[Primary ciliary dyskinesia: clinical and genetic aspects]

Primary ciliary dyskinesia (PCD) is a rare, genetically heterogeneous disease, characterized by ciliary disfunction and impaired mucociliary clearance, resulting in a range of clinical manifestations such as chronic bronchitis, bronchiectasis, chronic rhino-sinusitis, chronic otitis media, situs viscerum inversus in almost 40-50% of cases and male infertility. The triad situs viscerum inversus, bronchiectasis and sinusitis is known as Kartagener syndrome. Up to now little is known about genetic, diagnostic and therapeutic aspects of primary motile ciliary diseases in children: for this reason, diagnosis is generally delayed and almost all treatments for PCD are not based on randomized studies but extrapolated from cystic fibrosis guidelines. The aim of this review is to propose to pediatricians a summary of current clinical and diagnostic evidence to obtain better knoledwge of this condition. The earlier diagnosis and the right treatment are both crucial to improve the prognosis of PCD.

Interleukin-28B (IL-28B) single-nucleotide polymorphisms and interferon plus ribavirin treatment outcome in Italian chronically HCV-infected patients

To determine the single or combined effect of both rs12979860 and rs8099917 SNPs on HCV treatment response, these variants were genotyped in samples from a cohort of 170 patients infected with different HCV genotypes (HCVGT). The favourable rs12979860 CC genotype was found only in patients with sustained or rapid virological responses (SVR/RVR) and at significantly high proportions in HCVGT1/4 SVR patients. A significant association was also found between the rs8099917 TT genotype and SVR in both HCVGT1/4 and HCVGT2/3 groups of patients. In contrast, we found that there was significantly more of the rs8099917 GG genotype in nonresponders (NR) than in SVR patients which suggests a good association of the minor homozygote GG with the lack of treatment response. The combination of rs12979860/rs8099917 CC/TT favourable genotypes was found only in SVR patients and matched the frequency observed for their rs12979860 CC genotypes alone. By contrast, the inverse unfavourable correlate rs12979860/rs8099917 TT/GG genotype was seen more in NR than in SVR patients as observed for the single GG genotype. This study confirms the impact of both rs12979860 and/or rs8099917 IL-28B SNPs on treatment-induced clearance of HCV-RNA and demonstrates that the rs12979860 CC genotype is stronger than rs8099917 TT genotype in predicting a positive treatment response in HCVGT1/4 patients. The unfavourable rs8099917 GG genotype seems to be more important in predicting the failure of treatment response independently from HCV genotype.

Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study

AIMS

To describe trends in diagnosed diabetes prevalence, incidence and mortality from 2000 to 2007 in the most heavily populated Italian region.

METHODS

We examined the prevalence and incidence rates of Type 1 and Type 2 diabetes and yearly mortality rates among individuals with diabetes from 2000 to 2007 using an administrative health database of prescription, disease-specific exemption and hospitalization records of more than 9 million inhabitants of Lombardy. Age- and sex-specific rates were calculated and temporal trends for subjects aged ≥ 30 years were analysed.

RESULTS

The crude point diabetes prevalence rose from 3.0% in 2000 to 4.2% in 2007, a 40% increase. The incidence remained stable during the study period with a rate of 4/1000 per year. Overall mortality declined from 43.2/1000 in 2001 to 40.3/1000 in 2007 (6.7% decrease) at a rate slightly higher than that of the general population (4.8% decrease). Our projection in subjects aged ≥ 30 years indicates that the prevalence will rise continuously over the next years, reaching 11.1% in 2030.

CONCLUSIONS

The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.

New molecular targets in bone metastases

Bone metastases have a major impact on morbidity and on mortality in cancer patients. Despite its clinical relevance, metastasis remains the most poorly elucidated aspect of carcinogenesis. The biological mechanisms leading to bone metastasis establishment have been referred as "vicious circle," a complex network between cancer cells and the bone microenvironment. This review is aimed to underline the new molecular targets in bone metastases management other than bisphosphonates. Different pathways or molecules such as RANK/RANKL/OPG, cathepsin K, endothelin-1, Wnt/DKK1, Src have recently emerged as potential targets and nowadays preclinical and clinical trials are underway. The results from those in the advanced clinical phases are encouraging and underlined the need to design large randomised clinical trials to validate these results in the next future. Targeting the bone by preventing skeletal related events (SREs) and bone metastases has major clinical impact in improving survival in bone metastatic patients and in preventing disease relapse in adjuvant setting.

Interferon-Induced Gene Expression in Cervical Mucosa during Human Papillomavirus Infection

The aim of this study is to monitor type I interferon (IFN) activation in the cervical mucosa of Human Papillomavirus (HPV)-infected and uninfected women attending a routine gynaecologic clinic. The expression of three IFN-induced genes (MxA coding for human Mixovirus resistance protein A, ISG15 Interferon Stimulated Gene coding for a 15 kDa ubiquitin-like protein and UBP43 coding for the ISG15 isopeptidase) was determined as the mRNA copy number in cervical cells, normalized to the mRNA ones of the beta-glucuronidase gene. Type-specific HPV-DNA load was concurrently determined in the HPV-positive samples. Out of 127 samples tested, 54 were sufficient for both DNA and RNA extraction. The type-specific HPV-DNA copy numbers in the 34 HPV-positive samples varied widely. No significant association was found between copy numbers of MxA, ISG15, UBP43 and HPV status or viral load. However, despite a marked inter-individual variability, ISG15 expression was significantly higher when low-risk HPV infections were compared with HPV-negative samples, while high-risk HPV infections had very low ISG15 levels. The lack of ISG15 activation in high-risk HPV-infected cervical cells could be due to the lack of p53-mediated induction or to HPV-directed specific inhibition of type I IFN pathways. This study approach might be of value in clarifying the role of type I IFN activation in determining the clearance or persistence of HPV infections.

Hospital admissions for respiratory conditions in children and outdoor air pollution in Southwest Milan, Italy

AIM

To evaluate whether a relationship exists in hospital admissions for respiratory conditions in children with outdoor pollution in the Southwest Milan, Italy.

METHODS

Daily count of hospital admissions for asthma, upper or lower respiratory diseases (LRD) occurred among children aged < or =14 years at the San Paolo Hospital during 2007-2008 was recorded. Pollutants included the particular matter of <10 microm diameter, ozone, carbon monoxide (CO) and nitrogen dioxide (NO(2)), reported on the same day of admission and 1 up to 5 days before admission. The moving weekly average (MWA) was also considered.

RESULTS

Total respiratory admissions were associated with the same day level of CO (30.6% increase per 1 mg/m(3) increase, 95% confidence interval, 3.9-69.9%) and with the MWA of NO(2) (9.0% increase per 10 microg/m(3) increase, 1.2-16.8%). The effect of CO was stronger on upper respiratory diseases (URD) (lag 0, 21.3% increase, 6.4-38.3%). The effect of NO(2) was stronger on LRD (MWA, 5.3% increase, 0.9-10.2%). Multipollutant models confirmed the role of CO on URD and that of NO(2) on LRD.

CONCLUSION

Carbon monoxide and nitrogen dioxide may be associated with emergency hospital admissions for respiratory conditions among children in Southwest Milan.

How individuals with phenylketonuria experience their illness: an age-related qualitative study

BACKGROUND

The aim of the study was to explore the illness experience of individuals affected by phenylketonuria (PKU) and its differences in different patient age groups.

METHODS

A qualitative-interpretative methodology was used through in-depth interviews. Textual data were explored using the principles of grounded theory.

RESULTS

Forty-seven patients participated in the study, aged from 10 to >25 years old. The results suggested the age-related PKU experience: (1) a paradox, either to feel normal but isolated from the social context, or to be different while participating in the convivial aspects of the social being; and (2) the need for education about the disease tailored to the individual and growing needs. Specific themes seem to characterize each age range.

CONCLUSIONS

This study constitutes a first attempt at understanding PKU from a non-medical-biological perspective.

Combined hyperlipidaemia as a presenting sign of cholesteryl ester storage disease

Lysosomal acid lipase (LAL) deficiency results in Wolman disease and cholesteryl ester storage disease (CESD), a more benign form. CESD is a recessive disorder characterized by hypercholesterolaemia, hypertriglyceridaemia, low blood HDL and variable phenotype, while hepatomegaly is usually evident during childhood or adolescence. An 11-year-old girl was referred to our department for combined hyperlipidaemia (total cholesterol 323, triglycerides 259 mg/dl). All family members had normal lipid profile and liver function tests. At 8 years she was admitted for acute Epstein-Barr virus infection, with hepatosplenomegaly and elevation of liver enzymes. Liver-spleen enlargement resolved, but serum alanine aminotransferase and aspartate aminotransferase were persistently twice the upper limits, with other liver function tests within the normal range. Ultrasonography showed normal liver and spleen size and minimal hepatic steatosis. Infectious, autoimmune and metabolic causes of elevated liver enzymes were ruled out, including glycogen storage disease. Dysbetalipoproteinaemia was also ruled out (ApoE phenotype: E3E3). In the following 2 years the girl was symptom-free, BMI was at the 50th-75th centile for age and lipid profile was unchanged despite a low-fat diet. At 13 years of age, low acid lipase activity was demonstrated in leukocytes (10 nmol/h/ per mg protein, normal 140-380) and cultured skin fibroblasts (181 nmol/h per mg protein, normal 1100-2400), leading to diagnosis of CESD. CESD usually progresses to hepatic fibrosis, with high risk of premature atherosclerosis. CESD prevalence may be underestimated in the general population. The diagnosis may be considered in all subjects with atypical combined hyperlipidaemia (usually dominant in transmission or related to metabolic syndrome) and atypical 'fatty liver disease', in the absence of overweight.

Breakfast: a good habit, not a repetitive custom

In developed countries, obesity is the most frequent nutritional disorder, and overweight and obesity prevalences have increased whilst physical activity and breakfast consumption have declined. There is growing scientific interest in the possible role of breakfast in weight control and in factors such as appetite control, dietary quality and reduced risk for chronic diseases. The current article reviews the literature and discusses how the breakfast 'environment' and the composition of breakfast meals might be improved, particularly in children, so as to maintain the breakfast eating habit throughout life. Recommendations are proposed to encourage children to keep eating breakfast and the nutritional composition of the 'American breakfast' and two types of Mediterranean 'cereal breakfasts' are compared. We also propose a new breakfast type for children and adolescents that is based on chocolate hazelnut spread within a mixed breakfast type in order to reinforce positive experiences.

Enterobacter sakazakii: an emerging problem in paediatric nutrition

Recently there has been considerable concern related to the presence of bacteria, in particular Enterobacter sakazakii, in powdered infant formula milk. E. sakazakii, a member of the family Enterobacteriaceae, is an emerging opportunistic pathogen that has been associated with cases of meningitis, necrotizing enterocolitis and sepsis in premature and full-term infants. Feeding with powdered infant formula has been epidemiologically implicated in several clinical cases. Powdered infant formula is not a sterile product; good hygienic practice is, therefore, necessary in its reconstitution to reduce the risk of infection. The ingestion of raised numbers of E. sakazakii resulting from storage at room temperature after reconstitution is highlighted as well as the uncertain routes of E. sakazakii product contamination.

Maternal smoking habits are associated with differences in infants' long-chain polyunsaturated fatty acids in whole blood: a case-control study

OBJECTIVE

To study the effects of maternal smoking on the status of long-chain polyunsaturated fatty acids (LCPUFA) in infants' whole-blood lipids.

DESIGN

A case-control matched study planned on the basis of preliminary observations.

SETTING

Maternity ward.

PATIENTS

A total of 159 healthy, term, breastfed infants with weight appropriate for gestational age, subdivided (53 per group) into those born to non-smokers (reference), smokers (> or = 5 cigarettes per day) who either stopped within the first trimester of pregnancy (early smokers) or who continued througout pregnancy (late smokers).

INTERVENTIONS

The fatty acid profile of 4-day-old infants was determined on whole blood.

RESULTS

Higher levels of linoleic (LA) and alpha-linolenic acid (ALA) and lower levels of the metabolic products di-homo-gammalinolenic (DHGLA) and arachidonic (AA), of the n-6 series, and docosahexaenoic acid (DHA), of the n-3 series, were found in infants born to late smokers compared with the reference group. The DHGLA/LA and AA/DHGLA ratios in the n-6 series and DHA/ALA in the n-3 series, which are indices of the metabolic processes in LCPUFA synthesis, were lower in infants born to smokers compared with those born to non-smokers. Infants born to early smokers showed n-6 PUFA levels and ratios similar to references and n-3 parameters closer to those born to late smokers. No dietary differences were found among the three groups of mothers. All the independent associations with smoking persisted after adjustment for maternal covariates. Pre-pregnancy body weight, which is lower in late smokers compared with non-smokers, independently correlated with LCPUFA levels in both series.

CONCLUSIONS

Maternal smoking is associated with a reduction in LCPUFA pools in infants, which might have structural and functional consequences.

Probiotics in clinical practice: an overview

The observation that intestinal bacterial microflora might be able to influence immune system surveillance through changed nutritional habits has raised awareness of the role of probiotics. These are live microorganisms that are able to reach the gastrointestinal tract and alter its microfloral composition, producing beneficial health effects when consumed in adequate amounts. Recent clinical trials have evaluated the clinical effectiveness of probiotics in the treatment and prevention of a wide range of acute and chronic gastrointestinal diseases, and also non-gastrointestinal diseases, such as atopy, respiratory infections, vaginitis and hypercholesterolaemia. Probiotic supplements are generally regarded as safe because the microorganisms they contain are identical to those found in human gastrointestinal and vaginal microflora. Guidelines on the use of probiotics in the clinical setting require periodical updates for the latest data to be included in clinical applications. The purpose of this clinical report is to review current evidence on the use of probiotics in a variety of gastrointestinal and non-gastrointestinal conditions.

Usefulness of chemical-shift MRI in discriminating increased liver echogenicity in glycogenosis

BACKGROUND

Glycogen storage diseases are inherited defects which cause accumulation of glycogen in the tissues. Hepatic steatosis is defined as accumulation of fat within hepatocytes. On sonography, liver shows increased echogenicity both in glycogen storage diseases and steatosis. Liver hyperechogenicity in glycogen storage diseases may depend on accumulation of glycogen and/or fat. Chemical-shift magnetic resonance imaging can discriminate tissues only containing water from those containing both fat and water.

AIM

The primary aim of the present study was to evaluate the usefulness of liver chemical-shift magnetic resonance imaging for detecting liver steatosis in patients with metabolic impairment due to glycogen storage diseases.

SUBJECTS

Twelve patients with type I (n=8) or type III (n=4) glycogen storage diseases were studied and compared to 12 obese-overweight subjects with known liver steatosis. As control group 12 lean normal voluntary subjects were recruited.

METHODS

Liver was evaluated by sonography and chemical-shift magnetic resonance imaging to calculate hepatic fat fraction.

RESULTS

A significant difference in echogenicity between patients with glycogen storage diseases and normal subjects was observed (p<0.05), while this difference was not present between overweight-obese and glycogen storage diseases patients. On the contrary, fat fraction was similar between glycogen storage diseases patients and normal subjects and different between glycogen storage diseases patients and overweight-obese (p<0.05).

CONCLUSION

The present data suggest that chemical-shift magnetic resonance imaging may exclude fat deposition as a cause of liver hyperechogenicity in subjects with glycogen storage diseases.

Comparison of the nutritional values of follow-on formulae available in Italy

If breast milk is not available during complementary feeding, 'follow-on' formula milk ensures a balanced intake of nutrients and is undoubtedly more suitable for infants than cows' milk. Formula milk provides a lower intake of proteins and saturated fats and a higher concentration of polyunsaturated fats, iron and zinc than cows' milk. In particular, delaying the introduction of cows' milk until the end of the first year of life, or even until after the second year, appears to play a fundamental role in the prevention of iron deficiency anaemia. It may also prevent excess weight gain and obesity and the development of immunoallergic symptoms, and may be important for neurobehavioural development. More than 30 varieties of follow-on formula milk are currently available in Italy alone. This review outlines the nutritional differences between breast, formula and cows' milks, and compares different brands of formula milk.

Phenylketonuria: dietary and therapeutic challenges

PKU subjects need special attention in the definition of optimal supplementation of nutrients, which may be insufficient in relation to the type of diet and may otherwise manifest symptoms of deficit. In particular, it is necessary to pay great attention to the long-chain polyunsaturated fatty acid (LC-PUFA) levels in relation to correct development of the central nervous system. On the basis of numerous beneficial effects currently known, a permanent supplementation with LC-PUFAs, in particular with docosahexaenoic acid, should be considered. Moreover, new formulas, Phe-free peptides, and 'modulated' amino acid preparations might help in preventing nutritional deficiencies and imbalances, with the ultimate aim of improving growth. New strategies--such as supply of tetrahydrobiopterin--need to be optimized in terms of targets, patients and expected outcomes.

Markers of human papillomavirus infection and their correlation with cervical dysplasia in human immunodeficiency virus-positive women

Human papillomavirus (HPV) genotypes and HPV DNA load were analysed in cervical smears from 76 human immunodeficiency virus (HIV)-positive and 54 HIV-negative women. The prevalence of genotypes was similar for all women, with the exception of HPV62, which was over-represented in HIV-positive samples. HIV-positive women showed a higher prevalence of multiple genotypes that correlated neither with CD4(+) T-cell counts nor with cervical dysplasia. No significant differences were observed in terms of total or single-type HPV DNA load. The HPV DNA load in both HIV-positive and HIV-negative women was significantly higher in squamous intra-epithelial lesions than in negative Pap smears.

Isolated Horner's syndrome caused by intraoral gunshot

A 45-year-old man developed Horner's syndrome after sustaining an intraoral gunshot in a suicide attempt. Examination did not show any major vascular injury or other neurological symptoms. Radiograph of the skull and helical computed tomography angiography of the brain and neck detected a bullet embedded in the interior of the left internal carotid artery (ICA) sheath. Surgical examination showed an intact left ICA. Horner's syndrome resulting from intraoral trauma rarely presents as an isolated sign and is generally associated with carotid injuries. It may herald a life-threatening artery injury and needs urgent investigation.

Closer to the gold standard: an appraisal of formulae available in Italy for use in formula-fed infants

Infant formulae are the only alternatives to breast milk for infants who are unable to continue breastfeeding through the first year of life. They aim to provide formula-fed infants with the same structural and functional benefits observed in breastfed infants. To achieve this, bioactive nutrients have been added to infant formulae in recent years: long-chain polyunsaturated fatty acids for neurodevelopment; probiotics and prebiotics for local gastrointestinal defence; and nucleotides for promoting the immune response. Changes in protein quantity and quality allow infant formulae to achieve a balance between providing the correct plasma amino acid profile and reducing the protein intake, which could prevent obesity in later life. Hydrolysed proteins may help prevent atopic disorders. Many short-term trials have been published but long-term follow-up data are needed in infants who have been fed the newer infant formulae, to fully understand the role of bioactive nutrients.