[Clinical picture of the onset of AIDS in 2911 adults in Italy]

Since 1982, 2911 adult AIDS cases have been officially reported in Italy up to December 31, 1988. The clinical presentation of all cases, reported to the Istituto Superiore di Sanità, Rome, and contained into the National AIDS Register, has been analyzed, with particular attention to opportunistic infections. 168 cases (mainly homosexual men) were found exclusively affected at diagnosis by Kaposi's Sarcoma (KS), while the other 2743 patients were affected by opportunistic infections and/or other pathologies. At diagnosis, 23.5% of patients had Pneumocystis carinii pneumonia (PCP), 32% esophageal or pulmonary candidiasis, and 7% cerebral toxoplasmosis. A decrease in frequency of Cytomegalovirus (CMV) diseases has been observed, as well as an increase of HIV encephalopathy from 1982 to 1988. The clinical picture of full-blown AIDS showed stability during the whole period of observation, with slight geographical variations.

Survey on tuberculosis reports in a major Italian region

A survey was carried out on all cases of pulmonary and extrapulmonary tuberculosis reported in the Latium region of Italy during 1986, in order to characterize them from bacteriological and epidemiological points of view. A total of 497 TB notifications were investigated; reliable medical records were traced and consulted for 458 of these. Seventy-six percent of cases was classified as respiratory tb, 21.8% non-respiratory tb and 2% both. Ninety-two percent of all cases had been hospitalized for long periods (mean: 69 days/median: 63 days for cases of respiratory TB and mean: 40/median 29 days for non-respiratory patients). Contrary to the definition of a reportable case in Italy, evidence of Mycobacteria on direct or cultural examination was present in only half of all reported patients. Twenty-seven percent of respiratory cases and 33.3% of non-respiratory had a previous diagnosis of TB mentioned on the clinical record. High daily alcohol intake is reported more frequently among TB patients with respect to the general population, while drug abusers, immigrants and HIV seropositives represent a very low proportion. Delays in notification have been observed and current notification system is evaluated.

Immunization coverage in Italy

In Italy information on immunization coverage against pertussis, measles, and rubella is absent or incomplete. In 1985 the Istituto Superiore di Sanità (ISS) organized a series of immunization coverage surveys for these diseases in several local health units (Unità Sanitaria Locale) (USL). The surveys were conducted simultaneously in 80 USLs in 1985 with modified EPI cluster sampling techniques, using schools attended by children aged 3 to 10 years as the clusters. Information on previously performed immunizations was collected for each child sampled. The total immunization coverage and proportion of immunized children in eight birth cohorts were calculated.Low immunization coverage was reported by the USLs surveyed, and regional differences in the coverage were apparent between the north, centre, and south of Italy. In addition, a steady or decreasing trend in the use of pertussis vaccine was found, while an increasing coverage was observed for measles and rubella immunizations.

[Seasonal variations and trends in cardiovascular disease mortality in Naples, 1974-1978]

Death certificates of people who died from cardiovascular diseases in the City of Naples from 1974 through 1978 were reviewed. Data were classified according to three different groups of causes of death: 1. from all cardiovascular diseases (codes of the International Classification of Diseases-ICD-, VIII Revision from 393.0 through 458.9), 2. from ischaemic heart diseases (ICD from 410.0 through 411.9) and 3. from acute ischaemic heart diseases (ICD from 410.0 through 411.9). The monthly number of deaths in each group was analyzed using time series techniques to assess the seasonal pattern and the secular trend. A clear seasonal pattern was found in all groups, though in group 3 it was less evident. The maximum number of deaths per month was found to occur during the cold season and the minimum during the summer. The secular trend was found to be stable for groups 1 and 2. Group 3 showed an evident increase over the five years under study.

Outbreak of Salmonella napoli infection caused by contaminated chocolate bars

An outbreak of Salmonella napoli infection in England and Wales in 1982 was detected by the surveillance of routine reports of salmonella infections from hospital and public-health laboratories. Epidemiological investigation quickly identified two types of small chocolate-covered bars, imported from Italy, as the vehicles of infection, and subsequently both were found to be contaminated with the organism. The prompt recognition of this outbreak and rapid identification of the vehicle of infection enabled four-fifths of the consignment of contaminated chocolate to be withdrawn from the market. The 245 reported cases resulted from the sale of 600 000 bars; as these were presumably only a small fraction of the total number of cases, it is likely that many thousands of infections were prevented.

Distribution and respiratory properties of sheep hemoglobins A and B containing the II alphaHis chain

We recently reported the discovery of a second alpha chain, differing from the common alpha chain by the replacement 113 (or 114) Leucine leads to Histidine, in the hemoglobin of several domestic sheep. The ratio of the common alpha chain, here called alpha Leu, to the variant one, here called II alpha His, was either about 1.8:1 or about 4:1. In this study, the distribution of the II alpha His chain in 217 sheep from 8 domestic breeds was investigated: the II alpha His chain is present in 30% of animals from different breeds. Oxygen equilibrium determination showed no differences in the oxygen affinity, the Bohr effect and the heme-heme interaction of Hb A (alpha 2 beta 2A) and Hb B (alpha 2 beta 2B), each containing one of the three possible alpha chain phenotypes.

Recurrence of Pelecypod-associated cholera in Sardinia

From Oct. 30 to Nov. 7, 1979, 10 people in the Sardinian province of Cagliari had onset of bacteriologically confirmed cholera. Two symptom-free excretors of Vibrio cholerae O:1 were detected in household contacts of the patients. There were no deaths. All but 1 of the 12 people with V. cholerae O:1 infection gave a history of recent consumption of marine bivalves known locally as arselle (pelecypods). Triplicate matched neighbourhood controls for each of the first 7 cases identified were also interviewed; none had recently eaten arselle. V. cholerae O:1 was also recovered from samples of water and bivalves obtained from a lagoon on the outskirts of the city of Cagliari. Arselle had also been implicated as the vehicle of transmission in 1973 in the last outbreak of cholera in Sardinia. It seems unlikely that cholera transmission had persisted locally in the interim.

Higher oxygen affinity of sheep Hb C compared to Hb A and Hb B

Sheep which have Hb A, synthesize the perinatal Hb C in response to severe tissue hypoxia. It is known that Hb A displays a higher oxygen affinity than Hb B. The results of this study indicate that Hb C exhibits an oxygen affinity and a Bohr effect higher than those of Hb A and Hb B.