. It has long been recognized that many hymenopterans, especially scelionids (Platygastridae), show a recurring pattern of black head, orange/red mesosoma, and black metasoma (BOB coloration). However, the taxonomic distribution of this striking color pattern has never been documented across the entire order. The main objective of our research was to provide a preliminary tabulation of this color pattern in Hymenoptera, through examination of museum specimens and relevant literature. We included 11 variations of the typical BOB color pattern but did not include all possible variations. These color patterns were found in species belonging to 23 families of Hymenoptera, and was most frequently observed in scelionids, evaniids, and mutillids, but was relatively infrequent in Cynipoids, Diaprioids, Chalcidoids, and Apoids. The widespread occurrence of this color pattern in Hymenoptera strongly suggests convergent evolution and a potentially important function. The BOB color pattern was found in species from all biogeographic regions and within a species it was usually present in both sexes (with a few notable exceptions). In better studied tropical regions, such as Costa Rica, this color pattern was more common in species occurring at lower elevations (below 2,000 m). The biology of the tabulated taxa encompasses both ecto- and endoparasitoids, idiobionts and koinobionts, from a diversity of hosts, as well as phytophagous sawflies.

Transoral glossoepiglottopexy in the treatment of adult obstructive sleep apnoea: a surgical approach

SUMMARY

The treatment of obstructive sleep apnoea syndrome (OSAS) is still a matter of debate; among the different therapeutic alternatives, both surgical and conservative, treatment with continuous positive airway pressure (CPAP) is considered the "gold standard". The recent scientific literature reports that even if CPAP represents an effective solution for sleep apnoeas, 12% of patients do not benefit from its use. In most cases, primary collapse of the epiglottis is responsible for failure. We developed a surgical technique that provides a stable support to the epiglottis without influencing its function during swallowing while preserving laryngeal anatomy and physiology. The procedure we propose is based on that conceived by Monnier for children affected by laryngomalacia. We analysed a group of 20 patients who underwent glossoepiglottopexy between January 2015 and September 2016 and compared data (AHI, ODI, t90, ESS, EAT10, etc.) collected before and 6 months after surgery to demonstrate the safety and effectiveness of our glossoepiglottopexy (GEP). The results allow us to consider GEP as a valid choice to treat adults who suffer from sleep apnoeas.

Rheopheresis for Sudden Hearing Loss (SHL)

Rheopheresis has met an increasing interest and application in different disease conditions affecting microcirculation. Its last applications are for the management of Macular and Cochlear disorders. The sudden hearing loss syndrome is a condition that affects 20 out of 100000 persons per year, reduces the patient's social interaction and quality of life. It is associated with vascular and coagulation risk factors and it is considered as a result of local hypoperfusion secondary both to inflammatory and dysimmune conditions determining inadequate NO release and endothelial dysfunction. Rheopheresis treatment is a new approach which brings to satisfactory clinical results. Cascade filtration, heparin induced lipid precipitation and conventional plasma exchange are equally effective, and only 2 sessions are required for producing long lasting benefits. Our experience is with 60 patients, 90% of which getting from partial to complete recovery after treatment as measured by pure tone audiometry.

Presence of Autoantibodies in the Sera of Meniere's Disease

We examined the sera of patients with Meniere's disease for the presence of antibodies against 8 inner ear antigens by enzyme-linked immunosorbent assay (ELISA). One hundred eight patients with Meniere's disease and 28 control subjects were studied. The antibodies against chicken type II collagen, bovine type II collagen, the cyanogen bromide cleaved peptide 11 (CB11) of each, type IX and XI collagens, C-Raf, and tubulin were measured by ELISA. The sensitivity of each antigen was between 37% and 60% individually, and was 91% when all 8 inner ear antigens were combined. These results showed that 91% of Meniere's disease sera have antibody activities to 1 or more of these inner ear antigens. The results suggest that performing ELISA for these 8 inner ear antigens was useful as a diagnostic tool for Meniere's disease. Further study is required for elucidating the role of these antigens in the pathogenesis of Meniere's disease, which might eventually result in better therapy.

Role(s) of formyl-peptide receptors expressed in nasal epithelial cells

Chronic rhinosinusitis is one of the most frequent chronic diseases in humans. Little is known about stimuli initiating tissue remodeling process that determines the morphological expression of the disease. N-formyl peptide receptors (FPRs) are innate immunity receptors important in tissue remodeling of gastric and intestinal epithelium. The expression and functions of FPRs in nasal epithelial cells were examined to evaluate whether they could be important in the remodeling of nasal mucosa. The aim of this study is to examine FPR expression in a nasal epithelial cell line (RPMI-2650) at mRNA and protein levels. To determine whether FPRs were functional, chemotaxis experiments were carried out. In addition the effects of FPRs agonists on the expression (PCR and ELISA) of VEGF-A and TGF-beta, two key mediators of tissue remodelling, were examined. Here we demonstrate that RPMI-2650 express FPR and FPRL2, but not FPRL1. fMLP, a bacterial product active on FPR, and uPAR(84-95), an inflammatory mediator agonist for FPRL2, stimulated migration of nasal epithelial cells. fMLP and uPAR(84-95) induce expression and secretion of VEGF-A and TGF-beta. Our results suggest a possible mechanisms initiating tissue remodeling observed during chronic rhinosinusitis. This study provides further evidence that FPRs play a more complex role in human pathophysiology than bacterial recognition.

Comparison of the diagnosis of malaria by microscopy, immunochromatography and PCR in endemic areas of Venezuela

Whole blood samples (N = 295) were obtained from different locations in Amazonas and Sucre States, in Venezuela. Malaria was diagnosed by microscopy, OptiMAL and polymerase chain reaction (PCR), with Plasmodium vivax, P. falciparum, and P. malariae being detected when possible. We identified 93 infections, 66 of which were caused by P. vivax, 26 by P. falciparum, and 1 was a mixed infection. No infection caused by P. malariae was detected. The sensitivity and specificity of each diagnostic method were high: 95.7 and 97.9% for microscopy, 87.0 and 97.9% for OptiMAL, and 98.0 and 100% for PCR, respectively. Most samples (72.2%) showed more than 5000 parasites/microL blood. The sensitivity of the diagnosis by microscopy and OptiMAL decreased with lower parasitemia. All samples showing disagreement among the methods were reevaluated, but the first result was used for the calculations. Parasites were detected in the 6 false-negative samples by microscopy after the second examination. The mixed infection was only detected by PCR, while the other methods diagnosed it as P. falciparum (microscopy) or P. vivax (OptiMAL) infection. Most of the false results obtained with the OptiMAL strip were related to the P. falciparum-specific band, including 3 species misdiagnoses, which could be related to the test itself or to genetic variation of the Venezuelan strains. The use of the microscopic method for malaria detection is recommended for its low cost but is very difficult to implement in large scale, population-based studies; thus, we report here more efficient methods suitable for this purpose.

[Ultrasound bone densitometry in children and adolescents; Italian refence curves with multi-site device (Omnisense)]

The values of bone density represent one of the best parameters for the prediction of the risk of fracture in the adult. Since the peak of bone mass depends over that on genetic factors also on modifiable environmental factors, the evaluation of the state of bone health in paediatric populations has assumed great importance; the ultrasound techniques seem to represent a potential alternative to DXA and QTC. Using Omnisense device (Omnisense, Sunlight Ultrasound Technologies) we have evaluated the bone strength in a champion of 652 children and teen-agers aged 6-18 (328 females, 324 males). The measurements have been made at the distal third of the radius and midshaft tibia. The purpose has been to record the values of SOS in a healthy paediatric population, building a normal database and to find a correlation between the SOS values and anthropometric data, dietary factors and physical activity. The comparison with an analogous study conducted by other Authors prompted us to conclude that in the paediatric population the construction of proper curves of reference, with which to compare the data of the patients, is essential to avoid errors in the evaluation of bone density, in agreement with how much already underlined in literature. Besides a correct interpretation of the data obtained with ultrasounds systems asks for a change of the thresholds values established by the OMS for the diagnosis of osteopenia/osteoporosis with the DXA. As already happened for the adult population in children also it will be therefore necessary to compare a great number of pathological subjects with the normal database, establishing so the new values of Z-Score and giving a clinical meaning to the effected measurements.

[Association among postural and skull-cervico-mandibular disorders in childhood and adolescence. Analysis of 428 subjects]

The aim of the study is to appraise the prevalence of the mild defects of the spine or paramorphysm in a normal paediatric population, without orthopaedic pathology, and to verify the possible association with the dysfunctions of the dental apparatus. The recovery of a real association among these pathologies could furnish a sprout for a correct therapeutic approach. In the study 428 subjects (211 females and 217 males), aged 9 to 14 years, have been analyzed. The data have been recorded on special schedules, orthopaedic and orthodontic, containing the number of progressive order and the initials of name and last name, in the respect of the privacy of the subjects. From the study a 2.8% scoliosis incidence has emerged, an incidence of scoliotic attitudes 9.5% and an incidence of 83% normality deviations. As deviations by the normality have been classified the isolated skeletal asymmetries, agreements as varying functional not yet pathological, for instance scapular or flank asymmetry, mild genu varum or valgum, femoral anteversion. A statistically significant relationship among that disorders of posture and malocclusion (P < 0.005) and ogival palate (P < 0.002) has been found. Despite these correlations, it is very difficult to explain this association from the point of view of etiopathogenesis. For this we hold to have to continue the study, to give a meaning to such correlations and to find an appropriate therapy.

Cochlear schwannomas

In a series of 179 cerebellopontine angle (CPA) tumors, the authors present nine cases (5%) that were cochlear nerve neuromas. There were six men and three women (mean age, 51 years). Preoperative magnetic resonance imaging confirmed the diagnosis in one case with a labyrinthine extension and raised suspicions in the other four cases, which were confirmed during surgery. The remaining neuromas were discovered intraoperatively. The mean time between first observation and surgery was 9 months. Preoperatively, all patients underwent a complete otoneurological assessment. The middle fossa approach was used for the patient with the labyrinthine extension, and the retrosigmoid approach was used for the other eight cases. In all patients facial nerve function was preserved. Sudden or major hearing loss without associated vestibular symptoms or preoperative facial paralysis may be predictive of a cochlear component of a CPA tumor. The near-field relationships of cochlear neuromas located at the level of the acoustic and facial nerves can be appreciated because of their small size and strong contrast enhancement.

Static and dynamic posturography in patients with asymptomatic HIV-1 infection and AIDS

Alterations of the vestibulo-ocular reflex, optokinetic nystagmus, and visuo-vestibular-ocular reflex, have already been described in patients with AIDS and HIV-1 positive asymptomatic subjects. The introduction to the clinical practice of posturographic techniques allows us to study, with precision, postural perturbation that may be present when performing Romberg's test and to study the vestibulo-spinal reflex as a component of the vestibular system. The relative lack of studies on posturography and AIDS, encouraged us to continue our research on the vestibular system both in asymptomatic HIV-1 seropositive patients and in patients with AIDS (IV stage according to the classification proposed by the Centre for Disease Control). Recordings were made in group 1 (control group, 55 normal subjects), in group 2 (15 asymptomatic HIV-positive subjects), and in group 3 (15 patients with AIDS stage IV). Static and dynamic posturography were carried out using Tonnies platform system (Tonnies GmbH & Co., Wurzburg, Germany) and the data were analysed with Tonnies Posturographic Tübingen (TPOST) software vers. 5.19. In asymptomatic HIV+ subjects, we observed an increase in RW, RA and M3 reflex latency. AIDS patients (stage IV) exhibited significant alterations in almost all the posturographic parameters and the electromyographic potentials. Our results validate static and dynamic posturography as a method for otoneurological investigation and appear to confirm that the entire vestibular system is involved since the earliest stages of the HIV infection. In the HIV+ subjects, a variable dysfunction in the reflex control to long latency was observed, which is correlated with the alteration of the central dopaminergic system; in AIDS patients, the central nervous system damage appears more important, globally distributed and correlated also with immunosuppression.

Iris yellow spot virus in Onion in Chile

Iris yellow spot virus (IYSV) (genus Tospovirus, family Bunyaviridae) has become endemic in several parts of the world. Between 2000 and 2004, the virus was reported from several states in the United States and the most recent report was from Georgia (2). In South America, IYSV was first reported from Brazil (3). Symptoms indicative of IYSV infection (1), such as diamond-shaped and irregular chlorotic and necrotic lesions, were observed during 2004 and 2005 in onion fields in Colina and Tiltil (Chacabuco Province) and Rengo (Cachapoal Province) located in central Chile. In the sampled fields, as much as 50% of the crop showed symptoms. In all three locations, the crop was destined for bulb production and the cultivar was a long-day Valenciana-type. Approximately 50 and 5 ha in Chacabuco and Cachapoal provinces, respectively, were surveyed. Symptomatic plants were collected and tested in the laboratory for confirmation of IYSV infection. A commercially available IYSV-specific enzyme-linked immunosorbent assay kit was used (Adgen Limited, Ayr, Scotland, UK) that confirmed the samples were infected with IYSV. Total nucleic acids were extracted, and using primers flanking the nucleoprotein (NP) gene of IYSV, reverse transcription-polymerase chain reaction was used to verify virus identity. Primer sequences were 5'-TAA AAC AAA CAT TCA AAC AA-3' and 5'-CTC TTA AAC ACA TTT AAC AAG CAC-3'. The resulting 1.2-kb DNA amplicons from five samples were cloned and sequenced (GenBank Accession No. DQ150107). Nucleotide sequence comparisons with known IYSV NP gene sequences showed 95 to 98% identity, confirming the virus as IYSV. The presence of IYSV in Brazil and now in Chile indicates its potential to become established in onion crops in the region. References: (1) L. J. du Toit et al. APSnet Image of the Week. http://apsnet.org/online/archive/2003/IW000030.asp , 2003. (2) S. W. Mullis et al. Plant Dis. 88:1285, 2004. (3) L. Pozzer et al. Plant Dis. 83:345, 1999.

[Autoimmune disease in primary antibody deficiencies]

BACKGROUND

Immunodeficiency and autoimmune phenomena may occur concomitantly in the same individual. Many immune deficiency syndromes, mainly humoral defects, are associated with autoimmune disorders. In the present study, we describe the frequency of autoimmune disorders in these patients.

METHODS AND RESULTS

We performed a retrospective review of the medical records of a cohort of 152 patients with primary antibody deficiency in the Clinical Immunology Unit of the Gregorio Maranon University Hospital in Madrid: common variable immunodeficiency (CVID) (n = 35), IgA deficiency (n = 43), specific IgG subclass deficiency (n = 56), antibody deficiency with normal immunoglobulin (n = 14) and X-linked agammaglobulinemia (n = 4). Of the 152 patients with primary antibody deficiencies, autoimmune disorders were found in 35 (23 %). Autoimmune hematologic disease was found in 14 patients (9.2 %), autoimmune diseases of the gastrointestinal tract in eight (5.3 %), autoimmune endocrine diseases in six (3.9 %), autoimmune rheumatic diseases in six (3.9 %) and vitiligo in four. Autoimmune diseases were more frequent in CVID patients (37.1 %) than in those with selective IgA deficiency (25.5 %) or selective IgG subclass deficiency (12.5 %). Thirty-seven percent of autoimmune episodes occurred prior to the diagnosis of primary antibody deficiency. Sixteen patients (10.5 %) had autoantibodies without clinical data of an autoimmune disease.

CONCLUSIONS

Primary antibody deficiencies have variable autoimmune manifestations. For early detection and appropriate treatment, autoimmune disease should be suspected in patients with immunodeficiency.

Restoration of immune-mediated sensorineural hearing loss with sodium enoxaparin: a case report

The aim of the study was to assess the efficacy of sodium enoxaparin in the treatment of autoimmune sensorineural hearing loss. A small number of patients with unilateral sensorineural hearing loss were selected and divided randomly into two numerically equal groups (groups A and B) if they fulfilled the inclusion criteria, i.e. being between 20 and 65 years of age, had been affected by systemic lupus erythematosus, had presented with a hearing loss of at least 30 dB of audibility threshold involving the medium frequencies (2000-4000 Hz), and had provided informed consent. Group A received sodium enoxaparin while group B (control) received placebo. In group A, all patients except one showed an improvement in hearing after sodium enoxaparin treatment. In group B, no patients showed an improvement in auditory function. In conclusion, our results underline the important role of sodium enoxaparin in the therapeutic management of this disease. The low number of patients suggests that further studies are required to confirm this initial data but this study suggests that sodium enoxaparin provides encouraging results in the treatment of autoimmune sensorineural hearing loss.

OSAS in children

BACKGROUND

Major risk factors for obstructive sleep apnea syndrome (OSAS) in children include adenotonsillar hypertrophy, neuromuscular disease and syndromes such as Down's or Pierre-Robin's syndrome; there is currently no consensus concerning diagnosis and therapy.

METHODS

The study analyses 40 children, aged 2 through 14 years, with macroscopic tonsillar hypertrophy (without recurrent tonsillitis but with OSAS) underwent adenotonsillectomy. Parents were invited to indicate the intensity of their children's symptomatology using a subjective evaluation scale, each patient underwent cephalometric analysis and polysomnography (PSG) before and after surgery.

RESULTS

The subjective scale of symptoms passed from 3.01 before treatment to 0.42 after treatment, rhinomanometry, passed from 3.456 to 0.896 p after 1 month the surgical operation (P<0.05). The polysomnography showed a resolution of the number of obstructive events in 37 patients and a reduction in 3 patients and RDI index fell from a mean of 26.9-2.6 after therapy. The average of oxygen saturation changed from 79% before treatment to 95% after therapy.

CONCLUSIONS

Adenotonsillectomy plays a major role in the treatment of OSAS.

High frequency surgery in the treatment of turbinate hypertrophy: 11 years' experience

For over a century, surgical management of lower turbinate hypertrophy has given rise to much discussion. Aim of the present investigation was to establish, by means of the analysis of a large patient population, the efficacy and reproducibility of high frequency surgery in the treatment of this condition. A total of 1689 non-allergic patients with nasal obstruction, presenting hypertrophy of the lower turbinates, were submitted, under local anaesthesia, to turbinates decongestion using a high frequency instrumental unit with a bipolar terminal electrode. Efficacy of the procedure was evaluated on the basis of objective examination, results of questionnaires, active anterior rhinomanometry and mucociliar transport time. Results revealed a reduction of hypertrophy, an improvement in symptoms, a reduction in nasal resistances and an improvement of mucociliar transport time. The large patient population, low post-operative complication rate and the good patient compliance, due also to the fact that no haemostatic procedure is necessary, would suggest that this method is particularly valid, effective and safe for the treatment of hypertrophy of the lower turbinates.

Betahistine dihydrochloride in the treatment of peripheral vestibular vertigo

The present study compares the efficacy and safety of betahistine dihydrochloride to that of a placebo in recurrent vertigo resulting from Meniere's disease (MD) or in paroxysmal positional vertigo (PPV) of probable vascular origin. The design was double-blind, multicentre and parallel-group randomised. Eleven Italian centres enrolled 144 patients: 75 of the patients were treated with betahistine (41 MD/34 PPV) and 69 with placebos (40 MD/29 PPV). The betahistine dosage was 16 mg twice per day for 3 months. Compared to the placebo, betahistine had a significant effect on the frequency, intensity and duration of vertigo attacks. Associated symptoms and the quality of life also were significantly improved by betahistine. Both the physician's judgement and the patient's opinion on the efficacy and acceptability of the treatment were in agreement as to the superiority of betahistine. The effective and safe profile of betahistine in the treatment of vertigo due to peripheral vestibular disorders was confirmed.

Airbags and permanent auditory deficits. A real correlation?

OBJECTIVES

To evaluate the relationship between airbag-induced noise and individual metabolic risk factors in determining persistent hypoacusia in drivers after road accidents.

METHODOLOGY

We selected 22 patients previously involved in a car accident with deployment of airbags. Patients underwent general and audiological clinical history, tonal audiometric examination, vocal audiometric examination, impedance meter examination and blood tests.

RESULTS

We divided patients, according to audiometric data, into 2 groups: group A with no residual otological disturbances (6 subjects) and group B with persistent hypoacusia (16 subjects). Blood parameters were into physiological levels in all group A patients; on the contrary 12 (subgroup B1) out of 16 group B patients had altered blood levels of glucose, urea and cholesterol, with mean values of 155.8 +/- 38.6 mg/dl, 48.2 +/- 8.3 mg/dl and 250.8 +/- 28.1 mg/dl, respectively, revealing statistically significant differences in these parameters when compared with the other 4 hypoacusic cases (Sub-group B2) and with the normal subjects (Group A) (p < 0.01 for glucose, p < 0.05 for urea and p < 0.001 for cholesterol).

CONCLUSIONS

Our findings confirm the transitory otological damage due to airbag deployment: the intensity of the acoustic wave hitting the ear after airbag deployment is responsible for a temporary rise in the acoustic threshold but the persistence of an auditory deficit can be due to co-factors able to interfere with the acute acoustic trauma recovery processes through a metabolic, angiopathic, neuropathic or unknown mechanism. Moreover, also the age of the patients could affect in a significant way the recovery from the acoustic trauma.

[Computerized modification of Fukuda test]

OBJECTIVES

To study a new method to apply to Fukuda test in order to overcome the interpretational difficulty associated with a subjective evaluation of the exam.

MATERIALS AND METHODS

During the exam, the patient wears a specially-designed headpiece, with a band at the back fitted with a sensor accommodating both a gyroscope and a bi-axial accelerometer. When asked to step in place, he does so in the Romberg position, eyes closed, successively rotating his head to the right and to the left.

RESULTS

On analyzing the data obtained through the laterality variable (right/left oscillation) and time variable, it resulted that the difference between the averages referring to the laterality variable of right-handed and left-handed subjects was statistically significant (P = 0.001), while the difference between the averages of the time variable was not.

CONCLUSIONS

To be able to propose an evaluation of the clinical validity of the test, further research must be carried out on pathological subjects, thus verifying the applicability of the method to the full.

[Behavior of serum IgE and IgA in patients with allergic rhinitis treated with iodine bromide thermal water]

The aim of this study was to test the effects of the iodine bromide water of the thermal baths of Salsomaggiore on patients suffering from specific nonseasonal rhinitis (Dermatophagoides Farinae and Dermatophagoides Pteronyssinus). The patients, 80 in all, were divided in two groups (group A and group B). All of the patients underwent rhinoscopic examination, anterior rhinomanometry, prick test, rast screening, total IgE assay together with that of the other immunoglobulins (IgA, IgM, IgG), mucociliary clearance evaluation and were asked to evaluate their degree of nasal obstruction, before and after 30 days of treatment. Group A carried out the experiment by applying endonasal Acqua Sal spray seven times a day for 30 days; group B used oily drops for the same time and with the same frequency. At the end of the trial period, the patients in group A showed a 100% improvement in their subjective perception of their symptomatology, in comparison with a 33% improvement in the control group. A characteristic decrease in the IgE and increase in the IgA was observed in the serum of the patients who had been treated with Acqua Sal spray. Iodine bromide water has a general and local anti-inflammatory effect, which is also due to the activation of the corticosurrenal system (with a relative increase in cortisol). The cleansing action of hypertonic water in the nasal cavities must also be cited, as it minimizes contact between the mucosa and allergens.

[Allergic rhinitis: evaluation of prick test positivity for German and American cockroaches (Blatella Germanica, Periplaneta Americana)]

Allergies are a widespread phenomenon and one that is in continuous expansion, especially in large cities. A heretofore underestimated allergen, at least in Italy, is the cockroach. Between April and June 2000, we administered a prick test (including the cockroach antigen in the allergen kit) to 163 patients. The prick test was executed utilizing histamine as the positive control and a normal diluent as the negative control; both indoor allergens (including dermatophagoids and dog and cat epithelium) and outdoor allergens (including trees, grasses, pollens and spores) were employed. The results obtained were evaluated by comparing the reaction provoked by these allergens to that of the histamine. About 20% of the patients who reacted to the other indoor allergens also tested positive to the cockroach antigen. Also on the basis of experiences previously carried out in other countries (United States, Korea, Japan, Turkey), the cockroach must be borne in mind as a possible significant cause of allergic reactions in Italy, too.

A preventive measure for otitis media in children with upper respiratory tract infections

Recurrent upper respiratory tract infections (URTI) are very common in patients of all ages. Rhinitis, bronchitis, chronic sinusitis and otitis appear to be the prevalent forms of recurrent respiratory infections in the paediatric population. The aim of treatment is so the solution of the respiratory pathology and the also the prevention of their complications. Antibacterial therapy is still the classical treatment approach in patients both with respiratory tract infections and with otitis media, despite the fact that antibacterials have several well known drawbacks, especially when used to treat recurrent infections. Eighty-four paediatric patients of both sexes (range: 4-14 years) with otitis were enrolled in the study. Patients were included if they had a >2 years' history of recurrent or chronic respiratory infections, and/or had experienced at least three episodes requiring medical consultations and/or treatment during the winter prior to the study. The young patients were randomised to receive Immucytal (group A) or placebo (group B) treatment according to the following protocol: (1) starting therapy (1 month): one tablet daily in the morning 4 days per week for 3 consecutive weeks; (2) maintenance period (5 months): one tablet daily in the morning 4 days per week for 1 week every month. Placebo and Immucytal tablets were identical in shape and size, in order to maintain double-blind conditions. Patients of group A with recurrent URTI had a significantly decreased incidence of ENT infections, fever and shorter duration of illness, decreased requirement for ancillary medications and fewer work-days lost. The reduction in the incidence of infectious episodes became significant vs. placebo. A significantly improved outcome vs. placebo was also observed on the incidence of fever, frequency and duration of infectious episodes, ancillary therapies. Immucytal treatment was associated with significant changes in both immunological and auditory function parameters. Serum concentrations of immunoglobulins were significantly increased in Immucytal. For both evaluations, a significant difference between treatment groups was found (P>0.001). Preventive strategies, such as ribosomal immunotherapy, may represent a valid alternative approach.

Sociodemographic characteristics and HIV risk behaviour patterns of male sex workers in Madrid, Spain

This paper describes the sociodemographic and work characteristics, prevalence of HIV infection and associated risk behaviours among male sex workers (MSWs) in Madrid (Spain). Using an anonymous semi-structured questionnaire, educators attached to a mobile unit under a street-based prostitution programme surveyed 84 MSWs from several Madrid areas. Of the total surveyed: 35% were immigrants, mean age was 23 years, mean period in prostitution was four years; 21% had no primary education; 16% had injected drugs at some time; 11% reported private sexual relationships exclusively with women; 89% always used condoms in anal practices with clients; and 41% were in sexual relationships with their partners. Only 11% had ever used fortified condoms. In the preceding month, 37% had experienced condom failure, 82% without having used any lubricant. In all, 67% reported having undergone HIV testing, with a higher percentage of positive results among injecting (60%) versus non-injecting drug users (17%). Immigrants had a lower level of education, made less use of condoms, had more condom failures and, in their private lives, a greater proportion reported sexual relationships exclusively with women. In Spain, MSWs should be included in HIV prevention programmes, which ought to be specifically adapted to immigrants. Priority should be given to reducing the condom failure rate in anal intercourse, by improving access to fortified condoms.

Hysteresivity of the lung and tissue strip in the normal rat: effects of heterogeneities

We measured lung impedance in rats in closed chest (CC), open chest (OC), and isolated lungs (IL) at four transpulmonary pressures with a optimal ventilator waveform. Data were analyzed with an homogeneous linear or an inhomogeneous linear model. Both models include tissue damping and elastance and airway inertance. The homogeneous linear model includes airway resistance (Raw), whereas the inhomogeneous linear model has a continuous distribution of Raw characterized by the mean Raw and the standard deviation of Raw (SDR). Lung mechanics were compared with tissue strip mechanics at frequencies and operating stresses comparable to those during lung impedance measurements. The hysteresivity (eta) was calculated as tissue damping/elastance. We found that 1) airway and tissue parameters were different in the IL than in the CC and OC conditions; 2) SDR was lowest in the IL; and 3) eta in IL at low transpulmonary pressure was similar to eta in the tissue strip. We conclude that eta is primarily determined by lung connective tissue, and its elevated estimates from impedance data in the CC and OC conditions are a consequence of compartment-like heterogeneity being greater in CC and OC conditions than in the IL.

Decreased surfactant protein-B expression and surfactant dysfunction in a murine model of acute lung injury

This study examines the relationships between inflammation, surfactant protein (SP) expression, surfactant function, and lung physiology in a murine model of acute lung injury (ALI). 129/J mice received aerosolized endotoxin lipopolysaccharide [LPS] daily for up to 96 h to simulate the cytokine release and acute inflammation of ALI. Lung elastance (E(L)) and resistance, lavage fluid cell counts, cytokine levels, phospholipid and protein content, and surfactant function were measured. Lavage and lung tissue SP content were determined by Western blot and immunohistochemistry, and tissue messenger RNA (mRNA) levels were assessed by Northern blot and in situ hybridization. Tumor necrosis factor-alpha and neutrophil counts in bronchoalveolar lavage fluid increased within 2 h of LPS exposure, followed by increases in total protein, interleukin (IL)-1beta, IL-6, and interferon-gamma. E(L) increased within 24 h of LPS exposure and remained abnormal up to 96 h. SP-B protein and mRNA levels were decreased at 24, 48, and 96 h. By contrast, SP-A protein and mRNA levels and SP-C mRNA levels were not reduced. Surfactant dysfunction occurred coincident with changes in SP-B levels. This study demonstrates that lung dysfunction in mice with LPS-ALI corresponds closely with abnormal surfactant function and reduced SP-B expression.

Oral administration of collagen conjugated with cholera toxin induces tolerance to type II collagen and suppresses chondritis in an animal model of autoimmune ear disease

B10.RIII (H-2r) mice were orally administered cyanogen bromide peptide 11 (CB11) or cholera toxin B (CTB)-conjugated CB11 to induce tolerance in collagen-induced autoimmune ear disease. Oral administration of a high dosage of CB11 provided partial protection from chondritis. However, administration of a tiny amount of CTB-CB11 conjugate effectively suppressed chondritis. Oral administration of CTB-CB11 conjugate did not alter the stimulation of T cells in vitro or the fine specificities of B cells. The oral administration of CTB-CB11 caused a higher level of type II collagen-specific IgG and its subclass. Interestingly, increases of TH1 cytokine (interferon-gamma) in Peyer's patches and of TH1/TH2 cytokines (interleukin-2 and interleukin-4) in lymph nodes were detected in mice that had been fed CTB-CB11. An increase of CD8+ T cells in the Peyer's patches with a decrease of CD8+ T cells in lymph nodes was seen in mice that had been fed CTB-CB11. These results suggest that protection from chondritis by oral administration of minute amounts of CTB-CB11 conjugate can be achieved by a mechanism distinct from that of conventional oral tolerance induction.

[Paraplegia after left thoracotomy in a patient carrying an epidural catheter]

A 61-year-old man undergoing left thoracotomy, in whom a lumbar epidural catheter had been inserted, experienced paraplegia in the immediate recovery period. Diagnostic tests and clinical examinations ruled out neurological causes attributable to the catheter, indicating that the cause was surgical. Paraplegia after thoracotomy is rare but has been described in the literature. We discuss ways that injuries may produce medullary lesions related to thoracic surgery.

Chromosomal localization of 18S rDNA and telomere sequence in the aye-aye, Daubentonia madagascariensis

Chromosomal localization of 18S rDNA and telomere sequence was attempted on the chromosomes of the aye-aye (2n = 30) using fluorescence in situ hybridization (FISH) and primed in situ labeling (PRINS), respectively. The rDNA was localized at the tip or whole of the short arm of acrocentric chromosomes 13 and 14 in all spreads observed. However, post-FISH silver-nitrate (Ag) staining showed that transcriptional activity of the rRNA genes was variable, particularly in chromosome 14, which was most frequently negative in one homologue carrying the smaller copy number of rDNA. This observation supports, at the molecular cytogenetic level, previous data concerning the relationship between the copy number of rDNA and its trancriptional activity. On the other hand, telomere sequence was localized only at the telomeric region of all chromosomes, the so-called telomere-only pattern, a characteristic similar to that of the greater bushbaby. These data may provide information on the chromosomal evolution of the lemur, because locations of rDNA and telomere sequences frequently offer important clues in reconstruction of karyotype differentiation.

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution]

OBJECTIVE

To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes.

METHODS

Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected.

RESULTS

132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had).

CONCLUSIONS

HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

Determinants of surfactant function in acute lung injury and early recovery

Relationships between lung function and surfactant function and composition were examined during the evolution of acute lung injury in guinea pigs. Lung mechanics and gas exchange were assessed 12, 24, or 48 h after exposure to nebulized lipopolysaccharide (LPS). Bronchoalveolar lavage (BAL) fluid was processed for phospholipid and protein contents and surfactant protein (SP) A and SP-B levels; surfactant function was measured by pulsating bubble surfactometry. Lung elastance, tissue resistance, and arterial-alveolar gradient were moderately elevated by 12 h after LPS exposure and continued to increase over the first 24 h but began to recover between 24 and 48 h. Similarly, the absolute amount of 30,000 g pelleted SP-A and SP-B, the phospholipid content of BAL fluid, and surfactant function declined over the first 24 h after exposure, with recovery between 24 and 48 h. BAL fluid total protein content increased steadily over the first 48 h after LPS nebulization. In this model of acute lung injury, the intra-alveolar repletion of surfactant components in early recovery led to improved surfactant function despite the presence of potentially inhibitory plasma proteins.

[Adaptation of the clinician-administered rating scale for mania]

INTRODUCTION

There is no mania rating scale properly adapted in Spain, and it's a true problem in research.

METHODS

The adaptation process has been the following one: The authors start from CARS-M of Altman et al. First the carry out the translation and back translation which was revised by the author of the scale. Then they fullfill some previous training with video filming and lastly they apply the scale to a group of 24 patients.

RESULTS

The Clinician-Administered Rating Scale for Mania (CARS-M) shows good psychometric proprieties among those its internal consistency of the scale, the interobservers reliability, and the item-total correlation. These results are lightly worse in the psychoticism sub-scale.

CONCLUSIONS

This rating scale for mania show itself as a useful instrument in clinic and research.

Pivotal role of anionic phospholipids in determining dynamic behavior of lung surfactant

Phosphatidylglycerol (PG) and phosphatidylinositol (PI) are anionic phospholipids (APLs) present in lung surfactant of virtually all species studied, although their specific contribution to function is unknown. This study examines how APLs influence surfactant monolayer stability and adsorption under static and dynamic conditions. Interfacial properties of surfactants reconstituted with native phospholipids (PL), and phospholipids devoid of anionic species (DAPL), were characterized by pulsating bubble surfactometry. Measurements were made for PL and DAPL alone; with 3% surfactant proteins B and C (SP-B/C); with SP-B/C and 5% surfactant protein A (SP-A); and with SP-B/C, SP-A, and 8% neutral lipids (NL). Equilibrium and dynamic properties of PL and DAPL were similar. However, whereas (DAPL + SP-B/C) and (DAPL + SP-B/C + SP-A) mixtures were similar to corresponding PL mixtures with respect to gamma(equil), they displayed markedly different dynamic behavior. In particular, the degree of film compression required to reach gamma(min) was significantly increased in DAPL mixtures (80 to 90% area reduction) compared with PL, although both samples reached gamma(min) < 3.0 dynes/cm. The addition of NL to (DAPL + SP-B/C + SP-A) produced an increase in gamma(min) to 15 to 20 dynes/cm during dynamic compression, whereas NL had no significant impact on the behavior of (PL + SP-B/C + SP-A). Purified PG (5% wt/wt) restored nearly normal dynamic properties to (DAPL + SP-B/C + SP-A + NL), whereas phosphatidylcholine (PC) (5% wt/wt) had no beneficial effect. These results suggest that APLs play a critical role in promoting surface film stability during dynamic compression through interactions with nonlipid surfactant components, and prevent destabilization of the surface film by cholesterol and other NL.

[Prescription and costs of artificial nutrition before and after a new utilization protocol]

In order to improve the quality of prescription and reduce expenditure, the artificial nutrition department has designed a new usage protocol: justification sheet, table of indications for parenteral nutrition (PN), nutritional assessment, etc. The Pharmacy Department is in charge of the follow-up of this programme and maintaining the database derived from it. Comparing the data for the year before (1996) and after (1998) implementation of this programme, we can see that as a result 9 patients/day switched from total parenteral nutrition by central administration to hypocaloric peripheral nutrition, with the prevalence of the former dropping to 1.4% of admissions and 2% of stays. The share of enteral nutrition (30.6%) and hypocaloric peripheral nutrition (27.8%) increases in the overall expenditure on artificial nutrition, with a reduction in the total parenteral nutrition (41.6%). The costs of parenteral nutrition per admission and stay are reduced by 39.3% and 33.5%, respectively, to 1,625 and 183 pesetas. This represents a saving of 16.5 million pesetas. The expenditure on PN elements declines by two percentage points to 2.2% of pharmaceutical expenditure. As an additional benefit, it is possible to identify each of the clinical situations which give rise to this indication and to allocate costs by diagnosis and department. Together with the containment of expenditure, it has been possible to increase the participation of everyone in the rational use of clinical nutrition thus highlighting its interdisciplinary nature.

Calcium-dependent degradation of surfactant protein A by activated neutrophils due to serine proteases

The effects of activated leukocytes on surfactant function and composition were examined to better define the mechanisms by which acute inflammation contributes to respiratory distress syndrome (ARDS). Peripheral blood leukocytes from healthy volunteers were incubated in vitro with surfactant for 4 hours: (1) in the absence of activation; (2) following activation by addition of phorbol myristate acetate (PMA); (3) following addition of PMA + FeCl2/EDTA; (4) PMA + FeCl2; (5) PMA + EDTA; (6) PMA + FeCl2 + superoxide dismutase (SOD) + catalase; (7) PMA + EDTA + serine or cysteine protease inhibitors. Surfactant was then repurified by sucrose gradient centrifugation, and function, phospholipid and protein composition, and extent of lipid peroxidation were assessed. PMA caused activation of leukocytes as detected by dichlorofluorescene assay. Lipid peroxidation (assessed by conjugated diene assay) was detected in all samples containing PMA. Abnormal function was noted in surfactant exposed to activated cells with 1 mM EDTA, whereas activation alone, or with FeCl2, had no effect. SOD + catalase prevented lipid peroxidation, but did not prevent leukocyte-mediated dysfunction, which was associated with a marked reduction in surfactant protein A (SP-A), but no detectable change in surfactant protein B (SP-B) or phospholipid composition. Serine protease inhibitors prevented SP-A degradation and dysfunction, whereas cysteine protease inhibitors had no protective effect. Addition of purified SP-A (5% w/w) to dysfunctional surfactant restored normal function, while SP-B/C mixture (3%) did not. Activated leukocytes cause surfactant dysfunction in vitro by serine protease-mediated degradation of SP-A, which occurs only in the presence of EDTA, and is prevented by addition of calcium. Although lipid peroxidation mediated by leukocyte release of free-radical products was also detected, surfactant dysfunction appears to be unrelated to this process.

Caveolin-2 localizes to the golgi complex but redistributes to plasma membrane, caveolae, and rafts when co-expressed with caveolin-1

We have characterized comparatively the subcellular distributions of caveolins-1 and -2, their interactions and their roles in caveolar formation in polarized epithelial cells. In Fischer rat thyroid (FRT) cells, which express low levels of caveolin-2 and no caveolin-1, caveolin-2 localizes exclusively to the Golgi complex but is partially redistributed to the plasma membrane upon co-expression of caveolin-1 by transfection or by adenovirus-mediated transduction. In Madin-Darby canine kidney (MDCK) cells, which constitutively express both caveolin-1 and -2, caveolin-2 localized to both the Golgi complex and to the plasma membrane, where it co-distributed with caveolin-1 in flat patches and in caveolae. In FRT cells, endogenous or overexpressed caveolin-2 did not associate with low density Triton insoluble membranes that floated in sucrose density gradients but was recruited to these membranes when co-expressed together with caveolin-1. In MDCK cells, both caveolin-1 and caveolin-2 associated with low density Triton-insoluble membranes. In FRT cells, transfection of caveolin-1 promoted the assembly of plasma membrane caveolae that localized preferentially (over 99%) to the basolateral surface, like constitutive caveolae of MDCK cells. In contrast, as expected from its intracellular distribution, endogenous or overexpressed caveolin-2 did not promote the assembly of caveolae; rather, it appeared to promote the assembly of intracellular vesicles in the peri-Golgi area. The data reported here demonstrate that caveolin-1 and -2 have different and complementary subcellular localizations and functional properties in polarized epithelial cells and suggest that the two proteins co-operate to carry out specific as yet unknown tasks between the Golgi complex and the cell surface.